hospital_name,last_updated_on,version,location_name,hospital_address,license_number|TN,type_2_npi,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",attester_name,,,,,,,,,,,,,,,,,,,
"Knoxville Rehabilitation Hospital, LLC",2026-03-16,3.0.0,"Knoxville Rehabilitation Hospital, LLC",1250 Tennova Medical Way Knoxville TN 37909,191,1184214512,TRUE,Katherine Clark,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Aetna,Aetna,1500,,,,,,,per diem,1103,11409.4098,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Aetna MGG,Aetna MGG,11409.4098,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,BCBS,BCBS,1103,,,,,,,per diem,1103,11409.4098,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,BCBS MGG,BCBS MGG,11409.4098,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Cigna,Cigna,1257,,,,,,,per diem,1103,11409.4098,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Cigna MGG,Cigna MGG,11409.4098,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Humana,Humana,1400,,,,,,,per diem,1103,11409.4098,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Humana MGG,Humana MGG,10838.93931,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Optum VA,Optum VA,11409.4098,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,UHC,UHC,1400,,,,,,,per diem,1103,11409.4098,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,UHC MGG,UHC MGG,11409.4098,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,VA,VA,11409.4098,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Wellcare MGG,Wellcare MGG,11409.4098,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Bright Health - commercial,Bright Health - commercial,11409.4098,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,11409.4098,11409.4098,Bright Health MGG,Bright Health MGG,11409.4098,,,,,,,case rate,1103,11409.4098,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Aetna,Aetna,1500,,,,,,,per diem,1103,14950.2078,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Aetna MGG,Aetna MGG,14950.2078,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,BCBS,BCBS,1103,,,,,,,per diem,1103,14950.2078,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,BCBS MGG,BCBS MGG,14950.2078,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Cigna,Cigna,1257,,,,,,,per diem,1103,14950.2078,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Cigna MGG,Cigna MGG,14950.2078,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Humana,Humana,1400,,,,,,,per diem,1103,14950.2078,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Humana MGG,Humana MGG,14202.69741,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Optum VA,Optum VA,14950.2078,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,UHC,UHC,1400,,,,,,,per diem,1103,14950.2078,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,UHC MGG,UHC MGG,14950.2078,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,VA,VA,14950.2078,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Wellcare MGG,Wellcare MGG,14950.2078,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Bright Health - commercial,Bright Health - commercial,14950.2078,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,14950.2078,14950.2078,Bright Health MGG,Bright Health MGG,14950.2078,,,,,,,case rate,1103,14950.2078,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Aetna,Aetna,1500,,,,,,,per diem,1103,13275.6732,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Aetna MGG,Aetna MGG,13275.6732,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,BCBS,BCBS,1103,,,,,,,per diem,1103,13275.6732,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,BCBS MGG,BCBS MGG,13275.6732,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Cigna,Cigna,1257,,,,,,,per diem,1103,13275.6732,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Cigna MGG,Cigna MGG,13275.6732,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Humana,Humana,1400,,,,,,,per diem,1103,13275.6732,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Humana MGG,Humana MGG,12611.88954,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Optum VA,Optum VA,13275.6732,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,UHC,UHC,1400,,,,,,,per diem,1103,13275.6732,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,UHC MGG,UHC MGG,13275.6732,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,VA,VA,13275.6732,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Wellcare MGG,Wellcare MGG,13275.6732,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Bright Health - commercial,Bright Health - commercial,13275.6732,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,13275.6732,13275.6732,Bright Health MGG,Bright Health MGG,13275.6732,,,,,,,case rate,1103,13275.6732,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Aetna,Aetna,1500,,,,,,,per diem,1103,12027.8898,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Aetna MGG,Aetna MGG,12027.8898,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,BCBS,BCBS,1103,,,,,,,per diem,1103,12027.8898,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,BCBS MGG,BCBS MGG,12027.8898,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Cigna,Cigna,1257,,,,,,,per diem,1103,12027.8898,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Cigna MGG,Cigna MGG,12027.8898,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Humana,Humana,1400,,,,,,,per diem,1103,12027.8898,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Humana MGG,Humana MGG,11426.49531,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Optum VA,Optum VA,12027.8898,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,UHC,UHC,1400,,,,,,,per diem,1103,12027.8898,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,UHC MGG,UHC MGG,12027.8898,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,VA,VA,12027.8898,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Wellcare MGG,Wellcare MGG,12027.8898,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Bright Health - commercial,Bright Health - commercial,12027.8898,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,12027.8898,12027.8898,Bright Health MGG,Bright Health MGG,12027.8898,,,,,,,case rate,1103,12027.8898,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Aetna,Aetna,1500,,,,,,,per diem,1103,14521.9104,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Aetna MGG,Aetna MGG,14521.9104,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,BCBS,BCBS,1103,,,,,,,per diem,1103,14521.9104,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,BCBS MGG,BCBS MGG,14521.9104,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Cigna,Cigna,1257,,,,,,,per diem,1103,14521.9104,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Cigna MGG,Cigna MGG,14521.9104,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Humana,Humana,1400,,,,,,,per diem,1103,14521.9104,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Humana MGG,Humana MGG,13795.81488,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Optum VA,Optum VA,14521.9104,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,UHC,UHC,1400,,,,,,,per diem,1103,14521.9104,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,UHC MGG,UHC MGG,14521.9104,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,VA,VA,14521.9104,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Wellcare MGG,Wellcare MGG,14521.9104,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Bright Health - commercial,Bright Health - commercial,14521.9104,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,14521.9104,14521.9104,Bright Health MGG,Bright Health MGG,14521.9104,,,,,,,case rate,1103,14521.9104,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Aetna,Aetna,1500,,,,,,,per diem,1103,19027.5372,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Aetna MGG,Aetna MGG,19027.5372,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,BCBS,BCBS,1103,,,,,,,per diem,1103,19027.5372,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,BCBS MGG,BCBS MGG,19027.5372,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Cigna,Cigna,1257,,,,,,,per diem,1103,19027.5372,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Cigna MGG,Cigna MGG,19027.5372,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Humana,Humana,1400,,,,,,,per diem,1103,19027.5372,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Humana MGG,Humana MGG,18076.16034,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Optum VA,Optum VA,19027.5372,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,UHC,UHC,1400,,,,,,,per diem,1103,19027.5372,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,UHC MGG,UHC MGG,19027.5372,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,VA,VA,19027.5372,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Wellcare MGG,Wellcare MGG,19027.5372,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Bright Health - commercial,Bright Health - commercial,19027.5372,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,19027.5372,19027.5372,Bright Health MGG,Bright Health MGG,19027.5372,,,,,,,case rate,1103,19027.5372,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Aetna,Aetna,1500,,,,,,,per diem,1103,16896.8736,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Aetna MGG,Aetna MGG,16896.8736,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,BCBS,BCBS,1103,,,,,,,per diem,1103,16896.8736,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,BCBS MGG,BCBS MGG,16896.8736,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Cigna,Cigna,1257,,,,,,,per diem,1103,16896.8736,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Cigna MGG,Cigna MGG,16896.8736,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Humana,Humana,1400,,,,,,,per diem,1103,16896.8736,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Humana MGG,Humana MGG,16052.02992,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Optum VA,Optum VA,16896.8736,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,UHC,UHC,1400,,,,,,,per diem,1103,16896.8736,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,UHC MGG,UHC MGG,16896.8736,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,VA,VA,16896.8736,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Wellcare MGG,Wellcare MGG,16896.8736,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Bright Health - commercial,Bright Health - commercial,16896.8736,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,16896.8736,16896.8736,Bright Health MGG,Bright Health MGG,16896.8736,,,,,,,case rate,1103,16896.8736,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Aetna,Aetna,1500,,,,,,,per diem,1103,15308.9262,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Aetna MGG,Aetna MGG,15308.9262,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,BCBS,BCBS,1103,,,,,,,per diem,1103,15308.9262,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,BCBS MGG,BCBS MGG,15308.9262,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Cigna,Cigna,1257,,,,,,,per diem,1103,15308.9262,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Cigna MGG,Cigna MGG,15308.9262,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Humana,Humana,1400,,,,,,,per diem,1103,15308.9262,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Humana MGG,Humana MGG,14543.47989,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Optum VA,Optum VA,15308.9262,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,UHC,UHC,1400,,,,,,,per diem,1103,15308.9262,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,UHC MGG,UHC MGG,15308.9262,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,VA,VA,15308.9262,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Wellcare MGG,Wellcare MGG,15308.9262,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Bright Health - commercial,Bright Health - commercial,15308.9262,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,15308.9262,15308.9262,Bright Health MGG,Bright Health MGG,15308.9262,,,,,,,case rate,1103,15308.9262,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Aetna,Aetna,1500,,,,,,,per diem,1103,18640.9872,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Aetna MGG,Aetna MGG,18640.9872,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,BCBS,BCBS,1103,,,,,,,per diem,1103,18640.9872,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,BCBS MGG,BCBS MGG,18640.9872,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Cigna,Cigna,1257,,,,,,,per diem,1103,18640.9872,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Cigna MGG,Cigna MGG,18640.9872,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Humana,Humana,1400,,,,,,,per diem,1103,18640.9872,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Humana MGG,Humana MGG,17708.93784,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Optum VA,Optum VA,18640.9872,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,UHC,UHC,1400,,,,,,,per diem,1103,18640.9872,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,UHC MGG,UHC MGG,18640.9872,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,VA,VA,18640.9872,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Wellcare MGG,Wellcare MGG,18640.9872,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Bright Health - commercial,Bright Health - commercial,18640.9872,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,18640.9872,18640.9872,Bright Health MGG,Bright Health MGG,18640.9872,,,,,,,case rate,1103,18640.9872,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Aetna,Aetna,1500,,,,,,,per diem,1103,24426.8676,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Aetna MGG,Aetna MGG,24426.8676,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,BCBS,BCBS,1103,,,,,,,per diem,1103,24426.8676,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,BCBS MGG,BCBS MGG,24426.8676,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Cigna,Cigna,1257,,,,,,,per diem,1103,24426.8676,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Cigna MGG,Cigna MGG,24426.8676,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Humana,Humana,1400,,,,,,,per diem,1103,24426.8676,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Humana MGG,Humana MGG,23205.52422,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Optum VA,Optum VA,24426.8676,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,UHC,UHC,1400,,,,,,,per diem,1103,24426.8676,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,UHC MGG,UHC MGG,24426.8676,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,VA,VA,24426.8676,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Wellcare MGG,Wellcare MGG,24426.8676,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Bright Health - commercial,Bright Health - commercial,24426.8676,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,24426.8676,24426.8676,Bright Health MGG,Bright Health MGG,24426.8676,,,,,,,case rate,1103,24426.8676,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Aetna,Aetna,1500,,,,,,,per diem,1103,21691.6398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Aetna MGG,Aetna MGG,21691.6398,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,BCBS,BCBS,1103,,,,,,,per diem,1103,21691.6398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,BCBS MGG,BCBS MGG,21691.6398,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Cigna,Cigna,1257,,,,,,,per diem,1103,21691.6398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Cigna MGG,Cigna MGG,21691.6398,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Humana,Humana,1400,,,,,,,per diem,1103,21691.6398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Humana MGG,Humana MGG,20607.05781,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Optum VA,Optum VA,21691.6398,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,UHC,UHC,1400,,,,,,,per diem,1103,21691.6398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,UHC MGG,UHC MGG,21691.6398,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,VA,VA,21691.6398,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Wellcare MGG,Wellcare MGG,21691.6398,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Bright Health - commercial,Bright Health - commercial,21691.6398,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,21691.6398,21691.6398,Bright Health MGG,Bright Health MGG,21691.6398,,,,,,,case rate,1103,21691.6398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Aetna,Aetna,1500,,,,,,,per diem,1103,19652.202,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Aetna MGG,Aetna MGG,19652.202,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,BCBS,BCBS,1103,,,,,,,per diem,1103,19652.202,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,BCBS MGG,BCBS MGG,19652.202,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Cigna,Cigna,1257,,,,,,,per diem,1103,19652.202,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Cigna MGG,Cigna MGG,19652.202,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Humana,Humana,1400,,,,,,,per diem,1103,19652.202,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Humana MGG,Humana MGG,18669.5919,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Optum VA,Optum VA,19652.202,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,UHC,UHC,1400,,,,,,,per diem,1103,19652.202,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,UHC MGG,UHC MGG,19652.202,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,VA,VA,19652.202,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Wellcare MGG,Wellcare MGG,19652.202,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Bright Health - commercial,Bright Health - commercial,19652.202,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,19652.202,19652.202,Bright Health MGG,Bright Health MGG,19652.202,,,,,,,case rate,1103,19652.202,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Aetna,Aetna,1500,,,,,,,per diem,1103,23808.3876,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Aetna MGG,Aetna MGG,23808.3876,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,BCBS,BCBS,1103,,,,,,,per diem,1103,23808.3876,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,BCBS MGG,BCBS MGG,23808.3876,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Cigna,Cigna,1257,,,,,,,per diem,1103,23808.3876,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Cigna MGG,Cigna MGG,23808.3876,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Humana,Humana,1400,,,,,,,per diem,1103,23808.3876,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Humana MGG,Humana MGG,22617.96822,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Optum VA,Optum VA,23808.3876,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,UHC,UHC,1400,,,,,,,per diem,1103,23808.3876,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,UHC MGG,UHC MGG,23808.3876,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,VA,VA,23808.3876,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Wellcare MGG,Wellcare MGG,23808.3876,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Bright Health - commercial,Bright Health - commercial,23808.3876,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,23808.3876,23808.3876,Bright Health MGG,Bright Health MGG,23808.3876,,,,,,,case rate,1103,23808.3876,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Aetna,Aetna,1500,,,,,,,per diem,1103,31197.6774,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Aetna MGG,Aetna MGG,31197.6774,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,BCBS,BCBS,1103,,,,,,,per diem,1103,31197.6774,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,BCBS MGG,BCBS MGG,31197.6774,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Cigna,Cigna,1257,,,,,,,per diem,1103,31197.6774,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Cigna MGG,Cigna MGG,31197.6774,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Humana,Humana,1400,,,,,,,per diem,1103,31197.6774,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Humana MGG,Humana MGG,29637.79353,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Optum VA,Optum VA,31197.6774,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,UHC,UHC,1400,,,,,,,per diem,1103,31197.6774,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,UHC MGG,UHC MGG,31197.6774,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,VA,VA,31197.6774,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Wellcare MGG,Wellcare MGG,31197.6774,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Bright Health - commercial,Bright Health - commercial,31197.6774,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,31197.6774,31197.6774,Bright Health MGG,Bright Health MGG,31197.6774,,,,,,,case rate,1103,31197.6774,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Aetna,Aetna,1500,,,,,,,per diem,1103,27704.8116,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Aetna MGG,Aetna MGG,27704.8116,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,BCBS,BCBS,1103,,,,,,,per diem,1103,27704.8116,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,BCBS MGG,BCBS MGG,27704.8116,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Cigna,Cigna,1257,,,,,,,per diem,1103,27704.8116,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Cigna MGG,Cigna MGG,27704.8116,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Humana,Humana,1400,,,,,,,per diem,1103,27704.8116,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Humana MGG,Humana MGG,26319.57102,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Optum VA,Optum VA,27704.8116,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,UHC,UHC,1400,,,,,,,per diem,1103,27704.8116,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,UHC MGG,UHC MGG,27704.8116,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,VA,VA,27704.8116,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Wellcare MGG,Wellcare MGG,27704.8116,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Bright Health - commercial,Bright Health - commercial,27704.8116,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,27704.8116,27704.8116,Bright Health MGG,Bright Health MGG,27704.8116,,,,,,,case rate,1103,27704.8116,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Aetna,Aetna,1500,,,,,,,per diem,1103,25101.0108,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Aetna MGG,Aetna MGG,25101.0108,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,BCBS,BCBS,1103,,,,,,,per diem,1103,25101.0108,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,BCBS MGG,BCBS MGG,25101.0108,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Cigna,Cigna,1257,,,,,,,per diem,1103,25101.0108,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Cigna MGG,Cigna MGG,25101.0108,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Humana,Humana,1400,,,,,,,per diem,1103,25101.0108,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Humana MGG,Humana MGG,23845.96026,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Optum VA,Optum VA,25101.0108,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,UHC,UHC,1400,,,,,,,per diem,1103,25101.0108,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,UHC MGG,UHC MGG,25101.0108,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,VA,VA,25101.0108,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Wellcare MGG,Wellcare MGG,25101.0108,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Bright Health - commercial,Bright Health - commercial,25101.0108,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,25101.0108,25101.0108,Bright Health MGG,Bright Health MGG,25101.0108,,,,,,,case rate,1103,25101.0108,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Aetna,Aetna,1500,,,,,,,per diem,1103,29671.578,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Aetna MGG,Aetna MGG,29671.578,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,BCBS,BCBS,1103,,,,,,,per diem,1103,29671.578,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,BCBS MGG,BCBS MGG,29671.578,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Cigna,Cigna,1257,,,,,,,per diem,1103,29671.578,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Cigna MGG,Cigna MGG,29671.578,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Humana,Humana,1400,,,,,,,per diem,1103,29671.578,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Humana MGG,Humana MGG,28187.9991,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Optum VA,Optum VA,29671.578,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,UHC,UHC,1400,,,,,,,per diem,1103,29671.578,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,UHC MGG,UHC MGG,29671.578,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,VA,VA,29671.578,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Wellcare MGG,Wellcare MGG,29671.578,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Bright Health - commercial,Bright Health - commercial,29671.578,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,29671.578,29671.578,Bright Health MGG,Bright Health MGG,29671.578,,,,,,,case rate,1103,29671.578,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Aetna,Aetna,1500,,,,,,,per diem,1103,38880.7452,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Aetna MGG,Aetna MGG,38880.7452,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,BCBS,BCBS,1103,,,,,,,per diem,1103,38880.7452,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,BCBS MGG,BCBS MGG,38880.7452,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Cigna,Cigna,1257,,,,,,,per diem,1103,38880.7452,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Cigna MGG,Cigna MGG,38880.7452,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Humana,Humana,1400,,,,,,,per diem,1103,38880.7452,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Humana MGG,Humana MGG,36936.70794,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Optum VA,Optum VA,38880.7452,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,UHC,UHC,1400,,,,,,,per diem,1103,38880.7452,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,UHC MGG,UHC MGG,38880.7452,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,VA,VA,38880.7452,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Wellcare MGG,Wellcare MGG,38880.7452,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Bright Health - commercial,Bright Health - commercial,38880.7452,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,38880.7452,38880.7452,Bright Health MGG,Bright Health MGG,38880.7452,,,,,,,case rate,1103,38880.7452,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Aetna,Aetna,1500,,,,,,,per diem,1103,34526.646,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Aetna MGG,Aetna MGG,34526.646,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,BCBS,BCBS,1103,,,,,,,per diem,1103,34526.646,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,BCBS MGG,BCBS MGG,34526.646,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Cigna,Cigna,1257,,,,,,,per diem,1103,34526.646,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Cigna MGG,Cigna MGG,34526.646,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Humana,Humana,1400,,,,,,,per diem,1103,34526.646,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Humana MGG,Humana MGG,32800.3137,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Optum VA,Optum VA,34526.646,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,UHC,UHC,1400,,,,,,,per diem,1103,34526.646,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,UHC MGG,UHC MGG,34526.646,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,VA,VA,34526.646,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Wellcare MGG,Wellcare MGG,34526.646,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Bright Health - commercial,Bright Health - commercial,34526.646,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,34526.646,34526.646,Bright Health MGG,Bright Health MGG,34526.646,,,,,,,case rate,1103,34526.646,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Aetna,Aetna,1500,,,,,,,per diem,1103,31281.1722,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Aetna MGG,Aetna MGG,31281.1722,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,BCBS,BCBS,1103,,,,,,,per diem,1103,31281.1722,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,BCBS MGG,BCBS MGG,31281.1722,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Cigna,Cigna,1257,,,,,,,per diem,1103,31281.1722,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Cigna MGG,Cigna MGG,31281.1722,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Humana,Humana,1400,,,,,,,per diem,1103,31281.1722,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Humana MGG,Humana MGG,29717.11359,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Optum VA,Optum VA,31281.1722,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,UHC,UHC,1400,,,,,,,per diem,1103,31281.1722,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,UHC MGG,UHC MGG,31281.1722,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,VA,VA,31281.1722,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Wellcare MGG,Wellcare MGG,31281.1722,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Bright Health - commercial,Bright Health - commercial,31281.1722,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,31281.1722,31281.1722,Bright Health MGG,Bright Health MGG,31281.1722,,,,,,,case rate,1103,31281.1722,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Aetna,Aetna,1500,,,,,,,per diem,1103,33422.6592,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Aetna MGG,Aetna MGG,33422.6592,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,BCBS,BCBS,1103,,,,,,,per diem,1103,33422.6592,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,BCBS MGG,BCBS MGG,33422.6592,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Cigna,Cigna,1257,,,,,,,per diem,1103,33422.6592,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Cigna MGG,Cigna MGG,33422.6592,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Humana,Humana,1400,,,,,,,per diem,1103,33422.6592,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Humana MGG,Humana MGG,31751.52624,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Optum VA,Optum VA,33422.6592,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,UHC,UHC,1400,,,,,,,per diem,1103,33422.6592,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,UHC MGG,UHC MGG,33422.6592,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,VA,VA,33422.6592,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Wellcare MGG,Wellcare MGG,33422.6592,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Bright Health - commercial,Bright Health - commercial,33422.6592,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,33422.6592,33422.6592,Bright Health MGG,Bright Health MGG,33422.6592,,,,,,,case rate,1103,33422.6592,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Aetna,Aetna,1500,,,,,,,per diem,1103,43796.115,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Aetna MGG,Aetna MGG,43796.115,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,BCBS,BCBS,1103,,,,,,,per diem,1103,43796.115,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,BCBS MGG,BCBS MGG,43796.115,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Cigna,Cigna,1257,,,,,,,per diem,1103,43796.115,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Cigna MGG,Cigna MGG,43796.115,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Humana,Humana,1400,,,,,,,per diem,1103,43796.115,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Humana MGG,Humana MGG,41606.30925,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Optum VA,Optum VA,43796.115,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,UHC,UHC,1400,,,,,,,per diem,1103,43796.115,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,UHC MGG,UHC MGG,43796.115,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,VA,VA,43796.115,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Wellcare MGG,Wellcare MGG,43796.115,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Bright Health - commercial,Bright Health - commercial,43796.115,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,43796.115,43796.115,Bright Health MGG,Bright Health MGG,43796.115,,,,,,,case rate,1103,43796.115,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Aetna,Aetna,1500,,,,,,,per diem,1103,38891.5686,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Aetna MGG,Aetna MGG,38891.5686,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,BCBS,BCBS,1103,,,,,,,per diem,1103,38891.5686,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,BCBS MGG,BCBS MGG,38891.5686,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Cigna,Cigna,1257,,,,,,,per diem,1103,38891.5686,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Cigna MGG,Cigna MGG,38891.5686,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Humana,Humana,1400,,,,,,,per diem,1103,38891.5686,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Humana MGG,Humana MGG,36946.99017,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Optum VA,Optum VA,38891.5686,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,UHC,UHC,1400,,,,,,,per diem,1103,38891.5686,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,UHC MGG,UHC MGG,38891.5686,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,VA,VA,38891.5686,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Wellcare MGG,Wellcare MGG,38891.5686,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Bright Health - commercial,Bright Health - commercial,38891.5686,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,38891.5686,38891.5686,Bright Health MGG,Bright Health MGG,38891.5686,,,,,,,case rate,1103,38891.5686,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Aetna,Aetna,1500,,,,,,,per diem,1103,35236.3518,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Aetna MGG,Aetna MGG,35236.3518,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,BCBS,BCBS,1103,,,,,,,per diem,1103,35236.3518,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,BCBS MGG,BCBS MGG,35236.3518,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Cigna,Cigna,1257,,,,,,,per diem,1103,35236.3518,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Cigna MGG,Cigna MGG,35236.3518,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Humana,Humana,1400,,,,,,,per diem,1103,35236.3518,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Humana MGG,Humana MGG,33474.53421,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Optum VA,Optum VA,35236.3518,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,UHC,UHC,1400,,,,,,,per diem,1103,35236.3518,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,UHC MGG,UHC MGG,35236.3518,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,VA,VA,35236.3518,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Wellcare MGG,Wellcare MGG,35236.3518,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Bright Health - commercial,Bright Health - commercial,35236.3518,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,35236.3518,35236.3518,Bright Health MGG,Bright Health MGG,35236.3518,,,,,,,case rate,1103,35236.3518,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Aetna,Aetna,1500,,,,,,,per diem,1103,11200.6728,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Aetna MGG,Aetna MGG,11200.6728,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,BCBS,BCBS,1103,,,,,,,per diem,1103,11200.6728,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,BCBS MGG,BCBS MGG,11200.6728,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Cigna,Cigna,1257,,,,,,,per diem,1103,11200.6728,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Cigna MGG,Cigna MGG,11200.6728,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Humana,Humana,1400,,,,,,,per diem,1103,11200.6728,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Humana MGG,Humana MGG,10640.63916,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Optum VA,Optum VA,11200.6728,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,UHC,UHC,1400,,,,,,,per diem,1103,11200.6728,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,UHC MGG,UHC MGG,11200.6728,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,VA,VA,11200.6728,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Wellcare MGG,Wellcare MGG,11200.6728,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Bright Health - commercial,Bright Health - commercial,11200.6728,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,11200.6728,11200.6728,Bright Health MGG,Bright Health MGG,11200.6728,,,,,,,case rate,1103,11200.6728,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Aetna,Aetna,1500,,,,,,,per diem,1103,16411.3668,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Aetna MGG,Aetna MGG,16411.3668,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,BCBS,BCBS,1103,,,,,,,per diem,1103,16411.3668,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,BCBS MGG,BCBS MGG,16411.3668,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Cigna,Cigna,1257,,,,,,,per diem,1103,16411.3668,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Cigna MGG,Cigna MGG,16411.3668,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Humana,Humana,1400,,,,,,,per diem,1103,16411.3668,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Humana MGG,Humana MGG,15590.79846,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Optum VA,Optum VA,16411.3668,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,UHC,UHC,1400,,,,,,,per diem,1103,16411.3668,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,UHC MGG,UHC MGG,16411.3668,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,VA,VA,16411.3668,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Wellcare MGG,Wellcare MGG,16411.3668,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Bright Health - commercial,Bright Health - commercial,16411.3668,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,16411.3668,16411.3668,Bright Health MGG,Bright Health MGG,16411.3668,,,,,,,case rate,1103,16411.3668,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Aetna,Aetna,1500,,,,,,,per diem,1103,13049.928,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Aetna MGG,Aetna MGG,13049.928,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,BCBS,BCBS,1103,,,,,,,per diem,1103,13049.928,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,BCBS MGG,BCBS MGG,13049.928,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Cigna,Cigna,1257,,,,,,,per diem,1103,13049.928,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Cigna MGG,Cigna MGG,13049.928,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Humana,Humana,1400,,,,,,,per diem,1103,13049.928,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Humana MGG,Humana MGG,12397.4316,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Optum VA,Optum VA,13049.928,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,UHC,UHC,1400,,,,,,,per diem,1103,13049.928,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,UHC MGG,UHC MGG,13049.928,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,VA,VA,13049.928,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Wellcare MGG,Wellcare MGG,13049.928,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Bright Health - commercial,Bright Health - commercial,13049.928,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,13049.928,13049.928,Bright Health MGG,Bright Health MGG,13049.928,,,,,,,case rate,1103,13049.928,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Aetna,Aetna,1500,,,,,,,per diem,1103,11921.202,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Aetna MGG,Aetna MGG,11921.202,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,BCBS,BCBS,1103,,,,,,,per diem,1103,11921.202,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,BCBS MGG,BCBS MGG,11921.202,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Cigna,Cigna,1257,,,,,,,per diem,1103,11921.202,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Cigna MGG,Cigna MGG,11921.202,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Humana,Humana,1400,,,,,,,per diem,1103,11921.202,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Humana MGG,Humana MGG,11325.1419,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Optum VA,Optum VA,11921.202,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,UHC,UHC,1400,,,,,,,per diem,1103,11921.202,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,UHC MGG,UHC MGG,11921.202,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,VA,VA,11921.202,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Wellcare MGG,Wellcare MGG,11921.202,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Bright Health - commercial,Bright Health - commercial,11921.202,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,11921.202,11921.202,Bright Health MGG,Bright Health MGG,11921.202,,,,,,,case rate,1103,11921.202,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Aetna,Aetna,1500,,,,,,,per diem,1103,14627.052,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Aetna MGG,Aetna MGG,14627.052,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,BCBS,BCBS,1103,,,,,,,per diem,1103,14627.052,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,BCBS MGG,BCBS MGG,14627.052,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Cigna,Cigna,1257,,,,,,,per diem,1103,14627.052,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Cigna MGG,Cigna MGG,14627.052,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Humana,Humana,1400,,,,,,,per diem,1103,14627.052,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Humana MGG,Humana MGG,13895.6994,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Optum VA,Optum VA,14627.052,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,UHC,UHC,1400,,,,,,,per diem,1103,14627.052,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,UHC MGG,UHC MGG,14627.052,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,VA,VA,14627.052,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Wellcare MGG,Wellcare MGG,14627.052,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Bright Health - commercial,Bright Health - commercial,14627.052,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,14627.052,14627.052,Bright Health MGG,Bright Health MGG,14627.052,,,,,,,case rate,1103,14627.052,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Aetna,Aetna,1500,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Aetna MGG,Aetna MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,BCBS,BCBS,1103,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,BCBS MGG,BCBS MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Cigna,Cigna,1257,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Cigna MGG,Cigna MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Humana,Humana,1400,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Humana MGG,Humana MGG,20360.28429,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Optum VA,Optum VA,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,UHC,UHC,1400,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,UHC MGG,UHC MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,VA,VA,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Wellcare MGG,Wellcare MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Bright Health - commercial,Bright Health - commercial,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Bright Health MGG,Bright Health MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Aetna,Aetna,1500,,,,,,,per diem,1103,17040.6702,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Aetna MGG,Aetna MGG,17040.6702,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,BCBS,BCBS,1103,,,,,,,per diem,1103,17040.6702,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,BCBS MGG,BCBS MGG,17040.6702,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Cigna,Cigna,1257,,,,,,,per diem,1103,17040.6702,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Cigna MGG,Cigna MGG,17040.6702,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Humana,Humana,1400,,,,,,,per diem,1103,17040.6702,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Humana MGG,Humana MGG,16188.63669,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Optum VA,Optum VA,17040.6702,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,UHC,UHC,1400,,,,,,,per diem,1103,17040.6702,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,UHC MGG,UHC MGG,17040.6702,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,VA,VA,17040.6702,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Wellcare MGG,Wellcare MGG,17040.6702,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Bright Health - commercial,Bright Health - commercial,17040.6702,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,17040.6702,17040.6702,Bright Health MGG,Bright Health MGG,17040.6702,,,,,,,case rate,1103,17040.6702,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Aetna,Aetna,1500,,,,,,,per diem,1103,15568.6878,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Aetna MGG,Aetna MGG,15568.6878,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,BCBS,BCBS,1103,,,,,,,per diem,1103,15568.6878,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,BCBS MGG,BCBS MGG,15568.6878,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Cigna,Cigna,1257,,,,,,,per diem,1103,15568.6878,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Cigna MGG,Cigna MGG,15568.6878,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Humana,Humana,1400,,,,,,,per diem,1103,15568.6878,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Humana MGG,Humana MGG,14790.25341,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Optum VA,Optum VA,15568.6878,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,UHC,UHC,1400,,,,,,,per diem,1103,15568.6878,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,UHC MGG,UHC MGG,15568.6878,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,VA,VA,15568.6878,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Wellcare MGG,Wellcare MGG,15568.6878,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Bright Health - commercial,Bright Health - commercial,15568.6878,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,15568.6878,15568.6878,Bright Health MGG,Bright Health MGG,15568.6878,,,,,,,case rate,1103,15568.6878,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Aetna,Aetna,1500,,,,,,,per diem,1103,18184.8582,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Aetna MGG,Aetna MGG,18184.8582,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,BCBS,BCBS,1103,,,,,,,per diem,1103,18184.8582,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,BCBS MGG,BCBS MGG,18184.8582,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Cigna,Cigna,1257,,,,,,,per diem,1103,18184.8582,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Cigna MGG,Cigna MGG,18184.8582,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Humana,Humana,1400,,,,,,,per diem,1103,18184.8582,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Humana MGG,Humana MGG,17275.61529,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Optum VA,Optum VA,18184.8582,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,UHC,UHC,1400,,,,,,,per diem,1103,18184.8582,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,UHC MGG,UHC MGG,18184.8582,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,VA,VA,18184.8582,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Wellcare MGG,Wellcare MGG,18184.8582,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Bright Health - commercial,Bright Health - commercial,18184.8582,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,18184.8582,18184.8582,Bright Health MGG,Bright Health MGG,18184.8582,,,,,,,case rate,1103,18184.8582,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Aetna,Aetna,1500,,,,,,,per diem,1103,26645.6646,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Aetna MGG,Aetna MGG,26645.6646,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,BCBS,BCBS,1103,,,,,,,per diem,1103,26645.6646,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,BCBS MGG,BCBS MGG,26645.6646,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Cigna,Cigna,1257,,,,,,,per diem,1103,26645.6646,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Cigna MGG,Cigna MGG,26645.6646,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Humana,Humana,1400,,,,,,,per diem,1103,26645.6646,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Humana MGG,Humana MGG,25313.38137,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Optum VA,Optum VA,26645.6646,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,UHC,UHC,1400,,,,,,,per diem,1103,26645.6646,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,UHC MGG,UHC MGG,26645.6646,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,VA,VA,26645.6646,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Wellcare MGG,Wellcare MGG,26645.6646,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Bright Health - commercial,Bright Health - commercial,26645.6646,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,26645.6646,26645.6646,Bright Health MGG,Bright Health MGG,26645.6646,,,,,,,case rate,1103,26645.6646,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Aetna,Aetna,1500,,,,,,,per diem,1103,21186.0324,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Aetna MGG,Aetna MGG,21186.0324,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,BCBS,BCBS,1103,,,,,,,per diem,1103,21186.0324,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,BCBS MGG,BCBS MGG,21186.0324,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Cigna,Cigna,1257,,,,,,,per diem,1103,21186.0324,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Cigna MGG,Cigna MGG,21186.0324,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Humana,Humana,1400,,,,,,,per diem,1103,21186.0324,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Humana MGG,Humana MGG,20126.73078,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Optum VA,Optum VA,21186.0324,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,UHC,UHC,1400,,,,,,,per diem,1103,21186.0324,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,UHC MGG,UHC MGG,21186.0324,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,VA,VA,21186.0324,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Wellcare MGG,Wellcare MGG,21186.0324,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Bright Health - commercial,Bright Health - commercial,21186.0324,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,21186.0324,21186.0324,Bright Health MGG,Bright Health MGG,21186.0324,,,,,,,case rate,1103,21186.0324,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Aetna,Aetna,1500,,,,,,,per diem,1103,19355.3316,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Aetna MGG,Aetna MGG,19355.3316,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,BCBS,BCBS,1103,,,,,,,per diem,1103,19355.3316,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,BCBS MGG,BCBS MGG,19355.3316,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Cigna,Cigna,1257,,,,,,,per diem,1103,19355.3316,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Cigna MGG,Cigna MGG,19355.3316,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Humana,Humana,1400,,,,,,,per diem,1103,19355.3316,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Humana MGG,Humana MGG,18387.56502,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Optum VA,Optum VA,19355.3316,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,UHC,UHC,1400,,,,,,,per diem,1103,19355.3316,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,UHC MGG,UHC MGG,19355.3316,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,VA,VA,19355.3316,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Wellcare MGG,Wellcare MGG,19355.3316,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Bright Health - commercial,Bright Health - commercial,19355.3316,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,19355.3316,19355.3316,Bright Health MGG,Bright Health MGG,19355.3316,,,,,,,case rate,1103,19355.3316,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Aetna,Aetna,1500,,,,,,,per diem,1103,22412.169,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Aetna MGG,Aetna MGG,22412.169,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,BCBS,BCBS,1103,,,,,,,per diem,1103,22412.169,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,BCBS MGG,BCBS MGG,22412.169,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Cigna,Cigna,1257,,,,,,,per diem,1103,22412.169,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Cigna MGG,Cigna MGG,22412.169,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Humana,Humana,1400,,,,,,,per diem,1103,22412.169,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Humana MGG,Humana MGG,21291.56055,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Optum VA,Optum VA,22412.169,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,UHC,UHC,1400,,,,,,,per diem,1103,22412.169,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,UHC MGG,UHC MGG,22412.169,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,VA,VA,22412.169,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Wellcare MGG,Wellcare MGG,22412.169,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Bright Health - commercial,Bright Health - commercial,22412.169,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,22412.169,22412.169,Bright Health MGG,Bright Health MGG,22412.169,,,,,,,case rate,1103,22412.169,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Aetna,Aetna,1500,,,,,,,per diem,1103,32839.7418,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Aetna MGG,Aetna MGG,32839.7418,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,BCBS,BCBS,1103,,,,,,,per diem,1103,32839.7418,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,BCBS MGG,BCBS MGG,32839.7418,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Cigna,Cigna,1257,,,,,,,per diem,1103,32839.7418,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Cigna MGG,Cigna MGG,32839.7418,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Humana,Humana,1400,,,,,,,per diem,1103,32839.7418,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Humana MGG,Humana MGG,31197.75471,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Optum VA,Optum VA,32839.7418,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,UHC,UHC,1400,,,,,,,per diem,1103,32839.7418,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,UHC MGG,UHC MGG,32839.7418,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,VA,VA,32839.7418,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Wellcare MGG,Wellcare MGG,32839.7418,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Bright Health - commercial,Bright Health - commercial,32839.7418,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,32839.7418,32839.7418,Bright Health MGG,Bright Health MGG,32839.7418,,,,,,,case rate,1103,32839.7418,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Aetna,Aetna,1500,,,,,,,per diem,1103,26110.6794,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Aetna MGG,Aetna MGG,26110.6794,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,BCBS,BCBS,1103,,,,,,,per diem,1103,26110.6794,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,BCBS MGG,BCBS MGG,26110.6794,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Cigna,Cigna,1257,,,,,,,per diem,1103,26110.6794,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Cigna MGG,Cigna MGG,26110.6794,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Humana,Humana,1400,,,,,,,per diem,1103,26110.6794,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Humana MGG,Humana MGG,24805.14543,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Optum VA,Optum VA,26110.6794,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,UHC,UHC,1400,,,,,,,per diem,1103,26110.6794,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,UHC MGG,UHC MGG,26110.6794,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,VA,VA,26110.6794,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Wellcare MGG,Wellcare MGG,26110.6794,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Bright Health - commercial,Bright Health - commercial,26110.6794,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,26110.6794,26110.6794,Bright Health MGG,Bright Health MGG,26110.6794,,,,,,,case rate,1103,26110.6794,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Aetna,Aetna,1500,,,,,,,per diem,1103,23854.7736,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Aetna MGG,Aetna MGG,23854.7736,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,BCBS,BCBS,1103,,,,,,,per diem,1103,23854.7736,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,BCBS MGG,BCBS MGG,23854.7736,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Cigna,Cigna,1257,,,,,,,per diem,1103,23854.7736,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Cigna MGG,Cigna MGG,23854.7736,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Humana,Humana,1400,,,,,,,per diem,1103,23854.7736,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Humana MGG,Humana MGG,22662.03492,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Optum VA,Optum VA,23854.7736,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,UHC,UHC,1400,,,,,,,per diem,1103,23854.7736,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,UHC MGG,UHC MGG,23854.7736,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,VA,VA,23854.7736,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Wellcare MGG,Wellcare MGG,23854.7736,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Bright Health - commercial,Bright Health - commercial,23854.7736,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,23854.7736,23854.7736,Bright Health MGG,Bright Health MGG,23854.7736,,,,,,,case rate,1103,23854.7736,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Aetna,Aetna,1500,,,,,,,per diem,1103,28753.1352,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Aetna MGG,Aetna MGG,28753.1352,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,BCBS,BCBS,1103,,,,,,,per diem,1103,28753.1352,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,BCBS MGG,BCBS MGG,28753.1352,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Cigna,Cigna,1257,,,,,,,per diem,1103,28753.1352,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Cigna MGG,Cigna MGG,28753.1352,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Humana,Humana,1400,,,,,,,per diem,1103,28753.1352,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Humana MGG,Humana MGG,27315.47844,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Optum VA,Optum VA,28753.1352,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,UHC,UHC,1400,,,,,,,per diem,1103,28753.1352,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,UHC MGG,UHC MGG,28753.1352,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,VA,VA,28753.1352,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Wellcare MGG,Wellcare MGG,28753.1352,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Bright Health - commercial,Bright Health - commercial,28753.1352,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,28753.1352,28753.1352,Bright Health MGG,Bright Health MGG,28753.1352,,,,,,,case rate,1103,28753.1352,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Aetna,Aetna,1500,,,,,,,per diem,1103,42130.8576,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Aetna MGG,Aetna MGG,42130.8576,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,BCBS,BCBS,1103,,,,,,,per diem,1103,42130.8576,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,BCBS MGG,BCBS MGG,42130.8576,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Cigna,Cigna,1257,,,,,,,per diem,1103,42130.8576,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Cigna MGG,Cigna MGG,42130.8576,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Humana,Humana,1400,,,,,,,per diem,1103,42130.8576,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Humana MGG,Humana MGG,40024.31472,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Optum VA,Optum VA,42130.8576,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,UHC,UHC,1400,,,,,,,per diem,1103,42130.8576,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,UHC MGG,UHC MGG,42130.8576,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,VA,VA,42130.8576,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Wellcare MGG,Wellcare MGG,42130.8576,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Bright Health - commercial,Bright Health - commercial,42130.8576,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,42130.8576,42130.8576,Bright Health MGG,Bright Health MGG,42130.8576,,,,,,,case rate,1103,42130.8576,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Aetna,Aetna,1500,,,,,,,per diem,1103,33498.423,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Aetna MGG,Aetna MGG,33498.423,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,BCBS,BCBS,1103,,,,,,,per diem,1103,33498.423,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,BCBS MGG,BCBS MGG,33498.423,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Cigna,Cigna,1257,,,,,,,per diem,1103,33498.423,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Cigna MGG,Cigna MGG,33498.423,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Humana,Humana,1400,,,,,,,per diem,1103,33498.423,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Humana MGG,Humana MGG,31823.50185,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Optum VA,Optum VA,33498.423,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,UHC,UHC,1400,,,,,,,per diem,1103,33498.423,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,UHC MGG,UHC MGG,33498.423,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,VA,VA,33498.423,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Wellcare MGG,Wellcare MGG,33498.423,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Bright Health - commercial,Bright Health - commercial,33498.423,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,33498.423,33498.423,Bright Health MGG,Bright Health MGG,33498.423,,,,,,,case rate,1103,33498.423,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Aetna,Aetna,1500,,,,,,,per diem,1103,30603.9366,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Aetna MGG,Aetna MGG,30603.9366,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,BCBS,BCBS,1103,,,,,,,per diem,1103,30603.9366,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,BCBS MGG,BCBS MGG,30603.9366,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Cigna,Cigna,1257,,,,,,,per diem,1103,30603.9366,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Cigna MGG,Cigna MGG,30603.9366,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Humana,Humana,1400,,,,,,,per diem,1103,30603.9366,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Humana MGG,Humana MGG,29073.73977,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Optum VA,Optum VA,30603.9366,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,UHC,UHC,1400,,,,,,,per diem,1103,30603.9366,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,UHC MGG,UHC MGG,30603.9366,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,VA,VA,30603.9366,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Wellcare MGG,Wellcare MGG,30603.9366,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Bright Health - commercial,Bright Health - commercial,30603.9366,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,30603.9366,30603.9366,Bright Health MGG,Bright Health MGG,30603.9366,,,,,,,case rate,1103,30603.9366,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Aetna,Aetna,1500,,,,,,,per diem,1103,12770.0658,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Aetna MGG,Aetna MGG,12770.0658,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,BCBS,BCBS,1103,,,,,,,per diem,1103,12770.0658,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,BCBS MGG,BCBS MGG,12770.0658,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Cigna,Cigna,1257,,,,,,,per diem,1103,12770.0658,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Cigna MGG,Cigna MGG,12770.0658,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Humana,Humana,1400,,,,,,,per diem,1103,12770.0658,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Humana MGG,Humana MGG,12131.56251,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Optum VA,Optum VA,12770.0658,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,UHC,UHC,1400,,,,,,,per diem,1103,12770.0658,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,UHC MGG,UHC MGG,12770.0658,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,VA,VA,12770.0658,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Wellcare MGG,Wellcare MGG,12770.0658,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Bright Health - commercial,Bright Health - commercial,12770.0658,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,12770.0658,12770.0658,Bright Health MGG,Bright Health MGG,12770.0658,,,,,,,case rate,1103,12770.0658,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Aetna,Aetna,1500,,,,,,,per diem,1103,18460.0818,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Aetna MGG,Aetna MGG,18460.0818,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,BCBS,BCBS,1103,,,,,,,per diem,1103,18460.0818,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,BCBS MGG,BCBS MGG,18460.0818,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Cigna,Cigna,1257,,,,,,,per diem,1103,18460.0818,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Cigna MGG,Cigna MGG,18460.0818,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Humana,Humana,1400,,,,,,,per diem,1103,18460.0818,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Humana MGG,Humana MGG,17537.07771,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Optum VA,Optum VA,18460.0818,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,UHC,UHC,1400,,,,,,,per diem,1103,18460.0818,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,UHC MGG,UHC MGG,18460.0818,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,VA,VA,18460.0818,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Wellcare MGG,Wellcare MGG,18460.0818,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Bright Health - commercial,Bright Health - commercial,18460.0818,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,18460.0818,18460.0818,Bright Health MGG,Bright Health MGG,18460.0818,,,,,,,case rate,1103,18460.0818,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Aetna,Aetna,1500,,,,,,,per diem,1103,14630.1444,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Aetna MGG,Aetna MGG,14630.1444,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,BCBS,BCBS,1103,,,,,,,per diem,1103,14630.1444,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,BCBS MGG,BCBS MGG,14630.1444,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Cigna,Cigna,1257,,,,,,,per diem,1103,14630.1444,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Cigna MGG,Cigna MGG,14630.1444,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Humana,Humana,1400,,,,,,,per diem,1103,14630.1444,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Humana MGG,Humana MGG,13898.63718,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Optum VA,Optum VA,14630.1444,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,UHC,UHC,1400,,,,,,,per diem,1103,14630.1444,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,UHC MGG,UHC MGG,14630.1444,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,VA,VA,14630.1444,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Wellcare MGG,Wellcare MGG,14630.1444,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Bright Health - commercial,Bright Health - commercial,14630.1444,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,14630.1444,14630.1444,Bright Health MGG,Bright Health MGG,14630.1444,,,,,,,case rate,1103,14630.1444,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Aetna,Aetna,1500,,,,,,,per diem,1103,13640.5764,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Aetna MGG,Aetna MGG,13640.5764,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,BCBS,BCBS,1103,,,,,,,per diem,1103,13640.5764,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,BCBS MGG,BCBS MGG,13640.5764,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Cigna,Cigna,1257,,,,,,,per diem,1103,13640.5764,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Cigna MGG,Cigna MGG,13640.5764,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Humana,Humana,1400,,,,,,,per diem,1103,13640.5764,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Humana MGG,Humana MGG,12958.54758,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Optum VA,Optum VA,13640.5764,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,UHC,UHC,1400,,,,,,,per diem,1103,13640.5764,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,UHC MGG,UHC MGG,13640.5764,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,VA,VA,13640.5764,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Wellcare MGG,Wellcare MGG,13640.5764,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Bright Health - commercial,Bright Health - commercial,13640.5764,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,13640.5764,13640.5764,Bright Health MGG,Bright Health MGG,13640.5764,,,,,,,case rate,1103,13640.5764,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Aetna,Aetna,1500,,,,,,,per diem,1103,16518.0546,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Aetna MGG,Aetna MGG,16518.0546,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,BCBS,BCBS,1103,,,,,,,per diem,1103,16518.0546,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,BCBS MGG,BCBS MGG,16518.0546,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Cigna,Cigna,1257,,,,,,,per diem,1103,16518.0546,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Cigna MGG,Cigna MGG,16518.0546,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Humana,Humana,1400,,,,,,,per diem,1103,16518.0546,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Humana MGG,Humana MGG,15692.15187,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Optum VA,Optum VA,16518.0546,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,UHC,UHC,1400,,,,,,,per diem,1103,16518.0546,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,UHC MGG,UHC MGG,16518.0546,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,VA,VA,16518.0546,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Wellcare MGG,Wellcare MGG,16518.0546,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Bright Health - commercial,Bright Health - commercial,16518.0546,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,16518.0546,16518.0546,Bright Health MGG,Bright Health MGG,16518.0546,,,,,,,case rate,1103,16518.0546,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Aetna,Aetna,1500,,,,,,,per diem,1103,23881.059,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Aetna MGG,Aetna MGG,23881.059,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,BCBS,BCBS,1103,,,,,,,per diem,1103,23881.059,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,BCBS MGG,BCBS MGG,23881.059,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Cigna,Cigna,1257,,,,,,,per diem,1103,23881.059,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Cigna MGG,Cigna MGG,23881.059,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Humana,Humana,1400,,,,,,,per diem,1103,23881.059,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Humana MGG,Humana MGG,22687.00605,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Optum VA,Optum VA,23881.059,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,UHC,UHC,1400,,,,,,,per diem,1103,23881.059,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,UHC MGG,UHC MGG,23881.059,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,VA,VA,23881.059,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Wellcare MGG,Wellcare MGG,23881.059,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Bright Health - commercial,Bright Health - commercial,23881.059,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,23881.059,23881.059,Bright Health MGG,Bright Health MGG,23881.059,,,,,,,case rate,1103,23881.059,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Aetna,Aetna,1500,,,,,,,per diem,1103,18927.0342,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Aetna MGG,Aetna MGG,18927.0342,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,BCBS,BCBS,1103,,,,,,,per diem,1103,18927.0342,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,BCBS MGG,BCBS MGG,18927.0342,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Cigna,Cigna,1257,,,,,,,per diem,1103,18927.0342,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Cigna MGG,Cigna MGG,18927.0342,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Humana,Humana,1400,,,,,,,per diem,1103,18927.0342,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Humana MGG,Humana MGG,17980.68249,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Optum VA,Optum VA,18927.0342,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,UHC,UHC,1400,,,,,,,per diem,1103,18927.0342,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,UHC MGG,UHC MGG,18927.0342,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,VA,VA,18927.0342,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Wellcare MGG,Wellcare MGG,18927.0342,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Bright Health - commercial,Bright Health - commercial,18927.0342,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,18927.0342,18927.0342,Bright Health MGG,Bright Health MGG,18927.0342,,,,,,,case rate,1103,18927.0342,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Aetna,Aetna,1500,,,,,,,per diem,1103,17645.2344,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Aetna MGG,Aetna MGG,17645.2344,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,BCBS,BCBS,1103,,,,,,,per diem,1103,17645.2344,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,BCBS MGG,BCBS MGG,17645.2344,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Cigna,Cigna,1257,,,,,,,per diem,1103,17645.2344,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Cigna MGG,Cigna MGG,17645.2344,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Humana,Humana,1400,,,,,,,per diem,1103,17645.2344,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Humana MGG,Humana MGG,16762.97268,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Optum VA,Optum VA,17645.2344,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,UHC,UHC,1400,,,,,,,per diem,1103,17645.2344,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,UHC MGG,UHC MGG,17645.2344,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,VA,VA,17645.2344,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Wellcare MGG,Wellcare MGG,17645.2344,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Bright Health - commercial,Bright Health - commercial,17645.2344,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,17645.2344,17645.2344,Bright Health MGG,Bright Health MGG,17645.2344,,,,,,,case rate,1103,17645.2344,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Aetna,Aetna,1500,,,,,,,per diem,1103,19533.1446,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Aetna MGG,Aetna MGG,19533.1446,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,BCBS,BCBS,1103,,,,,,,per diem,1103,19533.1446,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,BCBS MGG,BCBS MGG,19533.1446,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Cigna,Cigna,1257,,,,,,,per diem,1103,19533.1446,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Cigna MGG,Cigna MGG,19533.1446,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Humana,Humana,1400,,,,,,,per diem,1103,19533.1446,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Humana MGG,Humana MGG,18556.48737,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Optum VA,Optum VA,19533.1446,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,UHC,UHC,1400,,,,,,,per diem,1103,19533.1446,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,UHC MGG,UHC MGG,19533.1446,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,VA,VA,19533.1446,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Wellcare MGG,Wellcare MGG,19533.1446,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Bright Health - commercial,Bright Health - commercial,19533.1446,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,19533.1446,19533.1446,Bright Health MGG,Bright Health MGG,19533.1446,,,,,,,case rate,1103,19533.1446,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Aetna,Aetna,1500,,,,,,,per diem,1103,28236.7044,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Aetna MGG,Aetna MGG,28236.7044,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,BCBS,BCBS,1103,,,,,,,per diem,1103,28236.7044,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,BCBS MGG,BCBS MGG,28236.7044,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Cigna,Cigna,1257,,,,,,,per diem,1103,28236.7044,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Cigna MGG,Cigna MGG,28236.7044,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Humana,Humana,1400,,,,,,,per diem,1103,28236.7044,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Humana MGG,Humana MGG,26824.86918,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Optum VA,Optum VA,28236.7044,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,UHC,UHC,1400,,,,,,,per diem,1103,28236.7044,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,UHC MGG,UHC MGG,28236.7044,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,VA,VA,28236.7044,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Wellcare MGG,Wellcare MGG,28236.7044,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Bright Health - commercial,Bright Health - commercial,28236.7044,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,28236.7044,28236.7044,Bright Health MGG,Bright Health MGG,28236.7044,,,,,,,case rate,1103,28236.7044,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Aetna,Aetna,1500,,,,,,,per diem,1103,22379.6988,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Aetna MGG,Aetna MGG,22379.6988,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,BCBS,BCBS,1103,,,,,,,per diem,1103,22379.6988,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,BCBS MGG,BCBS MGG,22379.6988,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Cigna,Cigna,1257,,,,,,,per diem,1103,22379.6988,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Cigna MGG,Cigna MGG,22379.6988,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Humana,Humana,1400,,,,,,,per diem,1103,22379.6988,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Humana MGG,Humana MGG,21260.71386,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Optum VA,Optum VA,22379.6988,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,UHC,UHC,1400,,,,,,,per diem,1103,22379.6988,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,UHC MGG,UHC MGG,22379.6988,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,VA,VA,22379.6988,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Wellcare MGG,Wellcare MGG,22379.6988,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Bright Health - commercial,Bright Health - commercial,22379.6988,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,22379.6988,22379.6988,Bright Health MGG,Bright Health MGG,22379.6988,,,,,,,case rate,1103,22379.6988,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Aetna,Aetna,1500,,,,,,,per diem,1103,20864.4228,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Aetna MGG,Aetna MGG,20864.4228,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,BCBS,BCBS,1103,,,,,,,per diem,1103,20864.4228,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,BCBS MGG,BCBS MGG,20864.4228,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Cigna,Cigna,1257,,,,,,,per diem,1103,20864.4228,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Cigna MGG,Cigna MGG,20864.4228,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Humana,Humana,1400,,,,,,,per diem,1103,20864.4228,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Humana MGG,Humana MGG,19821.20166,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Optum VA,Optum VA,20864.4228,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,UHC,UHC,1400,,,,,,,per diem,1103,20864.4228,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,UHC MGG,UHC MGG,20864.4228,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,VA,VA,20864.4228,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Wellcare MGG,Wellcare MGG,20864.4228,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Bright Health - commercial,Bright Health - commercial,20864.4228,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,20864.4228,20864.4228,Bright Health MGG,Bright Health MGG,20864.4228,,,,,,,case rate,1103,20864.4228,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Aetna,Aetna,1500,,,,,,,per diem,1103,23138.883,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Aetna MGG,Aetna MGG,23138.883,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,BCBS,BCBS,1103,,,,,,,per diem,1103,23138.883,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,BCBS MGG,BCBS MGG,23138.883,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Cigna,Cigna,1257,,,,,,,per diem,1103,23138.883,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Cigna MGG,Cigna MGG,23138.883,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Humana,Humana,1400,,,,,,,per diem,1103,23138.883,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Humana MGG,Humana MGG,21981.93885,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Optum VA,Optum VA,23138.883,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,UHC,UHC,1400,,,,,,,per diem,1103,23138.883,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,UHC MGG,UHC MGG,23138.883,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,VA,VA,23138.883,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Wellcare MGG,Wellcare MGG,23138.883,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Bright Health - commercial,Bright Health - commercial,23138.883,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,23138.883,23138.883,Bright Health MGG,Bright Health MGG,23138.883,,,,,,,case rate,1103,23138.883,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Aetna,Aetna,1500,,,,,,,per diem,1103,33452.037,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Aetna MGG,Aetna MGG,33452.037,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,BCBS,BCBS,1103,,,,,,,per diem,1103,33452.037,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,BCBS MGG,BCBS MGG,33452.037,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Cigna,Cigna,1257,,,,,,,per diem,1103,33452.037,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Cigna MGG,Cigna MGG,33452.037,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Humana,Humana,1400,,,,,,,per diem,1103,33452.037,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Humana MGG,Humana MGG,31779.43515,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Optum VA,Optum VA,33452.037,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,UHC,UHC,1400,,,,,,,per diem,1103,33452.037,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,UHC MGG,UHC MGG,33452.037,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,VA,VA,33452.037,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Wellcare MGG,Wellcare MGG,33452.037,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Bright Health - commercial,Bright Health - commercial,33452.037,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,33452.037,33452.037,Bright Health MGG,Bright Health MGG,33452.037,,,,,,,case rate,1103,33452.037,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Aetna,Aetna,1500,,,,,,,per diem,1103,26512.6914,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Aetna MGG,Aetna MGG,26512.6914,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,BCBS,BCBS,1103,,,,,,,per diem,1103,26512.6914,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,BCBS MGG,BCBS MGG,26512.6914,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Cigna,Cigna,1257,,,,,,,per diem,1103,26512.6914,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Cigna MGG,Cigna MGG,26512.6914,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Humana,Humana,1400,,,,,,,per diem,1103,26512.6914,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Humana MGG,Humana MGG,25187.05683,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Optum VA,Optum VA,26512.6914,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,UHC,UHC,1400,,,,,,,per diem,1103,26512.6914,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,UHC MGG,UHC MGG,26512.6914,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,VA,VA,26512.6914,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Wellcare MGG,Wellcare MGG,26512.6914,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Bright Health - commercial,Bright Health - commercial,26512.6914,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,26512.6914,26512.6914,Bright Health MGG,Bright Health MGG,26512.6914,,,,,,,case rate,1103,26512.6914,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Aetna,Aetna,1500,,,,,,,per diem,1103,24716.007,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Aetna MGG,Aetna MGG,24716.007,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,BCBS,BCBS,1103,,,,,,,per diem,1103,24716.007,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,BCBS MGG,BCBS MGG,24716.007,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Cigna,Cigna,1257,,,,,,,per diem,1103,24716.007,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Cigna MGG,Cigna MGG,24716.007,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Humana,Humana,1400,,,,,,,per diem,1103,24716.007,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Humana MGG,Humana MGG,23480.20665,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Optum VA,Optum VA,24716.007,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,UHC,UHC,1400,,,,,,,per diem,1103,24716.007,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,UHC MGG,UHC MGG,24716.007,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,VA,VA,24716.007,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Wellcare MGG,Wellcare MGG,24716.007,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Bright Health - commercial,Bright Health - commercial,24716.007,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,24716.007,24716.007,Bright Health MGG,Bright Health MGG,24716.007,,,,,,,case rate,1103,24716.007,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Aetna,Aetna,1500,,,,,,,per diem,1103,25346.8566,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Aetna MGG,Aetna MGG,25346.8566,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,BCBS,BCBS,1103,,,,,,,per diem,1103,25346.8566,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,BCBS MGG,BCBS MGG,25346.8566,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Cigna,Cigna,1257,,,,,,,per diem,1103,25346.8566,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Cigna MGG,Cigna MGG,25346.8566,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Humana,Humana,1400,,,,,,,per diem,1103,25346.8566,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Humana MGG,Humana MGG,24079.51377,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Optum VA,Optum VA,25346.8566,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,UHC,UHC,1400,,,,,,,per diem,1103,25346.8566,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,UHC MGG,UHC MGG,25346.8566,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,VA,VA,25346.8566,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Wellcare MGG,Wellcare MGG,25346.8566,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Bright Health - commercial,Bright Health - commercial,25346.8566,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,25346.8566,25346.8566,Bright Health MGG,Bright Health MGG,25346.8566,,,,,,,case rate,1103,25346.8566,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Aetna,Aetna,1500,,,,,,,per diem,1103,36643.3938,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Aetna MGG,Aetna MGG,36643.3938,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,BCBS,BCBS,1103,,,,,,,per diem,1103,36643.3938,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,BCBS MGG,BCBS MGG,36643.3938,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Cigna,Cigna,1257,,,,,,,per diem,1103,36643.3938,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Cigna MGG,Cigna MGG,36643.3938,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Humana,Humana,1400,,,,,,,per diem,1103,36643.3938,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Humana MGG,Humana MGG,34811.22411,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Optum VA,Optum VA,36643.3938,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,UHC,UHC,1400,,,,,,,per diem,1103,36643.3938,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,UHC MGG,UHC MGG,36643.3938,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,VA,VA,36643.3938,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Wellcare MGG,Wellcare MGG,36643.3938,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Bright Health - commercial,Bright Health - commercial,36643.3938,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,36643.3938,36643.3938,Bright Health MGG,Bright Health MGG,36643.3938,,,,,,,case rate,1103,36643.3938,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Aetna,Aetna,1500,,,,,,,per diem,1103,29042.2746,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Aetna MGG,Aetna MGG,29042.2746,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,BCBS,BCBS,1103,,,,,,,per diem,1103,29042.2746,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,BCBS MGG,BCBS MGG,29042.2746,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Cigna,Cigna,1257,,,,,,,per diem,1103,29042.2746,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Cigna MGG,Cigna MGG,29042.2746,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Humana,Humana,1400,,,,,,,per diem,1103,29042.2746,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Humana MGG,Humana MGG,27590.16087,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Optum VA,Optum VA,29042.2746,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,UHC,UHC,1400,,,,,,,per diem,1103,29042.2746,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,UHC MGG,UHC MGG,29042.2746,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,VA,VA,29042.2746,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Wellcare MGG,Wellcare MGG,29042.2746,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Bright Health - commercial,Bright Health - commercial,29042.2746,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,29042.2746,29042.2746,Bright Health MGG,Bright Health MGG,29042.2746,,,,,,,case rate,1103,29042.2746,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Aetna,Aetna,1500,,,,,,,per diem,1103,27075.5082,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Aetna MGG,Aetna MGG,27075.5082,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,BCBS,BCBS,1103,,,,,,,per diem,1103,27075.5082,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,BCBS MGG,BCBS MGG,27075.5082,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Cigna,Cigna,1257,,,,,,,per diem,1103,27075.5082,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Cigna MGG,Cigna MGG,27075.5082,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Humana,Humana,1400,,,,,,,per diem,1103,27075.5082,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Humana MGG,Humana MGG,25721.73279,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Optum VA,Optum VA,27075.5082,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,UHC,UHC,1400,,,,,,,per diem,1103,27075.5082,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,UHC MGG,UHC MGG,27075.5082,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,VA,VA,27075.5082,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Wellcare MGG,Wellcare MGG,27075.5082,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Bright Health - commercial,Bright Health - commercial,27075.5082,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,27075.5082,27075.5082,Bright Health MGG,Bright Health MGG,27075.5082,,,,,,,case rate,1103,27075.5082,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Aetna,Aetna,1500,,,,,,,per diem,1103,15086.2734,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Aetna MGG,Aetna MGG,15086.2734,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,BCBS,BCBS,1103,,,,,,,per diem,1103,15086.2734,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,BCBS MGG,BCBS MGG,15086.2734,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Cigna,Cigna,1257,,,,,,,per diem,1103,15086.2734,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Cigna MGG,Cigna MGG,15086.2734,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Humana,Humana,1400,,,,,,,per diem,1103,15086.2734,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Humana MGG,Humana MGG,14331.95973,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Optum VA,Optum VA,15086.2734,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,UHC,UHC,1400,,,,,,,per diem,1103,15086.2734,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,UHC MGG,UHC MGG,15086.2734,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,VA,VA,15086.2734,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Wellcare MGG,Wellcare MGG,15086.2734,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Bright Health - commercial,Bright Health - commercial,15086.2734,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,15086.2734,15086.2734,Bright Health MGG,Bright Health MGG,15086.2734,,,,,,,case rate,1103,15086.2734,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Aetna,Aetna,1500,,,,,,,per diem,1103,20947.9176,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Aetna MGG,Aetna MGG,20947.9176,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,BCBS,BCBS,1103,,,,,,,per diem,1103,20947.9176,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,BCBS MGG,BCBS MGG,20947.9176,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Cigna,Cigna,1257,,,,,,,per diem,1103,20947.9176,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Cigna MGG,Cigna MGG,20947.9176,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Humana,Humana,1400,,,,,,,per diem,1103,20947.9176,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Humana MGG,Humana MGG,19900.52172,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Optum VA,Optum VA,20947.9176,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,UHC,UHC,1400,,,,,,,per diem,1103,20947.9176,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,UHC MGG,UHC MGG,20947.9176,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,VA,VA,20947.9176,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Wellcare MGG,Wellcare MGG,20947.9176,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Bright Health - commercial,Bright Health - commercial,20947.9176,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,20947.9176,20947.9176,Bright Health MGG,Bright Health MGG,20947.9176,,,,,,,case rate,1103,20947.9176,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Aetna,Aetna,1500,,,,,,,per diem,1103,17122.6188,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Aetna MGG,Aetna MGG,17122.6188,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,BCBS,BCBS,1103,,,,,,,per diem,1103,17122.6188,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,BCBS MGG,BCBS MGG,17122.6188,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Cigna,Cigna,1257,,,,,,,per diem,1103,17122.6188,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Cigna MGG,Cigna MGG,17122.6188,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Humana,Humana,1400,,,,,,,per diem,1103,17122.6188,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Humana MGG,Humana MGG,16266.48786,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Optum VA,Optum VA,17122.6188,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,UHC,UHC,1400,,,,,,,per diem,1103,17122.6188,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,UHC MGG,UHC MGG,17122.6188,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,VA,VA,17122.6188,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Wellcare MGG,Wellcare MGG,17122.6188,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Bright Health - commercial,Bright Health - commercial,17122.6188,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,17122.6188,17122.6188,Bright Health MGG,Bright Health MGG,17122.6188,,,,,,,case rate,1103,17122.6188,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Aetna,Aetna,1500,,,,,,,per diem,1103,16672.6746,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Aetna MGG,Aetna MGG,16672.6746,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,BCBS,BCBS,1103,,,,,,,per diem,1103,16672.6746,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,BCBS MGG,BCBS MGG,16672.6746,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Cigna,Cigna,1257,,,,,,,per diem,1103,16672.6746,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Cigna MGG,Cigna MGG,16672.6746,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Humana,Humana,1400,,,,,,,per diem,1103,16672.6746,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Humana MGG,Humana MGG,15839.04087,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Optum VA,Optum VA,16672.6746,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,UHC,UHC,1400,,,,,,,per diem,1103,16672.6746,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,UHC MGG,UHC MGG,16672.6746,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,VA,VA,16672.6746,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Wellcare MGG,Wellcare MGG,16672.6746,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Bright Health - commercial,Bright Health - commercial,16672.6746,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,16672.6746,16672.6746,Bright Health MGG,Bright Health MGG,16672.6746,,,,,,,case rate,1103,16672.6746,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Aetna,Aetna,1500,,,,,,,per diem,1103,18913.1184,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Aetna MGG,Aetna MGG,18913.1184,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,BCBS,BCBS,1103,,,,,,,per diem,1103,18913.1184,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,BCBS MGG,BCBS MGG,18913.1184,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Cigna,Cigna,1257,,,,,,,per diem,1103,18913.1184,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Cigna MGG,Cigna MGG,18913.1184,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Humana,Humana,1400,,,,,,,per diem,1103,18913.1184,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Humana MGG,Humana MGG,17967.46248,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Optum VA,Optum VA,18913.1184,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,UHC,UHC,1400,,,,,,,per diem,1103,18913.1184,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,UHC MGG,UHC MGG,18913.1184,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,VA,VA,18913.1184,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Wellcare MGG,Wellcare MGG,18913.1184,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Bright Health - commercial,Bright Health - commercial,18913.1184,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,18913.1184,18913.1184,Bright Health MGG,Bright Health MGG,18913.1184,,,,,,,case rate,1103,18913.1184,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Aetna,Aetna,1500,,,,,,,per diem,1103,26262.207,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Aetna MGG,Aetna MGG,26262.207,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,BCBS,BCBS,1103,,,,,,,per diem,1103,26262.207,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,BCBS MGG,BCBS MGG,26262.207,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Cigna,Cigna,1257,,,,,,,per diem,1103,26262.207,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Cigna MGG,Cigna MGG,26262.207,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Humana,Humana,1400,,,,,,,per diem,1103,26262.207,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Humana MGG,Humana MGG,24949.09665,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Optum VA,Optum VA,26262.207,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,UHC,UHC,1400,,,,,,,per diem,1103,26262.207,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,UHC MGG,UHC MGG,26262.207,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,VA,VA,26262.207,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Wellcare MGG,Wellcare MGG,26262.207,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Bright Health - commercial,Bright Health - commercial,26262.207,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,26262.207,26262.207,Bright Health MGG,Bright Health MGG,26262.207,,,,,,,case rate,1103,26262.207,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Aetna,Aetna,1500,,,,,,,per diem,1103,21465.8946,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Aetna MGG,Aetna MGG,21465.8946,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,BCBS,BCBS,1103,,,,,,,per diem,1103,21465.8946,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,BCBS MGG,BCBS MGG,21465.8946,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Cigna,Cigna,1257,,,,,,,per diem,1103,21465.8946,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Cigna MGG,Cigna MGG,21465.8946,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Humana,Humana,1400,,,,,,,per diem,1103,21465.8946,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Humana MGG,Humana MGG,20392.59987,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Optum VA,Optum VA,21465.8946,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,UHC,UHC,1400,,,,,,,per diem,1103,21465.8946,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,UHC MGG,UHC MGG,21465.8946,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,VA,VA,21465.8946,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Wellcare MGG,Wellcare MGG,21465.8946,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Bright Health - commercial,Bright Health - commercial,21465.8946,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,21465.8946,21465.8946,Bright Health MGG,Bright Health MGG,21465.8946,,,,,,,case rate,1103,21465.8946,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Aetna,Aetna,1500,,,,,,,per diem,1103,20901.5316,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Aetna MGG,Aetna MGG,20901.5316,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,BCBS,BCBS,1103,,,,,,,per diem,1103,20901.5316,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,BCBS MGG,BCBS MGG,20901.5316,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Cigna,Cigna,1257,,,,,,,per diem,1103,20901.5316,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Cigna MGG,Cigna MGG,20901.5316,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Humana,Humana,1400,,,,,,,per diem,1103,20901.5316,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Humana MGG,Humana MGG,19856.45502,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Optum VA,Optum VA,20901.5316,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,UHC,UHC,1400,,,,,,,per diem,1103,20901.5316,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,UHC MGG,UHC MGG,20901.5316,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,VA,VA,20901.5316,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Wellcare MGG,Wellcare MGG,20901.5316,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Bright Health - commercial,Bright Health - commercial,20901.5316,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,20901.5316,20901.5316,Bright Health MGG,Bright Health MGG,20901.5316,,,,,,,case rate,1103,20901.5316,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Aetna,Aetna,1500,,,,,,,per diem,1103,21829.2516,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Aetna MGG,Aetna MGG,21829.2516,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,BCBS,BCBS,1103,,,,,,,per diem,1103,21829.2516,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,BCBS MGG,BCBS MGG,21829.2516,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Cigna,Cigna,1257,,,,,,,per diem,1103,21829.2516,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Cigna MGG,Cigna MGG,21829.2516,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Humana,Humana,1400,,,,,,,per diem,1103,21829.2516,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Humana MGG,Humana MGG,20737.78902,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Optum VA,Optum VA,21829.2516,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,UHC,UHC,1400,,,,,,,per diem,1103,21829.2516,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,UHC MGG,UHC MGG,21829.2516,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,VA,VA,21829.2516,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Wellcare MGG,Wellcare MGG,21829.2516,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Bright Health - commercial,Bright Health - commercial,21829.2516,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,21829.2516,21829.2516,Bright Health MGG,Bright Health MGG,21829.2516,,,,,,,case rate,1103,21829.2516,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Aetna,Aetna,1500,,,,,,,per diem,1103,30311.7048,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Aetna MGG,Aetna MGG,30311.7048,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,BCBS,BCBS,1103,,,,,,,per diem,1103,30311.7048,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,BCBS MGG,BCBS MGG,30311.7048,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Cigna,Cigna,1257,,,,,,,per diem,1103,30311.7048,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Cigna MGG,Cigna MGG,30311.7048,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Humana,Humana,1400,,,,,,,per diem,1103,30311.7048,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Humana MGG,Humana MGG,28796.11956,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Optum VA,Optum VA,30311.7048,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,UHC,UHC,1400,,,,,,,per diem,1103,30311.7048,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,UHC MGG,UHC MGG,30311.7048,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,VA,VA,30311.7048,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Wellcare MGG,Wellcare MGG,30311.7048,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Bright Health - commercial,Bright Health - commercial,30311.7048,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,30311.7048,30311.7048,Bright Health MGG,Bright Health MGG,30311.7048,,,,,,,case rate,1103,30311.7048,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Aetna,Aetna,1500,,,,,,,per diem,1103,24776.3088,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Aetna MGG,Aetna MGG,24776.3088,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,BCBS,BCBS,1103,,,,,,,per diem,1103,24776.3088,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,BCBS MGG,BCBS MGG,24776.3088,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Cigna,Cigna,1257,,,,,,,per diem,1103,24776.3088,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Cigna MGG,Cigna MGG,24776.3088,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Humana,Humana,1400,,,,,,,per diem,1103,24776.3088,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Humana MGG,Humana MGG,23537.49336,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Optum VA,Optum VA,24776.3088,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,UHC,UHC,1400,,,,,,,per diem,1103,24776.3088,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,UHC MGG,UHC MGG,24776.3088,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,VA,VA,24776.3088,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Wellcare MGG,Wellcare MGG,24776.3088,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Bright Health - commercial,Bright Health - commercial,24776.3088,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,24776.3088,24776.3088,Bright Health MGG,Bright Health MGG,24776.3088,,,,,,,case rate,1103,24776.3088,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Aetna,Aetna,1500,,,,,,,per diem,1103,24123.8124,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Aetna MGG,Aetna MGG,24123.8124,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,BCBS,BCBS,1103,,,,,,,per diem,1103,24123.8124,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,BCBS MGG,BCBS MGG,24123.8124,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Cigna,Cigna,1257,,,,,,,per diem,1103,24123.8124,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Cigna MGG,Cigna MGG,24123.8124,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Humana,Humana,1400,,,,,,,per diem,1103,24123.8124,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Humana MGG,Humana MGG,22917.62178,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Optum VA,Optum VA,24123.8124,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,UHC,UHC,1400,,,,,,,per diem,1103,24123.8124,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,UHC MGG,UHC MGG,24123.8124,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,VA,VA,24123.8124,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Wellcare MGG,Wellcare MGG,24123.8124,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Bright Health - commercial,Bright Health - commercial,24123.8124,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,24123.8124,24123.8124,Bright Health MGG,Bright Health MGG,24123.8124,,,,,,,case rate,1103,24123.8124,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Aetna,Aetna,1500,,,,,,,per diem,1103,35372.4174,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Aetna MGG,Aetna MGG,35372.4174,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,BCBS,BCBS,1103,,,,,,,per diem,1103,35372.4174,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,BCBS MGG,BCBS MGG,35372.4174,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Cigna,Cigna,1257,,,,,,,per diem,1103,35372.4174,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Cigna MGG,Cigna MGG,35372.4174,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Humana,Humana,1400,,,,,,,per diem,1103,35372.4174,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Humana MGG,Humana MGG,33603.79653,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Optum VA,Optum VA,35372.4174,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,UHC,UHC,1400,,,,,,,per diem,1103,35372.4174,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,UHC MGG,UHC MGG,35372.4174,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,VA,VA,35372.4174,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Wellcare MGG,Wellcare MGG,35372.4174,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Bright Health - commercial,Bright Health - commercial,35372.4174,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,35372.4174,35372.4174,Bright Health MGG,Bright Health MGG,35372.4174,,,,,,,case rate,1103,35372.4174,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Aetna,Aetna,1500,,,,,,,per diem,1103,49115.043,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Aetna MGG,Aetna MGG,49115.043,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,BCBS,BCBS,1103,,,,,,,per diem,1103,49115.043,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,BCBS MGG,BCBS MGG,49115.043,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Cigna,Cigna,1257,,,,,,,per diem,1103,49115.043,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Cigna MGG,Cigna MGG,49115.043,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Humana,Humana,1400,,,,,,,per diem,1103,49115.043,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Humana MGG,Humana MGG,46659.29085,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Optum VA,Optum VA,49115.043,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,UHC,UHC,1400,,,,,,,per diem,1103,49115.043,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,UHC MGG,UHC MGG,49115.043,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,VA,VA,49115.043,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Wellcare MGG,Wellcare MGG,49115.043,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Bright Health - commercial,Bright Health - commercial,49115.043,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,49115.043,49115.043,Bright Health MGG,Bright Health MGG,49115.043,,,,,,,case rate,1103,49115.043,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Aetna,Aetna,1500,,,,,,,per diem,1103,40145.5368,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Aetna MGG,Aetna MGG,40145.5368,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,BCBS,BCBS,1103,,,,,,,per diem,1103,40145.5368,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,BCBS MGG,BCBS MGG,40145.5368,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Cigna,Cigna,1257,,,,,,,per diem,1103,40145.5368,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Cigna MGG,Cigna MGG,40145.5368,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Humana,Humana,1400,,,,,,,per diem,1103,40145.5368,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Humana MGG,Humana MGG,38138.25996,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Optum VA,Optum VA,40145.5368,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,UHC,UHC,1400,,,,,,,per diem,1103,40145.5368,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,UHC MGG,UHC MGG,40145.5368,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,VA,VA,40145.5368,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Wellcare MGG,Wellcare MGG,40145.5368,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Bright Health - commercial,Bright Health - commercial,40145.5368,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,40145.5368,40145.5368,Bright Health MGG,Bright Health MGG,40145.5368,,,,,,,case rate,1103,40145.5368,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Aetna,Aetna,1500,,,,,,,per diem,1103,39089.4822,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Aetna MGG,Aetna MGG,39089.4822,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,BCBS,BCBS,1103,,,,,,,per diem,1103,39089.4822,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,BCBS MGG,BCBS MGG,39089.4822,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Cigna,Cigna,1257,,,,,,,per diem,1103,39089.4822,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Cigna MGG,Cigna MGG,39089.4822,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Humana,Humana,1400,,,,,,,per diem,1103,39089.4822,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Humana MGG,Humana MGG,37135.00809,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Optum VA,Optum VA,39089.4822,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,UHC,UHC,1400,,,,,,,per diem,1103,39089.4822,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,UHC MGG,UHC MGG,39089.4822,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,VA,VA,39089.4822,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Wellcare MGG,Wellcare MGG,39089.4822,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Bright Health - commercial,Bright Health - commercial,39089.4822,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,39089.4822,39089.4822,Bright Health MGG,Bright Health MGG,39089.4822,,,,,,,case rate,1103,39089.4822,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Aetna,Aetna,1500,,,,,,,per diem,1103,28018.6902,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Aetna MGG,Aetna MGG,28018.6902,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,BCBS,BCBS,1103,,,,,,,per diem,1103,28018.6902,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,BCBS MGG,BCBS MGG,28018.6902,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Cigna,Cigna,1257,,,,,,,per diem,1103,28018.6902,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Cigna MGG,Cigna MGG,28018.6902,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Humana,Humana,1400,,,,,,,per diem,1103,28018.6902,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Humana MGG,Humana MGG,26617.75569,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Optum VA,Optum VA,28018.6902,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,UHC,UHC,1400,,,,,,,per diem,1103,28018.6902,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,UHC MGG,UHC MGG,28018.6902,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,VA,VA,28018.6902,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Wellcare MGG,Wellcare MGG,28018.6902,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Bright Health - commercial,Bright Health - commercial,28018.6902,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,28018.6902,28018.6902,Bright Health MGG,Bright Health MGG,28018.6902,,,,,,,case rate,1103,28018.6902,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Aetna,Aetna,1500,,,,,,,per diem,1103,38903.9382,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Aetna MGG,Aetna MGG,38903.9382,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,BCBS,BCBS,1103,,,,,,,per diem,1103,38903.9382,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,BCBS MGG,BCBS MGG,38903.9382,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Cigna,Cigna,1257,,,,,,,per diem,1103,38903.9382,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Cigna MGG,Cigna MGG,38903.9382,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Humana,Humana,1400,,,,,,,per diem,1103,38903.9382,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Humana MGG,Humana MGG,36958.74129,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Optum VA,Optum VA,38903.9382,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,UHC,UHC,1400,,,,,,,per diem,1103,38903.9382,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,UHC MGG,UHC MGG,38903.9382,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,VA,VA,38903.9382,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Wellcare MGG,Wellcare MGG,38903.9382,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Bright Health - commercial,Bright Health - commercial,38903.9382,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,38903.9382,38903.9382,Bright Health MGG,Bright Health MGG,38903.9382,,,,,,,case rate,1103,38903.9382,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Aetna,Aetna,1500,,,,,,,per diem,1103,31799.1492,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Aetna MGG,Aetna MGG,31799.1492,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,BCBS,BCBS,1103,,,,,,,per diem,1103,31799.1492,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,BCBS MGG,BCBS MGG,31799.1492,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Cigna,Cigna,1257,,,,,,,per diem,1103,31799.1492,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Cigna MGG,Cigna MGG,31799.1492,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Humana,Humana,1400,,,,,,,per diem,1103,31799.1492,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Humana MGG,Humana MGG,30209.19174,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Optum VA,Optum VA,31799.1492,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,UHC,UHC,1400,,,,,,,per diem,1103,31799.1492,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,UHC MGG,UHC MGG,31799.1492,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,VA,VA,31799.1492,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Wellcare MGG,Wellcare MGG,31799.1492,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Bright Health - commercial,Bright Health - commercial,31799.1492,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,31799.1492,31799.1492,Bright Health MGG,Bright Health MGG,31799.1492,,,,,,,case rate,1103,31799.1492,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Aetna,Aetna,1500,,,,,,,per diem,1103,30962.655,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Aetna MGG,Aetna MGG,30962.655,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,BCBS,BCBS,1103,,,,,,,per diem,1103,30962.655,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,BCBS MGG,BCBS MGG,30962.655,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Cigna,Cigna,1257,,,,,,,per diem,1103,30962.655,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Cigna MGG,Cigna MGG,30962.655,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Humana,Humana,1400,,,,,,,per diem,1103,30962.655,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Humana MGG,Humana MGG,29414.52225,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Optum VA,Optum VA,30962.655,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,UHC,UHC,1400,,,,,,,per diem,1103,30962.655,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,UHC MGG,UHC MGG,30962.655,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,VA,VA,30962.655,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Wellcare MGG,Wellcare MGG,30962.655,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Bright Health - commercial,Bright Health - commercial,30962.655,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,30962.655,30962.655,Bright Health MGG,Bright Health MGG,30962.655,,,,,,,case rate,1103,30962.655,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Aetna,Aetna,1500,,,,,,,per diem,1103,36858.3156,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Aetna MGG,Aetna MGG,36858.3156,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,BCBS,BCBS,1103,,,,,,,per diem,1103,36858.3156,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,BCBS MGG,BCBS MGG,36858.3156,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Cigna,Cigna,1257,,,,,,,per diem,1103,36858.3156,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Cigna MGG,Cigna MGG,36858.3156,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Humana,Humana,1400,,,,,,,per diem,1103,36858.3156,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Humana MGG,Humana MGG,35015.39982,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Optum VA,Optum VA,36858.3156,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,UHC,UHC,1400,,,,,,,per diem,1103,36858.3156,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,UHC MGG,UHC MGG,36858.3156,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,VA,VA,36858.3156,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Wellcare MGG,Wellcare MGG,36858.3156,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Bright Health - commercial,Bright Health - commercial,36858.3156,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,36858.3156,36858.3156,Bright Health MGG,Bright Health MGG,36858.3156,,,,,,,case rate,1103,36858.3156,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Aetna,Aetna,1500,,,,,,,per diem,1103,51179.22,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Aetna MGG,Aetna MGG,51179.22,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,BCBS,BCBS,1103,,,,,,,per diem,1103,51179.22,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,BCBS MGG,BCBS MGG,51179.22,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Cigna,Cigna,1257,,,,,,,per diem,1103,51179.22,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Cigna MGG,Cigna MGG,51179.22,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Humana,Humana,1400,,,,,,,per diem,1103,51179.22,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Humana MGG,Humana MGG,48620.259,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Optum VA,Optum VA,51179.22,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,UHC,UHC,1400,,,,,,,per diem,1103,51179.22,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,UHC MGG,UHC MGG,51179.22,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,VA,VA,51179.22,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Wellcare MGG,Wellcare MGG,51179.22,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Bright Health - commercial,Bright Health - commercial,51179.22,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,51179.22,51179.22,Bright Health MGG,Bright Health MGG,51179.22,,,,,,,case rate,1103,51179.22,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Aetna,Aetna,1500,,,,,,,per diem,1103,41832.441,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Aetna MGG,Aetna MGG,41832.441,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,BCBS,BCBS,1103,,,,,,,per diem,1103,41832.441,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,BCBS MGG,BCBS MGG,41832.441,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Cigna,Cigna,1257,,,,,,,per diem,1103,41832.441,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Cigna MGG,Cigna MGG,41832.441,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Humana,Humana,1400,,,,,,,per diem,1103,41832.441,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Humana MGG,Humana MGG,39740.81895,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Optum VA,Optum VA,41832.441,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,UHC,UHC,1400,,,,,,,per diem,1103,41832.441,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,UHC MGG,UHC MGG,41832.441,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,VA,VA,41832.441,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Wellcare MGG,Wellcare MGG,41832.441,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Bright Health - commercial,Bright Health - commercial,41832.441,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,41832.441,41832.441,Bright Health MGG,Bright Health MGG,41832.441,,,,,,,case rate,1103,41832.441,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Aetna,Aetna,1500,,,,,,,per diem,1103,40731.5466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Aetna MGG,Aetna MGG,40731.5466,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,BCBS,BCBS,1103,,,,,,,per diem,1103,40731.5466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,BCBS MGG,BCBS MGG,40731.5466,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Cigna,Cigna,1257,,,,,,,per diem,1103,40731.5466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Cigna MGG,Cigna MGG,40731.5466,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Humana,Humana,1400,,,,,,,per diem,1103,40731.5466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Humana MGG,Humana MGG,38694.96927,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Optum VA,Optum VA,40731.5466,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,UHC,UHC,1400,,,,,,,per diem,1103,40731.5466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,UHC MGG,UHC MGG,40731.5466,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,VA,VA,40731.5466,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Wellcare MGG,Wellcare MGG,40731.5466,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Bright Health - commercial,Bright Health - commercial,40731.5466,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,40731.5466,40731.5466,Bright Health MGG,Bright Health MGG,40731.5466,,,,,,,case rate,1103,40731.5466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Aetna,Aetna,1500,,,,,,,per diem,1103,50474.1528,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Aetna MGG,Aetna MGG,50474.1528,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,BCBS,BCBS,1103,,,,,,,per diem,1103,50474.1528,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,BCBS MGG,BCBS MGG,50474.1528,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Cigna,Cigna,1257,,,,,,,per diem,1103,50474.1528,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Cigna MGG,Cigna MGG,50474.1528,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Humana,Humana,1400,,,,,,,per diem,1103,50474.1528,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Humana MGG,Humana MGG,47950.44516,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Optum VA,Optum VA,50474.1528,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,UHC,UHC,1400,,,,,,,per diem,1103,50474.1528,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,UHC MGG,UHC MGG,50474.1528,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,VA,VA,50474.1528,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Wellcare MGG,Wellcare MGG,50474.1528,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Bright Health - commercial,Bright Health - commercial,50474.1528,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,50474.1528,50474.1528,Bright Health MGG,Bright Health MGG,50474.1528,,,,,,,case rate,1103,50474.1528,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Aetna,Aetna,1500,,,,,,,per diem,1103,70086.1536,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Aetna MGG,Aetna MGG,70086.1536,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,BCBS,BCBS,1103,,,,,,,per diem,1103,70086.1536,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,BCBS MGG,BCBS MGG,70086.1536,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Cigna,Cigna,1257,,,,,,,per diem,1103,70086.1536,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Cigna MGG,Cigna MGG,70086.1536,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Humana,Humana,1400,,,,,,,per diem,1103,70086.1536,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Humana MGG,Humana MGG,66581.84592,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Optum VA,Optum VA,70086.1536,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,UHC,UHC,1400,,,,,,,per diem,1103,70086.1536,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,UHC MGG,UHC MGG,70086.1536,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,VA,VA,70086.1536,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Wellcare MGG,Wellcare MGG,70086.1536,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Bright Health - commercial,Bright Health - commercial,70086.1536,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,70086.1536,70086.1536,Bright Health MGG,Bright Health MGG,70086.1536,,,,,,,case rate,1103,70086.1536,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Aetna,Aetna,1500,,,,,,,per diem,1103,57286.71,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Aetna MGG,Aetna MGG,57286.71,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,BCBS,BCBS,1103,,,,,,,per diem,1103,57286.71,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,BCBS MGG,BCBS MGG,57286.71,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Cigna,Cigna,1257,,,,,,,per diem,1103,57286.71,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Cigna MGG,Cigna MGG,57286.71,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Humana,Humana,1400,,,,,,,per diem,1103,57286.71,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Humana MGG,Humana MGG,54422.3745,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Optum VA,Optum VA,57286.71,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,UHC,UHC,1400,,,,,,,per diem,1103,57286.71,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,UHC MGG,UHC MGG,57286.71,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,VA,VA,57286.71,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Wellcare MGG,Wellcare MGG,57286.71,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Bright Health - commercial,Bright Health - commercial,57286.71,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,57286.71,57286.71,Bright Health MGG,Bright Health MGG,57286.71,,,,,,,case rate,1103,57286.71,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Aetna,Aetna,1500,,,,,,,per diem,1103,55779.165,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Aetna MGG,Aetna MGG,55779.165,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,BCBS,BCBS,1103,,,,,,,per diem,1103,55779.165,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,BCBS MGG,BCBS MGG,55779.165,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Cigna,Cigna,1257,,,,,,,per diem,1103,55779.165,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Cigna MGG,Cigna MGG,55779.165,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Humana,Humana,1400,,,,,,,per diem,1103,55779.165,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Humana MGG,Humana MGG,52990.20675,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Optum VA,Optum VA,55779.165,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,UHC,UHC,1400,,,,,,,per diem,1103,55779.165,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,UHC MGG,UHC MGG,55779.165,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,VA,VA,55779.165,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Wellcare MGG,Wellcare MGG,55779.165,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Bright Health - commercial,Bright Health - commercial,55779.165,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,55779.165,55779.165,Bright Health MGG,Bright Health MGG,55779.165,,,,,,,case rate,1103,55779.165,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Aetna,Aetna,1500,,,,,,,per diem,1103,13335.975,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Aetna MGG,Aetna MGG,13335.975,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,BCBS,BCBS,1103,,,,,,,per diem,1103,13335.975,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,BCBS MGG,BCBS MGG,13335.975,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Cigna,Cigna,1257,,,,,,,per diem,1103,13335.975,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Cigna MGG,Cigna MGG,13335.975,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Humana,Humana,1400,,,,,,,per diem,1103,13335.975,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Humana MGG,Humana MGG,12669.17625,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Optum VA,Optum VA,13335.975,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,UHC,UHC,1400,,,,,,,per diem,1103,13335.975,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,UHC MGG,UHC MGG,13335.975,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,VA,VA,13335.975,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Wellcare MGG,Wellcare MGG,13335.975,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Bright Health - commercial,Bright Health - commercial,13335.975,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,13335.975,13335.975,Bright Health MGG,Bright Health MGG,13335.975,,,,,,,case rate,1103,13335.975,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Aetna,Aetna,1500,,,,,,,per diem,1103,20239.758,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Aetna MGG,Aetna MGG,20239.758,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,BCBS,BCBS,1103,,,,,,,per diem,1103,20239.758,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,BCBS MGG,BCBS MGG,20239.758,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Cigna,Cigna,1257,,,,,,,per diem,1103,20239.758,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Cigna MGG,Cigna MGG,20239.758,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Humana,Humana,1400,,,,,,,per diem,1103,20239.758,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Humana MGG,Humana MGG,19227.7701,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Optum VA,Optum VA,20239.758,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,UHC,UHC,1400,,,,,,,per diem,1103,20239.758,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,UHC MGG,UHC MGG,20239.758,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,VA,VA,20239.758,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Wellcare MGG,Wellcare MGG,20239.758,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Bright Health - commercial,Bright Health - commercial,20239.758,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,20239.758,20239.758,Bright Health MGG,Bright Health MGG,20239.758,,,,,,,case rate,1103,20239.758,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Aetna,Aetna,1500,,,,,,,per diem,1103,15554.772,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Aetna MGG,Aetna MGG,15554.772,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,BCBS,BCBS,1103,,,,,,,per diem,1103,15554.772,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,BCBS MGG,BCBS MGG,15554.772,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Cigna,Cigna,1257,,,,,,,per diem,1103,15554.772,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Cigna MGG,Cigna MGG,15554.772,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Humana,Humana,1400,,,,,,,per diem,1103,15554.772,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Humana MGG,Humana MGG,14777.0334,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Optum VA,Optum VA,15554.772,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,UHC,UHC,1400,,,,,,,per diem,1103,15554.772,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,UHC MGG,UHC MGG,15554.772,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,VA,VA,15554.772,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Wellcare MGG,Wellcare MGG,15554.772,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Bright Health - commercial,Bright Health - commercial,15554.772,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,15554.772,15554.772,Bright Health MGG,Bright Health MGG,15554.772,,,,,,,case rate,1103,15554.772,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Aetna,Aetna,1500,,,,,,,per diem,1103,14470.8858,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Aetna MGG,Aetna MGG,14470.8858,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,BCBS,BCBS,1103,,,,,,,per diem,1103,14470.8858,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,BCBS MGG,BCBS MGG,14470.8858,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Cigna,Cigna,1257,,,,,,,per diem,1103,14470.8858,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Cigna MGG,Cigna MGG,14470.8858,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Humana,Humana,1400,,,,,,,per diem,1103,14470.8858,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Humana MGG,Humana MGG,13747.34151,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Optum VA,Optum VA,14470.8858,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,UHC,UHC,1400,,,,,,,per diem,1103,14470.8858,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,UHC MGG,UHC MGG,14470.8858,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,VA,VA,14470.8858,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Wellcare MGG,Wellcare MGG,14470.8858,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Bright Health - commercial,Bright Health - commercial,14470.8858,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,14470.8858,14470.8858,Bright Health MGG,Bright Health MGG,14470.8858,,,,,,,case rate,1103,14470.8858,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Aetna,Aetna,1500,,,,,,,per diem,1103,16555.1634,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Aetna MGG,Aetna MGG,16555.1634,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,BCBS,BCBS,1103,,,,,,,per diem,1103,16555.1634,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,BCBS MGG,BCBS MGG,16555.1634,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Cigna,Cigna,1257,,,,,,,per diem,1103,16555.1634,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Cigna MGG,Cigna MGG,16555.1634,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Humana,Humana,1400,,,,,,,per diem,1103,16555.1634,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Humana MGG,Humana MGG,15727.40523,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Optum VA,Optum VA,16555.1634,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,UHC,UHC,1400,,,,,,,per diem,1103,16555.1634,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,UHC MGG,UHC MGG,16555.1634,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,VA,VA,16555.1634,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Wellcare MGG,Wellcare MGG,16555.1634,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Bright Health - commercial,Bright Health - commercial,16555.1634,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,16555.1634,16555.1634,Bright Health MGG,Bright Health MGG,16555.1634,,,,,,,case rate,1103,16555.1634,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Aetna,Aetna,1500,,,,,,,per diem,1103,25127.2962,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Aetna MGG,Aetna MGG,25127.2962,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,BCBS,BCBS,1103,,,,,,,per diem,1103,25127.2962,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,BCBS MGG,BCBS MGG,25127.2962,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Cigna,Cigna,1257,,,,,,,per diem,1103,25127.2962,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Cigna MGG,Cigna MGG,25127.2962,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Humana,Humana,1400,,,,,,,per diem,1103,25127.2962,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Humana MGG,Humana MGG,23870.93139,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Optum VA,Optum VA,25127.2962,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,UHC,UHC,1400,,,,,,,per diem,1103,25127.2962,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,UHC MGG,UHC MGG,25127.2962,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,VA,VA,25127.2962,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Wellcare MGG,Wellcare MGG,25127.2962,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Bright Health - commercial,Bright Health - commercial,25127.2962,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,25127.2962,25127.2962,Bright Health MGG,Bright Health MGG,25127.2962,,,,,,,case rate,1103,25127.2962,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Aetna,Aetna,1500,,,,,,,per diem,1103,19310.4918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Aetna MGG,Aetna MGG,19310.4918,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,BCBS,BCBS,1103,,,,,,,per diem,1103,19310.4918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,BCBS MGG,BCBS MGG,19310.4918,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Cigna,Cigna,1257,,,,,,,per diem,1103,19310.4918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Cigna MGG,Cigna MGG,19310.4918,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Humana,Humana,1400,,,,,,,per diem,1103,19310.4918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Humana MGG,Humana MGG,18344.96721,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Optum VA,Optum VA,19310.4918,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,UHC,UHC,1400,,,,,,,per diem,1103,19310.4918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,UHC MGG,UHC MGG,19310.4918,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,VA,VA,19310.4918,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Wellcare MGG,Wellcare MGG,19310.4918,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Bright Health - commercial,Bright Health - commercial,19310.4918,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,19310.4918,19310.4918,Bright Health MGG,Bright Health MGG,19310.4918,,,,,,,case rate,1103,19310.4918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Aetna,Aetna,1500,,,,,,,per diem,1103,17963.7516,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Aetna MGG,Aetna MGG,17963.7516,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,BCBS,BCBS,1103,,,,,,,per diem,1103,17963.7516,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,BCBS MGG,BCBS MGG,17963.7516,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Cigna,Cigna,1257,,,,,,,per diem,1103,17963.7516,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Cigna MGG,Cigna MGG,17963.7516,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Humana,Humana,1400,,,,,,,per diem,1103,17963.7516,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Humana MGG,Humana MGG,17065.56402,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Optum VA,Optum VA,17963.7516,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,UHC,UHC,1400,,,,,,,per diem,1103,17963.7516,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,UHC MGG,UHC MGG,17963.7516,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,VA,VA,17963.7516,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Wellcare MGG,Wellcare MGG,17963.7516,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Bright Health - commercial,Bright Health - commercial,17963.7516,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,17963.7516,17963.7516,Bright Health MGG,Bright Health MGG,17963.7516,,,,,,,case rate,1103,17963.7516,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Aetna,Aetna,1500,,,,,,,per diem,1103,18746.1288,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Aetna MGG,Aetna MGG,18746.1288,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,BCBS,BCBS,1103,,,,,,,per diem,1103,18746.1288,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,BCBS MGG,BCBS MGG,18746.1288,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Cigna,Cigna,1257,,,,,,,per diem,1103,18746.1288,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Cigna MGG,Cigna MGG,18746.1288,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Humana,Humana,1400,,,,,,,per diem,1103,18746.1288,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Humana MGG,Humana MGG,17808.82236,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Optum VA,Optum VA,18746.1288,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,UHC,UHC,1400,,,,,,,per diem,1103,18746.1288,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,UHC MGG,UHC MGG,18746.1288,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,VA,VA,18746.1288,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Wellcare MGG,Wellcare MGG,18746.1288,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Bright Health - commercial,Bright Health - commercial,18746.1288,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,18746.1288,18746.1288,Bright Health MGG,Bright Health MGG,18746.1288,,,,,,,case rate,1103,18746.1288,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Aetna,Aetna,1500,,,,,,,per diem,1103,28453.1724,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Aetna MGG,Aetna MGG,28453.1724,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,BCBS,BCBS,1103,,,,,,,per diem,1103,28453.1724,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,BCBS MGG,BCBS MGG,28453.1724,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Cigna,Cigna,1257,,,,,,,per diem,1103,28453.1724,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Cigna MGG,Cigna MGG,28453.1724,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Humana,Humana,1400,,,,,,,per diem,1103,28453.1724,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Humana MGG,Humana MGG,27030.51378,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Optum VA,Optum VA,28453.1724,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,UHC,UHC,1400,,,,,,,per diem,1103,28453.1724,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,UHC MGG,UHC MGG,28453.1724,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,VA,VA,28453.1724,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Wellcare MGG,Wellcare MGG,28453.1724,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Bright Health - commercial,Bright Health - commercial,28453.1724,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,28453.1724,28453.1724,Bright Health MGG,Bright Health MGG,28453.1724,,,,,,,case rate,1103,28453.1724,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Aetna,Aetna,1500,,,,,,,per diem,1103,21866.3604,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Aetna MGG,Aetna MGG,21866.3604,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,BCBS,BCBS,1103,,,,,,,per diem,1103,21866.3604,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,BCBS MGG,BCBS MGG,21866.3604,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Cigna,Cigna,1257,,,,,,,per diem,1103,21866.3604,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Cigna MGG,Cigna MGG,21866.3604,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Humana,Humana,1400,,,,,,,per diem,1103,21866.3604,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Humana MGG,Humana MGG,20773.04238,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Optum VA,Optum VA,21866.3604,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,UHC,UHC,1400,,,,,,,per diem,1103,21866.3604,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,UHC MGG,UHC MGG,21866.3604,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,VA,VA,21866.3604,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Wellcare MGG,Wellcare MGG,21866.3604,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Bright Health - commercial,Bright Health - commercial,21866.3604,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,21866.3604,21866.3604,Bright Health MGG,Bright Health MGG,21866.3604,,,,,,,case rate,1103,21866.3604,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Aetna,Aetna,1500,,,,,,,per diem,1103,20341.8072,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Aetna MGG,Aetna MGG,20341.8072,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,BCBS,BCBS,1103,,,,,,,per diem,1103,20341.8072,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,BCBS MGG,BCBS MGG,20341.8072,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Cigna,Cigna,1257,,,,,,,per diem,1103,20341.8072,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Cigna MGG,Cigna MGG,20341.8072,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Humana,Humana,1400,,,,,,,per diem,1103,20341.8072,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Humana MGG,Humana MGG,19324.71684,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Optum VA,Optum VA,20341.8072,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,UHC,UHC,1400,,,,,,,per diem,1103,20341.8072,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,UHC MGG,UHC MGG,20341.8072,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,VA,VA,20341.8072,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Wellcare MGG,Wellcare MGG,20341.8072,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Bright Health - commercial,Bright Health - commercial,20341.8072,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,20341.8072,20341.8072,Bright Health MGG,Bright Health MGG,20341.8072,,,,,,,case rate,1103,20341.8072,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Aetna,Aetna,1500,,,,,,,per diem,1103,22399.7994,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Aetna MGG,Aetna MGG,22399.7994,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,BCBS,BCBS,1103,,,,,,,per diem,1103,22399.7994,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,BCBS MGG,BCBS MGG,22399.7994,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Cigna,Cigna,1257,,,,,,,per diem,1103,22399.7994,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Cigna MGG,Cigna MGG,22399.7994,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Humana,Humana,1400,,,,,,,per diem,1103,22399.7994,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Humana MGG,Humana MGG,21279.80943,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Optum VA,Optum VA,22399.7994,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,UHC,UHC,1400,,,,,,,per diem,1103,22399.7994,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,UHC MGG,UHC MGG,22399.7994,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,VA,VA,22399.7994,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Wellcare MGG,Wellcare MGG,22399.7994,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Bright Health - commercial,Bright Health - commercial,22399.7994,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,22399.7994,22399.7994,Bright Health MGG,Bright Health MGG,22399.7994,,,,,,,case rate,1103,22399.7994,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Aetna,Aetna,1500,,,,,,,per diem,1103,33999.3918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Aetna MGG,Aetna MGG,33999.3918,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,BCBS,BCBS,1103,,,,,,,per diem,1103,33999.3918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,BCBS MGG,BCBS MGG,33999.3918,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Cigna,Cigna,1257,,,,,,,per diem,1103,33999.3918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Cigna MGG,Cigna MGG,33999.3918,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Humana,Humana,1400,,,,,,,per diem,1103,33999.3918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Humana MGG,Humana MGG,32299.42221,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Optum VA,Optum VA,33999.3918,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,UHC,UHC,1400,,,,,,,per diem,1103,33999.3918,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,UHC MGG,UHC MGG,33999.3918,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,VA,VA,33999.3918,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Wellcare MGG,Wellcare MGG,33999.3918,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Bright Health - commercial,Bright Health - commercial,33999.3918,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,33999.3918,33999.3918,Bright Health MGG,Bright Health MGG,33999.3918,,,,,,,case rate,1103,33999.3918,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Aetna,Aetna,1500,,,,,,,per diem,1103,26127.6876,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Aetna MGG,Aetna MGG,26127.6876,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,BCBS,BCBS,1103,,,,,,,per diem,1103,26127.6876,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,BCBS MGG,BCBS MGG,26127.6876,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Cigna,Cigna,1257,,,,,,,per diem,1103,26127.6876,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Cigna MGG,Cigna MGG,26127.6876,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Humana,Humana,1400,,,,,,,per diem,1103,26127.6876,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Humana MGG,Humana MGG,24821.30322,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Optum VA,Optum VA,26127.6876,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,UHC,UHC,1400,,,,,,,per diem,1103,26127.6876,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,UHC MGG,UHC MGG,26127.6876,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,VA,VA,26127.6876,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Wellcare MGG,Wellcare MGG,26127.6876,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Bright Health - commercial,Bright Health - commercial,26127.6876,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,26127.6876,26127.6876,Bright Health MGG,Bright Health MGG,26127.6876,,,,,,,case rate,1103,26127.6876,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Aetna,Aetna,1500,,,,,,,per diem,1103,24306.264,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Aetna MGG,Aetna MGG,24306.264,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,BCBS,BCBS,1103,,,,,,,per diem,1103,24306.264,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,BCBS MGG,BCBS MGG,24306.264,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Cigna,Cigna,1257,,,,,,,per diem,1103,24306.264,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Cigna MGG,Cigna MGG,24306.264,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Humana,Humana,1400,,,,,,,per diem,1103,24306.264,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Humana MGG,Humana MGG,23090.9508,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Optum VA,Optum VA,24306.264,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,UHC,UHC,1400,,,,,,,per diem,1103,24306.264,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,UHC MGG,UHC MGG,24306.264,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,VA,VA,24306.264,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Wellcare MGG,Wellcare MGG,24306.264,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Bright Health - commercial,Bright Health - commercial,24306.264,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,24306.264,24306.264,Bright Health MGG,Bright Health MGG,24306.264,,,,,,,case rate,1103,24306.264,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Aetna,Aetna,1500,,,,,,,per diem,1103,31826.9808,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Aetna MGG,Aetna MGG,31826.9808,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,BCBS,BCBS,1103,,,,,,,per diem,1103,31826.9808,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,BCBS MGG,BCBS MGG,31826.9808,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Cigna,Cigna,1257,,,,,,,per diem,1103,31826.9808,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Cigna MGG,Cigna MGG,31826.9808,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Humana,Humana,1400,,,,,,,per diem,1103,31826.9808,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Humana MGG,Humana MGG,30235.63176,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Optum VA,Optum VA,31826.9808,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,UHC,UHC,1400,,,,,,,per diem,1103,31826.9808,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,UHC MGG,UHC MGG,31826.9808,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,VA,VA,31826.9808,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Wellcare MGG,Wellcare MGG,31826.9808,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Bright Health - commercial,Bright Health - commercial,31826.9808,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,31826.9808,31826.9808,Bright Health MGG,Bright Health MGG,31826.9808,,,,,,,case rate,1103,31826.9808,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Aetna,Aetna,1500,,,,,,,per diem,1103,48306.3804,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Aetna MGG,Aetna MGG,48306.3804,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,BCBS,BCBS,1103,,,,,,,per diem,1103,48306.3804,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,BCBS MGG,BCBS MGG,48306.3804,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Cigna,Cigna,1257,,,,,,,per diem,1103,48306.3804,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Cigna MGG,Cigna MGG,48306.3804,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Humana,Humana,1400,,,,,,,per diem,1103,48306.3804,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Humana MGG,Humana MGG,45891.06138,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Optum VA,Optum VA,48306.3804,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,UHC,UHC,1400,,,,,,,per diem,1103,48306.3804,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,UHC MGG,UHC MGG,48306.3804,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,VA,VA,48306.3804,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Wellcare MGG,Wellcare MGG,48306.3804,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Bright Health - commercial,Bright Health - commercial,48306.3804,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,48306.3804,48306.3804,Bright Health MGG,Bright Health MGG,48306.3804,,,,,,,case rate,1103,48306.3804,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Aetna,Aetna,1500,,,,,,,per diem,1103,37122.7158,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Aetna MGG,Aetna MGG,37122.7158,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,BCBS,BCBS,1103,,,,,,,per diem,1103,37122.7158,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,BCBS MGG,BCBS MGG,37122.7158,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Cigna,Cigna,1257,,,,,,,per diem,1103,37122.7158,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Cigna MGG,Cigna MGG,37122.7158,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Humana,Humana,1400,,,,,,,per diem,1103,37122.7158,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Humana MGG,Humana MGG,35266.58001,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Optum VA,Optum VA,37122.7158,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,UHC,UHC,1400,,,,,,,per diem,1103,37122.7158,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,UHC MGG,UHC MGG,37122.7158,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,VA,VA,37122.7158,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Wellcare MGG,Wellcare MGG,37122.7158,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Bright Health - commercial,Bright Health - commercial,37122.7158,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,37122.7158,37122.7158,Bright Health MGG,Bright Health MGG,37122.7158,,,,,,,case rate,1103,37122.7158,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Aetna,Aetna,1500,,,,,,,per diem,1103,34535.9232,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Aetna MGG,Aetna MGG,34535.9232,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,BCBS,BCBS,1103,,,,,,,per diem,1103,34535.9232,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,BCBS MGG,BCBS MGG,34535.9232,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Cigna,Cigna,1257,,,,,,,per diem,1103,34535.9232,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Cigna MGG,Cigna MGG,34535.9232,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Humana,Humana,1400,,,,,,,per diem,1103,34535.9232,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Humana MGG,Humana MGG,32809.12704,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Optum VA,Optum VA,34535.9232,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,UHC,UHC,1400,,,,,,,per diem,1103,34535.9232,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,UHC MGG,UHC MGG,34535.9232,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,VA,VA,34535.9232,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Wellcare MGG,Wellcare MGG,34535.9232,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Bright Health - commercial,Bright Health - commercial,34535.9232,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,34535.9232,34535.9232,Bright Health MGG,Bright Health MGG,34535.9232,,,,,,,case rate,1103,34535.9232,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Aetna,Aetna,1500,,,,,,,per diem,1103,12972.618,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Aetna MGG,Aetna MGG,12972.618,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,BCBS,BCBS,1103,,,,,,,per diem,1103,12972.618,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,BCBS MGG,BCBS MGG,12972.618,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Cigna,Cigna,1257,,,,,,,per diem,1103,12972.618,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Cigna MGG,Cigna MGG,12972.618,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Humana,Humana,1400,,,,,,,per diem,1103,12972.618,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Humana MGG,Humana MGG,12323.9871,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Optum VA,Optum VA,12972.618,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,UHC,UHC,1400,,,,,,,per diem,1103,12972.618,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,UHC MGG,UHC MGG,12972.618,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,VA,VA,12972.618,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Wellcare MGG,Wellcare MGG,12972.618,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Bright Health - commercial,Bright Health - commercial,12972.618,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,12972.618,12972.618,Bright Health MGG,Bright Health MGG,12972.618,,,,,,,case rate,1103,12972.618,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Aetna,Aetna,1500,,,,,,,per diem,1103,20247.489,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Aetna MGG,Aetna MGG,20247.489,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,BCBS,BCBS,1103,,,,,,,per diem,1103,20247.489,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,BCBS MGG,BCBS MGG,20247.489,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Cigna,Cigna,1257,,,,,,,per diem,1103,20247.489,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Cigna MGG,Cigna MGG,20247.489,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Humana,Humana,1400,,,,,,,per diem,1103,20247.489,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Humana MGG,Humana MGG,19235.11455,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Optum VA,Optum VA,20247.489,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,UHC,UHC,1400,,,,,,,per diem,1103,20247.489,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,UHC MGG,UHC MGG,20247.489,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,VA,VA,20247.489,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Wellcare MGG,Wellcare MGG,20247.489,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Bright Health - commercial,Bright Health - commercial,20247.489,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,20247.489,20247.489,Bright Health MGG,Bright Health MGG,20247.489,,,,,,,case rate,1103,20247.489,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Aetna,Aetna,1500,,,,,,,per diem,1103,15335.2116,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Aetna MGG,Aetna MGG,15335.2116,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,BCBS,BCBS,1103,,,,,,,per diem,1103,15335.2116,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,BCBS MGG,BCBS MGG,15335.2116,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Cigna,Cigna,1257,,,,,,,per diem,1103,15335.2116,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Cigna MGG,Cigna MGG,15335.2116,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Humana,Humana,1400,,,,,,,per diem,1103,15335.2116,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Humana MGG,Humana MGG,14568.45102,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Optum VA,Optum VA,15335.2116,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,UHC,UHC,1400,,,,,,,per diem,1103,15335.2116,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,UHC MGG,UHC MGG,15335.2116,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,VA,VA,15335.2116,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Wellcare MGG,Wellcare MGG,15335.2116,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Bright Health - commercial,Bright Health - commercial,15335.2116,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,15335.2116,15335.2116,Bright Health MGG,Bright Health MGG,15335.2116,,,,,,,case rate,1103,15335.2116,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Aetna,Aetna,1500,,,,,,,per diem,1103,14443.0542,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Aetna MGG,Aetna MGG,14443.0542,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,BCBS,BCBS,1103,,,,,,,per diem,1103,14443.0542,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,BCBS MGG,BCBS MGG,14443.0542,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Cigna,Cigna,1257,,,,,,,per diem,1103,14443.0542,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Cigna MGG,Cigna MGG,14443.0542,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Humana,Humana,1400,,,,,,,per diem,1103,14443.0542,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Humana MGG,Humana MGG,13720.90149,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Optum VA,Optum VA,14443.0542,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,UHC,UHC,1400,,,,,,,per diem,1103,14443.0542,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,UHC MGG,UHC MGG,14443.0542,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,VA,VA,14443.0542,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Wellcare MGG,Wellcare MGG,14443.0542,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Bright Health - commercial,Bright Health - commercial,14443.0542,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,14443.0542,14443.0542,Bright Health MGG,Bright Health MGG,14443.0542,,,,,,,case rate,1103,14443.0542,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Aetna,Aetna,1500,,,,,,,per diem,1103,16137.6894,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Aetna MGG,Aetna MGG,16137.6894,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,BCBS,BCBS,1103,,,,,,,per diem,1103,16137.6894,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,BCBS MGG,BCBS MGG,16137.6894,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Cigna,Cigna,1257,,,,,,,per diem,1103,16137.6894,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Cigna MGG,Cigna MGG,16137.6894,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Humana,Humana,1400,,,,,,,per diem,1103,16137.6894,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Humana MGG,Humana MGG,15330.80493,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Optum VA,Optum VA,16137.6894,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,UHC,UHC,1400,,,,,,,per diem,1103,16137.6894,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,UHC MGG,UHC MGG,16137.6894,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,VA,VA,16137.6894,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Wellcare MGG,Wellcare MGG,16137.6894,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Bright Health - commercial,Bright Health - commercial,16137.6894,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,16137.6894,16137.6894,Bright Health MGG,Bright Health MGG,16137.6894,,,,,,,case rate,1103,16137.6894,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Aetna,Aetna,1500,,,,,,,per diem,1103,25186.0518,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Aetna MGG,Aetna MGG,25186.0518,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,BCBS,BCBS,1103,,,,,,,per diem,1103,25186.0518,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,BCBS MGG,BCBS MGG,25186.0518,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Cigna,Cigna,1257,,,,,,,per diem,1103,25186.0518,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Cigna MGG,Cigna MGG,25186.0518,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Humana,Humana,1400,,,,,,,per diem,1103,25186.0518,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Humana MGG,Humana MGG,23926.74921,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Optum VA,Optum VA,25186.0518,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,UHC,UHC,1400,,,,,,,per diem,1103,25186.0518,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,UHC MGG,UHC MGG,25186.0518,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,VA,VA,25186.0518,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Wellcare MGG,Wellcare MGG,25186.0518,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Bright Health - commercial,Bright Health - commercial,25186.0518,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,25186.0518,25186.0518,Bright Health MGG,Bright Health MGG,25186.0518,,,,,,,case rate,1103,25186.0518,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Aetna,Aetna,1500,,,,,,,per diem,1103,19075.4694,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Aetna MGG,Aetna MGG,19075.4694,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,BCBS,BCBS,1103,,,,,,,per diem,1103,19075.4694,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,BCBS MGG,BCBS MGG,19075.4694,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Cigna,Cigna,1257,,,,,,,per diem,1103,19075.4694,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Cigna MGG,Cigna MGG,19075.4694,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Humana,Humana,1400,,,,,,,per diem,1103,19075.4694,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Humana MGG,Humana MGG,18121.69593,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Optum VA,Optum VA,19075.4694,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,UHC,UHC,1400,,,,,,,per diem,1103,19075.4694,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,UHC MGG,UHC MGG,19075.4694,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,VA,VA,19075.4694,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Wellcare MGG,Wellcare MGG,19075.4694,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Bright Health - commercial,Bright Health - commercial,19075.4694,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,19075.4694,19075.4694,Bright Health MGG,Bright Health MGG,19075.4694,,,,,,,case rate,1103,19075.4694,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Aetna,Aetna,1500,,,,,,,per diem,1103,17965.2978,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Aetna MGG,Aetna MGG,17965.2978,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,BCBS,BCBS,1103,,,,,,,per diem,1103,17965.2978,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,BCBS MGG,BCBS MGG,17965.2978,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Cigna,Cigna,1257,,,,,,,per diem,1103,17965.2978,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Cigna MGG,Cigna MGG,17965.2978,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Humana,Humana,1400,,,,,,,per diem,1103,17965.2978,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Humana MGG,Humana MGG,17067.03291,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Optum VA,Optum VA,17965.2978,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,UHC,UHC,1400,,,,,,,per diem,1103,17965.2978,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,UHC MGG,UHC MGG,17965.2978,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,VA,VA,17965.2978,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Wellcare MGG,Wellcare MGG,17965.2978,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Bright Health - commercial,Bright Health - commercial,17965.2978,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,17965.2978,17965.2978,Bright Health MGG,Bright Health MGG,17965.2978,,,,,,,case rate,1103,17965.2978,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Aetna,Aetna,1500,,,,,,,per diem,1103,19189.8882,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Aetna MGG,Aetna MGG,19189.8882,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,BCBS,BCBS,1103,,,,,,,per diem,1103,19189.8882,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,BCBS MGG,BCBS MGG,19189.8882,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Cigna,Cigna,1257,,,,,,,per diem,1103,19189.8882,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Cigna MGG,Cigna MGG,19189.8882,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Humana,Humana,1400,,,,,,,per diem,1103,19189.8882,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Humana MGG,Humana MGG,18230.39379,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Optum VA,Optum VA,19189.8882,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,UHC,UHC,1400,,,,,,,per diem,1103,19189.8882,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,UHC MGG,UHC MGG,19189.8882,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,VA,VA,19189.8882,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Wellcare MGG,Wellcare MGG,19189.8882,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Bright Health - commercial,Bright Health - commercial,19189.8882,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,19189.8882,19189.8882,Bright Health MGG,Bright Health MGG,19189.8882,,,,,,,case rate,1103,19189.8882,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Aetna,Aetna,1500,,,,,,,per diem,1103,29949.894,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Aetna MGG,Aetna MGG,29949.894,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,BCBS,BCBS,1103,,,,,,,per diem,1103,29949.894,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,BCBS MGG,BCBS MGG,29949.894,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Cigna,Cigna,1257,,,,,,,per diem,1103,29949.894,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Cigna MGG,Cigna MGG,29949.894,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Humana,Humana,1400,,,,,,,per diem,1103,29949.894,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Humana MGG,Humana MGG,28452.3993,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Optum VA,Optum VA,29949.894,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,UHC,UHC,1400,,,,,,,per diem,1103,29949.894,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,UHC MGG,UHC MGG,29949.894,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,VA,VA,29949.894,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Wellcare MGG,Wellcare MGG,29949.894,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Bright Health - commercial,Bright Health - commercial,29949.894,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,29949.894,29949.894,Bright Health MGG,Bright Health MGG,29949.894,,,,,,,case rate,1103,29949.894,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Aetna,Aetna,1500,,,,,,,per diem,1103,22682.754,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Aetna MGG,Aetna MGG,22682.754,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,BCBS,BCBS,1103,,,,,,,per diem,1103,22682.754,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,BCBS MGG,BCBS MGG,22682.754,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Cigna,Cigna,1257,,,,,,,per diem,1103,22682.754,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Cigna MGG,Cigna MGG,22682.754,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Humana,Humana,1400,,,,,,,per diem,1103,22682.754,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Humana MGG,Humana MGG,21548.6163,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Optum VA,Optum VA,22682.754,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,UHC,UHC,1400,,,,,,,per diem,1103,22682.754,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,UHC MGG,UHC MGG,22682.754,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,VA,VA,22682.754,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Wellcare MGG,Wellcare MGG,22682.754,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Bright Health - commercial,Bright Health - commercial,22682.754,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,22682.754,22682.754,Bright Health MGG,Bright Health MGG,22682.754,,,,,,,case rate,1103,22682.754,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Aetna,Aetna,1500,,,,,,,per diem,1103,21363.8454,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Aetna MGG,Aetna MGG,21363.8454,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,BCBS,BCBS,1103,,,,,,,per diem,1103,21363.8454,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,BCBS MGG,BCBS MGG,21363.8454,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Cigna,Cigna,1257,,,,,,,per diem,1103,21363.8454,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Cigna MGG,Cigna MGG,21363.8454,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Humana,Humana,1400,,,,,,,per diem,1103,21363.8454,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Humana MGG,Humana MGG,20295.65313,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Optum VA,Optum VA,21363.8454,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,UHC,UHC,1400,,,,,,,per diem,1103,21363.8454,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,UHC MGG,UHC MGG,21363.8454,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,VA,VA,21363.8454,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Wellcare MGG,Wellcare MGG,21363.8454,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Bright Health - commercial,Bright Health - commercial,21363.8454,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,21363.8454,21363.8454,Bright Health MGG,Bright Health MGG,21363.8454,,,,,,,case rate,1103,21363.8454,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Aetna,Aetna,1500,,,,,,,per diem,1103,24269.1552,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Aetna MGG,Aetna MGG,24269.1552,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,BCBS,BCBS,1103,,,,,,,per diem,1103,24269.1552,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,BCBS MGG,BCBS MGG,24269.1552,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Cigna,Cigna,1257,,,,,,,per diem,1103,24269.1552,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Cigna MGG,Cigna MGG,24269.1552,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Humana,Humana,1400,,,,,,,per diem,1103,24269.1552,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Humana MGG,Humana MGG,23055.69744,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Optum VA,Optum VA,24269.1552,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,UHC,UHC,1400,,,,,,,per diem,1103,24269.1552,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,UHC MGG,UHC MGG,24269.1552,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,VA,VA,24269.1552,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Wellcare MGG,Wellcare MGG,24269.1552,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Bright Health - commercial,Bright Health - commercial,24269.1552,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,24269.1552,24269.1552,Bright Health MGG,Bright Health MGG,24269.1552,,,,,,,case rate,1103,24269.1552,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Aetna,Aetna,1500,,,,,,,per diem,1103,37878.8076,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Aetna MGG,Aetna MGG,37878.8076,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,BCBS,BCBS,1103,,,,,,,per diem,1103,37878.8076,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,BCBS MGG,BCBS MGG,37878.8076,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Cigna,Cigna,1257,,,,,,,per diem,1103,37878.8076,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Cigna MGG,Cigna MGG,37878.8076,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Humana,Humana,1400,,,,,,,per diem,1103,37878.8076,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Humana MGG,Humana MGG,35984.86722,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Optum VA,Optum VA,37878.8076,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,UHC,UHC,1400,,,,,,,per diem,1103,37878.8076,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,UHC MGG,UHC MGG,37878.8076,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,VA,VA,37878.8076,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Wellcare MGG,Wellcare MGG,37878.8076,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Bright Health - commercial,Bright Health - commercial,37878.8076,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,37878.8076,37878.8076,Bright Health MGG,Bright Health MGG,37878.8076,,,,,,,case rate,1103,37878.8076,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Aetna,Aetna,1500,,,,,,,per diem,1103,28686.6486,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Aetna MGG,Aetna MGG,28686.6486,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,BCBS,BCBS,1103,,,,,,,per diem,1103,28686.6486,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,BCBS MGG,BCBS MGG,28686.6486,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Cigna,Cigna,1257,,,,,,,per diem,1103,28686.6486,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Cigna MGG,Cigna MGG,28686.6486,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Humana,Humana,1400,,,,,,,per diem,1103,28686.6486,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Humana MGG,Humana MGG,27252.31617,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Optum VA,Optum VA,28686.6486,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,UHC,UHC,1400,,,,,,,per diem,1103,28686.6486,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,UHC MGG,UHC MGG,28686.6486,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,VA,VA,28686.6486,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Wellcare MGG,Wellcare MGG,28686.6486,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Bright Health - commercial,Bright Health - commercial,28686.6486,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,28686.6486,28686.6486,Bright Health MGG,Bright Health MGG,28686.6486,,,,,,,case rate,1103,28686.6486,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Aetna,Aetna,1500,,,,,,,per diem,1103,27019.845,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Aetna MGG,Aetna MGG,27019.845,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,BCBS,BCBS,1103,,,,,,,per diem,1103,27019.845,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,BCBS MGG,BCBS MGG,27019.845,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Cigna,Cigna,1257,,,,,,,per diem,1103,27019.845,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Cigna MGG,Cigna MGG,27019.845,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Humana,Humana,1400,,,,,,,per diem,1103,27019.845,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Humana MGG,Humana MGG,25668.85275,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Optum VA,Optum VA,27019.845,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,UHC,UHC,1400,,,,,,,per diem,1103,27019.845,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,UHC MGG,UHC MGG,27019.845,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,VA,VA,27019.845,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Wellcare MGG,Wellcare MGG,27019.845,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Bright Health - commercial,Bright Health - commercial,27019.845,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,27019.845,27019.845,Bright Health MGG,Bright Health MGG,27019.845,,,,,,,case rate,1103,27019.845,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Aetna,Aetna,1500,,,,,,,per diem,1103,13162.8006,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Aetna MGG,Aetna MGG,13162.8006,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,BCBS,BCBS,1103,,,,,,,per diem,1103,13162.8006,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,BCBS MGG,BCBS MGG,13162.8006,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Cigna,Cigna,1257,,,,,,,per diem,1103,13162.8006,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Cigna MGG,Cigna MGG,13162.8006,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Humana,Humana,1400,,,,,,,per diem,1103,13162.8006,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Humana MGG,Humana MGG,12504.66057,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Optum VA,Optum VA,13162.8006,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,UHC,UHC,1400,,,,,,,per diem,1103,13162.8006,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,UHC MGG,UHC MGG,13162.8006,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,VA,VA,13162.8006,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Wellcare MGG,Wellcare MGG,13162.8006,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Bright Health - commercial,Bright Health - commercial,13162.8006,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,13162.8006,13162.8006,Bright Health MGG,Bright Health MGG,13162.8006,,,,,,,case rate,1103,13162.8006,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Aetna,Aetna,1500,,,,,,,per diem,1103,18970.3278,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Aetna MGG,Aetna MGG,18970.3278,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,BCBS,BCBS,1103,,,,,,,per diem,1103,18970.3278,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,BCBS MGG,BCBS MGG,18970.3278,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Cigna,Cigna,1257,,,,,,,per diem,1103,18970.3278,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Cigna MGG,Cigna MGG,18970.3278,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Humana,Humana,1400,,,,,,,per diem,1103,18970.3278,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Humana MGG,Humana MGG,18021.81141,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Optum VA,Optum VA,18970.3278,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,UHC,UHC,1400,,,,,,,per diem,1103,18970.3278,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,UHC MGG,UHC MGG,18970.3278,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,VA,VA,18970.3278,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Wellcare MGG,Wellcare MGG,18970.3278,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Bright Health - commercial,Bright Health - commercial,18970.3278,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,18970.3278,18970.3278,Bright Health MGG,Bright Health MGG,18970.3278,,,,,,,case rate,1103,18970.3278,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Aetna,Aetna,1500,,,,,,,per diem,1103,15166.6758,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Aetna MGG,Aetna MGG,15166.6758,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,BCBS,BCBS,1103,,,,,,,per diem,1103,15166.6758,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,BCBS MGG,BCBS MGG,15166.6758,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Cigna,Cigna,1257,,,,,,,per diem,1103,15166.6758,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Cigna MGG,Cigna MGG,15166.6758,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Humana,Humana,1400,,,,,,,per diem,1103,15166.6758,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Humana MGG,Humana MGG,14408.34201,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Optum VA,Optum VA,15166.6758,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,UHC,UHC,1400,,,,,,,per diem,1103,15166.6758,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,UHC MGG,UHC MGG,15166.6758,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,VA,VA,15166.6758,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Wellcare MGG,Wellcare MGG,15166.6758,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Bright Health - commercial,Bright Health - commercial,15166.6758,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,15166.6758,15166.6758,Bright Health MGG,Bright Health MGG,15166.6758,,,,,,,case rate,1103,15166.6758,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Aetna,Aetna,1500,,,,,,,per diem,1103,14404.3992,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Aetna MGG,Aetna MGG,14404.3992,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,BCBS,BCBS,1103,,,,,,,per diem,1103,14404.3992,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,BCBS MGG,BCBS MGG,14404.3992,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Cigna,Cigna,1257,,,,,,,per diem,1103,14404.3992,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Cigna MGG,Cigna MGG,14404.3992,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Humana,Humana,1400,,,,,,,per diem,1103,14404.3992,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Humana MGG,Humana MGG,13684.17924,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Optum VA,Optum VA,14404.3992,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,UHC,UHC,1400,,,,,,,per diem,1103,14404.3992,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,UHC MGG,UHC MGG,14404.3992,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,VA,VA,14404.3992,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Wellcare MGG,Wellcare MGG,14404.3992,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Bright Health - commercial,Bright Health - commercial,14404.3992,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,14404.3992,14404.3992,Bright Health MGG,Bright Health MGG,14404.3992,,,,,,,case rate,1103,14404.3992,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Aetna,Aetna,1500,,,,,,,per diem,1103,16270.6626,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Aetna MGG,Aetna MGG,16270.6626,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,BCBS,BCBS,1103,,,,,,,per diem,1103,16270.6626,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,BCBS MGG,BCBS MGG,16270.6626,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Cigna,Cigna,1257,,,,,,,per diem,1103,16270.6626,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Cigna MGG,Cigna MGG,16270.6626,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Humana,Humana,1400,,,,,,,per diem,1103,16270.6626,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Humana MGG,Humana MGG,15457.12947,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Optum VA,Optum VA,16270.6626,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,UHC,UHC,1400,,,,,,,per diem,1103,16270.6626,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,UHC MGG,UHC MGG,16270.6626,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,VA,VA,16270.6626,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Wellcare MGG,Wellcare MGG,16270.6626,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Bright Health - commercial,Bright Health - commercial,16270.6626,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,16270.6626,16270.6626,Bright Health MGG,Bright Health MGG,16270.6626,,,,,,,case rate,1103,16270.6626,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Aetna,Aetna,1500,,,,,,,per diem,1103,23448.123,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Aetna MGG,Aetna MGG,23448.123,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,BCBS,BCBS,1103,,,,,,,per diem,1103,23448.123,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,BCBS MGG,BCBS MGG,23448.123,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Cigna,Cigna,1257,,,,,,,per diem,1103,23448.123,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Cigna MGG,Cigna MGG,23448.123,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Humana,Humana,1400,,,,,,,per diem,1103,23448.123,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Humana MGG,Humana MGG,22275.71685,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Optum VA,Optum VA,23448.123,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,UHC,UHC,1400,,,,,,,per diem,1103,23448.123,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,UHC MGG,UHC MGG,23448.123,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,VA,VA,23448.123,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Wellcare MGG,Wellcare MGG,23448.123,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Bright Health - commercial,Bright Health - commercial,23448.123,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,23448.123,23448.123,Bright Health MGG,Bright Health MGG,23448.123,,,,,,,case rate,1103,23448.123,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Aetna,Aetna,1500,,,,,,,per diem,1103,18747.675,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Aetna MGG,Aetna MGG,18747.675,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,BCBS,BCBS,1103,,,,,,,per diem,1103,18747.675,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,BCBS MGG,BCBS MGG,18747.675,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Cigna,Cigna,1257,,,,,,,per diem,1103,18747.675,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Cigna MGG,Cigna MGG,18747.675,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Humana,Humana,1400,,,,,,,per diem,1103,18747.675,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Humana MGG,Humana MGG,17810.29125,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Optum VA,Optum VA,18747.675,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,UHC,UHC,1400,,,,,,,per diem,1103,18747.675,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,UHC MGG,UHC MGG,18747.675,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,VA,VA,18747.675,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Wellcare MGG,Wellcare MGG,18747.675,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Bright Health - commercial,Bright Health - commercial,18747.675,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,18747.675,18747.675,Bright Health MGG,Bright Health MGG,18747.675,,,,,,,case rate,1103,18747.675,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Aetna,Aetna,1500,,,,,,,per diem,1103,17804.493,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Aetna MGG,Aetna MGG,17804.493,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,BCBS,BCBS,1103,,,,,,,per diem,1103,17804.493,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,BCBS MGG,BCBS MGG,17804.493,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Cigna,Cigna,1257,,,,,,,per diem,1103,17804.493,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Cigna MGG,Cigna MGG,17804.493,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Humana,Humana,1400,,,,,,,per diem,1103,17804.493,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Humana MGG,Humana MGG,16914.26835,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Optum VA,Optum VA,17804.493,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,UHC,UHC,1400,,,,,,,per diem,1103,17804.493,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,UHC MGG,UHC MGG,17804.493,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,VA,VA,17804.493,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Wellcare MGG,Wellcare MGG,17804.493,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Bright Health - commercial,Bright Health - commercial,17804.493,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,17804.493,17804.493,Bright Health MGG,Bright Health MGG,17804.493,,,,,,,case rate,1103,17804.493,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Aetna,Aetna,1500,,,,,,,per diem,1103,19933.6104,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Aetna MGG,Aetna MGG,19933.6104,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,BCBS,BCBS,1103,,,,,,,per diem,1103,19933.6104,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,BCBS MGG,BCBS MGG,19933.6104,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Cigna,Cigna,1257,,,,,,,per diem,1103,19933.6104,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Cigna MGG,Cigna MGG,19933.6104,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Humana,Humana,1400,,,,,,,per diem,1103,19933.6104,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Humana MGG,Humana MGG,18936.92988,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Optum VA,Optum VA,19933.6104,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,UHC,UHC,1400,,,,,,,per diem,1103,19933.6104,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,UHC MGG,UHC MGG,19933.6104,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,VA,VA,19933.6104,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Wellcare MGG,Wellcare MGG,19933.6104,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Bright Health - commercial,Bright Health - commercial,19933.6104,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,19933.6104,19933.6104,Bright Health MGG,Bright Health MGG,19933.6104,,,,,,,case rate,1103,19933.6104,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Aetna,Aetna,1500,,,,,,,per diem,1103,28725.3036,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Aetna MGG,Aetna MGG,28725.3036,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,BCBS,BCBS,1103,,,,,,,per diem,1103,28725.3036,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,BCBS MGG,BCBS MGG,28725.3036,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Cigna,Cigna,1257,,,,,,,per diem,1103,28725.3036,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Cigna MGG,Cigna MGG,28725.3036,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Humana,Humana,1400,,,,,,,per diem,1103,28725.3036,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Humana MGG,Humana MGG,27289.03842,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Optum VA,Optum VA,28725.3036,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,UHC,UHC,1400,,,,,,,per diem,1103,28725.3036,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,UHC MGG,UHC MGG,28725.3036,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,VA,VA,28725.3036,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Wellcare MGG,Wellcare MGG,28725.3036,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Bright Health - commercial,Bright Health - commercial,28725.3036,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,28725.3036,28725.3036,Bright Health MGG,Bright Health MGG,28725.3036,,,,,,,case rate,1103,28725.3036,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Aetna,Aetna,1500,,,,,,,per diem,1103,22967.2548,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Aetna MGG,Aetna MGG,22967.2548,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,BCBS,BCBS,1103,,,,,,,per diem,1103,22967.2548,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,BCBS MGG,BCBS MGG,22967.2548,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Cigna,Cigna,1257,,,,,,,per diem,1103,22967.2548,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Cigna MGG,Cigna MGG,22967.2548,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Humana,Humana,1400,,,,,,,per diem,1103,22967.2548,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Humana MGG,Humana MGG,21818.89206,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Optum VA,Optum VA,22967.2548,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,UHC,UHC,1400,,,,,,,per diem,1103,22967.2548,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,UHC MGG,UHC MGG,22967.2548,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,VA,VA,22967.2548,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Wellcare MGG,Wellcare MGG,22967.2548,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Bright Health - commercial,Bright Health - commercial,22967.2548,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,22967.2548,22967.2548,Bright Health MGG,Bright Health MGG,22967.2548,,,,,,,case rate,1103,22967.2548,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Aetna,Aetna,1500,,,,,,,per diem,1103,21813.7896,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Aetna MGG,Aetna MGG,21813.7896,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,BCBS,BCBS,1103,,,,,,,per diem,1103,21813.7896,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,BCBS MGG,BCBS MGG,21813.7896,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Cigna,Cigna,1257,,,,,,,per diem,1103,21813.7896,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Cigna MGG,Cigna MGG,21813.7896,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Humana,Humana,1400,,,,,,,per diem,1103,21813.7896,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Humana MGG,Humana MGG,20723.10012,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Optum VA,Optum VA,21813.7896,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,UHC,UHC,1400,,,,,,,per diem,1103,21813.7896,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,UHC MGG,UHC MGG,21813.7896,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,VA,VA,21813.7896,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Wellcare MGG,Wellcare MGG,21813.7896,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Bright Health - commercial,Bright Health - commercial,21813.7896,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,21813.7896,21813.7896,Bright Health MGG,Bright Health MGG,21813.7896,,,,,,,case rate,1103,21813.7896,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Aetna,Aetna,1500,,,,,,,per diem,1103,24612.4116,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Aetna MGG,Aetna MGG,24612.4116,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,BCBS,BCBS,1103,,,,,,,per diem,1103,24612.4116,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,BCBS MGG,BCBS MGG,24612.4116,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Cigna,Cigna,1257,,,,,,,per diem,1103,24612.4116,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Cigna MGG,Cigna MGG,24612.4116,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Humana,Humana,1400,,,,,,,per diem,1103,24612.4116,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Humana MGG,Humana MGG,23381.79102,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Optum VA,Optum VA,24612.4116,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,UHC,UHC,1400,,,,,,,per diem,1103,24612.4116,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,UHC MGG,UHC MGG,24612.4116,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,VA,VA,24612.4116,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Wellcare MGG,Wellcare MGG,24612.4116,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Bright Health - commercial,Bright Health - commercial,24612.4116,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,24612.4116,24612.4116,Bright Health MGG,Bright Health MGG,24612.4116,,,,,,,case rate,1103,24612.4116,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Aetna,Aetna,1500,,,,,,,per diem,1103,35469.828,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Aetna MGG,Aetna MGG,35469.828,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,BCBS,BCBS,1103,,,,,,,per diem,1103,35469.828,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,BCBS MGG,BCBS MGG,35469.828,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Cigna,Cigna,1257,,,,,,,per diem,1103,35469.828,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Cigna MGG,Cigna MGG,35469.828,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Humana,Humana,1400,,,,,,,per diem,1103,35469.828,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Humana MGG,Humana MGG,33696.3366,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Optum VA,Optum VA,35469.828,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,UHC,UHC,1400,,,,,,,per diem,1103,35469.828,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,UHC MGG,UHC MGG,35469.828,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,VA,VA,35469.828,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Wellcare MGG,Wellcare MGG,35469.828,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Bright Health - commercial,Bright Health - commercial,35469.828,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,35469.828,35469.828,Bright Health MGG,Bright Health MGG,35469.828,,,,,,,case rate,1103,35469.828,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Aetna,Aetna,1500,,,,,,,per diem,1103,28360.4004,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Aetna MGG,Aetna MGG,28360.4004,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,BCBS,BCBS,1103,,,,,,,per diem,1103,28360.4004,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,BCBS MGG,BCBS MGG,28360.4004,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Cigna,Cigna,1257,,,,,,,per diem,1103,28360.4004,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Cigna MGG,Cigna MGG,28360.4004,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Humana,Humana,1400,,,,,,,per diem,1103,28360.4004,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Humana MGG,Humana MGG,26942.38038,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Optum VA,Optum VA,28360.4004,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,UHC,UHC,1400,,,,,,,per diem,1103,28360.4004,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,UHC MGG,UHC MGG,28360.4004,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,VA,VA,28360.4004,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Wellcare MGG,Wellcare MGG,28360.4004,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Bright Health - commercial,Bright Health - commercial,28360.4004,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,28360.4004,28360.4004,Bright Health MGG,Bright Health MGG,28360.4004,,,,,,,case rate,1103,28360.4004,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Aetna,Aetna,1500,,,,,,,per diem,1103,26934.804,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Aetna MGG,Aetna MGG,26934.804,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,BCBS,BCBS,1103,,,,,,,per diem,1103,26934.804,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,BCBS MGG,BCBS MGG,26934.804,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Cigna,Cigna,1257,,,,,,,per diem,1103,26934.804,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Cigna MGG,Cigna MGG,26934.804,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Humana,Humana,1400,,,,,,,per diem,1103,26934.804,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Humana MGG,Humana MGG,25588.0638,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Optum VA,Optum VA,26934.804,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,UHC,UHC,1400,,,,,,,per diem,1103,26934.804,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,UHC MGG,UHC MGG,26934.804,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,VA,VA,26934.804,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Wellcare MGG,Wellcare MGG,26934.804,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Bright Health - commercial,Bright Health - commercial,26934.804,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,26934.804,26934.804,Bright Health MGG,Bright Health MGG,26934.804,,,,,,,case rate,1103,26934.804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Aetna,Aetna,1500,,,,,,,per diem,1103,12848.922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Aetna MGG,Aetna MGG,12848.922,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,BCBS,BCBS,1103,,,,,,,per diem,1103,12848.922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,BCBS MGG,BCBS MGG,12848.922,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Cigna,Cigna,1257,,,,,,,per diem,1103,12848.922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Cigna MGG,Cigna MGG,12848.922,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Humana,Humana,1400,,,,,,,per diem,1103,12848.922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Humana MGG,Humana MGG,12206.4759,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Optum VA,Optum VA,12848.922,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,UHC,UHC,1400,,,,,,,per diem,1103,12848.922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,UHC MGG,UHC MGG,12848.922,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,VA,VA,12848.922,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Wellcare MGG,Wellcare MGG,12848.922,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Bright Health - commercial,Bright Health - commercial,12848.922,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,12848.922,12848.922,Bright Health MGG,Bright Health MGG,12848.922,,,,,,,case rate,1103,12848.922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Aetna,Aetna,1500,,,,,,,per diem,1103,18215.7822,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Aetna MGG,Aetna MGG,18215.7822,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,BCBS,BCBS,1103,,,,,,,per diem,1103,18215.7822,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,BCBS MGG,BCBS MGG,18215.7822,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Cigna,Cigna,1257,,,,,,,per diem,1103,18215.7822,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Cigna MGG,Cigna MGG,18215.7822,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Humana,Humana,1400,,,,,,,per diem,1103,18215.7822,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Humana MGG,Humana MGG,17304.99309,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Optum VA,Optum VA,18215.7822,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,UHC,UHC,1400,,,,,,,per diem,1103,18215.7822,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,UHC MGG,UHC MGG,18215.7822,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,VA,VA,18215.7822,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Wellcare MGG,Wellcare MGG,18215.7822,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Bright Health - commercial,Bright Health - commercial,18215.7822,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,18215.7822,18215.7822,Bright Health MGG,Bright Health MGG,18215.7822,,,,,,,case rate,1103,18215.7822,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Aetna,Aetna,1500,,,,,,,per diem,1103,15341.3964,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Aetna MGG,Aetna MGG,15341.3964,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,BCBS,BCBS,1103,,,,,,,per diem,1103,15341.3964,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,BCBS MGG,BCBS MGG,15341.3964,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Cigna,Cigna,1257,,,,,,,per diem,1103,15341.3964,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Cigna MGG,Cigna MGG,15341.3964,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Humana,Humana,1400,,,,,,,per diem,1103,15341.3964,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Humana MGG,Humana MGG,14574.32658,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Optum VA,Optum VA,15341.3964,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,UHC,UHC,1400,,,,,,,per diem,1103,15341.3964,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,UHC MGG,UHC MGG,15341.3964,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,VA,VA,15341.3964,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Wellcare MGG,Wellcare MGG,15341.3964,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Bright Health - commercial,Bright Health - commercial,15341.3964,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,15341.3964,15341.3964,Bright Health MGG,Bright Health MGG,15341.3964,,,,,,,case rate,1103,15341.3964,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Aetna,Aetna,1500,,,,,,,per diem,1103,13713.2478,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Aetna MGG,Aetna MGG,13713.2478,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,BCBS,BCBS,1103,,,,,,,per diem,1103,13713.2478,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,BCBS MGG,BCBS MGG,13713.2478,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Cigna,Cigna,1257,,,,,,,per diem,1103,13713.2478,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Cigna MGG,Cigna MGG,13713.2478,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Humana,Humana,1400,,,,,,,per diem,1103,13713.2478,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Humana MGG,Humana MGG,13027.58541,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Optum VA,Optum VA,13713.2478,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,UHC,UHC,1400,,,,,,,per diem,1103,13713.2478,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,UHC MGG,UHC MGG,13713.2478,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,VA,VA,13713.2478,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Wellcare MGG,Wellcare MGG,13713.2478,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Bright Health - commercial,Bright Health - commercial,13713.2478,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,13713.2478,13713.2478,Bright Health MGG,Bright Health MGG,13713.2478,,,,,,,case rate,1103,13713.2478,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Aetna,Aetna,1500,,,,,,,per diem,1103,14645.6064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Aetna MGG,Aetna MGG,14645.6064,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,BCBS,BCBS,1103,,,,,,,per diem,1103,14645.6064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,BCBS MGG,BCBS MGG,14645.6064,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Cigna,Cigna,1257,,,,,,,per diem,1103,14645.6064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Cigna MGG,Cigna MGG,14645.6064,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Humana,Humana,1400,,,,,,,per diem,1103,14645.6064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Humana MGG,Humana MGG,13913.32608,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Optum VA,Optum VA,14645.6064,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,UHC,UHC,1400,,,,,,,per diem,1103,14645.6064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,UHC MGG,UHC MGG,14645.6064,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,VA,VA,14645.6064,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Wellcare MGG,Wellcare MGG,14645.6064,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Bright Health - commercial,Bright Health - commercial,14645.6064,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,14645.6064,14645.6064,Bright Health MGG,Bright Health MGG,14645.6064,,,,,,,case rate,1103,14645.6064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Aetna,Aetna,1500,,,,,,,per diem,1103,20762.3736,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Aetna MGG,Aetna MGG,20762.3736,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,BCBS,BCBS,1103,,,,,,,per diem,1103,20762.3736,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,BCBS MGG,BCBS MGG,20762.3736,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Cigna,Cigna,1257,,,,,,,per diem,1103,20762.3736,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Cigna MGG,Cigna MGG,20762.3736,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Humana,Humana,1400,,,,,,,per diem,1103,20762.3736,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Humana MGG,Humana MGG,19724.25492,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Optum VA,Optum VA,20762.3736,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,UHC,UHC,1400,,,,,,,per diem,1103,20762.3736,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,UHC MGG,UHC MGG,20762.3736,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,VA,VA,20762.3736,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Wellcare MGG,Wellcare MGG,20762.3736,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Bright Health - commercial,Bright Health - commercial,20762.3736,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,20762.3736,20762.3736,Bright Health MGG,Bright Health MGG,20762.3736,,,,,,,case rate,1103,20762.3736,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Aetna,Aetna,1500,,,,,,,per diem,1103,17487.522,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Aetna MGG,Aetna MGG,17487.522,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,BCBS,BCBS,1103,,,,,,,per diem,1103,17487.522,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,BCBS MGG,BCBS MGG,17487.522,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Cigna,Cigna,1257,,,,,,,per diem,1103,17487.522,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Cigna MGG,Cigna MGG,17487.522,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Humana,Humana,1400,,,,,,,per diem,1103,17487.522,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Humana MGG,Humana MGG,16613.1459,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Optum VA,Optum VA,17487.522,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,UHC,UHC,1400,,,,,,,per diem,1103,17487.522,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,UHC MGG,UHC MGG,17487.522,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,VA,VA,17487.522,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Wellcare MGG,Wellcare MGG,17487.522,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Bright Health - commercial,Bright Health - commercial,17487.522,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,17487.522,17487.522,Bright Health MGG,Bright Health MGG,17487.522,,,,,,,case rate,1103,17487.522,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Aetna,Aetna,1500,,,,,,,per diem,1103,15630.5358,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Aetna MGG,Aetna MGG,15630.5358,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,BCBS,BCBS,1103,,,,,,,per diem,1103,15630.5358,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,BCBS MGG,BCBS MGG,15630.5358,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Cigna,Cigna,1257,,,,,,,per diem,1103,15630.5358,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Cigna MGG,Cigna MGG,15630.5358,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Humana,Humana,1400,,,,,,,per diem,1103,15630.5358,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Humana MGG,Humana MGG,14849.00901,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Optum VA,Optum VA,15630.5358,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,UHC,UHC,1400,,,,,,,per diem,1103,15630.5358,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,UHC MGG,UHC MGG,15630.5358,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,VA,VA,15630.5358,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Wellcare MGG,Wellcare MGG,15630.5358,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Bright Health - commercial,Bright Health - commercial,15630.5358,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,15630.5358,15630.5358,Bright Health MGG,Bright Health MGG,15630.5358,,,,,,,case rate,1103,15630.5358,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Aetna,Aetna,1500,,,,,,,per diem,1103,16117.5888,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Aetna MGG,Aetna MGG,16117.5888,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,BCBS,BCBS,1103,,,,,,,per diem,1103,16117.5888,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,BCBS MGG,BCBS MGG,16117.5888,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Cigna,Cigna,1257,,,,,,,per diem,1103,16117.5888,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Cigna MGG,Cigna MGG,16117.5888,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Humana,Humana,1400,,,,,,,per diem,1103,16117.5888,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Humana MGG,Humana MGG,15311.70936,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Optum VA,Optum VA,16117.5888,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,UHC,UHC,1400,,,,,,,per diem,1103,16117.5888,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,UHC MGG,UHC MGG,16117.5888,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,VA,VA,16117.5888,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Wellcare MGG,Wellcare MGG,16117.5888,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Bright Health - commercial,Bright Health - commercial,16117.5888,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,16117.5888,16117.5888,Bright Health MGG,Bright Health MGG,16117.5888,,,,,,,case rate,1103,16117.5888,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Aetna,Aetna,1500,,,,,,,per diem,1103,22849.7436,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Aetna MGG,Aetna MGG,22849.7436,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,BCBS,BCBS,1103,,,,,,,per diem,1103,22849.7436,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,BCBS MGG,BCBS MGG,22849.7436,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Cigna,Cigna,1257,,,,,,,per diem,1103,22849.7436,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Cigna MGG,Cigna MGG,22849.7436,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Humana,Humana,1400,,,,,,,per diem,1103,22849.7436,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Humana MGG,Humana MGG,21707.25642,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Optum VA,Optum VA,22849.7436,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,UHC,UHC,1400,,,,,,,per diem,1103,22849.7436,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,UHC MGG,UHC MGG,22849.7436,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,VA,VA,22849.7436,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Wellcare MGG,Wellcare MGG,22849.7436,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Bright Health - commercial,Bright Health - commercial,22849.7436,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,22849.7436,22849.7436,Bright Health MGG,Bright Health MGG,22849.7436,,,,,,,case rate,1103,22849.7436,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Aetna,Aetna,1500,,,,,,,per diem,1103,19245.5514,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Aetna MGG,Aetna MGG,19245.5514,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,BCBS,BCBS,1103,,,,,,,per diem,1103,19245.5514,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,BCBS MGG,BCBS MGG,19245.5514,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Cigna,Cigna,1257,,,,,,,per diem,1103,19245.5514,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Cigna MGG,Cigna MGG,19245.5514,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Humana,Humana,1400,,,,,,,per diem,1103,19245.5514,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Humana MGG,Humana MGG,18283.27383,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Optum VA,Optum VA,19245.5514,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,UHC,UHC,1400,,,,,,,per diem,1103,19245.5514,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,UHC MGG,UHC MGG,19245.5514,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,VA,VA,19245.5514,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Wellcare MGG,Wellcare MGG,19245.5514,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Bright Health - commercial,Bright Health - commercial,19245.5514,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,19245.5514,19245.5514,Bright Health MGG,Bright Health MGG,19245.5514,,,,,,,case rate,1103,19245.5514,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Aetna,Aetna,1500,,,,,,,per diem,1103,17203.0212,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Aetna MGG,Aetna MGG,17203.0212,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,BCBS,BCBS,1103,,,,,,,per diem,1103,17203.0212,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,BCBS MGG,BCBS MGG,17203.0212,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Cigna,Cigna,1257,,,,,,,per diem,1103,17203.0212,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Cigna MGG,Cigna MGG,17203.0212,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Humana,Humana,1400,,,,,,,per diem,1103,17203.0212,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Humana MGG,Humana MGG,16342.87014,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Optum VA,Optum VA,17203.0212,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,UHC,UHC,1400,,,,,,,per diem,1103,17203.0212,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,UHC MGG,UHC MGG,17203.0212,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,VA,VA,17203.0212,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Wellcare MGG,Wellcare MGG,17203.0212,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Bright Health - commercial,Bright Health - commercial,17203.0212,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,17203.0212,17203.0212,Bright Health MGG,Bright Health MGG,17203.0212,,,,,,,case rate,1103,17203.0212,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Aetna,Aetna,1500,,,,,,,per diem,1103,18310.1004,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Aetna MGG,Aetna MGG,18310.1004,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,BCBS,BCBS,1103,,,,,,,per diem,1103,18310.1004,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,BCBS MGG,BCBS MGG,18310.1004,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Cigna,Cigna,1257,,,,,,,per diem,1103,18310.1004,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Cigna MGG,Cigna MGG,18310.1004,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Humana,Humana,1400,,,,,,,per diem,1103,18310.1004,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Humana MGG,Humana MGG,17394.59538,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Optum VA,Optum VA,18310.1004,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,UHC,UHC,1400,,,,,,,per diem,1103,18310.1004,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,UHC MGG,UHC MGG,18310.1004,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,VA,VA,18310.1004,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Wellcare MGG,Wellcare MGG,18310.1004,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Bright Health - commercial,Bright Health - commercial,18310.1004,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,18310.1004,18310.1004,Bright Health MGG,Bright Health MGG,18310.1004,,,,,,,case rate,1103,18310.1004,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Aetna,Aetna,1500,,,,,,,per diem,1103,25957.6056,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Aetna MGG,Aetna MGG,25957.6056,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,BCBS,BCBS,1103,,,,,,,per diem,1103,25957.6056,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,BCBS MGG,BCBS MGG,25957.6056,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Cigna,Cigna,1257,,,,,,,per diem,1103,25957.6056,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Cigna MGG,Cigna MGG,25957.6056,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Humana,Humana,1400,,,,,,,per diem,1103,25957.6056,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Humana MGG,Humana MGG,24659.72532,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Optum VA,Optum VA,25957.6056,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,UHC,UHC,1400,,,,,,,per diem,1103,25957.6056,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,UHC MGG,UHC MGG,25957.6056,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,VA,VA,25957.6056,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Wellcare MGG,Wellcare MGG,25957.6056,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Bright Health - commercial,Bright Health - commercial,25957.6056,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,25957.6056,25957.6056,Bright Health MGG,Bright Health MGG,25957.6056,,,,,,,case rate,1103,25957.6056,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Aetna,Aetna,1500,,,,,,,per diem,1103,21863.268,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Aetna MGG,Aetna MGG,21863.268,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,BCBS,BCBS,1103,,,,,,,per diem,1103,21863.268,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,BCBS MGG,BCBS MGG,21863.268,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Cigna,Cigna,1257,,,,,,,per diem,1103,21863.268,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Cigna MGG,Cigna MGG,21863.268,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Humana,Humana,1400,,,,,,,per diem,1103,21863.268,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Humana MGG,Humana MGG,20770.1046,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Optum VA,Optum VA,21863.268,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,UHC,UHC,1400,,,,,,,per diem,1103,21863.268,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,UHC MGG,UHC MGG,21863.268,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,VA,VA,21863.268,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Wellcare MGG,Wellcare MGG,21863.268,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Bright Health - commercial,Bright Health - commercial,21863.268,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,21863.268,21863.268,Bright Health MGG,Bright Health MGG,21863.268,,,,,,,case rate,1103,21863.268,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Aetna,Aetna,1500,,,,,,,per diem,1103,19542.4218,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Aetna MGG,Aetna MGG,19542.4218,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,BCBS,BCBS,1103,,,,,,,per diem,1103,19542.4218,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,BCBS MGG,BCBS MGG,19542.4218,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Cigna,Cigna,1257,,,,,,,per diem,1103,19542.4218,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Cigna MGG,Cigna MGG,19542.4218,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Humana,Humana,1400,,,,,,,per diem,1103,19542.4218,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Humana MGG,Humana MGG,18565.30071,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Optum VA,Optum VA,19542.4218,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,UHC,UHC,1400,,,,,,,per diem,1103,19542.4218,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,UHC MGG,UHC MGG,19542.4218,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,VA,VA,19542.4218,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Wellcare MGG,Wellcare MGG,19542.4218,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Bright Health - commercial,Bright Health - commercial,19542.4218,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,19542.4218,19542.4218,Bright Health MGG,Bright Health MGG,19542.4218,,,,,,,case rate,1103,19542.4218,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Aetna,Aetna,1500,,,,,,,per diem,1103,22804.9038,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Aetna MGG,Aetna MGG,22804.9038,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,BCBS,BCBS,1103,,,,,,,per diem,1103,22804.9038,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,BCBS MGG,BCBS MGG,22804.9038,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Cigna,Cigna,1257,,,,,,,per diem,1103,22804.9038,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Cigna MGG,Cigna MGG,22804.9038,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Humana,Humana,1400,,,,,,,per diem,1103,22804.9038,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Humana MGG,Humana MGG,21664.65861,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Optum VA,Optum VA,22804.9038,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,UHC,UHC,1400,,,,,,,per diem,1103,22804.9038,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,UHC MGG,UHC MGG,22804.9038,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,VA,VA,22804.9038,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Wellcare MGG,Wellcare MGG,22804.9038,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Bright Health - commercial,Bright Health - commercial,22804.9038,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,22804.9038,22804.9038,Bright Health MGG,Bright Health MGG,22804.9038,,,,,,,case rate,1103,22804.9038,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Aetna,Aetna,1500,,,,,,,per diem,1103,32331.042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Aetna MGG,Aetna MGG,32331.042,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,BCBS,BCBS,1103,,,,,,,per diem,1103,32331.042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,BCBS MGG,BCBS MGG,32331.042,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Cigna,Cigna,1257,,,,,,,per diem,1103,32331.042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Cigna MGG,Cigna MGG,32331.042,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Humana,Humana,1400,,,,,,,per diem,1103,32331.042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Humana MGG,Humana MGG,30714.4899,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Optum VA,Optum VA,32331.042,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,UHC,UHC,1400,,,,,,,per diem,1103,32331.042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,UHC MGG,UHC MGG,32331.042,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,VA,VA,32331.042,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Wellcare MGG,Wellcare MGG,32331.042,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Bright Health - commercial,Bright Health - commercial,32331.042,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,32331.042,32331.042,Bright Health MGG,Bright Health MGG,32331.042,,,,,,,case rate,1103,32331.042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Aetna,Aetna,1500,,,,,,,per diem,1103,27230.1282,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Aetna MGG,Aetna MGG,27230.1282,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,BCBS,BCBS,1103,,,,,,,per diem,1103,27230.1282,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,BCBS MGG,BCBS MGG,27230.1282,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Cigna,Cigna,1257,,,,,,,per diem,1103,27230.1282,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Cigna MGG,Cigna MGG,27230.1282,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Humana,Humana,1400,,,,,,,per diem,1103,27230.1282,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Humana MGG,Humana MGG,25868.62179,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Optum VA,Optum VA,27230.1282,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,UHC,UHC,1400,,,,,,,per diem,1103,27230.1282,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,UHC MGG,UHC MGG,27230.1282,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,VA,VA,27230.1282,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Wellcare MGG,Wellcare MGG,27230.1282,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Bright Health - commercial,Bright Health - commercial,27230.1282,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,27230.1282,27230.1282,Bright Health MGG,Bright Health MGG,27230.1282,,,,,,,case rate,1103,27230.1282,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Aetna,Aetna,1500,,,,,,,per diem,1103,24340.2804,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Aetna MGG,Aetna MGG,24340.2804,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,BCBS,BCBS,1103,,,,,,,per diem,1103,24340.2804,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,BCBS MGG,BCBS MGG,24340.2804,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Cigna,Cigna,1257,,,,,,,per diem,1103,24340.2804,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Cigna MGG,Cigna MGG,24340.2804,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Humana,Humana,1400,,,,,,,per diem,1103,24340.2804,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Humana MGG,Humana MGG,23123.26638,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Optum VA,Optum VA,24340.2804,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,UHC,UHC,1400,,,,,,,per diem,1103,24340.2804,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,UHC MGG,UHC MGG,24340.2804,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,VA,VA,24340.2804,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Wellcare MGG,Wellcare MGG,24340.2804,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Bright Health - commercial,Bright Health - commercial,24340.2804,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,24340.2804,24340.2804,Bright Health MGG,Bright Health MGG,24340.2804,,,,,,,case rate,1103,24340.2804,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Aetna,Aetna,1500,,,,,,,per diem,1103,12499.4808,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Aetna MGG,Aetna MGG,12499.4808,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,BCBS,BCBS,1103,,,,,,,per diem,1103,12499.4808,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,BCBS MGG,BCBS MGG,12499.4808,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Cigna,Cigna,1257,,,,,,,per diem,1103,12499.4808,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Cigna MGG,Cigna MGG,12499.4808,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Humana,Humana,1400,,,,,,,per diem,1103,12499.4808,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Humana MGG,Humana MGG,11874.50676,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Optum VA,Optum VA,12499.4808,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,UHC,UHC,1400,,,,,,,per diem,1103,12499.4808,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,UHC MGG,UHC MGG,12499.4808,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,VA,VA,12499.4808,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Wellcare MGG,Wellcare MGG,12499.4808,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Bright Health - commercial,Bright Health - commercial,12499.4808,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,12499.4808,12499.4808,Bright Health MGG,Bright Health MGG,12499.4808,,,,,,,case rate,1103,12499.4808,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Aetna,Aetna,1500,,,,,,,per diem,1103,19149.687,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Aetna MGG,Aetna MGG,19149.687,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,BCBS,BCBS,1103,,,,,,,per diem,1103,19149.687,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,BCBS MGG,BCBS MGG,19149.687,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Cigna,Cigna,1257,,,,,,,per diem,1103,19149.687,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Cigna MGG,Cigna MGG,19149.687,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Humana,Humana,1400,,,,,,,per diem,1103,19149.687,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Humana MGG,Humana MGG,18192.20265,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Optum VA,Optum VA,19149.687,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,UHC,UHC,1400,,,,,,,per diem,1103,19149.687,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,UHC MGG,UHC MGG,19149.687,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,VA,VA,19149.687,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Wellcare MGG,Wellcare MGG,19149.687,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Bright Health - commercial,Bright Health - commercial,19149.687,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,19149.687,19149.687,Bright Health MGG,Bright Health MGG,19149.687,,,,,,,case rate,1103,19149.687,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Aetna,Aetna,1500,,,,,,,per diem,1103,14504.9022,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Aetna MGG,Aetna MGG,14504.9022,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,BCBS,BCBS,1103,,,,,,,per diem,1103,14504.9022,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,BCBS MGG,BCBS MGG,14504.9022,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Cigna,Cigna,1257,,,,,,,per diem,1103,14504.9022,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Cigna MGG,Cigna MGG,14504.9022,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Humana,Humana,1400,,,,,,,per diem,1103,14504.9022,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Humana MGG,Humana MGG,13779.65709,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Optum VA,Optum VA,14504.9022,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,UHC,UHC,1400,,,,,,,per diem,1103,14504.9022,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,UHC MGG,UHC MGG,14504.9022,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,VA,VA,14504.9022,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Wellcare MGG,Wellcare MGG,14504.9022,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Bright Health - commercial,Bright Health - commercial,14504.9022,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,14504.9022,14504.9022,Bright Health MGG,Bright Health MGG,14504.9022,,,,,,,case rate,1103,14504.9022,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Aetna,Aetna,1500,,,,,,,per diem,1103,13702.4244,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Aetna MGG,Aetna MGG,13702.4244,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,BCBS,BCBS,1103,,,,,,,per diem,1103,13702.4244,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,BCBS MGG,BCBS MGG,13702.4244,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Cigna,Cigna,1257,,,,,,,per diem,1103,13702.4244,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Cigna MGG,Cigna MGG,13702.4244,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Humana,Humana,1400,,,,,,,per diem,1103,13702.4244,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Humana MGG,Humana MGG,13017.30318,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Optum VA,Optum VA,13702.4244,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,UHC,UHC,1400,,,,,,,per diem,1103,13702.4244,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,UHC MGG,UHC MGG,13702.4244,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,VA,VA,13702.4244,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Wellcare MGG,Wellcare MGG,13702.4244,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Bright Health - commercial,Bright Health - commercial,13702.4244,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,13702.4244,13702.4244,Bright Health MGG,Bright Health MGG,13702.4244,,,,,,,case rate,1103,13702.4244,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Aetna,Aetna,1500,,,,,,,per diem,1103,15879.474,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Aetna MGG,Aetna MGG,15879.474,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,BCBS,BCBS,1103,,,,,,,per diem,1103,15879.474,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,BCBS MGG,BCBS MGG,15879.474,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Cigna,Cigna,1257,,,,,,,per diem,1103,15879.474,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Cigna MGG,Cigna MGG,15879.474,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Humana,Humana,1400,,,,,,,per diem,1103,15879.474,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Humana MGG,Humana MGG,15085.5003,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Optum VA,Optum VA,15879.474,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,UHC,UHC,1400,,,,,,,per diem,1103,15879.474,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,UHC MGG,UHC MGG,15879.474,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,VA,VA,15879.474,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Wellcare MGG,Wellcare MGG,15879.474,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Bright Health - commercial,Bright Health - commercial,15879.474,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,15879.474,15879.474,Bright Health MGG,Bright Health MGG,15879.474,,,,,,,case rate,1103,15879.474,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Aetna,Aetna,1500,,,,,,,per diem,1103,24326.3646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Aetna MGG,Aetna MGG,24326.3646,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,BCBS,BCBS,1103,,,,,,,per diem,1103,24326.3646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,BCBS MGG,BCBS MGG,24326.3646,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Cigna,Cigna,1257,,,,,,,per diem,1103,24326.3646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Cigna MGG,Cigna MGG,24326.3646,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Humana,Humana,1400,,,,,,,per diem,1103,24326.3646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Humana MGG,Humana MGG,23110.04637,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Optum VA,Optum VA,24326.3646,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,UHC,UHC,1400,,,,,,,per diem,1103,24326.3646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,UHC MGG,UHC MGG,24326.3646,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,VA,VA,24326.3646,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Wellcare MGG,Wellcare MGG,24326.3646,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Bright Health - commercial,Bright Health - commercial,24326.3646,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,24326.3646,24326.3646,Bright Health MGG,Bright Health MGG,24326.3646,,,,,,,case rate,1103,24326.3646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Aetna,Aetna,1500,,,,,,,per diem,1103,18426.0654,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Aetna MGG,Aetna MGG,18426.0654,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,BCBS,BCBS,1103,,,,,,,per diem,1103,18426.0654,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,BCBS MGG,BCBS MGG,18426.0654,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Cigna,Cigna,1257,,,,,,,per diem,1103,18426.0654,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Cigna MGG,Cigna MGG,18426.0654,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Humana,Humana,1400,,,,,,,per diem,1103,18426.0654,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Humana MGG,Humana MGG,17504.76213,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Optum VA,Optum VA,18426.0654,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,UHC,UHC,1400,,,,,,,per diem,1103,18426.0654,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,UHC MGG,UHC MGG,18426.0654,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,VA,VA,18426.0654,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Wellcare MGG,Wellcare MGG,18426.0654,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Bright Health - commercial,Bright Health - commercial,18426.0654,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,18426.0654,18426.0654,Bright Health MGG,Bright Health MGG,18426.0654,,,,,,,case rate,1103,18426.0654,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Aetna,Aetna,1500,,,,,,,per diem,1103,17405.5734,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Aetna MGG,Aetna MGG,17405.5734,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,BCBS,BCBS,1103,,,,,,,per diem,1103,17405.5734,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,BCBS MGG,BCBS MGG,17405.5734,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Cigna,Cigna,1257,,,,,,,per diem,1103,17405.5734,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Cigna MGG,Cigna MGG,17405.5734,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Humana,Humana,1400,,,,,,,per diem,1103,17405.5734,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Humana MGG,Humana MGG,16535.29473,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Optum VA,Optum VA,17405.5734,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,UHC,UHC,1400,,,,,,,per diem,1103,17405.5734,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,UHC MGG,UHC MGG,17405.5734,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,VA,VA,17405.5734,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Wellcare MGG,Wellcare MGG,17405.5734,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Bright Health - commercial,Bright Health - commercial,17405.5734,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,17405.5734,17405.5734,Bright Health MGG,Bright Health MGG,17405.5734,,,,,,,case rate,1103,17405.5734,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Aetna,Aetna,1500,,,,,,,per diem,1103,18843.5394,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Aetna MGG,Aetna MGG,18843.5394,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,BCBS,BCBS,1103,,,,,,,per diem,1103,18843.5394,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,BCBS MGG,BCBS MGG,18843.5394,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Cigna,Cigna,1257,,,,,,,per diem,1103,18843.5394,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Cigna MGG,Cigna MGG,18843.5394,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Humana,Humana,1400,,,,,,,per diem,1103,18843.5394,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Humana MGG,Humana MGG,17901.36243,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Optum VA,Optum VA,18843.5394,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,UHC,UHC,1400,,,,,,,per diem,1103,18843.5394,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,UHC MGG,UHC MGG,18843.5394,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,VA,VA,18843.5394,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Wellcare MGG,Wellcare MGG,18843.5394,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Bright Health - commercial,Bright Health - commercial,18843.5394,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,18843.5394,18843.5394,Bright Health MGG,Bright Health MGG,18843.5394,,,,,,,case rate,1103,18843.5394,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Aetna,Aetna,1500,,,,,,,per diem,1103,28867.554,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Aetna MGG,Aetna MGG,28867.554,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,BCBS,BCBS,1103,,,,,,,per diem,1103,28867.554,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,BCBS MGG,BCBS MGG,28867.554,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Cigna,Cigna,1257,,,,,,,per diem,1103,28867.554,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Cigna MGG,Cigna MGG,28867.554,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Humana,Humana,1400,,,,,,,per diem,1103,28867.554,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Humana MGG,Humana MGG,27424.1763,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Optum VA,Optum VA,28867.554,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,UHC,UHC,1400,,,,,,,per diem,1103,28867.554,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,UHC MGG,UHC MGG,28867.554,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,VA,VA,28867.554,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Wellcare MGG,Wellcare MGG,28867.554,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Bright Health - commercial,Bright Health - commercial,28867.554,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,28867.554,28867.554,Bright Health MGG,Bright Health MGG,28867.554,,,,,,,case rate,1103,28867.554,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Aetna,Aetna,1500,,,,,,,per diem,1103,21864.8142,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Aetna MGG,Aetna MGG,21864.8142,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,BCBS,BCBS,1103,,,,,,,per diem,1103,21864.8142,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,BCBS MGG,BCBS MGG,21864.8142,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Cigna,Cigna,1257,,,,,,,per diem,1103,21864.8142,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Cigna MGG,Cigna MGG,21864.8142,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Humana,Humana,1400,,,,,,,per diem,1103,21864.8142,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Humana MGG,Humana MGG,20771.57349,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Optum VA,Optum VA,21864.8142,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,UHC,UHC,1400,,,,,,,per diem,1103,21864.8142,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,UHC MGG,UHC MGG,21864.8142,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,VA,VA,21864.8142,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Wellcare MGG,Wellcare MGG,21864.8142,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Bright Health - commercial,Bright Health - commercial,21864.8142,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,21864.8142,21864.8142,Bright Health MGG,Bright Health MGG,21864.8142,,,,,,,case rate,1103,21864.8142,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Aetna,Aetna,1500,,,,,,,per diem,1103,20654.1396,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Aetna MGG,Aetna MGG,20654.1396,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,BCBS,BCBS,1103,,,,,,,per diem,1103,20654.1396,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,BCBS MGG,BCBS MGG,20654.1396,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Cigna,Cigna,1257,,,,,,,per diem,1103,20654.1396,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Cigna MGG,Cigna MGG,20654.1396,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Humana,Humana,1400,,,,,,,per diem,1103,20654.1396,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Humana MGG,Humana MGG,19621.43262,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Optum VA,Optum VA,20654.1396,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,UHC,UHC,1400,,,,,,,per diem,1103,20654.1396,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,UHC MGG,UHC MGG,20654.1396,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,VA,VA,20654.1396,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Wellcare MGG,Wellcare MGG,20654.1396,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Bright Health - commercial,Bright Health - commercial,20654.1396,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,20654.1396,20654.1396,Bright Health MGG,Bright Health MGG,20654.1396,,,,,,,case rate,1103,20654.1396,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Aetna,Aetna,1500,,,,,,,per diem,1103,22690.485,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Aetna MGG,Aetna MGG,22690.485,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,BCBS,BCBS,1103,,,,,,,per diem,1103,22690.485,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,BCBS MGG,BCBS MGG,22690.485,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Cigna,Cigna,1257,,,,,,,per diem,1103,22690.485,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Cigna MGG,Cigna MGG,22690.485,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Humana,Humana,1400,,,,,,,per diem,1103,22690.485,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Humana MGG,Humana MGG,21555.96075,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Optum VA,Optum VA,22690.485,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,UHC,UHC,1400,,,,,,,per diem,1103,22690.485,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,UHC MGG,UHC MGG,22690.485,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,VA,VA,22690.485,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Wellcare MGG,Wellcare MGG,22690.485,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Bright Health - commercial,Bright Health - commercial,22690.485,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,22690.485,22690.485,Bright Health MGG,Bright Health MGG,22690.485,,,,,,,case rate,1103,22690.485,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Aetna,Aetna,1500,,,,,,,per diem,1103,34761.6684,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Aetna MGG,Aetna MGG,34761.6684,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,BCBS,BCBS,1103,,,,,,,per diem,1103,34761.6684,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,BCBS MGG,BCBS MGG,34761.6684,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Cigna,Cigna,1257,,,,,,,per diem,1103,34761.6684,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Cigna MGG,Cigna MGG,34761.6684,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Humana,Humana,1400,,,,,,,per diem,1103,34761.6684,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Humana MGG,Humana MGG,33023.58498,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Optum VA,Optum VA,34761.6684,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,UHC,UHC,1400,,,,,,,per diem,1103,34761.6684,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,UHC MGG,UHC MGG,34761.6684,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,VA,VA,34761.6684,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Wellcare MGG,Wellcare MGG,34761.6684,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Bright Health - commercial,Bright Health - commercial,34761.6684,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,34761.6684,34761.6684,Bright Health MGG,Bright Health MGG,34761.6684,,,,,,,case rate,1103,34761.6684,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Aetna,Aetna,1500,,,,,,,per diem,1103,26330.2398,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Aetna MGG,Aetna MGG,26330.2398,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,BCBS,BCBS,1103,,,,,,,per diem,1103,26330.2398,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,BCBS MGG,BCBS MGG,26330.2398,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Cigna,Cigna,1257,,,,,,,per diem,1103,26330.2398,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Cigna MGG,Cigna MGG,26330.2398,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Humana,Humana,1400,,,,,,,per diem,1103,26330.2398,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Humana MGG,Humana MGG,25013.72781,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Optum VA,Optum VA,26330.2398,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,UHC,UHC,1400,,,,,,,per diem,1103,26330.2398,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,UHC MGG,UHC MGG,26330.2398,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,VA,VA,26330.2398,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Wellcare MGG,Wellcare MGG,26330.2398,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Bright Health - commercial,Bright Health - commercial,26330.2398,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,26330.2398,26330.2398,Bright Health MGG,Bright Health MGG,26330.2398,,,,,,,case rate,1103,26330.2398,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Aetna,Aetna,1500,,,,,,,per diem,1103,24872.1732,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Aetna MGG,Aetna MGG,24872.1732,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,BCBS,BCBS,1103,,,,,,,per diem,1103,24872.1732,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,BCBS MGG,BCBS MGG,24872.1732,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Cigna,Cigna,1257,,,,,,,per diem,1103,24872.1732,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Cigna MGG,Cigna MGG,24872.1732,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Humana,Humana,1400,,,,,,,per diem,1103,24872.1732,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Humana MGG,Humana MGG,23628.56454,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Optum VA,Optum VA,24872.1732,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,UHC,UHC,1400,,,,,,,per diem,1103,24872.1732,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,UHC MGG,UHC MGG,24872.1732,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,VA,VA,24872.1732,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Wellcare MGG,Wellcare MGG,24872.1732,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Bright Health - commercial,Bright Health - commercial,24872.1732,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,24872.1732,24872.1732,Bright Health MGG,Bright Health MGG,24872.1732,,,,,,,case rate,1103,24872.1732,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Aetna,Aetna,1500,,,,,,,per diem,1103,13305.051,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Aetna MGG,Aetna MGG,13305.051,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,BCBS,BCBS,1103,,,,,,,per diem,1103,13305.051,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,BCBS MGG,BCBS MGG,13305.051,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Cigna,Cigna,1257,,,,,,,per diem,1103,13305.051,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Cigna MGG,Cigna MGG,13305.051,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Humana,Humana,1400,,,,,,,per diem,1103,13305.051,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Humana MGG,Humana MGG,12639.79845,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Optum VA,Optum VA,13305.051,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,UHC,UHC,1400,,,,,,,per diem,1103,13305.051,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,UHC MGG,UHC MGG,13305.051,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,VA,VA,13305.051,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Wellcare MGG,Wellcare MGG,13305.051,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Bright Health - commercial,Bright Health - commercial,13305.051,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,13305.051,13305.051,Bright Health MGG,Bright Health MGG,13305.051,,,,,,,case rate,1103,13305.051,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Aetna,Aetna,1500,,,,,,,per diem,1103,19001.2518,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Aetna MGG,Aetna MGG,19001.2518,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,BCBS,BCBS,1103,,,,,,,per diem,1103,19001.2518,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,BCBS MGG,BCBS MGG,19001.2518,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Cigna,Cigna,1257,,,,,,,per diem,1103,19001.2518,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Cigna MGG,Cigna MGG,19001.2518,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Humana,Humana,1400,,,,,,,per diem,1103,19001.2518,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Humana MGG,Humana MGG,18051.18921,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Optum VA,Optum VA,19001.2518,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,UHC,UHC,1400,,,,,,,per diem,1103,19001.2518,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,UHC MGG,UHC MGG,19001.2518,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,VA,VA,19001.2518,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Wellcare MGG,Wellcare MGG,19001.2518,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Bright Health - commercial,Bright Health - commercial,19001.2518,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,19001.2518,19001.2518,Bright Health MGG,Bright Health MGG,19001.2518,,,,,,,case rate,1103,19001.2518,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Aetna,Aetna,1500,,,,,,,per diem,1103,15788.2482,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Aetna MGG,Aetna MGG,15788.2482,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,BCBS,BCBS,1103,,,,,,,per diem,1103,15788.2482,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,BCBS MGG,BCBS MGG,15788.2482,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Cigna,Cigna,1257,,,,,,,per diem,1103,15788.2482,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Cigna MGG,Cigna MGG,15788.2482,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Humana,Humana,1400,,,,,,,per diem,1103,15788.2482,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Humana MGG,Humana MGG,14998.83579,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Optum VA,Optum VA,15788.2482,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,UHC,UHC,1400,,,,,,,per diem,1103,15788.2482,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,UHC MGG,UHC MGG,15788.2482,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,VA,VA,15788.2482,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Wellcare MGG,Wellcare MGG,15788.2482,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Bright Health - commercial,Bright Health - commercial,15788.2482,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,15788.2482,15788.2482,Bright Health MGG,Bright Health MGG,15788.2482,,,,,,,case rate,1103,15788.2482,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Aetna,Aetna,1500,,,,,,,per diem,1103,14330.1816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Aetna MGG,Aetna MGG,14330.1816,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,BCBS,BCBS,1103,,,,,,,per diem,1103,14330.1816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,BCBS MGG,BCBS MGG,14330.1816,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Cigna,Cigna,1257,,,,,,,per diem,1103,14330.1816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Cigna MGG,Cigna MGG,14330.1816,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Humana,Humana,1400,,,,,,,per diem,1103,14330.1816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Humana MGG,Humana MGG,13613.67252,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Optum VA,Optum VA,14330.1816,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,UHC,UHC,1400,,,,,,,per diem,1103,14330.1816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,UHC MGG,UHC MGG,14330.1816,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,VA,VA,14330.1816,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Wellcare MGG,Wellcare MGG,14330.1816,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Bright Health - commercial,Bright Health - commercial,14330.1816,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,14330.1816,14330.1816,Bright Health MGG,Bright Health MGG,14330.1816,,,,,,,case rate,1103,14330.1816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Aetna,Aetna,1500,,,,,,,per diem,1103,16163.9748,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Aetna MGG,Aetna MGG,16163.9748,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,BCBS,BCBS,1103,,,,,,,per diem,1103,16163.9748,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,BCBS MGG,BCBS MGG,16163.9748,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Cigna,Cigna,1257,,,,,,,per diem,1103,16163.9748,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Cigna MGG,Cigna MGG,16163.9748,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Humana,Humana,1400,,,,,,,per diem,1103,16163.9748,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Humana MGG,Humana MGG,15355.77606,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Optum VA,Optum VA,16163.9748,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,UHC,UHC,1400,,,,,,,per diem,1103,16163.9748,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,UHC MGG,UHC MGG,16163.9748,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,VA,VA,16163.9748,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Wellcare MGG,Wellcare MGG,16163.9748,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Bright Health - commercial,Bright Health - commercial,16163.9748,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,16163.9748,16163.9748,Bright Health MGG,Bright Health MGG,16163.9748,,,,,,,case rate,1103,16163.9748,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Aetna,Aetna,1500,,,,,,,per diem,1103,23083.2198,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Aetna MGG,Aetna MGG,23083.2198,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,BCBS,BCBS,1103,,,,,,,per diem,1103,23083.2198,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,BCBS MGG,BCBS MGG,23083.2198,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Cigna,Cigna,1257,,,,,,,per diem,1103,23083.2198,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Cigna MGG,Cigna MGG,23083.2198,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Humana,Humana,1400,,,,,,,per diem,1103,23083.2198,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Humana MGG,Humana MGG,21929.05881,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Optum VA,Optum VA,23083.2198,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,UHC,UHC,1400,,,,,,,per diem,1103,23083.2198,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,UHC MGG,UHC MGG,23083.2198,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,VA,VA,23083.2198,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Wellcare MGG,Wellcare MGG,23083.2198,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Bright Health - commercial,Bright Health - commercial,23083.2198,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,23083.2198,23083.2198,Bright Health MGG,Bright Health MGG,23083.2198,,,,,,,case rate,1103,23083.2198,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Aetna,Aetna,1500,,,,,,,per diem,1103,19180.611,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Aetna MGG,Aetna MGG,19180.611,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,BCBS,BCBS,1103,,,,,,,per diem,1103,19180.611,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,BCBS MGG,BCBS MGG,19180.611,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Cigna,Cigna,1257,,,,,,,per diem,1103,19180.611,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Cigna MGG,Cigna MGG,19180.611,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Humana,Humana,1400,,,,,,,per diem,1103,19180.611,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Humana MGG,Humana MGG,18221.58045,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Optum VA,Optum VA,19180.611,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,UHC,UHC,1400,,,,,,,per diem,1103,19180.611,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,UHC MGG,UHC MGG,19180.611,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,VA,VA,19180.611,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Wellcare MGG,Wellcare MGG,19180.611,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Bright Health - commercial,Bright Health - commercial,19180.611,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,19180.611,19180.611,Bright Health MGG,Bright Health MGG,19180.611,,,,,,,case rate,1103,19180.611,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Aetna,Aetna,1500,,,,,,,per diem,1103,17408.6658,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Aetna MGG,Aetna MGG,17408.6658,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,BCBS,BCBS,1103,,,,,,,per diem,1103,17408.6658,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,BCBS MGG,BCBS MGG,17408.6658,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Cigna,Cigna,1257,,,,,,,per diem,1103,17408.6658,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Cigna MGG,Cigna MGG,17408.6658,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Humana,Humana,1400,,,,,,,per diem,1103,17408.6658,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Humana MGG,Humana MGG,16538.23251,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Optum VA,Optum VA,17408.6658,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,UHC,UHC,1400,,,,,,,per diem,1103,17408.6658,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,UHC MGG,UHC MGG,17408.6658,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,VA,VA,17408.6658,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Wellcare MGG,Wellcare MGG,17408.6658,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Bright Health - commercial,Bright Health - commercial,17408.6658,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,17408.6658,17408.6658,Bright Health MGG,Bright Health MGG,17408.6658,,,,,,,case rate,1103,17408.6658,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Aetna,Aetna,1500,,,,,,,per diem,1103,19237.8204,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Aetna MGG,Aetna MGG,19237.8204,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,BCBS,BCBS,1103,,,,,,,per diem,1103,19237.8204,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,BCBS MGG,BCBS MGG,19237.8204,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Cigna,Cigna,1257,,,,,,,per diem,1103,19237.8204,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Cigna MGG,Cigna MGG,19237.8204,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Humana,Humana,1400,,,,,,,per diem,1103,19237.8204,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Humana MGG,Humana MGG,18275.92938,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Optum VA,Optum VA,19237.8204,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,UHC,UHC,1400,,,,,,,per diem,1103,19237.8204,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,UHC MGG,UHC MGG,19237.8204,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,VA,VA,19237.8204,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Wellcare MGG,Wellcare MGG,19237.8204,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Bright Health - commercial,Bright Health - commercial,19237.8204,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,19237.8204,19237.8204,Bright Health MGG,Bright Health MGG,19237.8204,,,,,,,case rate,1103,19237.8204,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Aetna,Aetna,1500,,,,,,,per diem,1103,27472.8816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Aetna MGG,Aetna MGG,27472.8816,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,BCBS,BCBS,1103,,,,,,,per diem,1103,27472.8816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,BCBS MGG,BCBS MGG,27472.8816,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Cigna,Cigna,1257,,,,,,,per diem,1103,27472.8816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Cigna MGG,Cigna MGG,27472.8816,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Humana,Humana,1400,,,,,,,per diem,1103,27472.8816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Humana MGG,Humana MGG,26099.23752,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Optum VA,Optum VA,27472.8816,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,UHC,UHC,1400,,,,,,,per diem,1103,27472.8816,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,UHC MGG,UHC MGG,27472.8816,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,VA,VA,27472.8816,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Wellcare MGG,Wellcare MGG,27472.8816,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Bright Health - commercial,Bright Health - commercial,27472.8816,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,27472.8816,27472.8816,Bright Health MGG,Bright Health MGG,27472.8816,,,,,,,case rate,1103,27472.8816,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Aetna,Aetna,1500,,,,,,,per diem,1103,22828.0968,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Aetna MGG,Aetna MGG,22828.0968,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,BCBS,BCBS,1103,,,,,,,per diem,1103,22828.0968,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,BCBS MGG,BCBS MGG,22828.0968,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Cigna,Cigna,1257,,,,,,,per diem,1103,22828.0968,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Cigna MGG,Cigna MGG,22828.0968,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Humana,Humana,1400,,,,,,,per diem,1103,22828.0968,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Humana MGG,Humana MGG,21686.69196,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Optum VA,Optum VA,22828.0968,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,UHC,UHC,1400,,,,,,,per diem,1103,22828.0968,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,UHC MGG,UHC MGG,22828.0968,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,VA,VA,22828.0968,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Wellcare MGG,Wellcare MGG,22828.0968,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Bright Health - commercial,Bright Health - commercial,22828.0968,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,22828.0968,22828.0968,Bright Health MGG,Bright Health MGG,22828.0968,,,,,,,case rate,1103,22828.0968,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Aetna,Aetna,1500,,,,,,,per diem,1103,20719.08,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Aetna MGG,Aetna MGG,20719.08,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,BCBS,BCBS,1103,,,,,,,per diem,1103,20719.08,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,BCBS MGG,BCBS MGG,20719.08,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Cigna,Cigna,1257,,,,,,,per diem,1103,20719.08,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Cigna MGG,Cigna MGG,20719.08,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Humana,Humana,1400,,,,,,,per diem,1103,20719.08,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Humana MGG,Humana MGG,19683.126,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Optum VA,Optum VA,20719.08,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,UHC,UHC,1400,,,,,,,per diem,1103,20719.08,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,UHC MGG,UHC MGG,20719.08,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,VA,VA,20719.08,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Wellcare MGG,Wellcare MGG,20719.08,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Bright Health - commercial,Bright Health - commercial,20719.08,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,20719.08,20719.08,Bright Health MGG,Bright Health MGG,20719.08,,,,,,,case rate,1103,20719.08,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Aetna,Aetna,1500,,,,,,,per diem,1103,25589.61,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Aetna MGG,Aetna MGG,25589.61,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,BCBS,BCBS,1103,,,,,,,per diem,1103,25589.61,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,BCBS MGG,BCBS MGG,25589.61,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Cigna,Cigna,1257,,,,,,,per diem,1103,25589.61,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Cigna MGG,Cigna MGG,25589.61,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Humana,Humana,1400,,,,,,,per diem,1103,25589.61,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Humana MGG,Humana MGG,24310.1295,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Optum VA,Optum VA,25589.61,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,UHC,UHC,1400,,,,,,,per diem,1103,25589.61,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,UHC MGG,UHC MGG,25589.61,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,VA,VA,25589.61,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Wellcare MGG,Wellcare MGG,25589.61,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Bright Health - commercial,Bright Health - commercial,25589.61,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,25589.61,25589.61,Bright Health MGG,Bright Health MGG,25589.61,,,,,,,case rate,1103,25589.61,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Aetna,Aetna,1500,,,,,,,per diem,1103,36542.8908,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Aetna MGG,Aetna MGG,36542.8908,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,BCBS,BCBS,1103,,,,,,,per diem,1103,36542.8908,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,BCBS MGG,BCBS MGG,36542.8908,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Cigna,Cigna,1257,,,,,,,per diem,1103,36542.8908,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Cigna MGG,Cigna MGG,36542.8908,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Humana,Humana,1400,,,,,,,per diem,1103,36542.8908,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Humana MGG,Humana MGG,34715.74626,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Optum VA,Optum VA,36542.8908,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,UHC,UHC,1400,,,,,,,per diem,1103,36542.8908,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,UHC MGG,UHC MGG,36542.8908,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,VA,VA,36542.8908,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Wellcare MGG,Wellcare MGG,36542.8908,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Bright Health - commercial,Bright Health - commercial,36542.8908,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,36542.8908,36542.8908,Bright Health MGG,Bright Health MGG,36542.8908,,,,,,,case rate,1103,36542.8908,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Aetna,Aetna,1500,,,,,,,per diem,1103,30364.2756,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Aetna MGG,Aetna MGG,30364.2756,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,BCBS,BCBS,1103,,,,,,,per diem,1103,30364.2756,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,BCBS MGG,BCBS MGG,30364.2756,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Cigna,Cigna,1257,,,,,,,per diem,1103,30364.2756,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Cigna MGG,Cigna MGG,30364.2756,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Humana,Humana,1400,,,,,,,per diem,1103,30364.2756,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Humana MGG,Humana MGG,28846.06182,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Optum VA,Optum VA,30364.2756,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,UHC,UHC,1400,,,,,,,per diem,1103,30364.2756,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,UHC MGG,UHC MGG,30364.2756,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,VA,VA,30364.2756,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Wellcare MGG,Wellcare MGG,30364.2756,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Bright Health - commercial,Bright Health - commercial,30364.2756,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,30364.2756,30364.2756,Bright Health MGG,Bright Health MGG,30364.2756,,,,,,,case rate,1103,30364.2756,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Aetna,Aetna,1500,,,,,,,per diem,1103,27559.4688,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Aetna MGG,Aetna MGG,27559.4688,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,BCBS,BCBS,1103,,,,,,,per diem,1103,27559.4688,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,BCBS MGG,BCBS MGG,27559.4688,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Cigna,Cigna,1257,,,,,,,per diem,1103,27559.4688,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Cigna MGG,Cigna MGG,27559.4688,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Humana,Humana,1400,,,,,,,per diem,1103,27559.4688,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Humana MGG,Humana MGG,26181.49536,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Optum VA,Optum VA,27559.4688,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,UHC,UHC,1400,,,,,,,per diem,1103,27559.4688,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,UHC MGG,UHC MGG,27559.4688,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,VA,VA,27559.4688,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Wellcare MGG,Wellcare MGG,27559.4688,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Bright Health - commercial,Bright Health - commercial,27559.4688,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,27559.4688,27559.4688,Bright Health MGG,Bright Health MGG,27559.4688,,,,,,,case rate,1103,27559.4688,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Aetna,Aetna,1500,,,,,,,per diem,1103,14906.9142,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Aetna MGG,Aetna MGG,14906.9142,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,BCBS,BCBS,1103,,,,,,,per diem,1103,14906.9142,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,BCBS MGG,BCBS MGG,14906.9142,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Cigna,Cigna,1257,,,,,,,per diem,1103,14906.9142,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Cigna MGG,Cigna MGG,14906.9142,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Humana,Humana,1400,,,,,,,per diem,1103,14906.9142,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Humana MGG,Humana MGG,14161.56849,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Optum VA,Optum VA,14906.9142,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,UHC,UHC,1400,,,,,,,per diem,1103,14906.9142,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,UHC MGG,UHC MGG,14906.9142,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,VA,VA,14906.9142,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Wellcare MGG,Wellcare MGG,14906.9142,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Bright Health - commercial,Bright Health - commercial,14906.9142,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,14906.9142,14906.9142,Bright Health MGG,Bright Health MGG,14906.9142,,,,,,,case rate,1103,14906.9142,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Aetna,Aetna,1500,,,,,,,per diem,1103,20910.8088,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Aetna MGG,Aetna MGG,20910.8088,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,BCBS,BCBS,1103,,,,,,,per diem,1103,20910.8088,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,BCBS MGG,BCBS MGG,20910.8088,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Cigna,Cigna,1257,,,,,,,per diem,1103,20910.8088,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Cigna MGG,Cigna MGG,20910.8088,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Humana,Humana,1400,,,,,,,per diem,1103,20910.8088,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Humana MGG,Humana MGG,19865.26836,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Optum VA,Optum VA,20910.8088,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,UHC,UHC,1400,,,,,,,per diem,1103,20910.8088,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,UHC MGG,UHC MGG,20910.8088,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,VA,VA,20910.8088,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Wellcare MGG,Wellcare MGG,20910.8088,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Bright Health - commercial,Bright Health - commercial,20910.8088,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,20910.8088,20910.8088,Bright Health MGG,Bright Health MGG,20910.8088,,,,,,,case rate,1103,20910.8088,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Aetna,Aetna,1500,,,,,,,per diem,1103,19797.5448,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Aetna MGG,Aetna MGG,19797.5448,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,BCBS,BCBS,1103,,,,,,,per diem,1103,19797.5448,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,BCBS MGG,BCBS MGG,19797.5448,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Cigna,Cigna,1257,,,,,,,per diem,1103,19797.5448,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Cigna MGG,Cigna MGG,19797.5448,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Humana,Humana,1400,,,,,,,per diem,1103,19797.5448,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Humana MGG,Humana MGG,18807.66756,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Optum VA,Optum VA,19797.5448,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,UHC,UHC,1400,,,,,,,per diem,1103,19797.5448,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,UHC MGG,UHC MGG,19797.5448,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,VA,VA,19797.5448,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Wellcare MGG,Wellcare MGG,19797.5448,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Bright Health - commercial,Bright Health - commercial,19797.5448,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,19797.5448,19797.5448,Bright Health MGG,Bright Health MGG,19797.5448,,,,,,,case rate,1103,19797.5448,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Aetna,Aetna,1500,,,,,,,per diem,1103,17037.5778,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Aetna MGG,Aetna MGG,17037.5778,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,BCBS,BCBS,1103,,,,,,,per diem,1103,17037.5778,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,BCBS MGG,BCBS MGG,17037.5778,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Cigna,Cigna,1257,,,,,,,per diem,1103,17037.5778,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Cigna MGG,Cigna MGG,17037.5778,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Humana,Humana,1400,,,,,,,per diem,1103,17037.5778,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Humana MGG,Humana MGG,16185.69891,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Optum VA,Optum VA,17037.5778,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,UHC,UHC,1400,,,,,,,per diem,1103,17037.5778,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,UHC MGG,UHC MGG,17037.5778,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,VA,VA,17037.5778,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Wellcare MGG,Wellcare MGG,17037.5778,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Bright Health - commercial,Bright Health - commercial,17037.5778,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,17037.5778,17037.5778,Bright Health MGG,Bright Health MGG,17037.5778,,,,,,,case rate,1103,17037.5778,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Aetna,Aetna,1500,,,,,,,per diem,1103,17022.1158,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Aetna MGG,Aetna MGG,17022.1158,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,BCBS,BCBS,1103,,,,,,,per diem,1103,17022.1158,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,BCBS MGG,BCBS MGG,17022.1158,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Cigna,Cigna,1257,,,,,,,per diem,1103,17022.1158,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Cigna MGG,Cigna MGG,17022.1158,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Humana,Humana,1400,,,,,,,per diem,1103,17022.1158,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Humana MGG,Humana MGG,16171.01001,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Optum VA,Optum VA,17022.1158,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,UHC,UHC,1400,,,,,,,per diem,1103,17022.1158,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,UHC MGG,UHC MGG,17022.1158,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,VA,VA,17022.1158,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Wellcare MGG,Wellcare MGG,17022.1158,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Bright Health - commercial,Bright Health - commercial,17022.1158,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,17022.1158,17022.1158,Bright Health MGG,Bright Health MGG,17022.1158,,,,,,,case rate,1103,17022.1158,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Aetna,Aetna,1500,,,,,,,per diem,1103,23879.5128,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Aetna MGG,Aetna MGG,23879.5128,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,BCBS,BCBS,1103,,,,,,,per diem,1103,23879.5128,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,BCBS MGG,BCBS MGG,23879.5128,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Cigna,Cigna,1257,,,,,,,per diem,1103,23879.5128,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Cigna MGG,Cigna MGG,23879.5128,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Humana,Humana,1400,,,,,,,per diem,1103,23879.5128,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Humana MGG,Humana MGG,22685.53716,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Optum VA,Optum VA,23879.5128,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,UHC,UHC,1400,,,,,,,per diem,1103,23879.5128,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,UHC MGG,UHC MGG,23879.5128,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,VA,VA,23879.5128,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Wellcare MGG,Wellcare MGG,23879.5128,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Bright Health - commercial,Bright Health - commercial,23879.5128,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,23879.5128,23879.5128,Bright Health MGG,Bright Health MGG,23879.5128,,,,,,,case rate,1103,23879.5128,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Aetna,Aetna,1500,,,,,,,per diem,1103,22606.9902,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Aetna MGG,Aetna MGG,22606.9902,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,BCBS,BCBS,1103,,,,,,,per diem,1103,22606.9902,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,BCBS MGG,BCBS MGG,22606.9902,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Cigna,Cigna,1257,,,,,,,per diem,1103,22606.9902,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Cigna MGG,Cigna MGG,22606.9902,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Humana,Humana,1400,,,,,,,per diem,1103,22606.9902,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Humana MGG,Humana MGG,21476.64069,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Optum VA,Optum VA,22606.9902,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,UHC,UHC,1400,,,,,,,per diem,1103,22606.9902,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,UHC MGG,UHC MGG,22606.9902,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,VA,VA,22606.9902,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Wellcare MGG,Wellcare MGG,22606.9902,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Bright Health - commercial,Bright Health - commercial,22606.9902,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,22606.9902,22606.9902,Bright Health MGG,Bright Health MGG,22606.9902,,,,,,,case rate,1103,22606.9902,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Aetna,Aetna,1500,,,,,,,per diem,1103,19454.2884,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Aetna MGG,Aetna MGG,19454.2884,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,BCBS,BCBS,1103,,,,,,,per diem,1103,19454.2884,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,BCBS MGG,BCBS MGG,19454.2884,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Cigna,Cigna,1257,,,,,,,per diem,1103,19454.2884,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Cigna MGG,Cigna MGG,19454.2884,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Humana,Humana,1400,,,,,,,per diem,1103,19454.2884,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Humana MGG,Humana MGG,18481.57398,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Optum VA,Optum VA,19454.2884,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,UHC,UHC,1400,,,,,,,per diem,1103,19454.2884,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,UHC MGG,UHC MGG,19454.2884,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,VA,VA,19454.2884,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Wellcare MGG,Wellcare MGG,19454.2884,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Bright Health - commercial,Bright Health - commercial,19454.2884,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,19454.2884,19454.2884,Bright Health MGG,Bright Health MGG,19454.2884,,,,,,,case rate,1103,19454.2884,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Aetna,Aetna,1500,,,,,,,per diem,1103,21320.5518,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Aetna MGG,Aetna MGG,21320.5518,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,BCBS,BCBS,1103,,,,,,,per diem,1103,21320.5518,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,BCBS MGG,BCBS MGG,21320.5518,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Cigna,Cigna,1257,,,,,,,per diem,1103,21320.5518,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Cigna MGG,Cigna MGG,21320.5518,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Humana,Humana,1400,,,,,,,per diem,1103,21320.5518,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Humana MGG,Humana MGG,20254.52421,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Optum VA,Optum VA,21320.5518,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,UHC,UHC,1400,,,,,,,per diem,1103,21320.5518,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,UHC MGG,UHC MGG,21320.5518,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,VA,VA,21320.5518,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Wellcare MGG,Wellcare MGG,21320.5518,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Bright Health - commercial,Bright Health - commercial,21320.5518,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,21320.5518,21320.5518,Bright Health MGG,Bright Health MGG,21320.5518,,,,,,,case rate,1103,21320.5518,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Aetna,Aetna,1500,,,,,,,per diem,1103,29909.6928,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Aetna MGG,Aetna MGG,29909.6928,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,BCBS,BCBS,1103,,,,,,,per diem,1103,29909.6928,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,BCBS MGG,BCBS MGG,29909.6928,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Cigna,Cigna,1257,,,,,,,per diem,1103,29909.6928,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Cigna MGG,Cigna MGG,29909.6928,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Humana,Humana,1400,,,,,,,per diem,1103,29909.6928,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Humana MGG,Humana MGG,28414.20816,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Optum VA,Optum VA,29909.6928,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,UHC,UHC,1400,,,,,,,per diem,1103,29909.6928,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,UHC MGG,UHC MGG,29909.6928,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,VA,VA,29909.6928,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Wellcare MGG,Wellcare MGG,29909.6928,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Bright Health - commercial,Bright Health - commercial,29909.6928,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,29909.6928,29909.6928,Bright Health MGG,Bright Health MGG,29909.6928,,,,,,,case rate,1103,29909.6928,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Aetna,Aetna,1500,,,,,,,per diem,1103,28315.5606,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Aetna MGG,Aetna MGG,28315.5606,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,BCBS,BCBS,1103,,,,,,,per diem,1103,28315.5606,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,BCBS MGG,BCBS MGG,28315.5606,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Cigna,Cigna,1257,,,,,,,per diem,1103,28315.5606,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Cigna MGG,Cigna MGG,28315.5606,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Humana,Humana,1400,,,,,,,per diem,1103,28315.5606,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Humana MGG,Humana MGG,26899.78257,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Optum VA,Optum VA,28315.5606,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,UHC,UHC,1400,,,,,,,per diem,1103,28315.5606,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,UHC MGG,UHC MGG,28315.5606,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,VA,VA,28315.5606,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Wellcare MGG,Wellcare MGG,28315.5606,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Bright Health - commercial,Bright Health - commercial,28315.5606,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,28315.5606,28315.5606,Bright Health MGG,Bright Health MGG,28315.5606,,,,,,,case rate,1103,28315.5606,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Aetna,Aetna,1500,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Aetna MGG,Aetna MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,BCBS,BCBS,1103,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,BCBS MGG,BCBS MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Cigna,Cigna,1257,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Cigna MGG,Cigna MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Humana,Humana,1400,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Humana MGG,Humana MGG,23149.7064,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Optum VA,Optum VA,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,UHC,UHC,1400,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,UHC MGG,UHC MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,VA,VA,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Wellcare MGG,Wellcare MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Bright Health - commercial,Bright Health - commercial,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Bright Health MGG,Bright Health MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Aetna,Aetna,1500,,,,,,,per diem,1103,13455.0324,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Aetna MGG,Aetna MGG,13455.0324,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,BCBS,BCBS,1103,,,,,,,per diem,1103,13455.0324,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,BCBS MGG,BCBS MGG,13455.0324,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Cigna,Cigna,1257,,,,,,,per diem,1103,13455.0324,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Cigna MGG,Cigna MGG,13455.0324,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Humana,Humana,1400,,,,,,,per diem,1103,13455.0324,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Humana MGG,Humana MGG,12782.28078,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Optum VA,Optum VA,13455.0324,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,UHC,UHC,1400,,,,,,,per diem,1103,13455.0324,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,UHC MGG,UHC MGG,13455.0324,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,VA,VA,13455.0324,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Wellcare MGG,Wellcare MGG,13455.0324,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Bright Health - commercial,Bright Health - commercial,13455.0324,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,13455.0324,13455.0324,Bright Health MGG,Bright Health MGG,13455.0324,,,,,,,case rate,1103,13455.0324,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Aetna,Aetna,1500,,,,,,,per diem,1103,20482.5114,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Aetna MGG,Aetna MGG,20482.5114,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,BCBS,BCBS,1103,,,,,,,per diem,1103,20482.5114,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,BCBS MGG,BCBS MGG,20482.5114,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Cigna,Cigna,1257,,,,,,,per diem,1103,20482.5114,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Cigna MGG,Cigna MGG,20482.5114,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Humana,Humana,1400,,,,,,,per diem,1103,20482.5114,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Humana MGG,Humana MGG,19458.38583,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Optum VA,Optum VA,20482.5114,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,UHC,UHC,1400,,,,,,,per diem,1103,20482.5114,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,UHC MGG,UHC MGG,20482.5114,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,VA,VA,20482.5114,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Wellcare MGG,Wellcare MGG,20482.5114,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Bright Health - commercial,Bright Health - commercial,20482.5114,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,20482.5114,20482.5114,Bright Health MGG,Bright Health MGG,20482.5114,,,,,,,case rate,1103,20482.5114,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Aetna,Aetna,1500,,,,,,,per diem,1103,16256.7468,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Aetna MGG,Aetna MGG,16256.7468,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,BCBS,BCBS,1103,,,,,,,per diem,1103,16256.7468,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,BCBS MGG,BCBS MGG,16256.7468,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Cigna,Cigna,1257,,,,,,,per diem,1103,16256.7468,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Cigna MGG,Cigna MGG,16256.7468,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Humana,Humana,1400,,,,,,,per diem,1103,16256.7468,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Humana MGG,Humana MGG,15443.90946,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Optum VA,Optum VA,16256.7468,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,UHC,UHC,1400,,,,,,,per diem,1103,16256.7468,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,UHC MGG,UHC MGG,16256.7468,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,VA,VA,16256.7468,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Wellcare MGG,Wellcare MGG,16256.7468,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Bright Health - commercial,Bright Health - commercial,16256.7468,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,16256.7468,16256.7468,Bright Health MGG,Bright Health MGG,16256.7468,,,,,,,case rate,1103,16256.7468,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Aetna,Aetna,1500,,,,,,,per diem,1103,14528.0952,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Aetna MGG,Aetna MGG,14528.0952,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,BCBS,BCBS,1103,,,,,,,per diem,1103,14528.0952,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,BCBS MGG,BCBS MGG,14528.0952,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Cigna,Cigna,1257,,,,,,,per diem,1103,14528.0952,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Cigna MGG,Cigna MGG,14528.0952,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Humana,Humana,1400,,,,,,,per diem,1103,14528.0952,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Humana MGG,Humana MGG,13801.69044,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Optum VA,Optum VA,14528.0952,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,UHC,UHC,1400,,,,,,,per diem,1103,14528.0952,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,UHC MGG,UHC MGG,14528.0952,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,VA,VA,14528.0952,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Wellcare MGG,Wellcare MGG,14528.0952,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Bright Health - commercial,Bright Health - commercial,14528.0952,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,14528.0952,14528.0952,Bright Health MGG,Bright Health MGG,14528.0952,,,,,,,case rate,1103,14528.0952,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Aetna,Aetna,1500,,,,,,,per diem,1103,15819.1722,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Aetna MGG,Aetna MGG,15819.1722,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,BCBS,BCBS,1103,,,,,,,per diem,1103,15819.1722,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,BCBS MGG,BCBS MGG,15819.1722,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Cigna,Cigna,1257,,,,,,,per diem,1103,15819.1722,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Cigna MGG,Cigna MGG,15819.1722,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Humana,Humana,1400,,,,,,,per diem,1103,15819.1722,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Humana MGG,Humana MGG,15028.21359,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Optum VA,Optum VA,15819.1722,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,UHC,UHC,1400,,,,,,,per diem,1103,15819.1722,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,UHC MGG,UHC MGG,15819.1722,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,VA,VA,15819.1722,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Wellcare MGG,Wellcare MGG,15819.1722,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Bright Health - commercial,Bright Health - commercial,15819.1722,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,15819.1722,15819.1722,Bright Health MGG,Bright Health MGG,15819.1722,,,,,,,case rate,1103,15819.1722,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Aetna,Aetna,1500,,,,,,,per diem,1103,24083.6112,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Aetna MGG,Aetna MGG,24083.6112,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,BCBS,BCBS,1103,,,,,,,per diem,1103,24083.6112,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,BCBS MGG,BCBS MGG,24083.6112,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Cigna,Cigna,1257,,,,,,,per diem,1103,24083.6112,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Cigna MGG,Cigna MGG,24083.6112,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Humana,Humana,1400,,,,,,,per diem,1103,24083.6112,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Humana MGG,Humana MGG,22879.43064,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Optum VA,Optum VA,24083.6112,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,UHC,UHC,1400,,,,,,,per diem,1103,24083.6112,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,UHC MGG,UHC MGG,24083.6112,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,VA,VA,24083.6112,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Wellcare MGG,Wellcare MGG,24083.6112,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Bright Health - commercial,Bright Health - commercial,24083.6112,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,24083.6112,24083.6112,Bright Health MGG,Bright Health MGG,24083.6112,,,,,,,case rate,1103,24083.6112,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Aetna,Aetna,1500,,,,,,,per diem,1103,19114.1244,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Aetna MGG,Aetna MGG,19114.1244,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,BCBS,BCBS,1103,,,,,,,per diem,1103,19114.1244,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,BCBS MGG,BCBS MGG,19114.1244,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Cigna,Cigna,1257,,,,,,,per diem,1103,19114.1244,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Cigna MGG,Cigna MGG,19114.1244,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Humana,Humana,1400,,,,,,,per diem,1103,19114.1244,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Humana MGG,Humana MGG,18158.41818,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Optum VA,Optum VA,19114.1244,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,UHC,UHC,1400,,,,,,,per diem,1103,19114.1244,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,UHC MGG,UHC MGG,19114.1244,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,VA,VA,19114.1244,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Wellcare MGG,Wellcare MGG,19114.1244,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Bright Health - commercial,Bright Health - commercial,19114.1244,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,19114.1244,19114.1244,Bright Health MGG,Bright Health MGG,19114.1244,,,,,,,case rate,1103,19114.1244,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Aetna,Aetna,1500,,,,,,,per diem,1103,17080.8714,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Aetna MGG,Aetna MGG,17080.8714,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,BCBS,BCBS,1103,,,,,,,per diem,1103,17080.8714,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,BCBS MGG,BCBS MGG,17080.8714,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Cigna,Cigna,1257,,,,,,,per diem,1103,17080.8714,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Cigna MGG,Cigna MGG,17080.8714,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Humana,Humana,1400,,,,,,,per diem,1103,17080.8714,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Humana MGG,Humana MGG,16226.82783,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Optum VA,Optum VA,17080.8714,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,UHC,UHC,1400,,,,,,,per diem,1103,17080.8714,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,UHC MGG,UHC MGG,17080.8714,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,VA,VA,17080.8714,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Wellcare MGG,Wellcare MGG,17080.8714,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Bright Health - commercial,Bright Health - commercial,17080.8714,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,17080.8714,17080.8714,Bright Health MGG,Bright Health MGG,17080.8714,,,,,,,case rate,1103,17080.8714,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Aetna,Aetna,1500,,,,,,,per diem,1103,21176.7552,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Aetna MGG,Aetna MGG,21176.7552,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,BCBS,BCBS,1103,,,,,,,per diem,1103,21176.7552,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,BCBS MGG,BCBS MGG,21176.7552,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Cigna,Cigna,1257,,,,,,,per diem,1103,21176.7552,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Cigna MGG,Cigna MGG,21176.7552,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Humana,Humana,1400,,,,,,,per diem,1103,21176.7552,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Humana MGG,Humana MGG,20117.91744,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Optum VA,Optum VA,21176.7552,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,UHC,UHC,1400,,,,,,,per diem,1103,21176.7552,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,UHC MGG,UHC MGG,21176.7552,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,VA,VA,21176.7552,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Wellcare MGG,Wellcare MGG,21176.7552,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Bright Health - commercial,Bright Health - commercial,21176.7552,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,21176.7552,21176.7552,Bright Health MGG,Bright Health MGG,21176.7552,,,,,,,case rate,1103,21176.7552,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Aetna,Aetna,1500,,,,,,,per diem,1103,32238.27,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Aetna MGG,Aetna MGG,32238.27,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,BCBS,BCBS,1103,,,,,,,per diem,1103,32238.27,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,BCBS MGG,BCBS MGG,32238.27,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Cigna,Cigna,1257,,,,,,,per diem,1103,32238.27,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Cigna MGG,Cigna MGG,32238.27,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Humana,Humana,1400,,,,,,,per diem,1103,32238.27,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Humana MGG,Humana MGG,30626.3565,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Optum VA,Optum VA,32238.27,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,UHC,UHC,1400,,,,,,,per diem,1103,32238.27,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,UHC MGG,UHC MGG,32238.27,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,VA,VA,32238.27,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Wellcare MGG,Wellcare MGG,32238.27,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Bright Health - commercial,Bright Health - commercial,32238.27,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,32238.27,32238.27,Bright Health MGG,Bright Health MGG,32238.27,,,,,,,case rate,1103,32238.27,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Aetna,Aetna,1500,,,,,,,per diem,1103,25586.5176,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Aetna MGG,Aetna MGG,25586.5176,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,BCBS,BCBS,1103,,,,,,,per diem,1103,25586.5176,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,BCBS MGG,BCBS MGG,25586.5176,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Cigna,Cigna,1257,,,,,,,per diem,1103,25586.5176,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Cigna MGG,Cigna MGG,25586.5176,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Humana,Humana,1400,,,,,,,per diem,1103,25586.5176,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Humana MGG,Humana MGG,24307.19172,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Optum VA,Optum VA,25586.5176,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,UHC,UHC,1400,,,,,,,per diem,1103,25586.5176,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,UHC MGG,UHC MGG,25586.5176,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,VA,VA,25586.5176,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Wellcare MGG,Wellcare MGG,25586.5176,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Bright Health - commercial,Bright Health - commercial,25586.5176,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,25586.5176,25586.5176,Bright Health MGG,Bright Health MGG,25586.5176,,,,,,,case rate,1103,25586.5176,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Aetna,Aetna,1500,,,,,,,per diem,1103,22865.2056,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Aetna MGG,Aetna MGG,22865.2056,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,BCBS,BCBS,1103,,,,,,,per diem,1103,22865.2056,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,BCBS MGG,BCBS MGG,22865.2056,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Cigna,Cigna,1257,,,,,,,per diem,1103,22865.2056,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Cigna MGG,Cigna MGG,22865.2056,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Humana,Humana,1400,,,,,,,per diem,1103,22865.2056,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Humana MGG,Humana MGG,21721.94532,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Optum VA,Optum VA,22865.2056,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,UHC,UHC,1400,,,,,,,per diem,1103,22865.2056,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,UHC MGG,UHC MGG,22865.2056,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,VA,VA,22865.2056,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Wellcare MGG,Wellcare MGG,22865.2056,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Bright Health - commercial,Bright Health - commercial,22865.2056,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,22865.2056,22865.2056,Bright Health MGG,Bright Health MGG,22865.2056,,,,,,,case rate,1103,22865.2056,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Aetna,Aetna,1500,,,,,,,per diem,1103,21801.42,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Aetna MGG,Aetna MGG,21801.42,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,BCBS,BCBS,1103,,,,,,,per diem,1103,21801.42,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,BCBS MGG,BCBS MGG,21801.42,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Cigna,Cigna,1257,,,,,,,per diem,1103,21801.42,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Cigna MGG,Cigna MGG,21801.42,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Humana,Humana,1400,,,,,,,per diem,1103,21801.42,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Humana MGG,Humana MGG,20711.349,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Optum VA,Optum VA,21801.42,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,UHC,UHC,1400,,,,,,,per diem,1103,21801.42,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,UHC MGG,UHC MGG,21801.42,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,VA,VA,21801.42,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Wellcare MGG,Wellcare MGG,21801.42,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Bright Health - commercial,Bright Health - commercial,21801.42,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,21801.42,21801.42,Bright Health MGG,Bright Health MGG,21801.42,,,,,,,case rate,1103,21801.42,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Aetna,Aetna,1500,,,,,,,per diem,1103,33189.183,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Aetna MGG,Aetna MGG,33189.183,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,BCBS,BCBS,1103,,,,,,,per diem,1103,33189.183,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,BCBS MGG,BCBS MGG,33189.183,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Cigna,Cigna,1257,,,,,,,per diem,1103,33189.183,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Cigna MGG,Cigna MGG,33189.183,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Humana,Humana,1400,,,,,,,per diem,1103,33189.183,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Humana MGG,Humana MGG,31529.72385,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Optum VA,Optum VA,33189.183,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,UHC,UHC,1400,,,,,,,per diem,1103,33189.183,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,UHC MGG,UHC MGG,33189.183,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,VA,VA,33189.183,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Wellcare MGG,Wellcare MGG,33189.183,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Bright Health - commercial,Bright Health - commercial,33189.183,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,33189.183,33189.183,Bright Health MGG,Bright Health MGG,33189.183,,,,,,,case rate,1103,33189.183,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Aetna,Aetna,1500,,,,,,,per diem,1103,26342.6094,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Aetna MGG,Aetna MGG,26342.6094,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,BCBS,BCBS,1103,,,,,,,per diem,1103,26342.6094,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,BCBS MGG,BCBS MGG,26342.6094,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Cigna,Cigna,1257,,,,,,,per diem,1103,26342.6094,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Cigna MGG,Cigna MGG,26342.6094,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Humana,Humana,1400,,,,,,,per diem,1103,26342.6094,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Humana MGG,Humana MGG,25025.47893,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Optum VA,Optum VA,26342.6094,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,UHC,UHC,1400,,,,,,,per diem,1103,26342.6094,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,UHC MGG,UHC MGG,26342.6094,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,VA,VA,26342.6094,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Wellcare MGG,Wellcare MGG,26342.6094,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Bright Health - commercial,Bright Health - commercial,26342.6094,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,26342.6094,26342.6094,Bright Health MGG,Bright Health MGG,26342.6094,,,,,,,case rate,1103,26342.6094,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Aetna,Aetna,1500,,,,,,,per diem,1103,23540.895,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Aetna MGG,Aetna MGG,23540.895,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,BCBS,BCBS,1103,,,,,,,per diem,1103,23540.895,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,BCBS MGG,BCBS MGG,23540.895,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Cigna,Cigna,1257,,,,,,,per diem,1103,23540.895,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Cigna MGG,Cigna MGG,23540.895,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Humana,Humana,1400,,,,,,,per diem,1103,23540.895,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Humana MGG,Humana MGG,22363.85025,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Optum VA,Optum VA,23540.895,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,UHC,UHC,1400,,,,,,,per diem,1103,23540.895,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,UHC MGG,UHC MGG,23540.895,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,VA,VA,23540.895,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Wellcare MGG,Wellcare MGG,23540.895,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Bright Health - commercial,Bright Health - commercial,23540.895,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,23540.895,23540.895,Bright Health MGG,Bright Health MGG,23540.895,,,,,,,case rate,1103,23540.895,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Aetna,Aetna,1500,,,,,,,per diem,1103,12889.1232,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Aetna MGG,Aetna MGG,12889.1232,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,BCBS,BCBS,1103,,,,,,,per diem,1103,12889.1232,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,BCBS MGG,BCBS MGG,12889.1232,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Cigna,Cigna,1257,,,,,,,per diem,1103,12889.1232,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Cigna MGG,Cigna MGG,12889.1232,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Humana,Humana,1400,,,,,,,per diem,1103,12889.1232,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Humana MGG,Humana MGG,12244.66704,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Optum VA,Optum VA,12889.1232,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,UHC,UHC,1400,,,,,,,per diem,1103,12889.1232,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,UHC MGG,UHC MGG,12889.1232,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,VA,VA,12889.1232,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Wellcare MGG,Wellcare MGG,12889.1232,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Bright Health - commercial,Bright Health - commercial,12889.1232,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,12889.1232,12889.1232,Bright Health MGG,Bright Health MGG,12889.1232,,,,,,,case rate,1103,12889.1232,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Aetna,Aetna,1500,,,,,,,per diem,1103,19369.2474,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Aetna MGG,Aetna MGG,19369.2474,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,BCBS,BCBS,1103,,,,,,,per diem,1103,19369.2474,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,BCBS MGG,BCBS MGG,19369.2474,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Cigna,Cigna,1257,,,,,,,per diem,1103,19369.2474,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Cigna MGG,Cigna MGG,19369.2474,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Humana,Humana,1400,,,,,,,per diem,1103,19369.2474,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Humana MGG,Humana MGG,18400.78503,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Optum VA,Optum VA,19369.2474,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,UHC,UHC,1400,,,,,,,per diem,1103,19369.2474,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,UHC MGG,UHC MGG,19369.2474,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,VA,VA,19369.2474,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Wellcare MGG,Wellcare MGG,19369.2474,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Bright Health - commercial,Bright Health - commercial,19369.2474,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,19369.2474,19369.2474,Bright Health MGG,Bright Health MGG,19369.2474,,,,,,,case rate,1103,19369.2474,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Aetna,Aetna,1500,,,,,,,per diem,1103,15485.193,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Aetna MGG,Aetna MGG,15485.193,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,BCBS,BCBS,1103,,,,,,,per diem,1103,15485.193,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,BCBS MGG,BCBS MGG,15485.193,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Cigna,Cigna,1257,,,,,,,per diem,1103,15485.193,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Cigna MGG,Cigna MGG,15485.193,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Humana,Humana,1400,,,,,,,per diem,1103,15485.193,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Humana MGG,Humana MGG,14710.93335,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Optum VA,Optum VA,15485.193,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,UHC,UHC,1400,,,,,,,per diem,1103,15485.193,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,UHC MGG,UHC MGG,15485.193,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,VA,VA,15485.193,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Wellcare MGG,Wellcare MGG,15485.193,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Bright Health - commercial,Bright Health - commercial,15485.193,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,15485.193,15485.193,Bright Health MGG,Bright Health MGG,15485.193,,,,,,,case rate,1103,15485.193,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Aetna,Aetna,1500,,,,,,,per diem,1103,14187.9312,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Aetna MGG,Aetna MGG,14187.9312,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,BCBS,BCBS,1103,,,,,,,per diem,1103,14187.9312,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,BCBS MGG,BCBS MGG,14187.9312,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Cigna,Cigna,1257,,,,,,,per diem,1103,14187.9312,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Cigna MGG,Cigna MGG,14187.9312,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Humana,Humana,1400,,,,,,,per diem,1103,14187.9312,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Humana MGG,Humana MGG,13478.53464,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Optum VA,Optum VA,14187.9312,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,UHC,UHC,1400,,,,,,,per diem,1103,14187.9312,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,UHC MGG,UHC MGG,14187.9312,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,VA,VA,14187.9312,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Wellcare MGG,Wellcare MGG,14187.9312,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Bright Health - commercial,Bright Health - commercial,14187.9312,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,14187.9312,14187.9312,Bright Health MGG,Bright Health MGG,14187.9312,,,,,,,case rate,1103,14187.9312,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Aetna,Aetna,1500,,,,,,,per diem,1103,15803.7102,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Aetna MGG,Aetna MGG,15803.7102,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,BCBS,BCBS,1103,,,,,,,per diem,1103,15803.7102,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,BCBS MGG,BCBS MGG,15803.7102,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Cigna,Cigna,1257,,,,,,,per diem,1103,15803.7102,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Cigna MGG,Cigna MGG,15803.7102,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Humana,Humana,1400,,,,,,,per diem,1103,15803.7102,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Humana MGG,Humana MGG,15013.52469,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Optum VA,Optum VA,15803.7102,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,UHC,UHC,1400,,,,,,,per diem,1103,15803.7102,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,UHC MGG,UHC MGG,15803.7102,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,VA,VA,15803.7102,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Wellcare MGG,Wellcare MGG,15803.7102,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Bright Health - commercial,Bright Health - commercial,15803.7102,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,15803.7102,15803.7102,Bright Health MGG,Bright Health MGG,15803.7102,,,,,,,case rate,1103,15803.7102,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Aetna,Aetna,1500,,,,,,,per diem,1103,23749.632,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Aetna MGG,Aetna MGG,23749.632,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,BCBS,BCBS,1103,,,,,,,per diem,1103,23749.632,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,BCBS MGG,BCBS MGG,23749.632,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Cigna,Cigna,1257,,,,,,,per diem,1103,23749.632,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Cigna MGG,Cigna MGG,23749.632,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Humana,Humana,1400,,,,,,,per diem,1103,23749.632,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Humana MGG,Humana MGG,22562.1504,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Optum VA,Optum VA,23749.632,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,UHC,UHC,1400,,,,,,,per diem,1103,23749.632,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,UHC MGG,UHC MGG,23749.632,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,VA,VA,23749.632,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Wellcare MGG,Wellcare MGG,23749.632,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Bright Health - commercial,Bright Health - commercial,23749.632,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,23749.632,23749.632,Bright Health MGG,Bright Health MGG,23749.632,,,,,,,case rate,1103,23749.632,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Aetna,Aetna,1500,,,,,,,per diem,1103,18987.336,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Aetna MGG,Aetna MGG,18987.336,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,BCBS,BCBS,1103,,,,,,,per diem,1103,18987.336,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,BCBS MGG,BCBS MGG,18987.336,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Cigna,Cigna,1257,,,,,,,per diem,1103,18987.336,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Cigna MGG,Cigna MGG,18987.336,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Humana,Humana,1400,,,,,,,per diem,1103,18987.336,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Humana MGG,Humana MGG,18037.9692,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Optum VA,Optum VA,18987.336,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,UHC,UHC,1400,,,,,,,per diem,1103,18987.336,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,UHC MGG,UHC MGG,18987.336,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,VA,VA,18987.336,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Wellcare MGG,Wellcare MGG,18987.336,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Bright Health - commercial,Bright Health - commercial,18987.336,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,18987.336,18987.336,Bright Health MGG,Bright Health MGG,18987.336,,,,,,,case rate,1103,18987.336,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Aetna,Aetna,1500,,,,,,,per diem,1103,17397.8424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Aetna MGG,Aetna MGG,17397.8424,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,BCBS,BCBS,1103,,,,,,,per diem,1103,17397.8424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,BCBS MGG,BCBS MGG,17397.8424,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Cigna,Cigna,1257,,,,,,,per diem,1103,17397.8424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Cigna MGG,Cigna MGG,17397.8424,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Humana,Humana,1400,,,,,,,per diem,1103,17397.8424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Humana MGG,Humana MGG,16527.95028,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Optum VA,Optum VA,17397.8424,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,UHC,UHC,1400,,,,,,,per diem,1103,17397.8424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,UHC MGG,UHC MGG,17397.8424,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,VA,VA,17397.8424,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Wellcare MGG,Wellcare MGG,17397.8424,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Bright Health - commercial,Bright Health - commercial,17397.8424,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,17397.8424,17397.8424,Bright Health MGG,Bright Health MGG,17397.8424,,,,,,,case rate,1103,17397.8424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Aetna,Aetna,1500,,,,,,,per diem,1103,18263.7144,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Aetna MGG,Aetna MGG,18263.7144,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,BCBS,BCBS,1103,,,,,,,per diem,1103,18263.7144,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,BCBS MGG,BCBS MGG,18263.7144,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Cigna,Cigna,1257,,,,,,,per diem,1103,18263.7144,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Cigna MGG,Cigna MGG,18263.7144,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Humana,Humana,1400,,,,,,,per diem,1103,18263.7144,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Humana MGG,Humana MGG,17350.52868,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Optum VA,Optum VA,18263.7144,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,UHC,UHC,1400,,,,,,,per diem,1103,18263.7144,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,UHC MGG,UHC MGG,18263.7144,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,VA,VA,18263.7144,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Wellcare MGG,Wellcare MGG,18263.7144,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Bright Health - commercial,Bright Health - commercial,18263.7144,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,18263.7144,18263.7144,Bright Health MGG,Bright Health MGG,18263.7144,,,,,,,case rate,1103,18263.7144,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Aetna,Aetna,1500,,,,,,,per diem,1103,27448.1424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Aetna MGG,Aetna MGG,27448.1424,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,BCBS,BCBS,1103,,,,,,,per diem,1103,27448.1424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,BCBS MGG,BCBS MGG,27448.1424,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Cigna,Cigna,1257,,,,,,,per diem,1103,27448.1424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Cigna MGG,Cigna MGG,27448.1424,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Humana,Humana,1400,,,,,,,per diem,1103,27448.1424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Humana MGG,Humana MGG,26075.73528,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Optum VA,Optum VA,27448.1424,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,UHC,UHC,1400,,,,,,,per diem,1103,27448.1424,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,UHC MGG,UHC MGG,27448.1424,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,VA,VA,27448.1424,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Wellcare MGG,Wellcare MGG,27448.1424,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Bright Health - commercial,Bright Health - commercial,27448.1424,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,27448.1424,27448.1424,Bright Health MGG,Bright Health MGG,27448.1424,,,,,,,case rate,1103,27448.1424,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Aetna,Aetna,1500,,,,,,,per diem,1103,21943.6704,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Aetna MGG,Aetna MGG,21943.6704,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,BCBS,BCBS,1103,,,,,,,per diem,1103,21943.6704,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,BCBS MGG,BCBS MGG,21943.6704,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Cigna,Cigna,1257,,,,,,,per diem,1103,21943.6704,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Cigna MGG,Cigna MGG,21943.6704,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Humana,Humana,1400,,,,,,,per diem,1103,21943.6704,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Humana MGG,Humana MGG,20846.48688,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Optum VA,Optum VA,21943.6704,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,UHC,UHC,1400,,,,,,,per diem,1103,21943.6704,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,UHC MGG,UHC MGG,21943.6704,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,VA,VA,21943.6704,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Wellcare MGG,Wellcare MGG,21943.6704,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Bright Health - commercial,Bright Health - commercial,21943.6704,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,21943.6704,21943.6704,Bright Health MGG,Bright Health MGG,21943.6704,,,,,,,case rate,1103,21943.6704,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Aetna,Aetna,1500,,,,,,,per diem,1103,20106.7848,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Aetna MGG,Aetna MGG,20106.7848,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,BCBS,BCBS,1103,,,,,,,per diem,1103,20106.7848,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,BCBS MGG,BCBS MGG,20106.7848,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Cigna,Cigna,1257,,,,,,,per diem,1103,20106.7848,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Cigna MGG,Cigna MGG,20106.7848,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Humana,Humana,1400,,,,,,,per diem,1103,20106.7848,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Humana MGG,Humana MGG,19101.44556,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Optum VA,Optum VA,20106.7848,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,UHC,UHC,1400,,,,,,,per diem,1103,20106.7848,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,UHC MGG,UHC MGG,20106.7848,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,VA,VA,20106.7848,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Wellcare MGG,Wellcare MGG,20106.7848,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Bright Health - commercial,Bright Health - commercial,20106.7848,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,20106.7848,20106.7848,Bright Health MGG,Bright Health MGG,20106.7848,,,,,,,case rate,1103,20106.7848,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Aetna,Aetna,1500,,,,,,,per diem,1103,23573.3652,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Aetna MGG,Aetna MGG,23573.3652,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,BCBS,BCBS,1103,,,,,,,per diem,1103,23573.3652,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,BCBS MGG,BCBS MGG,23573.3652,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Cigna,Cigna,1257,,,,,,,per diem,1103,23573.3652,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Cigna MGG,Cigna MGG,23573.3652,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Humana,Humana,1400,,,,,,,per diem,1103,23573.3652,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Humana MGG,Humana MGG,22394.69694,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Optum VA,Optum VA,23573.3652,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,UHC,UHC,1400,,,,,,,per diem,1103,23573.3652,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,UHC MGG,UHC MGG,23573.3652,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,VA,VA,23573.3652,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Wellcare MGG,Wellcare MGG,23573.3652,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Bright Health - commercial,Bright Health - commercial,23573.3652,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,23573.3652,23573.3652,Bright Health MGG,Bright Health MGG,23573.3652,,,,,,,case rate,1103,23573.3652,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Aetna,Aetna,1500,,,,,,,per diem,1103,35426.5344,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Aetna MGG,Aetna MGG,35426.5344,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,BCBS,BCBS,1103,,,,,,,per diem,1103,35426.5344,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,BCBS MGG,BCBS MGG,35426.5344,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Cigna,Cigna,1257,,,,,,,per diem,1103,35426.5344,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Cigna MGG,Cigna MGG,35426.5344,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Humana,Humana,1400,,,,,,,per diem,1103,35426.5344,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Humana MGG,Humana MGG,33655.20768,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Optum VA,Optum VA,35426.5344,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,UHC,UHC,1400,,,,,,,per diem,1103,35426.5344,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,UHC MGG,UHC MGG,35426.5344,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,VA,VA,35426.5344,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Wellcare MGG,Wellcare MGG,35426.5344,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Bright Health - commercial,Bright Health - commercial,35426.5344,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,35426.5344,35426.5344,Bright Health MGG,Bright Health MGG,35426.5344,,,,,,,case rate,1103,35426.5344,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Aetna,Aetna,1500,,,,,,,per diem,1103,28323.2916,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Aetna MGG,Aetna MGG,28323.2916,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,BCBS,BCBS,1103,,,,,,,per diem,1103,28323.2916,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,BCBS MGG,BCBS MGG,28323.2916,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Cigna,Cigna,1257,,,,,,,per diem,1103,28323.2916,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Cigna MGG,Cigna MGG,28323.2916,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Humana,Humana,1400,,,,,,,per diem,1103,28323.2916,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Humana MGG,Humana MGG,26907.12702,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Optum VA,Optum VA,28323.2916,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,UHC,UHC,1400,,,,,,,per diem,1103,28323.2916,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,UHC MGG,UHC MGG,28323.2916,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,VA,VA,28323.2916,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Wellcare MGG,Wellcare MGG,28323.2916,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Bright Health - commercial,Bright Health - commercial,28323.2916,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,28323.2916,28323.2916,Bright Health MGG,Bright Health MGG,28323.2916,,,,,,,case rate,1103,28323.2916,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Aetna,Aetna,1500,,,,,,,per diem,1103,25951.4208,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Aetna MGG,Aetna MGG,25951.4208,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,BCBS,BCBS,1103,,,,,,,per diem,1103,25951.4208,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,BCBS MGG,BCBS MGG,25951.4208,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Cigna,Cigna,1257,,,,,,,per diem,1103,25951.4208,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Cigna MGG,Cigna MGG,25951.4208,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Humana,Humana,1400,,,,,,,per diem,1103,25951.4208,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Humana MGG,Humana MGG,24653.84976,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Optum VA,Optum VA,25951.4208,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,UHC,UHC,1400,,,,,,,per diem,1103,25951.4208,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,UHC MGG,UHC MGG,25951.4208,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,VA,VA,25951.4208,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Wellcare MGG,Wellcare MGG,25951.4208,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Bright Health - commercial,Bright Health - commercial,25951.4208,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,25951.4208,25951.4208,Bright Health MGG,Bright Health MGG,25951.4208,,,,,,,case rate,1103,25951.4208,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Aetna,Aetna,1500,,,,,,,per diem,1103,23526.9792,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Aetna MGG,Aetna MGG,23526.9792,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,BCBS,BCBS,1103,,,,,,,per diem,1103,23526.9792,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,BCBS MGG,BCBS MGG,23526.9792,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Cigna,Cigna,1257,,,,,,,per diem,1103,23526.9792,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Cigna MGG,Cigna MGG,23526.9792,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Humana,Humana,1400,,,,,,,per diem,1103,23526.9792,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Humana MGG,Humana MGG,22350.63024,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Optum VA,Optum VA,23526.9792,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,UHC,UHC,1400,,,,,,,per diem,1103,23526.9792,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,UHC MGG,UHC MGG,23526.9792,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,VA,VA,23526.9792,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Wellcare MGG,Wellcare MGG,23526.9792,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Bright Health - commercial,Bright Health - commercial,23526.9792,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,23526.9792,23526.9792,Bright Health MGG,Bright Health MGG,23526.9792,,,,,,,case rate,1103,23526.9792,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Aetna,Aetna,1500,,,,,,,per diem,1103,35356.9554,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Aetna MGG,Aetna MGG,35356.9554,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,BCBS,BCBS,1103,,,,,,,per diem,1103,35356.9554,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,BCBS MGG,BCBS MGG,35356.9554,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Cigna,Cigna,1257,,,,,,,per diem,1103,35356.9554,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Cigna MGG,Cigna MGG,35356.9554,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Humana,Humana,1400,,,,,,,per diem,1103,35356.9554,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Humana MGG,Humana MGG,33589.10763,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Optum VA,Optum VA,35356.9554,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,UHC,UHC,1400,,,,,,,per diem,1103,35356.9554,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,UHC MGG,UHC MGG,35356.9554,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,VA,VA,35356.9554,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Wellcare MGG,Wellcare MGG,35356.9554,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Bright Health - commercial,Bright Health - commercial,35356.9554,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,35356.9554,35356.9554,Bright Health MGG,Bright Health MGG,35356.9554,,,,,,,case rate,1103,35356.9554,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Aetna,Aetna,1500,,,,,,,per diem,1103,28266.0822,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Aetna MGG,Aetna MGG,28266.0822,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,BCBS,BCBS,1103,,,,,,,per diem,1103,28266.0822,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,BCBS MGG,BCBS MGG,28266.0822,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Cigna,Cigna,1257,,,,,,,per diem,1103,28266.0822,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Cigna MGG,Cigna MGG,28266.0822,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Humana,Humana,1400,,,,,,,per diem,1103,28266.0822,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Humana MGG,Humana MGG,26852.77809,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Optum VA,Optum VA,28266.0822,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,UHC,UHC,1400,,,,,,,per diem,1103,28266.0822,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,UHC MGG,UHC MGG,28266.0822,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,VA,VA,28266.0822,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Wellcare MGG,Wellcare MGG,28266.0822,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Bright Health - commercial,Bright Health - commercial,28266.0822,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,28266.0822,28266.0822,Bright Health MGG,Bright Health MGG,28266.0822,,,,,,,case rate,1103,28266.0822,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Aetna,Aetna,1500,,,,,,,per diem,1103,25898.85,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Aetna MGG,Aetna MGG,25898.85,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,BCBS,BCBS,1103,,,,,,,per diem,1103,25898.85,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,BCBS MGG,BCBS MGG,25898.85,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Cigna,Cigna,1257,,,,,,,per diem,1103,25898.85,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Cigna MGG,Cigna MGG,25898.85,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Humana,Humana,1400,,,,,,,per diem,1103,25898.85,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Humana MGG,Humana MGG,24603.9075,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Optum VA,Optum VA,25898.85,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,UHC,UHC,1400,,,,,,,per diem,1103,25898.85,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,UHC MGG,UHC MGG,25898.85,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,VA,VA,25898.85,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Wellcare MGG,Wellcare MGG,25898.85,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Bright Health - commercial,Bright Health - commercial,25898.85,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,25898.85,25898.85,Bright Health MGG,Bright Health MGG,25898.85,,,,,,,case rate,1103,25898.85,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Aetna,Aetna,1500,,,,,,,per diem,1103,11834.6148,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Aetna MGG,Aetna MGG,11834.6148,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,BCBS,BCBS,1103,,,,,,,per diem,1103,11834.6148,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,BCBS MGG,BCBS MGG,11834.6148,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Cigna,Cigna,1257,,,,,,,per diem,1103,11834.6148,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Cigna MGG,Cigna MGG,11834.6148,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Humana,Humana,1400,,,,,,,per diem,1103,11834.6148,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Humana MGG,Humana MGG,11242.88406,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Optum VA,Optum VA,11834.6148,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,UHC,UHC,1400,,,,,,,per diem,1103,11834.6148,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,UHC MGG,UHC MGG,11834.6148,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,VA,VA,11834.6148,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Wellcare MGG,Wellcare MGG,11834.6148,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Bright Health - commercial,Bright Health - commercial,11834.6148,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,11834.6148,11834.6148,Bright Health MGG,Bright Health MGG,11834.6148,,,,,,,case rate,1103,11834.6148,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Aetna,Aetna,1500,,,,,,,per diem,1103,17278.785,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Aetna MGG,Aetna MGG,17278.785,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,BCBS,BCBS,1103,,,,,,,per diem,1103,17278.785,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,BCBS MGG,BCBS MGG,17278.785,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Cigna,Cigna,1257,,,,,,,per diem,1103,17278.785,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Cigna MGG,Cigna MGG,17278.785,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Humana,Humana,1400,,,,,,,per diem,1103,17278.785,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Humana MGG,Humana MGG,16414.84575,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Optum VA,Optum VA,17278.785,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,UHC,UHC,1400,,,,,,,per diem,1103,17278.785,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,UHC MGG,UHC MGG,17278.785,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,VA,VA,17278.785,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Wellcare MGG,Wellcare MGG,17278.785,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Bright Health - commercial,Bright Health - commercial,17278.785,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,17278.785,17278.785,Bright Health MGG,Bright Health MGG,17278.785,,,,,,,case rate,1103,17278.785,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Aetna,Aetna,1500,,,,,,,per diem,1103,13918.8924,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Aetna MGG,Aetna MGG,13918.8924,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,BCBS,BCBS,1103,,,,,,,per diem,1103,13918.8924,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,BCBS MGG,BCBS MGG,13918.8924,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Cigna,Cigna,1257,,,,,,,per diem,1103,13918.8924,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Cigna MGG,Cigna MGG,13918.8924,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Humana,Humana,1400,,,,,,,per diem,1103,13918.8924,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Humana MGG,Humana MGG,13222.94778,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Optum VA,Optum VA,13918.8924,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,UHC,UHC,1400,,,,,,,per diem,1103,13918.8924,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,UHC MGG,UHC MGG,13918.8924,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,VA,VA,13918.8924,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Wellcare MGG,Wellcare MGG,13918.8924,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Bright Health - commercial,Bright Health - commercial,13918.8924,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,13918.8924,13918.8924,Bright Health MGG,Bright Health MGG,13918.8924,,,,,,,case rate,1103,13918.8924,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Aetna,Aetna,1500,,,,,,,per diem,1103,12869.0226,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Aetna MGG,Aetna MGG,12869.0226,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,BCBS,BCBS,1103,,,,,,,per diem,1103,12869.0226,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,BCBS MGG,BCBS MGG,12869.0226,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Cigna,Cigna,1257,,,,,,,per diem,1103,12869.0226,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Cigna MGG,Cigna MGG,12869.0226,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Humana,Humana,1400,,,,,,,per diem,1103,12869.0226,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Humana MGG,Humana MGG,12225.57147,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Optum VA,Optum VA,12869.0226,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,UHC,UHC,1400,,,,,,,per diem,1103,12869.0226,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,UHC MGG,UHC MGG,12869.0226,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,VA,VA,12869.0226,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Wellcare MGG,Wellcare MGG,12869.0226,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Bright Health - commercial,Bright Health - commercial,12869.0226,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,12869.0226,12869.0226,Bright Health MGG,Bright Health MGG,12869.0226,,,,,,,case rate,1103,12869.0226,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Aetna,Aetna,1500,,,,,,,per diem,1103,15076.9962,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Aetna MGG,Aetna MGG,15076.9962,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,BCBS,BCBS,1103,,,,,,,per diem,1103,15076.9962,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,BCBS MGG,BCBS MGG,15076.9962,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Cigna,Cigna,1257,,,,,,,per diem,1103,15076.9962,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Cigna MGG,Cigna MGG,15076.9962,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Humana,Humana,1400,,,,,,,per diem,1103,15076.9962,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Humana MGG,Humana MGG,14323.14639,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Optum VA,Optum VA,15076.9962,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,UHC,UHC,1400,,,,,,,per diem,1103,15076.9962,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,UHC MGG,UHC MGG,15076.9962,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,VA,VA,15076.9962,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Wellcare MGG,Wellcare MGG,15076.9962,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Bright Health - commercial,Bright Health - commercial,15076.9962,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,15076.9962,15076.9962,Bright Health MGG,Bright Health MGG,15076.9962,,,,,,,case rate,1103,15076.9962,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Aetna,Aetna,1500,,,,,,,per diem,1103,22011.7032,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Aetna MGG,Aetna MGG,22011.7032,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,BCBS,BCBS,1103,,,,,,,per diem,1103,22011.7032,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,BCBS MGG,BCBS MGG,22011.7032,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Cigna,Cigna,1257,,,,,,,per diem,1103,22011.7032,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Cigna MGG,Cigna MGG,22011.7032,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Humana,Humana,1400,,,,,,,per diem,1103,22011.7032,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Humana MGG,Humana MGG,20911.11804,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Optum VA,Optum VA,22011.7032,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,UHC,UHC,1400,,,,,,,per diem,1103,22011.7032,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,UHC MGG,UHC MGG,22011.7032,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,VA,VA,22011.7032,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Wellcare MGG,Wellcare MGG,22011.7032,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Bright Health - commercial,Bright Health - commercial,22011.7032,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,22011.7032,22011.7032,Bright Health MGG,Bright Health MGG,22011.7032,,,,,,,case rate,1103,22011.7032,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Aetna,Aetna,1500,,,,,,,per diem,1103,17731.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Aetna MGG,Aetna MGG,17731.8216,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,BCBS,BCBS,1103,,,,,,,per diem,1103,17731.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,BCBS MGG,BCBS MGG,17731.8216,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Cigna,Cigna,1257,,,,,,,per diem,1103,17731.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Cigna MGG,Cigna MGG,17731.8216,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Humana,Humana,1400,,,,,,,per diem,1103,17731.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Humana MGG,Humana MGG,16845.23052,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Optum VA,Optum VA,17731.8216,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,UHC,UHC,1400,,,,,,,per diem,1103,17731.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,UHC MGG,UHC MGG,17731.8216,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,VA,VA,17731.8216,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Wellcare MGG,Wellcare MGG,17731.8216,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Bright Health - commercial,Bright Health - commercial,17731.8216,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,17731.8216,17731.8216,Bright Health MGG,Bright Health MGG,17731.8216,,,,,,,case rate,1103,17731.8216,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Aetna,Aetna,1500,,,,,,,per diem,1103,16394.3586,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Aetna MGG,Aetna MGG,16394.3586,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,BCBS,BCBS,1103,,,,,,,per diem,1103,16394.3586,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,BCBS MGG,BCBS MGG,16394.3586,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Cigna,Cigna,1257,,,,,,,per diem,1103,16394.3586,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Cigna MGG,Cigna MGG,16394.3586,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Humana,Humana,1400,,,,,,,per diem,1103,16394.3586,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Humana MGG,Humana MGG,15574.64067,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Optum VA,Optum VA,16394.3586,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,UHC,UHC,1400,,,,,,,per diem,1103,16394.3586,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,UHC MGG,UHC MGG,16394.3586,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,VA,VA,16394.3586,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Wellcare MGG,Wellcare MGG,16394.3586,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Bright Health - commercial,Bright Health - commercial,16394.3586,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,16394.3586,16394.3586,Bright Health MGG,Bright Health MGG,16394.3586,,,,,,,case rate,1103,16394.3586,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Aetna,Aetna,1500,,,,,,,per diem,1103,18223.5132,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Aetna MGG,Aetna MGG,18223.5132,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,BCBS,BCBS,1103,,,,,,,per diem,1103,18223.5132,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,BCBS MGG,BCBS MGG,18223.5132,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Cigna,Cigna,1257,,,,,,,per diem,1103,18223.5132,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Cigna MGG,Cigna MGG,18223.5132,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Humana,Humana,1400,,,,,,,per diem,1103,18223.5132,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Humana MGG,Humana MGG,17312.33754,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Optum VA,Optum VA,18223.5132,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,UHC,UHC,1400,,,,,,,per diem,1103,18223.5132,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,UHC MGG,UHC MGG,18223.5132,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,VA,VA,18223.5132,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Wellcare MGG,Wellcare MGG,18223.5132,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Bright Health - commercial,Bright Health - commercial,18223.5132,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,18223.5132,18223.5132,Bright Health MGG,Bright Health MGG,18223.5132,,,,,,,case rate,1103,18223.5132,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Aetna,Aetna,1500,,,,,,,per diem,1103,26605.4634,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Aetna MGG,Aetna MGG,26605.4634,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,BCBS,BCBS,1103,,,,,,,per diem,1103,26605.4634,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,BCBS MGG,BCBS MGG,26605.4634,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Cigna,Cigna,1257,,,,,,,per diem,1103,26605.4634,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Cigna MGG,Cigna MGG,26605.4634,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Humana,Humana,1400,,,,,,,per diem,1103,26605.4634,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Humana MGG,Humana MGG,25275.19023,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Optum VA,Optum VA,26605.4634,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,UHC,UHC,1400,,,,,,,per diem,1103,26605.4634,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,UHC MGG,UHC MGG,26605.4634,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,VA,VA,26605.4634,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Wellcare MGG,Wellcare MGG,26605.4634,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Bright Health - commercial,Bright Health - commercial,26605.4634,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,26605.4634,26605.4634,Bright Health MGG,Bright Health MGG,26605.4634,,,,,,,case rate,1103,26605.4634,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Aetna,Aetna,1500,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Aetna MGG,Aetna MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,BCBS,BCBS,1103,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,BCBS MGG,BCBS MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Cigna,Cigna,1257,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Cigna MGG,Cigna MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Humana,Humana,1400,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Humana MGG,Humana MGG,20360.28429,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Optum VA,Optum VA,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,UHC,UHC,1400,,,,,,,per diem,1103,21431.8782,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,UHC MGG,UHC MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,VA,VA,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Wellcare MGG,Wellcare MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Bright Health - commercial,Bright Health - commercial,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,21431.8782,21431.8782,Bright Health MGG,Bright Health MGG,21431.8782,,,,,,,case rate,1103,21431.8782,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Aetna,Aetna,1500,,,,,,,per diem,1103,19816.0992,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Aetna MGG,Aetna MGG,19816.0992,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,BCBS,BCBS,1103,,,,,,,per diem,1103,19816.0992,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,BCBS MGG,BCBS MGG,19816.0992,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Cigna,Cigna,1257,,,,,,,per diem,1103,19816.0992,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Cigna MGG,Cigna MGG,19816.0992,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Humana,Humana,1400,,,,,,,per diem,1103,19816.0992,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Humana MGG,Humana MGG,18825.29424,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Optum VA,Optum VA,19816.0992,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,UHC,UHC,1400,,,,,,,per diem,1103,19816.0992,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,UHC MGG,UHC MGG,19816.0992,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,VA,VA,19816.0992,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Wellcare MGG,Wellcare MGG,19816.0992,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Bright Health - commercial,Bright Health - commercial,19816.0992,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,19816.0992,19816.0992,Bright Health MGG,Bright Health MGG,19816.0992,,,,,,,case rate,1103,19816.0992,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Aetna,Aetna,1500,,,,,,,per diem,1103,22736.871,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Aetna MGG,Aetna MGG,22736.871,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,BCBS,BCBS,1103,,,,,,,per diem,1103,22736.871,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,BCBS MGG,BCBS MGG,22736.871,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Cigna,Cigna,1257,,,,,,,per diem,1103,22736.871,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Cigna MGG,Cigna MGG,22736.871,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Humana,Humana,1400,,,,,,,per diem,1103,22736.871,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Humana MGG,Humana MGG,21600.02745,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Optum VA,Optum VA,22736.871,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,UHC,UHC,1400,,,,,,,per diem,1103,22736.871,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,UHC MGG,UHC MGG,22736.871,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,VA,VA,22736.871,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Wellcare MGG,Wellcare MGG,22736.871,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Bright Health - commercial,Bright Health - commercial,22736.871,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,22736.871,22736.871,Bright Health MGG,Bright Health MGG,22736.871,,,,,,,case rate,1103,22736.871,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Aetna,Aetna,1500,,,,,,,per diem,1103,33193.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Aetna MGG,Aetna MGG,33193.8216,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,BCBS,BCBS,1103,,,,,,,per diem,1103,33193.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,BCBS MGG,BCBS MGG,33193.8216,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Cigna,Cigna,1257,,,,,,,per diem,1103,33193.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Cigna MGG,Cigna MGG,33193.8216,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Humana,Humana,1400,,,,,,,per diem,1103,33193.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Humana MGG,Humana MGG,31534.13052,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Optum VA,Optum VA,33193.8216,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,UHC,UHC,1400,,,,,,,per diem,1103,33193.8216,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,UHC MGG,UHC MGG,33193.8216,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,VA,VA,33193.8216,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Wellcare MGG,Wellcare MGG,33193.8216,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Bright Health - commercial,Bright Health - commercial,33193.8216,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,33193.8216,33193.8216,Bright Health MGG,Bright Health MGG,33193.8216,,,,,,,case rate,1103,33193.8216,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Aetna,Aetna,1500,,,,,,,per diem,1103,26739.9828,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Aetna MGG,Aetna MGG,26739.9828,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,BCBS,BCBS,1103,,,,,,,per diem,1103,26739.9828,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,BCBS MGG,BCBS MGG,26739.9828,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Cigna,Cigna,1257,,,,,,,per diem,1103,26739.9828,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Cigna MGG,Cigna MGG,26739.9828,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Humana,Humana,1400,,,,,,,per diem,1103,26739.9828,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Humana MGG,Humana MGG,25402.98366,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Optum VA,Optum VA,26739.9828,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,UHC,UHC,1400,,,,,,,per diem,1103,26739.9828,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,UHC MGG,UHC MGG,26739.9828,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,VA,VA,26739.9828,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Wellcare MGG,Wellcare MGG,26739.9828,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Bright Health - commercial,Bright Health - commercial,26739.9828,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,26739.9828,26739.9828,Bright Health MGG,Bright Health MGG,26739.9828,,,,,,,case rate,1103,26739.9828,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Aetna,Aetna,1500,,,,,,,per diem,1103,24725.2842,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Aetna MGG,Aetna MGG,24725.2842,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,BCBS,BCBS,1103,,,,,,,per diem,1103,24725.2842,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,BCBS MGG,BCBS MGG,24725.2842,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Cigna,Cigna,1257,,,,,,,per diem,1103,24725.2842,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Cigna MGG,Cigna MGG,24725.2842,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Humana,Humana,1400,,,,,,,per diem,1103,24725.2842,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Humana MGG,Humana MGG,23489.01999,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Optum VA,Optum VA,24725.2842,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,UHC,UHC,1400,,,,,,,per diem,1103,24725.2842,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,UHC MGG,UHC MGG,24725.2842,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,VA,VA,24725.2842,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Wellcare MGG,Wellcare MGG,24725.2842,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Bright Health - commercial,Bright Health - commercial,24725.2842,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,24725.2842,24725.2842,Bright Health MGG,Bright Health MGG,24725.2842,,,,,,,case rate,1103,24725.2842,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Aetna,Aetna,1500,,,,,,,per diem,1103,14583.7584,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Aetna MGG,Aetna MGG,14583.7584,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,BCBS,BCBS,1103,,,,,,,per diem,1103,14583.7584,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,BCBS MGG,BCBS MGG,14583.7584,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Cigna,Cigna,1257,,,,,,,per diem,1103,14583.7584,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Cigna MGG,Cigna MGG,14583.7584,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Humana,Humana,1400,,,,,,,per diem,1103,14583.7584,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Humana MGG,Humana MGG,13854.57048,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Optum VA,Optum VA,14583.7584,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,UHC,UHC,1400,,,,,,,per diem,1103,14583.7584,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,UHC MGG,UHC MGG,14583.7584,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,VA,VA,14583.7584,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Wellcare MGG,Wellcare MGG,14583.7584,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Bright Health - commercial,Bright Health - commercial,14583.7584,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,14583.7584,14583.7584,Bright Health MGG,Bright Health MGG,14583.7584,,,,,,,case rate,1103,14583.7584,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Aetna,Aetna,1500,,,,,,,per diem,1103,20259.8586,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Aetna MGG,Aetna MGG,20259.8586,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,BCBS,BCBS,1103,,,,,,,per diem,1103,20259.8586,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,BCBS MGG,BCBS MGG,20259.8586,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Cigna,Cigna,1257,,,,,,,per diem,1103,20259.8586,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Cigna MGG,Cigna MGG,20259.8586,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Humana,Humana,1400,,,,,,,per diem,1103,20259.8586,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Humana MGG,Humana MGG,19246.86567,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Optum VA,Optum VA,20259.8586,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,UHC,UHC,1400,,,,,,,per diem,1103,20259.8586,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,UHC MGG,UHC MGG,20259.8586,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,VA,VA,20259.8586,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Wellcare MGG,Wellcare MGG,20259.8586,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Bright Health - commercial,Bright Health - commercial,20259.8586,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,20259.8586,20259.8586,Bright Health MGG,Bright Health MGG,20259.8586,,,,,,,case rate,1103,20259.8586,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Aetna,Aetna,1500,,,,,,,per diem,1103,16290.7632,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Aetna MGG,Aetna MGG,16290.7632,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,BCBS,BCBS,1103,,,,,,,per diem,1103,16290.7632,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,BCBS MGG,BCBS MGG,16290.7632,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Cigna,Cigna,1257,,,,,,,per diem,1103,16290.7632,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Cigna MGG,Cigna MGG,16290.7632,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Humana,Humana,1400,,,,,,,per diem,1103,16290.7632,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Humana MGG,Humana MGG,15476.22504,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Optum VA,Optum VA,16290.7632,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,UHC,UHC,1400,,,,,,,per diem,1103,16290.7632,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,UHC MGG,UHC MGG,16290.7632,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,VA,VA,16290.7632,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Wellcare MGG,Wellcare MGG,16290.7632,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Bright Health - commercial,Bright Health - commercial,16290.7632,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,16290.7632,16290.7632,Bright Health MGG,Bright Health MGG,16290.7632,,,,,,,case rate,1103,16290.7632,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Aetna,Aetna,1500,,,,,,,per diem,1103,15256.3554,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Aetna MGG,Aetna MGG,15256.3554,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,BCBS,BCBS,1103,,,,,,,per diem,1103,15256.3554,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,BCBS MGG,BCBS MGG,15256.3554,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Cigna,Cigna,1257,,,,,,,per diem,1103,15256.3554,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Cigna MGG,Cigna MGG,15256.3554,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Humana,Humana,1400,,,,,,,per diem,1103,15256.3554,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Humana MGG,Humana MGG,14493.53763,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Optum VA,Optum VA,15256.3554,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,UHC,UHC,1400,,,,,,,per diem,1103,15256.3554,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,UHC MGG,UHC MGG,15256.3554,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,VA,VA,15256.3554,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Wellcare MGG,Wellcare MGG,15256.3554,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Bright Health - commercial,Bright Health - commercial,15256.3554,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,15256.3554,15256.3554,Bright Health MGG,Bright Health MGG,15256.3554,,,,,,,case rate,1103,15256.3554,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Aetna,Aetna,1500,,,,,,,per diem,1103,17833.8708,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Aetna MGG,Aetna MGG,17833.8708,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,BCBS,BCBS,1103,,,,,,,per diem,1103,17833.8708,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,BCBS MGG,BCBS MGG,17833.8708,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Cigna,Cigna,1257,,,,,,,per diem,1103,17833.8708,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Cigna MGG,Cigna MGG,17833.8708,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Humana,Humana,1400,,,,,,,per diem,1103,17833.8708,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Humana MGG,Humana MGG,16942.17726,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Optum VA,Optum VA,17833.8708,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,UHC,UHC,1400,,,,,,,per diem,1103,17833.8708,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,UHC MGG,UHC MGG,17833.8708,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,VA,VA,17833.8708,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Wellcare MGG,Wellcare MGG,17833.8708,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Bright Health - commercial,Bright Health - commercial,17833.8708,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,17833.8708,17833.8708,Bright Health MGG,Bright Health MGG,17833.8708,,,,,,,case rate,1103,17833.8708,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Aetna,Aetna,1500,,,,,,,per diem,1103,24773.2164,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Aetna MGG,Aetna MGG,24773.2164,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,BCBS,BCBS,1103,,,,,,,per diem,1103,24773.2164,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,BCBS MGG,BCBS MGG,24773.2164,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Cigna,Cigna,1257,,,,,,,per diem,1103,24773.2164,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Cigna MGG,Cigna MGG,24773.2164,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Humana,Humana,1400,,,,,,,per diem,1103,24773.2164,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Humana MGG,Humana MGG,23534.55558,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Optum VA,Optum VA,24773.2164,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,UHC,UHC,1400,,,,,,,per diem,1103,24773.2164,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,UHC MGG,UHC MGG,24773.2164,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,VA,VA,24773.2164,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Wellcare MGG,Wellcare MGG,24773.2164,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Bright Health - commercial,Bright Health - commercial,24773.2164,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,24773.2164,24773.2164,Bright Health MGG,Bright Health MGG,24773.2164,,,,,,,case rate,1103,24773.2164,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Aetna,Aetna,1500,,,,,,,per diem,1103,19919.6946,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Aetna MGG,Aetna MGG,19919.6946,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,BCBS,BCBS,1103,,,,,,,per diem,1103,19919.6946,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,BCBS MGG,BCBS MGG,19919.6946,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Cigna,Cigna,1257,,,,,,,per diem,1103,19919.6946,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Cigna MGG,Cigna MGG,19919.6946,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Humana,Humana,1400,,,,,,,per diem,1103,19919.6946,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Humana MGG,Humana MGG,18923.70987,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Optum VA,Optum VA,19919.6946,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,UHC,UHC,1400,,,,,,,per diem,1103,19919.6946,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,UHC MGG,UHC MGG,19919.6946,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,VA,VA,19919.6946,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Wellcare MGG,Wellcare MGG,19919.6946,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Bright Health - commercial,Bright Health - commercial,19919.6946,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,19919.6946,19919.6946,Bright Health MGG,Bright Health MGG,19919.6946,,,,,,,case rate,1103,19919.6946,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Aetna,Aetna,1500,,,,,,,per diem,1103,18654.903,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Aetna MGG,Aetna MGG,18654.903,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,BCBS,BCBS,1103,,,,,,,per diem,1103,18654.903,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,BCBS MGG,BCBS MGG,18654.903,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Cigna,Cigna,1257,,,,,,,per diem,1103,18654.903,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Cigna MGG,Cigna MGG,18654.903,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Humana,Humana,1400,,,,,,,per diem,1103,18654.903,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Humana MGG,Humana MGG,17722.15785,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Optum VA,Optum VA,18654.903,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,UHC,UHC,1400,,,,,,,per diem,1103,18654.903,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,UHC MGG,UHC MGG,18654.903,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,VA,VA,18654.903,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Wellcare MGG,Wellcare MGG,18654.903,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Bright Health - commercial,Bright Health - commercial,18654.903,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,18654.903,18654.903,Bright Health MGG,Bright Health MGG,18654.903,,,,,,,case rate,1103,18654.903,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Aetna,Aetna,1500,,,,,,,per diem,1103,20790.2052,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Aetna MGG,Aetna MGG,20790.2052,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,BCBS,BCBS,1103,,,,,,,per diem,1103,20790.2052,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,BCBS MGG,BCBS MGG,20790.2052,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Cigna,Cigna,1257,,,,,,,per diem,1103,20790.2052,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Cigna MGG,Cigna MGG,20790.2052,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Humana,Humana,1400,,,,,,,per diem,1103,20790.2052,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Humana MGG,Humana MGG,19750.69494,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Optum VA,Optum VA,20790.2052,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,UHC,UHC,1400,,,,,,,per diem,1103,20790.2052,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,UHC MGG,UHC MGG,20790.2052,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,VA,VA,20790.2052,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Wellcare MGG,Wellcare MGG,20790.2052,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Bright Health - commercial,Bright Health - commercial,20790.2052,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,20790.2052,20790.2052,Bright Health MGG,Bright Health MGG,20790.2052,,,,,,,case rate,1103,20790.2052,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Aetna,Aetna,1500,,,,,,,per diem,1103,28883.016,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Aetna MGG,Aetna MGG,28883.016,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,BCBS,BCBS,1103,,,,,,,per diem,1103,28883.016,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,BCBS MGG,BCBS MGG,28883.016,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Cigna,Cigna,1257,,,,,,,per diem,1103,28883.016,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Cigna MGG,Cigna MGG,28883.016,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Humana,Humana,1400,,,,,,,per diem,1103,28883.016,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Humana MGG,Humana MGG,27438.8652,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Optum VA,Optum VA,28883.016,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,UHC,UHC,1400,,,,,,,per diem,1103,28883.016,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,UHC MGG,UHC MGG,28883.016,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,VA,VA,28883.016,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Wellcare MGG,Wellcare MGG,28883.016,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Bright Health - commercial,Bright Health - commercial,28883.016,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,28883.016,28883.016,Bright Health MGG,Bright Health MGG,28883.016,,,,,,,case rate,1103,28883.016,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Aetna,Aetna,1500,,,,,,,per diem,1103,23223.924,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Aetna MGG,Aetna MGG,23223.924,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,BCBS,BCBS,1103,,,,,,,per diem,1103,23223.924,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,BCBS MGG,BCBS MGG,23223.924,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Cigna,Cigna,1257,,,,,,,per diem,1103,23223.924,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Cigna MGG,Cigna MGG,23223.924,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Humana,Humana,1400,,,,,,,per diem,1103,23223.924,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Humana MGG,Humana MGG,22062.7278,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Optum VA,Optum VA,23223.924,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,UHC,UHC,1400,,,,,,,per diem,1103,23223.924,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,UHC MGG,UHC MGG,23223.924,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,VA,VA,23223.924,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Wellcare MGG,Wellcare MGG,23223.924,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Bright Health - commercial,Bright Health - commercial,23223.924,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,23223.924,23223.924,Bright Health MGG,Bright Health MGG,23223.924,,,,,,,case rate,1103,23223.924,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Aetna,Aetna,1500,,,,,,,per diem,1103,21748.8492,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Aetna MGG,Aetna MGG,21748.8492,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,BCBS,BCBS,1103,,,,,,,per diem,1103,21748.8492,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,BCBS MGG,BCBS MGG,21748.8492,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Cigna,Cigna,1257,,,,,,,per diem,1103,21748.8492,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Cigna MGG,Cigna MGG,21748.8492,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Humana,Humana,1400,,,,,,,per diem,1103,21748.8492,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Humana MGG,Humana MGG,20661.40674,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Optum VA,Optum VA,21748.8492,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,UHC,UHC,1400,,,,,,,per diem,1103,21748.8492,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,UHC MGG,UHC MGG,21748.8492,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,VA,VA,21748.8492,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Wellcare MGG,Wellcare MGG,21748.8492,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Bright Health - commercial,Bright Health - commercial,21748.8492,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,21748.8492,21748.8492,Bright Health MGG,Bright Health MGG,21748.8492,,,,,,,case rate,1103,21748.8492,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Aetna,Aetna,1500,,,,,,,per diem,1103,26072.0244,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Aetna MGG,Aetna MGG,26072.0244,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,BCBS,BCBS,1103,,,,,,,per diem,1103,26072.0244,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,BCBS MGG,BCBS MGG,26072.0244,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Cigna,Cigna,1257,,,,,,,per diem,1103,26072.0244,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Cigna MGG,Cigna MGG,26072.0244,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Humana,Humana,1400,,,,,,,per diem,1103,26072.0244,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Humana MGG,Humana MGG,24768.42318,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Optum VA,Optum VA,26072.0244,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,UHC,UHC,1400,,,,,,,per diem,1103,26072.0244,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,UHC MGG,UHC MGG,26072.0244,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,VA,VA,26072.0244,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Wellcare MGG,Wellcare MGG,26072.0244,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Bright Health - commercial,Bright Health - commercial,26072.0244,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,26072.0244,26072.0244,Bright Health MGG,Bright Health MGG,26072.0244,,,,,,,case rate,1103,26072.0244,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Aetna,Aetna,1500,,,,,,,per diem,1103,36219.735,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Aetna MGG,Aetna MGG,36219.735,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,BCBS,BCBS,1103,,,,,,,per diem,1103,36219.735,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,BCBS MGG,BCBS MGG,36219.735,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Cigna,Cigna,1257,,,,,,,per diem,1103,36219.735,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Cigna MGG,Cigna MGG,36219.735,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Humana,Humana,1400,,,,,,,per diem,1103,36219.735,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Humana MGG,Humana MGG,34408.74825,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Optum VA,Optum VA,36219.735,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,UHC,UHC,1400,,,,,,,per diem,1103,36219.735,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,UHC MGG,UHC MGG,36219.735,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,VA,VA,36219.735,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Wellcare MGG,Wellcare MGG,36219.735,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Bright Health - commercial,Bright Health - commercial,36219.735,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,36219.735,36219.735,Bright Health MGG,Bright Health MGG,36219.735,,,,,,,case rate,1103,36219.735,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Aetna,Aetna,1500,,,,,,,per diem,1103,29122.677,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Aetna MGG,Aetna MGG,29122.677,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,BCBS,BCBS,1103,,,,,,,per diem,1103,29122.677,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,BCBS MGG,BCBS MGG,29122.677,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Cigna,Cigna,1257,,,,,,,per diem,1103,29122.677,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Cigna MGG,Cigna MGG,29122.677,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Humana,Humana,1400,,,,,,,per diem,1103,29122.677,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Humana MGG,Humana MGG,27666.54315,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Optum VA,Optum VA,29122.677,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,UHC,UHC,1400,,,,,,,per diem,1103,29122.677,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,UHC MGG,UHC MGG,29122.677,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,VA,VA,29122.677,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Wellcare MGG,Wellcare MGG,29122.677,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Bright Health - commercial,Bright Health - commercial,29122.677,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,29122.677,29122.677,Bright Health MGG,Bright Health MGG,29122.677,,,,,,,case rate,1103,29122.677,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Aetna,Aetna,1500,,,,,,,per diem,1103,27273.4218,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Aetna MGG,Aetna MGG,27273.4218,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,BCBS,BCBS,1103,,,,,,,per diem,1103,27273.4218,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,BCBS MGG,BCBS MGG,27273.4218,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Cigna,Cigna,1257,,,,,,,per diem,1103,27273.4218,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Cigna MGG,Cigna MGG,27273.4218,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Humana,Humana,1400,,,,,,,per diem,1103,27273.4218,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Humana MGG,Humana MGG,25909.75071,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Optum VA,Optum VA,27273.4218,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,UHC,UHC,1400,,,,,,,per diem,1103,27273.4218,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,UHC MGG,UHC MGG,27273.4218,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,VA,VA,27273.4218,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Wellcare MGG,Wellcare MGG,27273.4218,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Bright Health - commercial,Bright Health - commercial,27273.4218,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,27273.4218,27273.4218,Bright Health MGG,Bright Health MGG,27273.4218,,,,,,,case rate,1103,27273.4218,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Aetna,Aetna,1500,,,,,,,per diem,1103,12077.3682,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Aetna MGG,Aetna MGG,12077.3682,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,BCBS,BCBS,1103,,,,,,,per diem,1103,12077.3682,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,BCBS MGG,BCBS MGG,12077.3682,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Cigna,Cigna,1257,,,,,,,per diem,1103,12077.3682,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Cigna MGG,Cigna MGG,12077.3682,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Humana,Humana,1400,,,,,,,per diem,1103,12077.3682,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Humana MGG,Humana MGG,11473.49979,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Optum VA,Optum VA,12077.3682,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,UHC,UHC,1400,,,,,,,per diem,1103,12077.3682,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,UHC MGG,UHC MGG,12077.3682,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,VA,VA,12077.3682,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Wellcare MGG,Wellcare MGG,12077.3682,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Bright Health - commercial,Bright Health - commercial,12077.3682,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,12077.3682,12077.3682,Bright Health MGG,Bright Health MGG,12077.3682,,,,,,,case rate,1103,12077.3682,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Aetna,Aetna,1500,,,,,,,per diem,1103,16253.6544,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Aetna MGG,Aetna MGG,16253.6544,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,BCBS,BCBS,1103,,,,,,,per diem,1103,16253.6544,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,BCBS MGG,BCBS MGG,16253.6544,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Cigna,Cigna,1257,,,,,,,per diem,1103,16253.6544,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Cigna MGG,Cigna MGG,16253.6544,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Humana,Humana,1400,,,,,,,per diem,1103,16253.6544,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Humana MGG,Humana MGG,15440.97168,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Optum VA,Optum VA,16253.6544,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,UHC,UHC,1400,,,,,,,per diem,1103,16253.6544,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,UHC MGG,UHC MGG,16253.6544,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,VA,VA,16253.6544,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Wellcare MGG,Wellcare MGG,16253.6544,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Bright Health - commercial,Bright Health - commercial,16253.6544,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,16253.6544,16253.6544,Bright Health MGG,Bright Health MGG,16253.6544,,,,,,,case rate,1103,16253.6544,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Aetna,Aetna,1500,,,,,,,per diem,1103,14565.204,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Aetna MGG,Aetna MGG,14565.204,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,BCBS,BCBS,1103,,,,,,,per diem,1103,14565.204,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,BCBS MGG,BCBS MGG,14565.204,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Cigna,Cigna,1257,,,,,,,per diem,1103,14565.204,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Cigna MGG,Cigna MGG,14565.204,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Humana,Humana,1400,,,,,,,per diem,1103,14565.204,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Humana MGG,Humana MGG,13836.9438,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Optum VA,Optum VA,14565.204,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,UHC,UHC,1400,,,,,,,per diem,1103,14565.204,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,UHC MGG,UHC MGG,14565.204,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,VA,VA,14565.204,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Wellcare MGG,Wellcare MGG,14565.204,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Bright Health - commercial,Bright Health - commercial,14565.204,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,14565.204,14565.204,Bright Health MGG,Bright Health MGG,14565.204,,,,,,,case rate,1103,14565.204,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Aetna,Aetna,1500,,,,,,,per diem,1103,13323.6054,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Aetna MGG,Aetna MGG,13323.6054,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,BCBS,BCBS,1103,,,,,,,per diem,1103,13323.6054,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,BCBS MGG,BCBS MGG,13323.6054,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Cigna,Cigna,1257,,,,,,,per diem,1103,13323.6054,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Cigna MGG,Cigna MGG,13323.6054,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Humana,Humana,1400,,,,,,,per diem,1103,13323.6054,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Humana MGG,Humana MGG,12657.42513,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Optum VA,Optum VA,13323.6054,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,UHC,UHC,1400,,,,,,,per diem,1103,13323.6054,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,UHC MGG,UHC MGG,13323.6054,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,VA,VA,13323.6054,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Wellcare MGG,Wellcare MGG,13323.6054,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Bright Health - commercial,Bright Health - commercial,13323.6054,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,13323.6054,13323.6054,Bright Health MGG,Bright Health MGG,13323.6054,,,,,,,case rate,1103,13323.6054,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Aetna,Aetna,1500,,,,,,,per diem,1103,14532.7338,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Aetna MGG,Aetna MGG,14532.7338,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,BCBS,BCBS,1103,,,,,,,per diem,1103,14532.7338,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,BCBS MGG,BCBS MGG,14532.7338,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Cigna,Cigna,1257,,,,,,,per diem,1103,14532.7338,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Cigna MGG,Cigna MGG,14532.7338,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Humana,Humana,1400,,,,,,,per diem,1103,14532.7338,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Humana MGG,Humana MGG,13806.09711,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Optum VA,Optum VA,14532.7338,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,UHC,UHC,1400,,,,,,,per diem,1103,14532.7338,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,UHC MGG,UHC MGG,14532.7338,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,VA,VA,14532.7338,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Wellcare MGG,Wellcare MGG,14532.7338,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Bright Health - commercial,Bright Health - commercial,14532.7338,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,14532.7338,14532.7338,Bright Health MGG,Bright Health MGG,14532.7338,,,,,,,case rate,1103,14532.7338,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Aetna,Aetna,1500,,,,,,,per diem,1103,19556.3376,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Aetna MGG,Aetna MGG,19556.3376,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,BCBS,BCBS,1103,,,,,,,per diem,1103,19556.3376,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,BCBS MGG,BCBS MGG,19556.3376,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Cigna,Cigna,1257,,,,,,,per diem,1103,19556.3376,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Cigna MGG,Cigna MGG,19556.3376,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Humana,Humana,1400,,,,,,,per diem,1103,19556.3376,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Humana MGG,Humana MGG,18578.52072,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Optum VA,Optum VA,19556.3376,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,UHC,UHC,1400,,,,,,,per diem,1103,19556.3376,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,UHC MGG,UHC MGG,19556.3376,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,VA,VA,19556.3376,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Wellcare MGG,Wellcare MGG,19556.3376,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Bright Health - commercial,Bright Health - commercial,19556.3376,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,19556.3376,19556.3376,Bright Health MGG,Bright Health MGG,19556.3376,,,,,,,case rate,1103,19556.3376,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Aetna,Aetna,1500,,,,,,,per diem,1103,17526.177,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Aetna MGG,Aetna MGG,17526.177,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,BCBS,BCBS,1103,,,,,,,per diem,1103,17526.177,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,BCBS MGG,BCBS MGG,17526.177,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Cigna,Cigna,1257,,,,,,,per diem,1103,17526.177,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Cigna MGG,Cigna MGG,17526.177,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Humana,Humana,1400,,,,,,,per diem,1103,17526.177,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Humana MGG,Humana MGG,16649.86815,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Optum VA,Optum VA,17526.177,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,UHC,UHC,1400,,,,,,,per diem,1103,17526.177,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,UHC MGG,UHC MGG,17526.177,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,VA,VA,17526.177,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Wellcare MGG,Wellcare MGG,17526.177,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Bright Health - commercial,Bright Health - commercial,17526.177,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,17526.177,17526.177,Bright Health MGG,Bright Health MGG,17526.177,,,,,,,case rate,1103,17526.177,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Aetna,Aetna,1500,,,,,,,per diem,1103,16031.0016,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Aetna MGG,Aetna MGG,16031.0016,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,BCBS,BCBS,1103,,,,,,,per diem,1103,16031.0016,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,BCBS MGG,BCBS MGG,16031.0016,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Cigna,Cigna,1257,,,,,,,per diem,1103,16031.0016,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Cigna MGG,Cigna MGG,16031.0016,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Humana,Humana,1400,,,,,,,per diem,1103,16031.0016,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Humana MGG,Humana MGG,15229.45152,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Optum VA,Optum VA,16031.0016,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,UHC,UHC,1400,,,,,,,per diem,1103,16031.0016,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,UHC MGG,UHC MGG,16031.0016,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,VA,VA,16031.0016,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Wellcare MGG,Wellcare MGG,16031.0016,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Bright Health - commercial,Bright Health - commercial,16031.0016,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,16031.0016,16031.0016,Bright Health MGG,Bright Health MGG,16031.0016,,,,,,,case rate,1103,16031.0016,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Aetna,Aetna,1500,,,,,,,per diem,1103,17598.8484,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Aetna MGG,Aetna MGG,17598.8484,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,BCBS,BCBS,1103,,,,,,,per diem,1103,17598.8484,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,BCBS MGG,BCBS MGG,17598.8484,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Cigna,Cigna,1257,,,,,,,per diem,1103,17598.8484,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Cigna MGG,Cigna MGG,17598.8484,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Humana,Humana,1400,,,,,,,per diem,1103,17598.8484,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Humana MGG,Humana MGG,16718.90598,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Optum VA,Optum VA,17598.8484,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,UHC,UHC,1400,,,,,,,per diem,1103,17598.8484,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,UHC MGG,UHC MGG,17598.8484,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,VA,VA,17598.8484,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Wellcare MGG,Wellcare MGG,17598.8484,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Bright Health - commercial,Bright Health - commercial,17598.8484,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,17598.8484,17598.8484,Bright Health MGG,Bright Health MGG,17598.8484,,,,,,,case rate,1103,17598.8484,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Aetna,Aetna,1500,,,,,,,per diem,1103,23683.1454,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Aetna MGG,Aetna MGG,23683.1454,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,BCBS,BCBS,1103,,,,,,,per diem,1103,23683.1454,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,BCBS MGG,BCBS MGG,23683.1454,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Cigna,Cigna,1257,,,,,,,per diem,1103,23683.1454,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Cigna MGG,Cigna MGG,23683.1454,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Humana,Humana,1400,,,,,,,per diem,1103,23683.1454,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Humana MGG,Humana MGG,22498.98813,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Optum VA,Optum VA,23683.1454,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,UHC,UHC,1400,,,,,,,per diem,1103,23683.1454,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,UHC MGG,UHC MGG,23683.1454,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,VA,VA,23683.1454,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Wellcare MGG,Wellcare MGG,23683.1454,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Bright Health - commercial,Bright Health - commercial,23683.1454,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,23683.1454,23683.1454,Bright Health MGG,Bright Health MGG,23683.1454,,,,,,,case rate,1103,23683.1454,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Aetna,Aetna,1500,,,,,,,per diem,1103,21224.6874,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Aetna MGG,Aetna MGG,21224.6874,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,BCBS,BCBS,1103,,,,,,,per diem,1103,21224.6874,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,BCBS MGG,BCBS MGG,21224.6874,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Cigna,Cigna,1257,,,,,,,per diem,1103,21224.6874,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Cigna MGG,Cigna MGG,21224.6874,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Humana,Humana,1400,,,,,,,per diem,1103,21224.6874,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Humana MGG,Humana MGG,20163.45303,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Optum VA,Optum VA,21224.6874,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,UHC,UHC,1400,,,,,,,per diem,1103,21224.6874,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,UHC MGG,UHC MGG,21224.6874,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,VA,VA,21224.6874,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Wellcare MGG,Wellcare MGG,21224.6874,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Bright Health - commercial,Bright Health - commercial,21224.6874,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,21224.6874,21224.6874,Bright Health MGG,Bright Health MGG,21224.6874,,,,,,,case rate,1103,21224.6874,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Aetna,Aetna,1500,,,,,,,per diem,1103,19415.6334,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Aetna MGG,Aetna MGG,19415.6334,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,BCBS,BCBS,1103,,,,,,,per diem,1103,19415.6334,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,BCBS MGG,BCBS MGG,19415.6334,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Cigna,Cigna,1257,,,,,,,per diem,1103,19415.6334,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Cigna MGG,Cigna MGG,19415.6334,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Humana,Humana,1400,,,,,,,per diem,1103,19415.6334,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Humana MGG,Humana MGG,18444.85173,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Optum VA,Optum VA,19415.6334,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,UHC,UHC,1400,,,,,,,per diem,1103,19415.6334,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,UHC MGG,UHC MGG,19415.6334,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,VA,VA,19415.6334,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Wellcare MGG,Wellcare MGG,19415.6334,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Bright Health - commercial,Bright Health - commercial,19415.6334,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,19415.6334,19415.6334,Bright Health MGG,Bright Health MGG,19415.6334,,,,,,,case rate,1103,19415.6334,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Aetna,Aetna,1500,,,,,,,per diem,1103,23035.2876,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Aetna MGG,Aetna MGG,23035.2876,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,BCBS,BCBS,1103,,,,,,,per diem,1103,23035.2876,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,BCBS MGG,BCBS MGG,23035.2876,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Cigna,Cigna,1257,,,,,,,per diem,1103,23035.2876,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Cigna MGG,Cigna MGG,23035.2876,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Humana,Humana,1400,,,,,,,per diem,1103,23035.2876,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Humana MGG,Humana MGG,21883.52322,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Optum VA,Optum VA,23035.2876,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,UHC,UHC,1400,,,,,,,per diem,1103,23035.2876,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,UHC MGG,UHC MGG,23035.2876,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,VA,VA,23035.2876,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Wellcare MGG,Wellcare MGG,23035.2876,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Bright Health - commercial,Bright Health - commercial,23035.2876,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,23035.2876,23035.2876,Bright Health MGG,Bright Health MGG,23035.2876,,,,,,,case rate,1103,23035.2876,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Aetna,Aetna,1500,,,,,,,per diem,1103,30999.7638,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Aetna MGG,Aetna MGG,30999.7638,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,BCBS,BCBS,1103,,,,,,,per diem,1103,30999.7638,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,BCBS MGG,BCBS MGG,30999.7638,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Cigna,Cigna,1257,,,,,,,per diem,1103,30999.7638,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Cigna MGG,Cigna MGG,30999.7638,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Humana,Humana,1400,,,,,,,per diem,1103,30999.7638,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Humana MGG,Humana MGG,29449.77561,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Optum VA,Optum VA,30999.7638,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,UHC,UHC,1400,,,,,,,per diem,1103,30999.7638,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,UHC MGG,UHC MGG,30999.7638,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,VA,VA,30999.7638,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Wellcare MGG,Wellcare MGG,30999.7638,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Bright Health - commercial,Bright Health - commercial,30999.7638,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,30999.7638,30999.7638,Bright Health MGG,Bright Health MGG,30999.7638,,,,,,,case rate,1103,30999.7638,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Aetna,Aetna,1500,,,,,,,per diem,1103,27782.1216,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Aetna MGG,Aetna MGG,27782.1216,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,BCBS,BCBS,1103,,,,,,,per diem,1103,27782.1216,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,BCBS MGG,BCBS MGG,27782.1216,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Cigna,Cigna,1257,,,,,,,per diem,1103,27782.1216,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Cigna MGG,Cigna MGG,27782.1216,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Humana,Humana,1400,,,,,,,per diem,1103,27782.1216,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Humana MGG,Humana MGG,26393.01552,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Optum VA,Optum VA,27782.1216,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,UHC,UHC,1400,,,,,,,per diem,1103,27782.1216,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,UHC MGG,UHC MGG,27782.1216,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,VA,VA,27782.1216,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Wellcare MGG,Wellcare MGG,27782.1216,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Bright Health - commercial,Bright Health - commercial,27782.1216,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,27782.1216,27782.1216,Bright Health MGG,Bright Health MGG,27782.1216,,,,,,,case rate,1103,27782.1216,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Aetna,Aetna,1500,,,,,,,per diem,1103,25413.3432,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Aetna MGG,Aetna MGG,25413.3432,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,BCBS,BCBS,1103,,,,,,,per diem,1103,25413.3432,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,BCBS MGG,BCBS MGG,25413.3432,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Cigna,Cigna,1257,,,,,,,per diem,1103,25413.3432,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Cigna MGG,Cigna MGG,25413.3432,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Humana,Humana,1400,,,,,,,per diem,1103,25413.3432,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Humana MGG,Humana MGG,24142.67604,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Optum VA,Optum VA,25413.3432,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,UHC,UHC,1400,,,,,,,per diem,1103,25413.3432,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,UHC MGG,UHC MGG,25413.3432,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,VA,VA,25413.3432,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Wellcare MGG,Wellcare MGG,25413.3432,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Bright Health - commercial,Bright Health - commercial,25413.3432,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,25413.3432,25413.3432,Bright Health MGG,Bright Health MGG,25413.3432,,,,,,,case rate,1103,25413.3432,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Aetna,Aetna,1500,,,,,,,per diem,1103,13810.6584,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Aetna MGG,Aetna MGG,13810.6584,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,BCBS,BCBS,1103,,,,,,,per diem,1103,13810.6584,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,BCBS MGG,BCBS MGG,13810.6584,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Cigna,Cigna,1257,,,,,,,per diem,1103,13810.6584,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Cigna MGG,Cigna MGG,13810.6584,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Humana,Humana,1400,,,,,,,per diem,1103,13810.6584,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Humana MGG,Humana MGG,13120.12548,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Optum VA,Optum VA,13810.6584,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,UHC,UHC,1400,,,,,,,per diem,1103,13810.6584,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,UHC MGG,UHC MGG,13810.6584,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,VA,VA,13810.6584,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Wellcare MGG,Wellcare MGG,13810.6584,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Bright Health - commercial,Bright Health - commercial,13810.6584,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,13810.6584,13810.6584,Bright Health MGG,Bright Health MGG,13810.6584,,,,,,,case rate,1103,13810.6584,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Aetna,Aetna,1500,,,,,,,per diem,1103,20395.9242,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Aetna MGG,Aetna MGG,20395.9242,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,BCBS,BCBS,1103,,,,,,,per diem,1103,20395.9242,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,BCBS MGG,BCBS MGG,20395.9242,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Cigna,Cigna,1257,,,,,,,per diem,1103,20395.9242,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Cigna MGG,Cigna MGG,20395.9242,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Humana,Humana,1400,,,,,,,per diem,1103,20395.9242,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Humana MGG,Humana MGG,19376.12799,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Optum VA,Optum VA,20395.9242,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,UHC,UHC,1400,,,,,,,per diem,1103,20395.9242,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,UHC MGG,UHC MGG,20395.9242,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,VA,VA,20395.9242,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Wellcare MGG,Wellcare MGG,20395.9242,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Bright Health - commercial,Bright Health - commercial,20395.9242,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,20395.9242,20395.9242,Bright Health MGG,Bright Health MGG,20395.9242,,,,,,,case rate,1103,20395.9242,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Aetna,Aetna,1500,,,,,,,per diem,1103,16157.79,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Aetna MGG,Aetna MGG,16157.79,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,BCBS,BCBS,1103,,,,,,,per diem,1103,16157.79,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,BCBS MGG,BCBS MGG,16157.79,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Cigna,Cigna,1257,,,,,,,per diem,1103,16157.79,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Cigna MGG,Cigna MGG,16157.79,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Humana,Humana,1400,,,,,,,per diem,1103,16157.79,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Humana MGG,Humana MGG,15349.9005,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Optum VA,Optum VA,16157.79,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,UHC,UHC,1400,,,,,,,per diem,1103,16157.79,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,UHC MGG,UHC MGG,16157.79,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,VA,VA,16157.79,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Wellcare MGG,Wellcare MGG,16157.79,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Bright Health - commercial,Bright Health - commercial,16157.79,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,16157.79,16157.79,Bright Health MGG,Bright Health MGG,16157.79,,,,,,,case rate,1103,16157.79,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Aetna,Aetna,1500,,,,,,,per diem,1103,15001.2324,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Aetna MGG,Aetna MGG,15001.2324,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,BCBS,BCBS,1103,,,,,,,per diem,1103,15001.2324,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,BCBS MGG,BCBS MGG,15001.2324,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Cigna,Cigna,1257,,,,,,,per diem,1103,15001.2324,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Cigna MGG,Cigna MGG,15001.2324,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Humana,Humana,1400,,,,,,,per diem,1103,15001.2324,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Humana MGG,Humana MGG,14251.17078,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Optum VA,Optum VA,15001.2324,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,UHC,UHC,1400,,,,,,,per diem,1103,15001.2324,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,UHC MGG,UHC MGG,15001.2324,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,VA,VA,15001.2324,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Wellcare MGG,Wellcare MGG,15001.2324,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Bright Health - commercial,Bright Health - commercial,15001.2324,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,15001.2324,15001.2324,Bright Health MGG,Bright Health MGG,15001.2324,,,,,,,case rate,1103,15001.2324,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Aetna,Aetna,1500,,,,,,,per diem,1103,17023.662,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Aetna MGG,Aetna MGG,17023.662,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,BCBS,BCBS,1103,,,,,,,per diem,1103,17023.662,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,BCBS MGG,BCBS MGG,17023.662,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Cigna,Cigna,1257,,,,,,,per diem,1103,17023.662,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Cigna MGG,Cigna MGG,17023.662,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Humana,Humana,1400,,,,,,,per diem,1103,17023.662,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Humana MGG,Humana MGG,16172.4789,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Optum VA,Optum VA,17023.662,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,UHC,UHC,1400,,,,,,,per diem,1103,17023.662,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,UHC MGG,UHC MGG,17023.662,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,VA,VA,17023.662,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Wellcare MGG,Wellcare MGG,17023.662,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Bright Health - commercial,Bright Health - commercial,17023.662,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,17023.662,17023.662,Bright Health MGG,Bright Health MGG,17023.662,,,,,,,case rate,1103,17023.662,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Aetna,Aetna,1500,,,,,,,per diem,1103,25141.212,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Aetna MGG,Aetna MGG,25141.212,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,BCBS,BCBS,1103,,,,,,,per diem,1103,25141.212,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,BCBS MGG,BCBS MGG,25141.212,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Cigna,Cigna,1257,,,,,,,per diem,1103,25141.212,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Cigna MGG,Cigna MGG,25141.212,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Humana,Humana,1400,,,,,,,per diem,1103,25141.212,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Humana MGG,Humana MGG,23884.1514,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Optum VA,Optum VA,25141.212,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,UHC,UHC,1400,,,,,,,per diem,1103,25141.212,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,UHC MGG,UHC MGG,25141.212,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,VA,VA,25141.212,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Wellcare MGG,Wellcare MGG,25141.212,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Bright Health - commercial,Bright Health - commercial,25141.212,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,25141.212,25141.212,Bright Health MGG,Bright Health MGG,25141.212,,,,,,,case rate,1103,25141.212,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Aetna,Aetna,1500,,,,,,,per diem,1103,19916.6022,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Aetna MGG,Aetna MGG,19916.6022,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,BCBS,BCBS,1103,,,,,,,per diem,1103,19916.6022,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,BCBS MGG,BCBS MGG,19916.6022,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Cigna,Cigna,1257,,,,,,,per diem,1103,19916.6022,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Cigna MGG,Cigna MGG,19916.6022,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Humana,Humana,1400,,,,,,,per diem,1103,19916.6022,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Humana MGG,Humana MGG,18920.77209,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Optum VA,Optum VA,19916.6022,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,UHC,UHC,1400,,,,,,,per diem,1103,19916.6022,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,UHC MGG,UHC MGG,19916.6022,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,VA,VA,19916.6022,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Wellcare MGG,Wellcare MGG,19916.6022,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Bright Health - commercial,Bright Health - commercial,19916.6022,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,19916.6022,19916.6022,Bright Health MGG,Bright Health MGG,19916.6022,,,,,,,case rate,1103,19916.6022,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Aetna,Aetna,1500,,,,,,,per diem,1103,18492.552,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Aetna MGG,Aetna MGG,18492.552,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,BCBS,BCBS,1103,,,,,,,per diem,1103,18492.552,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,BCBS MGG,BCBS MGG,18492.552,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Cigna,Cigna,1257,,,,,,,per diem,1103,18492.552,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Cigna MGG,Cigna MGG,18492.552,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Humana,Humana,1400,,,,,,,per diem,1103,18492.552,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Humana MGG,Humana MGG,17567.9244,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Optum VA,Optum VA,18492.552,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,UHC,UHC,1400,,,,,,,per diem,1103,18492.552,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,UHC MGG,UHC MGG,18492.552,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,VA,VA,18492.552,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Wellcare MGG,Wellcare MGG,18492.552,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Bright Health - commercial,Bright Health - commercial,18492.552,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,18492.552,18492.552,Bright Health MGG,Bright Health MGG,18492.552,,,,,,,case rate,1103,18492.552,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Aetna,Aetna,1500,,,,,,,per diem,1103,19975.3578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Aetna MGG,Aetna MGG,19975.3578,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,BCBS,BCBS,1103,,,,,,,per diem,1103,19975.3578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,BCBS MGG,BCBS MGG,19975.3578,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Cigna,Cigna,1257,,,,,,,per diem,1103,19975.3578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Cigna MGG,Cigna MGG,19975.3578,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Humana,Humana,1400,,,,,,,per diem,1103,19975.3578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Humana MGG,Humana MGG,18976.58991,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Optum VA,Optum VA,19975.3578,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,UHC,UHC,1400,,,,,,,per diem,1103,19975.3578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,UHC MGG,UHC MGG,19975.3578,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,VA,VA,19975.3578,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Wellcare MGG,Wellcare MGG,19975.3578,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Bright Health - commercial,Bright Health - commercial,19975.3578,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,19975.3578,19975.3578,Bright Health MGG,Bright Health MGG,19975.3578,,,,,,,case rate,1103,19975.3578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Aetna,Aetna,1500,,,,,,,per diem,1103,29498.4036,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Aetna MGG,Aetna MGG,29498.4036,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,BCBS,BCBS,1103,,,,,,,per diem,1103,29498.4036,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,BCBS MGG,BCBS MGG,29498.4036,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Cigna,Cigna,1257,,,,,,,per diem,1103,29498.4036,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Cigna MGG,Cigna MGG,29498.4036,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Humana,Humana,1400,,,,,,,per diem,1103,29498.4036,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Humana MGG,Humana MGG,28023.48342,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Optum VA,Optum VA,29498.4036,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,UHC,UHC,1400,,,,,,,per diem,1103,29498.4036,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,UHC MGG,UHC MGG,29498.4036,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,VA,VA,29498.4036,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Wellcare MGG,Wellcare MGG,29498.4036,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Bright Health - commercial,Bright Health - commercial,29498.4036,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,29498.4036,29498.4036,Bright Health MGG,Bright Health MGG,29498.4036,,,,,,,case rate,1103,29498.4036,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Aetna,Aetna,1500,,,,,,,per diem,1103,23369.2668,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Aetna MGG,Aetna MGG,23369.2668,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,BCBS,BCBS,1103,,,,,,,per diem,1103,23369.2668,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,BCBS MGG,BCBS MGG,23369.2668,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Cigna,Cigna,1257,,,,,,,per diem,1103,23369.2668,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Cigna MGG,Cigna MGG,23369.2668,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Humana,Humana,1400,,,,,,,per diem,1103,23369.2668,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Humana MGG,Humana MGG,22200.80346,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Optum VA,Optum VA,23369.2668,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,UHC,UHC,1400,,,,,,,per diem,1103,23369.2668,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,UHC MGG,UHC MGG,23369.2668,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,VA,VA,23369.2668,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Wellcare MGG,Wellcare MGG,23369.2668,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Bright Health - commercial,Bright Health - commercial,23369.2668,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,23369.2668,23369.2668,Bright Health MGG,Bright Health MGG,23369.2668,,,,,,,case rate,1103,23369.2668,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Aetna,Aetna,1500,,,,,,,per diem,1103,21697.8246,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Aetna MGG,Aetna MGG,21697.8246,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,BCBS,BCBS,1103,,,,,,,per diem,1103,21697.8246,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,BCBS MGG,BCBS MGG,21697.8246,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Cigna,Cigna,1257,,,,,,,per diem,1103,21697.8246,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Cigna MGG,Cigna MGG,21697.8246,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Humana,Humana,1400,,,,,,,per diem,1103,21697.8246,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Humana MGG,Humana MGG,20612.93337,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Optum VA,Optum VA,21697.8246,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,UHC,UHC,1400,,,,,,,per diem,1103,21697.8246,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,UHC MGG,UHC MGG,21697.8246,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,VA,VA,21697.8246,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Wellcare MGG,Wellcare MGG,21697.8246,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Bright Health - commercial,Bright Health - commercial,21697.8246,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,21697.8246,21697.8246,Bright Health MGG,Bright Health MGG,21697.8246,,,,,,,case rate,1103,21697.8246,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Aetna,Aetna,1500,,,,,,,per diem,1103,22985.8092,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Aetna MGG,Aetna MGG,22985.8092,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,BCBS,BCBS,1103,,,,,,,per diem,1103,22985.8092,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,BCBS MGG,BCBS MGG,22985.8092,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Cigna,Cigna,1257,,,,,,,per diem,1103,22985.8092,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Cigna MGG,Cigna MGG,22985.8092,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Humana,Humana,1400,,,,,,,per diem,1103,22985.8092,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Humana MGG,Humana MGG,21836.51874,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Optum VA,Optum VA,22985.8092,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,UHC,UHC,1400,,,,,,,per diem,1103,22985.8092,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,UHC MGG,UHC MGG,22985.8092,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,VA,VA,22985.8092,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Wellcare MGG,Wellcare MGG,22985.8092,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Bright Health - commercial,Bright Health - commercial,22985.8092,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,22985.8092,22985.8092,Bright Health MGG,Bright Health MGG,22985.8092,,,,,,,case rate,1103,22985.8092,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Aetna,Aetna,1500,,,,,,,per diem,1103,33943.7286,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Aetna MGG,Aetna MGG,33943.7286,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,BCBS,BCBS,1103,,,,,,,per diem,1103,33943.7286,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,BCBS MGG,BCBS MGG,33943.7286,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Cigna,Cigna,1257,,,,,,,per diem,1103,33943.7286,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Cigna MGG,Cigna MGG,33943.7286,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Humana,Humana,1400,,,,,,,per diem,1103,33943.7286,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Humana MGG,Humana MGG,32246.54217,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Optum VA,Optum VA,33943.7286,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,UHC,UHC,1400,,,,,,,per diem,1103,33943.7286,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,UHC MGG,UHC MGG,33943.7286,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,VA,VA,33943.7286,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Wellcare MGG,Wellcare MGG,33943.7286,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Bright Health - commercial,Bright Health - commercial,33943.7286,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,33943.7286,33943.7286,Bright Health MGG,Bright Health MGG,33943.7286,,,,,,,case rate,1103,33943.7286,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Aetna,Aetna,1500,,,,,,,per diem,1103,26891.5104,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Aetna MGG,Aetna MGG,26891.5104,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,BCBS,BCBS,1103,,,,,,,per diem,1103,26891.5104,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,BCBS MGG,BCBS MGG,26891.5104,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Cigna,Cigna,1257,,,,,,,per diem,1103,26891.5104,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Cigna MGG,Cigna MGG,26891.5104,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Humana,Humana,1400,,,,,,,per diem,1103,26891.5104,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Humana MGG,Humana MGG,25546.93488,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Optum VA,Optum VA,26891.5104,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,UHC,UHC,1400,,,,,,,per diem,1103,26891.5104,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,UHC MGG,UHC MGG,26891.5104,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,VA,VA,26891.5104,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Wellcare MGG,Wellcare MGG,26891.5104,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Bright Health - commercial,Bright Health - commercial,26891.5104,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,26891.5104,26891.5104,Bright Health MGG,Bright Health MGG,26891.5104,,,,,,,case rate,1103,26891.5104,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Aetna,Aetna,1500,,,,,,,per diem,1103,24968.0376,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Aetna MGG,Aetna MGG,24968.0376,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,BCBS,BCBS,1103,,,,,,,per diem,1103,24968.0376,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,BCBS MGG,BCBS MGG,24968.0376,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Cigna,Cigna,1257,,,,,,,per diem,1103,24968.0376,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Cigna MGG,Cigna MGG,24968.0376,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Humana,Humana,1400,,,,,,,per diem,1103,24968.0376,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Humana MGG,Humana MGG,23719.63572,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Optum VA,Optum VA,24968.0376,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,UHC,UHC,1400,,,,,,,per diem,1103,24968.0376,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,UHC MGG,UHC MGG,24968.0376,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,VA,VA,24968.0376,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Wellcare MGG,Wellcare MGG,24968.0376,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Bright Health - commercial,Bright Health - commercial,24968.0376,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,24968.0376,24968.0376,Bright Health MGG,Bright Health MGG,24968.0376,,,,,,,case rate,1103,24968.0376,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Aetna,Aetna,1500,,,,,,,per diem,1103,26758.5372,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Aetna MGG,Aetna MGG,26758.5372,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,BCBS,BCBS,1103,,,,,,,per diem,1103,26758.5372,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,BCBS MGG,BCBS MGG,26758.5372,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Cigna,Cigna,1257,,,,,,,per diem,1103,26758.5372,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Cigna MGG,Cigna MGG,26758.5372,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Humana,Humana,1400,,,,,,,per diem,1103,26758.5372,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Humana MGG,Humana MGG,25420.61034,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Optum VA,Optum VA,26758.5372,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,UHC,UHC,1400,,,,,,,per diem,1103,26758.5372,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,UHC MGG,UHC MGG,26758.5372,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,VA,VA,26758.5372,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Wellcare MGG,Wellcare MGG,26758.5372,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Bright Health - commercial,Bright Health - commercial,26758.5372,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,26758.5372,26758.5372,Bright Health MGG,Bright Health MGG,26758.5372,,,,,,,case rate,1103,26758.5372,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Aetna,Aetna,1500,,,,,,,per diem,1103,39516.2334,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Aetna MGG,Aetna MGG,39516.2334,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,BCBS,BCBS,1103,,,,,,,per diem,1103,39516.2334,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,BCBS MGG,BCBS MGG,39516.2334,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Cigna,Cigna,1257,,,,,,,per diem,1103,39516.2334,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Cigna MGG,Cigna MGG,39516.2334,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Humana,Humana,1400,,,,,,,per diem,1103,39516.2334,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Humana MGG,Humana MGG,37540.42173,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Optum VA,Optum VA,39516.2334,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,UHC,UHC,1400,,,,,,,per diem,1103,39516.2334,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,UHC MGG,UHC MGG,39516.2334,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,VA,VA,39516.2334,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Wellcare MGG,Wellcare MGG,39516.2334,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Bright Health - commercial,Bright Health - commercial,39516.2334,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,39516.2334,39516.2334,Bright Health MGG,Bright Health MGG,39516.2334,,,,,,,case rate,1103,39516.2334,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Aetna,Aetna,1500,,,,,,,per diem,1103,31305.9114,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Aetna MGG,Aetna MGG,31305.9114,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,BCBS,BCBS,1103,,,,,,,per diem,1103,31305.9114,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,BCBS MGG,BCBS MGG,31305.9114,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Cigna,Cigna,1257,,,,,,,per diem,1103,31305.9114,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Cigna MGG,Cigna MGG,31305.9114,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Humana,Humana,1400,,,,,,,per diem,1103,31305.9114,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Humana MGG,Humana MGG,29740.61583,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Optum VA,Optum VA,31305.9114,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,UHC,UHC,1400,,,,,,,per diem,1103,31305.9114,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,UHC MGG,UHC MGG,31305.9114,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,VA,VA,31305.9114,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Wellcare MGG,Wellcare MGG,31305.9114,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Bright Health - commercial,Bright Health - commercial,31305.9114,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,31305.9114,31305.9114,Bright Health MGG,Bright Health MGG,31305.9114,,,,,,,case rate,1103,31305.9114,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Aetna,Aetna,1500,,,,,,,per diem,1103,29067.0138,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Aetna MGG,Aetna MGG,29067.0138,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,BCBS,BCBS,1103,,,,,,,per diem,1103,29067.0138,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,BCBS MGG,BCBS MGG,29067.0138,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Cigna,Cigna,1257,,,,,,,per diem,1103,29067.0138,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Cigna MGG,Cigna MGG,29067.0138,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Humana,Humana,1400,,,,,,,per diem,1103,29067.0138,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Humana MGG,Humana MGG,27613.66311,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Optum VA,Optum VA,29067.0138,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,UHC,UHC,1400,,,,,,,per diem,1103,29067.0138,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,UHC MGG,UHC MGG,29067.0138,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,VA,VA,29067.0138,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Wellcare MGG,Wellcare MGG,29067.0138,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Bright Health - commercial,Bright Health - commercial,29067.0138,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,29067.0138,29067.0138,Bright Health MGG,Bright Health MGG,29067.0138,,,,,,,case rate,1103,29067.0138,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Aetna,Aetna,1500,,,,,,,per diem,1103,12221.1648,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Aetna MGG,Aetna MGG,12221.1648,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,BCBS,BCBS,1103,,,,,,,per diem,1103,12221.1648,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,BCBS MGG,BCBS MGG,12221.1648,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Cigna,Cigna,1257,,,,,,,per diem,1103,12221.1648,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Cigna MGG,Cigna MGG,12221.1648,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Humana,Humana,1400,,,,,,,per diem,1103,12221.1648,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Humana MGG,Humana MGG,11610.10656,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Optum VA,Optum VA,12221.1648,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,UHC,UHC,1400,,,,,,,per diem,1103,12221.1648,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,UHC MGG,UHC MGG,12221.1648,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,VA,VA,12221.1648,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Wellcare MGG,Wellcare MGG,12221.1648,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Bright Health - commercial,Bright Health - commercial,12221.1648,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,12221.1648,12221.1648,Bright Health MGG,Bright Health MGG,12221.1648,,,,,,,case rate,1103,12221.1648,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Aetna,Aetna,1500,,,,,,,per diem,1103,17300.4318,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Aetna MGG,Aetna MGG,17300.4318,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,BCBS,BCBS,1103,,,,,,,per diem,1103,17300.4318,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,BCBS MGG,BCBS MGG,17300.4318,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Cigna,Cigna,1257,,,,,,,per diem,1103,17300.4318,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Cigna MGG,Cigna MGG,17300.4318,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Humana,Humana,1400,,,,,,,per diem,1103,17300.4318,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Humana MGG,Humana MGG,16435.41021,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Optum VA,Optum VA,17300.4318,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,UHC,UHC,1400,,,,,,,per diem,1103,17300.4318,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,UHC MGG,UHC MGG,17300.4318,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,VA,VA,17300.4318,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Wellcare MGG,Wellcare MGG,17300.4318,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Bright Health - commercial,Bright Health - commercial,17300.4318,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,17300.4318,17300.4318,Bright Health MGG,Bright Health MGG,17300.4318,,,,,,,case rate,1103,17300.4318,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Aetna,Aetna,1500,,,,,,,per diem,1103,14153.9148,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Aetna MGG,Aetna MGG,14153.9148,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,BCBS,BCBS,1103,,,,,,,per diem,1103,14153.9148,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,BCBS MGG,BCBS MGG,14153.9148,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Cigna,Cigna,1257,,,,,,,per diem,1103,14153.9148,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Cigna MGG,Cigna MGG,14153.9148,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Humana,Humana,1400,,,,,,,per diem,1103,14153.9148,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Humana MGG,Humana MGG,13446.21906,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Optum VA,Optum VA,14153.9148,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,UHC,UHC,1400,,,,,,,per diem,1103,14153.9148,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,UHC MGG,UHC MGG,14153.9148,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,VA,VA,14153.9148,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Wellcare MGG,Wellcare MGG,14153.9148,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Bright Health - commercial,Bright Health - commercial,14153.9148,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,14153.9148,14153.9148,Bright Health MGG,Bright Health MGG,14153.9148,,,,,,,case rate,1103,14153.9148,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Aetna,Aetna,1500,,,,,,,per diem,1103,13020.5502,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Aetna MGG,Aetna MGG,13020.5502,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,BCBS,BCBS,1103,,,,,,,per diem,1103,13020.5502,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,BCBS MGG,BCBS MGG,13020.5502,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Cigna,Cigna,1257,,,,,,,per diem,1103,13020.5502,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Cigna MGG,Cigna MGG,13020.5502,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Humana,Humana,1400,,,,,,,per diem,1103,13020.5502,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Humana MGG,Humana MGG,12369.52269,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Optum VA,Optum VA,13020.5502,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,UHC,UHC,1400,,,,,,,per diem,1103,13020.5502,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,UHC MGG,UHC MGG,13020.5502,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,VA,VA,13020.5502,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Wellcare MGG,Wellcare MGG,13020.5502,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Bright Health - commercial,Bright Health - commercial,13020.5502,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,13020.5502,13020.5502,Bright Health MGG,Bright Health MGG,13020.5502,,,,,,,case rate,1103,13020.5502,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Aetna,Aetna,1500,,,,,,,per diem,1103,15534.6714,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Aetna MGG,Aetna MGG,15534.6714,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,BCBS,BCBS,1103,,,,,,,per diem,1103,15534.6714,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,BCBS MGG,BCBS MGG,15534.6714,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Cigna,Cigna,1257,,,,,,,per diem,1103,15534.6714,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Cigna MGG,Cigna MGG,15534.6714,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Humana,Humana,1400,,,,,,,per diem,1103,15534.6714,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Humana MGG,Humana MGG,14757.93783,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Optum VA,Optum VA,15534.6714,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,UHC,UHC,1400,,,,,,,per diem,1103,15534.6714,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,UHC MGG,UHC MGG,15534.6714,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,VA,VA,15534.6714,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Wellcare MGG,Wellcare MGG,15534.6714,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Bright Health - commercial,Bright Health - commercial,15534.6714,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,15534.6714,15534.6714,Bright Health MGG,Bright Health MGG,15534.6714,,,,,,,case rate,1103,15534.6714,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Aetna,Aetna,1500,,,,,,,per diem,1103,21991.6026,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Aetna MGG,Aetna MGG,21991.6026,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,BCBS,BCBS,1103,,,,,,,per diem,1103,21991.6026,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,BCBS MGG,BCBS MGG,21991.6026,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Cigna,Cigna,1257,,,,,,,per diem,1103,21991.6026,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Cigna MGG,Cigna MGG,21991.6026,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Humana,Humana,1400,,,,,,,per diem,1103,21991.6026,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Humana MGG,Humana MGG,20892.02247,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Optum VA,Optum VA,21991.6026,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,UHC,UHC,1400,,,,,,,per diem,1103,21991.6026,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,UHC MGG,UHC MGG,21991.6026,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,VA,VA,21991.6026,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Wellcare MGG,Wellcare MGG,21991.6026,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Bright Health - commercial,Bright Health - commercial,21991.6026,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,21991.6026,21991.6026,Bright Health MGG,Bright Health MGG,21991.6026,,,,,,,case rate,1103,21991.6026,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Aetna,Aetna,1500,,,,,,,per diem,1103,17991.5832,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Aetna MGG,Aetna MGG,17991.5832,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,BCBS,BCBS,1103,,,,,,,per diem,1103,17991.5832,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,BCBS MGG,BCBS MGG,17991.5832,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Cigna,Cigna,1257,,,,,,,per diem,1103,17991.5832,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Cigna MGG,Cigna MGG,17991.5832,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Humana,Humana,1400,,,,,,,per diem,1103,17991.5832,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Humana MGG,Humana MGG,17092.00404,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Optum VA,Optum VA,17991.5832,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,UHC,UHC,1400,,,,,,,per diem,1103,17991.5832,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,UHC MGG,UHC MGG,17991.5832,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,VA,VA,17991.5832,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Wellcare MGG,Wellcare MGG,17991.5832,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Bright Health - commercial,Bright Health - commercial,17991.5832,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,17991.5832,17991.5832,Bright Health MGG,Bright Health MGG,17991.5832,,,,,,,case rate,1103,17991.5832,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Aetna,Aetna,1500,,,,,,,per diem,1103,16550.5248,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Aetna MGG,Aetna MGG,16550.5248,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,BCBS,BCBS,1103,,,,,,,per diem,1103,16550.5248,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,BCBS MGG,BCBS MGG,16550.5248,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Cigna,Cigna,1257,,,,,,,per diem,1103,16550.5248,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Cigna MGG,Cigna MGG,16550.5248,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Humana,Humana,1400,,,,,,,per diem,1103,16550.5248,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Humana MGG,Humana MGG,15722.99856,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Optum VA,Optum VA,16550.5248,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,UHC,UHC,1400,,,,,,,per diem,1103,16550.5248,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,UHC MGG,UHC MGG,16550.5248,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,VA,VA,16550.5248,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Wellcare MGG,Wellcare MGG,16550.5248,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Bright Health - commercial,Bright Health - commercial,16550.5248,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,16550.5248,16550.5248,Bright Health MGG,Bright Health MGG,16550.5248,,,,,,,case rate,1103,16550.5248,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Aetna,Aetna,1500,,,,,,,per diem,1103,19324.4076,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Aetna MGG,Aetna MGG,19324.4076,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,BCBS,BCBS,1103,,,,,,,per diem,1103,19324.4076,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,BCBS MGG,BCBS MGG,19324.4076,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Cigna,Cigna,1257,,,,,,,per diem,1103,19324.4076,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Cigna MGG,Cigna MGG,19324.4076,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Humana,Humana,1400,,,,,,,per diem,1103,19324.4076,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Humana MGG,Humana MGG,18358.18722,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Optum VA,Optum VA,19324.4076,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,UHC,UHC,1400,,,,,,,per diem,1103,19324.4076,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,UHC MGG,UHC MGG,19324.4076,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,VA,VA,19324.4076,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Wellcare MGG,Wellcare MGG,19324.4076,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Bright Health - commercial,Bright Health - commercial,19324.4076,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,19324.4076,19324.4076,Bright Health MGG,Bright Health MGG,19324.4076,,,,,,,case rate,1103,19324.4076,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Aetna,Aetna,1500,,,,,,,per diem,1103,27358.4628,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Aetna MGG,Aetna MGG,27358.4628,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,BCBS,BCBS,1103,,,,,,,per diem,1103,27358.4628,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,BCBS MGG,BCBS MGG,27358.4628,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Cigna,Cigna,1257,,,,,,,per diem,1103,27358.4628,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Cigna MGG,Cigna MGG,27358.4628,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Humana,Humana,1400,,,,,,,per diem,1103,27358.4628,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Humana MGG,Humana MGG,25990.53966,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Optum VA,Optum VA,27358.4628,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,UHC,UHC,1400,,,,,,,per diem,1103,27358.4628,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,UHC MGG,UHC MGG,27358.4628,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,VA,VA,27358.4628,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Wellcare MGG,Wellcare MGG,27358.4628,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Bright Health - commercial,Bright Health - commercial,27358.4628,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,27358.4628,27358.4628,Bright Health MGG,Bright Health MGG,27358.4628,,,,,,,case rate,1103,27358.4628,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Aetna,Aetna,1500,,,,,,,per diem,1103,22381.245,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Aetna MGG,Aetna MGG,22381.245,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,BCBS,BCBS,1103,,,,,,,per diem,1103,22381.245,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,BCBS MGG,BCBS MGG,22381.245,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Cigna,Cigna,1257,,,,,,,per diem,1103,22381.245,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Cigna MGG,Cigna MGG,22381.245,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Humana,Humana,1400,,,,,,,per diem,1103,22381.245,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Humana MGG,Humana MGG,21262.18275,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Optum VA,Optum VA,22381.245,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,UHC,UHC,1400,,,,,,,per diem,1103,22381.245,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,UHC MGG,UHC MGG,22381.245,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,VA,VA,22381.245,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Wellcare MGG,Wellcare MGG,22381.245,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Bright Health - commercial,Bright Health - commercial,22381.245,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,22381.245,22381.245,Bright Health MGG,Bright Health MGG,22381.245,,,,,,,case rate,1103,22381.245,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Aetna,Aetna,1500,,,,,,,per diem,1103,20589.1992,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Aetna MGG,Aetna MGG,20589.1992,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,BCBS,BCBS,1103,,,,,,,per diem,1103,20589.1992,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,BCBS MGG,BCBS MGG,20589.1992,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Cigna,Cigna,1257,,,,,,,per diem,1103,20589.1992,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Cigna MGG,Cigna MGG,20589.1992,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Humana,Humana,1400,,,,,,,per diem,1103,20589.1992,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Humana MGG,Humana MGG,19559.73924,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Optum VA,Optum VA,20589.1992,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,UHC,UHC,1400,,,,,,,per diem,1103,20589.1992,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,UHC MGG,UHC MGG,20589.1992,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,VA,VA,20589.1992,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Wellcare MGG,Wellcare MGG,20589.1992,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Bright Health - commercial,Bright Health - commercial,20589.1992,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,20589.1992,20589.1992,Bright Health MGG,Bright Health MGG,20589.1992,,,,,,,case rate,1103,20589.1992,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Aetna,Aetna,1500,,,,,,,per diem,1103,22569.8814,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Aetna MGG,Aetna MGG,22569.8814,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,BCBS,BCBS,1103,,,,,,,per diem,1103,22569.8814,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,BCBS MGG,BCBS MGG,22569.8814,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Cigna,Cigna,1257,,,,,,,per diem,1103,22569.8814,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Cigna MGG,Cigna MGG,22569.8814,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Humana,Humana,1400,,,,,,,per diem,1103,22569.8814,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Humana MGG,Humana MGG,21441.38733,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Optum VA,Optum VA,22569.8814,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,UHC,UHC,1400,,,,,,,per diem,1103,22569.8814,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,UHC MGG,UHC MGG,22569.8814,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,VA,VA,22569.8814,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Wellcare MGG,Wellcare MGG,22569.8814,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Bright Health - commercial,Bright Health - commercial,22569.8814,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,22569.8814,22569.8814,Bright Health MGG,Bright Health MGG,22569.8814,,,,,,,case rate,1103,22569.8814,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Aetna,Aetna,1500,,,,,,,per diem,1103,31952.223,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Aetna MGG,Aetna MGG,31952.223,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,BCBS,BCBS,1103,,,,,,,per diem,1103,31952.223,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,BCBS MGG,BCBS MGG,31952.223,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Cigna,Cigna,1257,,,,,,,per diem,1103,31952.223,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Cigna MGG,Cigna MGG,31952.223,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Humana,Humana,1400,,,,,,,per diem,1103,31952.223,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Humana MGG,Humana MGG,30354.61185,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Optum VA,Optum VA,31952.223,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,UHC,UHC,1400,,,,,,,per diem,1103,31952.223,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,UHC MGG,UHC MGG,31952.223,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,VA,VA,31952.223,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Wellcare MGG,Wellcare MGG,31952.223,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Bright Health - commercial,Bright Health - commercial,31952.223,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,31952.223,31952.223,Bright Health MGG,Bright Health MGG,31952.223,,,,,,,case rate,1103,31952.223,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Aetna,Aetna,1500,,,,,,,per diem,1103,26140.0572,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Aetna MGG,Aetna MGG,26140.0572,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,BCBS,BCBS,1103,,,,,,,per diem,1103,26140.0572,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,BCBS MGG,BCBS MGG,26140.0572,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Cigna,Cigna,1257,,,,,,,per diem,1103,26140.0572,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Cigna MGG,Cigna MGG,26140.0572,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Humana,Humana,1400,,,,,,,per diem,1103,26140.0572,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Humana MGG,Humana MGG,24833.05434,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Optum VA,Optum VA,26140.0572,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,UHC,UHC,1400,,,,,,,per diem,1103,26140.0572,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,UHC MGG,UHC MGG,26140.0572,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,VA,VA,26140.0572,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Wellcare MGG,Wellcare MGG,26140.0572,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Bright Health - commercial,Bright Health - commercial,26140.0572,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,26140.0572,26140.0572,Bright Health MGG,Bright Health MGG,26140.0572,,,,,,,case rate,1103,26140.0572,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Aetna,Aetna,1500,,,,,,,per diem,1103,24046.5024,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Aetna MGG,Aetna MGG,24046.5024,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,BCBS,BCBS,1103,,,,,,,per diem,1103,24046.5024,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,BCBS MGG,BCBS MGG,24046.5024,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Cigna,Cigna,1257,,,,,,,per diem,1103,24046.5024,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Cigna MGG,Cigna MGG,24046.5024,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Humana,Humana,1400,,,,,,,per diem,1103,24046.5024,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Humana MGG,Humana MGG,22844.17728,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Optum VA,Optum VA,24046.5024,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,UHC,UHC,1400,,,,,,,per diem,1103,24046.5024,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,UHC MGG,UHC MGG,24046.5024,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,VA,VA,24046.5024,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Wellcare MGG,Wellcare MGG,24046.5024,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Bright Health - commercial,Bright Health - commercial,24046.5024,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,24046.5024,24046.5024,Bright Health MGG,Bright Health MGG,24046.5024,,,,,,,case rate,1103,24046.5024,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Aetna,Aetna,1500,,,,,,,per diem,1103,27077.0544,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Aetna MGG,Aetna MGG,27077.0544,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,BCBS,BCBS,1103,,,,,,,per diem,1103,27077.0544,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,BCBS MGG,BCBS MGG,27077.0544,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Cigna,Cigna,1257,,,,,,,per diem,1103,27077.0544,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Cigna MGG,Cigna MGG,27077.0544,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Humana,Humana,1400,,,,,,,per diem,1103,27077.0544,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Humana MGG,Humana MGG,25723.20168,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Optum VA,Optum VA,27077.0544,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,UHC,UHC,1400,,,,,,,per diem,1103,27077.0544,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,UHC MGG,UHC MGG,27077.0544,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,VA,VA,27077.0544,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Wellcare MGG,Wellcare MGG,27077.0544,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Bright Health - commercial,Bright Health - commercial,27077.0544,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,27077.0544,27077.0544,Bright Health MGG,Bright Health MGG,27077.0544,,,,,,,case rate,1103,27077.0544,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Aetna,Aetna,1500,,,,,,,per diem,1103,38333.3904,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Aetna MGG,Aetna MGG,38333.3904,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,BCBS,BCBS,1103,,,,,,,per diem,1103,38333.3904,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,BCBS MGG,BCBS MGG,38333.3904,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Cigna,Cigna,1257,,,,,,,per diem,1103,38333.3904,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Cigna MGG,Cigna MGG,38333.3904,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Humana,Humana,1400,,,,,,,per diem,1103,38333.3904,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Humana MGG,Humana MGG,36416.72088,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Optum VA,Optum VA,38333.3904,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,UHC,UHC,1400,,,,,,,per diem,1103,38333.3904,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,UHC MGG,UHC MGG,38333.3904,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,VA,VA,38333.3904,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Wellcare MGG,Wellcare MGG,38333.3904,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Bright Health - commercial,Bright Health - commercial,38333.3904,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,38333.3904,38333.3904,Bright Health MGG,Bright Health MGG,38333.3904,,,,,,,case rate,1103,38333.3904,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Aetna,Aetna,1500,,,,,,,per diem,1103,31360.0284,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Aetna MGG,Aetna MGG,31360.0284,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,BCBS,BCBS,1103,,,,,,,per diem,1103,31360.0284,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,BCBS MGG,BCBS MGG,31360.0284,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Cigna,Cigna,1257,,,,,,,per diem,1103,31360.0284,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Cigna MGG,Cigna MGG,31360.0284,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Humana,Humana,1400,,,,,,,per diem,1103,31360.0284,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Humana MGG,Humana MGG,29792.02698,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Optum VA,Optum VA,31360.0284,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,UHC,UHC,1400,,,,,,,per diem,1103,31360.0284,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,UHC MGG,UHC MGG,31360.0284,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,VA,VA,31360.0284,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Wellcare MGG,Wellcare MGG,31360.0284,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Bright Health - commercial,Bright Health - commercial,31360.0284,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,31360.0284,31360.0284,Bright Health MGG,Bright Health MGG,31360.0284,,,,,,,case rate,1103,31360.0284,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Aetna,Aetna,1500,,,,,,,per diem,1103,28848.9996,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Aetna MGG,Aetna MGG,28848.9996,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,BCBS,BCBS,1103,,,,,,,per diem,1103,28848.9996,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,BCBS MGG,BCBS MGG,28848.9996,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Cigna,Cigna,1257,,,,,,,per diem,1103,28848.9996,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Cigna MGG,Cigna MGG,28848.9996,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Humana,Humana,1400,,,,,,,per diem,1103,28848.9996,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Humana MGG,Humana MGG,27406.54962,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Optum VA,Optum VA,28848.9996,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,UHC,UHC,1400,,,,,,,per diem,1103,28848.9996,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,UHC MGG,UHC MGG,28848.9996,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,VA,VA,28848.9996,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Wellcare MGG,Wellcare MGG,28848.9996,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Bright Health - commercial,Bright Health - commercial,28848.9996,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,28848.9996,28848.9996,Bright Health MGG,Bright Health MGG,28848.9996,,,,,,,case rate,1103,28848.9996,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Aetna,Aetna,1500,,,,,,,per diem,1103,39230.1864,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Aetna MGG,Aetna MGG,39230.1864,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,BCBS,BCBS,1103,,,,,,,per diem,1103,39230.1864,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,BCBS MGG,BCBS MGG,39230.1864,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Cigna,Cigna,1257,,,,,,,per diem,1103,39230.1864,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Cigna MGG,Cigna MGG,39230.1864,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Humana,Humana,1400,,,,,,,per diem,1103,39230.1864,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Humana MGG,Humana MGG,37268.67708,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Optum VA,Optum VA,39230.1864,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,UHC,UHC,1400,,,,,,,per diem,1103,39230.1864,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,UHC MGG,UHC MGG,39230.1864,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,VA,VA,39230.1864,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Wellcare MGG,Wellcare MGG,39230.1864,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Bright Health - commercial,Bright Health - commercial,39230.1864,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,39230.1864,39230.1864,Bright Health MGG,Bright Health MGG,39230.1864,,,,,,,case rate,1103,39230.1864,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Aetna,Aetna,1500,,,,,,,per diem,1103,55537.9578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Aetna MGG,Aetna MGG,55537.9578,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,BCBS,BCBS,1103,,,,,,,per diem,1103,55537.9578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,BCBS MGG,BCBS MGG,55537.9578,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Cigna,Cigna,1257,,,,,,,per diem,1103,55537.9578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Cigna MGG,Cigna MGG,55537.9578,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Humana,Humana,1400,,,,,,,per diem,1103,55537.9578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Humana MGG,Humana MGG,52761.05991,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Optum VA,Optum VA,55537.9578,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,UHC,UHC,1400,,,,,,,per diem,1103,55537.9578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,UHC MGG,UHC MGG,55537.9578,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,VA,VA,55537.9578,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Wellcare MGG,Wellcare MGG,55537.9578,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Bright Health - commercial,Bright Health - commercial,55537.9578,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,55537.9578,55537.9578,Bright Health MGG,Bright Health MGG,55537.9578,,,,,,,case rate,1103,55537.9578,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Aetna,Aetna,1500,,,,,,,per diem,1103,45435.087,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Aetna MGG,Aetna MGG,45435.087,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,BCBS,BCBS,1103,,,,,,,per diem,1103,45435.087,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,BCBS MGG,BCBS MGG,45435.087,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Cigna,Cigna,1257,,,,,,,per diem,1103,45435.087,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Cigna MGG,Cigna MGG,45435.087,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Humana,Humana,1400,,,,,,,per diem,1103,45435.087,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Humana MGG,Humana MGG,43163.33265,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Optum VA,Optum VA,45435.087,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,UHC,UHC,1400,,,,,,,per diem,1103,45435.087,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,UHC MGG,UHC MGG,45435.087,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,VA,VA,45435.087,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Wellcare MGG,Wellcare MGG,45435.087,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Bright Health - commercial,Bright Health - commercial,45435.087,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,45435.087,45435.087,Bright Health MGG,Bright Health MGG,45435.087,,,,,,,case rate,1103,45435.087,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Aetna,Aetna,1500,,,,,,,per diem,1103,41796.8784,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Aetna MGG,Aetna MGG,41796.8784,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,BCBS,BCBS,1103,,,,,,,per diem,1103,41796.8784,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,BCBS MGG,BCBS MGG,41796.8784,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Cigna,Cigna,1257,,,,,,,per diem,1103,41796.8784,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Cigna MGG,Cigna MGG,41796.8784,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Humana,Humana,1400,,,,,,,per diem,1103,41796.8784,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Humana MGG,Humana MGG,39707.03448,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Optum VA,Optum VA,41796.8784,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,UHC,UHC,1400,,,,,,,per diem,1103,41796.8784,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,UHC MGG,UHC MGG,41796.8784,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,VA,VA,41796.8784,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Wellcare MGG,Wellcare MGG,41796.8784,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Bright Health - commercial,Bright Health - commercial,41796.8784,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,41796.8784,41796.8784,Bright Health MGG,Bright Health MGG,41796.8784,,,,,,,case rate,1103,41796.8784,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Aetna,Aetna,1500,,,,,,,per diem,1103,12740.688,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Aetna MGG,Aetna MGG,12740.688,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,BCBS,BCBS,1103,,,,,,,per diem,1103,12740.688,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,BCBS MGG,BCBS MGG,12740.688,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Cigna,Cigna,1257,,,,,,,per diem,1103,12740.688,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Cigna MGG,Cigna MGG,12740.688,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Humana,Humana,1400,,,,,,,per diem,1103,12740.688,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Humana MGG,Humana MGG,12103.6536,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Optum VA,Optum VA,12740.688,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,UHC,UHC,1400,,,,,,,per diem,1103,12740.688,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,UHC MGG,UHC MGG,12740.688,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,VA,VA,12740.688,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Wellcare MGG,Wellcare MGG,12740.688,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Bright Health - commercial,Bright Health - commercial,12740.688,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,12740.688,12740.688,Bright Health MGG,Bright Health MGG,12740.688,,,,,,,case rate,1103,12740.688,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Aetna,Aetna,1500,,,,,,,per diem,1103,20729.9034,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Aetna MGG,Aetna MGG,20729.9034,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,BCBS,BCBS,1103,,,,,,,per diem,1103,20729.9034,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,BCBS MGG,BCBS MGG,20729.9034,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Cigna,Cigna,1257,,,,,,,per diem,1103,20729.9034,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Cigna MGG,Cigna MGG,20729.9034,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Humana,Humana,1400,,,,,,,per diem,1103,20729.9034,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Humana MGG,Humana MGG,19693.40823,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Optum VA,Optum VA,20729.9034,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,UHC,UHC,1400,,,,,,,per diem,1103,20729.9034,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,UHC MGG,UHC MGG,20729.9034,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,VA,VA,20729.9034,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Wellcare MGG,Wellcare MGG,20729.9034,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Bright Health - commercial,Bright Health - commercial,20729.9034,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,20729.9034,20729.9034,Bright Health MGG,Bright Health MGG,20729.9034,,,,,,,case rate,1103,20729.9034,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Aetna,Aetna,1500,,,,,,,per diem,1103,14650.245,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Aetna MGG,Aetna MGG,14650.245,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,BCBS,BCBS,1103,,,,,,,per diem,1103,14650.245,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,BCBS MGG,BCBS MGG,14650.245,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Cigna,Cigna,1257,,,,,,,per diem,1103,14650.245,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Cigna MGG,Cigna MGG,14650.245,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Humana,Humana,1400,,,,,,,per diem,1103,14650.245,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Humana MGG,Humana MGG,13917.73275,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Optum VA,Optum VA,14650.245,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,UHC,UHC,1400,,,,,,,per diem,1103,14650.245,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,UHC MGG,UHC MGG,14650.245,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,VA,VA,14650.245,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Wellcare MGG,Wellcare MGG,14650.245,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Bright Health - commercial,Bright Health - commercial,14650.245,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,14650.245,14650.245,Bright Health MGG,Bright Health MGG,14650.245,,,,,,,case rate,1103,14650.245,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Aetna,Aetna,1500,,,,,,,per diem,1103,12736.0494,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Aetna MGG,Aetna MGG,12736.0494,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,BCBS,BCBS,1103,,,,,,,per diem,1103,12736.0494,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,BCBS MGG,BCBS MGG,12736.0494,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Cigna,Cigna,1257,,,,,,,per diem,1103,12736.0494,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Cigna MGG,Cigna MGG,12736.0494,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Humana,Humana,1400,,,,,,,per diem,1103,12736.0494,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Humana MGG,Humana MGG,12099.24693,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Optum VA,Optum VA,12736.0494,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,UHC,UHC,1400,,,,,,,per diem,1103,12736.0494,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,UHC MGG,UHC MGG,12736.0494,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,VA,VA,12736.0494,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Wellcare MGG,Wellcare MGG,12736.0494,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Bright Health - commercial,Bright Health - commercial,12736.0494,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,12736.0494,12736.0494,Bright Health MGG,Bright Health MGG,12736.0494,,,,,,,case rate,1103,12736.0494,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Aetna,Aetna,1500,,,,,,,per diem,1103,18534.2994,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Aetna MGG,Aetna MGG,18534.2994,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,BCBS,BCBS,1103,,,,,,,per diem,1103,18534.2994,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,BCBS MGG,BCBS MGG,18534.2994,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Cigna,Cigna,1257,,,,,,,per diem,1103,18534.2994,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Cigna MGG,Cigna MGG,18534.2994,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Humana,Humana,1400,,,,,,,per diem,1103,18534.2994,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Humana MGG,Humana MGG,17607.58443,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Optum VA,Optum VA,18534.2994,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,UHC,UHC,1400,,,,,,,per diem,1103,18534.2994,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,UHC MGG,UHC MGG,18534.2994,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,VA,VA,18534.2994,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Wellcare MGG,Wellcare MGG,18534.2994,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Bright Health - commercial,Bright Health - commercial,18534.2994,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,18534.2994,18534.2994,Bright Health MGG,Bright Health MGG,18534.2994,,,,,,,case rate,1103,18534.2994,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Aetna,Aetna,1500,,,,,,,per diem,1103,30158.631,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Aetna MGG,Aetna MGG,30158.631,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,BCBS,BCBS,1103,,,,,,,per diem,1103,30158.631,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,BCBS MGG,BCBS MGG,30158.631,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Cigna,Cigna,1257,,,,,,,per diem,1103,30158.631,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Cigna MGG,Cigna MGG,30158.631,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Humana,Humana,1400,,,,,,,per diem,1103,30158.631,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Humana MGG,Humana MGG,28650.69945,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Optum VA,Optum VA,30158.631,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,UHC,UHC,1400,,,,,,,per diem,1103,30158.631,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,UHC MGG,UHC MGG,30158.631,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,VA,VA,30158.631,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Wellcare MGG,Wellcare MGG,30158.631,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Bright Health - commercial,Bright Health - commercial,30158.631,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,30158.631,30158.631,Bright Health MGG,Bright Health MGG,30158.631,,,,,,,case rate,1103,30158.631,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Aetna,Aetna,1500,,,,,,,per diem,1103,21314.367,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Aetna MGG,Aetna MGG,21314.367,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,BCBS,BCBS,1103,,,,,,,per diem,1103,21314.367,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,BCBS MGG,BCBS MGG,21314.367,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Cigna,Cigna,1257,,,,,,,per diem,1103,21314.367,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Cigna MGG,Cigna MGG,21314.367,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Humana,Humana,1400,,,,,,,per diem,1103,21314.367,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Humana MGG,Humana MGG,20248.64865,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Optum VA,Optum VA,21314.367,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,UHC,UHC,1400,,,,,,,per diem,1103,21314.367,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,UHC MGG,UHC MGG,21314.367,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,VA,VA,21314.367,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Wellcare MGG,Wellcare MGG,21314.367,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Bright Health - commercial,Bright Health - commercial,21314.367,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,21314.367,21314.367,Bright Health MGG,Bright Health MGG,21314.367,,,,,,,case rate,1103,21314.367,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Aetna,Aetna,1500,,,,,,,per diem,1103,18529.6608,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Aetna MGG,Aetna MGG,18529.6608,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,BCBS,BCBS,1103,,,,,,,per diem,1103,18529.6608,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,BCBS MGG,BCBS MGG,18529.6608,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Cigna,Cigna,1257,,,,,,,per diem,1103,18529.6608,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Cigna MGG,Cigna MGG,18529.6608,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Humana,Humana,1400,,,,,,,per diem,1103,18529.6608,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Humana MGG,Humana MGG,17603.17776,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Optum VA,Optum VA,18529.6608,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,UHC,UHC,1400,,,,,,,per diem,1103,18529.6608,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,UHC MGG,UHC MGG,18529.6608,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,VA,VA,18529.6608,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Wellcare MGG,Wellcare MGG,18529.6608,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Bright Health - commercial,Bright Health - commercial,18529.6608,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,18529.6608,18529.6608,Bright Health MGG,Bright Health MGG,18529.6608,,,,,,,case rate,1103,18529.6608,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Aetna,Aetna,1500,,,,,,,per diem,1103,26223.552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Aetna MGG,Aetna MGG,26223.552,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,BCBS,BCBS,1103,,,,,,,per diem,1103,26223.552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,BCBS MGG,BCBS MGG,26223.552,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Cigna,Cigna,1257,,,,,,,per diem,1103,26223.552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Cigna MGG,Cigna MGG,26223.552,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Humana,Humana,1400,,,,,,,per diem,1103,26223.552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Humana MGG,Humana MGG,24912.3744,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Optum VA,Optum VA,26223.552,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,UHC,UHC,1400,,,,,,,per diem,1103,26223.552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,UHC MGG,UHC MGG,26223.552,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,VA,VA,26223.552,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Wellcare MGG,Wellcare MGG,26223.552,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Bright Health - commercial,Bright Health - commercial,26223.552,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,26223.552,26223.552,Bright Health MGG,Bright Health MGG,26223.552,,,,,,,case rate,1103,26223.552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Aetna,Aetna,1500,,,,,,,per diem,1103,42670.4814,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Aetna MGG,Aetna MGG,42670.4814,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,BCBS,BCBS,1103,,,,,,,per diem,1103,42670.4814,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,BCBS MGG,BCBS MGG,42670.4814,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Cigna,Cigna,1257,,,,,,,per diem,1103,42670.4814,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Cigna MGG,Cigna MGG,42670.4814,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Humana,Humana,1400,,,,,,,per diem,1103,42670.4814,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Humana MGG,Humana MGG,40536.95733,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Optum VA,Optum VA,42670.4814,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,UHC,UHC,1400,,,,,,,per diem,1103,42670.4814,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,UHC MGG,UHC MGG,42670.4814,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,VA,VA,42670.4814,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Wellcare MGG,Wellcare MGG,42670.4814,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Bright Health - commercial,Bright Health - commercial,42670.4814,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,42670.4814,42670.4814,Bright Health MGG,Bright Health MGG,42670.4814,,,,,,,case rate,1103,42670.4814,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Aetna,Aetna,1500,,,,,,,per diem,1103,30157.0848,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Aetna MGG,Aetna MGG,30157.0848,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,BCBS,BCBS,1103,,,,,,,per diem,1103,30157.0848,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,BCBS MGG,BCBS MGG,30157.0848,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Cigna,Cigna,1257,,,,,,,per diem,1103,30157.0848,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Cigna MGG,Cigna MGG,30157.0848,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Humana,Humana,1400,,,,,,,per diem,1103,30157.0848,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Humana MGG,Humana MGG,28649.23056,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Optum VA,Optum VA,30157.0848,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,UHC,UHC,1400,,,,,,,per diem,1103,30157.0848,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,UHC MGG,UHC MGG,30157.0848,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,VA,VA,30157.0848,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Wellcare MGG,Wellcare MGG,30157.0848,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Bright Health - commercial,Bright Health - commercial,30157.0848,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,30157.0848,30157.0848,Bright Health MGG,Bright Health MGG,30157.0848,,,,,,,case rate,1103,30157.0848,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Aetna,Aetna,1500,,,,,,,per diem,1103,26217.3672,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Aetna MGG,Aetna MGG,26217.3672,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,BCBS,BCBS,1103,,,,,,,per diem,1103,26217.3672,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,BCBS MGG,BCBS MGG,26217.3672,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Cigna,Cigna,1257,,,,,,,per diem,1103,26217.3672,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Cigna MGG,Cigna MGG,26217.3672,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Humana,Humana,1400,,,,,,,per diem,1103,26217.3672,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Humana MGG,Humana MGG,24906.49884,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Optum VA,Optum VA,26217.3672,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,UHC,UHC,1400,,,,,,,per diem,1103,26217.3672,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,UHC MGG,UHC MGG,26217.3672,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,VA,VA,26217.3672,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Wellcare MGG,Wellcare MGG,26217.3672,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Bright Health - commercial,Bright Health - commercial,26217.3672,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,26217.3672,26217.3672,Bright Health MGG,Bright Health MGG,26217.3672,,,,,,,case rate,1103,26217.3672,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Aetna,Aetna,1500,,,,,,,per diem,1103,40324.896,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Aetna MGG,Aetna MGG,40324.896,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,BCBS,BCBS,1103,,,,,,,per diem,1103,40324.896,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,BCBS MGG,BCBS MGG,40324.896,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Cigna,Cigna,1257,,,,,,,per diem,1103,40324.896,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Cigna MGG,Cigna MGG,40324.896,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Humana,Humana,1400,,,,,,,per diem,1103,40324.896,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Humana MGG,Humana MGG,38308.6512,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Optum VA,Optum VA,40324.896,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,UHC,UHC,1400,,,,,,,per diem,1103,40324.896,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,UHC MGG,UHC MGG,40324.896,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,VA,VA,40324.896,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Wellcare MGG,Wellcare MGG,40324.896,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Bright Health - commercial,Bright Health - commercial,40324.896,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,40324.896,40324.896,Bright Health MGG,Bright Health MGG,40324.896,,,,,,,case rate,1103,40324.896,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Aetna,Aetna,1500,,,,,,,per diem,1103,65614.5432,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Aetna MGG,Aetna MGG,65614.5432,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,BCBS,BCBS,1103,,,,,,,per diem,1103,65614.5432,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,BCBS MGG,BCBS MGG,65614.5432,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Cigna,Cigna,1257,,,,,,,per diem,1103,65614.5432,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Cigna MGG,Cigna MGG,65614.5432,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Humana,Humana,1400,,,,,,,per diem,1103,65614.5432,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Humana MGG,Humana MGG,62333.81604,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Optum VA,Optum VA,65614.5432,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,UHC,UHC,1400,,,,,,,per diem,1103,65614.5432,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,UHC MGG,UHC MGG,65614.5432,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,VA,VA,65614.5432,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Wellcare MGG,Wellcare MGG,65614.5432,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Bright Health - commercial,Bright Health - commercial,65614.5432,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,65614.5432,65614.5432,Bright Health MGG,Bright Health MGG,65614.5432,,,,,,,case rate,1103,65614.5432,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Aetna,Aetna,1500,,,,,,,per diem,1103,46372.0842,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Aetna MGG,Aetna MGG,46372.0842,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,BCBS,BCBS,1103,,,,,,,per diem,1103,46372.0842,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,BCBS MGG,BCBS MGG,46372.0842,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Cigna,Cigna,1257,,,,,,,per diem,1103,46372.0842,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Cigna MGG,Cigna MGG,46372.0842,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Humana,Humana,1400,,,,,,,per diem,1103,46372.0842,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Humana MGG,Humana MGG,44053.47999,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Optum VA,Optum VA,46372.0842,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,UHC,UHC,1400,,,,,,,per diem,1103,46372.0842,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,UHC MGG,UHC MGG,46372.0842,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,VA,VA,46372.0842,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Wellcare MGG,Wellcare MGG,46372.0842,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Bright Health - commercial,Bright Health - commercial,46372.0842,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,46372.0842,46372.0842,Bright Health MGG,Bright Health MGG,46372.0842,,,,,,,case rate,1103,46372.0842,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Aetna,Aetna,1500,,,,,,,per diem,1103,40312.5264,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Aetna MGG,Aetna MGG,40312.5264,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,BCBS,BCBS,1103,,,,,,,per diem,1103,40312.5264,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,BCBS MGG,BCBS MGG,40312.5264,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Cigna,Cigna,1257,,,,,,,per diem,1103,40312.5264,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Cigna MGG,Cigna MGG,40312.5264,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Humana,Humana,1400,,,,,,,per diem,1103,40312.5264,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Humana MGG,Humana MGG,38296.90008,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Optum VA,Optum VA,40312.5264,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,UHC,UHC,1400,,,,,,,per diem,1103,40312.5264,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,UHC MGG,UHC MGG,40312.5264,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,VA,VA,40312.5264,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Wellcare MGG,Wellcare MGG,40312.5264,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Bright Health - commercial,Bright Health - commercial,40312.5264,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,40312.5264,40312.5264,Bright Health MGG,Bright Health MGG,40312.5264,,,,,,,case rate,1103,40312.5264,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Aetna,Aetna,1500,,,,,,,per diem,1103,12545.8668,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Aetna MGG,Aetna MGG,12545.8668,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,BCBS,BCBS,1103,,,,,,,per diem,1103,12545.8668,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,BCBS MGG,BCBS MGG,12545.8668,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Cigna,Cigna,1257,,,,,,,per diem,1103,12545.8668,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Cigna MGG,Cigna MGG,12545.8668,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Humana,Humana,1400,,,,,,,per diem,1103,12545.8668,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Humana MGG,Humana MGG,11918.57346,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Optum VA,Optum VA,12545.8668,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,UHC,UHC,1400,,,,,,,per diem,1103,12545.8668,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,UHC MGG,UHC MGG,12545.8668,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,VA,VA,12545.8668,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Wellcare MGG,Wellcare MGG,12545.8668,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Bright Health - commercial,Bright Health - commercial,12545.8668,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,12545.8668,12545.8668,Bright Health MGG,Bright Health MGG,12545.8668,,,,,,,case rate,1103,12545.8668,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Aetna,Aetna,1500,,,,,,,per diem,1103,18375.0408,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Aetna MGG,Aetna MGG,18375.0408,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,BCBS,BCBS,1103,,,,,,,per diem,1103,18375.0408,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,BCBS MGG,BCBS MGG,18375.0408,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Cigna,Cigna,1257,,,,,,,per diem,1103,18375.0408,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Cigna MGG,Cigna MGG,18375.0408,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Humana,Humana,1400,,,,,,,per diem,1103,18375.0408,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Humana MGG,Humana MGG,17456.28876,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Optum VA,Optum VA,18375.0408,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,UHC,UHC,1400,,,,,,,per diem,1103,18375.0408,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,UHC MGG,UHC MGG,18375.0408,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,VA,VA,18375.0408,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Wellcare MGG,Wellcare MGG,18375.0408,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Bright Health - commercial,Bright Health - commercial,18375.0408,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,18375.0408,18375.0408,Bright Health MGG,Bright Health MGG,18375.0408,,,,,,,case rate,1103,18375.0408,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Aetna,Aetna,1500,,,,,,,per diem,1103,14736.8322,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Aetna MGG,Aetna MGG,14736.8322,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,BCBS,BCBS,1103,,,,,,,per diem,1103,14736.8322,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,BCBS MGG,BCBS MGG,14736.8322,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Cigna,Cigna,1257,,,,,,,per diem,1103,14736.8322,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Cigna MGG,Cigna MGG,14736.8322,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Humana,Humana,1400,,,,,,,per diem,1103,14736.8322,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Humana MGG,Humana MGG,13999.99059,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Optum VA,Optum VA,14736.8322,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,UHC,UHC,1400,,,,,,,per diem,1103,14736.8322,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,UHC MGG,UHC MGG,14736.8322,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,VA,VA,14736.8322,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Wellcare MGG,Wellcare MGG,14736.8322,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Bright Health - commercial,Bright Health - commercial,14736.8322,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,14736.8322,14736.8322,Bright Health MGG,Bright Health MGG,14736.8322,,,,,,,case rate,1103,14736.8322,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Aetna,Aetna,1500,,,,,,,per diem,1103,13705.5168,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Aetna MGG,Aetna MGG,13705.5168,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,BCBS,BCBS,1103,,,,,,,per diem,1103,13705.5168,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,BCBS MGG,BCBS MGG,13705.5168,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Cigna,Cigna,1257,,,,,,,per diem,1103,13705.5168,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Cigna MGG,Cigna MGG,13705.5168,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Humana,Humana,1400,,,,,,,per diem,1103,13705.5168,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Humana MGG,Humana MGG,13020.24096,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Optum VA,Optum VA,13705.5168,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,UHC,UHC,1400,,,,,,,per diem,1103,13705.5168,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,UHC MGG,UHC MGG,13705.5168,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,VA,VA,13705.5168,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Wellcare MGG,Wellcare MGG,13705.5168,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Bright Health - commercial,Bright Health - commercial,13705.5168,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,13705.5168,13705.5168,Bright Health MGG,Bright Health MGG,13705.5168,,,,,,,case rate,1103,13705.5168,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Aetna,Aetna,1500,,,,,,,per diem,1103,15576.4188,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Aetna MGG,Aetna MGG,15576.4188,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,BCBS,BCBS,1103,,,,,,,per diem,1103,15576.4188,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,BCBS MGG,BCBS MGG,15576.4188,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Cigna,Cigna,1257,,,,,,,per diem,1103,15576.4188,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Cigna MGG,Cigna MGG,15576.4188,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Humana,Humana,1400,,,,,,,per diem,1103,15576.4188,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Humana MGG,Humana MGG,14797.59786,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Optum VA,Optum VA,15576.4188,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,UHC,UHC,1400,,,,,,,per diem,1103,15576.4188,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,UHC MGG,UHC MGG,15576.4188,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,VA,VA,15576.4188,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Wellcare MGG,Wellcare MGG,15576.4188,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Bright Health - commercial,Bright Health - commercial,15576.4188,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,15576.4188,15576.4188,Bright Health MGG,Bright Health MGG,15576.4188,,,,,,,case rate,1103,15576.4188,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Aetna,Aetna,1500,,,,,,,per diem,1103,22814.181,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Aetna MGG,Aetna MGG,22814.181,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,BCBS,BCBS,1103,,,,,,,per diem,1103,22814.181,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,BCBS MGG,BCBS MGG,22814.181,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Cigna,Cigna,1257,,,,,,,per diem,1103,22814.181,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Cigna MGG,Cigna MGG,22814.181,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Humana,Humana,1400,,,,,,,per diem,1103,22814.181,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Humana MGG,Humana MGG,21673.47195,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Optum VA,Optum VA,22814.181,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,UHC,UHC,1400,,,,,,,per diem,1103,22814.181,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,UHC MGG,UHC MGG,22814.181,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,VA,VA,22814.181,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Wellcare MGG,Wellcare MGG,22814.181,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Bright Health - commercial,Bright Health - commercial,22814.181,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,22814.181,22814.181,Bright Health MGG,Bright Health MGG,22814.181,,,,,,,case rate,1103,22814.181,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Aetna,Aetna,1500,,,,,,,per diem,1103,18296.1846,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Aetna MGG,Aetna MGG,18296.1846,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,BCBS,BCBS,1103,,,,,,,per diem,1103,18296.1846,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,BCBS MGG,BCBS MGG,18296.1846,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Cigna,Cigna,1257,,,,,,,per diem,1103,18296.1846,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Cigna MGG,Cigna MGG,18296.1846,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Humana,Humana,1400,,,,,,,per diem,1103,18296.1846,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Humana MGG,Humana MGG,17381.37537,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Optum VA,Optum VA,18296.1846,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,UHC,UHC,1400,,,,,,,per diem,1103,18296.1846,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,UHC MGG,UHC MGG,18296.1846,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,VA,VA,18296.1846,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Wellcare MGG,Wellcare MGG,18296.1846,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Bright Health - commercial,Bright Health - commercial,18296.1846,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,18296.1846,18296.1846,Bright Health MGG,Bright Health MGG,18296.1846,,,,,,,case rate,1103,18296.1846,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Aetna,Aetna,1500,,,,,,,per diem,1103,17014.3848,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Aetna MGG,Aetna MGG,17014.3848,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,BCBS,BCBS,1103,,,,,,,per diem,1103,17014.3848,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,BCBS MGG,BCBS MGG,17014.3848,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Cigna,Cigna,1257,,,,,,,per diem,1103,17014.3848,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Cigna MGG,Cigna MGG,17014.3848,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Humana,Humana,1400,,,,,,,per diem,1103,17014.3848,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Humana MGG,Humana MGG,16163.66556,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Optum VA,Optum VA,17014.3848,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,UHC,UHC,1400,,,,,,,per diem,1103,17014.3848,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,UHC MGG,UHC MGG,17014.3848,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,VA,VA,17014.3848,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Wellcare MGG,Wellcare MGG,17014.3848,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Bright Health - commercial,Bright Health - commercial,17014.3848,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,17014.3848,17014.3848,Bright Health MGG,Bright Health MGG,17014.3848,,,,,,,case rate,1103,17014.3848,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Aetna,Aetna,1500,,,,,,,per diem,1103,18291.546,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Aetna MGG,Aetna MGG,18291.546,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,BCBS,BCBS,1103,,,,,,,per diem,1103,18291.546,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,BCBS MGG,BCBS MGG,18291.546,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Cigna,Cigna,1257,,,,,,,per diem,1103,18291.546,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Cigna MGG,Cigna MGG,18291.546,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Humana,Humana,1400,,,,,,,per diem,1103,18291.546,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Humana MGG,Humana MGG,17376.9687,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Optum VA,Optum VA,18291.546,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,UHC,UHC,1400,,,,,,,per diem,1103,18291.546,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,UHC MGG,UHC MGG,18291.546,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,VA,VA,18291.546,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Wellcare MGG,Wellcare MGG,18291.546,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Bright Health - commercial,Bright Health - commercial,18291.546,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,18291.546,18291.546,Bright Health MGG,Bright Health MGG,18291.546,,,,,,,case rate,1103,18291.546,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Aetna,Aetna,1500,,,,,,,per diem,1103,26789.4612,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Aetna MGG,Aetna MGG,26789.4612,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,BCBS,BCBS,1103,,,,,,,per diem,1103,26789.4612,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,BCBS MGG,BCBS MGG,26789.4612,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Cigna,Cigna,1257,,,,,,,per diem,1103,26789.4612,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Cigna MGG,Cigna MGG,26789.4612,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Humana,Humana,1400,,,,,,,per diem,1103,26789.4612,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Humana MGG,Humana MGG,25449.98814,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Optum VA,Optum VA,26789.4612,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,UHC,UHC,1400,,,,,,,per diem,1103,26789.4612,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,UHC MGG,UHC MGG,26789.4612,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,VA,VA,26789.4612,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Wellcare MGG,Wellcare MGG,26789.4612,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Bright Health - commercial,Bright Health - commercial,26789.4612,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,26789.4612,26789.4612,Bright Health MGG,Bright Health MGG,26789.4612,,,,,,,case rate,1103,26789.4612,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Aetna,Aetna,1500,,,,,,,per diem,1103,21484.449,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Aetna MGG,Aetna MGG,21484.449,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,BCBS,BCBS,1103,,,,,,,per diem,1103,21484.449,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,BCBS MGG,BCBS MGG,21484.449,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Cigna,Cigna,1257,,,,,,,per diem,1103,21484.449,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Cigna MGG,Cigna MGG,21484.449,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Humana,Humana,1400,,,,,,,per diem,1103,21484.449,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Humana MGG,Humana MGG,20410.22655,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Optum VA,Optum VA,21484.449,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,UHC,UHC,1400,,,,,,,per diem,1103,21484.449,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,UHC MGG,UHC MGG,21484.449,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,VA,VA,21484.449,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Wellcare MGG,Wellcare MGG,21484.449,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Bright Health - commercial,Bright Health - commercial,21484.449,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,21484.449,21484.449,Bright Health MGG,Bright Health MGG,21484.449,,,,,,,case rate,1103,21484.449,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Aetna,Aetna,1500,,,,,,,per diem,1103,19979.9964,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Aetna MGG,Aetna MGG,19979.9964,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,BCBS,BCBS,1103,,,,,,,per diem,1103,19979.9964,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,BCBS MGG,BCBS MGG,19979.9964,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Cigna,Cigna,1257,,,,,,,per diem,1103,19979.9964,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Cigna MGG,Cigna MGG,19979.9964,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Humana,Humana,1400,,,,,,,per diem,1103,19979.9964,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Humana MGG,Humana MGG,18980.99658,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Optum VA,Optum VA,19979.9964,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,UHC,UHC,1400,,,,,,,per diem,1103,19979.9964,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,UHC MGG,UHC MGG,19979.9964,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,VA,VA,19979.9964,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Wellcare MGG,Wellcare MGG,19979.9964,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Bright Health - commercial,Bright Health - commercial,19979.9964,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,19979.9964,19979.9964,Bright Health MGG,Bright Health MGG,19979.9964,,,,,,,case rate,1103,19979.9964,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Aetna,Aetna,1500,,,,,,,per diem,1103,22307.0274,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Aetna MGG,Aetna MGG,22307.0274,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,BCBS,BCBS,1103,,,,,,,per diem,1103,22307.0274,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,BCBS MGG,BCBS MGG,22307.0274,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Cigna,Cigna,1257,,,,,,,per diem,1103,22307.0274,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Cigna MGG,Cigna MGG,22307.0274,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Humana,Humana,1400,,,,,,,per diem,1103,22307.0274,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Humana MGG,Humana MGG,21191.67603,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Optum VA,Optum VA,22307.0274,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,UHC,UHC,1400,,,,,,,per diem,1103,22307.0274,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,UHC MGG,UHC MGG,22307.0274,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,VA,VA,22307.0274,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Wellcare MGG,Wellcare MGG,22307.0274,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Bright Health - commercial,Bright Health - commercial,22307.0274,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,22307.0274,22307.0274,Bright Health MGG,Bright Health MGG,22307.0274,,,,,,,case rate,1103,22307.0274,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Aetna,Aetna,1500,,,,,,,per diem,1103,32672.7522,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Aetna MGG,Aetna MGG,32672.7522,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,BCBS,BCBS,1103,,,,,,,per diem,1103,32672.7522,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,BCBS MGG,BCBS MGG,32672.7522,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Cigna,Cigna,1257,,,,,,,per diem,1103,32672.7522,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Cigna MGG,Cigna MGG,32672.7522,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Humana,Humana,1400,,,,,,,per diem,1103,32672.7522,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Humana MGG,Humana MGG,31039.11459,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Optum VA,Optum VA,32672.7522,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,UHC,UHC,1400,,,,,,,per diem,1103,32672.7522,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,UHC MGG,UHC MGG,32672.7522,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,VA,VA,32672.7522,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Wellcare MGG,Wellcare MGG,32672.7522,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Bright Health - commercial,Bright Health - commercial,32672.7522,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,32672.7522,32672.7522,Bright Health MGG,Bright Health MGG,32672.7522,,,,,,,case rate,1103,32672.7522,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Aetna,Aetna,1500,,,,,,,per diem,1103,26201.9052,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Aetna MGG,Aetna MGG,26201.9052,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,BCBS,BCBS,1103,,,,,,,per diem,1103,26201.9052,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,BCBS MGG,BCBS MGG,26201.9052,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Cigna,Cigna,1257,,,,,,,per diem,1103,26201.9052,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Cigna MGG,Cigna MGG,26201.9052,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Humana,Humana,1400,,,,,,,per diem,1103,26201.9052,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Humana MGG,Humana MGG,24891.80994,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Optum VA,Optum VA,26201.9052,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,UHC,UHC,1400,,,,,,,per diem,1103,26201.9052,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,UHC MGG,UHC MGG,26201.9052,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,VA,VA,26201.9052,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Wellcare MGG,Wellcare MGG,26201.9052,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Bright Health - commercial,Bright Health - commercial,26201.9052,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,26201.9052,26201.9052,Bright Health MGG,Bright Health MGG,26201.9052,,,,,,,case rate,1103,26201.9052,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Aetna,Aetna,1500,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Aetna MGG,Aetna MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,BCBS,BCBS,1103,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,BCBS MGG,BCBS MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Cigna,Cigna,1257,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Cigna MGG,Cigna MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Humana,Humana,1400,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Humana MGG,Humana MGG,23149.7064,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Optum VA,Optum VA,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,UHC,UHC,1400,,,,,,,per diem,1103,24368.112,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,UHC MGG,UHC MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,VA,VA,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Wellcare MGG,Wellcare MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Bright Health - commercial,Bright Health - commercial,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,24368.112,24368.112,Bright Health MGG,Bright Health MGG,24368.112,,,,,,,case rate,1103,24368.112,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Aetna,Aetna,1500,,,,,,,per diem,1103,23349.1662,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Aetna MGG,Aetna MGG,23349.1662,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,BCBS,BCBS,1103,,,,,,,per diem,1103,23349.1662,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,BCBS MGG,BCBS MGG,23349.1662,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Cigna,Cigna,1257,,,,,,,per diem,1103,23349.1662,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Cigna MGG,Cigna MGG,23349.1662,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Humana,Humana,1400,,,,,,,per diem,1103,23349.1662,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Humana MGG,Humana MGG,22181.70789,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Optum VA,Optum VA,23349.1662,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,UHC,UHC,1400,,,,,,,per diem,1103,23349.1662,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,UHC MGG,UHC MGG,23349.1662,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,VA,VA,23349.1662,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Wellcare MGG,Wellcare MGG,23349.1662,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Bright Health - commercial,Bright Health - commercial,23349.1662,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,23349.1662,23349.1662,Bright Health MGG,Bright Health MGG,23349.1662,,,,,,,case rate,1103,23349.1662,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Aetna,Aetna,1500,,,,,,,per diem,1103,34198.8516,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Aetna MGG,Aetna MGG,34198.8516,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,BCBS,BCBS,1103,,,,,,,per diem,1103,34198.8516,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,BCBS MGG,BCBS MGG,34198.8516,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Cigna,Cigna,1257,,,,,,,per diem,1103,34198.8516,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Cigna MGG,Cigna MGG,34198.8516,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Humana,Humana,1400,,,,,,,per diem,1103,34198.8516,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Humana MGG,Humana MGG,32488.90902,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Optum VA,Optum VA,34198.8516,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,UHC,UHC,1400,,,,,,,per diem,1103,34198.8516,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,UHC MGG,UHC MGG,34198.8516,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,VA,VA,34198.8516,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Wellcare MGG,Wellcare MGG,34198.8516,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Bright Health - commercial,Bright Health - commercial,34198.8516,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,34198.8516,34198.8516,Bright Health MGG,Bright Health MGG,34198.8516,,,,,,,case rate,1103,34198.8516,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Aetna,Aetna,1500,,,,,,,per diem,1103,27426.4956,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Aetna MGG,Aetna MGG,27426.4956,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,BCBS,BCBS,1103,,,,,,,per diem,1103,27426.4956,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,BCBS MGG,BCBS MGG,27426.4956,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Cigna,Cigna,1257,,,,,,,per diem,1103,27426.4956,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Cigna MGG,Cigna MGG,27426.4956,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Humana,Humana,1400,,,,,,,per diem,1103,27426.4956,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Humana MGG,Humana MGG,26055.17082,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Optum VA,Optum VA,27426.4956,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,UHC,UHC,1400,,,,,,,per diem,1103,27426.4956,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,UHC MGG,UHC MGG,27426.4956,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,VA,VA,27426.4956,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Wellcare MGG,Wellcare MGG,27426.4956,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Bright Health - commercial,Bright Health - commercial,27426.4956,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,27426.4956,27426.4956,Bright Health MGG,Bright Health MGG,27426.4956,,,,,,,case rate,1103,27426.4956,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Aetna,Aetna,1500,,,,,,,per diem,1103,25506.1152,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Aetna MGG,Aetna MGG,25506.1152,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,BCBS,BCBS,1103,,,,,,,per diem,1103,25506.1152,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,BCBS MGG,BCBS MGG,25506.1152,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Cigna,Cigna,1257,,,,,,,per diem,1103,25506.1152,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Cigna MGG,Cigna MGG,25506.1152,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Humana,Humana,1400,,,,,,,per diem,1103,25506.1152,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Humana MGG,Humana MGG,24230.80944,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Optum VA,Optum VA,25506.1152,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,UHC,UHC,1400,,,,,,,per diem,1103,25506.1152,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,UHC MGG,UHC MGG,25506.1152,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,VA,VA,25506.1152,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Wellcare MGG,Wellcare MGG,25506.1152,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Bright Health - commercial,Bright Health - commercial,25506.1152,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,25506.1152,25506.1152,Bright Health MGG,Bright Health MGG,25506.1152,,,,,,,case rate,1103,25506.1152,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Aetna,Aetna,1500,,,,,,,per diem,1103,15098.643,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Aetna MGG,Aetna MGG,15098.643,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,BCBS,BCBS,1103,,,,,,,per diem,1103,15098.643,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,BCBS MGG,BCBS MGG,15098.643,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Cigna,Cigna,1257,,,,,,,per diem,1103,15098.643,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Cigna MGG,Cigna MGG,15098.643,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Humana,Humana,1400,,,,,,,per diem,1103,15098.643,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Humana MGG,Humana MGG,14343.71085,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Optum VA,Optum VA,15098.643,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,UHC,UHC,1400,,,,,,,per diem,1103,15098.643,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,UHC MGG,UHC MGG,15098.643,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,VA,VA,15098.643,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Wellcare MGG,Wellcare MGG,15098.643,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Bright Health - commercial,Bright Health - commercial,15098.643,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,15098.643,15098.643,Bright Health MGG,Bright Health MGG,15098.643,,,,,,,case rate,1103,15098.643,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Aetna,Aetna,1500,,,,,,,per diem,1103,24833.5182,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Aetna MGG,Aetna MGG,24833.5182,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,BCBS,BCBS,1103,,,,,,,per diem,1103,24833.5182,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,BCBS MGG,BCBS MGG,24833.5182,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Cigna,Cigna,1257,,,,,,,per diem,1103,24833.5182,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Cigna MGG,Cigna MGG,24833.5182,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Humana,Humana,1400,,,,,,,per diem,1103,24833.5182,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Humana MGG,Humana MGG,23591.84229,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Optum VA,Optum VA,24833.5182,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,UHC,UHC,1400,,,,,,,per diem,1103,24833.5182,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,UHC MGG,UHC MGG,24833.5182,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,VA,VA,24833.5182,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Wellcare MGG,Wellcare MGG,24833.5182,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Bright Health - commercial,Bright Health - commercial,24833.5182,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,24833.5182,24833.5182,Bright Health MGG,Bright Health MGG,24833.5182,,,,,,,case rate,1103,24833.5182,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Aetna,Aetna,1500,,,,,,,per diem,1103,20878.3386,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Aetna MGG,Aetna MGG,20878.3386,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,BCBS,BCBS,1103,,,,,,,per diem,1103,20878.3386,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,BCBS MGG,BCBS MGG,20878.3386,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Cigna,Cigna,1257,,,,,,,per diem,1103,20878.3386,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Cigna MGG,Cigna MGG,20878.3386,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Humana,Humana,1400,,,,,,,per diem,1103,20878.3386,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Humana MGG,Humana MGG,19834.42167,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Optum VA,Optum VA,20878.3386,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,UHC,UHC,1400,,,,,,,per diem,1103,20878.3386,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,UHC MGG,UHC MGG,20878.3386,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,VA,VA,20878.3386,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Wellcare MGG,Wellcare MGG,20878.3386,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Bright Health - commercial,Bright Health - commercial,20878.3386,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,20878.3386,20878.3386,Bright Health MGG,Bright Health MGG,20878.3386,,,,,,,case rate,1103,20878.3386,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Aetna,Aetna,1500,,,,,,,per diem,1103,15744.9546,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Aetna MGG,Aetna MGG,15744.9546,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,BCBS,BCBS,1103,,,,,,,per diem,1103,15744.9546,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,BCBS MGG,BCBS MGG,15744.9546,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Cigna,Cigna,1257,,,,,,,per diem,1103,15744.9546,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Cigna MGG,Cigna MGG,15744.9546,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Humana,Humana,1400,,,,,,,per diem,1103,15744.9546,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Humana MGG,Humana MGG,14957.70687,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Optum VA,Optum VA,15744.9546,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,UHC,UHC,1400,,,,,,,per diem,1103,15744.9546,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,UHC MGG,UHC MGG,15744.9546,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,VA,VA,15744.9546,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Wellcare MGG,Wellcare MGG,15744.9546,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Bright Health - commercial,Bright Health - commercial,15744.9546,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,15744.9546,15744.9546,Bright Health MGG,Bright Health MGG,15744.9546,,,,,,,case rate,1103,15744.9546,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Aetna,Aetna,1500,,,,,,,per diem,1103,23925.8988,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Aetna MGG,Aetna MGG,23925.8988,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,BCBS,BCBS,1103,,,,,,,per diem,1103,23925.8988,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,BCBS MGG,BCBS MGG,23925.8988,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Cigna,Cigna,1257,,,,,,,per diem,1103,23925.8988,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Cigna MGG,Cigna MGG,23925.8988,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Humana,Humana,1400,,,,,,,per diem,1103,23925.8988,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Humana MGG,Humana MGG,22729.60386,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Optum VA,Optum VA,23925.8988,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,UHC,UHC,1400,,,,,,,per diem,1103,23925.8988,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,UHC MGG,UHC MGG,23925.8988,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,VA,VA,23925.8988,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Wellcare MGG,Wellcare MGG,23925.8988,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Bright Health - commercial,Bright Health - commercial,23925.8988,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,23925.8988,23925.8988,Bright Health MGG,Bright Health MGG,23925.8988,,,,,,,case rate,1103,23925.8988,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Aetna,Aetna,1500,,,,,,,per diem,1103,39352.3362,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Aetna MGG,Aetna MGG,39352.3362,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,BCBS,BCBS,1103,,,,,,,per diem,1103,39352.3362,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,BCBS MGG,BCBS MGG,39352.3362,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Cigna,Cigna,1257,,,,,,,per diem,1103,39352.3362,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Cigna MGG,Cigna MGG,39352.3362,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Humana,Humana,1400,,,,,,,per diem,1103,39352.3362,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Humana MGG,Humana MGG,37384.71939,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Optum VA,Optum VA,39352.3362,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,UHC,UHC,1400,,,,,,,per diem,1103,39352.3362,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,UHC MGG,UHC MGG,39352.3362,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,VA,VA,39352.3362,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Wellcare MGG,Wellcare MGG,39352.3362,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Bright Health - commercial,Bright Health - commercial,39352.3362,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,39352.3362,39352.3362,Bright Health MGG,Bright Health MGG,39352.3362,,,,,,,case rate,1103,39352.3362,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Aetna,Aetna,1500,,,,,,,per diem,1103,33084.0414,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Aetna MGG,Aetna MGG,33084.0414,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,BCBS,BCBS,1103,,,,,,,per diem,1103,33084.0414,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,BCBS MGG,BCBS MGG,33084.0414,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Cigna,Cigna,1257,,,,,,,per diem,1103,33084.0414,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Cigna MGG,Cigna MGG,33084.0414,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Humana,Humana,1400,,,,,,,per diem,1103,33084.0414,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Humana MGG,Humana MGG,31429.83933,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Optum VA,Optum VA,33084.0414,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,UHC,UHC,1400,,,,,,,per diem,1103,33084.0414,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,UHC MGG,UHC MGG,33084.0414,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,VA,VA,33084.0414,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Wellcare MGG,Wellcare MGG,33084.0414,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Bright Health - commercial,Bright Health - commercial,33084.0414,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,33084.0414,33084.0414,Bright Health MGG,Bright Health MGG,33084.0414,,,,,,,case rate,1103,33084.0414,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Aetna,Aetna,1500,,,,,,,per diem,1103,24949.4832,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Aetna MGG,Aetna MGG,24949.4832,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,BCBS,BCBS,1103,,,,,,,per diem,1103,24949.4832,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,BCBS MGG,BCBS MGG,24949.4832,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Cigna,Cigna,1257,,,,,,,per diem,1103,24949.4832,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Cigna MGG,Cigna MGG,24949.4832,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Humana,Humana,1400,,,,,,,per diem,1103,24949.4832,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Humana MGG,Humana MGG,23702.00904,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Optum VA,Optum VA,24949.4832,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,UHC,UHC,1400,,,,,,,per diem,1103,24949.4832,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,UHC MGG,UHC MGG,24949.4832,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,VA,VA,24949.4832,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Wellcare MGG,Wellcare MGG,24949.4832,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Bright Health - commercial,Bright Health - commercial,24949.4832,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,24949.4832,24949.4832,Bright Health MGG,Bright Health MGG,24949.4832,,,,,,,case rate,1103,24949.4832,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Aetna,Aetna,1500,,,,,,,per diem,1103,2713.581,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Aetna MGG,Aetna MGG,2713.581,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,BCBS,BCBS,1103,,,,,,,per diem,1103,2713.581,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,BCBS MGG,BCBS MGG,2713.581,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Cigna,Cigna,1257,,,,,,,per diem,1103,2713.581,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Cigna MGG,Cigna MGG,2713.581,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Humana,Humana,1400,,,,,,,per diem,1103,2713.581,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Humana MGG,Humana MGG,2577.90195,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Optum VA,Optum VA,2713.581,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,UHC,UHC,1400,,,,,,,per diem,1103,2713.581,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,UHC MGG,UHC MGG,2713.581,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,VA,VA,2713.581,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Wellcare MGG,Wellcare MGG,2713.581,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Bright Health - commercial,Bright Health - commercial,2713.581,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,2713.581,2713.581,Bright Health MGG,Bright Health MGG,2713.581,,,,,,,case rate,1103,2713.581,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Aetna,Aetna,1500,,,,,,,per diem,1103,13203.0018,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Aetna MGG,Aetna MGG,13203.0018,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,BCBS,BCBS,1103,,,,,,,per diem,1103,13203.0018,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,BCBS MGG,BCBS MGG,13203.0018,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Cigna,Cigna,1257,,,,,,,per diem,1103,13203.0018,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Cigna MGG,Cigna MGG,13203.0018,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Humana,Humana,1400,,,,,,,per diem,1103,13203.0018,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Humana MGG,Humana MGG,12542.85171,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Optum VA,Optum VA,13203.0018,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,UHC,UHC,1400,,,,,,,per diem,1103,13203.0018,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,UHC MGG,UHC MGG,13203.0018,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,VA,VA,13203.0018,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Wellcare MGG,Wellcare MGG,13203.0018,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Bright Health - commercial,Bright Health - commercial,13203.0018,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,13203.0018,13203.0018,Bright Health MGG,Bright Health MGG,13203.0018,,,,,,,case rate,1103,13203.0018,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Aetna,Aetna,1500,,,,,,,per diem,1103,31673.907,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Aetna MGG,Aetna MGG,31673.907,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,BCBS,BCBS,1103,,,,,,,per diem,1103,31673.907,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,BCBS MGG,BCBS MGG,31673.907,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Cigna,Cigna,1257,,,,,,,per diem,1103,31673.907,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Cigna MGG,Cigna MGG,31673.907,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Humana,Humana,1400,,,,,,,per diem,1103,31673.907,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Humana MGG,Humana MGG,30090.21165,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Optum VA,Optum VA,31673.907,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,UHC,UHC,1400,,,,,,,per diem,1103,31673.907,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,UHC MGG,UHC MGG,31673.907,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,VA,VA,31673.907,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Wellcare MGG,Wellcare MGG,31673.907,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Bright Health - commercial,Bright Health - commercial,31673.907,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,31673.907,31673.907,Bright Health MGG,Bright Health MGG,31673.907,,,,,,,case rate,1103,31673.907,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Aetna,Aetna,1500,,,,,,,per diem,1103,14098.2516,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Aetna MGG,Aetna MGG,14098.2516,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,BCBS,BCBS,1103,,,,,,,per diem,1103,14098.2516,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,BCBS MGG,BCBS MGG,14098.2516,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Cigna,Cigna,1257,,,,,,,per diem,1103,14098.2516,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Cigna MGG,Cigna MGG,14098.2516,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Humana,Humana,1400,,,,,,,per diem,1103,14098.2516,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Humana MGG,Humana MGG,13393.33902,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Optum VA,Optum VA,14098.2516,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,UHC,UHC,1400,,,,,,,per diem,1103,14098.2516,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,UHC MGG,UHC MGG,14098.2516,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,VA,VA,14098.2516,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Wellcare MGG,Wellcare MGG,14098.2516,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Bright Health - commercial,Bright Health - commercial,14098.2516,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,14098.2516,14098.2516,Bright Health MGG,Bright Health MGG,14098.2516,,,,,,,case rate,1103,14098.2516,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Aetna,Aetna,1500,,,,,,,per diem,1103,33832.4022,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Aetna MGG,Aetna MGG,33832.4022,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,BCBS,BCBS,1103,,,,,,,per diem,1103,33832.4022,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,BCBS MGG,BCBS MGG,33832.4022,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Cigna,Cigna,1257,,,,,,,per diem,1103,33832.4022,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Cigna MGG,Cigna MGG,33832.4022,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Humana,Humana,1400,,,,,,,per diem,1103,33832.4022,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Humana MGG,Humana MGG,32140.78209,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Optum VA,Optum VA,33832.4022,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,UHC,UHC,1400,,,,,,,per diem,1103,33832.4022,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,UHC MGG,UHC MGG,33832.4022,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,VA,VA,33832.4022,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Wellcare MGG,Wellcare MGG,33832.4022,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Bright Health - commercial,Bright Health - commercial,33832.4022,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,33832.4022,33832.4022,Bright Health MGG,Bright Health MGG,33832.4022,,,,,,,case rate,1103,33832.4022,Base Rate * Tier * Negotiated Percent
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Aetna,Aetna,2196.17,,,,,,,per diem,2196.17,2196.17,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Aetna MGG,Aetna MGG,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,BCBS,BCBS,2196.17,,,,,,,per diem,2196.17,2196.17,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,BCBS MGG,BCBS MGG,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Cigna,Cigna,2196.17,,,,,,,per diem,2196.17,2196.17,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Cigna MGG,Cigna MGG,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Humana,Humana,2196.17,,,,,,,per diem,2196.17,2196.17,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Humana MGG,Humana MGG,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Optum VA,Optum VA,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,UHC,UHC,2196.17,,,,,,,per diem,2196.17,2196.17,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,UHC MGG,UHC MGG,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,VA,VA,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Wellcare MGG,Wellcare MGG,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Bright Health - commercial,Bright Health - commercial,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2196.17,2196.17,Bright Health MGG,Bright Health MGG,2196.17,,,,,,,case rate,2196.17,2196.17,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Aetna,Aetna,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Aetna MGG,Aetna MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,BCBS,BCBS,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,BCBS MGG,BCBS MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Cigna,Cigna,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Cigna MGG,Cigna MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Humana,Humana,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Humana MGG,Humana MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Optum VA,Optum VA,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,UHC,UHC,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,UHC MGG,UHC MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,VA,VA,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Wellcare MGG,Wellcare MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Bright Health - commercial,Bright Health - commercial,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10600450,CDM,128,RC,,,,,,Inpatient,,,2091.59,2091.59,Bright Health MGG,Bright Health MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Aetna,Aetna,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Aetna MGG,Aetna MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,BCBS,BCBS,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,BCBS MGG,BCBS MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Cigna,Cigna,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Cigna MGG,Cigna MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Humana,Humana,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Humana MGG,Humana MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Optum VA,Optum VA,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,UHC,UHC,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,UHC MGG,UHC MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,VA,VA,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Wellcare MGG,Wellcare MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Bright Health - commercial,Bright Health - commercial,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
3/4 BED REHAB SEMI-PRIVATE    ,10600460,CDM,138,RC,,,,,,Inpatient,,,2091.59,2091.59,Bright Health MGG,Bright Health MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Aetna,Aetna,1973.2,,,,,,,per diem,1973.2,1973.2,"Per diem rate, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Aetna MGG,Aetna MGG,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,BCBS,BCBS,1973.2,,,,,,,per diem,1973.2,1973.2,"Per diem rate, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,BCBS MGG,BCBS MGG,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Cigna,Cigna,1973.2,,,,,,,per diem,1973.2,1973.2,"Per diem rate, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Cigna MGG,Cigna MGG,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Humana,Humana,1973.2,,,,,,,per diem,1973.2,1973.2,"Per diem rate, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Humana MGG,Humana MGG,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Optum VA,Optum VA,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,UHC,UHC,1973.2,,,,,,,per diem,1973.2,1973.2,"Per diem rate, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,UHC MGG,UHC MGG,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,VA,VA,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Wellcare MGG,Wellcare MGG,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Bright Health - commercial,Bright Health - commercial,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
DELUXE REHAB PRIVATE          ,10600470,CDM,148,RC,,,,,,Inpatient,,,1973.2,1973.2,Bright Health MGG,Bright Health MGG,1973.2,,,,,,,case rate,1973.2,1973.2,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Aetna,Aetna,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Aetna MGG,Aetna MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,BCBS,BCBS,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,BCBS MGG,BCBS MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Cigna,Cigna,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Cigna MGG,Cigna MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Humana,Humana,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Humana MGG,Humana MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Optum VA,Optum VA,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,UHC,UHC,2091.59,,,,,,,per diem,2091.59,2091.59,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,UHC MGG,UHC MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,VA,VA,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Wellcare MGG,Wellcare MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Bright Health - commercial,Bright Health - commercial,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,2091.59,2091.59,Bright Health MGG,Bright Health MGG,2091.59,,,,,,,case rate,2091.59,2091.59,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Aetna,Aetna,241,,,,,,,per diem,241,241,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Aetna MGG,Aetna MGG,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,BCBS,BCBS,241,,,,,,,per diem,241,241,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,BCBS MGG,BCBS MGG,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Cigna,Cigna,241,,,,,,,per diem,241,241,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Cigna MGG,Cigna MGG,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Humana,Humana,241,,,,,,,per diem,241,241,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Humana MGG,Humana MGG,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Optum VA,Optum VA,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,UHC,UHC,241,,,,,,,per diem,241,241,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,UHC MGG,UHC MGG,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,VA,VA,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Wellcare MGG,Wellcare MGG,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Bright Health - commercial,Bright Health - commercial,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,241,241,Bright Health MGG,Bright Health MGG,241,,,,,,,case rate,241,241,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Aetna,Aetna,2231.85,,,,,,,per diem,2231.85,2231.85,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Aetna MGG,Aetna MGG,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,BCBS,BCBS,2231.85,,,,,,,per diem,2231.85,2231.85,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,BCBS MGG,BCBS MGG,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Cigna,Cigna,2231.85,,,,,,,per diem,2231.85,2231.85,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Cigna MGG,Cigna MGG,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Humana,Humana,2231.85,,,,,,,per diem,2231.85,2231.85,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Humana MGG,Humana MGG,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Optum VA,Optum VA,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,UHC,UHC,2231.85,,,,,,,per diem,2231.85,2231.85,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,UHC MGG,UHC MGG,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,VA,VA,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Wellcare MGG,Wellcare MGG,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Bright Health - commercial,Bright Health - commercial,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2231.85,2231.85,Bright Health MGG,Bright Health MGG,2231.85,,,,,,,case rate,2231.85,2231.85,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Aetna,Aetna,983,,,,,,,per diem,983,983,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Aetna MGG,Aetna MGG,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,BCBS,BCBS,983,,,,,,,per diem,983,983,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,BCBS MGG,BCBS MGG,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Cigna,Cigna,983,,,,,,,per diem,983,983,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Cigna MGG,Cigna MGG,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Humana,Humana,983,,,,,,,per diem,983,983,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Humana MGG,Humana MGG,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Optum VA,Optum VA,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,UHC,UHC,983,,,,,,,per diem,983,983,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,UHC MGG,UHC MGG,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,VA,VA,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Wellcare MGG,Wellcare MGG,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Bright Health - commercial,Bright Health - commercial,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,983,983,Bright Health MGG,Bright Health MGG,983,,,,,,,case rate,983,983,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Aetna,Aetna,1903,,,,,,,per diem,1903,1903,"Per diem rate, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Aetna MGG,Aetna MGG,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,BCBS,BCBS,1903,,,,,,,per diem,1903,1903,"Per diem rate, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,BCBS MGG,BCBS MGG,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Cigna,Cigna,1903,,,,,,,per diem,1903,1903,"Per diem rate, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Cigna MGG,Cigna MGG,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Humana,Humana,1903,,,,,,,per diem,1903,1903,"Per diem rate, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Humana MGG,Humana MGG,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Optum VA,Optum VA,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,UHC,UHC,1903,,,,,,,per diem,1903,1903,"Per diem rate, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,UHC MGG,UHC MGG,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,VA,VA,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Wellcare MGG,Wellcare MGG,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Bright Health - commercial,Bright Health - commercial,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
EGD                           ,11600190,CDM,360,RC,,,,,,Inpatient,,,1903,1903,Bright Health MGG,Bright Health MGG,1903,,,,,,,case rate,1903,1903,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Aetna,Aetna,2435,,,,,,,per diem,2435,2435,"Per diem rate, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Aetna MGG,Aetna MGG,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,BCBS,BCBS,2435,,,,,,,per diem,2435,2435,"Per diem rate, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,BCBS MGG,BCBS MGG,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Cigna,Cigna,2435,,,,,,,per diem,2435,2435,"Per diem rate, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Cigna MGG,Cigna MGG,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Humana,Humana,2435,,,,,,,per diem,2435,2435,"Per diem rate, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Humana MGG,Humana MGG,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Optum VA,Optum VA,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,UHC,UHC,2435,,,,,,,per diem,2435,2435,"Per diem rate, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,UHC MGG,UHC MGG,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,VA,VA,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Wellcare MGG,Wellcare MGG,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Bright Health - commercial,Bright Health - commercial,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PEG PLACEMENT                 ,11600208,CDM,360,RC,,,,,,Inpatient,,,2435,2435,Bright Health MGG,Bright Health MGG,2435,,,,,,,case rate,2435,2435,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Aetna,Aetna,1387.5,,,,,,,per diem,1387.5,1387.5,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Aetna MGG,Aetna MGG,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,BCBS,BCBS,1387.5,,,,,,,per diem,1387.5,1387.5,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,BCBS MGG,BCBS MGG,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Cigna,Cigna,1387.5,,,,,,,per diem,1387.5,1387.5,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Cigna MGG,Cigna MGG,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Humana,Humana,1387.5,,,,,,,per diem,1387.5,1387.5,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Humana MGG,Humana MGG,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Optum VA,Optum VA,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,UHC,UHC,1387.5,,,,,,,per diem,1387.5,1387.5,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,UHC MGG,UHC MGG,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,VA,VA,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Wellcare MGG,Wellcare MGG,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Bright Health - commercial,Bright Health - commercial,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1387.5,1387.5,Bright Health MGG,Bright Health MGG,1387.5,,,,,,,case rate,1387.5,1387.5,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Aetna,Aetna,762,,,,,,,per diem,762,762,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Aetna MGG,Aetna MGG,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,BCBS,BCBS,762,,,,,,,per diem,762,762,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,BCBS MGG,BCBS MGG,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Cigna,Cigna,762,,,,,,,per diem,762,762,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Cigna MGG,Cigna MGG,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Humana,Humana,762,,,,,,,per diem,762,762,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Humana MGG,Humana MGG,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Optum VA,Optum VA,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,UHC,UHC,762,,,,,,,per diem,762,762,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,UHC MGG,UHC MGG,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,VA,VA,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Wellcare MGG,Wellcare MGG,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Bright Health - commercial,Bright Health - commercial,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,762,762,Bright Health MGG,Bright Health MGG,762,,,,,,,case rate,762,762,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Aetna,Aetna,219.86,,,,,,,per diem,219.86,219.86,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Aetna MGG,Aetna MGG,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,BCBS,BCBS,219.86,,,,,,,per diem,219.86,219.86,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,BCBS MGG,BCBS MGG,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Cigna,Cigna,219.86,,,,,,,per diem,219.86,219.86,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Cigna MGG,Cigna MGG,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Humana,Humana,219.86,,,,,,,per diem,219.86,219.86,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Humana MGG,Humana MGG,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Optum VA,Optum VA,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,UHC,UHC,219.86,,,,,,,per diem,219.86,219.86,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,UHC MGG,UHC MGG,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,VA,VA,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Wellcare MGG,Wellcare MGG,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Bright Health - commercial,Bright Health - commercial,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,219.86,219.86,Bright Health MGG,Bright Health MGG,219.86,,,,,,,case rate,219.86,219.86,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Aetna,Aetna,940.21,,,,,,,per diem,940.21,940.21,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Aetna MGG,Aetna MGG,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,BCBS,BCBS,940.21,,,,,,,per diem,940.21,940.21,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,BCBS MGG,BCBS MGG,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Cigna,Cigna,940.21,,,,,,,per diem,940.21,940.21,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Cigna MGG,Cigna MGG,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Humana,Humana,940.21,,,,,,,per diem,940.21,940.21,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Humana MGG,Humana MGG,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Optum VA,Optum VA,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,UHC,UHC,940.21,,,,,,,per diem,940.21,940.21,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,UHC MGG,UHC MGG,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,VA,VA,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Wellcare MGG,Wellcare MGG,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Bright Health - commercial,Bright Health - commercial,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,940.21,940.21,Bright Health MGG,Bright Health MGG,940.21,,,,,,,case rate,940.21,940.21,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Aetna,Aetna,1427.83,,,,,,,per diem,1427.83,1427.83,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Aetna MGG,Aetna MGG,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,BCBS,BCBS,1427.83,,,,,,,per diem,1427.83,1427.83,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,BCBS MGG,BCBS MGG,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Cigna,Cigna,1427.83,,,,,,,per diem,1427.83,1427.83,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Cigna MGG,Cigna MGG,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Humana,Humana,1427.83,,,,,,,per diem,1427.83,1427.83,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Humana MGG,Humana MGG,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Optum VA,Optum VA,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,UHC,UHC,1427.83,,,,,,,per diem,1427.83,1427.83,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,UHC MGG,UHC MGG,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,VA,VA,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Wellcare MGG,Wellcare MGG,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Bright Health - commercial,Bright Health - commercial,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1427.83,1427.83,Bright Health MGG,Bright Health MGG,1427.83,,,,,,,case rate,1427.83,1427.83,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Aetna,Aetna,1159.53,,,,,,,per diem,1159.53,1159.53,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Aetna MGG,Aetna MGG,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,BCBS,BCBS,1159.53,,,,,,,per diem,1159.53,1159.53,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,BCBS MGG,BCBS MGG,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Cigna,Cigna,1159.53,,,,,,,per diem,1159.53,1159.53,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Cigna MGG,Cigna MGG,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Humana,Humana,1159.53,,,,,,,per diem,1159.53,1159.53,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Humana MGG,Humana MGG,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Optum VA,Optum VA,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,UHC,UHC,1159.53,,,,,,,per diem,1159.53,1159.53,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,UHC MGG,UHC MGG,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,VA,VA,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Wellcare MGG,Wellcare MGG,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Bright Health - commercial,Bright Health - commercial,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1159.53,1159.53,Bright Health MGG,Bright Health MGG,1159.53,,,,,,,case rate,1159.53,1159.53,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Aetna,Aetna,3513.94,,,,,,,per diem,3513.94,3513.94,"Per diem rate, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Aetna MGG,Aetna MGG,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,BCBS,BCBS,3513.94,,,,,,,per diem,3513.94,3513.94,"Per diem rate, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,BCBS MGG,BCBS MGG,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Cigna,Cigna,3513.94,,,,,,,per diem,3513.94,3513.94,"Per diem rate, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Cigna MGG,Cigna MGG,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Humana,Humana,3513.94,,,,,,,per diem,3513.94,3513.94,"Per diem rate, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Humana MGG,Humana MGG,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Optum VA,Optum VA,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,UHC,UHC,3513.94,,,,,,,per diem,3513.94,3513.94,"Per diem rate, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,UHC MGG,UHC MGG,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,VA,VA,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Wellcare MGG,Wellcare MGG,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Bright Health - commercial,Bright Health - commercial,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
OR - OUTSIDE SERVICE          ,11601000,CDM,360,RC,,,,,,Inpatient,,,3513.94,3513.94,Bright Health MGG,Bright Health MGG,3513.94,,,,,,,case rate,3513.94,3513.94,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Aetna,Aetna,84.62,,,,,,,per diem,84.62,84.62,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Aetna MGG,Aetna MGG,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,BCBS,BCBS,84.62,,,,,,,per diem,84.62,84.62,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,BCBS MGG,BCBS MGG,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Cigna,Cigna,84.62,,,,,,,per diem,84.62,84.62,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Cigna MGG,Cigna MGG,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Humana,Humana,84.62,,,,,,,per diem,84.62,84.62,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Humana MGG,Humana MGG,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Optum VA,Optum VA,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,UHC,UHC,84.62,,,,,,,per diem,84.62,84.62,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,UHC MGG,UHC MGG,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,VA,VA,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Wellcare MGG,Wellcare MGG,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Bright Health - commercial,Bright Health - commercial,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,84.62,84.62,Bright Health MGG,Bright Health MGG,84.62,,,,,,,case rate,84.62,84.62,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POUCH SENSUR MIO 1-PIECE DRNBL,33101016,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Aetna,Aetna,597.51,,,,,,,per diem,597.51,597.51,"Per diem rate, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Aetna MGG,Aetna MGG,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,BCBS,BCBS,597.51,,,,,,,per diem,597.51,597.51,"Per diem rate, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,BCBS MGG,BCBS MGG,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Cigna,Cigna,597.51,,,,,,,per diem,597.51,597.51,"Per diem rate, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Cigna MGG,Cigna MGG,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Humana,Humana,597.51,,,,,,,per diem,597.51,597.51,"Per diem rate, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Humana MGG,Humana MGG,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Optum VA,Optum VA,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,UHC,UHC,597.51,,,,,,,per diem,597.51,597.51,"Per diem rate, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,UHC MGG,UHC MGG,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,VA,VA,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Wellcare MGG,Wellcare MGG,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Bright Health - commercial,Bright Health - commercial,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
KIT ROSIDAL LYMPHSET DBL LEG  ,33101154,CDM,270,RC,,,,,,Inpatient,,,597.51,597.51,Bright Health MGG,Bright Health MGG,597.51,,,,,,,case rate,597.51,597.51,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna,Aetna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna MGG,Aetna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS,BCBS,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS MGG,BCBS MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna,Cigna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna MGG,Cigna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana,Humana,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana MGG,Humana MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Optum VA,Optum VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC,UHC,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC MGG,UHC MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,VA,VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Wellcare MGG,Wellcare MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health - commercial,Bright Health - commercial,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE MED,33102406,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health MGG,Bright Health MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna,Aetna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna MGG,Aetna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS,BCBS,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS MGG,BCBS MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna,Cigna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna MGG,Cigna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana,Humana,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana MGG,Humana MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Optum VA,Optum VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC,UHC,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC MGG,UHC MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,VA,VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Wellcare MGG,Wellcare MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health - commercial,Bright Health - commercial,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE LG ,33102407,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health MGG,Bright Health MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna,Aetna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna MGG,Aetna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS,BCBS,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS MGG,BCBS MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna,Cigna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna MGG,Cigna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana,Humana,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana MGG,Humana MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Optum VA,Optum VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC,UHC,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC MGG,UHC MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,VA,VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Wellcare MGG,Wellcare MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health - commercial,Bright Health - commercial,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAPARND REDDIE XL ,33102410,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health MGG,Bright Health MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CANNULA INTERTRACH DISP SZ4   ,33102994,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Aetna,Aetna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Aetna MGG,Aetna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,BCBS,BCBS,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,BCBS MGG,BCBS MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Cigna,Cigna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Cigna MGG,Cigna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Humana,Humana,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Humana MGG,Humana MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Optum VA,Optum VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,UHC,UHC,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,UHC MGG,UHC MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,VA,VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Wellcare MGG,Wellcare MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Bright Health - commercial,Bright Health - commercial,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 4 PANEL 45IN ,33103201,CDM,270,RC,,,,,,Inpatient,,,33.48,33.48,Bright Health MGG,Bright Health MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CATH MALE EXT 25MM SHORT      ,33103561,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Aetna,Aetna,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Aetna MGG,Aetna MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,BCBS,BCBS,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,BCBS MGG,BCBS MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Cigna,Cigna,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Cigna MGG,Cigna MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Humana,Humana,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Humana MGG,Humana MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Optum VA,Optum VA,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,UHC,UHC,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,UHC MGG,UHC MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,VA,VA,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Wellcare MGG,Wellcare MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Bright Health - commercial,Bright Health - commercial,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG LT      ,33103579,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Bright Health MGG,Bright Health MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Aetna,Aetna,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Aetna MGG,Aetna MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,BCBS,BCBS,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,BCBS MGG,BCBS MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Cigna,Cigna,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Cigna MGG,Cigna MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Humana,Humana,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Humana MGG,Humana MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Optum VA,Optum VA,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,UHC,UHC,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,UHC MGG,UHC MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,VA,VA,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Wellcare MGG,Wellcare MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Bright Health - commercial,Bright Health - commercial,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST LG RT      ,33103580,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Bright Health MGG,Bright Health MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Aetna,Aetna,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Aetna MGG,Aetna MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS,BCBS,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS MGG,BCBS MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Cigna,Cigna,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Cigna MGG,Cigna MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Humana,Humana,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Humana MGG,Humana MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Optum VA,Optum VA,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,UHC,UHC,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,UHC MGG,UHC MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,VA,VA,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Wellcare MGG,Wellcare MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Bright Health - commercial,Bright Health - commercial,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD LT      ,33103586,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Bright Health MGG,Bright Health MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Aetna,Aetna,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Aetna MGG,Aetna MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS,BCBS,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS MGG,BCBS MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Cigna,Cigna,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Cigna MGG,Cigna MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Humana,Humana,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Humana MGG,Humana MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Optum VA,Optum VA,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,UHC,UHC,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,UHC MGG,UHC MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,VA,VA,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Wellcare MGG,Wellcare MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Bright Health - commercial,Bright Health - commercial,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHOSIS HAND REST MD RT      ,33103588,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,Bright Health MGG,Bright Health MGG,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY SUT REMOVAL IRIS FORCEP  ,33103722,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH OST 2-PC HIGH OUTPUT RED  ,33103794,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Aetna,Aetna,8.49,,,,,,,per diem,8.49,8.49,"Per diem rate, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Aetna MGG,Aetna MGG,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,BCBS,BCBS,8.49,,,,,,,per diem,8.49,8.49,"Per diem rate, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,BCBS MGG,BCBS MGG,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Cigna,Cigna,8.49,,,,,,,per diem,8.49,8.49,"Per diem rate, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Cigna MGG,Cigna MGG,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Humana,Humana,8.49,,,,,,,per diem,8.49,8.49,"Per diem rate, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Humana MGG,Humana MGG,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Optum VA,Optum VA,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,UHC,UHC,8.49,,,,,,,per diem,8.49,8.49,"Per diem rate, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,UHC MGG,UHC MGG,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,VA,VA,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Wellcare MGG,Wellcare MGG,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Bright Health - commercial,Bright Health - commercial,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
SET CATH MALE SPEEDI 12-18FR  ,33103851,CDM,270,RC,,,,,,Inpatient,,,8.49,8.49,Bright Health MGG,Bright Health MGG,8.49,,,,,,,case rate,8.49,8.49,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Aetna,Aetna,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Aetna MGG,Aetna MGG,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,BCBS,BCBS,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,BCBS MGG,BCBS MGG,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Cigna,Cigna,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Cigna MGG,Cigna MGG,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Humana,Humana,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Humana MGG,Humana MGG,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Optum VA,Optum VA,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,UHC,UHC,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,UHC MGG,UHC MGG,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,VA,VA,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Wellcare MGG,Wellcare MGG,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Bright Health - commercial,Bright Health - commercial,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,Bright Health MGG,Bright Health MGG,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Aetna,Aetna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Aetna MGG,Aetna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,BCBS,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS MGG,BCBS MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Cigna,Cigna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Cigna MGG,Cigna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Humana,Humana,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Humana MGG,Humana MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Optum VA,Optum VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,UHC,UHC,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,UHC MGG,UHC MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,VA,VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Wellcare MGG,Wellcare MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Bright Health - commercial,Bright Health - commercial,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,63,63,Bright Health MGG,Bright Health MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Aetna,Aetna,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Aetna MGG,Aetna MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,BCBS,BCBS,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,BCBS MGG,BCBS MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Cigna,Cigna,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Cigna MGG,Cigna MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Humana,Humana,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Humana MGG,Humana MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Optum VA,Optum VA,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,UHC,UHC,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,UHC MGG,UHC MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,VA,VA,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Wellcare MGG,Wellcare MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Bright Health - commercial,Bright Health - commercial,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,59,59,Bright Health MGG,Bright Health MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Aetna,Aetna,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Aetna MGG,Aetna MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,BCBS,BCBS,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,BCBS MGG,BCBS MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Cigna,Cigna,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Cigna MGG,Cigna MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Humana,Humana,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Humana MGG,Humana MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Optum VA,Optum VA,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,UHC,UHC,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,UHC MGG,UHC MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,VA,VA,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Wellcare MGG,Wellcare MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Bright Health - commercial,Bright Health - commercial,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,59,59,Bright Health MGG,Bright Health MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Aetna,Aetna,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Aetna MGG,Aetna MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,BCBS,BCBS,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,BCBS MGG,BCBS MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Cigna,Cigna,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Cigna MGG,Cigna MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Humana,Humana,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Humana MGG,Humana MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Optum VA,Optum VA,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,UHC,UHC,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,UHC MGG,UHC MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,VA,VA,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Wellcare MGG,Wellcare MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Bright Health - commercial,Bright Health - commercial,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,59,59,Bright Health MGG,Bright Health MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna,Aetna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna MGG,Aetna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS,BCBS,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS MGG,BCBS MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna,Cigna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna MGG,Cigna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana,Humana,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana MGG,Humana MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Optum VA,Optum VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC,UHC,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC MGG,UHC MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,VA,VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Wellcare MGG,Wellcare MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health - commercial,Bright Health - commercial,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health MGG,Bright Health MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna,Aetna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna MGG,Aetna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS,BCBS,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS MGG,BCBS MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna,Cigna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna MGG,Cigna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana,Humana,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana MGG,Humana MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Optum VA,Optum VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC,UHC,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC MGG,UHC MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,VA,VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Wellcare MGG,Wellcare MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health - commercial,Bright Health - commercial,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health MGG,Bright Health MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna,Aetna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna MGG,Aetna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS,BCBS,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS MGG,BCBS MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna,Cigna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna MGG,Cigna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana,Humana,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana MGG,Humana MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Optum VA,Optum VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC,UHC,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC MGG,UHC MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,VA,VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Wellcare MGG,Wellcare MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health - commercial,Bright Health - commercial,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health MGG,Bright Health MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna,Aetna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna MGG,Aetna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS,BCBS,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS MGG,BCBS MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna,Cigna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna MGG,Cigna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana,Humana,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana MGG,Humana MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Optum VA,Optum VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC,UHC,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC MGG,UHC MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,VA,VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Wellcare MGG,Wellcare MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health - commercial,Bright Health - commercial,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health MGG,Bright Health MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna,Aetna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna MGG,Aetna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS,BCBS,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS MGG,BCBS MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna,Cigna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna MGG,Cigna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana,Humana,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana MGG,Humana MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Optum VA,Optum VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC,UHC,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC MGG,UHC MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,VA,VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Wellcare MGG,Wellcare MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health - commercial,Bright Health - commercial,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health MGG,Bright Health MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna,Aetna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Aetna MGG,Aetna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS,BCBS,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,BCBS MGG,BCBS MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna,Cigna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Cigna MGG,Cigna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana,Humana,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Humana MGG,Humana MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Optum VA,Optum VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC,UHC,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,UHC MGG,UHC MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,VA,VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Wellcare MGG,Wellcare MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health - commercial,Bright Health - commercial,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,22,22,Bright Health MGG,Bright Health MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Aetna,Aetna,41,,,,,,,per diem,41,41,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Aetna MGG,Aetna MGG,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,BCBS,BCBS,41,,,,,,,per diem,41,41,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,BCBS MGG,BCBS MGG,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Cigna,Cigna,41,,,,,,,per diem,41,41,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Cigna MGG,Cigna MGG,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Humana,Humana,41,,,,,,,per diem,41,41,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Humana MGG,Humana MGG,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Optum VA,Optum VA,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,UHC,UHC,41,,,,,,,per diem,41,41,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,UHC MGG,UHC MGG,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,VA,VA,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Wellcare MGG,Wellcare MGG,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Bright Health - commercial,Bright Health - commercial,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,41,41,Bright Health MGG,Bright Health MGG,41,,,,,,,case rate,41,41,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Aetna,Aetna,92,,,,,,,per diem,92,92,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Aetna MGG,Aetna MGG,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,BCBS,BCBS,92,,,,,,,per diem,92,92,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,BCBS MGG,BCBS MGG,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Cigna,Cigna,92,,,,,,,per diem,92,92,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Cigna MGG,Cigna MGG,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Humana,Humana,92,,,,,,,per diem,92,92,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Humana MGG,Humana MGG,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Optum VA,Optum VA,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,UHC,UHC,92,,,,,,,per diem,92,92,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,UHC MGG,UHC MGG,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,VA,VA,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Wellcare MGG,Wellcare MGG,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Bright Health - commercial,Bright Health - commercial,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,92,92,Bright Health MGG,Bright Health MGG,92,,,,,,,case rate,92,92,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
POWDER OSTOMY                 ,33106310,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Aetna,Aetna,44.67,,,,,,,per diem,44.67,44.67,"Per diem rate, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Aetna MGG,Aetna MGG,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,BCBS,BCBS,44.67,,,,,,,per diem,44.67,44.67,"Per diem rate, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,BCBS MGG,BCBS MGG,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Cigna,Cigna,44.67,,,,,,,per diem,44.67,44.67,"Per diem rate, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Cigna MGG,Cigna MGG,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Humana,Humana,44.67,,,,,,,per diem,44.67,44.67,"Per diem rate, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Humana MGG,Humana MGG,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Optum VA,Optum VA,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,UHC,UHC,44.67,,,,,,,per diem,44.67,44.67,"Per diem rate, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,UHC MGG,UHC MGG,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,VA,VA,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Wellcare MGG,Wellcare MGG,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Bright Health - commercial,Bright Health - commercial,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
BINDER ABDOM 4 PANEL 72 TO 96 ,33106368,CDM,270,RC,,,,,,Inpatient,,,44.67,44.67,Bright Health MGG,Bright Health MGG,44.67,,,,,,,case rate,44.67,44.67,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Aetna,Aetna,539,,,,,,,per diem,539,539,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Aetna MGG,Aetna MGG,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,BCBS,BCBS,539,,,,,,,per diem,539,539,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,BCBS MGG,BCBS MGG,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Cigna,Cigna,539,,,,,,,per diem,539,539,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Cigna MGG,Cigna MGG,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Humana,Humana,539,,,,,,,per diem,539,539,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Humana MGG,Humana MGG,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Optum VA,Optum VA,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,UHC,UHC,539,,,,,,,per diem,539,539,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,UHC MGG,UHC MGG,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,VA,VA,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Wellcare MGG,Wellcare MGG,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Bright Health - commercial,Bright Health - commercial,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,539,539,Bright Health MGG,Bright Health MGG,539,,,,,,,case rate,539,539,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Aetna,Aetna,768,,,,,,,per diem,768,768,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Aetna MGG,Aetna MGG,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,BCBS,BCBS,768,,,,,,,per diem,768,768,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,BCBS MGG,BCBS MGG,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Cigna,Cigna,768,,,,,,,per diem,768,768,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Cigna MGG,Cigna MGG,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Humana,Humana,768,,,,,,,per diem,768,768,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Humana MGG,Humana MGG,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Optum VA,Optum VA,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,UHC,UHC,768,,,,,,,per diem,768,768,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,UHC MGG,UHC MGG,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,VA,VA,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Wellcare MGG,Wellcare MGG,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Bright Health - commercial,Bright Health - commercial,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,768,768,Bright Health MGG,Bright Health MGG,768,,,,,,,case rate,768,768,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Aetna,Aetna,10,,,,,,,per diem,10,10,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Aetna MGG,Aetna MGG,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,BCBS,BCBS,10,,,,,,,per diem,10,10,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,BCBS MGG,BCBS MGG,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Cigna,Cigna,10,,,,,,,per diem,10,10,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Cigna MGG,Cigna MGG,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Humana,Humana,10,,,,,,,per diem,10,10,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Humana MGG,Humana MGG,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Optum VA,Optum VA,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,UHC,UHC,10,,,,,,,per diem,10,10,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,UHC MGG,UHC MGG,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,VA,VA,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Wellcare MGG,Wellcare MGG,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Bright Health - commercial,Bright Health - commercial,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10,10,Bright Health MGG,Bright Health MGG,10,,,,,,,case rate,10,10,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Aetna,Aetna,172,,,,,,,per diem,172,172,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Aetna MGG,Aetna MGG,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,BCBS,BCBS,172,,,,,,,per diem,172,172,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,BCBS MGG,BCBS MGG,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Cigna,Cigna,172,,,,,,,per diem,172,172,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Cigna MGG,Cigna MGG,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Humana,Humana,172,,,,,,,per diem,172,172,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Humana MGG,Humana MGG,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Optum VA,Optum VA,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,UHC,UHC,172,,,,,,,per diem,172,172,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,UHC MGG,UHC MGG,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,VA,VA,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Wellcare MGG,Wellcare MGG,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Bright Health - commercial,Bright Health - commercial,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,172,172,Bright Health MGG,Bright Health MGG,172,,,,,,,case rate,172,172,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Aetna,Aetna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Aetna MGG,Aetna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,BCBS,BCBS,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,BCBS MGG,BCBS MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Cigna,Cigna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Cigna MGG,Cigna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Humana,Humana,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Humana MGG,Humana MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Optum VA,Optum VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,UHC,UHC,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,UHC MGG,UHC MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,VA,VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Wellcare MGG,Wellcare MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Bright Health - commercial,Bright Health - commercial,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15,15,Bright Health MGG,Bright Health MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Aetna,Aetna,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Aetna MGG,Aetna MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,BCBS,BCBS,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,BCBS MGG,BCBS MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Cigna,Cigna,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Cigna MGG,Cigna MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Humana,Humana,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Humana MGG,Humana MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Optum VA,Optum VA,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,UHC,UHC,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,UHC MGG,UHC MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,VA,VA,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Wellcare MGG,Wellcare MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Bright Health - commercial,Bright Health - commercial,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,74,74,Bright Health MGG,Bright Health MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Aetna,Aetna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Aetna MGG,Aetna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,BCBS,BCBS,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,BCBS MGG,BCBS MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Cigna,Cigna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Cigna MGG,Cigna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Humana,Humana,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Humana MGG,Humana MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Optum VA,Optum VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,UHC,UHC,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,UHC MGG,UHC MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,VA,VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Wellcare MGG,Wellcare MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Bright Health - commercial,Bright Health - commercial,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,24,24,Bright Health MGG,Bright Health MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Aetna,Aetna,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Aetna MGG,Aetna MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,BCBS,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS MGG,BCBS MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Cigna,Cigna,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Cigna MGG,Cigna MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Humana,Humana,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Humana MGG,Humana MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Optum VA,Optum VA,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UHC,UHC,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UHC MGG,UHC MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,VA,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Wellcare MGG,Wellcare MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Bright Health - commercial,Bright Health - commercial,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
"BINDER ABD LG 4PANEL 55-72""   ",33109016,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,Bright Health MGG,Bright Health MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Aetna,Aetna,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Aetna MGG,Aetna MGG,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,BCBS,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS MGG,BCBS MGG,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Cigna,Cigna,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Cigna MGG,Cigna MGG,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Humana,Humana,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Humana MGG,Humana MGG,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Optum VA,Optum VA,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,UHC,UHC,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,UHC MGG,UHC MGG,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,VA,VA,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Wellcare MGG,Wellcare MGG,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Bright Health - commercial,Bright Health - commercial,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,Bright Health MGG,Bright Health MGG,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
EPUMP KANGAROO SFTYSCREW SPIKE,33109277,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Aetna,Aetna,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Aetna MGG,Aetna MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,BCBS,BCBS,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,BCBS MGG,BCBS MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Cigna,Cigna,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Cigna MGG,Cigna MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Humana,Humana,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Humana MGG,Humana MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Optum VA,Optum VA,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,UHC,UHC,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,UHC MGG,UHC MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,VA,VA,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Wellcare MGG,Wellcare MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Bright Health - commercial,Bright Health - commercial,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL LEFT    ,33109715,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Bright Health MGG,Bright Health MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Aetna,Aetna,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Aetna MGG,Aetna MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,BCBS,BCBS,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,BCBS MGG,BCBS MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Cigna,Cigna,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Cigna MGG,Cigna MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Humana,Humana,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Humana MGG,Humana MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Optum VA,Optum VA,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,UHC,UHC,169.44,,,,,,,per diem,169.44,169.44,"Per diem rate, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,UHC MGG,UHC MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,VA,VA,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Wellcare MGG,Wellcare MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Bright Health - commercial,Bright Health - commercial,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
ORTHOSIS REST HAND XL RIGHT   ,33109716,CDM,270,RC,,,,,,Inpatient,,,169.44,169.44,Bright Health MGG,Bright Health MGG,169.44,,,,,,,case rate,169.44,169.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Aetna,Aetna,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Aetna MGG,Aetna MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,BCBS,BCBS,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,BCBS MGG,BCBS MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Cigna,Cigna,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Cigna MGG,Cigna MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Humana,Humana,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Humana MGG,Humana MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Optum VA,Optum VA,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,UHC,UHC,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,UHC MGG,UHC MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,VA,VA,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Wellcare MGG,Wellcare MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Bright Health - commercial,Bright Health - commercial,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,112,112,Bright Health MGG,Bright Health MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Aetna,Aetna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Aetna MGG,Aetna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,BCBS,BCBS,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,BCBS MGG,BCBS MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Cigna,Cigna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Cigna MGG,Cigna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Humana,Humana,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Humana MGG,Humana MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Optum VA,Optum VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,UHC,UHC,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,UHC MGG,UHC MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,VA,VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Wellcare MGG,Wellcare MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Bright Health - commercial,Bright Health - commercial,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,24,24,Bright Health MGG,Bright Health MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Aetna,Aetna,74.81,,,,,,,per diem,74.81,74.81,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Aetna MGG,Aetna MGG,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,BCBS,BCBS,74.81,,,,,,,per diem,74.81,74.81,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,BCBS MGG,BCBS MGG,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Cigna,Cigna,74.81,,,,,,,per diem,74.81,74.81,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Cigna MGG,Cigna MGG,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Humana,Humana,74.81,,,,,,,per diem,74.81,74.81,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Humana MGG,Humana MGG,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Optum VA,Optum VA,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,UHC,UHC,74.81,,,,,,,per diem,74.81,74.81,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,UHC MGG,UHC MGG,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,VA,VA,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Wellcare MGG,Wellcare MGG,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Bright Health - commercial,Bright Health - commercial,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,74.81,74.81,Bright Health MGG,Bright Health MGG,74.81,,,,,,,case rate,74.81,74.81,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Aetna,Aetna,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Aetna MGG,Aetna MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,BCBS,BCBS,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,BCBS MGG,BCBS MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Cigna,Cigna,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Cigna MGG,Cigna MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Humana,Humana,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Humana MGG,Humana MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Optum VA,Optum VA,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,UHC,UHC,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,UHC MGG,UHC MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,VA,VA,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Wellcare MGG,Wellcare MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Bright Health - commercial,Bright Health - commercial,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,111,111,Bright Health MGG,Bright Health MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE NASOGASTRIC SUMP 16FR    ,33110205,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Aetna,Aetna,200.49,,,,,,,per diem,200.49,200.49,"Per diem rate, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Aetna MGG,Aetna MGG,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,BCBS,BCBS,200.49,,,,,,,per diem,200.49,200.49,"Per diem rate, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,BCBS MGG,BCBS MGG,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Cigna,Cigna,200.49,,,,,,,per diem,200.49,200.49,"Per diem rate, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Cigna MGG,Cigna MGG,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Humana,Humana,200.49,,,,,,,per diem,200.49,200.49,"Per diem rate, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Humana MGG,Humana MGG,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Optum VA,Optum VA,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,UHC,UHC,200.49,,,,,,,per diem,200.49,200.49,"Per diem rate, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,UHC MGG,UHC MGG,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,VA,VA,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Wellcare MGG,Wellcare MGG,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Bright Health - commercial,Bright Health - commercial,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
TUBE TRACHEAL JACKSON #6      ,33110366,CDM,270,RC,,,,,,Inpatient,,,200.49,200.49,Bright Health MGG,Bright Health MGG,200.49,,,,,,,case rate,200.49,200.49,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Aetna,Aetna,91.5,,,,,,,per diem,91.5,91.5,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Aetna MGG,Aetna MGG,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,BCBS,BCBS,91.5,,,,,,,per diem,91.5,91.5,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,BCBS MGG,BCBS MGG,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Cigna,Cigna,91.5,,,,,,,per diem,91.5,91.5,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Cigna MGG,Cigna MGG,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Humana,Humana,91.5,,,,,,,per diem,91.5,91.5,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Humana MGG,Humana MGG,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Optum VA,Optum VA,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,UHC,UHC,91.5,,,,,,,per diem,91.5,91.5,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,UHC MGG,UHC MGG,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,VA,VA,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Wellcare MGG,Wellcare MGG,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Bright Health - commercial,Bright Health - commercial,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,91.5,91.5,Bright Health MGG,Bright Health MGG,91.5,,,,,,,case rate,91.5,91.5,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Aetna,Aetna,160.29,,,,,,,per diem,160.29,160.29,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Aetna MGG,Aetna MGG,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,BCBS,BCBS,160.29,,,,,,,per diem,160.29,160.29,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,BCBS MGG,BCBS MGG,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Cigna,Cigna,160.29,,,,,,,per diem,160.29,160.29,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Cigna MGG,Cigna MGG,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Humana,Humana,160.29,,,,,,,per diem,160.29,160.29,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Humana MGG,Humana MGG,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Optum VA,Optum VA,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,UHC,UHC,160.29,,,,,,,per diem,160.29,160.29,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,UHC MGG,UHC MGG,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,VA,VA,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Wellcare MGG,Wellcare MGG,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Bright Health - commercial,Bright Health - commercial,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PSR RELIEF,33111265,CDM,270,RC,,,,,,Inpatient,,,160.29,160.29,Bright Health MGG,Bright Health MGG,160.29,,,,,,,case rate,160.29,160.29,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Aetna,Aetna,28.14,,,,,,,per diem,28.14,28.14,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Aetna MGG,Aetna MGG,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,BCBS,BCBS,28.14,,,,,,,per diem,28.14,28.14,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,BCBS MGG,BCBS MGG,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Cigna,Cigna,28.14,,,,,,,per diem,28.14,28.14,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Cigna MGG,Cigna MGG,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Humana,Humana,28.14,,,,,,,per diem,28.14,28.14,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Humana MGG,Humana MGG,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Optum VA,Optum VA,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,UHC,UHC,28.14,,,,,,,per diem,28.14,28.14,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,UHC MGG,UHC MGG,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,VA,VA,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Wellcare MGG,Wellcare MGG,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Bright Health - commercial,Bright Health - commercial,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,28.14,28.14,Bright Health MGG,Bright Health MGG,28.14,,,,,,,case rate,28.14,28.14,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 4000ML  ,33111733,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Aetna,Aetna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Aetna MGG,Aetna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS,BCBS,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS MGG,BCBS MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Cigna,Cigna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Cigna MGG,Cigna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Humana,Humana,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Humana MGG,Humana MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Optum VA,Optum VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,UHC,UHC,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,UHC MGG,UHC MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,VA,VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Wellcare MGG,Wellcare MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Bright Health - commercial,Bright Health - commercial,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,21,21,Bright Health MGG,Bright Health MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Aetna,Aetna,21.75,,,,,,,per diem,21.75,21.75,"Per diem rate, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Aetna MGG,Aetna MGG,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,BCBS,BCBS,21.75,,,,,,,per diem,21.75,21.75,"Per diem rate, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,BCBS MGG,BCBS MGG,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Cigna,Cigna,21.75,,,,,,,per diem,21.75,21.75,"Per diem rate, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Cigna MGG,Cigna MGG,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Humana,Humana,21.75,,,,,,,per diem,21.75,21.75,"Per diem rate, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Humana MGG,Humana MGG,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Optum VA,Optum VA,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,UHC,UHC,21.75,,,,,,,per diem,21.75,21.75,"Per diem rate, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,UHC MGG,UHC MGG,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,VA,VA,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Wellcare MGG,Wellcare MGG,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Bright Health - commercial,Bright Health - commercial,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
CATH COUDE 2W SIL 5CC14FR     ,33111976,CDM,270,RC,,,,,,Inpatient,,,21.75,21.75,Bright Health MGG,Bright Health MGG,21.75,,,,,,,case rate,21.75,21.75,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Aetna,Aetna,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Aetna MGG,Aetna MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,BCBS,BCBS,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,BCBS MGG,BCBS MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Cigna,Cigna,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Cigna MGG,Cigna MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Humana,Humana,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Humana MGG,Humana MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Optum VA,Optum VA,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,UHC,UHC,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,UHC MGG,UHC MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,VA,VA,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Wellcare MGG,Wellcare MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Bright Health - commercial,Bright Health - commercial,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA LG/XL               ,33112303,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Bright Health MGG,Bright Health MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Aetna,Aetna,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Aetna MGG,Aetna MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,BCBS,BCBS,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,BCBS MGG,BCBS MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Cigna,Cigna,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Cigna MGG,Cigna MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Humana,Humana,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Humana MGG,Humana MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Optum VA,Optum VA,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,UHC,UHC,53.28,,,,,,,per diem,53.28,53.28,"Per diem rate, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,UHC MGG,UHC MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,VA,VA,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Wellcare MGG,Wellcare MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Bright Health - commercial,Bright Health - commercial,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SLING CVA SML/MED             ,33112304,CDM,270,RC,,,,,,Inpatient,,,53.28,53.28,Bright Health MGG,Bright Health MGG,53.28,,,,,,,case rate,53.28,53.28,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Aetna,Aetna,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Aetna MGG,Aetna MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,BCBS,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS MGG,BCBS MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Cigna,Cigna,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Cigna MGG,Cigna MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Humana,Humana,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Humana MGG,Humana MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Optum VA,Optum VA,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,UHC,UHC,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,UHC MGG,UHC MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,VA,VA,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Wellcare MGG,Wellcare MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Bright Health - commercial,Bright Health - commercial,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,42,42,Bright Health MGG,Bright Health MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Aetna,Aetna,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Aetna MGG,Aetna MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,BCBS,BCBS,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,BCBS MGG,BCBS MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Cigna,Cigna,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Cigna MGG,Cigna MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Humana,Humana,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Humana MGG,Humana MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Optum VA,Optum VA,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,UHC,UHC,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,UHC MGG,UHC MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,VA,VA,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Wellcare MGG,Wellcare MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Bright Health - commercial,Bright Health - commercial,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
BINDER ABD 4PNL DRN BULB 46-62,33112688,CDM,270,RC,,,,,,Inpatient,,,52.14,52.14,Bright Health MGG,Bright Health MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY CATH INTERMIT LF 15FR    ,33113972,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Aetna,Aetna,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Aetna MGG,Aetna MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,BCBS,BCBS,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,BCBS MGG,BCBS MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Cigna,Cigna,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Cigna MGG,Cigna MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Humana,Humana,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Humana MGG,Humana MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Optum VA,Optum VA,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,UHC,UHC,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,UHC MGG,UHC MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,VA,VA,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Wellcare MGG,Wellcare MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Bright Health - commercial,Bright Health - commercial,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
TRAY FOL COMP CARE STATLK DVC ,33114341,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Bright Health MGG,Bright Health MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Aetna,Aetna,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Aetna MGG,Aetna MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,BCBS,BCBS,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,BCBS MGG,BCBS MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Cigna,Cigna,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Cigna MGG,Cigna MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Humana,Humana,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Humana MGG,Humana MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Optum VA,Optum VA,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,UHC,UHC,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,UHC MGG,UHC MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,VA,VA,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Wellcare MGG,Wellcare MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Bright Health - commercial,Bright Health - commercial,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,6.81,6.81,Bright Health MGG,Bright Health MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CATH FOLEY IC 3WAY 18FRX30CC  ,33119975,CDM,270,RC,,,,,,Inpatient,,,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Aetna,Aetna,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Aetna MGG,Aetna MGG,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,BCBS,BCBS,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,BCBS MGG,BCBS MGG,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Cigna,Cigna,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Cigna MGG,Cigna MGG,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Humana,Humana,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Humana MGG,Humana MGG,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Optum VA,Optum VA,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,UHC,UHC,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,UHC MGG,UHC MGG,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,VA,VA,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Wellcare MGG,Wellcare MGG,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Bright Health - commercial,Bright Health - commercial,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
AID SOCK FLEX FLAT            ,33120092,CDM,270,RC,,,,,,Inpatient,,,39.06,39.06,Bright Health MGG,Bright Health MGG,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Aetna,Aetna,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Aetna MGG,Aetna MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,BCBS,BCBS,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,BCBS MGG,BCBS MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Cigna,Cigna,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Cigna MGG,Cigna MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Humana,Humana,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Humana MGG,Humana MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Optum VA,Optum VA,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,UHC,UHC,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,UHC MGG,UHC MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,VA,VA,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Wellcare MGG,Wellcare MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Bright Health - commercial,Bright Health - commercial,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,540,540,Bright Health MGG,Bright Health MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Aetna,Aetna,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Aetna MGG,Aetna MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,BCBS,BCBS,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,BCBS MGG,BCBS MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Cigna,Cigna,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Cigna MGG,Cigna MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Humana,Humana,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Humana MGG,Humana MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Optum VA,Optum VA,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,UHC,UHC,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,UHC MGG,UHC MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,VA,VA,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Wellcare MGG,Wellcare MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Bright Health - commercial,Bright Health - commercial,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,540,540,Bright Health MGG,Bright Health MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Aetna,Aetna,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Aetna MGG,Aetna MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,BCBS,BCBS,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,BCBS MGG,BCBS MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Cigna,Cigna,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Cigna MGG,Cigna MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Humana,Humana,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Humana MGG,Humana MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Optum VA,Optum VA,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,UHC,UHC,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,UHC MGG,UHC MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,VA,VA,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Wellcare MGG,Wellcare MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Bright Health - commercial,Bright Health - commercial,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,540,540,Bright Health MGG,Bright Health MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Aetna,Aetna,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Aetna MGG,Aetna MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,BCBS,BCBS,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,BCBS MGG,BCBS MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Cigna,Cigna,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Cigna MGG,Cigna MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Humana,Humana,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Humana MGG,Humana MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Optum VA,Optum VA,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,UHC,UHC,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,UHC MGG,UHC MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,VA,VA,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Wellcare MGG,Wellcare MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Bright Health - commercial,Bright Health - commercial,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,125,125,Bright Health MGG,Bright Health MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Aetna,Aetna,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Aetna MGG,Aetna MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,BCBS,BCBS,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,BCBS MGG,BCBS MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Cigna,Cigna,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Cigna MGG,Cigna MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Humana,Humana,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Humana MGG,Humana MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Optum VA,Optum VA,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,UHC,UHC,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,UHC MGG,UHC MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,VA,VA,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Wellcare MGG,Wellcare MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Bright Health - commercial,Bright Health - commercial,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,194,194,Bright Health MGG,Bright Health MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Aetna,Aetna,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Aetna MGG,Aetna MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,BCBS,BCBS,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,BCBS MGG,BCBS MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Cigna,Cigna,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Cigna MGG,Cigna MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Humana,Humana,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Humana MGG,Humana MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Optum VA,Optum VA,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,UHC,UHC,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,UHC MGG,UHC MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,VA,VA,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Wellcare MGG,Wellcare MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Bright Health - commercial,Bright Health - commercial,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,35.64,35.64,Bright Health MGG,Bright Health MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Aetna,Aetna,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Aetna MGG,Aetna MGG,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,BCBS,BCBS,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,BCBS MGG,BCBS MGG,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Cigna,Cigna,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Cigna MGG,Cigna MGG,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Humana,Humana,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Humana MGG,Humana MGG,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Optum VA,Optum VA,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,UHC,UHC,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,UHC MGG,UHC MGG,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,VA,VA,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Wellcare MGG,Wellcare MGG,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Bright Health - commercial,Bright Health - commercial,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,49.58,49.58,Bright Health MGG,Bright Health MGG,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Aetna,Aetna,20.2,,,,,,,per diem,20.2,20.2,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Aetna MGG,Aetna MGG,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,BCBS,BCBS,20.2,,,,,,,per diem,20.2,20.2,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,BCBS MGG,BCBS MGG,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Cigna,Cigna,20.2,,,,,,,per diem,20.2,20.2,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Cigna MGG,Cigna MGG,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Humana,Humana,20.2,,,,,,,per diem,20.2,20.2,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Humana MGG,Humana MGG,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Optum VA,Optum VA,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,UHC,UHC,20.2,,,,,,,per diem,20.2,20.2,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,UHC MGG,UHC MGG,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,VA,VA,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Wellcare MGG,Wellcare MGG,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Bright Health - commercial,Bright Health - commercial,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,20.2,20.2,Bright Health MGG,Bright Health MGG,20.2,,,,,,,case rate,20.2,20.2,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Aetna,Aetna,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Aetna MGG,Aetna MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,BCBS,BCBS,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,BCBS MGG,BCBS MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Cigna,Cigna,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Cigna MGG,Cigna MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Humana,Humana,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Humana MGG,Humana MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Optum VA,Optum VA,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,UHC,UHC,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,UHC MGG,UHC MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,VA,VA,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Wellcare MGG,Wellcare MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Bright Health - commercial,Bright Health - commercial,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.47,5.47,Bright Health MGG,Bright Health MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Aetna,Aetna,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Aetna MGG,Aetna MGG,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,BCBS,BCBS,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,BCBS MGG,BCBS MGG,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Cigna,Cigna,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Cigna MGG,Cigna MGG,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Humana,Humana,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Humana MGG,Humana MGG,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Optum VA,Optum VA,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,UHC,UHC,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,UHC MGG,UHC MGG,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,VA,VA,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Wellcare MGG,Wellcare MGG,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Bright Health - commercial,Bright Health - commercial,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.42,5.42,Bright Health MGG,Bright Health MGG,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Aetna,Aetna,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Aetna MGG,Aetna MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,BCBS,BCBS,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,BCBS MGG,BCBS MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Cigna,Cigna,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Cigna MGG,Cigna MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Humana,Humana,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Humana MGG,Humana MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Optum VA,Optum VA,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,UHC,UHC,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,UHC MGG,UHC MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,VA,VA,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Wellcare MGG,Wellcare MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Bright Health - commercial,Bright Health - commercial,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,48.57,48.57,Bright Health MGG,Bright Health MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Aetna,Aetna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Aetna MGG,Aetna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,BCBS,BCBS,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,BCBS MGG,BCBS MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Cigna,Cigna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Cigna MGG,Cigna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Humana,Humana,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Humana MGG,Humana MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Optum VA,Optum VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,UHC,UHC,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,UHC MGG,UHC MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,VA,VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Wellcare MGG,Wellcare MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Bright Health - commercial,Bright Health - commercial,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Bright Health MGG,Bright Health MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Aetna,Aetna,12.56,,,,,,,per diem,12.56,12.56,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Aetna MGG,Aetna MGG,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,BCBS,BCBS,12.56,,,,,,,per diem,12.56,12.56,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,BCBS MGG,BCBS MGG,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Cigna,Cigna,12.56,,,,,,,per diem,12.56,12.56,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Cigna MGG,Cigna MGG,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Humana,Humana,12.56,,,,,,,per diem,12.56,12.56,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Humana MGG,Humana MGG,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Optum VA,Optum VA,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,UHC,UHC,12.56,,,,,,,per diem,12.56,12.56,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,UHC MGG,UHC MGG,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,VA,VA,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Wellcare MGG,Wellcare MGG,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Bright Health - commercial,Bright Health - commercial,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,12.56,12.56,Bright Health MGG,Bright Health MGG,12.56,,,,,,,case rate,12.56,12.56,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Aetna,Aetna,53.79,,,,,,,per diem,53.79,53.79,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Aetna MGG,Aetna MGG,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,BCBS,BCBS,53.79,,,,,,,per diem,53.79,53.79,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,BCBS MGG,BCBS MGG,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Cigna,Cigna,53.79,,,,,,,per diem,53.79,53.79,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Cigna MGG,Cigna MGG,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Humana,Humana,53.79,,,,,,,per diem,53.79,53.79,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Humana MGG,Humana MGG,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Optum VA,Optum VA,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,UHC,UHC,53.79,,,,,,,per diem,53.79,53.79,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,UHC MGG,UHC MGG,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,VA,VA,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Wellcare MGG,Wellcare MGG,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Bright Health - commercial,Bright Health - commercial,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,53.79,53.79,Bright Health MGG,Bright Health MGG,53.79,,,,,,,case rate,53.79,53.79,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Aetna,Aetna,23.77,,,,,,,per diem,23.77,23.77,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Aetna MGG,Aetna MGG,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,BCBS,BCBS,23.77,,,,,,,per diem,23.77,23.77,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,BCBS MGG,BCBS MGG,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Cigna,Cigna,23.77,,,,,,,per diem,23.77,23.77,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Cigna MGG,Cigna MGG,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Humana,Humana,23.77,,,,,,,per diem,23.77,23.77,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Humana MGG,Humana MGG,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Optum VA,Optum VA,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,UHC,UHC,23.77,,,,,,,per diem,23.77,23.77,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,UHC MGG,UHC MGG,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,VA,VA,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Wellcare MGG,Wellcare MGG,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Bright Health - commercial,Bright Health - commercial,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,23.77,23.77,Bright Health MGG,Bright Health MGG,23.77,,,,,,,case rate,23.77,23.77,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Aetna,Aetna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Aetna MGG,Aetna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,BCBS,BCBS,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,BCBS MGG,BCBS MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Cigna,Cigna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Cigna MGG,Cigna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Humana,Humana,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Humana MGG,Humana MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Optum VA,Optum VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,UHC,UHC,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,UHC MGG,UHC MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,VA,VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Wellcare MGG,Wellcare MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Bright Health - commercial,Bright Health - commercial,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Bright Health MGG,Bright Health MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Aetna,Aetna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Aetna MGG,Aetna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,BCBS,BCBS,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,BCBS MGG,BCBS MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Cigna,Cigna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Cigna MGG,Cigna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Humana,Humana,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Humana MGG,Humana MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Optum VA,Optum VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,UHC,UHC,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,UHC MGG,UHC MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,VA,VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Wellcare MGG,Wellcare MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Bright Health - commercial,Bright Health - commercial,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Bright Health MGG,Bright Health MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Aetna,Aetna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Aetna MGG,Aetna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,BCBS,BCBS,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,BCBS MGG,BCBS MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Cigna,Cigna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Cigna MGG,Cigna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Humana,Humana,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Humana MGG,Humana MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Optum VA,Optum VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,UHC,UHC,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,UHC MGG,UHC MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,VA,VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Wellcare MGG,Wellcare MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Bright Health - commercial,Bright Health - commercial,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,19.38,19.38,Bright Health MGG,Bright Health MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Aetna,Aetna,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Aetna MGG,Aetna MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,BCBS,BCBS,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,BCBS MGG,BCBS MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Cigna,Cigna,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Cigna MGG,Cigna MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Humana,Humana,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Humana MGG,Humana MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Optum VA,Optum VA,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,UHC,UHC,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,UHC MGG,UHC MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,VA,VA,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Wellcare MGG,Wellcare MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Bright Health - commercial,Bright Health - commercial,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,405,405,Bright Health MGG,Bright Health MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Aetna,Aetna,28.52,,,,,,,per diem,28.52,28.52,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Aetna MGG,Aetna MGG,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,BCBS,BCBS,28.52,,,,,,,per diem,28.52,28.52,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,BCBS MGG,BCBS MGG,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Cigna,Cigna,28.52,,,,,,,per diem,28.52,28.52,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Cigna MGG,Cigna MGG,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Humana,Humana,28.52,,,,,,,per diem,28.52,28.52,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Humana MGG,Humana MGG,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Optum VA,Optum VA,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,UHC,UHC,28.52,,,,,,,per diem,28.52,28.52,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,UHC MGG,UHC MGG,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,VA,VA,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Wellcare MGG,Wellcare MGG,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Bright Health - commercial,Bright Health - commercial,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,28.52,28.52,Bright Health MGG,Bright Health MGG,28.52,,,,,,,case rate,28.52,28.52,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Aetna,Aetna,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Aetna MGG,Aetna MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,BCBS,BCBS,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,BCBS MGG,BCBS MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Cigna,Cigna,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Cigna MGG,Cigna MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Humana,Humana,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Humana MGG,Humana MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Optum VA,Optum VA,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,UHC,UHC,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,UHC MGG,UHC MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,VA,VA,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Wellcare MGG,Wellcare MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Bright Health - commercial,Bright Health - commercial,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Bright Health MGG,Bright Health MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Aetna,Aetna,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Aetna MGG,Aetna MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,BCBS,BCBS,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,BCBS MGG,BCBS MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Cigna,Cigna,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Cigna MGG,Cigna MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Humana,Humana,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Humana MGG,Humana MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Optum VA,Optum VA,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,UHC,UHC,103.47,,,,,,,per diem,103.47,103.47,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,UHC MGG,UHC MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,VA,VA,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Wellcare MGG,Wellcare MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Bright Health - commercial,Bright Health - commercial,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,103.47,103.47,Bright Health MGG,Bright Health MGG,103.47,,,,,,,case rate,103.47,103.47,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Aetna,Aetna,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Aetna MGG,Aetna MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,BCBS,BCBS,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,BCBS MGG,BCBS MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Cigna,Cigna,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Cigna MGG,Cigna MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Humana,Humana,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Humana MGG,Humana MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Optum VA,Optum VA,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,UHC,UHC,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,UHC MGG,UHC MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,VA,VA,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Wellcare MGG,Wellcare MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Bright Health - commercial,Bright Health - commercial,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.29,10.29,Bright Health MGG,Bright Health MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Aetna,Aetna,139.86,,,,,,,per diem,139.86,139.86,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Aetna MGG,Aetna MGG,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,BCBS,BCBS,139.86,,,,,,,per diem,139.86,139.86,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,BCBS MGG,BCBS MGG,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Cigna,Cigna,139.86,,,,,,,per diem,139.86,139.86,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Cigna MGG,Cigna MGG,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Humana,Humana,139.86,,,,,,,per diem,139.86,139.86,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Humana MGG,Humana MGG,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Optum VA,Optum VA,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,UHC,UHC,139.86,,,,,,,per diem,139.86,139.86,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,UHC MGG,UHC MGG,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,VA,VA,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Wellcare MGG,Wellcare MGG,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Bright Health - commercial,Bright Health - commercial,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,139.86,139.86,Bright Health MGG,Bright Health MGG,139.86,,,,,,,case rate,139.86,139.86,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Aetna,Aetna,65.63,,,,,,,per diem,65.63,65.63,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Aetna MGG,Aetna MGG,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,BCBS,BCBS,65.63,,,,,,,per diem,65.63,65.63,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,BCBS MGG,BCBS MGG,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Cigna,Cigna,65.63,,,,,,,per diem,65.63,65.63,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Cigna MGG,Cigna MGG,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Humana,Humana,65.63,,,,,,,per diem,65.63,65.63,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Humana MGG,Humana MGG,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Optum VA,Optum VA,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,UHC,UHC,65.63,,,,,,,per diem,65.63,65.63,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,UHC MGG,UHC MGG,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,VA,VA,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Wellcare MGG,Wellcare MGG,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Bright Health - commercial,Bright Health - commercial,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,65.63,65.63,Bright Health MGG,Bright Health MGG,65.63,,,,,,,case rate,65.63,65.63,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Aetna,Aetna,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Aetna MGG,Aetna MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,BCBS,BCBS,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,BCBS MGG,BCBS MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Cigna,Cigna,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Cigna MGG,Cigna MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Humana,Humana,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Humana MGG,Humana MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Optum VA,Optum VA,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,UHC,UHC,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,UHC MGG,UHC MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,VA,VA,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Wellcare MGG,Wellcare MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Bright Health - commercial,Bright Health - commercial,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Bright Health MGG,Bright Health MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Aetna,Aetna,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Aetna MGG,Aetna MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,BCBS,BCBS,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,BCBS MGG,BCBS MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Cigna,Cigna,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Cigna MGG,Cigna MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Humana,Humana,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Humana MGG,Humana MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Optum VA,Optum VA,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,UHC,UHC,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,UHC MGG,UHC MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,VA,VA,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Wellcare MGG,Wellcare MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Bright Health - commercial,Bright Health - commercial,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Bright Health MGG,Bright Health MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Aetna,Aetna,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Aetna MGG,Aetna MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,BCBS,BCBS,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,BCBS MGG,BCBS MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Cigna,Cigna,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Cigna MGG,Cigna MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Humana,Humana,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Humana MGG,Humana MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Optum VA,Optum VA,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,UHC,UHC,122.19,,,,,,,per diem,122.19,122.19,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,UHC MGG,UHC MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,VA,VA,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Wellcare MGG,Wellcare MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Bright Health - commercial,Bright Health - commercial,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,122.19,122.19,Bright Health MGG,Bright Health MGG,122.19,,,,,,,case rate,122.19,122.19,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Aetna,Aetna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Aetna MGG,Aetna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,BCBS,BCBS,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,BCBS MGG,BCBS MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Cigna,Cigna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Cigna MGG,Cigna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Humana,Humana,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Humana MGG,Humana MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Optum VA,Optum VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,UHC,UHC,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,UHC MGG,UHC MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,VA,VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Wellcare MGG,Wellcare MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Bright Health - commercial,Bright Health - commercial,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,45,45,Bright Health MGG,Bright Health MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Aetna,Aetna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Aetna MGG,Aetna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,BCBS,BCBS,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,BCBS MGG,BCBS MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Cigna,Cigna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Cigna MGG,Cigna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Humana,Humana,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Humana MGG,Humana MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Optum VA,Optum VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,UHC,UHC,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,UHC MGG,UHC MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,VA,VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Wellcare MGG,Wellcare MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Bright Health - commercial,Bright Health - commercial,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,45,45,Bright Health MGG,Bright Health MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Aetna,Aetna,149.91,,,,,,,per diem,149.91,149.91,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Aetna MGG,Aetna MGG,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,BCBS,BCBS,149.91,,,,,,,per diem,149.91,149.91,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,BCBS MGG,BCBS MGG,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Cigna,Cigna,149.91,,,,,,,per diem,149.91,149.91,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Cigna MGG,Cigna MGG,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Humana,Humana,149.91,,,,,,,per diem,149.91,149.91,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Humana MGG,Humana MGG,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Optum VA,Optum VA,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,UHC,UHC,149.91,,,,,,,per diem,149.91,149.91,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,UHC MGG,UHC MGG,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,VA,VA,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Wellcare MGG,Wellcare MGG,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Bright Health - commercial,Bright Health - commercial,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,149.91,149.91,Bright Health MGG,Bright Health MGG,149.91,,,,,,,case rate,149.91,149.91,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Aetna,Aetna,389.98,,,,,,,per diem,389.98,389.98,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Aetna MGG,Aetna MGG,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,BCBS,BCBS,389.98,,,,,,,per diem,389.98,389.98,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,BCBS MGG,BCBS MGG,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Cigna,Cigna,389.98,,,,,,,per diem,389.98,389.98,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Cigna MGG,Cigna MGG,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Humana,Humana,389.98,,,,,,,per diem,389.98,389.98,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Humana MGG,Humana MGG,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Optum VA,Optum VA,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,UHC,UHC,389.98,,,,,,,per diem,389.98,389.98,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,UHC MGG,UHC MGG,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,VA,VA,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Wellcare MGG,Wellcare MGG,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Bright Health - commercial,Bright Health - commercial,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,389.98,389.98,Bright Health MGG,Bright Health MGG,389.98,,,,,,,case rate,389.98,389.98,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Aetna,Aetna,943.49,,,,,,,per diem,943.49,943.49,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Aetna MGG,Aetna MGG,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,BCBS,BCBS,943.49,,,,,,,per diem,943.49,943.49,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,BCBS MGG,BCBS MGG,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Cigna,Cigna,943.49,,,,,,,per diem,943.49,943.49,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Cigna MGG,Cigna MGG,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Humana,Humana,943.49,,,,,,,per diem,943.49,943.49,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Humana MGG,Humana MGG,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Optum VA,Optum VA,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,UHC,UHC,943.49,,,,,,,per diem,943.49,943.49,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,UHC MGG,UHC MGG,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,VA,VA,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Wellcare MGG,Wellcare MGG,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Bright Health - commercial,Bright Health - commercial,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,943.49,943.49,Bright Health MGG,Bright Health MGG,943.49,,,,,,,case rate,943.49,943.49,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Aetna,Aetna,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Aetna MGG,Aetna MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,BCBS,BCBS,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,BCBS MGG,BCBS MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Cigna,Cigna,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Cigna MGG,Cigna MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Humana,Humana,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Humana MGG,Humana MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Optum VA,Optum VA,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,UHC,UHC,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,UHC MGG,UHC MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,VA,VA,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Wellcare MGG,Wellcare MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Bright Health - commercial,Bright Health - commercial,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.46,6.46,Bright Health MGG,Bright Health MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Aetna,Aetna,1671.1,,,,,,,per diem,1671.1,1671.1,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Aetna MGG,Aetna MGG,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,BCBS,BCBS,1671.1,,,,,,,per diem,1671.1,1671.1,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,BCBS MGG,BCBS MGG,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Cigna,Cigna,1671.1,,,,,,,per diem,1671.1,1671.1,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Cigna MGG,Cigna MGG,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Humana,Humana,1671.1,,,,,,,per diem,1671.1,1671.1,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Humana MGG,Humana MGG,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Optum VA,Optum VA,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,UHC,UHC,1671.1,,,,,,,per diem,1671.1,1671.1,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,UHC MGG,UHC MGG,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,VA,VA,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Wellcare MGG,Wellcare MGG,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Bright Health - commercial,Bright Health - commercial,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1671.1,1671.1,Bright Health MGG,Bright Health MGG,1671.1,,,,,,,case rate,1671.1,1671.1,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Aetna,Aetna,1965.6,,,,,,,per diem,1965.6,1965.6,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Aetna MGG,Aetna MGG,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,BCBS,BCBS,1965.6,,,,,,,per diem,1965.6,1965.6,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,BCBS MGG,BCBS MGG,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Cigna,Cigna,1965.6,,,,,,,per diem,1965.6,1965.6,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Cigna MGG,Cigna MGG,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Humana,Humana,1965.6,,,,,,,per diem,1965.6,1965.6,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Humana MGG,Humana MGG,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Optum VA,Optum VA,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,UHC,UHC,1965.6,,,,,,,per diem,1965.6,1965.6,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,UHC MGG,UHC MGG,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,VA,VA,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Wellcare MGG,Wellcare MGG,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Bright Health - commercial,Bright Health - commercial,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,1965.6,1965.6,Bright Health MGG,Bright Health MGG,1965.6,,,,,,,case rate,1965.6,1965.6,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Aetna,Aetna,944.42,,,,,,,per diem,944.42,944.42,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Aetna MGG,Aetna MGG,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,BCBS,BCBS,944.42,,,,,,,per diem,944.42,944.42,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,BCBS MGG,BCBS MGG,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Cigna,Cigna,944.42,,,,,,,per diem,944.42,944.42,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Cigna MGG,Cigna MGG,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Humana,Humana,944.42,,,,,,,per diem,944.42,944.42,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Humana MGG,Humana MGG,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Optum VA,Optum VA,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,UHC,UHC,944.42,,,,,,,per diem,944.42,944.42,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,UHC MGG,UHC MGG,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,VA,VA,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Wellcare MGG,Wellcare MGG,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Bright Health - commercial,Bright Health - commercial,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,944.42,944.42,Bright Health MGG,Bright Health MGG,944.42,,,,,,,case rate,944.42,944.42,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Aetna,Aetna,377.4,,,,,,,per diem,377.4,377.4,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Aetna MGG,Aetna MGG,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,BCBS,BCBS,377.4,,,,,,,per diem,377.4,377.4,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,BCBS MGG,BCBS MGG,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Cigna,Cigna,377.4,,,,,,,per diem,377.4,377.4,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Cigna MGG,Cigna MGG,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Humana,Humana,377.4,,,,,,,per diem,377.4,377.4,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Humana MGG,Humana MGG,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Optum VA,Optum VA,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,UHC,UHC,377.4,,,,,,,per diem,377.4,377.4,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,UHC MGG,UHC MGG,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,VA,VA,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Wellcare MGG,Wellcare MGG,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Bright Health - commercial,Bright Health - commercial,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,377.4,377.4,Bright Health MGG,Bright Health MGG,377.4,,,,,,,case rate,377.4,377.4,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Aetna,Aetna,11.65,,,,,,,per diem,11.65,11.65,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Aetna MGG,Aetna MGG,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,BCBS,BCBS,11.65,,,,,,,per diem,11.65,11.65,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,BCBS MGG,BCBS MGG,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Cigna,Cigna,11.65,,,,,,,per diem,11.65,11.65,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Cigna MGG,Cigna MGG,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Humana,Humana,11.65,,,,,,,per diem,11.65,11.65,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Humana MGG,Humana MGG,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Optum VA,Optum VA,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,UHC,UHC,11.65,,,,,,,per diem,11.65,11.65,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,UHC MGG,UHC MGG,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,VA,VA,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Wellcare MGG,Wellcare MGG,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Bright Health - commercial,Bright Health - commercial,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,11.65,11.65,Bright Health MGG,Bright Health MGG,11.65,,,,,,,case rate,11.65,11.65,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Aetna,Aetna,181.95,,,,,,,per diem,181.95,181.95,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Aetna MGG,Aetna MGG,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,BCBS,BCBS,181.95,,,,,,,per diem,181.95,181.95,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,BCBS MGG,BCBS MGG,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Cigna,Cigna,181.95,,,,,,,per diem,181.95,181.95,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Cigna MGG,Cigna MGG,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Humana,Humana,181.95,,,,,,,per diem,181.95,181.95,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Humana MGG,Humana MGG,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Optum VA,Optum VA,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,UHC,UHC,181.95,,,,,,,per diem,181.95,181.95,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,UHC MGG,UHC MGG,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,VA,VA,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Wellcare MGG,Wellcare MGG,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Bright Health - commercial,Bright Health - commercial,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,181.95,181.95,Bright Health MGG,Bright Health MGG,181.95,,,,,,,case rate,181.95,181.95,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Aetna,Aetna,49.82,,,,,,,per diem,49.82,49.82,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Aetna MGG,Aetna MGG,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,BCBS,BCBS,49.82,,,,,,,per diem,49.82,49.82,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,BCBS MGG,BCBS MGG,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Cigna,Cigna,49.82,,,,,,,per diem,49.82,49.82,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Cigna MGG,Cigna MGG,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Humana,Humana,49.82,,,,,,,per diem,49.82,49.82,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Humana MGG,Humana MGG,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Optum VA,Optum VA,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,UHC,UHC,49.82,,,,,,,per diem,49.82,49.82,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,UHC MGG,UHC MGG,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,VA,VA,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Wellcare MGG,Wellcare MGG,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Bright Health - commercial,Bright Health - commercial,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,49.82,49.82,Bright Health MGG,Bright Health MGG,49.82,,,,,,,case rate,49.82,49.82,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Aetna,Aetna,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Aetna MGG,Aetna MGG,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,BCBS,BCBS,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,BCBS MGG,BCBS MGG,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Cigna,Cigna,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Cigna MGG,Cigna MGG,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Humana,Humana,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Humana MGG,Humana MGG,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Optum VA,Optum VA,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,UHC,UHC,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,UHC MGG,UHC MGG,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,VA,VA,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Wellcare MGG,Wellcare MGG,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Bright Health - commercial,Bright Health - commercial,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,97.34,97.34,Bright Health MGG,Bright Health MGG,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Aetna,Aetna,74.88,,,,,,,per diem,74.88,74.88,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Aetna MGG,Aetna MGG,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,BCBS,BCBS,74.88,,,,,,,per diem,74.88,74.88,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,BCBS MGG,BCBS MGG,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Cigna,Cigna,74.88,,,,,,,per diem,74.88,74.88,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Cigna MGG,Cigna MGG,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Humana,Humana,74.88,,,,,,,per diem,74.88,74.88,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Humana MGG,Humana MGG,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Optum VA,Optum VA,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,UHC,UHC,74.88,,,,,,,per diem,74.88,74.88,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,UHC MGG,UHC MGG,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,VA,VA,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Wellcare MGG,Wellcare MGG,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Bright Health - commercial,Bright Health - commercial,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,74.88,74.88,Bright Health MGG,Bright Health MGG,74.88,,,,,,,case rate,74.88,74.88,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Aetna,Aetna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Aetna MGG,Aetna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,BCBS,BCBS,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,BCBS MGG,BCBS MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Cigna,Cigna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Cigna MGG,Cigna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Humana,Humana,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Humana MGG,Humana MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Optum VA,Optum VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,UHC,UHC,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,UHC MGG,UHC MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,VA,VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Wellcare MGG,Wellcare MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Bright Health - commercial,Bright Health - commercial,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,180.54,180.54,Bright Health MGG,Bright Health MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Aetna,Aetna,37.44,,,,,,,per diem,37.44,37.44,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Aetna MGG,Aetna MGG,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,BCBS,BCBS,37.44,,,,,,,per diem,37.44,37.44,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,BCBS MGG,BCBS MGG,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Cigna,Cigna,37.44,,,,,,,per diem,37.44,37.44,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Cigna MGG,Cigna MGG,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Humana,Humana,37.44,,,,,,,per diem,37.44,37.44,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Humana MGG,Humana MGG,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Optum VA,Optum VA,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,UHC,UHC,37.44,,,,,,,per diem,37.44,37.44,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,UHC MGG,UHC MGG,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,VA,VA,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Wellcare MGG,Wellcare MGG,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Bright Health - commercial,Bright Health - commercial,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,37.44,37.44,Bright Health MGG,Bright Health MGG,37.44,,,,,,,case rate,37.44,37.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Aetna,Aetna,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Aetna MGG,Aetna MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,BCBS,BCBS,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,BCBS MGG,BCBS MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Cigna,Cigna,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Cigna MGG,Cigna MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Humana,Humana,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Humana MGG,Humana MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Optum VA,Optum VA,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,UHC,UHC,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,UHC MGG,UHC MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,VA,VA,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Wellcare MGG,Wellcare MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Bright Health - commercial,Bright Health - commercial,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Bright Health MGG,Bright Health MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Aetna,Aetna,27.52,,,,,,,per diem,27.52,27.52,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Aetna MGG,Aetna MGG,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,BCBS,BCBS,27.52,,,,,,,per diem,27.52,27.52,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,BCBS MGG,BCBS MGG,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Cigna,Cigna,27.52,,,,,,,per diem,27.52,27.52,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Cigna MGG,Cigna MGG,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Humana,Humana,27.52,,,,,,,per diem,27.52,27.52,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Humana MGG,Humana MGG,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Optum VA,Optum VA,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,UHC,UHC,27.52,,,,,,,per diem,27.52,27.52,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,UHC MGG,UHC MGG,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,VA,VA,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Wellcare MGG,Wellcare MGG,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Bright Health - commercial,Bright Health - commercial,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,27.52,27.52,Bright Health MGG,Bright Health MGG,27.52,,,,,,,case rate,27.52,27.52,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Aetna,Aetna,126.83,,,,,,,per diem,126.83,126.83,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Aetna MGG,Aetna MGG,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,BCBS,BCBS,126.83,,,,,,,per diem,126.83,126.83,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,BCBS MGG,BCBS MGG,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Cigna,Cigna,126.83,,,,,,,per diem,126.83,126.83,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Cigna MGG,Cigna MGG,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Humana,Humana,126.83,,,,,,,per diem,126.83,126.83,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Humana MGG,Humana MGG,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Optum VA,Optum VA,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,UHC,UHC,126.83,,,,,,,per diem,126.83,126.83,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,UHC MGG,UHC MGG,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,VA,VA,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Wellcare MGG,Wellcare MGG,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Bright Health - commercial,Bright Health - commercial,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,126.83,126.83,Bright Health MGG,Bright Health MGG,126.83,,,,,,,case rate,126.83,126.83,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Aetna,Aetna,35,,,,,,,per diem,35,35,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Aetna MGG,Aetna MGG,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,BCBS,BCBS,35,,,,,,,per diem,35,35,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,BCBS MGG,BCBS MGG,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Cigna,Cigna,35,,,,,,,per diem,35,35,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Cigna MGG,Cigna MGG,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Humana,Humana,35,,,,,,,per diem,35,35,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Humana MGG,Humana MGG,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Optum VA,Optum VA,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,UHC,UHC,35,,,,,,,per diem,35,35,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,UHC MGG,UHC MGG,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,VA,VA,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Wellcare MGG,Wellcare MGG,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Bright Health - commercial,Bright Health - commercial,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,35,35,Bright Health MGG,Bright Health MGG,35,,,,,,,case rate,35,35,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Aetna,Aetna,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Aetna MGG,Aetna MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,BCBS,BCBS,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,BCBS MGG,BCBS MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Cigna,Cigna,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Cigna MGG,Cigna MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Humana,Humana,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Humana MGG,Humana MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Optum VA,Optum VA,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,UHC,UHC,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,UHC MGG,UHC MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,VA,VA,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Wellcare MGG,Wellcare MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Bright Health - commercial,Bright Health - commercial,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Bright Health MGG,Bright Health MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Aetna,Aetna,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Aetna MGG,Aetna MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,BCBS,BCBS,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,BCBS MGG,BCBS MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Cigna,Cigna,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Cigna MGG,Cigna MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Humana,Humana,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Humana MGG,Humana MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Optum VA,Optum VA,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,UHC,UHC,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,UHC MGG,UHC MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,VA,VA,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Wellcare MGG,Wellcare MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Bright Health - commercial,Bright Health - commercial,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Bright Health MGG,Bright Health MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Aetna,Aetna,164.99,,,,,,,per diem,164.99,164.99,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Aetna MGG,Aetna MGG,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,BCBS,BCBS,164.99,,,,,,,per diem,164.99,164.99,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,BCBS MGG,BCBS MGG,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Cigna,Cigna,164.99,,,,,,,per diem,164.99,164.99,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Cigna MGG,Cigna MGG,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Humana,Humana,164.99,,,,,,,per diem,164.99,164.99,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Humana MGG,Humana MGG,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Optum VA,Optum VA,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,UHC,UHC,164.99,,,,,,,per diem,164.99,164.99,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,UHC MGG,UHC MGG,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,VA,VA,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Wellcare MGG,Wellcare MGG,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Bright Health - commercial,Bright Health - commercial,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,164.99,164.99,Bright Health MGG,Bright Health MGG,164.99,,,,,,,case rate,164.99,164.99,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Aetna,Aetna,238.65,,,,,,,per diem,238.65,238.65,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Aetna MGG,Aetna MGG,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,BCBS,BCBS,238.65,,,,,,,per diem,238.65,238.65,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,BCBS MGG,BCBS MGG,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Cigna,Cigna,238.65,,,,,,,per diem,238.65,238.65,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Cigna MGG,Cigna MGG,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Humana,Humana,238.65,,,,,,,per diem,238.65,238.65,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Humana MGG,Humana MGG,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Optum VA,Optum VA,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,UHC,UHC,238.65,,,,,,,per diem,238.65,238.65,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,UHC MGG,UHC MGG,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,VA,VA,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Wellcare MGG,Wellcare MGG,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Bright Health - commercial,Bright Health - commercial,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,238.65,238.65,Bright Health MGG,Bright Health MGG,238.65,,,,,,,case rate,238.65,238.65,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Aetna,Aetna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Aetna MGG,Aetna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,BCBS,BCBS,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,BCBS MGG,BCBS MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Cigna,Cigna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Cigna MGG,Cigna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Humana,Humana,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Humana MGG,Humana MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Optum VA,Optum VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,UHC,UHC,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,UHC MGG,UHC MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,VA,VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Wellcare MGG,Wellcare MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Bright Health - commercial,Bright Health - commercial,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,152,152,Bright Health MGG,Bright Health MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Aetna,Aetna,91.2,,,,,,,per diem,91.2,91.2,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Aetna MGG,Aetna MGG,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,BCBS,BCBS,91.2,,,,,,,per diem,91.2,91.2,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,BCBS MGG,BCBS MGG,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Cigna,Cigna,91.2,,,,,,,per diem,91.2,91.2,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Cigna MGG,Cigna MGG,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Humana,Humana,91.2,,,,,,,per diem,91.2,91.2,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Humana MGG,Humana MGG,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Optum VA,Optum VA,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,UHC,UHC,91.2,,,,,,,per diem,91.2,91.2,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,UHC MGG,UHC MGG,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,VA,VA,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Wellcare MGG,Wellcare MGG,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Bright Health - commercial,Bright Health - commercial,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,91.2,91.2,Bright Health MGG,Bright Health MGG,91.2,,,,,,,case rate,91.2,91.2,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Aetna,Aetna,21.28,,,,,,,per diem,21.28,21.28,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Aetna MGG,Aetna MGG,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,BCBS,BCBS,21.28,,,,,,,per diem,21.28,21.28,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,BCBS MGG,BCBS MGG,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Cigna,Cigna,21.28,,,,,,,per diem,21.28,21.28,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Cigna MGG,Cigna MGG,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Humana,Humana,21.28,,,,,,,per diem,21.28,21.28,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Humana MGG,Humana MGG,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Optum VA,Optum VA,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,UHC,UHC,21.28,,,,,,,per diem,21.28,21.28,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,UHC MGG,UHC MGG,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,VA,VA,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Wellcare MGG,Wellcare MGG,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Bright Health - commercial,Bright Health - commercial,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,21.28,21.28,Bright Health MGG,Bright Health MGG,21.28,,,,,,,case rate,21.28,21.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Aetna,Aetna,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Aetna MGG,Aetna MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,BCBS,BCBS,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,BCBS MGG,BCBS MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Cigna,Cigna,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Cigna MGG,Cigna MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Humana,Humana,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Humana MGG,Humana MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Optum VA,Optum VA,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,UHC,UHC,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,UHC MGG,UHC MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,VA,VA,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Wellcare MGG,Wellcare MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Bright Health - commercial,Bright Health - commercial,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL UP TO,33125840,CDM,270,RC,,,,,,Inpatient,,,16.74,16.74,Bright Health MGG,Bright Health MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Aetna,Aetna,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Aetna MGG,Aetna MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,BCBS,BCBS,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,BCBS MGG,BCBS MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Cigna,Cigna,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Cigna MGG,Cigna MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Humana,Humana,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Humana MGG,Humana MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Optum VA,Optum VA,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,UHC,UHC,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,UHC MGG,UHC MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,VA,VA,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Wellcare MGG,Wellcare MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Bright Health - commercial,Bright Health - commercial,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,22.92,22.92,Bright Health MGG,Bright Health MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Aetna,Aetna,0.35,,,,,,,per diem,0.35,0.35,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Aetna MGG,Aetna MGG,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,BCBS,BCBS,0.35,,,,,,,per diem,0.35,0.35,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,BCBS MGG,BCBS MGG,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Cigna,Cigna,0.35,,,,,,,per diem,0.35,0.35,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Cigna MGG,Cigna MGG,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Humana,Humana,0.35,,,,,,,per diem,0.35,0.35,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Humana MGG,Humana MGG,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Optum VA,Optum VA,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,UHC,UHC,0.35,,,,,,,per diem,0.35,0.35,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,UHC MGG,UHC MGG,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,VA,VA,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Wellcare MGG,Wellcare MGG,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Bright Health - commercial,Bright Health - commercial,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.35,0.35,Bright Health MGG,Bright Health MGG,0.35,,,,,,,case rate,0.35,0.35,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Aetna,Aetna,87.21,,,,,,,per diem,87.21,87.21,"Per diem rate, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Aetna MGG,Aetna MGG,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,BCBS,BCBS,87.21,,,,,,,per diem,87.21,87.21,"Per diem rate, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,BCBS MGG,BCBS MGG,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Cigna,Cigna,87.21,,,,,,,per diem,87.21,87.21,"Per diem rate, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Cigna MGG,Cigna MGG,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Humana,Humana,87.21,,,,,,,per diem,87.21,87.21,"Per diem rate, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Humana MGG,Humana MGG,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Optum VA,Optum VA,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,UHC,UHC,87.21,,,,,,,per diem,87.21,87.21,"Per diem rate, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,UHC MGG,UHC MGG,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,VA,VA,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Wellcare MGG,Wellcare MGG,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Bright Health - commercial,Bright Health - commercial,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
PROTECT HL/ELB FOAM CUSH LG   ,33126122,CDM,270,RC,,,,,,Inpatient,,,87.21,87.21,Bright Health MGG,Bright Health MGG,87.21,,,,,,,case rate,87.21,87.21,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Aetna,Aetna,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Aetna MGG,Aetna MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,BCBS,BCBS,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,BCBS MGG,BCBS MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Cigna,Cigna,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Cigna MGG,Cigna MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Humana,Humana,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Humana MGG,Humana MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Optum VA,Optum VA,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,UHC,UHC,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,UHC MGG,UHC MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,VA,VA,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Wellcare MGG,Wellcare MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Bright Health - commercial,Bright Health - commercial,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33126123,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Bright Health MGG,Bright Health MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna,Aetna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna MGG,Aetna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS,BCBS,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS MGG,BCBS MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna,Cigna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna MGG,Cigna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana,Humana,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana MGG,Humana MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Optum VA,Optum VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC,UHC,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC MGG,UHC MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,VA,VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Wellcare MGG,Wellcare MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health - commercial,Bright Health - commercial,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED MED,33126126,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health MGG,Bright Health MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna,Aetna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna MGG,Aetna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS,BCBS,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS MGG,BCBS MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna,Cigna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna MGG,Cigna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana,Humana,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana MGG,Humana MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Optum VA,Optum VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC,UHC,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC MGG,UHC MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,VA,VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Wellcare MGG,Wellcare MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health - commercial,Bright Health - commercial,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED LG ,33126127,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health MGG,Bright Health MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna,Aetna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Aetna MGG,Aetna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS,BCBS,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,BCBS MGG,BCBS MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna,Cigna,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Cigna MGG,Cigna MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana,Humana,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Humana MGG,Humana MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Optum VA,Optum VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC,UHC,128.43,,,,,,,per diem,128.43,128.43,"Per diem rate, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,UHC MGG,UHC MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,VA,VA,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Wellcare MGG,Wellcare MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health - commercial,Bright Health - commercial,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
BRACE KNEE WRAP AROUND RED XL ,33126128,CDM,270,RC,,,,,,Inpatient,,,128.43,128.43,Bright Health MGG,Bright Health MGG,128.43,,,,,,,case rate,128.43,128.43,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Aetna,Aetna,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Aetna MGG,Aetna MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,BCBS,BCBS,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,BCBS MGG,BCBS MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Cigna,Cigna,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Cigna MGG,Cigna MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Humana,Humana,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Humana MGG,Humana MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Optum VA,Optum VA,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,UHC,UHC,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,UHC MGG,UHC MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,VA,VA,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Wellcare MGG,Wellcare MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Bright Health - commercial,Bright Health - commercial,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESS RELIEF UNIV ,33126129,CDM,270,RC,,,,,,Inpatient,,,19.29,19.29,Bright Health MGG,Bright Health MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna,Aetna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna MGG,Aetna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,BCBS,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS MGG,BCBS MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna,Cigna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna MGG,Cigna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana,Humana,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana MGG,Humana MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Optum VA,Optum VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC,UHC,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC MGG,UHC MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,VA,VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Wellcare MGG,Wellcare MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health - commercial,Bright Health - commercial,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16      ,33126145,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health MGG,Bright Health MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Aetna,Aetna,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Aetna MGG,Aetna MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,BCBS,BCBS,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,BCBS MGG,BCBS MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Cigna,Cigna,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Cigna MGG,Cigna MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Humana,Humana,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Humana MGG,Humana MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Optum VA,Optum VA,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,UHC,UHC,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,UHC MGG,UHC MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,VA,VA,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Wellcare MGG,Wellcare MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Bright Health - commercial,Bright Health - commercial,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 20      ,33126146,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Bright Health MGG,Bright Health MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Aetna,Aetna,47.4,,,,,,,per diem,47.4,47.4,"Per diem rate, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Aetna MGG,Aetna MGG,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,BCBS,BCBS,47.4,,,,,,,per diem,47.4,47.4,"Per diem rate, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,BCBS MGG,BCBS MGG,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Cigna,Cigna,47.4,,,,,,,per diem,47.4,47.4,"Per diem rate, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Cigna MGG,Cigna MGG,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Humana,Humana,47.4,,,,,,,per diem,47.4,47.4,"Per diem rate, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Humana MGG,Humana MGG,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Optum VA,Optum VA,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,UHC,UHC,47.4,,,,,,,per diem,47.4,47.4,"Per diem rate, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,UHC MGG,UHC MGG,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,VA,VA,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Wellcare MGG,Wellcare MGG,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Bright Health - commercial,Bright Health - commercial,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
BIND ABD 4PAN W DRN HOLD 46-62,33126147,CDM,270,RC,,,,,,Inpatient,,,47.4,47.4,Bright Health MGG,Bright Health MGG,47.4,,,,,,,case rate,47.4,47.4,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Aetna,Aetna,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Aetna MGG,Aetna MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,BCBS,BCBS,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,BCBS MGG,BCBS MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Cigna,Cigna,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Cigna MGG,Cigna MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Humana,Humana,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Humana MGG,Humana MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Optum VA,Optum VA,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,UHC,UHC,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,UHC MGG,UHC MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,VA,VA,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Wellcare MGG,Wellcare MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Bright Health - commercial,Bright Health - commercial,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECT HELL ELB FOAM XL      ,33126148,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Bright Health MGG,Bright Health MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Aetna,Aetna,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Aetna MGG,Aetna MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,BCBS,BCBS,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,BCBS MGG,BCBS MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Cigna,Cigna,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Cigna MGG,Cigna MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Humana,Humana,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Humana MGG,Humana MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Optum VA,Optum VA,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,UHC,UHC,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,UHC MGG,UHC MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,VA,VA,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Wellcare MGG,Wellcare MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Bright Health - commercial,Bright Health - commercial,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4 PANEL 55-72      ,33126149,CDM,270,RC,,,,,,Inpatient,,,31.11,31.11,Bright Health MGG,Bright Health MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Aetna,Aetna,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Aetna MGG,Aetna MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,BCBS,BCBS,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,BCBS MGG,BCBS MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Cigna,Cigna,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Cigna MGG,Cigna MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Humana,Humana,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Humana MGG,Humana MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Optum VA,Optum VA,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,UHC,UHC,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,UHC MGG,UHC MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,VA,VA,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Wellcare MGG,Wellcare MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Bright Health - commercial,Bright Health - commercial,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 45IN          ,33126150,CDM,270,RC,,,,,,Inpatient,,,27.18,27.18,Bright Health MGG,Bright Health MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Aetna,Aetna,42.54,,,,,,,per diem,42.54,42.54,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Aetna MGG,Aetna MGG,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,BCBS,BCBS,42.54,,,,,,,per diem,42.54,42.54,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,BCBS MGG,BCBS MGG,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Cigna,Cigna,42.54,,,,,,,per diem,42.54,42.54,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Cigna MGG,Cigna MGG,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Humana,Humana,42.54,,,,,,,per diem,42.54,42.54,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Humana MGG,Humana MGG,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Optum VA,Optum VA,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,UHC,UHC,42.54,,,,,,,per diem,42.54,42.54,"Per diem rate, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,UHC MGG,UHC MGG,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,VA,VA,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Wellcare MGG,Wellcare MGG,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Bright Health - commercial,Bright Health - commercial,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
BIND ABDOM 4PAN 72-96         ,33126151,CDM,270,RC,,,,,,Inpatient,,,42.54,42.54,Bright Health MGG,Bright Health MGG,42.54,,,,,,,case rate,42.54,42.54,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Aetna,Aetna,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Aetna MGG,Aetna MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,BCBS,BCBS,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,BCBS MGG,BCBS MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Cigna,Cigna,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Cigna MGG,Cigna MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Humana,Humana,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Humana MGG,Humana MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Optum VA,Optum VA,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,UHC,UHC,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,UHC MGG,UHC MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,VA,VA,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Wellcare MGG,Wellcare MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Bright Health - commercial,Bright Health - commercial,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FL 1000ML      ,33126152,CDM,279,RC,,,,,,Inpatient,,,11.28,11.28,Bright Health MGG,Bright Health MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Aetna,Aetna,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Aetna MGG,Aetna MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,BCBS,BCBS,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,BCBS MGG,BCBS MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Cigna,Cigna,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Cigna MGG,Cigna MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Humana,Humana,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Humana MGG,Humana MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Optum VA,Optum VA,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,UHC,UHC,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,UHC MGG,UHC MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,VA,VA,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Wellcare MGG,Wellcare MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Bright Health - commercial,Bright Health - commercial,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33126153,CDM,279,RC,,,,,,Inpatient,,,5.16,5.16,Bright Health MGG,Bright Health MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Aetna,Aetna,17.63,,,,,,,per diem,17.63,17.63,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Aetna MGG,Aetna MGG,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,BCBS,BCBS,17.63,,,,,,,per diem,17.63,17.63,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,BCBS MGG,BCBS MGG,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Cigna,Cigna,17.63,,,,,,,per diem,17.63,17.63,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Cigna MGG,Cigna MGG,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Humana,Humana,17.63,,,,,,,per diem,17.63,17.63,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Humana MGG,Humana MGG,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Optum VA,Optum VA,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,UHC,UHC,17.63,,,,,,,per diem,17.63,17.63,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,UHC MGG,UHC MGG,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,VA,VA,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Wellcare MGG,Wellcare MGG,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Bright Health - commercial,Bright Health - commercial,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,17.63,17.63,Bright Health MGG,Bright Health MGG,17.63,,,,,,,case rate,17.63,17.63,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Aetna,Aetna,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Aetna MGG,Aetna MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,BCBS,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,BCBS MGG,BCBS MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Cigna,Cigna,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Cigna MGG,Cigna MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Humana,Humana,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Humana MGG,Humana MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Optum VA,Optum VA,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,UHC,UHC,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,UHC MGG,UHC MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,VA,VA,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Wellcare MGG,Wellcare MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Bright Health - commercial,Bright Health - commercial,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,40.95,40.95,Bright Health MGG,Bright Health MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Aetna,Aetna,102.75,,,,,,,per diem,102.75,102.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Aetna MGG,Aetna MGG,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,BCBS,BCBS,102.75,,,,,,,per diem,102.75,102.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,BCBS MGG,BCBS MGG,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Cigna,Cigna,102.75,,,,,,,per diem,102.75,102.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Cigna MGG,Cigna MGG,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Humana,Humana,102.75,,,,,,,per diem,102.75,102.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Humana MGG,Humana MGG,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Optum VA,Optum VA,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,UHC,UHC,102.75,,,,,,,per diem,102.75,102.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,UHC MGG,UHC MGG,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,VA,VA,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Wellcare MGG,Wellcare MGG,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Bright Health - commercial,Bright Health - commercial,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,102.75,102.75,Bright Health MGG,Bright Health MGG,102.75,,,,,,,case rate,102.75,102.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Aetna,Aetna,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Aetna MGG,Aetna MGG,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,BCBS,BCBS,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,BCBS MGG,BCBS MGG,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Cigna,Cigna,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Cigna MGG,Cigna MGG,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Humana,Humana,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Humana MGG,Humana MGG,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Optum VA,Optum VA,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,UHC,UHC,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,UHC MGG,UHC MGG,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,VA,VA,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Wellcare MGG,Wellcare MGG,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Bright Health - commercial,Bright Health - commercial,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,185.75,185.75,Bright Health MGG,Bright Health MGG,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Aetna,Aetna,90.25,,,,,,,per diem,90.25,90.25,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Aetna MGG,Aetna MGG,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,BCBS,BCBS,90.25,,,,,,,per diem,90.25,90.25,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,BCBS MGG,BCBS MGG,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Cigna,Cigna,90.25,,,,,,,per diem,90.25,90.25,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Cigna MGG,Cigna MGG,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Humana,Humana,90.25,,,,,,,per diem,90.25,90.25,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Humana MGG,Humana MGG,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Optum VA,Optum VA,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,UHC,UHC,90.25,,,,,,,per diem,90.25,90.25,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,UHC MGG,UHC MGG,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,VA,VA,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Wellcare MGG,Wellcare MGG,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Bright Health - commercial,Bright Health - commercial,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,90.25,90.25,Bright Health MGG,Bright Health MGG,90.25,,,,,,,case rate,90.25,90.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Aetna,Aetna,270.25,,,,,,,per diem,270.25,270.25,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Aetna MGG,Aetna MGG,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,BCBS,BCBS,270.25,,,,,,,per diem,270.25,270.25,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,BCBS MGG,BCBS MGG,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Cigna,Cigna,270.25,,,,,,,per diem,270.25,270.25,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Cigna MGG,Cigna MGG,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Humana,Humana,270.25,,,,,,,per diem,270.25,270.25,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Humana MGG,Humana MGG,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Optum VA,Optum VA,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,UHC,UHC,270.25,,,,,,,per diem,270.25,270.25,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,UHC MGG,UHC MGG,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,VA,VA,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Wellcare MGG,Wellcare MGG,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Bright Health - commercial,Bright Health - commercial,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,270.25,270.25,Bright Health MGG,Bright Health MGG,270.25,,,,,,,case rate,270.25,270.25,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Aetna,Aetna,33.88,,,,,,,per diem,33.88,33.88,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Aetna MGG,Aetna MGG,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,BCBS,BCBS,33.88,,,,,,,per diem,33.88,33.88,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,BCBS MGG,BCBS MGG,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Cigna,Cigna,33.88,,,,,,,per diem,33.88,33.88,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Cigna MGG,Cigna MGG,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Humana,Humana,33.88,,,,,,,per diem,33.88,33.88,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Humana MGG,Humana MGG,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Optum VA,Optum VA,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,UHC,UHC,33.88,,,,,,,per diem,33.88,33.88,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,UHC MGG,UHC MGG,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,VA,VA,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Wellcare MGG,Wellcare MGG,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Bright Health - commercial,Bright Health - commercial,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,33.88,33.88,Bright Health MGG,Bright Health MGG,33.88,,,,,,,case rate,33.88,33.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Aetna,Aetna,55,,,,,,,per diem,55,55,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Aetna MGG,Aetna MGG,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,BCBS,BCBS,55,,,,,,,per diem,55,55,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,BCBS MGG,BCBS MGG,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Cigna,Cigna,55,,,,,,,per diem,55,55,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Cigna MGG,Cigna MGG,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Humana,Humana,55,,,,,,,per diem,55,55,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Humana MGG,Humana MGG,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Optum VA,Optum VA,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,UHC,UHC,55,,,,,,,per diem,55,55,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,UHC MGG,UHC MGG,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,VA,VA,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Wellcare MGG,Wellcare MGG,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Bright Health - commercial,Bright Health - commercial,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,55,55,Bright Health MGG,Bright Health MGG,55,,,,,,,case rate,55,55,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Aetna,Aetna,68.5,,,,,,,per diem,68.5,68.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Aetna MGG,Aetna MGG,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,BCBS,BCBS,68.5,,,,,,,per diem,68.5,68.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,BCBS MGG,BCBS MGG,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Cigna,Cigna,68.5,,,,,,,per diem,68.5,68.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Cigna MGG,Cigna MGG,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Humana,Humana,68.5,,,,,,,per diem,68.5,68.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Humana MGG,Humana MGG,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Optum VA,Optum VA,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,UHC,UHC,68.5,,,,,,,per diem,68.5,68.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,UHC MGG,UHC MGG,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,VA,VA,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Wellcare MGG,Wellcare MGG,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Bright Health - commercial,Bright Health - commercial,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,68.5,68.5,Bright Health MGG,Bright Health MGG,68.5,,,,,,,case rate,68.5,68.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Aetna,Aetna,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Aetna MGG,Aetna MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,BCBS,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,BCBS MGG,BCBS MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Cigna,Cigna,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Cigna MGG,Cigna MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Humana,Humana,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Humana MGG,Humana MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Optum VA,Optum VA,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,UHC,UHC,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,UHC MGG,UHC MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,VA,VA,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Wellcare MGG,Wellcare MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Bright Health - commercial,Bright Health - commercial,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,27.5,27.5,Bright Health MGG,Bright Health MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Aetna,Aetna,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Aetna MGG,Aetna MGG,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,BCBS,BCBS,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,BCBS MGG,BCBS MGG,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Cigna,Cigna,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Cigna MGG,Cigna MGG,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Humana,Humana,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Humana MGG,Humana MGG,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Optum VA,Optum VA,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,UHC,UHC,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,UHC MGG,UHC MGG,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,VA,VA,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Wellcare MGG,Wellcare MGG,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Bright Health - commercial,Bright Health - commercial,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,79,79,Bright Health MGG,Bright Health MGG,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Aetna,Aetna,73.25,,,,,,,per diem,73.25,73.25,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Aetna MGG,Aetna MGG,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,BCBS,BCBS,73.25,,,,,,,per diem,73.25,73.25,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,BCBS MGG,BCBS MGG,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Cigna,Cigna,73.25,,,,,,,per diem,73.25,73.25,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Cigna MGG,Cigna MGG,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Humana,Humana,73.25,,,,,,,per diem,73.25,73.25,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Humana MGG,Humana MGG,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Optum VA,Optum VA,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,UHC,UHC,73.25,,,,,,,per diem,73.25,73.25,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,UHC MGG,UHC MGG,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,VA,VA,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Wellcare MGG,Wellcare MGG,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Bright Health - commercial,Bright Health - commercial,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,73.25,73.25,Bright Health MGG,Bright Health MGG,73.25,,,,,,,case rate,73.25,73.25,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Aetna,Aetna,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Aetna MGG,Aetna MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,BCBS,BCBS,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,BCBS MGG,BCBS MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Cigna,Cigna,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Cigna MGG,Cigna MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Humana,Humana,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Humana MGG,Humana MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Optum VA,Optum VA,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,UHC,UHC,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,UHC MGG,UHC MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,VA,VA,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Wellcare MGG,Wellcare MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Bright Health - commercial,Bright Health - commercial,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,9.93,9.93,Bright Health MGG,Bright Health MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Aetna,Aetna,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Aetna MGG,Aetna MGG,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,BCBS,BCBS,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,BCBS MGG,BCBS MGG,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Cigna,Cigna,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Cigna MGG,Cigna MGG,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Humana,Humana,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Humana MGG,Humana MGG,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Optum VA,Optum VA,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,UHC,UHC,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,UHC MGG,UHC MGG,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,VA,VA,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Wellcare MGG,Wellcare MGG,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Bright Health - commercial,Bright Health - commercial,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,11.75,11.75,Bright Health MGG,Bright Health MGG,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Aetna,Aetna,6.25,,,,,,,per diem,6.25,6.25,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Aetna MGG,Aetna MGG,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,BCBS,BCBS,6.25,,,,,,,per diem,6.25,6.25,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,BCBS MGG,BCBS MGG,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Cigna,Cigna,6.25,,,,,,,per diem,6.25,6.25,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Cigna MGG,Cigna MGG,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Humana,Humana,6.25,,,,,,,per diem,6.25,6.25,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Humana MGG,Humana MGG,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Optum VA,Optum VA,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,UHC,UHC,6.25,,,,,,,per diem,6.25,6.25,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,UHC MGG,UHC MGG,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,VA,VA,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Wellcare MGG,Wellcare MGG,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Bright Health - commercial,Bright Health - commercial,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.25,6.25,Bright Health MGG,Bright Health MGG,6.25,,,,,,,case rate,6.25,6.25,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Aetna,Aetna,63.5,,,,,,,per diem,63.5,63.5,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Aetna MGG,Aetna MGG,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,BCBS,BCBS,63.5,,,,,,,per diem,63.5,63.5,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,BCBS MGG,BCBS MGG,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Cigna,Cigna,63.5,,,,,,,per diem,63.5,63.5,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Cigna MGG,Cigna MGG,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Humana,Humana,63.5,,,,,,,per diem,63.5,63.5,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Humana MGG,Humana MGG,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Optum VA,Optum VA,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,UHC,UHC,63.5,,,,,,,per diem,63.5,63.5,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,UHC MGG,UHC MGG,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,VA,VA,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Wellcare MGG,Wellcare MGG,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Bright Health - commercial,Bright Health - commercial,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,63.5,63.5,Bright Health MGG,Bright Health MGG,63.5,,,,,,,case rate,63.5,63.5,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Aetna,Aetna,111.25,,,,,,,per diem,111.25,111.25,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Aetna MGG,Aetna MGG,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,BCBS,BCBS,111.25,,,,,,,per diem,111.25,111.25,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,BCBS MGG,BCBS MGG,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Cigna,Cigna,111.25,,,,,,,per diem,111.25,111.25,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Cigna MGG,Cigna MGG,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Humana,Humana,111.25,,,,,,,per diem,111.25,111.25,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Humana MGG,Humana MGG,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Optum VA,Optum VA,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,UHC,UHC,111.25,,,,,,,per diem,111.25,111.25,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,UHC MGG,UHC MGG,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,VA,VA,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Wellcare MGG,Wellcare MGG,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Bright Health - commercial,Bright Health - commercial,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,111.25,111.25,Bright Health MGG,Bright Health MGG,111.25,,,,,,,case rate,111.25,111.25,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Aetna,Aetna,132.36,,,,,,,per diem,132.36,132.36,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Aetna MGG,Aetna MGG,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,BCBS,BCBS,132.36,,,,,,,per diem,132.36,132.36,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,BCBS MGG,BCBS MGG,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Cigna,Cigna,132.36,,,,,,,per diem,132.36,132.36,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Cigna MGG,Cigna MGG,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Humana,Humana,132.36,,,,,,,per diem,132.36,132.36,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Humana MGG,Humana MGG,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Optum VA,Optum VA,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,UHC,UHC,132.36,,,,,,,per diem,132.36,132.36,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,UHC MGG,UHC MGG,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,VA,VA,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Wellcare MGG,Wellcare MGG,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Bright Health - commercial,Bright Health - commercial,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,132.36,132.36,Bright Health MGG,Bright Health MGG,132.36,,,,,,,case rate,132.36,132.36,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Aetna,Aetna,16.95,,,,,,,per diem,16.95,16.95,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Aetna MGG,Aetna MGG,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,BCBS,BCBS,16.95,,,,,,,per diem,16.95,16.95,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,BCBS MGG,BCBS MGG,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Cigna,Cigna,16.95,,,,,,,per diem,16.95,16.95,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Cigna MGG,Cigna MGG,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Humana,Humana,16.95,,,,,,,per diem,16.95,16.95,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Humana MGG,Humana MGG,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Optum VA,Optum VA,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,UHC,UHC,16.95,,,,,,,per diem,16.95,16.95,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,UHC MGG,UHC MGG,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,VA,VA,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Wellcare MGG,Wellcare MGG,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Bright Health - commercial,Bright Health - commercial,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,16.95,16.95,Bright Health MGG,Bright Health MGG,16.95,,,,,,,case rate,16.95,16.95,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Aetna,Aetna,14.33,,,,,,,per diem,14.33,14.33,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Aetna MGG,Aetna MGG,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,BCBS,BCBS,14.33,,,,,,,per diem,14.33,14.33,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,BCBS MGG,BCBS MGG,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Cigna,Cigna,14.33,,,,,,,per diem,14.33,14.33,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Cigna MGG,Cigna MGG,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Humana,Humana,14.33,,,,,,,per diem,14.33,14.33,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Humana MGG,Humana MGG,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Optum VA,Optum VA,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,UHC,UHC,14.33,,,,,,,per diem,14.33,14.33,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,UHC MGG,UHC MGG,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,VA,VA,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Wellcare MGG,Wellcare MGG,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Bright Health - commercial,Bright Health - commercial,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,14.33,14.33,Bright Health MGG,Bright Health MGG,14.33,,,,,,,case rate,14.33,14.33,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Aetna,Aetna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Aetna MGG,Aetna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,BCBS,BCBS,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,BCBS MGG,BCBS MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Cigna,Cigna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Cigna MGG,Cigna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Humana,Humana,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Humana MGG,Humana MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Optum VA,Optum VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,UHC,UHC,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,UHC MGG,UHC MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,VA,VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Wellcare MGG,Wellcare MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Bright Health - commercial,Bright Health - commercial,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.1,8.1,Bright Health MGG,Bright Health MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Aetna,Aetna,39.39,,,,,,,per diem,39.39,39.39,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Aetna MGG,Aetna MGG,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,BCBS,BCBS,39.39,,,,,,,per diem,39.39,39.39,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,BCBS MGG,BCBS MGG,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Cigna,Cigna,39.39,,,,,,,per diem,39.39,39.39,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Cigna MGG,Cigna MGG,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Humana,Humana,39.39,,,,,,,per diem,39.39,39.39,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Humana MGG,Humana MGG,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Optum VA,Optum VA,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,UHC,UHC,39.39,,,,,,,per diem,39.39,39.39,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,UHC MGG,UHC MGG,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,VA,VA,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Wellcare MGG,Wellcare MGG,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Bright Health - commercial,Bright Health - commercial,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,39.39,39.39,Bright Health MGG,Bright Health MGG,39.39,,,,,,,case rate,39.39,39.39,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Aetna,Aetna,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Aetna MGG,Aetna MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,BCBS,BCBS,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,BCBS MGG,BCBS MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Cigna,Cigna,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Cigna MGG,Cigna MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Humana,Humana,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Humana MGG,Humana MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Optum VA,Optum VA,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,UHC,UHC,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,UHC MGG,UHC MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,VA,VA,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Wellcare MGG,Wellcare MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Bright Health - commercial,Bright Health - commercial,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,39.54,39.54,Bright Health MGG,Bright Health MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Aetna,Aetna,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Aetna MGG,Aetna MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,BCBS,BCBS,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,BCBS MGG,BCBS MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Cigna,Cigna,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Cigna MGG,Cigna MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Humana,Humana,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Humana MGG,Humana MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Optum VA,Optum VA,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,UHC,UHC,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,UHC MGG,UHC MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,VA,VA,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Wellcare MGG,Wellcare MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Bright Health - commercial,Bright Health - commercial,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,68.58,68.58,Bright Health MGG,Bright Health MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Aetna,Aetna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Aetna MGG,Aetna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,BCBS,BCBS,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,BCBS MGG,BCBS MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Cigna,Cigna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Cigna MGG,Cigna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Humana,Humana,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Humana MGG,Humana MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Optum VA,Optum VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,UHC,UHC,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,UHC MGG,UHC MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,VA,VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Wellcare MGG,Wellcare MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Bright Health - commercial,Bright Health - commercial,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,18.75,18.75,Bright Health MGG,Bright Health MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Aetna,Aetna,51.91,,,,,,,per diem,51.91,51.91,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Aetna MGG,Aetna MGG,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,BCBS,BCBS,51.91,,,,,,,per diem,51.91,51.91,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,BCBS MGG,BCBS MGG,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Cigna,Cigna,51.91,,,,,,,per diem,51.91,51.91,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Cigna MGG,Cigna MGG,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Humana,Humana,51.91,,,,,,,per diem,51.91,51.91,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Humana MGG,Humana MGG,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Optum VA,Optum VA,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,UHC,UHC,51.91,,,,,,,per diem,51.91,51.91,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,UHC MGG,UHC MGG,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,VA,VA,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Wellcare MGG,Wellcare MGG,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Bright Health - commercial,Bright Health - commercial,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,51.91,51.91,Bright Health MGG,Bright Health MGG,51.91,,,,,,,case rate,51.91,51.91,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Aetna,Aetna,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Aetna MGG,Aetna MGG,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,BCBS,BCBS,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,BCBS MGG,BCBS MGG,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Cigna,Cigna,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Cigna MGG,Cigna MGG,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Humana,Humana,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Humana MGG,Humana MGG,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Optum VA,Optum VA,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,UHC,UHC,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,UHC MGG,UHC MGG,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,VA,VA,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Wellcare MGG,Wellcare MGG,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Bright Health - commercial,Bright Health - commercial,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.45,5.45,Bright Health MGG,Bright Health MGG,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Aetna,Aetna,115.4,,,,,,,per diem,115.4,115.4,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Aetna MGG,Aetna MGG,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,BCBS,BCBS,115.4,,,,,,,per diem,115.4,115.4,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,BCBS MGG,BCBS MGG,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Cigna,Cigna,115.4,,,,,,,per diem,115.4,115.4,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Cigna MGG,Cigna MGG,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Humana,Humana,115.4,,,,,,,per diem,115.4,115.4,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Humana MGG,Humana MGG,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Optum VA,Optum VA,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,UHC,UHC,115.4,,,,,,,per diem,115.4,115.4,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,UHC MGG,UHC MGG,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,VA,VA,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Wellcare MGG,Wellcare MGG,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Bright Health - commercial,Bright Health - commercial,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,115.4,115.4,Bright Health MGG,Bright Health MGG,115.4,,,,,,,case rate,115.4,115.4,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Aetna,Aetna,151,,,,,,,per diem,151,151,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Aetna MGG,Aetna MGG,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,BCBS,BCBS,151,,,,,,,per diem,151,151,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,BCBS MGG,BCBS MGG,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Cigna,Cigna,151,,,,,,,per diem,151,151,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Cigna MGG,Cigna MGG,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Humana,Humana,151,,,,,,,per diem,151,151,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Humana MGG,Humana MGG,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Optum VA,Optum VA,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,UHC,UHC,151,,,,,,,per diem,151,151,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,UHC MGG,UHC MGG,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,VA,VA,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Wellcare MGG,Wellcare MGG,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Bright Health - commercial,Bright Health - commercial,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,151,151,Bright Health MGG,Bright Health MGG,151,,,,,,,case rate,151,151,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Aetna,Aetna,98.8,,,,,,,per diem,98.8,98.8,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Aetna MGG,Aetna MGG,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,BCBS,BCBS,98.8,,,,,,,per diem,98.8,98.8,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,BCBS MGG,BCBS MGG,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Cigna,Cigna,98.8,,,,,,,per diem,98.8,98.8,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Cigna MGG,Cigna MGG,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Humana,Humana,98.8,,,,,,,per diem,98.8,98.8,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Humana MGG,Humana MGG,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Optum VA,Optum VA,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,UHC,UHC,98.8,,,,,,,per diem,98.8,98.8,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,UHC MGG,UHC MGG,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,VA,VA,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Wellcare MGG,Wellcare MGG,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Bright Health - commercial,Bright Health - commercial,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,98.8,98.8,Bright Health MGG,Bright Health MGG,98.8,,,,,,,case rate,98.8,98.8,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Aetna,Aetna,74.3,,,,,,,per diem,74.3,74.3,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Aetna MGG,Aetna MGG,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,BCBS,BCBS,74.3,,,,,,,per diem,74.3,74.3,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,BCBS MGG,BCBS MGG,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Cigna,Cigna,74.3,,,,,,,per diem,74.3,74.3,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Cigna MGG,Cigna MGG,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Humana,Humana,74.3,,,,,,,per diem,74.3,74.3,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Humana MGG,Humana MGG,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Optum VA,Optum VA,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,UHC,UHC,74.3,,,,,,,per diem,74.3,74.3,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,UHC MGG,UHC MGG,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,VA,VA,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Wellcare MGG,Wellcare MGG,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Bright Health - commercial,Bright Health - commercial,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,74.3,74.3,Bright Health MGG,Bright Health MGG,74.3,,,,,,,case rate,74.3,74.3,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Aetna,Aetna,193.43,,,,,,,per diem,193.43,193.43,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Aetna MGG,Aetna MGG,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,BCBS,BCBS,193.43,,,,,,,per diem,193.43,193.43,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,BCBS MGG,BCBS MGG,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Cigna,Cigna,193.43,,,,,,,per diem,193.43,193.43,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Cigna MGG,Cigna MGG,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Humana,Humana,193.43,,,,,,,per diem,193.43,193.43,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Humana MGG,Humana MGG,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Optum VA,Optum VA,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,UHC,UHC,193.43,,,,,,,per diem,193.43,193.43,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,UHC MGG,UHC MGG,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,VA,VA,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Wellcare MGG,Wellcare MGG,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Bright Health - commercial,Bright Health - commercial,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,193.43,193.43,Bright Health MGG,Bright Health MGG,193.43,,,,,,,case rate,193.43,193.43,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Aetna,Aetna,549.9,,,,,,,per diem,549.9,549.9,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Aetna MGG,Aetna MGG,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,BCBS,BCBS,549.9,,,,,,,per diem,549.9,549.9,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,BCBS MGG,BCBS MGG,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Cigna,Cigna,549.9,,,,,,,per diem,549.9,549.9,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Cigna MGG,Cigna MGG,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Humana,Humana,549.9,,,,,,,per diem,549.9,549.9,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Humana MGG,Humana MGG,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Optum VA,Optum VA,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,UHC,UHC,549.9,,,,,,,per diem,549.9,549.9,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,UHC MGG,UHC MGG,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,VA,VA,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Wellcare MGG,Wellcare MGG,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Bright Health - commercial,Bright Health - commercial,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,549.9,549.9,Bright Health MGG,Bright Health MGG,549.9,,,,,,,case rate,549.9,549.9,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Aetna,Aetna,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Aetna MGG,Aetna MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,BCBS,BCBS,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,BCBS MGG,BCBS MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Cigna,Cigna,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Cigna MGG,Cigna MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Humana,Humana,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Humana MGG,Humana MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Optum VA,Optum VA,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,UHC,UHC,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,UHC MGG,UHC MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,VA,VA,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Wellcare MGG,Wellcare MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Bright Health - commercial,Bright Health - commercial,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Bright Health MGG,Bright Health MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Aetna,Aetna,230.61,,,,,,,per diem,230.61,230.61,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Aetna MGG,Aetna MGG,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,BCBS,BCBS,230.61,,,,,,,per diem,230.61,230.61,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,BCBS MGG,BCBS MGG,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Cigna,Cigna,230.61,,,,,,,per diem,230.61,230.61,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Cigna MGG,Cigna MGG,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Humana,Humana,230.61,,,,,,,per diem,230.61,230.61,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Humana MGG,Humana MGG,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Optum VA,Optum VA,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,UHC,UHC,230.61,,,,,,,per diem,230.61,230.61,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,UHC MGG,UHC MGG,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,VA,VA,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Wellcare MGG,Wellcare MGG,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Bright Health - commercial,Bright Health - commercial,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,230.61,230.61,Bright Health MGG,Bright Health MGG,230.61,,,,,,,case rate,230.61,230.61,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Aetna,Aetna,84.57,,,,,,,per diem,84.57,84.57,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Aetna MGG,Aetna MGG,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,BCBS,BCBS,84.57,,,,,,,per diem,84.57,84.57,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,BCBS MGG,BCBS MGG,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Cigna,Cigna,84.57,,,,,,,per diem,84.57,84.57,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Cigna MGG,Cigna MGG,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Humana,Humana,84.57,,,,,,,per diem,84.57,84.57,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Humana MGG,Humana MGG,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Optum VA,Optum VA,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,UHC,UHC,84.57,,,,,,,per diem,84.57,84.57,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,UHC MGG,UHC MGG,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,VA,VA,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Wellcare MGG,Wellcare MGG,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Bright Health - commercial,Bright Health - commercial,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,84.57,84.57,Bright Health MGG,Bright Health MGG,84.57,,,,,,,case rate,84.57,84.57,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Aetna,Aetna,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Aetna MGG,Aetna MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,BCBS,BCBS,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,BCBS MGG,BCBS MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Cigna,Cigna,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Cigna MGG,Cigna MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Humana,Humana,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Humana MGG,Humana MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Optum VA,Optum VA,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,UHC,UHC,72.21,,,,,,,per diem,72.21,72.21,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,UHC MGG,UHC MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,VA,VA,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Wellcare MGG,Wellcare MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Bright Health - commercial,Bright Health - commercial,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,72.21,72.21,Bright Health MGG,Bright Health MGG,72.21,,,,,,,case rate,72.21,72.21,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Aetna,Aetna,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Aetna MGG,Aetna MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,BCBS,BCBS,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,BCBS MGG,BCBS MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Cigna,Cigna,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Cigna MGG,Cigna MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Humana,Humana,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Humana MGG,Humana MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Optum VA,Optum VA,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,UHC,UHC,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,UHC MGG,UHC MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,VA,VA,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Wellcare MGG,Wellcare MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Bright Health - commercial,Bright Health - commercial,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,81.54,81.54,Bright Health MGG,Bright Health MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Aetna,Aetna,63.72,,,,,,,per diem,63.72,63.72,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Aetna MGG,Aetna MGG,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,BCBS,BCBS,63.72,,,,,,,per diem,63.72,63.72,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,BCBS MGG,BCBS MGG,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Cigna,Cigna,63.72,,,,,,,per diem,63.72,63.72,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Cigna MGG,Cigna MGG,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Humana,Humana,63.72,,,,,,,per diem,63.72,63.72,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Humana MGG,Humana MGG,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Optum VA,Optum VA,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,UHC,UHC,63.72,,,,,,,per diem,63.72,63.72,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,UHC MGG,UHC MGG,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,VA,VA,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Wellcare MGG,Wellcare MGG,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Bright Health - commercial,Bright Health - commercial,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,63.72,63.72,Bright Health MGG,Bright Health MGG,63.72,,,,,,,case rate,63.72,63.72,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Aetna,Aetna,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Aetna MGG,Aetna MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,BCBS,BCBS,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,BCBS MGG,BCBS MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Cigna,Cigna,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Cigna MGG,Cigna MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Humana,Humana,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Humana MGG,Humana MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Optum VA,Optum VA,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,UHC,UHC,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,UHC MGG,UHC MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,VA,VA,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Wellcare MGG,Wellcare MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Bright Health - commercial,Bright Health - commercial,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Bright Health MGG,Bright Health MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Aetna,Aetna,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Aetna MGG,Aetna MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,BCBS,BCBS,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,BCBS MGG,BCBS MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Cigna,Cigna,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Cigna MGG,Cigna MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Humana,Humana,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Humana MGG,Humana MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Optum VA,Optum VA,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,UHC,UHC,175.71,,,,,,,per diem,175.71,175.71,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,UHC MGG,UHC MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,VA,VA,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Wellcare MGG,Wellcare MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Bright Health - commercial,Bright Health - commercial,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,175.71,175.71,Bright Health MGG,Bright Health MGG,175.71,,,,,,,case rate,175.71,175.71,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Aetna,Aetna,3.96,,,,,,,per diem,3.96,3.96,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Aetna MGG,Aetna MGG,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,BCBS,BCBS,3.96,,,,,,,per diem,3.96,3.96,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,BCBS MGG,BCBS MGG,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Cigna,Cigna,3.96,,,,,,,per diem,3.96,3.96,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Cigna MGG,Cigna MGG,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Humana,Humana,3.96,,,,,,,per diem,3.96,3.96,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Humana MGG,Humana MGG,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Optum VA,Optum VA,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,UHC,UHC,3.96,,,,,,,per diem,3.96,3.96,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,UHC MGG,UHC MGG,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,VA,VA,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Wellcare MGG,Wellcare MGG,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Bright Health - commercial,Bright Health - commercial,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,3.96,3.96,Bright Health MGG,Bright Health MGG,3.96,,,,,,,case rate,3.96,3.96,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Aetna,Aetna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Aetna MGG,Aetna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,BCBS,BCBS,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,BCBS MGG,BCBS MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Cigna,Cigna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Cigna MGG,Cigna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Humana,Humana,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Humana MGG,Humana MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Optum VA,Optum VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,UHC,UHC,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,UHC MGG,UHC MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,VA,VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Wellcare MGG,Wellcare MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Bright Health - commercial,Bright Health - commercial,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,180,180,Bright Health MGG,Bright Health MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Aetna,Aetna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Aetna MGG,Aetna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,BCBS,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,BCBS MGG,BCBS MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Cigna,Cigna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Cigna MGG,Cigna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Humana,Humana,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Humana MGG,Humana MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Optum VA,Optum VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,UHC,UHC,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,UHC MGG,UHC MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,VA,VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Wellcare MGG,Wellcare MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Bright Health - commercial,Bright Health - commercial,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Bright Health MGG,Bright Health MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Aetna,Aetna,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Aetna MGG,Aetna MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS,BCBS,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS MGG,BCBS MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Cigna,Cigna,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Cigna MGG,Cigna MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Humana,Humana,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Humana MGG,Humana MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Optum VA,Optum VA,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,UHC,UHC,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,UHC MGG,UHC MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,VA,VA,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Wellcare MGG,Wellcare MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Bright Health - commercial,Bright Health - commercial,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Bright Health MGG,Bright Health MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Aetna,Aetna,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Aetna MGG,Aetna MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,BCBS,BCBS,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,BCBS MGG,BCBS MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Cigna,Cigna,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Cigna MGG,Cigna MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Humana,Humana,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Humana MGG,Humana MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Optum VA,Optum VA,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,UHC,UHC,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,UHC MGG,UHC MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,VA,VA,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Wellcare MGG,Wellcare MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Bright Health - commercial,Bright Health - commercial,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Bright Health MGG,Bright Health MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Aetna,Aetna,136,,,,,,,per diem,136,136,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Aetna MGG,Aetna MGG,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,BCBS,BCBS,136,,,,,,,per diem,136,136,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,BCBS MGG,BCBS MGG,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Cigna,Cigna,136,,,,,,,per diem,136,136,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Cigna MGG,Cigna MGG,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Humana,Humana,136,,,,,,,per diem,136,136,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Humana MGG,Humana MGG,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Optum VA,Optum VA,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,UHC,UHC,136,,,,,,,per diem,136,136,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,UHC MGG,UHC MGG,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,VA,VA,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Wellcare MGG,Wellcare MGG,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Bright Health - commercial,Bright Health - commercial,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,136,136,Bright Health MGG,Bright Health MGG,136,,,,,,,case rate,136,136,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Aetna,Aetna,79.3,,,,,,,per diem,79.3,79.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Aetna MGG,Aetna MGG,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,BCBS,BCBS,79.3,,,,,,,per diem,79.3,79.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,BCBS MGG,BCBS MGG,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Cigna,Cigna,79.3,,,,,,,per diem,79.3,79.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Cigna MGG,Cigna MGG,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Humana,Humana,79.3,,,,,,,per diem,79.3,79.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Humana MGG,Humana MGG,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Optum VA,Optum VA,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,UHC,UHC,79.3,,,,,,,per diem,79.3,79.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,UHC MGG,UHC MGG,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,VA,VA,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Wellcare MGG,Wellcare MGG,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Bright Health - commercial,Bright Health - commercial,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,79.3,79.3,Bright Health MGG,Bright Health MGG,79.3,,,,,,,case rate,79.3,79.3,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Aetna,Aetna,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Aetna MGG,Aetna MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,BCBS,BCBS,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,BCBS MGG,BCBS MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Cigna,Cigna,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Cigna MGG,Cigna MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Humana,Humana,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Humana MGG,Humana MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Optum VA,Optum VA,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,UHC,UHC,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,UHC MGG,UHC MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,VA,VA,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Wellcare MGG,Wellcare MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Bright Health - commercial,Bright Health - commercial,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Bright Health MGG,Bright Health MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Aetna,Aetna,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Aetna MGG,Aetna MGG,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,BCBS,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,BCBS MGG,BCBS MGG,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Cigna,Cigna,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Cigna MGG,Cigna MGG,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Humana,Humana,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Humana MGG,Humana MGG,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Optum VA,Optum VA,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,UHC,UHC,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,UHC MGG,UHC MGG,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,VA,VA,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Wellcare MGG,Wellcare MGG,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Bright Health - commercial,Bright Health - commercial,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,160.15,160.15,Bright Health MGG,Bright Health MGG,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Aetna,Aetna,36.38,,,,,,,per diem,36.38,36.38,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Aetna MGG,Aetna MGG,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,BCBS,BCBS,36.38,,,,,,,per diem,36.38,36.38,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,BCBS MGG,BCBS MGG,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Cigna,Cigna,36.38,,,,,,,per diem,36.38,36.38,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Cigna MGG,Cigna MGG,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Humana,Humana,36.38,,,,,,,per diem,36.38,36.38,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Humana MGG,Humana MGG,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Optum VA,Optum VA,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,UHC,UHC,36.38,,,,,,,per diem,36.38,36.38,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,UHC MGG,UHC MGG,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,VA,VA,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Wellcare MGG,Wellcare MGG,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Bright Health - commercial,Bright Health - commercial,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,36.38,36.38,Bright Health MGG,Bright Health MGG,36.38,,,,,,,case rate,36.38,36.38,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Aetna,Aetna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Aetna MGG,Aetna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,BCBS,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS MGG,BCBS MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Cigna,Cigna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Cigna MGG,Cigna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Humana,Humana,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Humana MGG,Humana MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Optum VA,Optum VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UHC,UHC,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UHC MGG,UHC MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,VA,VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Wellcare MGG,Wellcare MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Bright Health - commercial,Bright Health - commercial,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,Bright Health MGG,Bright Health MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Aetna,Aetna,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Aetna MGG,Aetna MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS,BCBS,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS MGG,BCBS MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Cigna,Cigna,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Cigna MGG,Cigna MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Humana,Humana,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Humana MGG,Humana MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Optum VA,Optum VA,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,UHC,UHC,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,UHC MGG,UHC MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,VA,VA,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Wellcare MGG,Wellcare MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Bright Health - commercial,Bright Health - commercial,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,Bright Health MGG,Bright Health MGG,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Aetna,Aetna,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Aetna MGG,Aetna MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,BCBS,BCBS,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,BCBS MGG,BCBS MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Cigna,Cigna,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Cigna MGG,Cigna MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Humana,Humana,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Humana MGG,Humana MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Optum VA,Optum VA,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,UHC,UHC,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,UHC MGG,UHC MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,VA,VA,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Wellcare MGG,Wellcare MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Bright Health - commercial,Bright Health - commercial,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Bright Health MGG,Bright Health MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Aetna,Aetna,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Aetna MGG,Aetna MGG,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,BCBS,BCBS,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,BCBS MGG,BCBS MGG,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Cigna,Cigna,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Cigna MGG,Cigna MGG,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Humana,Humana,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Humana MGG,Humana MGG,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Optum VA,Optum VA,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,UHC,UHC,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,UHC MGG,UHC MGG,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,VA,VA,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Wellcare MGG,Wellcare MGG,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Bright Health - commercial,Bright Health - commercial,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,90.85,90.85,Bright Health MGG,Bright Health MGG,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Aetna,Aetna,181.65,,,,,,,per diem,181.65,181.65,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Aetna MGG,Aetna MGG,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,BCBS,BCBS,181.65,,,,,,,per diem,181.65,181.65,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,BCBS MGG,BCBS MGG,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Cigna,Cigna,181.65,,,,,,,per diem,181.65,181.65,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Cigna MGG,Cigna MGG,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Humana,Humana,181.65,,,,,,,per diem,181.65,181.65,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Humana MGG,Humana MGG,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Optum VA,Optum VA,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,UHC,UHC,181.65,,,,,,,per diem,181.65,181.65,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,UHC MGG,UHC MGG,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,VA,VA,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Wellcare MGG,Wellcare MGG,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Bright Health - commercial,Bright Health - commercial,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,181.65,181.65,Bright Health MGG,Bright Health MGG,181.65,,,,,,,case rate,181.65,181.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Aetna,Aetna,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Aetna MGG,Aetna MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,BCBS,BCBS,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,BCBS MGG,BCBS MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Cigna,Cigna,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Cigna MGG,Cigna MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Humana,Humana,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Humana MGG,Humana MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Optum VA,Optum VA,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,UHC,UHC,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,UHC MGG,UHC MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,VA,VA,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Wellcare MGG,Wellcare MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Bright Health - commercial,Bright Health - commercial,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Bright Health MGG,Bright Health MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Aetna,Aetna,22.6,,,,,,,per diem,22.6,22.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Aetna MGG,Aetna MGG,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,BCBS,BCBS,22.6,,,,,,,per diem,22.6,22.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,BCBS MGG,BCBS MGG,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Cigna,Cigna,22.6,,,,,,,per diem,22.6,22.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Cigna MGG,Cigna MGG,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Humana,Humana,22.6,,,,,,,per diem,22.6,22.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Humana MGG,Humana MGG,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Optum VA,Optum VA,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,UHC,UHC,22.6,,,,,,,per diem,22.6,22.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,UHC MGG,UHC MGG,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,VA,VA,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Wellcare MGG,Wellcare MGG,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Bright Health - commercial,Bright Health - commercial,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,22.6,22.6,Bright Health MGG,Bright Health MGG,22.6,,,,,,,case rate,22.6,22.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Aetna,Aetna,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Aetna MGG,Aetna MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,BCBS,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS MGG,BCBS MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Cigna,Cigna,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Cigna MGG,Cigna MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Humana,Humana,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Humana MGG,Humana MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Optum VA,Optum VA,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,UHC,UHC,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,UHC MGG,UHC MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,VA,VA,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Wellcare MGG,Wellcare MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Bright Health - commercial,Bright Health - commercial,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Bright Health MGG,Bright Health MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Aetna,Aetna,24.88,,,,,,,per diem,24.88,24.88,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Aetna MGG,Aetna MGG,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,BCBS,BCBS,24.88,,,,,,,per diem,24.88,24.88,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,BCBS MGG,BCBS MGG,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Cigna,Cigna,24.88,,,,,,,per diem,24.88,24.88,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Cigna MGG,Cigna MGG,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Humana,Humana,24.88,,,,,,,per diem,24.88,24.88,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Humana MGG,Humana MGG,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Optum VA,Optum VA,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,UHC,UHC,24.88,,,,,,,per diem,24.88,24.88,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,UHC MGG,UHC MGG,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,VA,VA,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Wellcare MGG,Wellcare MGG,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Bright Health - commercial,Bright Health - commercial,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,24.88,24.88,Bright Health MGG,Bright Health MGG,24.88,,,,,,,case rate,24.88,24.88,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Aetna,Aetna,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Aetna MGG,Aetna MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,BCBS,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS MGG,BCBS MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Cigna,Cigna,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Cigna MGG,Cigna MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Humana,Humana,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Humana MGG,Humana MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Optum VA,Optum VA,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,UHC,UHC,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,UHC MGG,UHC MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,VA,VA,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Wellcare MGG,Wellcare MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Bright Health - commercial,Bright Health - commercial,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,Bright Health MGG,Bright Health MGG,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Aetna,Aetna,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Aetna MGG,Aetna MGG,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,BCBS,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,BCBS MGG,BCBS MGG,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Cigna,Cigna,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Cigna MGG,Cigna MGG,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Humana,Humana,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Humana MGG,Humana MGG,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Optum VA,Optum VA,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,UHC,UHC,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,UHC MGG,UHC MGG,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,VA,VA,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Wellcare MGG,Wellcare MGG,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Bright Health - commercial,Bright Health - commercial,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,68.25,68.25,Bright Health MGG,Bright Health MGG,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Aetna,Aetna,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Aetna MGG,Aetna MGG,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,BCBS,BCBS,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,BCBS MGG,BCBS MGG,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Cigna,Cigna,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Cigna MGG,Cigna MGG,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Humana,Humana,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Humana MGG,Humana MGG,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Optum VA,Optum VA,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,UHC,UHC,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,UHC MGG,UHC MGG,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,VA,VA,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Wellcare MGG,Wellcare MGG,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Bright Health - commercial,Bright Health - commercial,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,170.1,170.1,Bright Health MGG,Bright Health MGG,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Aetna,Aetna,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Aetna MGG,Aetna MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,BCBS,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,BCBS MGG,BCBS MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Cigna,Cigna,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Cigna MGG,Cigna MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Humana,Humana,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Humana MGG,Humana MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Optum VA,Optum VA,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,UHC,UHC,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,UHC MGG,UHC MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,VA,VA,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Wellcare MGG,Wellcare MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Bright Health - commercial,Bright Health - commercial,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Bright Health MGG,Bright Health MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Aetna,Aetna,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Aetna MGG,Aetna MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,BCBS,BCBS,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,BCBS MGG,BCBS MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Cigna,Cigna,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Cigna MGG,Cigna MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Humana,Humana,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Humana MGG,Humana MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Optum VA,Optum VA,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,UHC,UHC,18.4,,,,,,,per diem,18.4,18.4,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,UHC MGG,UHC MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,VA,VA,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Wellcare MGG,Wellcare MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Bright Health - commercial,Bright Health - commercial,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,18.4,18.4,Bright Health MGG,Bright Health MGG,18.4,,,,,,,case rate,18.4,18.4,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Aetna,Aetna,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Aetna MGG,Aetna MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,BCBS,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,BCBS MGG,BCBS MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Cigna,Cigna,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Cigna MGG,Cigna MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Humana,Humana,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Humana MGG,Humana MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Optum VA,Optum VA,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,UHC,UHC,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,UHC MGG,UHC MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,VA,VA,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Wellcare MGG,Wellcare MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Bright Health - commercial,Bright Health - commercial,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Bright Health MGG,Bright Health MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Aetna,Aetna,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Aetna MGG,Aetna MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,BCBS,BCBS,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,BCBS MGG,BCBS MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Cigna,Cigna,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Cigna MGG,Cigna MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Humana,Humana,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Humana MGG,Humana MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Optum VA,Optum VA,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,UHC,UHC,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,UHC MGG,UHC MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,VA,VA,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Wellcare MGG,Wellcare MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Bright Health - commercial,Bright Health - commercial,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,7.9,7.9,Bright Health MGG,Bright Health MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Aetna,Aetna,174.85,,,,,,,per diem,174.85,174.85,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Aetna MGG,Aetna MGG,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,BCBS,BCBS,174.85,,,,,,,per diem,174.85,174.85,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,BCBS MGG,BCBS MGG,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Cigna,Cigna,174.85,,,,,,,per diem,174.85,174.85,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Cigna MGG,Cigna MGG,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Humana,Humana,174.85,,,,,,,per diem,174.85,174.85,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Humana MGG,Humana MGG,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Optum VA,Optum VA,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,UHC,UHC,174.85,,,,,,,per diem,174.85,174.85,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,UHC MGG,UHC MGG,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,VA,VA,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Wellcare MGG,Wellcare MGG,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Bright Health - commercial,Bright Health - commercial,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,174.85,174.85,Bright Health MGG,Bright Health MGG,174.85,,,,,,,case rate,174.85,174.85,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Aetna,Aetna,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Aetna MGG,Aetna MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,BCBS,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,BCBS MGG,BCBS MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Cigna,Cigna,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Cigna MGG,Cigna MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Humana,Humana,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Humana MGG,Humana MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Optum VA,Optum VA,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,UHC,UHC,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,UHC MGG,UHC MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,VA,VA,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Wellcare MGG,Wellcare MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Bright Health - commercial,Bright Health - commercial,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Bright Health MGG,Bright Health MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Aetna,Aetna,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Aetna MGG,Aetna MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,BCBS,BCBS,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,BCBS MGG,BCBS MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Cigna,Cigna,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Cigna MGG,Cigna MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Humana,Humana,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Humana MGG,Humana MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Optum VA,Optum VA,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,UHC,UHC,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,UHC MGG,UHC MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,VA,VA,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Wellcare MGG,Wellcare MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Bright Health - commercial,Bright Health - commercial,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Bright Health MGG,Bright Health MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Aetna,Aetna,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Aetna MGG,Aetna MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,BCBS,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,BCBS MGG,BCBS MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Cigna,Cigna,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Cigna MGG,Cigna MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Humana,Humana,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Humana MGG,Humana MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Optum VA,Optum VA,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,UHC,UHC,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,UHC MGG,UHC MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,VA,VA,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Wellcare MGG,Wellcare MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Bright Health - commercial,Bright Health - commercial,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Bright Health MGG,Bright Health MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Aetna,Aetna,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Aetna MGG,Aetna MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,BCBS,BCBS,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,BCBS MGG,BCBS MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Cigna,Cigna,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Cigna MGG,Cigna MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Humana,Humana,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Humana MGG,Humana MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Optum VA,Optum VA,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,UHC,UHC,34.15,,,,,,,per diem,34.15,34.15,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,UHC MGG,UHC MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,VA,VA,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Wellcare MGG,Wellcare MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Bright Health - commercial,Bright Health - commercial,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,34.15,34.15,Bright Health MGG,Bright Health MGG,34.15,,,,,,,case rate,34.15,34.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Aetna,Aetna,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Aetna MGG,Aetna MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,BCBS,BCBS,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,BCBS MGG,BCBS MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Cigna,Cigna,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Cigna MGG,Cigna MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Humana,Humana,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Humana MGG,Humana MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Optum VA,Optum VA,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,UHC,UHC,36.25,,,,,,,per diem,36.25,36.25,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,UHC MGG,UHC MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,VA,VA,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Wellcare MGG,Wellcare MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Bright Health - commercial,Bright Health - commercial,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,36.25,36.25,Bright Health MGG,Bright Health MGG,36.25,,,,,,,case rate,36.25,36.25,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Aetna,Aetna,4.75,,,,,,,per diem,4.75,4.75,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Aetna MGG,Aetna MGG,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,BCBS,BCBS,4.75,,,,,,,per diem,4.75,4.75,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,BCBS MGG,BCBS MGG,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Cigna,Cigna,4.75,,,,,,,per diem,4.75,4.75,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Cigna MGG,Cigna MGG,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Humana,Humana,4.75,,,,,,,per diem,4.75,4.75,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Humana MGG,Humana MGG,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Optum VA,Optum VA,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,UHC,UHC,4.75,,,,,,,per diem,4.75,4.75,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,UHC MGG,UHC MGG,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,VA,VA,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Wellcare MGG,Wellcare MGG,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Bright Health - commercial,Bright Health - commercial,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.75,4.75,Bright Health MGG,Bright Health MGG,4.75,,,,,,,case rate,4.75,4.75,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Aetna,Aetna,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Aetna MGG,Aetna MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,BCBS,BCBS,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,BCBS MGG,BCBS MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Cigna,Cigna,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Cigna MGG,Cigna MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Humana,Humana,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Humana MGG,Humana MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Optum VA,Optum VA,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,UHC,UHC,271.95,,,,,,,per diem,271.95,271.95,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,UHC MGG,UHC MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,VA,VA,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Wellcare MGG,Wellcare MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Bright Health - commercial,Bright Health - commercial,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,271.95,271.95,Bright Health MGG,Bright Health MGG,271.95,,,,,,,case rate,271.95,271.95,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Aetna,Aetna,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Aetna MGG,Aetna MGG,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,BCBS,BCBS,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,BCBS MGG,BCBS MGG,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Cigna,Cigna,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Cigna MGG,Cigna MGG,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Humana,Humana,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Humana MGG,Humana MGG,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Optum VA,Optum VA,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,UHC,UHC,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,UHC MGG,UHC MGG,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,VA,VA,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Wellcare MGG,Wellcare MGG,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Bright Health - commercial,Bright Health - commercial,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,Bright Health MGG,Bright Health MGG,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Aetna,Aetna,544.45,,,,,,,per diem,544.45,544.45,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Aetna MGG,Aetna MGG,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,BCBS,BCBS,544.45,,,,,,,per diem,544.45,544.45,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,BCBS MGG,BCBS MGG,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Cigna,Cigna,544.45,,,,,,,per diem,544.45,544.45,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Cigna MGG,Cigna MGG,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Humana,Humana,544.45,,,,,,,per diem,544.45,544.45,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Humana MGG,Humana MGG,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Optum VA,Optum VA,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,UHC,UHC,544.45,,,,,,,per diem,544.45,544.45,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,UHC MGG,UHC MGG,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,VA,VA,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Wellcare MGG,Wellcare MGG,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Bright Health - commercial,Bright Health - commercial,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,544.45,544.45,Bright Health MGG,Bright Health MGG,544.45,,,,,,,case rate,544.45,544.45,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Aetna,Aetna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Aetna MGG,Aetna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,BCBS,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,BCBS MGG,BCBS MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Cigna,Cigna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Cigna MGG,Cigna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Humana,Humana,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Humana MGG,Humana MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Optum VA,Optum VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,UHC,UHC,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,UHC MGG,UHC MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,VA,VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Wellcare MGG,Wellcare MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Bright Health - commercial,Bright Health - commercial,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Bright Health MGG,Bright Health MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Aetna,Aetna,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Aetna MGG,Aetna MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,BCBS,BCBS,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,BCBS MGG,BCBS MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Cigna,Cigna,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Cigna MGG,Cigna MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Humana,Humana,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Humana MGG,Humana MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Optum VA,Optum VA,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,UHC,UHC,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,UHC MGG,UHC MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,VA,VA,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Wellcare MGG,Wellcare MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Bright Health - commercial,Bright Health - commercial,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Bright Health MGG,Bright Health MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Aetna,Aetna,133.9,,,,,,,per diem,133.9,133.9,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Aetna MGG,Aetna MGG,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,BCBS,BCBS,133.9,,,,,,,per diem,133.9,133.9,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,BCBS MGG,BCBS MGG,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Cigna,Cigna,133.9,,,,,,,per diem,133.9,133.9,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Cigna MGG,Cigna MGG,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Humana,Humana,133.9,,,,,,,per diem,133.9,133.9,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Humana MGG,Humana MGG,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Optum VA,Optum VA,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,UHC,UHC,133.9,,,,,,,per diem,133.9,133.9,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,UHC MGG,UHC MGG,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,VA,VA,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Wellcare MGG,Wellcare MGG,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Bright Health - commercial,Bright Health - commercial,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,133.9,133.9,Bright Health MGG,Bright Health MGG,133.9,,,,,,,case rate,133.9,133.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Aetna,Aetna,61.45,,,,,,,per diem,61.45,61.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Aetna MGG,Aetna MGG,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,BCBS,BCBS,61.45,,,,,,,per diem,61.45,61.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,BCBS MGG,BCBS MGG,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Cigna,Cigna,61.45,,,,,,,per diem,61.45,61.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Cigna MGG,Cigna MGG,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Humana,Humana,61.45,,,,,,,per diem,61.45,61.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Humana MGG,Humana MGG,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Optum VA,Optum VA,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,UHC,UHC,61.45,,,,,,,per diem,61.45,61.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,UHC MGG,UHC MGG,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,VA,VA,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Wellcare MGG,Wellcare MGG,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Bright Health - commercial,Bright Health - commercial,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,61.45,61.45,Bright Health MGG,Bright Health MGG,61.45,,,,,,,case rate,61.45,61.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Aetna,Aetna,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Aetna MGG,Aetna MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,BCBS,BCBS,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,BCBS MGG,BCBS MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Cigna,Cigna,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Cigna MGG,Cigna MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Humana,Humana,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Humana MGG,Humana MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Optum VA,Optum VA,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,UHC,UHC,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,UHC MGG,UHC MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,VA,VA,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Wellcare MGG,Wellcare MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Bright Health - commercial,Bright Health - commercial,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,52,52,Bright Health MGG,Bright Health MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Aetna,Aetna,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Aetna MGG,Aetna MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,BCBS,BCBS,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,BCBS MGG,BCBS MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Cigna,Cigna,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Cigna MGG,Cigna MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Humana,Humana,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Humana MGG,Humana MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Optum VA,Optum VA,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,UHC,UHC,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,UHC MGG,UHC MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,VA,VA,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Wellcare MGG,Wellcare MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Bright Health - commercial,Bright Health - commercial,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Bright Health MGG,Bright Health MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Aetna,Aetna,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Aetna MGG,Aetna MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,BCBS,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,BCBS MGG,BCBS MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Cigna,Cigna,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Cigna MGG,Cigna MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Humana,Humana,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Humana MGG,Humana MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Optum VA,Optum VA,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,UHC,UHC,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,UHC MGG,UHC MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,VA,VA,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Wellcare MGG,Wellcare MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Bright Health - commercial,Bright Health - commercial,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,40.95,40.95,Bright Health MGG,Bright Health MGG,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Aetna,Aetna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Aetna MGG,Aetna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,BCBS,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,BCBS MGG,BCBS MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Cigna,Cigna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Cigna MGG,Cigna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Humana,Humana,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Humana MGG,Humana MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Optum VA,Optum VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,UHC,UHC,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,UHC MGG,UHC MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,VA,VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Wellcare MGG,Wellcare MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Bright Health - commercial,Bright Health - commercial,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,27.3,27.3,Bright Health MGG,Bright Health MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Aetna,Aetna,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Aetna MGG,Aetna MGG,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,BCBS,BCBS,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,BCBS MGG,BCBS MGG,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Cigna,Cigna,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Cigna MGG,Cigna MGG,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Humana,Humana,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Humana MGG,Humana MGG,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Optum VA,Optum VA,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,UHC,UHC,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,UHC MGG,UHC MGG,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,VA,VA,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Wellcare MGG,Wellcare MGG,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Bright Health - commercial,Bright Health - commercial,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,85.05,85.05,Bright Health MGG,Bright Health MGG,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Aetna,Aetna,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Aetna MGG,Aetna MGG,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,BCBS,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS MGG,BCBS MGG,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Cigna,Cigna,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Cigna MGG,Cigna MGG,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Humana,Humana,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Humana MGG,Humana MGG,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Optum VA,Optum VA,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UHC,UHC,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UHC MGG,UHC MGG,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,VA,VA,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Wellcare MGG,Wellcare MGG,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Bright Health - commercial,Bright Health - commercial,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,Bright Health MGG,Bright Health MGG,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Aetna,Aetna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Aetna MGG,Aetna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,BCBS,BCBS,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,BCBS MGG,BCBS MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Cigna,Cigna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Cigna MGG,Cigna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Humana,Humana,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Humana MGG,Humana MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Optum VA,Optum VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,UHC,UHC,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,UHC MGG,UHC MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,VA,VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Wellcare MGG,Wellcare MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Bright Health - commercial,Bright Health - commercial,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,84,84,Bright Health MGG,Bright Health MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Aetna,Aetna,47.8,,,,,,,per diem,47.8,47.8,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Aetna MGG,Aetna MGG,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,BCBS,BCBS,47.8,,,,,,,per diem,47.8,47.8,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,BCBS MGG,BCBS MGG,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Cigna,Cigna,47.8,,,,,,,per diem,47.8,47.8,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Cigna MGG,Cigna MGG,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Humana,Humana,47.8,,,,,,,per diem,47.8,47.8,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Humana MGG,Humana MGG,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Optum VA,Optum VA,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,UHC,UHC,47.8,,,,,,,per diem,47.8,47.8,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,UHC MGG,UHC MGG,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,VA,VA,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Wellcare MGG,Wellcare MGG,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Bright Health - commercial,Bright Health - commercial,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,47.8,47.8,Bright Health MGG,Bright Health MGG,47.8,,,,,,,case rate,47.8,47.8,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Aetna,Aetna,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Aetna MGG,Aetna MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,BCBS,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,BCBS MGG,BCBS MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Cigna,Cigna,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Cigna MGG,Cigna MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Humana,Humana,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Humana MGG,Humana MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Optum VA,Optum VA,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,UHC,UHC,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,UHC MGG,UHC MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,VA,VA,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Wellcare MGG,Wellcare MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Bright Health - commercial,Bright Health - commercial,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,39.9,39.9,Bright Health MGG,Bright Health MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Aetna,Aetna,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Aetna MGG,Aetna MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,BCBS,BCBS,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,BCBS MGG,BCBS MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Cigna,Cigna,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Cigna MGG,Cigna MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Humana,Humana,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Humana MGG,Humana MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Optum VA,Optum VA,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,UHC,UHC,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,UHC MGG,UHC MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,VA,VA,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Wellcare MGG,Wellcare MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Bright Health - commercial,Bright Health - commercial,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,52,52,Bright Health MGG,Bright Health MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Aetna,Aetna,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Aetna MGG,Aetna MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,BCBS,BCBS,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,BCBS MGG,BCBS MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Cigna,Cigna,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Cigna MGG,Cigna MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Humana,Humana,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Humana MGG,Humana MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Optum VA,Optum VA,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,UHC,UHC,137.05,,,,,,,per diem,137.05,137.05,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,UHC MGG,UHC MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,VA,VA,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Wellcare MGG,Wellcare MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Bright Health - commercial,Bright Health - commercial,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,137.05,137.05,Bright Health MGG,Bright Health MGG,137.05,,,,,,,case rate,137.05,137.05,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Aetna,Aetna,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Aetna MGG,Aetna MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,BCBS,BCBS,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,BCBS MGG,BCBS MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Cigna,Cigna,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Cigna MGG,Cigna MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Humana,Humana,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Humana MGG,Humana MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Optum VA,Optum VA,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,UHC,UHC,78.25,,,,,,,per diem,78.25,78.25,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,UHC MGG,UHC MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,VA,VA,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Wellcare MGG,Wellcare MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Bright Health - commercial,Bright Health - commercial,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,78.25,78.25,Bright Health MGG,Bright Health MGG,78.25,,,,,,,case rate,78.25,78.25,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Aetna,Aetna,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Aetna MGG,Aetna MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,BCBS,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,BCBS MGG,BCBS MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Cigna,Cigna,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Cigna MGG,Cigna MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Humana,Humana,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Humana MGG,Humana MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Optum VA,Optum VA,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,UHC,UHC,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,UHC MGG,UHC MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,VA,VA,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Wellcare MGG,Wellcare MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Bright Health - commercial,Bright Health - commercial,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,30.45,30.45,Bright Health MGG,Bright Health MGG,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Aetna,Aetna,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Aetna MGG,Aetna MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,BCBS,BCBS,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,BCBS MGG,BCBS MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Cigna,Cigna,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Cigna MGG,Cigna MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Humana,Humana,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Humana MGG,Humana MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Optum VA,Optum VA,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,UHC,UHC,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,UHC MGG,UHC MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,VA,VA,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Wellcare MGG,Wellcare MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Bright Health - commercial,Bright Health - commercial,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Bright Health MGG,Bright Health MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Aetna,Aetna,218.4,,,,,,,per diem,218.4,218.4,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Aetna MGG,Aetna MGG,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,BCBS,BCBS,218.4,,,,,,,per diem,218.4,218.4,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,BCBS MGG,BCBS MGG,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Cigna,Cigna,218.4,,,,,,,per diem,218.4,218.4,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Cigna MGG,Cigna MGG,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Humana,Humana,218.4,,,,,,,per diem,218.4,218.4,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Humana MGG,Humana MGG,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Optum VA,Optum VA,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,UHC,UHC,218.4,,,,,,,per diem,218.4,218.4,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,UHC MGG,UHC MGG,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,VA,VA,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Wellcare MGG,Wellcare MGG,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Bright Health - commercial,Bright Health - commercial,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,218.4,218.4,Bright Health MGG,Bright Health MGG,218.4,,,,,,,case rate,218.4,218.4,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Aetna,Aetna,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Aetna MGG,Aetna MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,BCBS,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,BCBS MGG,BCBS MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Cigna,Cigna,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Cigna MGG,Cigna MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Humana,Humana,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Humana MGG,Humana MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Optum VA,Optum VA,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,UHC,UHC,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,UHC MGG,UHC MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,VA,VA,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Wellcare MGG,Wellcare MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Bright Health - commercial,Bright Health - commercial,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,45.15,45.15,Bright Health MGG,Bright Health MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Aetna,Aetna,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Aetna MGG,Aetna MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,BCBS,BCBS,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,BCBS MGG,BCBS MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Cigna,Cigna,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Cigna MGG,Cigna MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Humana,Humana,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Humana MGG,Humana MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Optum VA,Optum VA,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,UHC,UHC,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,UHC MGG,UHC MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,VA,VA,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Wellcare MGG,Wellcare MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Bright Health - commercial,Bright Health - commercial,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,139.65,139.65,Bright Health MGG,Bright Health MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Aetna,Aetna,130.58,,,,,,,per diem,130.58,130.58,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Aetna MGG,Aetna MGG,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,BCBS,BCBS,130.58,,,,,,,per diem,130.58,130.58,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,BCBS MGG,BCBS MGG,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Cigna,Cigna,130.58,,,,,,,per diem,130.58,130.58,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Cigna MGG,Cigna MGG,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Humana,Humana,130.58,,,,,,,per diem,130.58,130.58,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Humana MGG,Humana MGG,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Optum VA,Optum VA,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,UHC,UHC,130.58,,,,,,,per diem,130.58,130.58,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,UHC MGG,UHC MGG,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,VA,VA,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Wellcare MGG,Wellcare MGG,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Bright Health - commercial,Bright Health - commercial,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,130.58,130.58,Bright Health MGG,Bright Health MGG,130.58,,,,,,,case rate,130.58,130.58,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Aetna,Aetna,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Aetna MGG,Aetna MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,BCBS,BCBS,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,BCBS MGG,BCBS MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Cigna,Cigna,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Cigna MGG,Cigna MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Humana,Humana,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Humana MGG,Humana MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Optum VA,Optum VA,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,UHC,UHC,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,UHC MGG,UHC MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,VA,VA,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Wellcare MGG,Wellcare MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Bright Health - commercial,Bright Health - commercial,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Bright Health MGG,Bright Health MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Aetna,Aetna,180.39,,,,,,,per diem,180.39,180.39,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Aetna MGG,Aetna MGG,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,BCBS,BCBS,180.39,,,,,,,per diem,180.39,180.39,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,BCBS MGG,BCBS MGG,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Cigna,Cigna,180.39,,,,,,,per diem,180.39,180.39,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Cigna MGG,Cigna MGG,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Humana,Humana,180.39,,,,,,,per diem,180.39,180.39,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Humana MGG,Humana MGG,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Optum VA,Optum VA,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,UHC,UHC,180.39,,,,,,,per diem,180.39,180.39,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,UHC MGG,UHC MGG,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,VA,VA,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Wellcare MGG,Wellcare MGG,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Bright Health - commercial,Bright Health - commercial,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,180.39,180.39,Bright Health MGG,Bright Health MGG,180.39,,,,,,,case rate,180.39,180.39,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Aetna,Aetna,147.55,,,,,,,per diem,147.55,147.55,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Aetna MGG,Aetna MGG,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,BCBS,BCBS,147.55,,,,,,,per diem,147.55,147.55,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,BCBS MGG,BCBS MGG,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Cigna,Cigna,147.55,,,,,,,per diem,147.55,147.55,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Cigna MGG,Cigna MGG,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Humana,Humana,147.55,,,,,,,per diem,147.55,147.55,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Humana MGG,Humana MGG,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Optum VA,Optum VA,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,UHC,UHC,147.55,,,,,,,per diem,147.55,147.55,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,UHC MGG,UHC MGG,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,VA,VA,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Wellcare MGG,Wellcare MGG,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Bright Health - commercial,Bright Health - commercial,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,147.55,147.55,Bright Health MGG,Bright Health MGG,147.55,,,,,,,case rate,147.55,147.55,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Aetna,Aetna,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Aetna MGG,Aetna MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,BCBS,BCBS,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,BCBS MGG,BCBS MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Cigna,Cigna,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Cigna MGG,Cigna MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Humana,Humana,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Humana MGG,Humana MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Optum VA,Optum VA,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,UHC,UHC,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,UHC MGG,UHC MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,VA,VA,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Wellcare MGG,Wellcare MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Bright Health - commercial,Bright Health - commercial,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,72.45,72.45,Bright Health MGG,Bright Health MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Aetna,Aetna,46.73,,,,,,,per diem,46.73,46.73,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Aetna MGG,Aetna MGG,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,BCBS,BCBS,46.73,,,,,,,per diem,46.73,46.73,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,BCBS MGG,BCBS MGG,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Cigna,Cigna,46.73,,,,,,,per diem,46.73,46.73,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Cigna MGG,Cigna MGG,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Humana,Humana,46.73,,,,,,,per diem,46.73,46.73,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Humana MGG,Humana MGG,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Optum VA,Optum VA,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,UHC,UHC,46.73,,,,,,,per diem,46.73,46.73,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,UHC MGG,UHC MGG,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,VA,VA,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Wellcare MGG,Wellcare MGG,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Bright Health - commercial,Bright Health - commercial,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,46.73,46.73,Bright Health MGG,Bright Health MGG,46.73,,,,,,,case rate,46.73,46.73,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Aetna,Aetna,708.75,,,,,,,per diem,708.75,708.75,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Aetna MGG,Aetna MGG,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,BCBS,BCBS,708.75,,,,,,,per diem,708.75,708.75,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,BCBS MGG,BCBS MGG,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Cigna,Cigna,708.75,,,,,,,per diem,708.75,708.75,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Cigna MGG,Cigna MGG,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Humana,Humana,708.75,,,,,,,per diem,708.75,708.75,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Humana MGG,Humana MGG,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Optum VA,Optum VA,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,UHC,UHC,708.75,,,,,,,per diem,708.75,708.75,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,UHC MGG,UHC MGG,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,VA,VA,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Wellcare MGG,Wellcare MGG,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Bright Health - commercial,Bright Health - commercial,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,708.75,708.75,Bright Health MGG,Bright Health MGG,708.75,,,,,,,case rate,708.75,708.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Aetna,Aetna,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Aetna MGG,Aetna MGG,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,BCBS,BCBS,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,BCBS MGG,BCBS MGG,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Cigna,Cigna,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Cigna MGG,Cigna MGG,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Humana,Humana,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Humana MGG,Humana MGG,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Optum VA,Optum VA,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,UHC,UHC,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,UHC MGG,UHC MGG,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,VA,VA,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Wellcare MGG,Wellcare MGG,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Bright Health - commercial,Bright Health - commercial,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,11.55,11.55,Bright Health MGG,Bright Health MGG,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Aetna,Aetna,3.7,,,,,,,per diem,3.7,3.7,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Aetna MGG,Aetna MGG,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,BCBS,BCBS,3.7,,,,,,,per diem,3.7,3.7,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,BCBS MGG,BCBS MGG,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Cigna,Cigna,3.7,,,,,,,per diem,3.7,3.7,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Cigna MGG,Cigna MGG,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Humana,Humana,3.7,,,,,,,per diem,3.7,3.7,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Humana MGG,Humana MGG,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Optum VA,Optum VA,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,UHC,UHC,3.7,,,,,,,per diem,3.7,3.7,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,UHC MGG,UHC MGG,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,VA,VA,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Wellcare MGG,Wellcare MGG,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Bright Health - commercial,Bright Health - commercial,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.7,3.7,Bright Health MGG,Bright Health MGG,3.7,,,,,,,case rate,3.7,3.7,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Aetna,Aetna,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Aetna MGG,Aetna MGG,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,BCBS,BCBS,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,BCBS MGG,BCBS MGG,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Cigna,Cigna,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Cigna MGG,Cigna MGG,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Humana,Humana,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Humana MGG,Humana MGG,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Optum VA,Optum VA,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,UHC,UHC,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,UHC MGG,UHC MGG,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,VA,VA,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Wellcare MGG,Wellcare MGG,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Bright Health - commercial,Bright Health - commercial,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,158.55,158.55,Bright Health MGG,Bright Health MGG,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Aetna,Aetna,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Aetna MGG,Aetna MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,BCBS,BCBS,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,BCBS MGG,BCBS MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Cigna,Cigna,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Cigna MGG,Cigna MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Humana,Humana,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Humana MGG,Humana MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Optum VA,Optum VA,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,UHC,UHC,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,UHC MGG,UHC MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,VA,VA,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Wellcare MGG,Wellcare MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Bright Health - commercial,Bright Health - commercial,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,105,105,Bright Health MGG,Bright Health MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna,Aetna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna MGG,Aetna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS,BCBS,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS MGG,BCBS MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna,Cigna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna MGG,Cigna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana,Humana,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana MGG,Humana MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Optum VA,Optum VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC,UHC,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC MGG,UHC MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,VA,VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Wellcare MGG,Wellcare MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health - commercial,Bright Health - commercial,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health MGG,Bright Health MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Aetna,Aetna,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Aetna MGG,Aetna MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,BCBS,BCBS,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,BCBS MGG,BCBS MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Cigna,Cigna,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Cigna MGG,Cigna MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Humana,Humana,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Humana MGG,Humana MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Optum VA,Optum VA,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,UHC,UHC,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,UHC MGG,UHC MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,VA,VA,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Wellcare MGG,Wellcare MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Bright Health - commercial,Bright Health - commercial,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,144,144,Bright Health MGG,Bright Health MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Aetna,Aetna,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Aetna MGG,Aetna MGG,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,BCBS,BCBS,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,BCBS MGG,BCBS MGG,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Cigna,Cigna,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Cigna MGG,Cigna MGG,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Humana,Humana,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Humana MGG,Humana MGG,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Optum VA,Optum VA,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,UHC,UHC,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,UHC MGG,UHC MGG,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,VA,VA,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Wellcare MGG,Wellcare MGG,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Bright Health - commercial,Bright Health - commercial,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,Bright Health MGG,Bright Health MGG,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Aetna,Aetna,59.65,,,,,,,per diem,59.65,59.65,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Aetna MGG,Aetna MGG,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,BCBS,BCBS,59.65,,,,,,,per diem,59.65,59.65,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,BCBS MGG,BCBS MGG,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Cigna,Cigna,59.65,,,,,,,per diem,59.65,59.65,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Cigna MGG,Cigna MGG,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Humana,Humana,59.65,,,,,,,per diem,59.65,59.65,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Humana MGG,Humana MGG,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Optum VA,Optum VA,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,UHC,UHC,59.65,,,,,,,per diem,59.65,59.65,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,UHC MGG,UHC MGG,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,VA,VA,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Wellcare MGG,Wellcare MGG,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Bright Health - commercial,Bright Health - commercial,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,59.65,59.65,Bright Health MGG,Bright Health MGG,59.65,,,,,,,case rate,59.65,59.65,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Aetna,Aetna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Aetna MGG,Aetna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,BCBS,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,BCBS MGG,BCBS MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Cigna,Cigna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Cigna MGG,Cigna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Humana,Humana,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Humana MGG,Humana MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Optum VA,Optum VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,UHC,UHC,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,UHC MGG,UHC MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,VA,VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Wellcare MGG,Wellcare MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Bright Health - commercial,Bright Health - commercial,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,Bright Health MGG,Bright Health MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Aetna,Aetna,638.95,,,,,,,per diem,638.95,638.95,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Aetna MGG,Aetna MGG,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,BCBS,BCBS,638.95,,,,,,,per diem,638.95,638.95,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,BCBS MGG,BCBS MGG,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Cigna,Cigna,638.95,,,,,,,per diem,638.95,638.95,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Cigna MGG,Cigna MGG,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Humana,Humana,638.95,,,,,,,per diem,638.95,638.95,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Humana MGG,Humana MGG,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Optum VA,Optum VA,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,UHC,UHC,638.95,,,,,,,per diem,638.95,638.95,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,UHC MGG,UHC MGG,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,VA,VA,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Wellcare MGG,Wellcare MGG,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Bright Health - commercial,Bright Health - commercial,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,638.95,638.95,Bright Health MGG,Bright Health MGG,638.95,,,,,,,case rate,638.95,638.95,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Aetna,Aetna,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Aetna MGG,Aetna MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,BCBS,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,BCBS MGG,BCBS MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Cigna,Cigna,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Cigna MGG,Cigna MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Humana,Humana,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Humana MGG,Humana MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Optum VA,Optum VA,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,UHC,UHC,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,UHC MGG,UHC MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,VA,VA,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Wellcare MGG,Wellcare MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Bright Health - commercial,Bright Health - commercial,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,31.5,31.5,Bright Health MGG,Bright Health MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Aetna,Aetna,45.13,,,,,,,per diem,45.13,45.13,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Aetna MGG,Aetna MGG,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,BCBS,BCBS,45.13,,,,,,,per diem,45.13,45.13,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,BCBS MGG,BCBS MGG,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Cigna,Cigna,45.13,,,,,,,per diem,45.13,45.13,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Cigna MGG,Cigna MGG,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Humana,Humana,45.13,,,,,,,per diem,45.13,45.13,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Humana MGG,Humana MGG,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Optum VA,Optum VA,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,UHC,UHC,45.13,,,,,,,per diem,45.13,45.13,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,UHC MGG,UHC MGG,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,VA,VA,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Wellcare MGG,Wellcare MGG,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Bright Health - commercial,Bright Health - commercial,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,45.13,45.13,Bright Health MGG,Bright Health MGG,45.13,,,,,,,case rate,45.13,45.13,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Aetna,Aetna,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Aetna MGG,Aetna MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,BCBS,BCBS,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,BCBS MGG,BCBS MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Cigna,Cigna,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Cigna MGG,Cigna MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Humana,Humana,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Humana MGG,Humana MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Optum VA,Optum VA,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,UHC,UHC,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,UHC MGG,UHC MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,VA,VA,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Wellcare MGG,Wellcare MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Bright Health - commercial,Bright Health - commercial,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Bright Health MGG,Bright Health MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Aetna,Aetna,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Aetna MGG,Aetna MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,BCBS,BCBS,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,BCBS MGG,BCBS MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Cigna,Cigna,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Cigna MGG,Cigna MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Humana,Humana,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Humana MGG,Humana MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Optum VA,Optum VA,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,UHC,UHC,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,UHC MGG,UHC MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,VA,VA,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Wellcare MGG,Wellcare MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Bright Health - commercial,Bright Health - commercial,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,277.2,277.2,Bright Health MGG,Bright Health MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Aetna,Aetna,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Aetna MGG,Aetna MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,BCBS,BCBS,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,BCBS MGG,BCBS MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Cigna,Cigna,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Cigna MGG,Cigna MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Humana,Humana,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Humana MGG,Humana MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Optum VA,Optum VA,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,UHC,UHC,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,UHC MGG,UHC MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,VA,VA,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Wellcare MGG,Wellcare MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Bright Health - commercial,Bright Health - commercial,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Bright Health MGG,Bright Health MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Aetna,Aetna,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Aetna MGG,Aetna MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,BCBS,BCBS,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,BCBS MGG,BCBS MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Cigna,Cigna,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Cigna MGG,Cigna MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Humana,Humana,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Humana MGG,Humana MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Optum VA,Optum VA,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,UHC,UHC,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,UHC MGG,UHC MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,VA,VA,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Wellcare MGG,Wellcare MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Bright Health - commercial,Bright Health - commercial,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,130.2,130.2,Bright Health MGG,Bright Health MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Aetna,Aetna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Aetna MGG,Aetna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,BCBS,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,BCBS MGG,BCBS MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Cigna,Cigna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Cigna MGG,Cigna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Humana,Humana,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Humana MGG,Humana MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Optum VA,Optum VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,UHC,UHC,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,UHC MGG,UHC MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,VA,VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Wellcare MGG,Wellcare MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Bright Health - commercial,Bright Health - commercial,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,113.4,113.4,Bright Health MGG,Bright Health MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Aetna,Aetna,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Aetna MGG,Aetna MGG,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,BCBS,BCBS,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,BCBS MGG,BCBS MGG,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Cigna,Cigna,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Cigna MGG,Cigna MGG,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Humana,Humana,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Humana MGG,Humana MGG,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Optum VA,Optum VA,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,UHC,UHC,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,UHC MGG,UHC MGG,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,VA,VA,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Wellcare MGG,Wellcare MGG,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Bright Health - commercial,Bright Health - commercial,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,226.8,226.8,Bright Health MGG,Bright Health MGG,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Aetna,Aetna,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Aetna MGG,Aetna MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,BCBS,BCBS,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,BCBS MGG,BCBS MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Cigna,Cigna,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Cigna MGG,Cigna MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Humana,Humana,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Humana MGG,Humana MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Optum VA,Optum VA,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,UHC,UHC,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,UHC MGG,UHC MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,VA,VA,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Wellcare MGG,Wellcare MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Bright Health - commercial,Bright Health - commercial,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,210,210,Bright Health MGG,Bright Health MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Aetna,Aetna,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Aetna MGG,Aetna MGG,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,BCBS,BCBS,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,BCBS MGG,BCBS MGG,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Cigna,Cigna,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Cigna MGG,Cigna MGG,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Humana,Humana,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Humana MGG,Humana MGG,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Optum VA,Optum VA,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,UHC,UHC,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,UHC MGG,UHC MGG,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,VA,VA,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Wellcare MGG,Wellcare MGG,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Bright Health - commercial,Bright Health - commercial,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,153.3,153.3,Bright Health MGG,Bright Health MGG,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Aetna,Aetna,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Aetna MGG,Aetna MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,BCBS,BCBS,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,BCBS MGG,BCBS MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Cigna,Cigna,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Cigna MGG,Cigna MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Humana,Humana,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Humana MGG,Humana MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Optum VA,Optum VA,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,UHC,UHC,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,UHC MGG,UHC MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,VA,VA,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Wellcare MGG,Wellcare MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Bright Health - commercial,Bright Health - commercial,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,340.2,340.2,Bright Health MGG,Bright Health MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Aetna,Aetna,369.6,,,,,,,per diem,369.6,369.6,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Aetna MGG,Aetna MGG,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,BCBS,BCBS,369.6,,,,,,,per diem,369.6,369.6,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,BCBS MGG,BCBS MGG,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Cigna,Cigna,369.6,,,,,,,per diem,369.6,369.6,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Cigna MGG,Cigna MGG,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Humana,Humana,369.6,,,,,,,per diem,369.6,369.6,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Humana MGG,Humana MGG,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Optum VA,Optum VA,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,UHC,UHC,369.6,,,,,,,per diem,369.6,369.6,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,UHC MGG,UHC MGG,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,VA,VA,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Wellcare MGG,Wellcare MGG,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Bright Health - commercial,Bright Health - commercial,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,369.6,369.6,Bright Health MGG,Bright Health MGG,369.6,,,,,,,case rate,369.6,369.6,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Aetna,Aetna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Aetna MGG,Aetna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,BCBS,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS MGG,BCBS MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Cigna,Cigna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Cigna MGG,Cigna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Humana,Humana,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Humana MGG,Humana MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Optum VA,Optum VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,UHC,UHC,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,UHC MGG,UHC MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,VA,VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Wellcare MGG,Wellcare MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Bright Health - commercial,Bright Health - commercial,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Bright Health MGG,Bright Health MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Aetna,Aetna,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Aetna MGG,Aetna MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,BCBS,BCBS,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,BCBS MGG,BCBS MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Cigna,Cigna,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Cigna MGG,Cigna MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Humana,Humana,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Humana MGG,Humana MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Optum VA,Optum VA,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,UHC,UHC,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,UHC MGG,UHC MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,VA,VA,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Wellcare MGG,Wellcare MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Bright Health - commercial,Bright Health - commercial,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Bright Health MGG,Bright Health MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Aetna,Aetna,110.75,,,,,,,per diem,110.75,110.75,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Aetna MGG,Aetna MGG,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,BCBS,BCBS,110.75,,,,,,,per diem,110.75,110.75,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,BCBS MGG,BCBS MGG,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Cigna,Cigna,110.75,,,,,,,per diem,110.75,110.75,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Cigna MGG,Cigna MGG,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Humana,Humana,110.75,,,,,,,per diem,110.75,110.75,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Humana MGG,Humana MGG,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Optum VA,Optum VA,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,UHC,UHC,110.75,,,,,,,per diem,110.75,110.75,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,UHC MGG,UHC MGG,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,VA,VA,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Wellcare MGG,Wellcare MGG,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Bright Health - commercial,Bright Health - commercial,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,110.75,110.75,Bright Health MGG,Bright Health MGG,110.75,,,,,,,case rate,110.75,110.75,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Aetna,Aetna,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Aetna MGG,Aetna MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,BCBS,BCBS,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,BCBS MGG,BCBS MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Cigna,Cigna,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Cigna MGG,Cigna MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Humana,Humana,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Humana MGG,Humana MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Optum VA,Optum VA,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,UHC,UHC,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,UHC MGG,UHC MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,VA,VA,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Wellcare MGG,Wellcare MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Bright Health - commercial,Bright Health - commercial,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,130.2,130.2,Bright Health MGG,Bright Health MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Aetna,Aetna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Aetna MGG,Aetna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,BCBS,BCBS,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,BCBS MGG,BCBS MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Cigna,Cigna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Cigna MGG,Cigna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Humana,Humana,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Humana MGG,Humana MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Optum VA,Optum VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,UHC,UHC,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,UHC MGG,UHC MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,VA,VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Wellcare MGG,Wellcare MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Bright Health - commercial,Bright Health - commercial,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,113.4,113.4,Bright Health MGG,Bright Health MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Aetna,Aetna,368.55,,,,,,,per diem,368.55,368.55,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Aetna MGG,Aetna MGG,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,BCBS,BCBS,368.55,,,,,,,per diem,368.55,368.55,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,BCBS MGG,BCBS MGG,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Cigna,Cigna,368.55,,,,,,,per diem,368.55,368.55,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Cigna MGG,Cigna MGG,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Humana,Humana,368.55,,,,,,,per diem,368.55,368.55,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Humana MGG,Humana MGG,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Optum VA,Optum VA,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,UHC,UHC,368.55,,,,,,,per diem,368.55,368.55,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,UHC MGG,UHC MGG,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,VA,VA,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Wellcare MGG,Wellcare MGG,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Bright Health - commercial,Bright Health - commercial,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,368.55,368.55,Bright Health MGG,Bright Health MGG,368.55,,,,,,,case rate,368.55,368.55,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Aetna,Aetna,292.32,,,,,,,per diem,292.32,292.32,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Aetna MGG,Aetna MGG,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,BCBS,BCBS,292.32,,,,,,,per diem,292.32,292.32,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,BCBS MGG,BCBS MGG,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Cigna,Cigna,292.32,,,,,,,per diem,292.32,292.32,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Cigna MGG,Cigna MGG,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Humana,Humana,292.32,,,,,,,per diem,292.32,292.32,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Humana MGG,Humana MGG,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Optum VA,Optum VA,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,UHC,UHC,292.32,,,,,,,per diem,292.32,292.32,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,UHC MGG,UHC MGG,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,VA,VA,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Wellcare MGG,Wellcare MGG,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Bright Health - commercial,Bright Health - commercial,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,292.32,292.32,Bright Health MGG,Bright Health MGG,292.32,,,,,,,case rate,292.32,292.32,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Aetna,Aetna,212.64,,,,,,,per diem,212.64,212.64,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Aetna MGG,Aetna MGG,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,BCBS,BCBS,212.64,,,,,,,per diem,212.64,212.64,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,BCBS MGG,BCBS MGG,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Cigna,Cigna,212.64,,,,,,,per diem,212.64,212.64,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Cigna MGG,Cigna MGG,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Humana,Humana,212.64,,,,,,,per diem,212.64,212.64,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Humana MGG,Humana MGG,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Optum VA,Optum VA,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,UHC,UHC,212.64,,,,,,,per diem,212.64,212.64,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,UHC MGG,UHC MGG,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,VA,VA,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Wellcare MGG,Wellcare MGG,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Bright Health - commercial,Bright Health - commercial,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,212.64,212.64,Bright Health MGG,Bright Health MGG,212.64,,,,,,,case rate,212.64,212.64,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Aetna,Aetna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Aetna MGG,Aetna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,BCBS,BCBS,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,BCBS MGG,BCBS MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Cigna,Cigna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Cigna MGG,Cigna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Humana,Humana,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Humana MGG,Humana MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Optum VA,Optum VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,UHC,UHC,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,UHC MGG,UHC MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,VA,VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Wellcare MGG,Wellcare MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Bright Health - commercial,Bright Health - commercial,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,150,150,Bright Health MGG,Bright Health MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Aetna,Aetna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Aetna MGG,Aetna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,BCBS,BCBS,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,BCBS MGG,BCBS MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Cigna,Cigna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Cigna MGG,Cigna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Humana,Humana,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Humana MGG,Humana MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Optum VA,Optum VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,UHC,UHC,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,UHC MGG,UHC MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,VA,VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Wellcare MGG,Wellcare MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Bright Health - commercial,Bright Health - commercial,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,150,150,Bright Health MGG,Bright Health MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Aetna,Aetna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Aetna MGG,Aetna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,BCBS,BCBS,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,BCBS MGG,BCBS MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Cigna,Cigna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Cigna MGG,Cigna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Humana,Humana,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Humana MGG,Humana MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Optum VA,Optum VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,UHC,UHC,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,UHC MGG,UHC MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,VA,VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Wellcare MGG,Wellcare MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Bright Health - commercial,Bright Health - commercial,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Bright Health MGG,Bright Health MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Aetna,Aetna,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Aetna MGG,Aetna MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,BCBS,BCBS,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,BCBS MGG,BCBS MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Cigna,Cigna,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Cigna MGG,Cigna MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Humana,Humana,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Humana MGG,Humana MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Optum VA,Optum VA,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,UHC,UHC,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,UHC MGG,UHC MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,VA,VA,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Wellcare MGG,Wellcare MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Bright Health - commercial,Bright Health - commercial,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,27.18,27.18,Bright Health MGG,Bright Health MGG,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Aetna,Aetna,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Aetna MGG,Aetna MGG,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,BCBS,BCBS,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,BCBS MGG,BCBS MGG,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Cigna,Cigna,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Cigna MGG,Cigna MGG,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Humana,Humana,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Humana MGG,Humana MGG,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Optum VA,Optum VA,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,UHC,UHC,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,UHC MGG,UHC MGG,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,VA,VA,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Wellcare MGG,Wellcare MGG,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Bright Health - commercial,Bright Health - commercial,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,34.61,34.61,Bright Health MGG,Bright Health MGG,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Aetna,Aetna,26.2,,,,,,,per diem,26.2,26.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Aetna MGG,Aetna MGG,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,BCBS,BCBS,26.2,,,,,,,per diem,26.2,26.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,BCBS MGG,BCBS MGG,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Cigna,Cigna,26.2,,,,,,,per diem,26.2,26.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Cigna MGG,Cigna MGG,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Humana,Humana,26.2,,,,,,,per diem,26.2,26.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Humana MGG,Humana MGG,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Optum VA,Optum VA,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,UHC,UHC,26.2,,,,,,,per diem,26.2,26.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,UHC MGG,UHC MGG,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,VA,VA,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Wellcare MGG,Wellcare MGG,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Bright Health - commercial,Bright Health - commercial,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,26.2,26.2,Bright Health MGG,Bright Health MGG,26.2,,,,,,,case rate,26.2,26.2,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Aetna,Aetna,93.71,,,,,,,per diem,93.71,93.71,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Aetna MGG,Aetna MGG,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,BCBS,BCBS,93.71,,,,,,,per diem,93.71,93.71,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,BCBS MGG,BCBS MGG,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Cigna,Cigna,93.71,,,,,,,per diem,93.71,93.71,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Cigna MGG,Cigna MGG,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Humana,Humana,93.71,,,,,,,per diem,93.71,93.71,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Humana MGG,Humana MGG,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Optum VA,Optum VA,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,UHC,UHC,93.71,,,,,,,per diem,93.71,93.71,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,UHC MGG,UHC MGG,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,VA,VA,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Wellcare MGG,Wellcare MGG,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Bright Health - commercial,Bright Health - commercial,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,93.71,93.71,Bright Health MGG,Bright Health MGG,93.71,,,,,,,case rate,93.71,93.71,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Aetna,Aetna,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Aetna MGG,Aetna MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,BCBS,BCBS,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,BCBS MGG,BCBS MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Cigna,Cigna,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Cigna MGG,Cigna MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Humana,Humana,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Humana MGG,Humana MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Optum VA,Optum VA,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,UHC,UHC,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,UHC MGG,UHC MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,VA,VA,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Wellcare MGG,Wellcare MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Bright Health - commercial,Bright Health - commercial,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.56,7.56,Bright Health MGG,Bright Health MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Aetna,Aetna,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Aetna MGG,Aetna MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,BCBS,BCBS,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,BCBS MGG,BCBS MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Cigna,Cigna,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Cigna MGG,Cigna MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Humana,Humana,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Humana MGG,Humana MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Optum VA,Optum VA,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,UHC,UHC,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,UHC MGG,UHC MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,VA,VA,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Wellcare MGG,Wellcare MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Bright Health - commercial,Bright Health - commercial,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,13.4,13.4,Bright Health MGG,Bright Health MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Aetna,Aetna,17.99,,,,,,,per diem,17.99,17.99,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Aetna MGG,Aetna MGG,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,BCBS,BCBS,17.99,,,,,,,per diem,17.99,17.99,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,BCBS MGG,BCBS MGG,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Cigna,Cigna,17.99,,,,,,,per diem,17.99,17.99,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Cigna MGG,Cigna MGG,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Humana,Humana,17.99,,,,,,,per diem,17.99,17.99,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Humana MGG,Humana MGG,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Optum VA,Optum VA,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,UHC,UHC,17.99,,,,,,,per diem,17.99,17.99,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,UHC MGG,UHC MGG,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,VA,VA,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Wellcare MGG,Wellcare MGG,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Bright Health - commercial,Bright Health - commercial,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,17.99,17.99,Bright Health MGG,Bright Health MGG,17.99,,,,,,,case rate,17.99,17.99,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Aetna,Aetna,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Aetna MGG,Aetna MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,BCBS,BCBS,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,BCBS MGG,BCBS MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Cigna,Cigna,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Cigna MGG,Cigna MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Humana,Humana,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Humana MGG,Humana MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Optum VA,Optum VA,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,UHC,UHC,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,UHC MGG,UHC MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,VA,VA,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Wellcare MGG,Wellcare MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Bright Health - commercial,Bright Health - commercial,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,37.2,37.2,Bright Health MGG,Bright Health MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Aetna,Aetna,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Aetna MGG,Aetna MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,BCBS,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS MGG,BCBS MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Cigna,Cigna,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Cigna MGG,Cigna MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Humana,Humana,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Humana MGG,Humana MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Optum VA,Optum VA,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,UHC,UHC,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,UHC MGG,UHC MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,VA,VA,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Wellcare MGG,Wellcare MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Bright Health - commercial,Bright Health - commercial,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,Bright Health MGG,Bright Health MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Aetna,Aetna,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Aetna MGG,Aetna MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,BCBS,BCBS,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,BCBS MGG,BCBS MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Cigna,Cigna,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Cigna MGG,Cigna MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Humana,Humana,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Humana MGG,Humana MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Optum VA,Optum VA,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,UHC,UHC,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,UHC MGG,UHC MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,VA,VA,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Wellcare MGG,Wellcare MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Bright Health - commercial,Bright Health - commercial,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,40.82,40.82,Bright Health MGG,Bright Health MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Aetna,Aetna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Aetna MGG,Aetna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,BCBS,BCBS,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,BCBS MGG,BCBS MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Cigna,Cigna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Cigna MGG,Cigna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Humana,Humana,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Humana MGG,Humana MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Optum VA,Optum VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,UHC,UHC,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,UHC MGG,UHC MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,VA,VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Wellcare MGG,Wellcare MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Bright Health - commercial,Bright Health - commercial,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,270,270,Bright Health MGG,Bright Health MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Aetna,Aetna,85.02,,,,,,,per diem,85.02,85.02,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Aetna MGG,Aetna MGG,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,BCBS,BCBS,85.02,,,,,,,per diem,85.02,85.02,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,BCBS MGG,BCBS MGG,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Cigna,Cigna,85.02,,,,,,,per diem,85.02,85.02,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Cigna MGG,Cigna MGG,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Humana,Humana,85.02,,,,,,,per diem,85.02,85.02,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Humana MGG,Humana MGG,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Optum VA,Optum VA,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,UHC,UHC,85.02,,,,,,,per diem,85.02,85.02,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,UHC MGG,UHC MGG,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,VA,VA,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Wellcare MGG,Wellcare MGG,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Bright Health - commercial,Bright Health - commercial,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,85.02,85.02,Bright Health MGG,Bright Health MGG,85.02,,,,,,,case rate,85.02,85.02,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Aetna,Aetna,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Aetna MGG,Aetna MGG,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,BCBS,BCBS,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,BCBS MGG,BCBS MGG,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Cigna,Cigna,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Cigna MGG,Cigna MGG,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Humana,Humana,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Humana MGG,Humana MGG,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Optum VA,Optum VA,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,UHC,UHC,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,UHC MGG,UHC MGG,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,VA,VA,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Wellcare MGG,Wellcare MGG,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Bright Health - commercial,Bright Health - commercial,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,70.8,70.8,Bright Health MGG,Bright Health MGG,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Aetna,Aetna,186.36,,,,,,,per diem,186.36,186.36,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Aetna MGG,Aetna MGG,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,BCBS,BCBS,186.36,,,,,,,per diem,186.36,186.36,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,BCBS MGG,BCBS MGG,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Cigna,Cigna,186.36,,,,,,,per diem,186.36,186.36,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Cigna MGG,Cigna MGG,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Humana,Humana,186.36,,,,,,,per diem,186.36,186.36,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Humana MGG,Humana MGG,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Optum VA,Optum VA,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,UHC,UHC,186.36,,,,,,,per diem,186.36,186.36,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,UHC MGG,UHC MGG,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,VA,VA,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Wellcare MGG,Wellcare MGG,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Bright Health - commercial,Bright Health - commercial,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,186.36,186.36,Bright Health MGG,Bright Health MGG,186.36,,,,,,,case rate,186.36,186.36,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Aetna,Aetna,21.48,,,,,,,per diem,21.48,21.48,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Aetna MGG,Aetna MGG,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,BCBS,BCBS,21.48,,,,,,,per diem,21.48,21.48,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,BCBS MGG,BCBS MGG,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Cigna,Cigna,21.48,,,,,,,per diem,21.48,21.48,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Cigna MGG,Cigna MGG,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Humana,Humana,21.48,,,,,,,per diem,21.48,21.48,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Humana MGG,Humana MGG,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Optum VA,Optum VA,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,UHC,UHC,21.48,,,,,,,per diem,21.48,21.48,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,UHC MGG,UHC MGG,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,VA,VA,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Wellcare MGG,Wellcare MGG,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Bright Health - commercial,Bright Health - commercial,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,21.48,21.48,Bright Health MGG,Bright Health MGG,21.48,,,,,,,case rate,21.48,21.48,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Aetna,Aetna,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Aetna MGG,Aetna MGG,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,BCBS,BCBS,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,BCBS MGG,BCBS MGG,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Cigna,Cigna,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Cigna MGG,Cigna MGG,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Humana,Humana,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Humana MGG,Humana MGG,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Optum VA,Optum VA,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,UHC,UHC,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,UHC MGG,UHC MGG,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,VA,VA,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Wellcare MGG,Wellcare MGG,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Bright Health - commercial,Bright Health - commercial,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,76.26,76.26,Bright Health MGG,Bright Health MGG,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Aetna,Aetna,90.63,,,,,,,per diem,90.63,90.63,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Aetna MGG,Aetna MGG,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,BCBS,BCBS,90.63,,,,,,,per diem,90.63,90.63,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,BCBS MGG,BCBS MGG,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Cigna,Cigna,90.63,,,,,,,per diem,90.63,90.63,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Cigna MGG,Cigna MGG,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Humana,Humana,90.63,,,,,,,per diem,90.63,90.63,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Humana MGG,Humana MGG,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Optum VA,Optum VA,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,UHC,UHC,90.63,,,,,,,per diem,90.63,90.63,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,UHC MGG,UHC MGG,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,VA,VA,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Wellcare MGG,Wellcare MGG,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Bright Health - commercial,Bright Health - commercial,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,90.63,90.63,Bright Health MGG,Bright Health MGG,90.63,,,,,,,case rate,90.63,90.63,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Aetna,Aetna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Aetna MGG,Aetna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,BCBS,BCBS,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,BCBS MGG,BCBS MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Cigna,Cigna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Cigna MGG,Cigna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Humana,Humana,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Humana MGG,Humana MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Optum VA,Optum VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,UHC,UHC,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,UHC MGG,UHC MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,VA,VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Wellcare MGG,Wellcare MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Bright Health - commercial,Bright Health - commercial,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,270,270,Bright Health MGG,Bright Health MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Aetna,Aetna,42.88,,,,,,,per diem,42.88,42.88,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Aetna MGG,Aetna MGG,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,BCBS,BCBS,42.88,,,,,,,per diem,42.88,42.88,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,BCBS MGG,BCBS MGG,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Cigna,Cigna,42.88,,,,,,,per diem,42.88,42.88,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Cigna MGG,Cigna MGG,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Humana,Humana,42.88,,,,,,,per diem,42.88,42.88,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Humana MGG,Humana MGG,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Optum VA,Optum VA,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,UHC,UHC,42.88,,,,,,,per diem,42.88,42.88,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,UHC MGG,UHC MGG,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,VA,VA,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Wellcare MGG,Wellcare MGG,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Bright Health - commercial,Bright Health - commercial,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,42.88,42.88,Bright Health MGG,Bright Health MGG,42.88,,,,,,,case rate,42.88,42.88,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Aetna,Aetna,26.5,,,,,,,per diem,26.5,26.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Aetna MGG,Aetna MGG,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,BCBS,BCBS,26.5,,,,,,,per diem,26.5,26.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,BCBS MGG,BCBS MGG,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Cigna,Cigna,26.5,,,,,,,per diem,26.5,26.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Cigna MGG,Cigna MGG,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Humana,Humana,26.5,,,,,,,per diem,26.5,26.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Humana MGG,Humana MGG,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Optum VA,Optum VA,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,UHC,UHC,26.5,,,,,,,per diem,26.5,26.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,UHC MGG,UHC MGG,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,VA,VA,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Wellcare MGG,Wellcare MGG,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Bright Health - commercial,Bright Health - commercial,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,26.5,26.5,Bright Health MGG,Bright Health MGG,26.5,,,,,,,case rate,26.5,26.5,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Aetna,Aetna,117.94,,,,,,,per diem,117.94,117.94,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Aetna MGG,Aetna MGG,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,BCBS,BCBS,117.94,,,,,,,per diem,117.94,117.94,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,BCBS MGG,BCBS MGG,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Cigna,Cigna,117.94,,,,,,,per diem,117.94,117.94,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Cigna MGG,Cigna MGG,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Humana,Humana,117.94,,,,,,,per diem,117.94,117.94,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Humana MGG,Humana MGG,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Optum VA,Optum VA,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,UHC,UHC,117.94,,,,,,,per diem,117.94,117.94,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,UHC MGG,UHC MGG,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,VA,VA,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Wellcare MGG,Wellcare MGG,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Bright Health - commercial,Bright Health - commercial,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,117.94,117.94,Bright Health MGG,Bright Health MGG,117.94,,,,,,,case rate,117.94,117.94,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Aetna,Aetna,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Aetna MGG,Aetna MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,BCBS,BCBS,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,BCBS MGG,BCBS MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Cigna,Cigna,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Cigna MGG,Cigna MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Humana,Humana,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Humana MGG,Humana MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Optum VA,Optum VA,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,UHC,UHC,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,UHC MGG,UHC MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,VA,VA,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Wellcare MGG,Wellcare MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Bright Health - commercial,Bright Health - commercial,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,38.51,38.51,Bright Health MGG,Bright Health MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Aetna,Aetna,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Aetna MGG,Aetna MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,BCBS,BCBS,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,BCBS MGG,BCBS MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Cigna,Cigna,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Cigna MGG,Cigna MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Humana,Humana,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Humana MGG,Humana MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Optum VA,Optum VA,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,UHC,UHC,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,UHC MGG,UHC MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,VA,VA,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Wellcare MGG,Wellcare MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Bright Health - commercial,Bright Health - commercial,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.28,8.28,Bright Health MGG,Bright Health MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Aetna,Aetna,36.05,,,,,,,per diem,36.05,36.05,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Aetna MGG,Aetna MGG,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,BCBS,BCBS,36.05,,,,,,,per diem,36.05,36.05,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,BCBS MGG,BCBS MGG,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Cigna,Cigna,36.05,,,,,,,per diem,36.05,36.05,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Cigna MGG,Cigna MGG,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Humana,Humana,36.05,,,,,,,per diem,36.05,36.05,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Humana MGG,Humana MGG,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Optum VA,Optum VA,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,UHC,UHC,36.05,,,,,,,per diem,36.05,36.05,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,UHC MGG,UHC MGG,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,VA,VA,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Wellcare MGG,Wellcare MGG,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Bright Health - commercial,Bright Health - commercial,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR -L  ,33130039,CDM,270,RC,,,,,,Inpatient,,,36.05,36.05,Bright Health MGG,Bright Health MGG,36.05,,,,,,,case rate,36.05,36.05,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Aetna,Aetna,656.37,,,,,,,per diem,656.37,656.37,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Aetna MGG,Aetna MGG,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,BCBS,BCBS,656.37,,,,,,,per diem,656.37,656.37,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,BCBS MGG,BCBS MGG,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Cigna,Cigna,656.37,,,,,,,per diem,656.37,656.37,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Cigna MGG,Cigna MGG,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Humana,Humana,656.37,,,,,,,per diem,656.37,656.37,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Humana MGG,Humana MGG,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Optum VA,Optum VA,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,UHC,UHC,656.37,,,,,,,per diem,656.37,656.37,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,UHC MGG,UHC MGG,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,VA,VA,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Wellcare MGG,Wellcare MGG,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Bright Health - commercial,Bright Health - commercial,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,656.37,656.37,Bright Health MGG,Bright Health MGG,656.37,,,,,,,case rate,656.37,656.37,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Aetna,Aetna,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Aetna MGG,Aetna MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,BCBS,BCBS,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,BCBS MGG,BCBS MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Cigna,Cigna,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Cigna MGG,Cigna MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Humana,Humana,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Humana MGG,Humana MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Optum VA,Optum VA,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,UHC,UHC,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,UHC MGG,UHC MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,VA,VA,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Wellcare MGG,Wellcare MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Bright Health - commercial,Bright Health - commercial,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Bright Health MGG,Bright Health MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Aetna,Aetna,290.96,,,,,,,per diem,290.96,290.96,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Aetna MGG,Aetna MGG,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,BCBS,BCBS,290.96,,,,,,,per diem,290.96,290.96,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,BCBS MGG,BCBS MGG,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Cigna,Cigna,290.96,,,,,,,per diem,290.96,290.96,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Cigna MGG,Cigna MGG,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Humana,Humana,290.96,,,,,,,per diem,290.96,290.96,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Humana MGG,Humana MGG,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Optum VA,Optum VA,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,UHC,UHC,290.96,,,,,,,per diem,290.96,290.96,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,UHC MGG,UHC MGG,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,VA,VA,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Wellcare MGG,Wellcare MGG,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Bright Health - commercial,Bright Health - commercial,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,290.96,290.96,Bright Health MGG,Bright Health MGG,290.96,,,,,,,case rate,290.96,290.96,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Aetna,Aetna,1368.33,,,,,,,per diem,1368.33,1368.33,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Aetna MGG,Aetna MGG,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,BCBS,BCBS,1368.33,,,,,,,per diem,1368.33,1368.33,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,BCBS MGG,BCBS MGG,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Cigna,Cigna,1368.33,,,,,,,per diem,1368.33,1368.33,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Cigna MGG,Cigna MGG,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Humana,Humana,1368.33,,,,,,,per diem,1368.33,1368.33,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Humana MGG,Humana MGG,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Optum VA,Optum VA,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,UHC,UHC,1368.33,,,,,,,per diem,1368.33,1368.33,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,UHC MGG,UHC MGG,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,VA,VA,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Wellcare MGG,Wellcare MGG,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Bright Health - commercial,Bright Health - commercial,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1368.33,1368.33,Bright Health MGG,Bright Health MGG,1368.33,,,,,,,case rate,1368.33,1368.33,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Aetna,Aetna,3.83,,,,,,,per diem,3.83,3.83,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Aetna MGG,Aetna MGG,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,BCBS,BCBS,3.83,,,,,,,per diem,3.83,3.83,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,BCBS MGG,BCBS MGG,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Cigna,Cigna,3.83,,,,,,,per diem,3.83,3.83,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Cigna MGG,Cigna MGG,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Humana,Humana,3.83,,,,,,,per diem,3.83,3.83,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Humana MGG,Humana MGG,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Optum VA,Optum VA,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,UHC,UHC,3.83,,,,,,,per diem,3.83,3.83,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,UHC MGG,UHC MGG,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,VA,VA,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Wellcare MGG,Wellcare MGG,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Bright Health - commercial,Bright Health - commercial,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,3.83,3.83,Bright Health MGG,Bright Health MGG,3.83,,,,,,,case rate,3.83,3.83,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Aetna,Aetna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Aetna MGG,Aetna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,BCBS,BCBS,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,BCBS MGG,BCBS MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Cigna,Cigna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Cigna MGG,Cigna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Humana,Humana,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Humana MGG,Humana MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Optum VA,Optum VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,UHC,UHC,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,UHC MGG,UHC MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,VA,VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Wellcare MGG,Wellcare MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Bright Health - commercial,Bright Health - commercial,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.61,5.61,Bright Health MGG,Bright Health MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Aetna,Aetna,122.15,,,,,,,per diem,122.15,122.15,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Aetna MGG,Aetna MGG,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,BCBS,BCBS,122.15,,,,,,,per diem,122.15,122.15,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,BCBS MGG,BCBS MGG,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Cigna,Cigna,122.15,,,,,,,per diem,122.15,122.15,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Cigna MGG,Cigna MGG,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Humana,Humana,122.15,,,,,,,per diem,122.15,122.15,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Humana MGG,Humana MGG,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Optum VA,Optum VA,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,UHC,UHC,122.15,,,,,,,per diem,122.15,122.15,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,UHC MGG,UHC MGG,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,VA,VA,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Wellcare MGG,Wellcare MGG,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Bright Health - commercial,Bright Health - commercial,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,122.15,122.15,Bright Health MGG,Bright Health MGG,122.15,,,,,,,case rate,122.15,122.15,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Aetna,Aetna,235.11,,,,,,,per diem,235.11,235.11,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Aetna MGG,Aetna MGG,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,BCBS,BCBS,235.11,,,,,,,per diem,235.11,235.11,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,BCBS MGG,BCBS MGG,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Cigna,Cigna,235.11,,,,,,,per diem,235.11,235.11,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Cigna MGG,Cigna MGG,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Humana,Humana,235.11,,,,,,,per diem,235.11,235.11,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Humana MGG,Humana MGG,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Optum VA,Optum VA,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,UHC,UHC,235.11,,,,,,,per diem,235.11,235.11,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,UHC MGG,UHC MGG,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,VA,VA,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Wellcare MGG,Wellcare MGG,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Bright Health - commercial,Bright Health - commercial,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,235.11,235.11,Bright Health MGG,Bright Health MGG,235.11,,,,,,,case rate,235.11,235.11,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Aetna,Aetna,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Aetna MGG,Aetna MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,BCBS,BCBS,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,BCBS MGG,BCBS MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Cigna,Cigna,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Cigna MGG,Cigna MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Humana,Humana,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Humana MGG,Humana MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Optum VA,Optum VA,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,UHC,UHC,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,UHC MGG,UHC MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,VA,VA,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Wellcare MGG,Wellcare MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Bright Health - commercial,Bright Health - commercial,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,158.82,158.82,Bright Health MGG,Bright Health MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Aetna,Aetna,23.97,,,,,,,per diem,23.97,23.97,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Aetna MGG,Aetna MGG,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,BCBS,BCBS,23.97,,,,,,,per diem,23.97,23.97,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,BCBS MGG,BCBS MGG,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Cigna,Cigna,23.97,,,,,,,per diem,23.97,23.97,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Cigna MGG,Cigna MGG,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Humana,Humana,23.97,,,,,,,per diem,23.97,23.97,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Humana MGG,Humana MGG,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Optum VA,Optum VA,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,UHC,UHC,23.97,,,,,,,per diem,23.97,23.97,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,UHC MGG,UHC MGG,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,VA,VA,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Wellcare MGG,Wellcare MGG,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Bright Health - commercial,Bright Health - commercial,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,23.97,23.97,Bright Health MGG,Bright Health MGG,23.97,,,,,,,case rate,23.97,23.97,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Aetna,Aetna,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Aetna MGG,Aetna MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,BCBS,BCBS,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,BCBS MGG,BCBS MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Cigna,Cigna,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Cigna MGG,Cigna MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Humana,Humana,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Humana MGG,Humana MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Optum VA,Optum VA,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,UHC,UHC,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,UHC MGG,UHC MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,VA,VA,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Wellcare MGG,Wellcare MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Bright Health - commercial,Bright Health - commercial,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,12.75,12.75,Bright Health MGG,Bright Health MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Aetna,Aetna,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Aetna MGG,Aetna MGG,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,BCBS,BCBS,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,BCBS MGG,BCBS MGG,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Cigna,Cigna,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Cigna MGG,Cigna MGG,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Humana,Humana,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Humana MGG,Humana MGG,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Optum VA,Optum VA,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,UHC,UHC,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,UHC MGG,UHC MGG,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,VA,VA,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Wellcare MGG,Wellcare MGG,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Bright Health - commercial,Bright Health - commercial,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,127.25,127.25,Bright Health MGG,Bright Health MGG,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Aetna,Aetna,205.28,,,,,,,per diem,205.28,205.28,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Aetna MGG,Aetna MGG,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,BCBS,BCBS,205.28,,,,,,,per diem,205.28,205.28,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,BCBS MGG,BCBS MGG,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Cigna,Cigna,205.28,,,,,,,per diem,205.28,205.28,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Cigna MGG,Cigna MGG,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Humana,Humana,205.28,,,,,,,per diem,205.28,205.28,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Humana MGG,Humana MGG,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Optum VA,Optum VA,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,UHC,UHC,205.28,,,,,,,per diem,205.28,205.28,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,UHC MGG,UHC MGG,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,VA,VA,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Wellcare MGG,Wellcare MGG,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Bright Health - commercial,Bright Health - commercial,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,205.28,205.28,Bright Health MGG,Bright Health MGG,205.28,,,,,,,case rate,205.28,205.28,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Aetna,Aetna,43.61,,,,,,,per diem,43.61,43.61,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Aetna MGG,Aetna MGG,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,BCBS,BCBS,43.61,,,,,,,per diem,43.61,43.61,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,BCBS MGG,BCBS MGG,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Cigna,Cigna,43.61,,,,,,,per diem,43.61,43.61,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Cigna MGG,Cigna MGG,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Humana,Humana,43.61,,,,,,,per diem,43.61,43.61,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Humana MGG,Humana MGG,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Optum VA,Optum VA,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,UHC,UHC,43.61,,,,,,,per diem,43.61,43.61,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,UHC MGG,UHC MGG,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,VA,VA,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Wellcare MGG,Wellcare MGG,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Bright Health - commercial,Bright Health - commercial,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,43.61,43.61,Bright Health MGG,Bright Health MGG,43.61,,,,,,,case rate,43.61,43.61,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Aetna,Aetna,330.74,,,,,,,per diem,330.74,330.74,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Aetna MGG,Aetna MGG,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,BCBS,BCBS,330.74,,,,,,,per diem,330.74,330.74,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,BCBS MGG,BCBS MGG,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Cigna,Cigna,330.74,,,,,,,per diem,330.74,330.74,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Cigna MGG,Cigna MGG,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Humana,Humana,330.74,,,,,,,per diem,330.74,330.74,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Humana MGG,Humana MGG,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Optum VA,Optum VA,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,UHC,UHC,330.74,,,,,,,per diem,330.74,330.74,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,UHC MGG,UHC MGG,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,VA,VA,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Wellcare MGG,Wellcare MGG,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Bright Health - commercial,Bright Health - commercial,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,330.74,330.74,Bright Health MGG,Bright Health MGG,330.74,,,,,,,case rate,330.74,330.74,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Aetna,Aetna,197.37,,,,,,,per diem,197.37,197.37,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Aetna MGG,Aetna MGG,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,BCBS,BCBS,197.37,,,,,,,per diem,197.37,197.37,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,BCBS MGG,BCBS MGG,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Cigna,Cigna,197.37,,,,,,,per diem,197.37,197.37,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Cigna MGG,Cigna MGG,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Humana,Humana,197.37,,,,,,,per diem,197.37,197.37,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Humana MGG,Humana MGG,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Optum VA,Optum VA,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,UHC,UHC,197.37,,,,,,,per diem,197.37,197.37,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,UHC MGG,UHC MGG,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,VA,VA,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Wellcare MGG,Wellcare MGG,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Bright Health - commercial,Bright Health - commercial,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,197.37,197.37,Bright Health MGG,Bright Health MGG,197.37,,,,,,,case rate,197.37,197.37,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Aetna,Aetna,242.4,,,,,,,per diem,242.4,242.4,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Aetna MGG,Aetna MGG,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,BCBS,BCBS,242.4,,,,,,,per diem,242.4,242.4,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,BCBS MGG,BCBS MGG,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Cigna,Cigna,242.4,,,,,,,per diem,242.4,242.4,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Cigna MGG,Cigna MGG,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Humana,Humana,242.4,,,,,,,per diem,242.4,242.4,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Humana MGG,Humana MGG,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Optum VA,Optum VA,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,UHC,UHC,242.4,,,,,,,per diem,242.4,242.4,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,UHC MGG,UHC MGG,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,VA,VA,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Wellcare MGG,Wellcare MGG,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Bright Health - commercial,Bright Health - commercial,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,242.4,242.4,Bright Health MGG,Bright Health MGG,242.4,,,,,,,case rate,242.4,242.4,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Aetna,Aetna,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Aetna MGG,Aetna MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,BCBS,BCBS,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,BCBS MGG,BCBS MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Cigna,Cigna,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Cigna MGG,Cigna MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Humana,Humana,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Humana MGG,Humana MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Optum VA,Optum VA,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,UHC,UHC,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,UHC MGG,UHC MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,VA,VA,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Wellcare MGG,Wellcare MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Bright Health - commercial,Bright Health - commercial,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,31.11,31.11,Bright Health MGG,Bright Health MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Aetna,Aetna,32.85,,,,,,,per diem,32.85,32.85,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Aetna MGG,Aetna MGG,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,BCBS,BCBS,32.85,,,,,,,per diem,32.85,32.85,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,BCBS MGG,BCBS MGG,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Cigna,Cigna,32.85,,,,,,,per diem,32.85,32.85,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Cigna MGG,Cigna MGG,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Humana,Humana,32.85,,,,,,,per diem,32.85,32.85,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Humana MGG,Humana MGG,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Optum VA,Optum VA,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,UHC,UHC,32.85,,,,,,,per diem,32.85,32.85,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,UHC MGG,UHC MGG,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,VA,VA,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Wellcare MGG,Wellcare MGG,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Bright Health - commercial,Bright Health - commercial,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,32.85,32.85,Bright Health MGG,Bright Health MGG,32.85,,,,,,,case rate,32.85,32.85,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Aetna,Aetna,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Aetna MGG,Aetna MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,BCBS,BCBS,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,BCBS MGG,BCBS MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Cigna,Cigna,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Cigna MGG,Cigna MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Humana,Humana,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Humana MGG,Humana MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Optum VA,Optum VA,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,UHC,UHC,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,UHC MGG,UHC MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,VA,VA,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Wellcare MGG,Wellcare MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Bright Health - commercial,Bright Health - commercial,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,177.48,177.48,Bright Health MGG,Bright Health MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Aetna,Aetna,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Aetna MGG,Aetna MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,BCBS,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,BCBS MGG,BCBS MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Cigna,Cigna,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Cigna MGG,Cigna MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Humana,Humana,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Humana MGG,Humana MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Optum VA,Optum VA,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,UHC,UHC,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,UHC MGG,UHC MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,VA,VA,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Wellcare MGG,Wellcare MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Bright Health - commercial,Bright Health - commercial,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,80.58,80.58,Bright Health MGG,Bright Health MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Aetna,Aetna,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Aetna MGG,Aetna MGG,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,BCBS,BCBS,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,BCBS MGG,BCBS MGG,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Cigna,Cigna,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Cigna MGG,Cigna MGG,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Humana,Humana,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Humana MGG,Humana MGG,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Optum VA,Optum VA,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,UHC,UHC,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,UHC MGG,UHC MGG,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,VA,VA,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Wellcare MGG,Wellcare MGG,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Bright Health - commercial,Bright Health - commercial,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,237.92,237.92,Bright Health MGG,Bright Health MGG,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Aetna,Aetna,268.52,,,,,,,per diem,268.52,268.52,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Aetna MGG,Aetna MGG,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,BCBS,BCBS,268.52,,,,,,,per diem,268.52,268.52,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,BCBS MGG,BCBS MGG,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Cigna,Cigna,268.52,,,,,,,per diem,268.52,268.52,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Cigna MGG,Cigna MGG,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Humana,Humana,268.52,,,,,,,per diem,268.52,268.52,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Humana MGG,Humana MGG,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Optum VA,Optum VA,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,UHC,UHC,268.52,,,,,,,per diem,268.52,268.52,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,UHC MGG,UHC MGG,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,VA,VA,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Wellcare MGG,Wellcare MGG,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Bright Health - commercial,Bright Health - commercial,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,268.52,268.52,Bright Health MGG,Bright Health MGG,268.52,,,,,,,case rate,268.52,268.52,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Aetna,Aetna,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Aetna MGG,Aetna MGG,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,BCBS,BCBS,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,BCBS MGG,BCBS MGG,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Cigna,Cigna,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Cigna MGG,Cigna MGG,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Humana,Humana,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Humana MGG,Humana MGG,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Optum VA,Optum VA,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,UHC,UHC,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,UHC MGG,UHC MGG,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,VA,VA,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Wellcare MGG,Wellcare MGG,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Bright Health - commercial,Bright Health - commercial,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,32.7,32.7,Bright Health MGG,Bright Health MGG,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Aetna,Aetna,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Aetna MGG,Aetna MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,BCBS,BCBS,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,BCBS MGG,BCBS MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Cigna,Cigna,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Cigna MGG,Cigna MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Humana,Humana,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Humana MGG,Humana MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Optum VA,Optum VA,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,UHC,UHC,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,UHC MGG,UHC MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,VA,VA,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Wellcare MGG,Wellcare MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Bright Health - commercial,Bright Health - commercial,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Bright Health MGG,Bright Health MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Aetna,Aetna,124.98,,,,,,,per diem,124.98,124.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Aetna MGG,Aetna MGG,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,BCBS,BCBS,124.98,,,,,,,per diem,124.98,124.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,BCBS MGG,BCBS MGG,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Cigna,Cigna,124.98,,,,,,,per diem,124.98,124.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Cigna MGG,Cigna MGG,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Humana,Humana,124.98,,,,,,,per diem,124.98,124.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Humana MGG,Humana MGG,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Optum VA,Optum VA,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,UHC,UHC,124.98,,,,,,,per diem,124.98,124.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,UHC MGG,UHC MGG,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,VA,VA,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Wellcare MGG,Wellcare MGG,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Bright Health - commercial,Bright Health - commercial,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,124.98,124.98,Bright Health MGG,Bright Health MGG,124.98,,,,,,,case rate,124.98,124.98,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna,Aetna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna MGG,Aetna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS,BCBS,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS MGG,BCBS MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna,Cigna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna MGG,Cigna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana,Humana,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana MGG,Humana MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Optum VA,Optum VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC,UHC,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC MGG,UHC MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,VA,VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Wellcare MGG,Wellcare MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health - commercial,Bright Health - commercial,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health MGG,Bright Health MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Aetna,Aetna,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Aetna MGG,Aetna MGG,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,BCBS,BCBS,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,BCBS MGG,BCBS MGG,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Cigna,Cigna,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Cigna MGG,Cigna MGG,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Humana,Humana,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Humana MGG,Humana MGG,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Optum VA,Optum VA,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,UHC,UHC,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,UHC MGG,UHC MGG,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,VA,VA,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Wellcare MGG,Wellcare MGG,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Bright Health - commercial,Bright Health - commercial,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.16,16.16,Bright Health MGG,Bright Health MGG,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Aetna,Aetna,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Aetna MGG,Aetna MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,BCBS,BCBS,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,BCBS MGG,BCBS MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Cigna,Cigna,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Cigna MGG,Cigna MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Humana,Humana,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Humana MGG,Humana MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Optum VA,Optum VA,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,UHC,UHC,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,UHC MGG,UHC MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,VA,VA,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Wellcare MGG,Wellcare MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Bright Health - commercial,Bright Health - commercial,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Bright Health MGG,Bright Health MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Aetna,Aetna,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Aetna MGG,Aetna MGG,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,BCBS,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS MGG,BCBS MGG,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Cigna,Cigna,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Cigna MGG,Cigna MGG,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Humana,Humana,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Humana MGG,Humana MGG,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Optum VA,Optum VA,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,UHC,UHC,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,UHC MGG,UHC MGG,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,VA,VA,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Wellcare MGG,Wellcare MGG,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Bright Health - commercial,Bright Health - commercial,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,Bright Health MGG,Bright Health MGG,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Aetna,Aetna,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Aetna MGG,Aetna MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,BCBS,BCBS,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,BCBS MGG,BCBS MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Cigna,Cigna,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Cigna MGG,Cigna MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Humana,Humana,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Humana MGG,Humana MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Optum VA,Optum VA,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,UHC,UHC,17.76,,,,,,,per diem,17.76,17.76,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,UHC MGG,UHC MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,VA,VA,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Wellcare MGG,Wellcare MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Bright Health - commercial,Bright Health - commercial,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,17.76,17.76,Bright Health MGG,Bright Health MGG,17.76,,,,,,,case rate,17.76,17.76,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna,Aetna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna MGG,Aetna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS,BCBS,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS MGG,BCBS MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna,Cigna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna MGG,Cigna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana,Humana,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana MGG,Humana MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Optum VA,Optum VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC,UHC,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC MGG,UHC MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,VA,VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Wellcare MGG,Wellcare MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health - commercial,Bright Health - commercial,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health MGG,Bright Health MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Aetna,Aetna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Aetna MGG,Aetna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,BCBS,BCBS,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,BCBS MGG,BCBS MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Cigna,Cigna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Cigna MGG,Cigna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Humana,Humana,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Humana MGG,Humana MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Optum VA,Optum VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,UHC,UHC,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,UHC MGG,UHC MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,VA,VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Wellcare MGG,Wellcare MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Bright Health - commercial,Bright Health - commercial,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,73.44,73.44,Bright Health MGG,Bright Health MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna,Aetna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna MGG,Aetna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS,BCBS,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS MGG,BCBS MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna,Cigna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna MGG,Cigna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana,Humana,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana MGG,Humana MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Optum VA,Optum VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC,UHC,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC MGG,UHC MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,VA,VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Wellcare MGG,Wellcare MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health - commercial,Bright Health - commercial,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health MGG,Bright Health MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna,Aetna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna MGG,Aetna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS,BCBS,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS MGG,BCBS MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna,Cigna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna MGG,Cigna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana,Humana,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana MGG,Humana MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Optum VA,Optum VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC,UHC,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC MGG,UHC MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,VA,VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Wellcare MGG,Wellcare MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health - commercial,Bright Health - commercial,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health MGG,Bright Health MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna,Aetna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna MGG,Aetna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS,BCBS,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS MGG,BCBS MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna,Cigna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna MGG,Cigna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana,Humana,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana MGG,Humana MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Optum VA,Optum VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC,UHC,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC MGG,UHC MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,VA,VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Wellcare MGG,Wellcare MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health - commercial,Bright Health - commercial,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health MGG,Bright Health MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna,Aetna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Aetna MGG,Aetna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS,BCBS,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,BCBS MGG,BCBS MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna,Cigna,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Cigna MGG,Cigna MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana,Humana,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Humana MGG,Humana MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Optum VA,Optum VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC,UHC,73.47,,,,,,,per diem,73.47,73.47,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,UHC MGG,UHC MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,VA,VA,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Wellcare MGG,Wellcare MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health - commercial,Bright Health - commercial,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,73.47,73.47,Bright Health MGG,Bright Health MGG,73.47,,,,,,,case rate,73.47,73.47,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Aetna,Aetna,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Aetna MGG,Aetna MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,BCBS,BCBS,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,BCBS MGG,BCBS MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Cigna,Cigna,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Cigna MGG,Cigna MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Humana,Humana,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Humana MGG,Humana MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Optum VA,Optum VA,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,UHC,UHC,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,UHC MGG,UHC MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,VA,VA,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Wellcare MGG,Wellcare MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Bright Health - commercial,Bright Health - commercial,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Bright Health MGG,Bright Health MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Aetna,Aetna,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Aetna MGG,Aetna MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,BCBS,BCBS,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,BCBS MGG,BCBS MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Cigna,Cigna,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Cigna MGG,Cigna MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Humana,Humana,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Humana MGG,Humana MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Optum VA,Optum VA,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,UHC,UHC,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,UHC MGG,UHC MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,VA,VA,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Wellcare MGG,Wellcare MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Bright Health - commercial,Bright Health - commercial,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Bright Health MGG,Bright Health MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Aetna,Aetna,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Aetna MGG,Aetna MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,BCBS,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS MGG,BCBS MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Cigna,Cigna,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Cigna MGG,Cigna MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Humana,Humana,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Humana MGG,Humana MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Optum VA,Optum VA,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,UHC,UHC,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,UHC MGG,UHC MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,VA,VA,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Wellcare MGG,Wellcare MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Bright Health - commercial,Bright Health - commercial,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Bright Health MGG,Bright Health MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Aetna,Aetna,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Aetna MGG,Aetna MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,BCBS,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS MGG,BCBS MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Cigna,Cigna,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Cigna MGG,Cigna MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Humana,Humana,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Humana MGG,Humana MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Optum VA,Optum VA,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,UHC,UHC,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,UHC MGG,UHC MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,VA,VA,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Wellcare MGG,Wellcare MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Bright Health - commercial,Bright Health - commercial,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,Bright Health MGG,Bright Health MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Aetna,Aetna,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Aetna MGG,Aetna MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,BCBS,BCBS,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,BCBS MGG,BCBS MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Cigna,Cigna,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Cigna MGG,Cigna MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Humana,Humana,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Humana MGG,Humana MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Optum VA,Optum VA,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,UHC,UHC,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,UHC MGG,UHC MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,VA,VA,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Wellcare MGG,Wellcare MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Bright Health - commercial,Bright Health - commercial,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Bright Health MGG,Bright Health MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Aetna,Aetna,143.16,,,,,,,per diem,143.16,143.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Aetna MGG,Aetna MGG,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,BCBS,BCBS,143.16,,,,,,,per diem,143.16,143.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,BCBS MGG,BCBS MGG,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Cigna,Cigna,143.16,,,,,,,per diem,143.16,143.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Cigna MGG,Cigna MGG,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Humana,Humana,143.16,,,,,,,per diem,143.16,143.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Humana MGG,Humana MGG,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Optum VA,Optum VA,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,UHC,UHC,143.16,,,,,,,per diem,143.16,143.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,UHC MGG,UHC MGG,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,VA,VA,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Wellcare MGG,Wellcare MGG,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Bright Health - commercial,Bright Health - commercial,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,143.16,143.16,Bright Health MGG,Bright Health MGG,143.16,,,,,,,case rate,143.16,143.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Aetna,Aetna,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Aetna MGG,Aetna MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,BCBS,BCBS,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,BCBS MGG,BCBS MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Cigna,Cigna,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Cigna MGG,Cigna MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Humana,Humana,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Humana MGG,Humana MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Optum VA,Optum VA,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,UHC,UHC,137.07,,,,,,,per diem,137.07,137.07,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,UHC MGG,UHC MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,VA,VA,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Wellcare MGG,Wellcare MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Bright Health - commercial,Bright Health - commercial,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,137.07,137.07,Bright Health MGG,Bright Health MGG,137.07,,,,,,,case rate,137.07,137.07,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Aetna,Aetna,137.16,,,,,,,per diem,137.16,137.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Aetna MGG,Aetna MGG,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,BCBS,BCBS,137.16,,,,,,,per diem,137.16,137.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,BCBS MGG,BCBS MGG,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Cigna,Cigna,137.16,,,,,,,per diem,137.16,137.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Cigna MGG,Cigna MGG,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Humana,Humana,137.16,,,,,,,per diem,137.16,137.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Humana MGG,Humana MGG,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Optum VA,Optum VA,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,UHC,UHC,137.16,,,,,,,per diem,137.16,137.16,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,UHC MGG,UHC MGG,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,VA,VA,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Wellcare MGG,Wellcare MGG,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Bright Health - commercial,Bright Health - commercial,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,137.16,137.16,Bright Health MGG,Bright Health MGG,137.16,,,,,,,case rate,137.16,137.16,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Aetna,Aetna,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Aetna MGG,Aetna MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,BCBS,BCBS,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,BCBS MGG,BCBS MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Cigna,Cigna,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Cigna MGG,Cigna MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Humana,Humana,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Humana MGG,Humana MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Optum VA,Optum VA,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,UHC,UHC,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,UHC MGG,UHC MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,VA,VA,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Wellcare MGG,Wellcare MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Bright Health - commercial,Bright Health - commercial,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Bright Health MGG,Bright Health MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Aetna,Aetna,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Aetna MGG,Aetna MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,BCBS,BCBS,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,BCBS MGG,BCBS MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Cigna,Cigna,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Cigna MGG,Cigna MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Humana,Humana,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Humana MGG,Humana MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Optum VA,Optum VA,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,UHC,UHC,54.66,,,,,,,per diem,54.66,54.66,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,UHC MGG,UHC MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,VA,VA,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Wellcare MGG,Wellcare MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Bright Health - commercial,Bright Health - commercial,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,54.66,54.66,Bright Health MGG,Bright Health MGG,54.66,,,,,,,case rate,54.66,54.66,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna,Aetna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna MGG,Aetna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS,BCBS,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS MGG,BCBS MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna,Cigna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna MGG,Cigna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana,Humana,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana MGG,Humana MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Optum VA,Optum VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC,UHC,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC MGG,UHC MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,VA,VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Wellcare MGG,Wellcare MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health - commercial,Bright Health - commercial,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health MGG,Bright Health MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna,Aetna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna MGG,Aetna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS,BCBS,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS MGG,BCBS MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna,Cigna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna MGG,Cigna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana,Humana,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana MGG,Humana MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Optum VA,Optum VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC,UHC,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC MGG,UHC MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,VA,VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Wellcare MGG,Wellcare MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health - commercial,Bright Health - commercial,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health MGG,Bright Health MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna,Aetna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna MGG,Aetna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS,BCBS,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS MGG,BCBS MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna,Cigna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna MGG,Cigna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana,Humana,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana MGG,Humana MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Optum VA,Optum VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC,UHC,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC MGG,UHC MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,VA,VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Wellcare MGG,Wellcare MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health - commercial,Bright Health - commercial,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health MGG,Bright Health MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna,Aetna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna MGG,Aetna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS,BCBS,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS MGG,BCBS MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna,Cigna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna MGG,Cigna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana,Humana,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana MGG,Humana MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Optum VA,Optum VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC,UHC,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC MGG,UHC MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,VA,VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Wellcare MGG,Wellcare MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health - commercial,Bright Health - commercial,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health MGG,Bright Health MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna,Aetna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna MGG,Aetna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS,BCBS,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS MGG,BCBS MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna,Cigna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna MGG,Cigna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana,Humana,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana MGG,Humana MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Optum VA,Optum VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC,UHC,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC MGG,UHC MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,VA,VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Wellcare MGG,Wellcare MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health - commercial,Bright Health - commercial,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health MGG,Bright Health MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna,Aetna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Aetna MGG,Aetna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS,BCBS,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,BCBS MGG,BCBS MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna,Cigna,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Cigna MGG,Cigna MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana,Humana,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Humana MGG,Humana MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Optum VA,Optum VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC,UHC,99.33,,,,,,,per diem,99.33,99.33,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,UHC MGG,UHC MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,VA,VA,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Wellcare MGG,Wellcare MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health - commercial,Bright Health - commercial,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,99.33,99.33,Bright Health MGG,Bright Health MGG,99.33,,,,,,,case rate,99.33,99.33,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Aetna,Aetna,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Aetna MGG,Aetna MGG,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,BCBS,BCBS,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,BCBS MGG,BCBS MGG,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Cigna,Cigna,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Cigna MGG,Cigna MGG,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Humana,Humana,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Humana MGG,Humana MGG,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Optum VA,Optum VA,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,UHC,UHC,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,UHC MGG,UHC MGG,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,VA,VA,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Wellcare MGG,Wellcare MGG,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Bright Health - commercial,Bright Health - commercial,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,Bright Health MGG,Bright Health MGG,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Aetna,Aetna,92.28,,,,,,,per diem,92.28,92.28,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Aetna MGG,Aetna MGG,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,BCBS,BCBS,92.28,,,,,,,per diem,92.28,92.28,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,BCBS MGG,BCBS MGG,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Cigna,Cigna,92.28,,,,,,,per diem,92.28,92.28,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Cigna MGG,Cigna MGG,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Humana,Humana,92.28,,,,,,,per diem,92.28,92.28,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Humana MGG,Humana MGG,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Optum VA,Optum VA,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,UHC,UHC,92.28,,,,,,,per diem,92.28,92.28,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,UHC MGG,UHC MGG,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,VA,VA,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Wellcare MGG,Wellcare MGG,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Bright Health - commercial,Bright Health - commercial,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,92.28,92.28,Bright Health MGG,Bright Health MGG,92.28,,,,,,,case rate,92.28,92.28,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Aetna,Aetna,95.37,,,,,,,per diem,95.37,95.37,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Aetna MGG,Aetna MGG,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,BCBS,BCBS,95.37,,,,,,,per diem,95.37,95.37,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,BCBS MGG,BCBS MGG,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Cigna,Cigna,95.37,,,,,,,per diem,95.37,95.37,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Cigna MGG,Cigna MGG,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Humana,Humana,95.37,,,,,,,per diem,95.37,95.37,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Humana MGG,Humana MGG,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Optum VA,Optum VA,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,UHC,UHC,95.37,,,,,,,per diem,95.37,95.37,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,UHC MGG,UHC MGG,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,VA,VA,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Wellcare MGG,Wellcare MGG,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Bright Health - commercial,Bright Health - commercial,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,95.37,95.37,Bright Health MGG,Bright Health MGG,95.37,,,,,,,case rate,95.37,95.37,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Aetna,Aetna,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Aetna MGG,Aetna MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,BCBS,BCBS,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,BCBS MGG,BCBS MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Cigna,Cigna,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Cigna MGG,Cigna MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Humana,Humana,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Humana MGG,Humana MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Optum VA,Optum VA,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,UHC,UHC,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,UHC MGG,UHC MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,VA,VA,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Wellcare MGG,Wellcare MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Bright Health - commercial,Bright Health - commercial,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Bright Health MGG,Bright Health MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Aetna,Aetna,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Aetna MGG,Aetna MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,BCBS,BCBS,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,BCBS MGG,BCBS MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Cigna,Cigna,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Cigna MGG,Cigna MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Humana,Humana,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Humana MGG,Humana MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Optum VA,Optum VA,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,UHC,UHC,152.52,,,,,,,per diem,152.52,152.52,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,UHC MGG,UHC MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,VA,VA,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Wellcare MGG,Wellcare MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Bright Health - commercial,Bright Health - commercial,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,152.52,152.52,Bright Health MGG,Bright Health MGG,152.52,,,,,,,case rate,152.52,152.52,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna,Aetna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna MGG,Aetna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS,BCBS,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS MGG,BCBS MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna,Cigna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna MGG,Cigna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana,Humana,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana MGG,Humana MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Optum VA,Optum VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC,UHC,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC MGG,UHC MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,VA,VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Wellcare MGG,Wellcare MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health - commercial,Bright Health - commercial,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health MGG,Bright Health MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna,Aetna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna MGG,Aetna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS,BCBS,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS MGG,BCBS MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna,Cigna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna MGG,Cigna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana,Humana,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana MGG,Humana MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Optum VA,Optum VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC,UHC,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC MGG,UHC MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,VA,VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Wellcare MGG,Wellcare MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health - commercial,Bright Health - commercial,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health MGG,Bright Health MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna,Aetna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna MGG,Aetna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS,BCBS,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS MGG,BCBS MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna,Cigna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna MGG,Cigna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana,Humana,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana MGG,Humana MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Optum VA,Optum VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC,UHC,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC MGG,UHC MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,VA,VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Wellcare MGG,Wellcare MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health - commercial,Bright Health - commercial,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health MGG,Bright Health MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna,Aetna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna MGG,Aetna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS,BCBS,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS MGG,BCBS MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna,Cigna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna MGG,Cigna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana,Humana,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana MGG,Humana MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Optum VA,Optum VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC,UHC,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC MGG,UHC MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,VA,VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Wellcare MGG,Wellcare MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health - commercial,Bright Health - commercial,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health MGG,Bright Health MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna,Aetna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna MGG,Aetna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS,BCBS,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS MGG,BCBS MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna,Cigna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna MGG,Cigna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana,Humana,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana MGG,Humana MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Optum VA,Optum VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC,UHC,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC MGG,UHC MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,VA,VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Wellcare MGG,Wellcare MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health - commercial,Bright Health - commercial,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health MGG,Bright Health MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna,Aetna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Aetna MGG,Aetna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS,BCBS,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,BCBS MGG,BCBS MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna,Cigna,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Cigna MGG,Cigna MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana,Humana,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Humana MGG,Humana MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Optum VA,Optum VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC,UHC,63.39,,,,,,,per diem,63.39,63.39,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,UHC MGG,UHC MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,VA,VA,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Wellcare MGG,Wellcare MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health - commercial,Bright Health - commercial,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,63.39,63.39,Bright Health MGG,Bright Health MGG,63.39,,,,,,,case rate,63.39,63.39,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Aetna,Aetna,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Aetna MGG,Aetna MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,BCBS,BCBS,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,BCBS MGG,BCBS MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Cigna,Cigna,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Cigna MGG,Cigna MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Humana,Humana,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Humana MGG,Humana MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Optum VA,Optum VA,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,UHC,UHC,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,UHC MGG,UHC MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,VA,VA,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Wellcare MGG,Wellcare MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Bright Health - commercial,Bright Health - commercial,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,29.07,29.07,Bright Health MGG,Bright Health MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Aetna,Aetna,180.48,,,,,,,per diem,180.48,180.48,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Aetna MGG,Aetna MGG,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,BCBS,BCBS,180.48,,,,,,,per diem,180.48,180.48,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,BCBS MGG,BCBS MGG,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Cigna,Cigna,180.48,,,,,,,per diem,180.48,180.48,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Cigna MGG,Cigna MGG,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Humana,Humana,180.48,,,,,,,per diem,180.48,180.48,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Humana MGG,Humana MGG,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Optum VA,Optum VA,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,UHC,UHC,180.48,,,,,,,per diem,180.48,180.48,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,UHC MGG,UHC MGG,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,VA,VA,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Wellcare MGG,Wellcare MGG,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Bright Health - commercial,Bright Health - commercial,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,180.48,180.48,Bright Health MGG,Bright Health MGG,180.48,,,,,,,case rate,180.48,180.48,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Aetna,Aetna,837,,,,,,,per diem,837,837,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Aetna MGG,Aetna MGG,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,BCBS,BCBS,837,,,,,,,per diem,837,837,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,BCBS MGG,BCBS MGG,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Cigna,Cigna,837,,,,,,,per diem,837,837,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Cigna MGG,Cigna MGG,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Humana,Humana,837,,,,,,,per diem,837,837,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Humana MGG,Humana MGG,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Optum VA,Optum VA,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,UHC,UHC,837,,,,,,,per diem,837,837,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,UHC MGG,UHC MGG,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,VA,VA,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Wellcare MGG,Wellcare MGG,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Bright Health - commercial,Bright Health - commercial,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,837,837,Bright Health MGG,Bright Health MGG,837,,,,,,,case rate,837,837,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Aetna,Aetna,603.6,,,,,,,per diem,603.6,603.6,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Aetna MGG,Aetna MGG,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,BCBS,BCBS,603.6,,,,,,,per diem,603.6,603.6,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,BCBS MGG,BCBS MGG,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Cigna,Cigna,603.6,,,,,,,per diem,603.6,603.6,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Cigna MGG,Cigna MGG,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Humana,Humana,603.6,,,,,,,per diem,603.6,603.6,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Humana MGG,Humana MGG,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Optum VA,Optum VA,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,UHC,UHC,603.6,,,,,,,per diem,603.6,603.6,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,UHC MGG,UHC MGG,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,VA,VA,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Wellcare MGG,Wellcare MGG,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Bright Health - commercial,Bright Health - commercial,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,603.6,603.6,Bright Health MGG,Bright Health MGG,603.6,,,,,,,case rate,603.6,603.6,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Aetna,Aetna,165.37,,,,,,,per diem,165.37,165.37,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Aetna MGG,Aetna MGG,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,BCBS,BCBS,165.37,,,,,,,per diem,165.37,165.37,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,BCBS MGG,BCBS MGG,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Cigna,Cigna,165.37,,,,,,,per diem,165.37,165.37,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Cigna MGG,Cigna MGG,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Humana,Humana,165.37,,,,,,,per diem,165.37,165.37,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Humana MGG,Humana MGG,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Optum VA,Optum VA,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,UHC,UHC,165.37,,,,,,,per diem,165.37,165.37,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,UHC MGG,UHC MGG,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,VA,VA,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Wellcare MGG,Wellcare MGG,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Bright Health - commercial,Bright Health - commercial,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,165.37,165.37,Bright Health MGG,Bright Health MGG,165.37,,,,,,,case rate,165.37,165.37,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Aetna,Aetna,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Aetna MGG,Aetna MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,BCBS,BCBS,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,BCBS MGG,BCBS MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Cigna,Cigna,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Cigna MGG,Cigna MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Humana,Humana,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Humana MGG,Humana MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Optum VA,Optum VA,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,UHC,UHC,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,UHC MGG,UHC MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,VA,VA,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Wellcare MGG,Wellcare MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Bright Health - commercial,Bright Health - commercial,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Bright Health MGG,Bright Health MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Aetna,Aetna,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Aetna MGG,Aetna MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,BCBS,BCBS,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,BCBS MGG,BCBS MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Cigna,Cigna,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Cigna MGG,Cigna MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Humana,Humana,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Humana MGG,Humana MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Optum VA,Optum VA,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,UHC,UHC,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,UHC MGG,UHC MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,VA,VA,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Wellcare MGG,Wellcare MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Bright Health - commercial,Bright Health - commercial,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,96.45,96.45,Bright Health MGG,Bright Health MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Aetna,Aetna,67.89,,,,,,,per diem,67.89,67.89,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Aetna MGG,Aetna MGG,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,BCBS,BCBS,67.89,,,,,,,per diem,67.89,67.89,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,BCBS MGG,BCBS MGG,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Cigna,Cigna,67.89,,,,,,,per diem,67.89,67.89,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Cigna MGG,Cigna MGG,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Humana,Humana,67.89,,,,,,,per diem,67.89,67.89,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Humana MGG,Humana MGG,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Optum VA,Optum VA,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,UHC,UHC,67.89,,,,,,,per diem,67.89,67.89,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,UHC MGG,UHC MGG,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,VA,VA,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Wellcare MGG,Wellcare MGG,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Bright Health - commercial,Bright Health - commercial,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,67.89,67.89,Bright Health MGG,Bright Health MGG,67.89,,,,,,,case rate,67.89,67.89,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Aetna,Aetna,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Aetna MGG,Aetna MGG,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,BCBS,BCBS,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,BCBS MGG,BCBS MGG,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Cigna,Cigna,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Cigna MGG,Cigna MGG,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Humana,Humana,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Humana MGG,Humana MGG,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Optum VA,Optum VA,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,UHC,UHC,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,UHC MGG,UHC MGG,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,VA,VA,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Wellcare MGG,Wellcare MGG,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Bright Health - commercial,Bright Health - commercial,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,162.75,162.75,Bright Health MGG,Bright Health MGG,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Aetna,Aetna,133.23,,,,,,,per diem,133.23,133.23,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Aetna MGG,Aetna MGG,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,BCBS,BCBS,133.23,,,,,,,per diem,133.23,133.23,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,BCBS MGG,BCBS MGG,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Cigna,Cigna,133.23,,,,,,,per diem,133.23,133.23,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Cigna MGG,Cigna MGG,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Humana,Humana,133.23,,,,,,,per diem,133.23,133.23,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Humana MGG,Humana MGG,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Optum VA,Optum VA,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,UHC,UHC,133.23,,,,,,,per diem,133.23,133.23,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,UHC MGG,UHC MGG,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,VA,VA,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Wellcare MGG,Wellcare MGG,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Bright Health - commercial,Bright Health - commercial,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,133.23,133.23,Bright Health MGG,Bright Health MGG,133.23,,,,,,,case rate,133.23,133.23,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Aetna,Aetna,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Aetna MGG,Aetna MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,BCBS,BCBS,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,BCBS MGG,BCBS MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Cigna,Cigna,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Cigna MGG,Cigna MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Humana,Humana,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Humana MGG,Humana MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Optum VA,Optum VA,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,UHC,UHC,65.7,,,,,,,per diem,65.7,65.7,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,UHC MGG,UHC MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,VA,VA,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Wellcare MGG,Wellcare MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Bright Health - commercial,Bright Health - commercial,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,65.7,65.7,Bright Health MGG,Bright Health MGG,65.7,,,,,,,case rate,65.7,65.7,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna,Aetna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna MGG,Aetna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS,BCBS,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS MGG,BCBS MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna,Cigna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna MGG,Cigna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana,Humana,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana MGG,Humana MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Optum VA,Optum VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC,UHC,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC MGG,UHC MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,VA,VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Wellcare MGG,Wellcare MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health - commercial,Bright Health - commercial,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health MGG,Bright Health MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Aetna,Aetna,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Aetna MGG,Aetna MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,BCBS,BCBS,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,BCBS MGG,BCBS MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Cigna,Cigna,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Cigna MGG,Cigna MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Humana,Humana,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Humana MGG,Humana MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Optum VA,Optum VA,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,UHC,UHC,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,UHC MGG,UHC MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,VA,VA,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Wellcare MGG,Wellcare MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Bright Health - commercial,Bright Health - commercial,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.07,8.07,Bright Health MGG,Bright Health MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Aetna,Aetna,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Aetna MGG,Aetna MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,BCBS,BCBS,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,BCBS MGG,BCBS MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Cigna,Cigna,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Cigna MGG,Cigna MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Humana,Humana,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Humana MGG,Humana MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Optum VA,Optum VA,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,UHC,UHC,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,UHC MGG,UHC MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,VA,VA,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Wellcare MGG,Wellcare MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Bright Health - commercial,Bright Health - commercial,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Bright Health MGG,Bright Health MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Aetna,Aetna,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Aetna MGG,Aetna MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,BCBS,BCBS,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,BCBS MGG,BCBS MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Cigna,Cigna,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Cigna MGG,Cigna MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Humana,Humana,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Humana MGG,Humana MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Optum VA,Optum VA,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,UHC,UHC,5.87,,,,,,,per diem,5.87,5.87,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,UHC MGG,UHC MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,VA,VA,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Wellcare MGG,Wellcare MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Bright Health - commercial,Bright Health - commercial,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,5.87,5.87,Bright Health MGG,Bright Health MGG,5.87,,,,,,,case rate,5.87,5.87,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna,Aetna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna MGG,Aetna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS,BCBS,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS MGG,BCBS MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna,Cigna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna MGG,Cigna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana,Humana,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana MGG,Humana MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Optum VA,Optum VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC,UHC,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC MGG,UHC MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,VA,VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Wellcare MGG,Wellcare MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health - commercial,Bright Health - commercial,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health MGG,Bright Health MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Aetna,Aetna,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Aetna MGG,Aetna MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,BCBS,BCBS,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,BCBS MGG,BCBS MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Cigna,Cigna,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Cigna MGG,Cigna MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Humana,Humana,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Humana MGG,Humana MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Optum VA,Optum VA,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,UHC,UHC,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,UHC MGG,UHC MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,VA,VA,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Wellcare MGG,Wellcare MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Bright Health - commercial,Bright Health - commercial,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Bright Health MGG,Bright Health MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Aetna,Aetna,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Aetna MGG,Aetna MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,BCBS,BCBS,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,BCBS MGG,BCBS MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Cigna,Cigna,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Cigna MGG,Cigna MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Humana,Humana,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Humana MGG,Humana MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Optum VA,Optum VA,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,UHC,UHC,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,UHC MGG,UHC MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,VA,VA,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Wellcare MGG,Wellcare MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Bright Health - commercial,Bright Health - commercial,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.37,11.37,Bright Health MGG,Bright Health MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna,Aetna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna MGG,Aetna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS,BCBS,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS MGG,BCBS MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna,Cigna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna MGG,Cigna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana,Humana,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana MGG,Humana MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Optum VA,Optum VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC,UHC,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC MGG,UHC MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,VA,VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Wellcare MGG,Wellcare MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health - commercial,Bright Health - commercial,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health MGG,Bright Health MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna,Aetna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna MGG,Aetna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS,BCBS,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS MGG,BCBS MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna,Cigna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna MGG,Cigna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana,Humana,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana MGG,Humana MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Optum VA,Optum VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC,UHC,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC MGG,UHC MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,VA,VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Wellcare MGG,Wellcare MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health - commercial,Bright Health - commercial,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health MGG,Bright Health MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna,Aetna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Aetna MGG,Aetna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS,BCBS,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,BCBS MGG,BCBS MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna,Cigna,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Cigna MGG,Cigna MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana,Humana,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Humana MGG,Humana MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Optum VA,Optum VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC,UHC,6.23,,,,,,,per diem,6.23,6.23,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,UHC MGG,UHC MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,VA,VA,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Wellcare MGG,Wellcare MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health - commercial,Bright Health - commercial,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.23,6.23,Bright Health MGG,Bright Health MGG,6.23,,,,,,,case rate,6.23,6.23,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Aetna,Aetna,50.62,,,,,,,per diem,50.62,50.62,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Aetna MGG,Aetna MGG,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,BCBS,BCBS,50.62,,,,,,,per diem,50.62,50.62,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,BCBS MGG,BCBS MGG,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Cigna,Cigna,50.62,,,,,,,per diem,50.62,50.62,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Cigna MGG,Cigna MGG,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Humana,Humana,50.62,,,,,,,per diem,50.62,50.62,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Humana MGG,Humana MGG,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Optum VA,Optum VA,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,UHC,UHC,50.62,,,,,,,per diem,50.62,50.62,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,UHC MGG,UHC MGG,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,VA,VA,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Wellcare MGG,Wellcare MGG,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Bright Health - commercial,Bright Health - commercial,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,50.62,50.62,Bright Health MGG,Bright Health MGG,50.62,,,,,,,case rate,50.62,50.62,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Aetna,Aetna,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Aetna MGG,Aetna MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,BCBS,BCBS,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,BCBS MGG,BCBS MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Cigna,Cigna,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Cigna MGG,Cigna MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Humana,Humana,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Humana MGG,Humana MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Optum VA,Optum VA,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,UHC,UHC,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,UHC MGG,UHC MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,VA,VA,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Wellcare MGG,Wellcare MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Bright Health - commercial,Bright Health - commercial,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,14.4,14.4,Bright Health MGG,Bright Health MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Aetna,Aetna,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Aetna MGG,Aetna MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,BCBS,BCBS,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,BCBS MGG,BCBS MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Cigna,Cigna,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Cigna MGG,Cigna MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Humana,Humana,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Humana MGG,Humana MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Optum VA,Optum VA,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,UHC,UHC,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,UHC MGG,UHC MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,VA,VA,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Wellcare MGG,Wellcare MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Bright Health - commercial,Bright Health - commercial,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,9.6,9.6,Bright Health MGG,Bright Health MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Aetna,Aetna,84.6,,,,,,,per diem,84.6,84.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Aetna MGG,Aetna MGG,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,BCBS,BCBS,84.6,,,,,,,per diem,84.6,84.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,BCBS MGG,BCBS MGG,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Cigna,Cigna,84.6,,,,,,,per diem,84.6,84.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Cigna MGG,Cigna MGG,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Humana,Humana,84.6,,,,,,,per diem,84.6,84.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Humana MGG,Humana MGG,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Optum VA,Optum VA,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,UHC,UHC,84.6,,,,,,,per diem,84.6,84.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,UHC MGG,UHC MGG,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,VA,VA,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Wellcare MGG,Wellcare MGG,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Bright Health - commercial,Bright Health - commercial,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,84.6,84.6,Bright Health MGG,Bright Health MGG,84.6,,,,,,,case rate,84.6,84.6,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Aetna,Aetna,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Aetna MGG,Aetna MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,BCBS,BCBS,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,BCBS MGG,BCBS MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Cigna,Cigna,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Cigna MGG,Cigna MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Humana,Humana,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Humana MGG,Humana MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Optum VA,Optum VA,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,UHC,UHC,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,UHC MGG,UHC MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,VA,VA,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Wellcare MGG,Wellcare MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Bright Health - commercial,Bright Health - commercial,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,19.2,19.2,Bright Health MGG,Bright Health MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Aetna,Aetna,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Aetna MGG,Aetna MGG,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,BCBS,BCBS,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,BCBS MGG,BCBS MGG,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Cigna,Cigna,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Cigna MGG,Cigna MGG,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Humana,Humana,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Humana MGG,Humana MGG,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Optum VA,Optum VA,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,UHC,UHC,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,UHC MGG,UHC MGG,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,VA,VA,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Wellcare MGG,Wellcare MGG,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Bright Health - commercial,Bright Health - commercial,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,6.67,6.67,Bright Health MGG,Bright Health MGG,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna,Aetna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna MGG,Aetna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS,BCBS,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS MGG,BCBS MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna,Cigna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna MGG,Cigna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana,Humana,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana MGG,Humana MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Optum VA,Optum VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC,UHC,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC MGG,UHC MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,VA,VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Wellcare MGG,Wellcare MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health - commercial,Bright Health - commercial,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health MGG,Bright Health MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna,Aetna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna MGG,Aetna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS,BCBS,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS MGG,BCBS MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna,Cigna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna MGG,Cigna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana,Humana,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana MGG,Humana MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Optum VA,Optum VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC,UHC,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC MGG,UHC MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,VA,VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Wellcare MGG,Wellcare MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health - commercial,Bright Health - commercial,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health MGG,Bright Health MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Aetna,Aetna,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Aetna MGG,Aetna MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,BCBS,BCBS,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,BCBS MGG,BCBS MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Cigna,Cigna,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Cigna MGG,Cigna MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Humana,Humana,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Humana MGG,Humana MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Optum VA,Optum VA,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,UHC,UHC,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,UHC MGG,UHC MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,VA,VA,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Wellcare MGG,Wellcare MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Bright Health - commercial,Bright Health - commercial,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,96,96,Bright Health MGG,Bright Health MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Aetna,Aetna,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Aetna MGG,Aetna MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,BCBS,BCBS,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,BCBS MGG,BCBS MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Cigna,Cigna,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Cigna MGG,Cigna MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Humana,Humana,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Humana MGG,Humana MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Optum VA,Optum VA,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,UHC,UHC,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,UHC MGG,UHC MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,VA,VA,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Wellcare MGG,Wellcare MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Bright Health - commercial,Bright Health - commercial,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,144,144,Bright Health MGG,Bright Health MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Aetna,Aetna,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Aetna MGG,Aetna MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,BCBS,BCBS,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,BCBS MGG,BCBS MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Cigna,Cigna,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Cigna MGG,Cigna MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Humana,Humana,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Humana MGG,Humana MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Optum VA,Optum VA,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,UHC,UHC,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,UHC MGG,UHC MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,VA,VA,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Wellcare MGG,Wellcare MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Bright Health - commercial,Bright Health - commercial,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Bright Health MGG,Bright Health MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Aetna,Aetna,2.4,,,,,,,per diem,2.4,2.4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Aetna MGG,Aetna MGG,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,BCBS,BCBS,2.4,,,,,,,per diem,2.4,2.4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,BCBS MGG,BCBS MGG,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Cigna,Cigna,2.4,,,,,,,per diem,2.4,2.4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Cigna MGG,Cigna MGG,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Humana,Humana,2.4,,,,,,,per diem,2.4,2.4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Humana MGG,Humana MGG,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Optum VA,Optum VA,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,UHC,UHC,2.4,,,,,,,per diem,2.4,2.4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,UHC MGG,UHC MGG,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,VA,VA,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Wellcare MGG,Wellcare MGG,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Bright Health - commercial,Bright Health - commercial,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.4,2.4,Bright Health MGG,Bright Health MGG,2.4,,,,,,,case rate,2.4,2.4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Aetna,Aetna,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Aetna MGG,Aetna MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,BCBS,BCBS,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,BCBS MGG,BCBS MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Cigna,Cigna,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Cigna MGG,Cigna MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Humana,Humana,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Humana MGG,Humana MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Optum VA,Optum VA,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,UHC,UHC,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,UHC MGG,UHC MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,VA,VA,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Wellcare MGG,Wellcare MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Bright Health - commercial,Bright Health - commercial,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,28.8,28.8,Bright Health MGG,Bright Health MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Aetna,Aetna,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Aetna MGG,Aetna MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,BCBS,BCBS,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,BCBS MGG,BCBS MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Cigna,Cigna,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Cigna MGG,Cigna MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Humana,Humana,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Humana MGG,Humana MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Optum VA,Optum VA,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,UHC,UHC,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,UHC MGG,UHC MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,VA,VA,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Wellcare MGG,Wellcare MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Bright Health - commercial,Bright Health - commercial,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4,4,Bright Health MGG,Bright Health MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Aetna,Aetna,92.58,,,,,,,per diem,92.58,92.58,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Aetna MGG,Aetna MGG,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,BCBS,BCBS,92.58,,,,,,,per diem,92.58,92.58,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,BCBS MGG,BCBS MGG,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Cigna,Cigna,92.58,,,,,,,per diem,92.58,92.58,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Cigna MGG,Cigna MGG,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Humana,Humana,92.58,,,,,,,per diem,92.58,92.58,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Humana MGG,Humana MGG,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Optum VA,Optum VA,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,UHC,UHC,92.58,,,,,,,per diem,92.58,92.58,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,UHC MGG,UHC MGG,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,VA,VA,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Wellcare MGG,Wellcare MGG,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Bright Health - commercial,Bright Health - commercial,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,92.58,92.58,Bright Health MGG,Bright Health MGG,92.58,,,,,,,case rate,92.58,92.58,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Aetna,Aetna,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Aetna MGG,Aetna MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,BCBS,BCBS,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,BCBS MGG,BCBS MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Cigna,Cigna,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Cigna MGG,Cigna MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Humana,Humana,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Humana MGG,Humana MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Optum VA,Optum VA,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,UHC,UHC,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,UHC MGG,UHC MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,VA,VA,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Wellcare MGG,Wellcare MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Bright Health - commercial,Bright Health - commercial,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,30.6,30.6,Bright Health MGG,Bright Health MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Aetna,Aetna,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Aetna MGG,Aetna MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,BCBS,BCBS,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,BCBS MGG,BCBS MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Cigna,Cigna,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Cigna MGG,Cigna MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Humana,Humana,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Humana MGG,Humana MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Optum VA,Optum VA,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,UHC,UHC,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,UHC MGG,UHC MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,VA,VA,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Wellcare MGG,Wellcare MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Bright Health - commercial,Bright Health - commercial,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,14.3,14.3,Bright Health MGG,Bright Health MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Aetna,Aetna,31.2,,,,,,,per diem,31.2,31.2,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Aetna MGG,Aetna MGG,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,BCBS,BCBS,31.2,,,,,,,per diem,31.2,31.2,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,BCBS MGG,BCBS MGG,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Cigna,Cigna,31.2,,,,,,,per diem,31.2,31.2,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Cigna MGG,Cigna MGG,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Humana,Humana,31.2,,,,,,,per diem,31.2,31.2,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Humana MGG,Humana MGG,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Optum VA,Optum VA,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,UHC,UHC,31.2,,,,,,,per diem,31.2,31.2,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,UHC MGG,UHC MGG,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,VA,VA,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Wellcare MGG,Wellcare MGG,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Bright Health - commercial,Bright Health - commercial,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,31.2,31.2,Bright Health MGG,Bright Health MGG,31.2,,,,,,,case rate,31.2,31.2,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Aetna,Aetna,115.63,,,,,,,per diem,115.63,115.63,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Aetna MGG,Aetna MGG,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,BCBS,BCBS,115.63,,,,,,,per diem,115.63,115.63,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,BCBS MGG,BCBS MGG,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Cigna,Cigna,115.63,,,,,,,per diem,115.63,115.63,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Cigna MGG,Cigna MGG,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Humana,Humana,115.63,,,,,,,per diem,115.63,115.63,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Humana MGG,Humana MGG,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Optum VA,Optum VA,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,UHC,UHC,115.63,,,,,,,per diem,115.63,115.63,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,UHC MGG,UHC MGG,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,VA,VA,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Wellcare MGG,Wellcare MGG,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Bright Health - commercial,Bright Health - commercial,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,115.63,115.63,Bright Health MGG,Bright Health MGG,115.63,,,,,,,case rate,115.63,115.63,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Aetna,Aetna,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Aetna MGG,Aetna MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,BCBS,BCBS,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,BCBS MGG,BCBS MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Cigna,Cigna,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Cigna MGG,Cigna MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Humana,Humana,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Humana MGG,Humana MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Optum VA,Optum VA,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,UHC,UHC,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,UHC MGG,UHC MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,VA,VA,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Wellcare MGG,Wellcare MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Bright Health - commercial,Bright Health - commercial,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Bright Health MGG,Bright Health MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Aetna,Aetna,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Aetna MGG,Aetna MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,BCBS,BCBS,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,BCBS MGG,BCBS MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Cigna,Cigna,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Cigna MGG,Cigna MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Humana,Humana,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Humana MGG,Humana MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Optum VA,Optum VA,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,UHC,UHC,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,UHC MGG,UHC MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,VA,VA,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Wellcare MGG,Wellcare MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Bright Health - commercial,Bright Health - commercial,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,35.1,35.1,Bright Health MGG,Bright Health MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Aetna,Aetna,113.7,,,,,,,per diem,113.7,113.7,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Aetna MGG,Aetna MGG,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,BCBS,BCBS,113.7,,,,,,,per diem,113.7,113.7,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,BCBS MGG,BCBS MGG,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Cigna,Cigna,113.7,,,,,,,per diem,113.7,113.7,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Cigna MGG,Cigna MGG,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Humana,Humana,113.7,,,,,,,per diem,113.7,113.7,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Humana MGG,Humana MGG,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Optum VA,Optum VA,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,UHC,UHC,113.7,,,,,,,per diem,113.7,113.7,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,UHC MGG,UHC MGG,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,VA,VA,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Wellcare MGG,Wellcare MGG,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Bright Health - commercial,Bright Health - commercial,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,113.7,113.7,Bright Health MGG,Bright Health MGG,113.7,,,,,,,case rate,113.7,113.7,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna,Aetna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna MGG,Aetna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS,BCBS,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS MGG,BCBS MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna,Cigna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna MGG,Cigna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana,Humana,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana MGG,Humana MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Optum VA,Optum VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC,UHC,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC MGG,UHC MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,VA,VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Wellcare MGG,Wellcare MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health - commercial,Bright Health - commercial,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health MGG,Bright Health MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna,Aetna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna MGG,Aetna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS,BCBS,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS MGG,BCBS MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna,Cigna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna MGG,Cigna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana,Humana,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana MGG,Humana MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Optum VA,Optum VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC,UHC,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC MGG,UHC MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,VA,VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Wellcare MGG,Wellcare MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health - commercial,Bright Health - commercial,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health MGG,Bright Health MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna,Aetna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna MGG,Aetna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS,BCBS,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS MGG,BCBS MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna,Cigna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna MGG,Cigna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana,Humana,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana MGG,Humana MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Optum VA,Optum VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC,UHC,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC MGG,UHC MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,VA,VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Wellcare MGG,Wellcare MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health - commercial,Bright Health - commercial,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health MGG,Bright Health MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna,Aetna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna MGG,Aetna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS,BCBS,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS MGG,BCBS MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna,Cigna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna MGG,Cigna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana,Humana,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana MGG,Humana MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Optum VA,Optum VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC,UHC,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC MGG,UHC MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,VA,VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Wellcare MGG,Wellcare MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health - commercial,Bright Health - commercial,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health MGG,Bright Health MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna,Aetna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna MGG,Aetna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS,BCBS,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS MGG,BCBS MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna,Cigna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna MGG,Cigna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana,Humana,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana MGG,Humana MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Optum VA,Optum VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC,UHC,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC MGG,UHC MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,VA,VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Wellcare MGG,Wellcare MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health - commercial,Bright Health - commercial,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health MGG,Bright Health MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna,Aetna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Aetna MGG,Aetna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS,BCBS,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,BCBS MGG,BCBS MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna,Cigna,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Cigna MGG,Cigna MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana,Humana,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Humana MGG,Humana MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Optum VA,Optum VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC,UHC,38.19,,,,,,,per diem,38.19,38.19,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,UHC MGG,UHC MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,VA,VA,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Wellcare MGG,Wellcare MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health - commercial,Bright Health - commercial,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,38.19,38.19,Bright Health MGG,Bright Health MGG,38.19,,,,,,,case rate,38.19,38.19,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Aetna,Aetna,61.53,,,,,,,per diem,61.53,61.53,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Aetna MGG,Aetna MGG,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,BCBS,BCBS,61.53,,,,,,,per diem,61.53,61.53,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,BCBS MGG,BCBS MGG,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Cigna,Cigna,61.53,,,,,,,per diem,61.53,61.53,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Cigna MGG,Cigna MGG,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Humana,Humana,61.53,,,,,,,per diem,61.53,61.53,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Humana MGG,Humana MGG,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Optum VA,Optum VA,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,UHC,UHC,61.53,,,,,,,per diem,61.53,61.53,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,UHC MGG,UHC MGG,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,VA,VA,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Wellcare MGG,Wellcare MGG,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Bright Health - commercial,Bright Health - commercial,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,61.53,61.53,Bright Health MGG,Bright Health MGG,61.53,,,,,,,case rate,61.53,61.53,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Aetna,Aetna,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Aetna MGG,Aetna MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,BCBS,BCBS,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,BCBS MGG,BCBS MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Cigna,Cigna,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Cigna MGG,Cigna MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Humana,Humana,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Humana MGG,Humana MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Optum VA,Optum VA,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,UHC,UHC,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,UHC MGG,UHC MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,VA,VA,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Wellcare MGG,Wellcare MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Bright Health - commercial,Bright Health - commercial,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Bright Health MGG,Bright Health MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Aetna,Aetna,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Aetna MGG,Aetna MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,BCBS,BCBS,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,BCBS MGG,BCBS MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Cigna,Cigna,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Cigna MGG,Cigna MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Humana,Humana,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Humana MGG,Humana MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Optum VA,Optum VA,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,UHC,UHC,64.02,,,,,,,per diem,64.02,64.02,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,UHC MGG,UHC MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,VA,VA,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Wellcare MGG,Wellcare MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Bright Health - commercial,Bright Health - commercial,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,64.02,64.02,Bright Health MGG,Bright Health MGG,64.02,,,,,,,case rate,64.02,64.02,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Aetna,Aetna,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Aetna MGG,Aetna MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,BCBS,BCBS,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,BCBS MGG,BCBS MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Cigna,Cigna,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Cigna MGG,Cigna MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Humana,Humana,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Humana MGG,Humana MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Optum VA,Optum VA,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,UHC,UHC,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,UHC MGG,UHC MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,VA,VA,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Wellcare MGG,Wellcare MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Bright Health - commercial,Bright Health - commercial,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Bright Health MGG,Bright Health MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Aetna,Aetna,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Aetna MGG,Aetna MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,BCBS,BCBS,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,BCBS MGG,BCBS MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Cigna,Cigna,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Cigna MGG,Cigna MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Humana,Humana,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Humana MGG,Humana MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Optum VA,Optum VA,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,UHC,UHC,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,UHC MGG,UHC MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,VA,VA,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Wellcare MGG,Wellcare MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Bright Health - commercial,Bright Health - commercial,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Bright Health MGG,Bright Health MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Aetna,Aetna,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Aetna MGG,Aetna MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,BCBS,BCBS,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,BCBS MGG,BCBS MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Cigna,Cigna,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Cigna MGG,Cigna MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Humana,Humana,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Humana MGG,Humana MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Optum VA,Optum VA,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,UHC,UHC,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,UHC MGG,UHC MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,VA,VA,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Wellcare MGG,Wellcare MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Bright Health - commercial,Bright Health - commercial,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Bright Health MGG,Bright Health MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Aetna,Aetna,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Aetna MGG,Aetna MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,BCBS,BCBS,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,BCBS MGG,BCBS MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Cigna,Cigna,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Cigna MGG,Cigna MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Humana,Humana,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Humana MGG,Humana MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Optum VA,Optum VA,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,UHC,UHC,46.38,,,,,,,per diem,46.38,46.38,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,UHC MGG,UHC MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,VA,VA,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Wellcare MGG,Wellcare MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Bright Health - commercial,Bright Health - commercial,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,46.38,46.38,Bright Health MGG,Bright Health MGG,46.38,,,,,,,case rate,46.38,46.38,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Aetna,Aetna,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Aetna MGG,Aetna MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,BCBS,BCBS,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,BCBS MGG,BCBS MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Cigna,Cigna,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Cigna MGG,Cigna MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Humana,Humana,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Humana MGG,Humana MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Optum VA,Optum VA,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,UHC,UHC,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,UHC MGG,UHC MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,VA,VA,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Wellcare MGG,Wellcare MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Bright Health - commercial,Bright Health - commercial,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Bright Health MGG,Bright Health MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Aetna,Aetna,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Aetna MGG,Aetna MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,BCBS,BCBS,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,BCBS MGG,BCBS MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Cigna,Cigna,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Cigna MGG,Cigna MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Humana,Humana,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Humana MGG,Humana MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Optum VA,Optum VA,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,UHC,UHC,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,UHC MGG,UHC MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,VA,VA,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Wellcare MGG,Wellcare MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Bright Health - commercial,Bright Health - commercial,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Bright Health MGG,Bright Health MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Aetna,Aetna,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Aetna MGG,Aetna MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,BCBS,BCBS,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,BCBS MGG,BCBS MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Cigna,Cigna,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Cigna MGG,Cigna MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Humana,Humana,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Humana MGG,Humana MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Optum VA,Optum VA,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,UHC,UHC,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,UHC MGG,UHC MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,VA,VA,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Wellcare MGG,Wellcare MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Bright Health - commercial,Bright Health - commercial,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Bright Health MGG,Bright Health MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Aetna,Aetna,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Aetna MGG,Aetna MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,BCBS,BCBS,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,BCBS MGG,BCBS MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Cigna,Cigna,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Cigna MGG,Cigna MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Humana,Humana,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Humana MGG,Humana MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Optum VA,Optum VA,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,UHC,UHC,113.82,,,,,,,per diem,113.82,113.82,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,UHC MGG,UHC MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,VA,VA,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Wellcare MGG,Wellcare MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Bright Health - commercial,Bright Health - commercial,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,113.82,113.82,Bright Health MGG,Bright Health MGG,113.82,,,,,,,case rate,113.82,113.82,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Aetna,Aetna,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Aetna MGG,Aetna MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,BCBS,BCBS,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,BCBS MGG,BCBS MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Cigna,Cigna,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Cigna MGG,Cigna MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Humana,Humana,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Humana MGG,Humana MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Optum VA,Optum VA,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,UHC,UHC,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,UHC MGG,UHC MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,VA,VA,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Wellcare MGG,Wellcare MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Bright Health - commercial,Bright Health - commercial,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,16.62,16.62,Bright Health MGG,Bright Health MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Aetna,Aetna,13.66,,,,,,,per diem,13.66,13.66,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Aetna MGG,Aetna MGG,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,BCBS,BCBS,13.66,,,,,,,per diem,13.66,13.66,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,BCBS MGG,BCBS MGG,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Cigna,Cigna,13.66,,,,,,,per diem,13.66,13.66,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Cigna MGG,Cigna MGG,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Humana,Humana,13.66,,,,,,,per diem,13.66,13.66,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Humana MGG,Humana MGG,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Optum VA,Optum VA,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,UHC,UHC,13.66,,,,,,,per diem,13.66,13.66,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,UHC MGG,UHC MGG,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,VA,VA,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Wellcare MGG,Wellcare MGG,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Bright Health - commercial,Bright Health - commercial,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,13.66,13.66,Bright Health MGG,Bright Health MGG,13.66,,,,,,,case rate,13.66,13.66,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Aetna,Aetna,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Aetna MGG,Aetna MGG,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,BCBS,BCBS,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,BCBS MGG,BCBS MGG,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Cigna,Cigna,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Cigna MGG,Cigna MGG,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Humana,Humana,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Humana MGG,Humana MGG,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Optum VA,Optum VA,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,UHC,UHC,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,UHC MGG,UHC MGG,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,VA,VA,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Wellcare MGG,Wellcare MGG,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Bright Health - commercial,Bright Health - commercial,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,7.94,7.94,Bright Health MGG,Bright Health MGG,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Aetna,Aetna,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Aetna MGG,Aetna MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,BCBS,BCBS,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,BCBS MGG,BCBS MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Cigna,Cigna,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Cigna MGG,Cigna MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Humana,Humana,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Humana MGG,Humana MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Optum VA,Optum VA,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,UHC,UHC,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,UHC MGG,UHC MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,VA,VA,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Wellcare MGG,Wellcare MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Bright Health - commercial,Bright Health - commercial,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.36,5.36,Bright Health MGG,Bright Health MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Aetna,Aetna,113.19,,,,,,,per diem,113.19,113.19,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Aetna MGG,Aetna MGG,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,BCBS,BCBS,113.19,,,,,,,per diem,113.19,113.19,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,BCBS MGG,BCBS MGG,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Cigna,Cigna,113.19,,,,,,,per diem,113.19,113.19,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Cigna MGG,Cigna MGG,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Humana,Humana,113.19,,,,,,,per diem,113.19,113.19,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Humana MGG,Humana MGG,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Optum VA,Optum VA,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,UHC,UHC,113.19,,,,,,,per diem,113.19,113.19,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,UHC MGG,UHC MGG,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,VA,VA,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Wellcare MGG,Wellcare MGG,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Bright Health - commercial,Bright Health - commercial,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,113.19,113.19,Bright Health MGG,Bright Health MGG,113.19,,,,,,,case rate,113.19,113.19,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Aetna,Aetna,148.1,,,,,,,per diem,148.1,148.1,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Aetna MGG,Aetna MGG,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,BCBS,BCBS,148.1,,,,,,,per diem,148.1,148.1,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,BCBS MGG,BCBS MGG,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Cigna,Cigna,148.1,,,,,,,per diem,148.1,148.1,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Cigna MGG,Cigna MGG,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Humana,Humana,148.1,,,,,,,per diem,148.1,148.1,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Humana MGG,Humana MGG,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Optum VA,Optum VA,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,UHC,UHC,148.1,,,,,,,per diem,148.1,148.1,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,UHC MGG,UHC MGG,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,VA,VA,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Wellcare MGG,Wellcare MGG,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Bright Health - commercial,Bright Health - commercial,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,148.1,148.1,Bright Health MGG,Bright Health MGG,148.1,,,,,,,case rate,148.1,148.1,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Aetna,Aetna,37.52,,,,,,,per diem,37.52,37.52,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Aetna MGG,Aetna MGG,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,BCBS,BCBS,37.52,,,,,,,per diem,37.52,37.52,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,BCBS MGG,BCBS MGG,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Cigna,Cigna,37.52,,,,,,,per diem,37.52,37.52,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Cigna MGG,Cigna MGG,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Humana,Humana,37.52,,,,,,,per diem,37.52,37.52,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Humana MGG,Humana MGG,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Optum VA,Optum VA,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,UHC,UHC,37.52,,,,,,,per diem,37.52,37.52,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,UHC MGG,UHC MGG,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,VA,VA,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Wellcare MGG,Wellcare MGG,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Bright Health - commercial,Bright Health - commercial,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,37.52,37.52,Bright Health MGG,Bright Health MGG,37.52,,,,,,,case rate,37.52,37.52,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Aetna,Aetna,96.92,,,,,,,per diem,96.92,96.92,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Aetna MGG,Aetna MGG,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,BCBS,BCBS,96.92,,,,,,,per diem,96.92,96.92,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,BCBS MGG,BCBS MGG,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Cigna,Cigna,96.92,,,,,,,per diem,96.92,96.92,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Cigna MGG,Cigna MGG,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Humana,Humana,96.92,,,,,,,per diem,96.92,96.92,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Humana MGG,Humana MGG,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Optum VA,Optum VA,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,UHC,UHC,96.92,,,,,,,per diem,96.92,96.92,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,UHC MGG,UHC MGG,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,VA,VA,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Wellcare MGG,Wellcare MGG,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Bright Health - commercial,Bright Health - commercial,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,96.92,96.92,Bright Health MGG,Bright Health MGG,96.92,,,,,,,case rate,96.92,96.92,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Aetna,Aetna,67.72,,,,,,,per diem,67.72,67.72,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Aetna MGG,Aetna MGG,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,BCBS,BCBS,67.72,,,,,,,per diem,67.72,67.72,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,BCBS MGG,BCBS MGG,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Cigna,Cigna,67.72,,,,,,,per diem,67.72,67.72,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Cigna MGG,Cigna MGG,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Humana,Humana,67.72,,,,,,,per diem,67.72,67.72,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Humana MGG,Humana MGG,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Optum VA,Optum VA,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,UHC,UHC,67.72,,,,,,,per diem,67.72,67.72,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,UHC MGG,UHC MGG,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,VA,VA,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Wellcare MGG,Wellcare MGG,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Bright Health - commercial,Bright Health - commercial,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,67.72,67.72,Bright Health MGG,Bright Health MGG,67.72,,,,,,,case rate,67.72,67.72,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Aetna,Aetna,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Aetna MGG,Aetna MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,BCBS,BCBS,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,BCBS MGG,BCBS MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Cigna,Cigna,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Cigna MGG,Cigna MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Humana,Humana,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Humana MGG,Humana MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Optum VA,Optum VA,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,UHC,UHC,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,UHC MGG,UHC MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,VA,VA,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Wellcare MGG,Wellcare MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Bright Health - commercial,Bright Health - commercial,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.1,10.1,Bright Health MGG,Bright Health MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Aetna,Aetna,58.49,,,,,,,per diem,58.49,58.49,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Aetna MGG,Aetna MGG,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,BCBS,BCBS,58.49,,,,,,,per diem,58.49,58.49,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,BCBS MGG,BCBS MGG,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Cigna,Cigna,58.49,,,,,,,per diem,58.49,58.49,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Cigna MGG,Cigna MGG,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Humana,Humana,58.49,,,,,,,per diem,58.49,58.49,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Humana MGG,Humana MGG,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Optum VA,Optum VA,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,UHC,UHC,58.49,,,,,,,per diem,58.49,58.49,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,UHC MGG,UHC MGG,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,VA,VA,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Wellcare MGG,Wellcare MGG,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Bright Health - commercial,Bright Health - commercial,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,58.49,58.49,Bright Health MGG,Bright Health MGG,58.49,,,,,,,case rate,58.49,58.49,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Aetna,Aetna,286.72,,,,,,,per diem,286.72,286.72,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Aetna MGG,Aetna MGG,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,BCBS,BCBS,286.72,,,,,,,per diem,286.72,286.72,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,BCBS MGG,BCBS MGG,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Cigna,Cigna,286.72,,,,,,,per diem,286.72,286.72,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Cigna MGG,Cigna MGG,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Humana,Humana,286.72,,,,,,,per diem,286.72,286.72,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Humana MGG,Humana MGG,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Optum VA,Optum VA,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,UHC,UHC,286.72,,,,,,,per diem,286.72,286.72,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,UHC MGG,UHC MGG,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,VA,VA,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Wellcare MGG,Wellcare MGG,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Bright Health - commercial,Bright Health - commercial,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,286.72,286.72,Bright Health MGG,Bright Health MGG,286.72,,,,,,,case rate,286.72,286.72,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Aetna,Aetna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Aetna MGG,Aetna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,BCBS,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,BCBS MGG,BCBS MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Cigna,Cigna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Cigna MGG,Cigna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Humana,Humana,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Humana MGG,Humana MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Optum VA,Optum VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,UHC,UHC,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,UHC MGG,UHC MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,VA,VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Wellcare MGG,Wellcare MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Bright Health - commercial,Bright Health - commercial,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Bright Health MGG,Bright Health MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Aetna,Aetna,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Aetna MGG,Aetna MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,BCBS,BCBS,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,BCBS MGG,BCBS MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Cigna,Cigna,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Cigna MGG,Cigna MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Humana,Humana,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Humana MGG,Humana MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Optum VA,Optum VA,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,UHC,UHC,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,UHC MGG,UHC MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,VA,VA,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Wellcare MGG,Wellcare MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Bright Health - commercial,Bright Health - commercial,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Bright Health MGG,Bright Health MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Aetna,Aetna,21.73,,,,,,,per diem,21.73,21.73,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Aetna MGG,Aetna MGG,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,BCBS,BCBS,21.73,,,,,,,per diem,21.73,21.73,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,BCBS MGG,BCBS MGG,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Cigna,Cigna,21.73,,,,,,,per diem,21.73,21.73,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Cigna MGG,Cigna MGG,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Humana,Humana,21.73,,,,,,,per diem,21.73,21.73,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Humana MGG,Humana MGG,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Optum VA,Optum VA,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,UHC,UHC,21.73,,,,,,,per diem,21.73,21.73,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,UHC MGG,UHC MGG,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,VA,VA,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Wellcare MGG,Wellcare MGG,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Bright Health - commercial,Bright Health - commercial,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,21.73,21.73,Bright Health MGG,Bright Health MGG,21.73,,,,,,,case rate,21.73,21.73,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Aetna,Aetna,133.39,,,,,,,per diem,133.39,133.39,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Aetna MGG,Aetna MGG,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,BCBS,BCBS,133.39,,,,,,,per diem,133.39,133.39,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,BCBS MGG,BCBS MGG,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Cigna,Cigna,133.39,,,,,,,per diem,133.39,133.39,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Cigna MGG,Cigna MGG,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Humana,Humana,133.39,,,,,,,per diem,133.39,133.39,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Humana MGG,Humana MGG,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Optum VA,Optum VA,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,UHC,UHC,133.39,,,,,,,per diem,133.39,133.39,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,UHC MGG,UHC MGG,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,VA,VA,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Wellcare MGG,Wellcare MGG,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Bright Health - commercial,Bright Health - commercial,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,133.39,133.39,Bright Health MGG,Bright Health MGG,133.39,,,,,,,case rate,133.39,133.39,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Aetna,Aetna,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Aetna MGG,Aetna MGG,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,BCBS,BCBS,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,BCBS MGG,BCBS MGG,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Cigna,Cigna,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Cigna MGG,Cigna MGG,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Humana,Humana,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Humana MGG,Humana MGG,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Optum VA,Optum VA,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,UHC,UHC,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,UHC MGG,UHC MGG,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,VA,VA,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Wellcare MGG,Wellcare MGG,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Bright Health - commercial,Bright Health - commercial,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,77.77,77.77,Bright Health MGG,Bright Health MGG,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Aetna,Aetna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Aetna MGG,Aetna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,BCBS,BCBS,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,BCBS MGG,BCBS MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Cigna,Cigna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Cigna MGG,Cigna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Humana,Humana,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Humana MGG,Humana MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Optum VA,Optum VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,UHC,UHC,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,UHC MGG,UHC MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,VA,VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Wellcare MGG,Wellcare MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Bright Health - commercial,Bright Health - commercial,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Bright Health MGG,Bright Health MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Aetna,Aetna,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Aetna MGG,Aetna MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,BCBS,BCBS,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,BCBS MGG,BCBS MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Cigna,Cigna,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Cigna MGG,Cigna MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Humana,Humana,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Humana MGG,Humana MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Optum VA,Optum VA,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,UHC,UHC,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,UHC MGG,UHC MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,VA,VA,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Wellcare MGG,Wellcare MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Bright Health - commercial,Bright Health - commercial,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,157.08,157.08,Bright Health MGG,Bright Health MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Aetna,Aetna,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Aetna MGG,Aetna MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,BCBS,BCBS,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,BCBS MGG,BCBS MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Cigna,Cigna,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Cigna MGG,Cigna MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Humana,Humana,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Humana MGG,Humana MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Optum VA,Optum VA,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,UHC,UHC,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,UHC MGG,UHC MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,VA,VA,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Wellcare MGG,Wellcare MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Bright Health - commercial,Bright Health - commercial,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Bright Health MGG,Bright Health MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Aetna,Aetna,12.36,,,,,,,per diem,12.36,12.36,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Aetna MGG,Aetna MGG,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,BCBS,BCBS,12.36,,,,,,,per diem,12.36,12.36,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,BCBS MGG,BCBS MGG,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Cigna,Cigna,12.36,,,,,,,per diem,12.36,12.36,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Cigna MGG,Cigna MGG,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Humana,Humana,12.36,,,,,,,per diem,12.36,12.36,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Humana MGG,Humana MGG,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Optum VA,Optum VA,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,UHC,UHC,12.36,,,,,,,per diem,12.36,12.36,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,UHC MGG,UHC MGG,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,VA,VA,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Wellcare MGG,Wellcare MGG,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Bright Health - commercial,Bright Health - commercial,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.36,12.36,Bright Health MGG,Bright Health MGG,12.36,,,,,,,case rate,12.36,12.36,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Aetna,Aetna,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Aetna MGG,Aetna MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,BCBS,BCBS,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,BCBS MGG,BCBS MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Cigna,Cigna,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Cigna MGG,Cigna MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Humana,Humana,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Humana MGG,Humana MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Optum VA,Optum VA,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,UHC,UHC,99.91,,,,,,,per diem,99.91,99.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,UHC MGG,UHC MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,VA,VA,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Wellcare MGG,Wellcare MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Bright Health - commercial,Bright Health - commercial,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,99.91,99.91,Bright Health MGG,Bright Health MGG,99.91,,,,,,,case rate,99.91,99.91,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Aetna,Aetna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Aetna MGG,Aetna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,BCBS,BCBS,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,BCBS MGG,BCBS MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Cigna,Cigna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Cigna MGG,Cigna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Humana,Humana,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Humana MGG,Humana MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Optum VA,Optum VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,UHC,UHC,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,UHC MGG,UHC MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,VA,VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Wellcare MGG,Wellcare MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Bright Health - commercial,Bright Health - commercial,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Bright Health MGG,Bright Health MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Aetna,Aetna,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Aetna MGG,Aetna MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,BCBS,BCBS,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,BCBS MGG,BCBS MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Cigna,Cigna,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Cigna MGG,Cigna MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Humana,Humana,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Humana MGG,Humana MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Optum VA,Optum VA,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,UHC,UHC,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,UHC MGG,UHC MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,VA,VA,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Wellcare MGG,Wellcare MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Bright Health - commercial,Bright Health - commercial,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,90.3,90.3,Bright Health MGG,Bright Health MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Aetna,Aetna,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Aetna MGG,Aetna MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,BCBS,BCBS,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,BCBS MGG,BCBS MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Cigna,Cigna,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Cigna MGG,Cigna MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Humana,Humana,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Humana MGG,Humana MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Optum VA,Optum VA,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,UHC,UHC,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,UHC MGG,UHC MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,VA,VA,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Wellcare MGG,Wellcare MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Bright Health - commercial,Bright Health - commercial,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,89.1,89.1,Bright Health MGG,Bright Health MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Aetna,Aetna,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Aetna MGG,Aetna MGG,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,BCBS,BCBS,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,BCBS MGG,BCBS MGG,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Cigna,Cigna,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Cigna MGG,Cigna MGG,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Humana,Humana,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Humana MGG,Humana MGG,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Optum VA,Optum VA,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,UHC,UHC,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,UHC MGG,UHC MGG,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,VA,VA,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Wellcare MGG,Wellcare MGG,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Bright Health - commercial,Bright Health - commercial,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,180.6,180.6,Bright Health MGG,Bright Health MGG,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Aetna,Aetna,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Aetna MGG,Aetna MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,BCBS,BCBS,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,BCBS MGG,BCBS MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Cigna,Cigna,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Cigna MGG,Cigna MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Humana,Humana,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Humana MGG,Humana MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Optum VA,Optum VA,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,UHC,UHC,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,UHC MGG,UHC MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,VA,VA,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Wellcare MGG,Wellcare MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Bright Health - commercial,Bright Health - commercial,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Bright Health MGG,Bright Health MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Aetna,Aetna,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Aetna MGG,Aetna MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,BCBS,BCBS,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,BCBS MGG,BCBS MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Cigna,Cigna,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Cigna MGG,Cigna MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Humana,Humana,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Humana MGG,Humana MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Optum VA,Optum VA,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,UHC,UHC,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,UHC MGG,UHC MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,VA,VA,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Wellcare MGG,Wellcare MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Bright Health - commercial,Bright Health - commercial,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,22.15,22.15,Bright Health MGG,Bright Health MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Aetna,Aetna,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Aetna MGG,Aetna MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,BCBS,BCBS,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,BCBS MGG,BCBS MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Cigna,Cigna,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Cigna MGG,Cigna MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Humana,Humana,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Humana MGG,Humana MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Optum VA,Optum VA,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,UHC,UHC,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,UHC MGG,UHC MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,VA,VA,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Wellcare MGG,Wellcare MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Bright Health - commercial,Bright Health - commercial,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Bright Health MGG,Bright Health MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Aetna,Aetna,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Aetna MGG,Aetna MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,BCBS,BCBS,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,BCBS MGG,BCBS MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Cigna,Cigna,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Cigna MGG,Cigna MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Humana,Humana,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Humana MGG,Humana MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Optum VA,Optum VA,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,UHC,UHC,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,UHC MGG,UHC MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,VA,VA,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Wellcare MGG,Wellcare MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Bright Health - commercial,Bright Health - commercial,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Bright Health MGG,Bright Health MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Aetna,Aetna,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Aetna MGG,Aetna MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,BCBS,BCBS,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,BCBS MGG,BCBS MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Cigna,Cigna,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Cigna MGG,Cigna MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Humana,Humana,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Humana MGG,Humana MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Optum VA,Optum VA,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,UHC,UHC,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,UHC MGG,UHC MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,VA,VA,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Wellcare MGG,Wellcare MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Bright Health - commercial,Bright Health - commercial,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,53.56,53.56,Bright Health MGG,Bright Health MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Aetna,Aetna,166.86,,,,,,,per diem,166.86,166.86,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Aetna MGG,Aetna MGG,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,BCBS,BCBS,166.86,,,,,,,per diem,166.86,166.86,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,BCBS MGG,BCBS MGG,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Cigna,Cigna,166.86,,,,,,,per diem,166.86,166.86,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Cigna MGG,Cigna MGG,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Humana,Humana,166.86,,,,,,,per diem,166.86,166.86,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Humana MGG,Humana MGG,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Optum VA,Optum VA,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,UHC,UHC,166.86,,,,,,,per diem,166.86,166.86,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,UHC MGG,UHC MGG,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,VA,VA,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Wellcare MGG,Wellcare MGG,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Bright Health - commercial,Bright Health - commercial,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,166.86,166.86,Bright Health MGG,Bright Health MGG,166.86,,,,,,,case rate,166.86,166.86,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Aetna,Aetna,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Aetna MGG,Aetna MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,BCBS,BCBS,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,BCBS MGG,BCBS MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Cigna,Cigna,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Cigna MGG,Cigna MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Humana,Humana,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Humana MGG,Humana MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Optum VA,Optum VA,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,UHC,UHC,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,UHC MGG,UHC MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,VA,VA,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Wellcare MGG,Wellcare MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Bright Health - commercial,Bright Health - commercial,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Bright Health MGG,Bright Health MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Aetna,Aetna,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Aetna MGG,Aetna MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,BCBS,BCBS,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,BCBS MGG,BCBS MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Cigna,Cigna,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Cigna MGG,Cigna MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Humana,Humana,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Humana MGG,Humana MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Optum VA,Optum VA,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,UHC,UHC,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,UHC MGG,UHC MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,VA,VA,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Wellcare MGG,Wellcare MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Bright Health - commercial,Bright Health - commercial,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.03,18.03,Bright Health MGG,Bright Health MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Aetna,Aetna,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Aetna MGG,Aetna MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,BCBS,BCBS,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,BCBS MGG,BCBS MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Cigna,Cigna,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Cigna MGG,Cigna MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Humana,Humana,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Humana MGG,Humana MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Optum VA,Optum VA,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,UHC,UHC,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,UHC MGG,UHC MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,VA,VA,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Wellcare MGG,Wellcare MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Bright Health - commercial,Bright Health - commercial,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Bright Health MGG,Bright Health MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Aetna,Aetna,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Aetna MGG,Aetna MGG,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,BCBS,BCBS,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,BCBS MGG,BCBS MGG,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Cigna,Cigna,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Cigna MGG,Cigna MGG,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Humana,Humana,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Humana MGG,Humana MGG,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Optum VA,Optum VA,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,UHC,UHC,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,UHC MGG,UHC MGG,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,VA,VA,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Wellcare MGG,Wellcare MGG,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Bright Health - commercial,Bright Health - commercial,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.21,7.21,Bright Health MGG,Bright Health MGG,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Aetna,Aetna,171.5,,,,,,,per diem,171.5,171.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Aetna MGG,Aetna MGG,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,BCBS,BCBS,171.5,,,,,,,per diem,171.5,171.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,BCBS MGG,BCBS MGG,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Cigna,Cigna,171.5,,,,,,,per diem,171.5,171.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Cigna MGG,Cigna MGG,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Humana,Humana,171.5,,,,,,,per diem,171.5,171.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Humana MGG,Humana MGG,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Optum VA,Optum VA,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,UHC,UHC,171.5,,,,,,,per diem,171.5,171.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,UHC MGG,UHC MGG,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,VA,VA,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Wellcare MGG,Wellcare MGG,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Bright Health - commercial,Bright Health - commercial,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,171.5,171.5,Bright Health MGG,Bright Health MGG,171.5,,,,,,,case rate,171.5,171.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Aetna,Aetna,54.67,,,,,,,per diem,54.67,54.67,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Aetna MGG,Aetna MGG,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,BCBS,BCBS,54.67,,,,,,,per diem,54.67,54.67,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,BCBS MGG,BCBS MGG,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Cigna,Cigna,54.67,,,,,,,per diem,54.67,54.67,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Cigna MGG,Cigna MGG,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Humana,Humana,54.67,,,,,,,per diem,54.67,54.67,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Humana MGG,Humana MGG,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Optum VA,Optum VA,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,UHC,UHC,54.67,,,,,,,per diem,54.67,54.67,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,UHC MGG,UHC MGG,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,VA,VA,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Wellcare MGG,Wellcare MGG,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Bright Health - commercial,Bright Health - commercial,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,54.67,54.67,Bright Health MGG,Bright Health MGG,54.67,,,,,,,case rate,54.67,54.67,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Aetna,Aetna,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Aetna MGG,Aetna MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,BCBS,BCBS,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,BCBS MGG,BCBS MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Cigna,Cigna,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Cigna MGG,Cigna MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Humana,Humana,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Humana MGG,Humana MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Optum VA,Optum VA,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,UHC,UHC,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,UHC MGG,UHC MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,VA,VA,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Wellcare MGG,Wellcare MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Bright Health - commercial,Bright Health - commercial,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Bright Health MGG,Bright Health MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Aetna,Aetna,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Aetna MGG,Aetna MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,BCBS,BCBS,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,BCBS MGG,BCBS MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Cigna,Cigna,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Cigna MGG,Cigna MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Humana,Humana,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Humana MGG,Humana MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Optum VA,Optum VA,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,UHC,UHC,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,UHC MGG,UHC MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,VA,VA,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Wellcare MGG,Wellcare MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Bright Health - commercial,Bright Health - commercial,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,7.73,7.73,Bright Health MGG,Bright Health MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Aetna,Aetna,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Aetna MGG,Aetna MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,BCBS,BCBS,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,BCBS MGG,BCBS MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Cigna,Cigna,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Cigna MGG,Cigna MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Humana,Humana,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Humana MGG,Humana MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Optum VA,Optum VA,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,UHC,UHC,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,UHC MGG,UHC MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,VA,VA,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Wellcare MGG,Wellcare MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Bright Health - commercial,Bright Health - commercial,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Bright Health MGG,Bright Health MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Aetna,Aetna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Aetna MGG,Aetna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,BCBS,BCBS,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,BCBS MGG,BCBS MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Cigna,Cigna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Cigna MGG,Cigna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Humana,Humana,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Humana MGG,Humana MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Optum VA,Optum VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,UHC,UHC,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,UHC MGG,UHC MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,VA,VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Wellcare MGG,Wellcare MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Bright Health - commercial,Bright Health - commercial,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,33.48,33.48,Bright Health MGG,Bright Health MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Aetna,Aetna,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Aetna MGG,Aetna MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,BCBS,BCBS,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,BCBS MGG,BCBS MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Cigna,Cigna,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Cigna MGG,Cigna MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Humana,Humana,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Humana MGG,Humana MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Optum VA,Optum VA,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,UHC,UHC,35.54,,,,,,,per diem,35.54,35.54,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,UHC MGG,UHC MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,VA,VA,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Wellcare MGG,Wellcare MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Bright Health - commercial,Bright Health - commercial,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,35.54,35.54,Bright Health MGG,Bright Health MGG,35.54,,,,,,,case rate,35.54,35.54,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Aetna,Aetna,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Aetna MGG,Aetna MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,BCBS,BCBS,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,BCBS MGG,BCBS MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Cigna,Cigna,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Cigna MGG,Cigna MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Humana,Humana,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Humana MGG,Humana MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Optum VA,Optum VA,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,UHC,UHC,4.64,,,,,,,per diem,4.64,4.64,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,UHC MGG,UHC MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,VA,VA,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Wellcare MGG,Wellcare MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Bright Health - commercial,Bright Health - commercial,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.64,4.64,Bright Health MGG,Bright Health MGG,4.64,,,,,,,case rate,4.64,4.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Aetna,Aetna,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Aetna MGG,Aetna MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,BCBS,BCBS,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,BCBS MGG,BCBS MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Cigna,Cigna,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Cigna MGG,Cigna MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Humana,Humana,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Humana MGG,Humana MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Optum VA,Optum VA,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,UHC,UHC,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,UHC MGG,UHC MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,VA,VA,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Wellcare MGG,Wellcare MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Bright Health - commercial,Bright Health - commercial,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,266.77,266.77,Bright Health MGG,Bright Health MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Aetna,Aetna,56.65,,,,,,,per diem,56.65,56.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Aetna MGG,Aetna MGG,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,BCBS,BCBS,56.65,,,,,,,per diem,56.65,56.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,BCBS MGG,BCBS MGG,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Cigna,Cigna,56.65,,,,,,,per diem,56.65,56.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Cigna MGG,Cigna MGG,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Humana,Humana,56.65,,,,,,,per diem,56.65,56.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Humana MGG,Humana MGG,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Optum VA,Optum VA,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,UHC,UHC,56.65,,,,,,,per diem,56.65,56.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,UHC MGG,UHC MGG,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,VA,VA,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Wellcare MGG,Wellcare MGG,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Bright Health - commercial,Bright Health - commercial,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,56.65,56.65,Bright Health MGG,Bright Health MGG,56.65,,,,,,,case rate,56.65,56.65,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Aetna,Aetna,534.06,,,,,,,per diem,534.06,534.06,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Aetna MGG,Aetna MGG,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,BCBS,BCBS,534.06,,,,,,,per diem,534.06,534.06,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,BCBS MGG,BCBS MGG,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Cigna,Cigna,534.06,,,,,,,per diem,534.06,534.06,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Cigna MGG,Cigna MGG,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Humana,Humana,534.06,,,,,,,per diem,534.06,534.06,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Humana MGG,Humana MGG,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Optum VA,Optum VA,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,UHC,UHC,534.06,,,,,,,per diem,534.06,534.06,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,UHC MGG,UHC MGG,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,VA,VA,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Wellcare MGG,Wellcare MGG,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Bright Health - commercial,Bright Health - commercial,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,534.06,534.06,Bright Health MGG,Bright Health MGG,534.06,,,,,,,case rate,534.06,534.06,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Aetna,Aetna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Aetna MGG,Aetna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,BCBS,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,BCBS MGG,BCBS MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Cigna,Cigna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Cigna MGG,Cigna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Humana,Humana,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Humana MGG,Humana MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Optum VA,Optum VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,UHC,UHC,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,UHC MGG,UHC MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,VA,VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Wellcare MGG,Wellcare MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Bright Health - commercial,Bright Health - commercial,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Bright Health MGG,Bright Health MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Aetna,Aetna,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Aetna MGG,Aetna MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,BCBS,BCBS,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,BCBS MGG,BCBS MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Cigna,Cigna,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Cigna MGG,Cigna MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Humana,Humana,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Humana MGG,Humana MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Optum VA,Optum VA,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,UHC,UHC,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,UHC MGG,UHC MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,VA,VA,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Wellcare MGG,Wellcare MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Bright Health - commercial,Bright Health - commercial,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Bright Health MGG,Bright Health MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Aetna,Aetna,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Aetna MGG,Aetna MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,BCBS,BCBS,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,BCBS MGG,BCBS MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Cigna,Cigna,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Cigna MGG,Cigna MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Humana,Humana,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Humana MGG,Humana MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Optum VA,Optum VA,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,UHC,UHC,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,UHC MGG,UHC MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,VA,VA,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Wellcare MGG,Wellcare MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Bright Health - commercial,Bright Health - commercial,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,131.33,131.33,Bright Health MGG,Bright Health MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Aetna,Aetna,60.26,,,,,,,per diem,60.26,60.26,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Aetna MGG,Aetna MGG,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,BCBS,BCBS,60.26,,,,,,,per diem,60.26,60.26,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,BCBS MGG,BCBS MGG,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Cigna,Cigna,60.26,,,,,,,per diem,60.26,60.26,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Cigna MGG,Cigna MGG,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Humana,Humana,60.26,,,,,,,per diem,60.26,60.26,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Humana MGG,Humana MGG,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Optum VA,Optum VA,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,UHC,UHC,60.26,,,,,,,per diem,60.26,60.26,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,UHC MGG,UHC MGG,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,VA,VA,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Wellcare MGG,Wellcare MGG,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Bright Health - commercial,Bright Health - commercial,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,60.26,60.26,Bright Health MGG,Bright Health MGG,60.26,,,,,,,case rate,60.26,60.26,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Aetna,Aetna,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Aetna MGG,Aetna MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,BCBS,BCBS,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,BCBS MGG,BCBS MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Cigna,Cigna,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Cigna MGG,Cigna MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Humana,Humana,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Humana MGG,Humana MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Optum VA,Optum VA,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,UHC,UHC,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,UHC MGG,UHC MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,VA,VA,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Wellcare MGG,Wellcare MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Bright Health - commercial,Bright Health - commercial,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Bright Health MGG,Bright Health MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Aetna,Aetna,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Aetna MGG,Aetna MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,BCBS,BCBS,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,BCBS MGG,BCBS MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Cigna,Cigna,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Cigna MGG,Cigna MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Humana,Humana,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Humana MGG,Humana MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Optum VA,Optum VA,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,UHC,UHC,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,UHC MGG,UHC MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,VA,VA,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Wellcare MGG,Wellcare MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Bright Health - commercial,Bright Health - commercial,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Bright Health MGG,Bright Health MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Aetna,Aetna,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Aetna MGG,Aetna MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,BCBS,BCBS,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,BCBS MGG,BCBS MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Cigna,Cigna,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Cigna MGG,Cigna MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Humana,Humana,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Humana MGG,Humana MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Optum VA,Optum VA,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,UHC,UHC,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,UHC MGG,UHC MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,VA,VA,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Wellcare MGG,Wellcare MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Bright Health - commercial,Bright Health - commercial,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,40.17,40.17,Bright Health MGG,Bright Health MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Aetna,Aetna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Aetna MGG,Aetna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,BCBS,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,BCBS MGG,BCBS MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Cigna,Cigna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Cigna MGG,Cigna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Humana,Humana,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Humana MGG,Humana MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Optum VA,Optum VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,UHC,UHC,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,UHC MGG,UHC MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,VA,VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Wellcare MGG,Wellcare MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Bright Health - commercial,Bright Health - commercial,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,26.78,26.78,Bright Health MGG,Bright Health MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Aetna,Aetna,83.43,,,,,,,per diem,83.43,83.43,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Aetna MGG,Aetna MGG,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,BCBS,BCBS,83.43,,,,,,,per diem,83.43,83.43,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,BCBS MGG,BCBS MGG,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Cigna,Cigna,83.43,,,,,,,per diem,83.43,83.43,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Cigna MGG,Cigna MGG,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Humana,Humana,83.43,,,,,,,per diem,83.43,83.43,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Humana MGG,Humana MGG,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Optum VA,Optum VA,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,UHC,UHC,83.43,,,,,,,per diem,83.43,83.43,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,UHC MGG,UHC MGG,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,VA,VA,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Wellcare MGG,Wellcare MGG,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Bright Health - commercial,Bright Health - commercial,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,83.43,83.43,Bright Health MGG,Bright Health MGG,83.43,,,,,,,case rate,83.43,83.43,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Aetna,Aetna,57.68,,,,,,,per diem,57.68,57.68,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Aetna MGG,Aetna MGG,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,BCBS,BCBS,57.68,,,,,,,per diem,57.68,57.68,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,BCBS MGG,BCBS MGG,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Cigna,Cigna,57.68,,,,,,,per diem,57.68,57.68,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Cigna MGG,Cigna MGG,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Humana,Humana,57.68,,,,,,,per diem,57.68,57.68,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Humana MGG,Humana MGG,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Optum VA,Optum VA,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,UHC,UHC,57.68,,,,,,,per diem,57.68,57.68,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,UHC MGG,UHC MGG,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,VA,VA,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Wellcare MGG,Wellcare MGG,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Bright Health - commercial,Bright Health - commercial,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,57.68,57.68,Bright Health MGG,Bright Health MGG,57.68,,,,,,,case rate,57.68,57.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Aetna,Aetna,82.4,,,,,,,per diem,82.4,82.4,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Aetna MGG,Aetna MGG,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,BCBS,BCBS,82.4,,,,,,,per diem,82.4,82.4,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,BCBS MGG,BCBS MGG,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Cigna,Cigna,82.4,,,,,,,per diem,82.4,82.4,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Cigna MGG,Cigna MGG,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Humana,Humana,82.4,,,,,,,per diem,82.4,82.4,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Humana MGG,Humana MGG,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Optum VA,Optum VA,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,UHC,UHC,82.4,,,,,,,per diem,82.4,82.4,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,UHC MGG,UHC MGG,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,VA,VA,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Wellcare MGG,Wellcare MGG,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Bright Health - commercial,Bright Health - commercial,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,82.4,82.4,Bright Health MGG,Bright Health MGG,82.4,,,,,,,case rate,82.4,82.4,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Aetna,Aetna,46.87,,,,,,,per diem,46.87,46.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Aetna MGG,Aetna MGG,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,BCBS,BCBS,46.87,,,,,,,per diem,46.87,46.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,BCBS MGG,BCBS MGG,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Cigna,Cigna,46.87,,,,,,,per diem,46.87,46.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Cigna MGG,Cigna MGG,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Humana,Humana,46.87,,,,,,,per diem,46.87,46.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Humana MGG,Humana MGG,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Optum VA,Optum VA,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,UHC,UHC,46.87,,,,,,,per diem,46.87,46.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,UHC MGG,UHC MGG,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,VA,VA,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Wellcare MGG,Wellcare MGG,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Bright Health - commercial,Bright Health - commercial,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,46.87,46.87,Bright Health MGG,Bright Health MGG,46.87,,,,,,,case rate,46.87,46.87,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Aetna,Aetna,39.14,,,,,,,per diem,39.14,39.14,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Aetna MGG,Aetna MGG,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,BCBS,BCBS,39.14,,,,,,,per diem,39.14,39.14,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,BCBS MGG,BCBS MGG,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Cigna,Cigna,39.14,,,,,,,per diem,39.14,39.14,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Cigna MGG,Cigna MGG,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Humana,Humana,39.14,,,,,,,per diem,39.14,39.14,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Humana MGG,Humana MGG,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Optum VA,Optum VA,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,UHC,UHC,39.14,,,,,,,per diem,39.14,39.14,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,UHC MGG,UHC MGG,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,VA,VA,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Wellcare MGG,Wellcare MGG,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Bright Health - commercial,Bright Health - commercial,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,39.14,39.14,Bright Health MGG,Bright Health MGG,39.14,,,,,,,case rate,39.14,39.14,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Aetna,Aetna,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Aetna MGG,Aetna MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,BCBS,BCBS,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,BCBS MGG,BCBS MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Cigna,Cigna,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Cigna MGG,Cigna MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Humana,Humana,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Humana MGG,Humana MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Optum VA,Optum VA,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,UHC,UHC,50.99,,,,,,,per diem,50.99,50.99,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,UHC MGG,UHC MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,VA,VA,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Wellcare MGG,Wellcare MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Bright Health - commercial,Bright Health - commercial,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,50.99,50.99,Bright Health MGG,Bright Health MGG,50.99,,,,,,,case rate,50.99,50.99,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Aetna,Aetna,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Aetna MGG,Aetna MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,BCBS,BCBS,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,BCBS MGG,BCBS MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Cigna,Cigna,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Cigna MGG,Cigna MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Humana,Humana,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Humana MGG,Humana MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Optum VA,Optum VA,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,UHC,UHC,134.42,,,,,,,per diem,134.42,134.42,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,UHC MGG,UHC MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,VA,VA,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Wellcare MGG,Wellcare MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Bright Health - commercial,Bright Health - commercial,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,134.42,134.42,Bright Health MGG,Bright Health MGG,134.42,,,,,,,case rate,134.42,134.42,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Aetna,Aetna,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Aetna MGG,Aetna MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,BCBS,BCBS,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,BCBS MGG,BCBS MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Cigna,Cigna,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Cigna MGG,Cigna MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Humana,Humana,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Humana MGG,Humana MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Optum VA,Optum VA,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,UHC,UHC,76.74,,,,,,,per diem,76.74,76.74,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,UHC MGG,UHC MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,VA,VA,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Wellcare MGG,Wellcare MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Bright Health - commercial,Bright Health - commercial,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,76.74,76.74,Bright Health MGG,Bright Health MGG,76.74,,,,,,,case rate,76.74,76.74,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Aetna,Aetna,29.87,,,,,,,per diem,29.87,29.87,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Aetna MGG,Aetna MGG,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,BCBS,BCBS,29.87,,,,,,,per diem,29.87,29.87,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,BCBS MGG,BCBS MGG,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Cigna,Cigna,29.87,,,,,,,per diem,29.87,29.87,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Cigna MGG,Cigna MGG,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Humana,Humana,29.87,,,,,,,per diem,29.87,29.87,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Humana MGG,Humana MGG,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Optum VA,Optum VA,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,UHC,UHC,29.87,,,,,,,per diem,29.87,29.87,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,UHC MGG,UHC MGG,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,VA,VA,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Wellcare MGG,Wellcare MGG,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Bright Health - commercial,Bright Health - commercial,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,29.87,29.87,Bright Health MGG,Bright Health MGG,29.87,,,,,,,case rate,29.87,29.87,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Aetna,Aetna,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Aetna MGG,Aetna MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,BCBS,BCBS,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,BCBS MGG,BCBS MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Cigna,Cigna,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Cigna MGG,Cigna MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Humana,Humana,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Humana MGG,Humana MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Optum VA,Optum VA,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,UHC,UHC,359.76,,,,,,,per diem,359.76,359.76,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,UHC MGG,UHC MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,VA,VA,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Wellcare MGG,Wellcare MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Bright Health - commercial,Bright Health - commercial,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,359.76,359.76,Bright Health MGG,Bright Health MGG,359.76,,,,,,,case rate,359.76,359.76,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Aetna,Aetna,214.24,,,,,,,per diem,214.24,214.24,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Aetna MGG,Aetna MGG,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,BCBS,BCBS,214.24,,,,,,,per diem,214.24,214.24,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,BCBS MGG,BCBS MGG,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Cigna,Cigna,214.24,,,,,,,per diem,214.24,214.24,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Cigna MGG,Cigna MGG,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Humana,Humana,214.24,,,,,,,per diem,214.24,214.24,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Humana MGG,Humana MGG,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Optum VA,Optum VA,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,UHC,UHC,214.24,,,,,,,per diem,214.24,214.24,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,UHC MGG,UHC MGG,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,VA,VA,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Wellcare MGG,Wellcare MGG,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Bright Health - commercial,Bright Health - commercial,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,214.24,214.24,Bright Health MGG,Bright Health MGG,214.24,,,,,,,case rate,214.24,214.24,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Aetna,Aetna,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Aetna MGG,Aetna MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,BCBS,BCBS,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,BCBS MGG,BCBS MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Cigna,Cigna,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Cigna MGG,Cigna MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Humana,Humana,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Humana MGG,Humana MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Optum VA,Optum VA,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,UHC,UHC,44.29,,,,,,,per diem,44.29,44.29,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,UHC MGG,UHC MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,VA,VA,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Wellcare MGG,Wellcare MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Bright Health - commercial,Bright Health - commercial,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,44.29,44.29,Bright Health MGG,Bright Health MGG,44.29,,,,,,,case rate,44.29,44.29,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Aetna,Aetna,136.99,,,,,,,per diem,136.99,136.99,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Aetna MGG,Aetna MGG,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,BCBS,BCBS,136.99,,,,,,,per diem,136.99,136.99,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,BCBS MGG,BCBS MGG,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Cigna,Cigna,136.99,,,,,,,per diem,136.99,136.99,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Cigna MGG,Cigna MGG,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Humana,Humana,136.99,,,,,,,per diem,136.99,136.99,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Humana MGG,Humana MGG,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Optum VA,Optum VA,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,UHC,UHC,136.99,,,,,,,per diem,136.99,136.99,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,UHC MGG,UHC MGG,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,VA,VA,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Wellcare MGG,Wellcare MGG,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Bright Health - commercial,Bright Health - commercial,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,136.99,136.99,Bright Health MGG,Bright Health MGG,136.99,,,,,,,case rate,136.99,136.99,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Aetna,Aetna,75.19,,,,,,,per diem,75.19,75.19,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Aetna MGG,Aetna MGG,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,BCBS,BCBS,75.19,,,,,,,per diem,75.19,75.19,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,BCBS MGG,BCBS MGG,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Cigna,Cigna,75.19,,,,,,,per diem,75.19,75.19,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Cigna MGG,Cigna MGG,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Humana,Humana,75.19,,,,,,,per diem,75.19,75.19,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Humana MGG,Humana MGG,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Optum VA,Optum VA,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,UHC,UHC,75.19,,,,,,,per diem,75.19,75.19,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,UHC MGG,UHC MGG,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,VA,VA,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Wellcare MGG,Wellcare MGG,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Bright Health - commercial,Bright Health - commercial,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,75.19,75.19,Bright Health MGG,Bright Health MGG,75.19,,,,,,,case rate,75.19,75.19,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Aetna,Aetna,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Aetna MGG,Aetna MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,BCBS,BCBS,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,BCBS MGG,BCBS MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Cigna,Cigna,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Cigna MGG,Cigna MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Humana,Humana,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Humana MGG,Humana MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Optum VA,Optum VA,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,UHC,UHC,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,UHC MGG,UHC MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,VA,VA,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Wellcare MGG,Wellcare MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Bright Health - commercial,Bright Health - commercial,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Bright Health MGG,Bright Health MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Aetna,Aetna,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Aetna MGG,Aetna MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,BCBS,BCBS,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,BCBS MGG,BCBS MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Cigna,Cigna,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Cigna MGG,Cigna MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Humana,Humana,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Humana MGG,Humana MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Optum VA,Optum VA,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,UHC,UHC,161.2,,,,,,,per diem,161.2,161.2,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,UHC MGG,UHC MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,VA,VA,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Wellcare MGG,Wellcare MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Bright Health - commercial,Bright Health - commercial,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,161.2,161.2,Bright Health MGG,Bright Health MGG,161.2,,,,,,,case rate,161.2,161.2,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Aetna,Aetna,144.72,,,,,,,per diem,144.72,144.72,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Aetna MGG,Aetna MGG,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,BCBS,BCBS,144.72,,,,,,,per diem,144.72,144.72,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,BCBS MGG,BCBS MGG,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Cigna,Cigna,144.72,,,,,,,per diem,144.72,144.72,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Cigna MGG,Cigna MGG,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Humana,Humana,144.72,,,,,,,per diem,144.72,144.72,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Humana MGG,Humana MGG,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Optum VA,Optum VA,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,UHC,UHC,144.72,,,,,,,per diem,144.72,144.72,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,UHC MGG,UHC MGG,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,VA,VA,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Wellcare MGG,Wellcare MGG,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Bright Health - commercial,Bright Health - commercial,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,144.72,144.72,Bright Health MGG,Bright Health MGG,144.72,,,,,,,case rate,144.72,144.72,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Aetna,Aetna,16.48,,,,,,,per diem,16.48,16.48,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Aetna MGG,Aetna MGG,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,BCBS,BCBS,16.48,,,,,,,per diem,16.48,16.48,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,BCBS MGG,BCBS MGG,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Cigna,Cigna,16.48,,,,,,,per diem,16.48,16.48,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Cigna MGG,Cigna MGG,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Humana,Humana,16.48,,,,,,,per diem,16.48,16.48,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Humana MGG,Humana MGG,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Optum VA,Optum VA,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,UHC,UHC,16.48,,,,,,,per diem,16.48,16.48,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,UHC MGG,UHC MGG,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,VA,VA,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Wellcare MGG,Wellcare MGG,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Bright Health - commercial,Bright Health - commercial,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,16.48,16.48,Bright Health MGG,Bright Health MGG,16.48,,,,,,,case rate,16.48,16.48,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Aetna,Aetna,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Aetna MGG,Aetna MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,BCBS,BCBS,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,BCBS MGG,BCBS MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Cigna,Cigna,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Cigna MGG,Cigna MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Humana,Humana,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Humana MGG,Humana MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Optum VA,Optum VA,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,UHC,UHC,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,UHC MGG,UHC MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,VA,VA,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Wellcare MGG,Wellcare MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Bright Health - commercial,Bright Health - commercial,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,71.07,71.07,Bright Health MGG,Bright Health MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Aetna,Aetna,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Aetna MGG,Aetna MGG,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,BCBS,BCBS,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,BCBS MGG,BCBS MGG,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Cigna,Cigna,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Cigna MGG,Cigna MGG,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Humana,Humana,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Humana MGG,Humana MGG,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Optum VA,Optum VA,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,UHC,UHC,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,UHC MGG,UHC MGG,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,VA,VA,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Wellcare MGG,Wellcare MGG,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Bright Health - commercial,Bright Health - commercial,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,27.81,27.81,Bright Health MGG,Bright Health MGG,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Aetna,Aetna,695.25,,,,,,,per diem,695.25,695.25,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Aetna MGG,Aetna MGG,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,BCBS,BCBS,695.25,,,,,,,per diem,695.25,695.25,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,BCBS MGG,BCBS MGG,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Cigna,Cigna,695.25,,,,,,,per diem,695.25,695.25,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Cigna MGG,Cigna MGG,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Humana,Humana,695.25,,,,,,,per diem,695.25,695.25,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Humana MGG,Humana MGG,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Optum VA,Optum VA,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,UHC,UHC,695.25,,,,,,,per diem,695.25,695.25,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,UHC MGG,UHC MGG,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,VA,VA,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Wellcare MGG,Wellcare MGG,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Bright Health - commercial,Bright Health - commercial,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,695.25,695.25,Bright Health MGG,Bright Health MGG,695.25,,,,,,,case rate,695.25,695.25,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Aetna,Aetna,11.33,,,,,,,per diem,11.33,11.33,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Aetna MGG,Aetna MGG,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,BCBS,BCBS,11.33,,,,,,,per diem,11.33,11.33,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,BCBS MGG,BCBS MGG,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Cigna,Cigna,11.33,,,,,,,per diem,11.33,11.33,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Cigna MGG,Cigna MGG,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Humana,Humana,11.33,,,,,,,per diem,11.33,11.33,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Humana MGG,Humana MGG,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Optum VA,Optum VA,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,UHC,UHC,11.33,,,,,,,per diem,11.33,11.33,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,UHC MGG,UHC MGG,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,VA,VA,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Wellcare MGG,Wellcare MGG,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Bright Health - commercial,Bright Health - commercial,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.33,11.33,Bright Health MGG,Bright Health MGG,11.33,,,,,,,case rate,11.33,11.33,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Aetna,Aetna,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Aetna MGG,Aetna MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,BCBS,BCBS,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,BCBS MGG,BCBS MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Cigna,Cigna,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Cigna MGG,Cigna MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Humana,Humana,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Humana MGG,Humana MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Optum VA,Optum VA,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,UHC,UHC,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,UHC MGG,UHC MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,VA,VA,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Wellcare MGG,Wellcare MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Bright Health - commercial,Bright Health - commercial,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,18.81,18.81,Bright Health MGG,Bright Health MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Aetna,Aetna,155.53,,,,,,,per diem,155.53,155.53,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Aetna MGG,Aetna MGG,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,BCBS,BCBS,155.53,,,,,,,per diem,155.53,155.53,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,BCBS MGG,BCBS MGG,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Cigna,Cigna,155.53,,,,,,,per diem,155.53,155.53,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Cigna MGG,Cigna MGG,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Humana,Humana,155.53,,,,,,,per diem,155.53,155.53,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Humana MGG,Humana MGG,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Optum VA,Optum VA,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,UHC,UHC,155.53,,,,,,,per diem,155.53,155.53,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,UHC MGG,UHC MGG,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,VA,VA,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Wellcare MGG,Wellcare MGG,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Bright Health - commercial,Bright Health - commercial,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,155.53,155.53,Bright Health MGG,Bright Health MGG,155.53,,,,,,,case rate,155.53,155.53,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Aetna,Aetna,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Aetna MGG,Aetna MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,BCBS,BCBS,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,BCBS MGG,BCBS MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Cigna,Cigna,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Cigna MGG,Cigna MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Humana,Humana,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Humana MGG,Humana MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Optum VA,Optum VA,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,UHC,UHC,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,UHC MGG,UHC MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,VA,VA,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Wellcare MGG,Wellcare MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Bright Health - commercial,Bright Health - commercial,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.18,6.18,Bright Health MGG,Bright Health MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Aetna,Aetna,56.14,,,,,,,per diem,56.14,56.14,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Aetna MGG,Aetna MGG,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,BCBS,BCBS,56.14,,,,,,,per diem,56.14,56.14,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,BCBS MGG,BCBS MGG,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Cigna,Cigna,56.14,,,,,,,per diem,56.14,56.14,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Cigna MGG,Cigna MGG,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Humana,Humana,56.14,,,,,,,per diem,56.14,56.14,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Humana MGG,Humana MGG,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Optum VA,Optum VA,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,UHC,UHC,56.14,,,,,,,per diem,56.14,56.14,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,UHC MGG,UHC MGG,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,VA,VA,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Wellcare MGG,Wellcare MGG,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Bright Health - commercial,Bright Health - commercial,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,56.14,56.14,Bright Health MGG,Bright Health MGG,56.14,,,,,,,case rate,56.14,56.14,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Aetna,Aetna,61.8,,,,,,,per diem,61.8,61.8,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Aetna MGG,Aetna MGG,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,BCBS,BCBS,61.8,,,,,,,per diem,61.8,61.8,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,BCBS MGG,BCBS MGG,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Cigna,Cigna,61.8,,,,,,,per diem,61.8,61.8,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Cigna MGG,Cigna MGG,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Humana,Humana,61.8,,,,,,,per diem,61.8,61.8,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Humana MGG,Humana MGG,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Optum VA,Optum VA,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,UHC,UHC,61.8,,,,,,,per diem,61.8,61.8,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,UHC MGG,UHC MGG,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,VA,VA,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Wellcare MGG,Wellcare MGG,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Bright Health - commercial,Bright Health - commercial,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,61.8,61.8,Bright Health MGG,Bright Health MGG,61.8,,,,,,,case rate,61.8,61.8,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Aetna,Aetna,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Aetna MGG,Aetna MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,BCBS,BCBS,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,BCBS MGG,BCBS MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Cigna,Cigna,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Cigna MGG,Cigna MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Humana,Humana,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Humana MGG,Humana MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Optum VA,Optum VA,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,UHC,UHC,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,UHC MGG,UHC MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,VA,VA,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Wellcare MGG,Wellcare MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Bright Health - commercial,Bright Health - commercial,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,144,144,Bright Health MGG,Bright Health MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Aetna,Aetna,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Aetna MGG,Aetna MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,BCBS,BCBS,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,BCBS MGG,BCBS MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Cigna,Cigna,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Cigna MGG,Cigna MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Humana,Humana,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Humana MGG,Humana MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Optum VA,Optum VA,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,UHC,UHC,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,UHC MGG,UHC MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,VA,VA,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Wellcare MGG,Wellcare MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Bright Health - commercial,Bright Health - commercial,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,10.2,10.2,Bright Health MGG,Bright Health MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Aetna,Aetna,10.69,,,,,,,per diem,10.69,10.69,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Aetna MGG,Aetna MGG,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,BCBS,BCBS,10.69,,,,,,,per diem,10.69,10.69,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,BCBS MGG,BCBS MGG,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Cigna,Cigna,10.69,,,,,,,per diem,10.69,10.69,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Cigna MGG,Cigna MGG,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Humana,Humana,10.69,,,,,,,per diem,10.69,10.69,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Humana MGG,Humana MGG,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Optum VA,Optum VA,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,UHC,UHC,10.69,,,,,,,per diem,10.69,10.69,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,UHC MGG,UHC MGG,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,VA,VA,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Wellcare MGG,Wellcare MGG,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Bright Health - commercial,Bright Health - commercial,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,10.69,10.69,Bright Health MGG,Bright Health MGG,10.69,,,,,,,case rate,10.69,10.69,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Aetna,Aetna,167.89,,,,,,,per diem,167.89,167.89,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Aetna MGG,Aetna MGG,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,BCBS,BCBS,167.89,,,,,,,per diem,167.89,167.89,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,BCBS MGG,BCBS MGG,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Cigna,Cigna,167.89,,,,,,,per diem,167.89,167.89,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Cigna MGG,Cigna MGG,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Humana,Humana,167.89,,,,,,,per diem,167.89,167.89,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Humana MGG,Humana MGG,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Optum VA,Optum VA,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,UHC,UHC,167.89,,,,,,,per diem,167.89,167.89,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,UHC MGG,UHC MGG,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,VA,VA,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Wellcare MGG,Wellcare MGG,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Bright Health - commercial,Bright Health - commercial,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,167.89,167.89,Bright Health MGG,Bright Health MGG,167.89,,,,,,,case rate,167.89,167.89,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Aetna,Aetna,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Aetna MGG,Aetna MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,BCBS,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,BCBS MGG,BCBS MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Cigna,Cigna,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Cigna MGG,Cigna MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Humana,Humana,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Humana MGG,Humana MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Optum VA,Optum VA,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,UHC,UHC,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,UHC MGG,UHC MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,VA,VA,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Wellcare MGG,Wellcare MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Bright Health - commercial,Bright Health - commercial,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,94.25,94.25,Bright Health MGG,Bright Health MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Aetna,Aetna,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Aetna MGG,Aetna MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,BCBS,BCBS,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,BCBS MGG,BCBS MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Cigna,Cigna,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Cigna MGG,Cigna MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Humana,Humana,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Humana MGG,Humana MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Optum VA,Optum VA,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,UHC,UHC,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,UHC MGG,UHC MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,VA,VA,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Wellcare MGG,Wellcare MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Bright Health - commercial,Bright Health - commercial,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Bright Health MGG,Bright Health MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Aetna,Aetna,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Aetna MGG,Aetna MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,BCBS,BCBS,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,BCBS MGG,BCBS MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Cigna,Cigna,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Cigna MGG,Cigna MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Humana,Humana,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Humana MGG,Humana MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Optum VA,Optum VA,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,UHC,UHC,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,UHC MGG,UHC MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,VA,VA,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Wellcare MGG,Wellcare MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Bright Health - commercial,Bright Health - commercial,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Bright Health MGG,Bright Health MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Aetna,Aetna,38.11,,,,,,,per diem,38.11,38.11,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Aetna MGG,Aetna MGG,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,BCBS,BCBS,38.11,,,,,,,per diem,38.11,38.11,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,BCBS MGG,BCBS MGG,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Cigna,Cigna,38.11,,,,,,,per diem,38.11,38.11,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Cigna MGG,Cigna MGG,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Humana,Humana,38.11,,,,,,,per diem,38.11,38.11,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Humana MGG,Humana MGG,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Optum VA,Optum VA,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,UHC,UHC,38.11,,,,,,,per diem,38.11,38.11,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,UHC MGG,UHC MGG,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,VA,VA,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Wellcare MGG,Wellcare MGG,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Bright Health - commercial,Bright Health - commercial,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,38.11,38.11,Bright Health MGG,Bright Health MGG,38.11,,,,,,,case rate,38.11,38.11,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Aetna,Aetna,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Aetna MGG,Aetna MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,BCBS,BCBS,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,BCBS MGG,BCBS MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Cigna,Cigna,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Cigna MGG,Cigna MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Humana,Humana,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Humana MGG,Humana MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Optum VA,Optum VA,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,UHC,UHC,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,UHC MGG,UHC MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,VA,VA,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Wellcare MGG,Wellcare MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Bright Health - commercial,Bright Health - commercial,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,43.26,43.26,Bright Health MGG,Bright Health MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Aetna,Aetna,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Aetna MGG,Aetna MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,BCBS,BCBS,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,BCBS MGG,BCBS MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Cigna,Cigna,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Cigna MGG,Cigna MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Humana,Humana,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Humana MGG,Humana MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Optum VA,Optum VA,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,UHC,UHC,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,UHC MGG,UHC MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,VA,VA,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Wellcare MGG,Wellcare MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Bright Health - commercial,Bright Health - commercial,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Bright Health MGG,Bright Health MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Aetna,Aetna,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Aetna MGG,Aetna MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,BCBS,BCBS,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,BCBS MGG,BCBS MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Cigna,Cigna,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Cigna MGG,Cigna MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Humana,Humana,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Humana MGG,Humana MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Optum VA,Optum VA,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,UHC,UHC,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,UHC MGG,UHC MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,VA,VA,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Wellcare MGG,Wellcare MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Bright Health - commercial,Bright Health - commercial,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,45.84,45.84,Bright Health MGG,Bright Health MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Aetna,Aetna,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Aetna MGG,Aetna MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,BCBS,BCBS,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,BCBS MGG,BCBS MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Cigna,Cigna,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Cigna MGG,Cigna MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Humana,Humana,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Humana MGG,Humana MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Optum VA,Optum VA,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,UHC,UHC,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,UHC MGG,UHC MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,VA,VA,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Wellcare MGG,Wellcare MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Bright Health - commercial,Bright Health - commercial,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,Bright Health MGG,Bright Health MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Aetna,Aetna,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Aetna MGG,Aetna MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,BCBS,BCBS,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,BCBS MGG,BCBS MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Cigna,Cigna,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Cigna MGG,Cigna MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Humana,Humana,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Humana MGG,Humana MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Optum VA,Optum VA,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,UHC,UHC,131.33,,,,,,,per diem,131.33,131.33,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,UHC MGG,UHC MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,VA,VA,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Wellcare MGG,Wellcare MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Bright Health - commercial,Bright Health - commercial,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,131.33,131.33,Bright Health MGG,Bright Health MGG,131.33,,,,,,,case rate,131.33,131.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Aetna,Aetna,73.65,,,,,,,per diem,73.65,73.65,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Aetna MGG,Aetna MGG,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,BCBS,BCBS,73.65,,,,,,,per diem,73.65,73.65,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,BCBS MGG,BCBS MGG,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Cigna,Cigna,73.65,,,,,,,per diem,73.65,73.65,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Cigna MGG,Cigna MGG,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Humana,Humana,73.65,,,,,,,per diem,73.65,73.65,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Humana MGG,Humana MGG,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Optum VA,Optum VA,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,UHC,UHC,73.65,,,,,,,per diem,73.65,73.65,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,UHC MGG,UHC MGG,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,VA,VA,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Wellcare MGG,Wellcare MGG,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Bright Health - commercial,Bright Health - commercial,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,73.65,73.65,Bright Health MGG,Bright Health MGG,73.65,,,,,,,case rate,73.65,73.65,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Aetna,Aetna,135.96,,,,,,,per diem,135.96,135.96,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Aetna MGG,Aetna MGG,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,BCBS,BCBS,135.96,,,,,,,per diem,135.96,135.96,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,BCBS MGG,BCBS MGG,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Cigna,Cigna,135.96,,,,,,,per diem,135.96,135.96,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Cigna MGG,Cigna MGG,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Humana,Humana,135.96,,,,,,,per diem,135.96,135.96,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Humana MGG,Humana MGG,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Optum VA,Optum VA,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,UHC,UHC,135.96,,,,,,,per diem,135.96,135.96,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,UHC MGG,UHC MGG,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,VA,VA,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Wellcare MGG,Wellcare MGG,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Bright Health - commercial,Bright Health - commercial,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,135.96,135.96,Bright Health MGG,Bright Health MGG,135.96,,,,,,,case rate,135.96,135.96,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Aetna,Aetna,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Aetna MGG,Aetna MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,BCBS,BCBS,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,BCBS MGG,BCBS MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Cigna,Cigna,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Cigna MGG,Cigna MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Humana,Humana,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Humana MGG,Humana MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Optum VA,Optum VA,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,UHC,UHC,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,UHC MGG,UHC MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,VA,VA,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Wellcare MGG,Wellcare MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Bright Health - commercial,Bright Health - commercial,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,97.85,97.85,Bright Health MGG,Bright Health MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Aetna,Aetna,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Aetna MGG,Aetna MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,BCBS,BCBS,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,BCBS MGG,BCBS MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Cigna,Cigna,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Cigna MGG,Cigna MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Humana,Humana,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Humana MGG,Humana MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Optum VA,Optum VA,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,UHC,UHC,34.51,,,,,,,per diem,34.51,34.51,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,UHC MGG,UHC MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,VA,VA,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Wellcare MGG,Wellcare MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Bright Health - commercial,Bright Health - commercial,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,34.51,34.51,Bright Health MGG,Bright Health MGG,34.51,,,,,,,case rate,34.51,34.51,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Aetna,Aetna,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Aetna MGG,Aetna MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,BCBS,BCBS,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,BCBS MGG,BCBS MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Cigna,Cigna,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Cigna MGG,Cigna MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Humana,Humana,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Humana MGG,Humana MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Optum VA,Optum VA,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,UHC,UHC,53.56,,,,,,,per diem,53.56,53.56,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,UHC MGG,UHC MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,VA,VA,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Wellcare MGG,Wellcare MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Bright Health - commercial,Bright Health - commercial,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,53.56,53.56,Bright Health MGG,Bright Health MGG,53.56,,,,,,,case rate,53.56,53.56,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Aetna,Aetna,82.92,,,,,,,per diem,82.92,82.92,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Aetna MGG,Aetna MGG,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,BCBS,BCBS,82.92,,,,,,,per diem,82.92,82.92,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,BCBS MGG,BCBS MGG,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Cigna,Cigna,82.92,,,,,,,per diem,82.92,82.92,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Cigna MGG,Cigna MGG,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Humana,Humana,82.92,,,,,,,per diem,82.92,82.92,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Humana MGG,Humana MGG,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Optum VA,Optum VA,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,UHC,UHC,82.92,,,,,,,per diem,82.92,82.92,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,UHC MGG,UHC MGG,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,VA,VA,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Wellcare MGG,Wellcare MGG,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Bright Health - commercial,Bright Health - commercial,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,82.92,82.92,Bright Health MGG,Bright Health MGG,82.92,,,,,,,case rate,82.92,82.92,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Aetna,Aetna,85.49,,,,,,,per diem,85.49,85.49,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Aetna MGG,Aetna MGG,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,BCBS,BCBS,85.49,,,,,,,per diem,85.49,85.49,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,BCBS MGG,BCBS MGG,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Cigna,Cigna,85.49,,,,,,,per diem,85.49,85.49,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Cigna MGG,Cigna MGG,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Humana,Humana,85.49,,,,,,,per diem,85.49,85.49,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Humana MGG,Humana MGG,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Optum VA,Optum VA,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,UHC,UHC,85.49,,,,,,,per diem,85.49,85.49,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,UHC MGG,UHC MGG,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,VA,VA,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Wellcare MGG,Wellcare MGG,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Bright Health - commercial,Bright Health - commercial,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,85.49,85.49,Bright Health MGG,Bright Health MGG,85.49,,,,,,,case rate,85.49,85.49,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Aetna,Aetna,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Aetna MGG,Aetna MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,BCBS,BCBS,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,BCBS MGG,BCBS MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Cigna,Cigna,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Cigna MGG,Cigna MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Humana,Humana,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Humana MGG,Humana MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Optum VA,Optum VA,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,UHC,UHC,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,UHC MGG,UHC MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,VA,VA,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Wellcare MGG,Wellcare MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Bright Health - commercial,Bright Health - commercial,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,48.93,48.93,Bright Health MGG,Bright Health MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Aetna,Aetna,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Aetna MGG,Aetna MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,BCBS,BCBS,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,BCBS MGG,BCBS MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Cigna,Cigna,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Cigna MGG,Cigna MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Humana,Humana,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Humana MGG,Humana MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Optum VA,Optum VA,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,UHC,UHC,266.77,,,,,,,per diem,266.77,266.77,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,UHC MGG,UHC MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,VA,VA,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Wellcare MGG,Wellcare MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Bright Health - commercial,Bright Health - commercial,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,266.77,266.77,Bright Health MGG,Bright Health MGG,266.77,,,,,,,case rate,266.77,266.77,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Aetna,Aetna,561.5,,,,,,,per diem,561.5,561.5,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Aetna MGG,Aetna MGG,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,BCBS,BCBS,561.5,,,,,,,per diem,561.5,561.5,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,BCBS MGG,BCBS MGG,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Cigna,Cigna,561.5,,,,,,,per diem,561.5,561.5,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Cigna MGG,Cigna MGG,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Humana,Humana,561.5,,,,,,,per diem,561.5,561.5,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Humana MGG,Humana MGG,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Optum VA,Optum VA,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,UHC,UHC,561.5,,,,,,,per diem,561.5,561.5,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,UHC MGG,UHC MGG,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,VA,VA,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Wellcare MGG,Wellcare MGG,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Bright Health - commercial,Bright Health - commercial,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,561.5,561.5,Bright Health MGG,Bright Health MGG,561.5,,,,,,,case rate,561.5,561.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Aetna,Aetna,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Aetna MGG,Aetna MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,BCBS,BCBS,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,BCBS MGG,BCBS MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Cigna,Cigna,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Cigna MGG,Cigna MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Humana,Humana,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Humana MGG,Humana MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Optum VA,Optum VA,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,UHC,UHC,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,UHC MGG,UHC MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,VA,VA,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Wellcare MGG,Wellcare MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Bright Health - commercial,Bright Health - commercial,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Bright Health MGG,Bright Health MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Aetna,Aetna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Aetna MGG,Aetna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,BCBS,BCBS,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,BCBS MGG,BCBS MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Cigna,Cigna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Cigna MGG,Cigna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Humana,Humana,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Humana MGG,Humana MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Optum VA,Optum VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,UHC,UHC,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,UHC MGG,UHC MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,VA,VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Wellcare MGG,Wellcare MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Bright Health - commercial,Bright Health - commercial,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,25.5,25.5,Bright Health MGG,Bright Health MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Aetna,Aetna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Aetna MGG,Aetna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,BCBS,BCBS,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,BCBS MGG,BCBS MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Cigna,Cigna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Cigna MGG,Cigna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Humana,Humana,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Humana MGG,Humana MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Optum VA,Optum VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,UHC,UHC,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,UHC MGG,UHC MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,VA,VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Wellcare MGG,Wellcare MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Bright Health - commercial,Bright Health - commercial,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,6.75,6.75,Bright Health MGG,Bright Health MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Aetna,Aetna,566,,,,,,,per diem,566,566,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Aetna MGG,Aetna MGG,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,BCBS,BCBS,566,,,,,,,per diem,566,566,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,BCBS MGG,BCBS MGG,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Cigna,Cigna,566,,,,,,,per diem,566,566,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Cigna MGG,Cigna MGG,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Humana,Humana,566,,,,,,,per diem,566,566,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Humana MGG,Humana MGG,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Optum VA,Optum VA,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,UHC,UHC,566,,,,,,,per diem,566,566,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,UHC MGG,UHC MGG,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,VA,VA,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Wellcare MGG,Wellcare MGG,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Bright Health - commercial,Bright Health - commercial,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,566,566,Bright Health MGG,Bright Health MGG,566,,,,,,,case rate,566,566,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Aetna,Aetna,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Aetna MGG,Aetna MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,BCBS,BCBS,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,BCBS MGG,BCBS MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Cigna,Cigna,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Cigna MGG,Cigna MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Humana,Humana,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Humana MGG,Humana MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Optum VA,Optum VA,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,UHC,UHC,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,UHC MGG,UHC MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,VA,VA,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Wellcare MGG,Wellcare MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Bright Health - commercial,Bright Health - commercial,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Bright Health MGG,Bright Health MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Aetna,Aetna,39.25,,,,,,,per diem,39.25,39.25,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Aetna MGG,Aetna MGG,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,BCBS,BCBS,39.25,,,,,,,per diem,39.25,39.25,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,BCBS MGG,BCBS MGG,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Cigna,Cigna,39.25,,,,,,,per diem,39.25,39.25,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Cigna MGG,Cigna MGG,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Humana,Humana,39.25,,,,,,,per diem,39.25,39.25,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Humana MGG,Humana MGG,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Optum VA,Optum VA,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,UHC,UHC,39.25,,,,,,,per diem,39.25,39.25,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,UHC MGG,UHC MGG,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,VA,VA,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Wellcare MGG,Wellcare MGG,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Bright Health - commercial,Bright Health - commercial,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,39.25,39.25,Bright Health MGG,Bright Health MGG,39.25,,,,,,,case rate,39.25,39.25,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Aetna,Aetna,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Aetna MGG,Aetna MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,BCBS,BCBS,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,BCBS MGG,BCBS MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Cigna,Cigna,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Cigna MGG,Cigna MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Humana,Humana,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Humana MGG,Humana MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Optum VA,Optum VA,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,UHC,UHC,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,UHC MGG,UHC MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,VA,VA,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Wellcare MGG,Wellcare MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Bright Health - commercial,Bright Health - commercial,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,306,306,Bright Health MGG,Bright Health MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Aetna,Aetna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Aetna MGG,Aetna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,BCBS,BCBS,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,BCBS MGG,BCBS MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Cigna,Cigna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Cigna MGG,Cigna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Humana,Humana,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Humana MGG,Humana MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Optum VA,Optum VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,UHC,UHC,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,UHC MGG,UHC MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,VA,VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Wellcare MGG,Wellcare MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Bright Health - commercial,Bright Health - commercial,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Bright Health MGG,Bright Health MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Aetna,Aetna,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Aetna MGG,Aetna MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,BCBS,BCBS,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,BCBS MGG,BCBS MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Cigna,Cigna,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Cigna MGG,Cigna MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Humana,Humana,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Humana MGG,Humana MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Optum VA,Optum VA,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,UHC,UHC,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,UHC MGG,UHC MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,VA,VA,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Wellcare MGG,Wellcare MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Bright Health - commercial,Bright Health - commercial,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,131,131,Bright Health MGG,Bright Health MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Aetna,Aetna,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Aetna MGG,Aetna MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,BCBS,BCBS,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,BCBS MGG,BCBS MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Cigna,Cigna,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Cigna MGG,Cigna MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Humana,Humana,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Humana MGG,Humana MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Optum VA,Optum VA,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,UHC,UHC,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,UHC MGG,UHC MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,VA,VA,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Wellcare MGG,Wellcare MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Bright Health - commercial,Bright Health - commercial,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Bright Health MGG,Bright Health MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Aetna,Aetna,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Aetna MGG,Aetna MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,BCBS,BCBS,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,BCBS MGG,BCBS MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Cigna,Cigna,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Cigna MGG,Cigna MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Humana,Humana,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Humana MGG,Humana MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Optum VA,Optum VA,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,UHC,UHC,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,UHC MGG,UHC MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,VA,VA,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Wellcare MGG,Wellcare MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Bright Health - commercial,Bright Health - commercial,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Bright Health MGG,Bright Health MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Aetna,Aetna,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Aetna MGG,Aetna MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,BCBS,BCBS,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,BCBS MGG,BCBS MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Cigna,Cigna,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Cigna MGG,Cigna MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Humana,Humana,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Humana MGG,Humana MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Optum VA,Optum VA,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,UHC,UHC,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,UHC MGG,UHC MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,VA,VA,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Wellcare MGG,Wellcare MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Bright Health - commercial,Bright Health - commercial,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,125,125,Bright Health MGG,Bright Health MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Aetna,Aetna,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Aetna MGG,Aetna MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,BCBS,BCBS,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,BCBS MGG,BCBS MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Cigna,Cigna,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Cigna MGG,Cigna MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Humana,Humana,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Humana MGG,Humana MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Optum VA,Optum VA,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,UHC,UHC,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,UHC MGG,UHC MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,VA,VA,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Wellcare MGG,Wellcare MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Bright Health - commercial,Bright Health - commercial,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,73,73,Bright Health MGG,Bright Health MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Aetna,Aetna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Aetna MGG,Aetna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,BCBS,BCBS,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,BCBS MGG,BCBS MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Cigna,Cigna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Cigna MGG,Cigna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Humana,Humana,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Humana MGG,Humana MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Optum VA,Optum VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,UHC,UHC,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,UHC MGG,UHC MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,VA,VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Wellcare MGG,Wellcare MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Bright Health - commercial,Bright Health - commercial,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,195,195,Bright Health MGG,Bright Health MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Aetna,Aetna,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Aetna MGG,Aetna MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,BCBS,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,BCBS MGG,BCBS MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Cigna,Cigna,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Cigna MGG,Cigna MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Humana,Humana,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Humana MGG,Humana MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Optum VA,Optum VA,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,UHC,UHC,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,UHC MGG,UHC MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,VA,VA,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Wellcare MGG,Wellcare MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Bright Health - commercial,Bright Health - commercial,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Bright Health MGG,Bright Health MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Aetna,Aetna,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Aetna MGG,Aetna MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,BCBS,BCBS,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,BCBS MGG,BCBS MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Cigna,Cigna,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Cigna MGG,Cigna MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Humana,Humana,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Humana MGG,Humana MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Optum VA,Optum VA,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,UHC,UHC,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,UHC MGG,UHC MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,VA,VA,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Wellcare MGG,Wellcare MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Bright Health - commercial,Bright Health - commercial,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Bright Health MGG,Bright Health MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Aetna,Aetna,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Aetna MGG,Aetna MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,BCBS,BCBS,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,BCBS MGG,BCBS MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Cigna,Cigna,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Cigna MGG,Cigna MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Humana,Humana,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Humana MGG,Humana MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Optum VA,Optum VA,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,UHC,UHC,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,UHC MGG,UHC MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,VA,VA,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Wellcare MGG,Wellcare MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Bright Health - commercial,Bright Health - commercial,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Bright Health MGG,Bright Health MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Aetna,Aetna,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Aetna MGG,Aetna MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,BCBS,BCBS,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,BCBS MGG,BCBS MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Cigna,Cigna,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Cigna MGG,Cigna MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Humana,Humana,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Humana MGG,Humana MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Optum VA,Optum VA,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,UHC,UHC,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,UHC MGG,UHC MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,VA,VA,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Wellcare MGG,Wellcare MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Bright Health - commercial,Bright Health - commercial,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,83,83,Bright Health MGG,Bright Health MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Aetna,Aetna,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Aetna MGG,Aetna MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,BCBS,BCBS,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,BCBS MGG,BCBS MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Cigna,Cigna,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Cigna MGG,Cigna MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Humana,Humana,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Humana MGG,Humana MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Optum VA,Optum VA,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,UHC,UHC,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,UHC MGG,UHC MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,VA,VA,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Wellcare MGG,Wellcare MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Bright Health - commercial,Bright Health - commercial,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,83,83,Bright Health MGG,Bright Health MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Aetna,Aetna,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Aetna MGG,Aetna MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,BCBS,BCBS,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,BCBS MGG,BCBS MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Cigna,Cigna,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Cigna MGG,Cigna MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Humana,Humana,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Humana MGG,Humana MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Optum VA,Optum VA,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,UHC,UHC,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,UHC MGG,UHC MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,VA,VA,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Wellcare MGG,Wellcare MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Bright Health - commercial,Bright Health - commercial,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Bright Health MGG,Bright Health MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Aetna,Aetna,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Aetna MGG,Aetna MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,BCBS,BCBS,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,BCBS MGG,BCBS MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Cigna,Cigna,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Cigna MGG,Cigna MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Humana,Humana,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Humana MGG,Humana MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Optum VA,Optum VA,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,UHC,UHC,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,UHC MGG,UHC MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,VA,VA,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Wellcare MGG,Wellcare MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Bright Health - commercial,Bright Health - commercial,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Bright Health MGG,Bright Health MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Aetna,Aetna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Aetna MGG,Aetna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,BCBS,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS MGG,BCBS MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Cigna,Cigna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Cigna MGG,Cigna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Humana,Humana,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Humana MGG,Humana MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Optum VA,Optum VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,UHC,UHC,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,UHC MGG,UHC MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,VA,VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Wellcare MGG,Wellcare MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Bright Health - commercial,Bright Health - commercial,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,21,21,Bright Health MGG,Bright Health MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Aetna,Aetna,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Aetna MGG,Aetna MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,BCBS,BCBS,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,BCBS MGG,BCBS MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Cigna,Cigna,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Cigna MGG,Cigna MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Humana,Humana,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Humana MGG,Humana MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Optum VA,Optum VA,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,UHC,UHC,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,UHC MGG,UHC MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,VA,VA,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Wellcare MGG,Wellcare MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Bright Health - commercial,Bright Health - commercial,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,50,50,Bright Health MGG,Bright Health MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Aetna,Aetna,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Aetna MGG,Aetna MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,BCBS,BCBS,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,BCBS MGG,BCBS MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Cigna,Cigna,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Cigna MGG,Cigna MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Humana,Humana,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Humana MGG,Humana MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Optum VA,Optum VA,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,UHC,UHC,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,UHC MGG,UHC MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,VA,VA,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Wellcare MGG,Wellcare MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Bright Health - commercial,Bright Health - commercial,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4,4,Bright Health MGG,Bright Health MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Aetna,Aetna,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Aetna MGG,Aetna MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,BCBS,BCBS,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,BCBS MGG,BCBS MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Cigna,Cigna,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Cigna MGG,Cigna MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Humana,Humana,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Humana MGG,Humana MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Optum VA,Optum VA,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,UHC,UHC,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,UHC MGG,UHC MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,VA,VA,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Wellcare MGG,Wellcare MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Bright Health - commercial,Bright Health - commercial,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,50,50,Bright Health MGG,Bright Health MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Aetna,Aetna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Aetna MGG,Aetna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,BCBS,BCBS,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,BCBS MGG,BCBS MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Cigna,Cigna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Cigna MGG,Cigna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Humana,Humana,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Humana MGG,Humana MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Optum VA,Optum VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,UHC,UHC,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,UHC MGG,UHC MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,VA,VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Wellcare MGG,Wellcare MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Bright Health - commercial,Bright Health - commercial,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,156,156,Bright Health MGG,Bright Health MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna,Aetna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna MGG,Aetna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS,BCBS,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS MGG,BCBS MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna,Cigna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna MGG,Cigna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana,Humana,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana MGG,Humana MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Optum VA,Optum VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC,UHC,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC MGG,UHC MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,VA,VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Wellcare MGG,Wellcare MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health - commercial,Bright Health - commercial,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health MGG,Bright Health MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Aetna,Aetna,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Aetna MGG,Aetna MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,BCBS,BCBS,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,BCBS MGG,BCBS MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Cigna,Cigna,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Cigna MGG,Cigna MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Humana,Humana,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Humana MGG,Humana MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Optum VA,Optum VA,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,UHC,UHC,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,UHC MGG,UHC MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,VA,VA,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Wellcare MGG,Wellcare MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Bright Health - commercial,Bright Health - commercial,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Bright Health MGG,Bright Health MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Aetna,Aetna,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Aetna MGG,Aetna MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,BCBS,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS MGG,BCBS MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Cigna,Cigna,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Cigna MGG,Cigna MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Humana,Humana,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Humana MGG,Humana MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Optum VA,Optum VA,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,UHC,UHC,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,UHC MGG,UHC MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,VA,VA,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Wellcare MGG,Wellcare MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Bright Health - commercial,Bright Health - commercial,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7,7,Bright Health MGG,Bright Health MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Aetna,Aetna,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Aetna MGG,Aetna MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,BCBS,BCBS,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,BCBS MGG,BCBS MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Cigna,Cigna,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Cigna MGG,Cigna MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Humana,Humana,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Humana MGG,Humana MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Optum VA,Optum VA,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,UHC,UHC,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,UHC MGG,UHC MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,VA,VA,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Wellcare MGG,Wellcare MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Bright Health - commercial,Bright Health - commercial,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Bright Health MGG,Bright Health MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna,Aetna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna MGG,Aetna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS,BCBS,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS MGG,BCBS MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna,Cigna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna MGG,Cigna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana,Humana,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana MGG,Humana MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Optum VA,Optum VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC,UHC,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC MGG,UHC MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,VA,VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Wellcare MGG,Wellcare MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health - commercial,Bright Health - commercial,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health MGG,Bright Health MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Aetna,Aetna,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Aetna MGG,Aetna MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,BCBS,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS MGG,BCBS MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Cigna,Cigna,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Cigna MGG,Cigna MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Humana,Humana,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Humana MGG,Humana MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Optum VA,Optum VA,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,UHC,UHC,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,UHC MGG,UHC MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,VA,VA,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Wellcare MGG,Wellcare MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Bright Health - commercial,Bright Health - commercial,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7,7,Bright Health MGG,Bright Health MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna,Aetna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna MGG,Aetna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS,BCBS,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS MGG,BCBS MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna,Cigna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna MGG,Cigna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana,Humana,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana MGG,Humana MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Optum VA,Optum VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC,UHC,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC MGG,UHC MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,VA,VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Wellcare MGG,Wellcare MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health - commercial,Bright Health - commercial,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health MGG,Bright Health MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Aetna,Aetna,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Aetna MGG,Aetna MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,BCBS,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,BCBS MGG,BCBS MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Cigna,Cigna,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Cigna MGG,Cigna MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Humana,Humana,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Humana MGG,Humana MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Optum VA,Optum VA,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,UHC,UHC,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,UHC MGG,UHC MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,VA,VA,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Wellcare MGG,Wellcare MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Bright Health - commercial,Bright Health - commercial,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Bright Health MGG,Bright Health MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Aetna,Aetna,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Aetna MGG,Aetna MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,BCBS,BCBS,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,BCBS MGG,BCBS MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Cigna,Cigna,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Cigna MGG,Cigna MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Humana,Humana,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Humana MGG,Humana MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Optum VA,Optum VA,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,UHC,UHC,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,UHC MGG,UHC MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,VA,VA,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Wellcare MGG,Wellcare MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Bright Health - commercial,Bright Health - commercial,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,13.5,13.5,Bright Health MGG,Bright Health MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Aetna,Aetna,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Aetna MGG,Aetna MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,BCBS,BCBS,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,BCBS MGG,BCBS MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Cigna,Cigna,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Cigna MGG,Cigna MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Humana,Humana,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Humana MGG,Humana MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Optum VA,Optum VA,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,UHC,UHC,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,UHC MGG,UHC MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,VA,VA,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Wellcare MGG,Wellcare MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Bright Health - commercial,Bright Health - commercial,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Bright Health MGG,Bright Health MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Aetna,Aetna,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Aetna MGG,Aetna MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,BCBS,BCBS,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,BCBS MGG,BCBS MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Cigna,Cigna,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Cigna MGG,Cigna MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Humana,Humana,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Humana MGG,Humana MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Optum VA,Optum VA,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,UHC,UHC,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,UHC MGG,UHC MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,VA,VA,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Wellcare MGG,Wellcare MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Bright Health - commercial,Bright Health - commercial,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,53,53,Bright Health MGG,Bright Health MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Aetna,Aetna,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Aetna MGG,Aetna MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,BCBS,BCBS,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,BCBS MGG,BCBS MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Cigna,Cigna,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Cigna MGG,Cigna MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Humana,Humana,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Humana MGG,Humana MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Optum VA,Optum VA,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,UHC,UHC,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,UHC MGG,UHC MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,VA,VA,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Wellcare MGG,Wellcare MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Bright Health - commercial,Bright Health - commercial,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,499,499,Bright Health MGG,Bright Health MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna,Aetna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna MGG,Aetna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS,BCBS,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS MGG,BCBS MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna,Cigna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna MGG,Cigna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana,Humana,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana MGG,Humana MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Optum VA,Optum VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC,UHC,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC MGG,UHC MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,VA,VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Wellcare MGG,Wellcare MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health - commercial,Bright Health - commercial,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health MGG,Bright Health MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Aetna,Aetna,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Aetna MGG,Aetna MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,BCBS,BCBS,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,BCBS MGG,BCBS MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Cigna,Cigna,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Cigna MGG,Cigna MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Humana,Humana,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Humana MGG,Humana MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Optum VA,Optum VA,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,UHC,UHC,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,UHC MGG,UHC MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,VA,VA,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Wellcare MGG,Wellcare MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Bright Health - commercial,Bright Health - commercial,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Bright Health MGG,Bright Health MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Aetna,Aetna,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Aetna MGG,Aetna MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,BCBS,BCBS,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,BCBS MGG,BCBS MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Cigna,Cigna,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Cigna MGG,Cigna MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Humana,Humana,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Humana MGG,Humana MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Optum VA,Optum VA,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,UHC,UHC,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,UHC MGG,UHC MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,VA,VA,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Wellcare MGG,Wellcare MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Bright Health - commercial,Bright Health - commercial,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,56,56,Bright Health MGG,Bright Health MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna,Aetna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna MGG,Aetna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS,BCBS,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS MGG,BCBS MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna,Cigna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna MGG,Cigna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana,Humana,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana MGG,Humana MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Optum VA,Optum VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC,UHC,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC MGG,UHC MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,VA,VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Wellcare MGG,Wellcare MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health - commercial,Bright Health - commercial,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health MGG,Bright Health MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna,Aetna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna MGG,Aetna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,BCBS,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS MGG,BCBS MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna,Cigna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna MGG,Cigna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana,Humana,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana MGG,Humana MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Optum VA,Optum VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC,UHC,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC MGG,UHC MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Wellcare MGG,Wellcare MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health - commercial,Bright Health - commercial,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health MGG,Bright Health MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Aetna,Aetna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Aetna MGG,Aetna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,BCBS,BCBS,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,BCBS MGG,BCBS MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Cigna,Cigna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Cigna MGG,Cigna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Humana,Humana,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Humana MGG,Humana MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Optum VA,Optum VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,UHC,UHC,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,UHC MGG,UHC MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,VA,VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Wellcare MGG,Wellcare MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Bright Health - commercial,Bright Health - commercial,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,78,78,Bright Health MGG,Bright Health MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Aetna,Aetna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Aetna MGG,Aetna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,BCBS,BCBS,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,BCBS MGG,BCBS MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Cigna,Cigna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Cigna MGG,Cigna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Humana,Humana,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Humana MGG,Humana MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Optum VA,Optum VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,UHC,UHC,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,UHC MGG,UHC MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,VA,VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Wellcare MGG,Wellcare MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Bright Health - commercial,Bright Health - commercial,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,77,77,Bright Health MGG,Bright Health MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Aetna,Aetna,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Aetna MGG,Aetna MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,BCBS,BCBS,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,BCBS MGG,BCBS MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Cigna,Cigna,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Cigna MGG,Cigna MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Humana,Humana,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Humana MGG,Humana MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Optum VA,Optum VA,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,UHC,UHC,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,UHC MGG,UHC MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,VA,VA,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Wellcare MGG,Wellcare MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Bright Health - commercial,Bright Health - commercial,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Bright Health MGG,Bright Health MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Aetna,Aetna,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Aetna MGG,Aetna MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,BCBS,BCBS,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,BCBS MGG,BCBS MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Cigna,Cigna,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Cigna MGG,Cigna MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Humana,Humana,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Humana MGG,Humana MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Optum VA,Optum VA,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,UHC,UHC,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,UHC MGG,UHC MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,VA,VA,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Wellcare MGG,Wellcare MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Bright Health - commercial,Bright Health - commercial,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Bright Health MGG,Bright Health MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Aetna,Aetna,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Aetna MGG,Aetna MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,BCBS,BCBS,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,BCBS MGG,BCBS MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Cigna,Cigna,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Cigna MGG,Cigna MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Humana,Humana,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Humana MGG,Humana MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Optum VA,Optum VA,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,UHC,UHC,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,UHC MGG,UHC MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,VA,VA,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Wellcare MGG,Wellcare MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Bright Health - commercial,Bright Health - commercial,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,56,56,Bright Health MGG,Bright Health MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna,Aetna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna MGG,Aetna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS,BCBS,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS MGG,BCBS MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna,Cigna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna MGG,Cigna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana,Humana,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana MGG,Humana MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Optum VA,Optum VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC,UHC,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC MGG,UHC MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,VA,VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Wellcare MGG,Wellcare MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health - commercial,Bright Health - commercial,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health MGG,Bright Health MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna,Aetna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna MGG,Aetna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,BCBS,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS MGG,BCBS MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna,Cigna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna MGG,Cigna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana,Humana,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana MGG,Humana MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Optum VA,Optum VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC,UHC,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC MGG,UHC MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Wellcare MGG,Wellcare MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health - commercial,Bright Health - commercial,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health MGG,Bright Health MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna,Aetna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna MGG,Aetna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS,BCBS,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS MGG,BCBS MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna,Cigna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna MGG,Cigna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana,Humana,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana MGG,Humana MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Optum VA,Optum VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC,UHC,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC MGG,UHC MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,VA,VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Wellcare MGG,Wellcare MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health - commercial,Bright Health - commercial,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health MGG,Bright Health MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Aetna,Aetna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Aetna MGG,Aetna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,BCBS,BCBS,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,BCBS MGG,BCBS MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Cigna,Cigna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Cigna MGG,Cigna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Humana,Humana,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Humana MGG,Humana MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Optum VA,Optum VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,UHC,UHC,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,UHC MGG,UHC MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,VA,VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Wellcare MGG,Wellcare MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Bright Health - commercial,Bright Health - commercial,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,28,28,Bright Health MGG,Bright Health MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Aetna,Aetna,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Aetna MGG,Aetna MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,BCBS,BCBS,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,BCBS MGG,BCBS MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Cigna,Cigna,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Cigna MGG,Cigna MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Humana,Humana,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Humana MGG,Humana MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Optum VA,Optum VA,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,UHC,UHC,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,UHC MGG,UHC MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,VA,VA,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Wellcare MGG,Wellcare MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Bright Health - commercial,Bright Health - commercial,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Bright Health MGG,Bright Health MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna,Aetna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna MGG,Aetna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS,BCBS,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS MGG,BCBS MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna,Cigna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna MGG,Cigna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana,Humana,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana MGG,Humana MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Optum VA,Optum VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC,UHC,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC MGG,UHC MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,VA,VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Wellcare MGG,Wellcare MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health - commercial,Bright Health - commercial,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health MGG,Bright Health MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Aetna,Aetna,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Aetna MGG,Aetna MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,BCBS,BCBS,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,BCBS MGG,BCBS MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Cigna,Cigna,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Cigna MGG,Cigna MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Humana,Humana,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Humana MGG,Humana MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Optum VA,Optum VA,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,UHC,UHC,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,UHC MGG,UHC MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,VA,VA,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Wellcare MGG,Wellcare MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Bright Health - commercial,Bright Health - commercial,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,128,128,Bright Health MGG,Bright Health MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Aetna,Aetna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Aetna MGG,Aetna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,BCBS,BCBS,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,BCBS MGG,BCBS MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Cigna,Cigna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Cigna MGG,Cigna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Humana,Humana,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Humana MGG,Humana MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Optum VA,Optum VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,UHC,UHC,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,UHC MGG,UHC MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,VA,VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Wellcare MGG,Wellcare MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Bright Health - commercial,Bright Health - commercial,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,70,70,Bright Health MGG,Bright Health MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna,Aetna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna MGG,Aetna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS,BCBS,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS MGG,BCBS MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna,Cigna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna MGG,Cigna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana,Humana,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana MGG,Humana MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Optum VA,Optum VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC,UHC,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC MGG,UHC MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,VA,VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Wellcare MGG,Wellcare MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health - commercial,Bright Health - commercial,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health MGG,Bright Health MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Aetna,Aetna,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Aetna MGG,Aetna MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,BCBS,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS MGG,BCBS MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Cigna,Cigna,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Cigna MGG,Cigna MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Humana,Humana,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Humana MGG,Humana MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Optum VA,Optum VA,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,UHC,UHC,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,UHC MGG,UHC MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,VA,VA,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Wellcare MGG,Wellcare MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Bright Health - commercial,Bright Health - commercial,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Bright Health MGG,Bright Health MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Aetna,Aetna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Aetna MGG,Aetna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,BCBS,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,BCBS MGG,BCBS MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Cigna,Cigna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Cigna MGG,Cigna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Humana,Humana,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Humana MGG,Humana MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Optum VA,Optum VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,UHC,UHC,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,UHC MGG,UHC MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,VA,VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Wellcare MGG,Wellcare MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Bright Health - commercial,Bright Health - commercial,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Bright Health MGG,Bright Health MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Aetna,Aetna,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Aetna MGG,Aetna MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,BCBS,BCBS,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,BCBS MGG,BCBS MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Cigna,Cigna,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Cigna MGG,Cigna MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Humana,Humana,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Humana MGG,Humana MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Optum VA,Optum VA,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,UHC,UHC,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,UHC MGG,UHC MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,VA,VA,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Wellcare MGG,Wellcare MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Bright Health - commercial,Bright Health - commercial,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3,3,Bright Health MGG,Bright Health MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Aetna,Aetna,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Aetna MGG,Aetna MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,BCBS,BCBS,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,BCBS MGG,BCBS MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Cigna,Cigna,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Cigna MGG,Cigna MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Humana,Humana,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Humana MGG,Humana MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Optum VA,Optum VA,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,UHC,UHC,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,UHC MGG,UHC MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,VA,VA,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Wellcare MGG,Wellcare MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Bright Health - commercial,Bright Health - commercial,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Bright Health MGG,Bright Health MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Aetna,Aetna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Aetna MGG,Aetna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,BCBS,BCBS,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,BCBS MGG,BCBS MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Cigna,Cigna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Cigna MGG,Cigna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Humana,Humana,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Humana MGG,Humana MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Optum VA,Optum VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,UHC,UHC,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,UHC MGG,UHC MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,VA,VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Wellcare MGG,Wellcare MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Bright Health - commercial,Bright Health - commercial,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Bright Health MGG,Bright Health MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Aetna,Aetna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Aetna MGG,Aetna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,BCBS,BCBS,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,BCBS MGG,BCBS MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Cigna,Cigna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Cigna MGG,Cigna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Humana,Humana,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Humana MGG,Humana MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Optum VA,Optum VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,UHC,UHC,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,UHC MGG,UHC MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,VA,VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Wellcare MGG,Wellcare MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Bright Health - commercial,Bright Health - commercial,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,22,22,Bright Health MGG,Bright Health MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Aetna,Aetna,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Aetna MGG,Aetna MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,BCBS,BCBS,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,BCBS MGG,BCBS MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Cigna,Cigna,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Cigna MGG,Cigna MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Humana,Humana,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Humana MGG,Humana MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Optum VA,Optum VA,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,UHC,UHC,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,UHC MGG,UHC MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,VA,VA,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Wellcare MGG,Wellcare MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Bright Health - commercial,Bright Health - commercial,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,109,109,Bright Health MGG,Bright Health MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Aetna,Aetna,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Aetna MGG,Aetna MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,BCBS,BCBS,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,BCBS MGG,BCBS MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Cigna,Cigna,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Cigna MGG,Cigna MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Humana,Humana,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Humana MGG,Humana MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Optum VA,Optum VA,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,UHC,UHC,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,UHC MGG,UHC MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,VA,VA,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Wellcare MGG,Wellcare MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Bright Health - commercial,Bright Health - commercial,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Bright Health MGG,Bright Health MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Aetna,Aetna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Aetna MGG,Aetna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,BCBS,BCBS,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,BCBS MGG,BCBS MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Cigna,Cigna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Cigna MGG,Cigna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Humana,Humana,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Humana MGG,Humana MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Optum VA,Optum VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,UHC,UHC,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,UHC MGG,UHC MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,VA,VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Wellcare MGG,Wellcare MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Bright Health - commercial,Bright Health - commercial,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,28,28,Bright Health MGG,Bright Health MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Aetna,Aetna,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Aetna MGG,Aetna MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,BCBS,BCBS,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,BCBS MGG,BCBS MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Cigna,Cigna,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Cigna MGG,Cigna MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Humana,Humana,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Humana MGG,Humana MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Optum VA,Optum VA,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,UHC,UHC,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,UHC MGG,UHC MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,VA,VA,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Wellcare MGG,Wellcare MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Bright Health - commercial,Bright Health - commercial,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,131,131,Bright Health MGG,Bright Health MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Aetna,Aetna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Aetna MGG,Aetna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,BCBS,BCBS,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,BCBS MGG,BCBS MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Cigna,Cigna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Cigna MGG,Cigna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Humana,Humana,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Humana MGG,Humana MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Optum VA,Optum VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,UHC,UHC,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,UHC MGG,UHC MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,VA,VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Wellcare MGG,Wellcare MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Bright Health - commercial,Bright Health - commercial,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,156,156,Bright Health MGG,Bright Health MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Aetna,Aetna,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Aetna MGG,Aetna MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,BCBS,BCBS,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,BCBS MGG,BCBS MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Cigna,Cigna,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Cigna MGG,Cigna MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Humana,Humana,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Humana MGG,Humana MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Optum VA,Optum VA,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,UHC,UHC,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,UHC MGG,UHC MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,VA,VA,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Wellcare MGG,Wellcare MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Bright Health - commercial,Bright Health - commercial,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Bright Health MGG,Bright Health MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Aetna,Aetna,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Aetna MGG,Aetna MGG,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,BCBS,BCBS,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,BCBS MGG,BCBS MGG,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Cigna,Cigna,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Cigna MGG,Cigna MGG,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Humana,Humana,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Humana MGG,Humana MGG,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Optum VA,Optum VA,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,UHC,UHC,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,UHC MGG,UHC MGG,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,VA,VA,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Wellcare MGG,Wellcare MGG,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Bright Health - commercial,Bright Health - commercial,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,34.59,34.59,Bright Health MGG,Bright Health MGG,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Aetna,Aetna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Aetna MGG,Aetna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,BCBS,BCBS,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,BCBS MGG,BCBS MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Cigna,Cigna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Cigna MGG,Cigna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Humana,Humana,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Humana MGG,Humana MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Optum VA,Optum VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,UHC,UHC,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,UHC MGG,UHC MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,VA,VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Wellcare MGG,Wellcare MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Bright Health - commercial,Bright Health - commercial,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,9.75,9.75,Bright Health MGG,Bright Health MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Aetna,Aetna,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Aetna MGG,Aetna MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,BCBS,BCBS,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,BCBS MGG,BCBS MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Cigna,Cigna,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Cigna MGG,Cigna MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Humana,Humana,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Humana MGG,Humana MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Optum VA,Optum VA,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,UHC,UHC,193.5,,,,,,,per diem,193.5,193.5,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,UHC MGG,UHC MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,VA,VA,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Wellcare MGG,Wellcare MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Bright Health - commercial,Bright Health - commercial,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,193.5,193.5,Bright Health MGG,Bright Health MGG,193.5,,,,,,,case rate,193.5,193.5,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Aetna,Aetna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Aetna MGG,Aetna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,BCBS,BCBS,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,BCBS MGG,BCBS MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Cigna,Cigna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Cigna MGG,Cigna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Humana,Humana,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Humana MGG,Humana MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Optum VA,Optum VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,UHC,UHC,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,UHC MGG,UHC MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,VA,VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Wellcare MGG,Wellcare MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Bright Health - commercial,Bright Health - commercial,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.46,8.46,Bright Health MGG,Bright Health MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Aetna,Aetna,39.18,,,,,,,per diem,39.18,39.18,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Aetna MGG,Aetna MGG,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,BCBS,BCBS,39.18,,,,,,,per diem,39.18,39.18,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,BCBS MGG,BCBS MGG,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Cigna,Cigna,39.18,,,,,,,per diem,39.18,39.18,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Cigna MGG,Cigna MGG,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Humana,Humana,39.18,,,,,,,per diem,39.18,39.18,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Humana MGG,Humana MGG,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Optum VA,Optum VA,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,UHC,UHC,39.18,,,,,,,per diem,39.18,39.18,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,UHC MGG,UHC MGG,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,VA,VA,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Wellcare MGG,Wellcare MGG,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Bright Health - commercial,Bright Health - commercial,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,39.18,39.18,Bright Health MGG,Bright Health MGG,39.18,,,,,,,case rate,39.18,39.18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna,Aetna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna MGG,Aetna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS,BCBS,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS MGG,BCBS MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna,Cigna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna MGG,Cigna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana,Humana,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana MGG,Humana MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Optum VA,Optum VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC,UHC,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC MGG,UHC MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,VA,VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Wellcare MGG,Wellcare MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health - commercial,Bright Health - commercial,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health MGG,Bright Health MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Aetna,Aetna,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Aetna MGG,Aetna MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,BCBS,BCBS,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,BCBS MGG,BCBS MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Cigna,Cigna,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Cigna MGG,Cigna MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Humana,Humana,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Humana MGG,Humana MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Optum VA,Optum VA,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,UHC,UHC,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,UHC MGG,UHC MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,VA,VA,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Wellcare MGG,Wellcare MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Bright Health - commercial,Bright Health - commercial,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,105,105,Bright Health MGG,Bright Health MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna,Aetna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna MGG,Aetna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS,BCBS,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS MGG,BCBS MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna,Cigna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna MGG,Cigna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana,Humana,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana MGG,Humana MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Optum VA,Optum VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC,UHC,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC MGG,UHC MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,VA,VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Wellcare MGG,Wellcare MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health - commercial,Bright Health - commercial,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health MGG,Bright Health MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna,Aetna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna MGG,Aetna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS,BCBS,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS MGG,BCBS MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna,Cigna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna MGG,Cigna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana,Humana,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana MGG,Humana MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Optum VA,Optum VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC,UHC,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC MGG,UHC MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,VA,VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Wellcare MGG,Wellcare MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health - commercial,Bright Health - commercial,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health MGG,Bright Health MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Aetna,Aetna,267.18,,,,,,,per diem,267.18,267.18,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Aetna MGG,Aetna MGG,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,BCBS,BCBS,267.18,,,,,,,per diem,267.18,267.18,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,BCBS MGG,BCBS MGG,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Cigna,Cigna,267.18,,,,,,,per diem,267.18,267.18,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Cigna MGG,Cigna MGG,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Humana,Humana,267.18,,,,,,,per diem,267.18,267.18,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Humana MGG,Humana MGG,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Optum VA,Optum VA,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,UHC,UHC,267.18,,,,,,,per diem,267.18,267.18,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,UHC MGG,UHC MGG,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,VA,VA,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Wellcare MGG,Wellcare MGG,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Bright Health - commercial,Bright Health - commercial,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,267.18,267.18,Bright Health MGG,Bright Health MGG,267.18,,,,,,,case rate,267.18,267.18,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Aetna,Aetna,279.51,,,,,,,per diem,279.51,279.51,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Aetna MGG,Aetna MGG,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,BCBS,BCBS,279.51,,,,,,,per diem,279.51,279.51,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,BCBS MGG,BCBS MGG,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Cigna,Cigna,279.51,,,,,,,per diem,279.51,279.51,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Cigna MGG,Cigna MGG,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Humana,Humana,279.51,,,,,,,per diem,279.51,279.51,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Humana MGG,Humana MGG,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Optum VA,Optum VA,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,UHC,UHC,279.51,,,,,,,per diem,279.51,279.51,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,UHC MGG,UHC MGG,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,VA,VA,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Wellcare MGG,Wellcare MGG,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Bright Health - commercial,Bright Health - commercial,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,279.51,279.51,Bright Health MGG,Bright Health MGG,279.51,,,,,,,case rate,279.51,279.51,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Aetna,Aetna,84.93,,,,,,,per diem,84.93,84.93,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Aetna MGG,Aetna MGG,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,BCBS,BCBS,84.93,,,,,,,per diem,84.93,84.93,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,BCBS MGG,BCBS MGG,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Cigna,Cigna,84.93,,,,,,,per diem,84.93,84.93,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Cigna MGG,Cigna MGG,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Humana,Humana,84.93,,,,,,,per diem,84.93,84.93,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Humana MGG,Humana MGG,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Optum VA,Optum VA,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,UHC,UHC,84.93,,,,,,,per diem,84.93,84.93,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,UHC MGG,UHC MGG,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,VA,VA,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Wellcare MGG,Wellcare MGG,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Bright Health - commercial,Bright Health - commercial,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,84.93,84.93,Bright Health MGG,Bright Health MGG,84.93,,,,,,,case rate,84.93,84.93,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Aetna,Aetna,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Aetna MGG,Aetna MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,BCBS,BCBS,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,BCBS MGG,BCBS MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Cigna,Cigna,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Cigna MGG,Cigna MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Humana,Humana,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Humana MGG,Humana MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Optum VA,Optum VA,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,UHC,UHC,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,UHC MGG,UHC MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,VA,VA,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Wellcare MGG,Wellcare MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Bright Health - commercial,Bright Health - commercial,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,84.09,84.09,Bright Health MGG,Bright Health MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Aetna,Aetna,183.48,,,,,,,per diem,183.48,183.48,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Aetna MGG,Aetna MGG,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,BCBS,BCBS,183.48,,,,,,,per diem,183.48,183.48,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,BCBS MGG,BCBS MGG,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Cigna,Cigna,183.48,,,,,,,per diem,183.48,183.48,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Cigna MGG,Cigna MGG,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Humana,Humana,183.48,,,,,,,per diem,183.48,183.48,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Humana MGG,Humana MGG,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Optum VA,Optum VA,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,UHC,UHC,183.48,,,,,,,per diem,183.48,183.48,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,UHC MGG,UHC MGG,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,VA,VA,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Wellcare MGG,Wellcare MGG,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Bright Health - commercial,Bright Health - commercial,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,183.48,183.48,Bright Health MGG,Bright Health MGG,183.48,,,,,,,case rate,183.48,183.48,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Aetna,Aetna,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Aetna MGG,Aetna MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,BCBS,BCBS,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,BCBS MGG,BCBS MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Cigna,Cigna,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Cigna MGG,Cigna MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Humana,Humana,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Humana MGG,Humana MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Optum VA,Optum VA,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,UHC,UHC,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,UHC MGG,UHC MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,VA,VA,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Wellcare MGG,Wellcare MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Bright Health - commercial,Bright Health - commercial,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,81.06,81.06,Bright Health MGG,Bright Health MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Aetna,Aetna,315.78,,,,,,,per diem,315.78,315.78,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Aetna MGG,Aetna MGG,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,BCBS,BCBS,315.78,,,,,,,per diem,315.78,315.78,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,BCBS MGG,BCBS MGG,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Cigna,Cigna,315.78,,,,,,,per diem,315.78,315.78,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Cigna MGG,Cigna MGG,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Humana,Humana,315.78,,,,,,,per diem,315.78,315.78,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Humana MGG,Humana MGG,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Optum VA,Optum VA,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,UHC,UHC,315.78,,,,,,,per diem,315.78,315.78,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,UHC MGG,UHC MGG,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,VA,VA,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Wellcare MGG,Wellcare MGG,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Bright Health - commercial,Bright Health - commercial,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,315.78,315.78,Bright Health MGG,Bright Health MGG,315.78,,,,,,,case rate,315.78,315.78,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Aetna,Aetna,194.67,,,,,,,per diem,194.67,194.67,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Aetna MGG,Aetna MGG,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,BCBS,BCBS,194.67,,,,,,,per diem,194.67,194.67,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,BCBS MGG,BCBS MGG,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Cigna,Cigna,194.67,,,,,,,per diem,194.67,194.67,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Cigna MGG,Cigna MGG,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Humana,Humana,194.67,,,,,,,per diem,194.67,194.67,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Humana MGG,Humana MGG,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Optum VA,Optum VA,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,UHC,UHC,194.67,,,,,,,per diem,194.67,194.67,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,UHC MGG,UHC MGG,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,VA,VA,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Wellcare MGG,Wellcare MGG,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Bright Health - commercial,Bright Health - commercial,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,194.67,194.67,Bright Health MGG,Bright Health MGG,194.67,,,,,,,case rate,194.67,194.67,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Aetna,Aetna,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Aetna MGG,Aetna MGG,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,BCBS,BCBS,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,BCBS MGG,BCBS MGG,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Cigna,Cigna,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Cigna MGG,Cigna MGG,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Humana,Humana,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Humana MGG,Humana MGG,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Optum VA,Optum VA,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,UHC,UHC,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,UHC MGG,UHC MGG,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,VA,VA,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Wellcare MGG,Wellcare MGG,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Bright Health - commercial,Bright Health - commercial,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,85.98,85.98,Bright Health MGG,Bright Health MGG,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Aetna,Aetna,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Aetna MGG,Aetna MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,BCBS,BCBS,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,BCBS MGG,BCBS MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Cigna,Cigna,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Cigna MGG,Cigna MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Humana,Humana,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Humana MGG,Humana MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Optum VA,Optum VA,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,UHC,UHC,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,UHC MGG,UHC MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,VA,VA,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Wellcare MGG,Wellcare MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Bright Health - commercial,Bright Health - commercial,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,20.67,20.67,Bright Health MGG,Bright Health MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Aetna,Aetna,1961.01,,,,,,,per diem,1961.01,1961.01,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Aetna MGG,Aetna MGG,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,BCBS,BCBS,1961.01,,,,,,,per diem,1961.01,1961.01,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,BCBS MGG,BCBS MGG,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Cigna,Cigna,1961.01,,,,,,,per diem,1961.01,1961.01,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Cigna MGG,Cigna MGG,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Humana,Humana,1961.01,,,,,,,per diem,1961.01,1961.01,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Humana MGG,Humana MGG,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Optum VA,Optum VA,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,UHC,UHC,1961.01,,,,,,,per diem,1961.01,1961.01,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,UHC MGG,UHC MGG,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,VA,VA,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Wellcare MGG,Wellcare MGG,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Bright Health - commercial,Bright Health - commercial,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,1961.01,1961.01,Bright Health MGG,Bright Health MGG,1961.01,,,,,,,case rate,1961.01,1961.01,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Aetna,Aetna,182.97,,,,,,,per diem,182.97,182.97,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Aetna MGG,Aetna MGG,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,BCBS,BCBS,182.97,,,,,,,per diem,182.97,182.97,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,BCBS MGG,BCBS MGG,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Cigna,Cigna,182.97,,,,,,,per diem,182.97,182.97,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Cigna MGG,Cigna MGG,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Humana,Humana,182.97,,,,,,,per diem,182.97,182.97,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Humana MGG,Humana MGG,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Optum VA,Optum VA,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,UHC,UHC,182.97,,,,,,,per diem,182.97,182.97,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,UHC MGG,UHC MGG,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,VA,VA,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Wellcare MGG,Wellcare MGG,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Bright Health - commercial,Bright Health - commercial,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,182.97,182.97,Bright Health MGG,Bright Health MGG,182.97,,,,,,,case rate,182.97,182.97,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Aetna,Aetna,12.5,,,,,,,per diem,12.5,12.5,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Aetna MGG,Aetna MGG,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,BCBS,BCBS,12.5,,,,,,,per diem,12.5,12.5,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,BCBS MGG,BCBS MGG,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Cigna,Cigna,12.5,,,,,,,per diem,12.5,12.5,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Cigna MGG,Cigna MGG,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Humana,Humana,12.5,,,,,,,per diem,12.5,12.5,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Humana MGG,Humana MGG,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Optum VA,Optum VA,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,UHC,UHC,12.5,,,,,,,per diem,12.5,12.5,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,UHC MGG,UHC MGG,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,VA,VA,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Wellcare MGG,Wellcare MGG,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Bright Health - commercial,Bright Health - commercial,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,12.5,12.5,Bright Health MGG,Bright Health MGG,12.5,,,,,,,case rate,12.5,12.5,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Aetna,Aetna,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Aetna MGG,Aetna MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,BCBS,BCBS,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,BCBS MGG,BCBS MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Cigna,Cigna,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Cigna MGG,Cigna MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Humana,Humana,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Humana MGG,Humana MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Optum VA,Optum VA,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,UHC,UHC,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,UHC MGG,UHC MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,VA,VA,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Wellcare MGG,Wellcare MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Bright Health - commercial,Bright Health - commercial,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,105,105,Bright Health MGG,Bright Health MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Aetna,Aetna,1.55,,,,,,,per diem,1.55,1.55,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Aetna MGG,Aetna MGG,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,BCBS,BCBS,1.55,,,,,,,per diem,1.55,1.55,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,BCBS MGG,BCBS MGG,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Cigna,Cigna,1.55,,,,,,,per diem,1.55,1.55,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Cigna MGG,Cigna MGG,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Humana,Humana,1.55,,,,,,,per diem,1.55,1.55,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Humana MGG,Humana MGG,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Optum VA,Optum VA,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,UHC,UHC,1.55,,,,,,,per diem,1.55,1.55,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,UHC MGG,UHC MGG,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,VA,VA,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Wellcare MGG,Wellcare MGG,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Bright Health - commercial,Bright Health - commercial,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.55,1.55,Bright Health MGG,Bright Health MGG,1.55,,,,,,,case rate,1.55,1.55,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Aetna,Aetna,1.29,,,,,,,per diem,1.29,1.29,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Aetna MGG,Aetna MGG,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,BCBS,BCBS,1.29,,,,,,,per diem,1.29,1.29,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,BCBS MGG,BCBS MGG,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Cigna,Cigna,1.29,,,,,,,per diem,1.29,1.29,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Cigna MGG,Cigna MGG,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Humana,Humana,1.29,,,,,,,per diem,1.29,1.29,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Humana MGG,Humana MGG,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Optum VA,Optum VA,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,UHC,UHC,1.29,,,,,,,per diem,1.29,1.29,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,UHC MGG,UHC MGG,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,VA,VA,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Wellcare MGG,Wellcare MGG,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Bright Health - commercial,Bright Health - commercial,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.29,1.29,Bright Health MGG,Bright Health MGG,1.29,,,,,,,case rate,1.29,1.29,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Aetna,Aetna,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Aetna MGG,Aetna MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,BCBS,BCBS,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,BCBS MGG,BCBS MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Cigna,Cigna,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Cigna MGG,Cigna MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Humana,Humana,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Humana MGG,Humana MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Optum VA,Optum VA,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,UHC,UHC,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,UHC MGG,UHC MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,VA,VA,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Wellcare MGG,Wellcare MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Bright Health - commercial,Bright Health - commercial,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,29.7,29.7,Bright Health MGG,Bright Health MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Aetna,Aetna,16.22,,,,,,,per diem,16.22,16.22,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Aetna MGG,Aetna MGG,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,BCBS,BCBS,16.22,,,,,,,per diem,16.22,16.22,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,BCBS MGG,BCBS MGG,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Cigna,Cigna,16.22,,,,,,,per diem,16.22,16.22,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Cigna MGG,Cigna MGG,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Humana,Humana,16.22,,,,,,,per diem,16.22,16.22,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Humana MGG,Humana MGG,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Optum VA,Optum VA,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,UHC,UHC,16.22,,,,,,,per diem,16.22,16.22,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,UHC MGG,UHC MGG,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,VA,VA,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Wellcare MGG,Wellcare MGG,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Bright Health - commercial,Bright Health - commercial,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,16.22,16.22,Bright Health MGG,Bright Health MGG,16.22,,,,,,,case rate,16.22,16.22,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Aetna,Aetna,331.13,,,,,,,per diem,331.13,331.13,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Aetna MGG,Aetna MGG,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,BCBS,BCBS,331.13,,,,,,,per diem,331.13,331.13,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,BCBS MGG,BCBS MGG,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Cigna,Cigna,331.13,,,,,,,per diem,331.13,331.13,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Cigna MGG,Cigna MGG,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Humana,Humana,331.13,,,,,,,per diem,331.13,331.13,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Humana MGG,Humana MGG,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Optum VA,Optum VA,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,UHC,UHC,331.13,,,,,,,per diem,331.13,331.13,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,UHC MGG,UHC MGG,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,VA,VA,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Wellcare MGG,Wellcare MGG,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Bright Health - commercial,Bright Health - commercial,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,331.13,331.13,Bright Health MGG,Bright Health MGG,331.13,,,,,,,case rate,331.13,331.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Aetna,Aetna,229.13,,,,,,,per diem,229.13,229.13,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Aetna MGG,Aetna MGG,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,BCBS,BCBS,229.13,,,,,,,per diem,229.13,229.13,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,BCBS MGG,BCBS MGG,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Cigna,Cigna,229.13,,,,,,,per diem,229.13,229.13,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Cigna MGG,Cigna MGG,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Humana,Humana,229.13,,,,,,,per diem,229.13,229.13,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Humana MGG,Humana MGG,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Optum VA,Optum VA,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,UHC,UHC,229.13,,,,,,,per diem,229.13,229.13,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,UHC MGG,UHC MGG,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,VA,VA,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Wellcare MGG,Wellcare MGG,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Bright Health - commercial,Bright Health - commercial,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,229.13,229.13,Bright Health MGG,Bright Health MGG,229.13,,,,,,,case rate,229.13,229.13,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Aetna,Aetna,75.63,,,,,,,per diem,75.63,75.63,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Aetna MGG,Aetna MGG,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,BCBS,BCBS,75.63,,,,,,,per diem,75.63,75.63,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,BCBS MGG,BCBS MGG,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Cigna,Cigna,75.63,,,,,,,per diem,75.63,75.63,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Cigna MGG,Cigna MGG,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Humana,Humana,75.63,,,,,,,per diem,75.63,75.63,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Humana MGG,Humana MGG,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Optum VA,Optum VA,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,UHC,UHC,75.63,,,,,,,per diem,75.63,75.63,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,UHC MGG,UHC MGG,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,VA,VA,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Wellcare MGG,Wellcare MGG,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Bright Health - commercial,Bright Health - commercial,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,75.63,75.63,Bright Health MGG,Bright Health MGG,75.63,,,,,,,case rate,75.63,75.63,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Aetna,Aetna,318.06,,,,,,,per diem,318.06,318.06,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Aetna MGG,Aetna MGG,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,BCBS,BCBS,318.06,,,,,,,per diem,318.06,318.06,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,BCBS MGG,BCBS MGG,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Cigna,Cigna,318.06,,,,,,,per diem,318.06,318.06,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Cigna MGG,Cigna MGG,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Humana,Humana,318.06,,,,,,,per diem,318.06,318.06,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Humana MGG,Humana MGG,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Optum VA,Optum VA,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,UHC,UHC,318.06,,,,,,,per diem,318.06,318.06,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,UHC MGG,UHC MGG,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,VA,VA,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Wellcare MGG,Wellcare MGG,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Bright Health - commercial,Bright Health - commercial,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,318.06,318.06,Bright Health MGG,Bright Health MGG,318.06,,,,,,,case rate,318.06,318.06,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Aetna,Aetna,395.96,,,,,,,per diem,395.96,395.96,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Aetna MGG,Aetna MGG,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,BCBS,BCBS,395.96,,,,,,,per diem,395.96,395.96,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,BCBS MGG,BCBS MGG,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Cigna,Cigna,395.96,,,,,,,per diem,395.96,395.96,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Cigna MGG,Cigna MGG,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Humana,Humana,395.96,,,,,,,per diem,395.96,395.96,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Humana MGG,Humana MGG,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Optum VA,Optum VA,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,UHC,UHC,395.96,,,,,,,per diem,395.96,395.96,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,UHC MGG,UHC MGG,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,VA,VA,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Wellcare MGG,Wellcare MGG,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Bright Health - commercial,Bright Health - commercial,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,395.96,395.96,Bright Health MGG,Bright Health MGG,395.96,,,,,,,case rate,395.96,395.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Aetna,Aetna,625.68,,,,,,,per diem,625.68,625.68,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Aetna MGG,Aetna MGG,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,BCBS,BCBS,625.68,,,,,,,per diem,625.68,625.68,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,BCBS MGG,BCBS MGG,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Cigna,Cigna,625.68,,,,,,,per diem,625.68,625.68,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Cigna MGG,Cigna MGG,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Humana,Humana,625.68,,,,,,,per diem,625.68,625.68,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Humana MGG,Humana MGG,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Optum VA,Optum VA,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,UHC,UHC,625.68,,,,,,,per diem,625.68,625.68,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,UHC MGG,UHC MGG,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,VA,VA,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Wellcare MGG,Wellcare MGG,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Bright Health - commercial,Bright Health - commercial,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,625.68,625.68,Bright Health MGG,Bright Health MGG,625.68,,,,,,,case rate,625.68,625.68,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Aetna,Aetna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Aetna MGG,Aetna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,BCBS,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,BCBS MGG,BCBS MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Cigna,Cigna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Cigna MGG,Cigna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Humana,Humana,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Humana MGG,Humana MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Optum VA,Optum VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,UHC,UHC,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,UHC MGG,UHC MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,VA,VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Wellcare MGG,Wellcare MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Bright Health - commercial,Bright Health - commercial,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Bright Health MGG,Bright Health MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Aetna,Aetna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Aetna MGG,Aetna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,BCBS,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,BCBS MGG,BCBS MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Cigna,Cigna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Cigna MGG,Cigna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Humana,Humana,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Humana MGG,Humana MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Optum VA,Optum VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,UHC,UHC,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,UHC MGG,UHC MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,VA,VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Wellcare MGG,Wellcare MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Bright Health - commercial,Bright Health - commercial,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Bright Health MGG,Bright Health MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Aetna,Aetna,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Aetna MGG,Aetna MGG,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,BCBS,BCBS,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,BCBS MGG,BCBS MGG,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Cigna,Cigna,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Cigna MGG,Cigna MGG,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Humana,Humana,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Humana MGG,Humana MGG,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Optum VA,Optum VA,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,UHC,UHC,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,UHC MGG,UHC MGG,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,VA,VA,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Wellcare MGG,Wellcare MGG,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Bright Health - commercial,Bright Health - commercial,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,31.19,31.19,Bright Health MGG,Bright Health MGG,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Aetna,Aetna,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Aetna MGG,Aetna MGG,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,BCBS,BCBS,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,BCBS MGG,BCBS MGG,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Cigna,Cigna,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Cigna MGG,Cigna MGG,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Humana,Humana,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Humana MGG,Humana MGG,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Optum VA,Optum VA,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,UHC,UHC,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,UHC MGG,UHC MGG,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,VA,VA,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Wellcare MGG,Wellcare MGG,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Bright Health - commercial,Bright Health - commercial,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,32.07,32.07,Bright Health MGG,Bright Health MGG,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna,Aetna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna MGG,Aetna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS,BCBS,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS MGG,BCBS MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna,Cigna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna MGG,Cigna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana,Humana,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana MGG,Humana MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Optum VA,Optum VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC,UHC,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC MGG,UHC MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,VA,VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Wellcare MGG,Wellcare MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health - commercial,Bright Health - commercial,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health MGG,Bright Health MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna,Aetna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna MGG,Aetna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS,BCBS,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS MGG,BCBS MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna,Cigna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna MGG,Cigna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana,Humana,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana MGG,Humana MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Optum VA,Optum VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC,UHC,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC MGG,UHC MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,VA,VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Wellcare MGG,Wellcare MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health - commercial,Bright Health - commercial,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health MGG,Bright Health MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna,Aetna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna MGG,Aetna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS,BCBS,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS MGG,BCBS MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna,Cigna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna MGG,Cigna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana,Humana,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana MGG,Humana MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Optum VA,Optum VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC,UHC,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC MGG,UHC MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,VA,VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Wellcare MGG,Wellcare MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health - commercial,Bright Health - commercial,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health MGG,Bright Health MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna,Aetna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna MGG,Aetna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS,BCBS,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS MGG,BCBS MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna,Cigna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna MGG,Cigna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana,Humana,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana MGG,Humana MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Optum VA,Optum VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC,UHC,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC MGG,UHC MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,VA,VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Wellcare MGG,Wellcare MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health - commercial,Bright Health - commercial,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health MGG,Bright Health MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna,Aetna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna MGG,Aetna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS,BCBS,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS MGG,BCBS MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna,Cigna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna MGG,Cigna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana,Humana,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana MGG,Humana MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Optum VA,Optum VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC,UHC,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC MGG,UHC MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,VA,VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Wellcare MGG,Wellcare MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health - commercial,Bright Health - commercial,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health MGG,Bright Health MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna,Aetna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Aetna MGG,Aetna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS,BCBS,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,BCBS MGG,BCBS MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna,Cigna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Cigna MGG,Cigna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana,Humana,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Humana MGG,Humana MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Optum VA,Optum VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC,UHC,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,UHC MGG,UHC MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,VA,VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Wellcare MGG,Wellcare MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health - commercial,Bright Health - commercial,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,37.77,37.77,Bright Health MGG,Bright Health MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Aetna,Aetna,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Aetna MGG,Aetna MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,BCBS,BCBS,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,BCBS MGG,BCBS MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Cigna,Cigna,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Cigna MGG,Cigna MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Humana,Humana,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Humana MGG,Humana MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Optum VA,Optum VA,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,UHC,UHC,34.68,,,,,,,per diem,34.68,34.68,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,UHC MGG,UHC MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,VA,VA,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Wellcare MGG,Wellcare MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Bright Health - commercial,Bright Health - commercial,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,34.68,34.68,Bright Health MGG,Bright Health MGG,34.68,,,,,,,case rate,34.68,34.68,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Aetna,Aetna,58.53,,,,,,,per diem,58.53,58.53,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Aetna MGG,Aetna MGG,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,BCBS,BCBS,58.53,,,,,,,per diem,58.53,58.53,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,BCBS MGG,BCBS MGG,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Cigna,Cigna,58.53,,,,,,,per diem,58.53,58.53,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Cigna MGG,Cigna MGG,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Humana,Humana,58.53,,,,,,,per diem,58.53,58.53,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Humana MGG,Humana MGG,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Optum VA,Optum VA,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,UHC,UHC,58.53,,,,,,,per diem,58.53,58.53,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,UHC MGG,UHC MGG,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,VA,VA,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Wellcare MGG,Wellcare MGG,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Bright Health - commercial,Bright Health - commercial,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,58.53,58.53,Bright Health MGG,Bright Health MGG,58.53,,,,,,,case rate,58.53,58.53,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Aetna,Aetna,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Aetna MGG,Aetna MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,BCBS,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,BCBS MGG,BCBS MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Cigna,Cigna,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Cigna MGG,Cigna MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Humana,Humana,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Humana MGG,Humana MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Optum VA,Optum VA,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,UHC,UHC,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,UHC MGG,UHC MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,VA,VA,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Wellcare MGG,Wellcare MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Bright Health - commercial,Bright Health - commercial,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,75.6,75.6,Bright Health MGG,Bright Health MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Aetna,Aetna,26.27,,,,,,,per diem,26.27,26.27,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Aetna MGG,Aetna MGG,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,BCBS,BCBS,26.27,,,,,,,per diem,26.27,26.27,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,BCBS MGG,BCBS MGG,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Cigna,Cigna,26.27,,,,,,,per diem,26.27,26.27,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Cigna MGG,Cigna MGG,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Humana,Humana,26.27,,,,,,,per diem,26.27,26.27,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Humana MGG,Humana MGG,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Optum VA,Optum VA,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,UHC,UHC,26.27,,,,,,,per diem,26.27,26.27,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,UHC MGG,UHC MGG,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,VA,VA,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Wellcare MGG,Wellcare MGG,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Bright Health - commercial,Bright Health - commercial,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,26.27,26.27,Bright Health MGG,Bright Health MGG,26.27,,,,,,,case rate,26.27,26.27,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Aetna,Aetna,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Aetna MGG,Aetna MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,BCBS,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,BCBS MGG,BCBS MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Cigna,Cigna,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Cigna MGG,Cigna MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Humana,Humana,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Humana MGG,Humana MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Optum VA,Optum VA,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,UHC,UHC,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,UHC MGG,UHC MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,VA,VA,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Wellcare MGG,Wellcare MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Bright Health - commercial,Bright Health - commercial,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,166.01,166.01,Bright Health MGG,Bright Health MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Aetna,Aetna,5586.53,,,,,,,per diem,5586.53,5586.53,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Aetna MGG,Aetna MGG,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,BCBS,BCBS,5586.53,,,,,,,per diem,5586.53,5586.53,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,BCBS MGG,BCBS MGG,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Cigna,Cigna,5586.53,,,,,,,per diem,5586.53,5586.53,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Cigna MGG,Cigna MGG,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Humana,Humana,5586.53,,,,,,,per diem,5586.53,5586.53,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Humana MGG,Humana MGG,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Optum VA,Optum VA,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,UHC,UHC,5586.53,,,,,,,per diem,5586.53,5586.53,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,UHC MGG,UHC MGG,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,VA,VA,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Wellcare MGG,Wellcare MGG,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Bright Health - commercial,Bright Health - commercial,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,5586.53,5586.53,Bright Health MGG,Bright Health MGG,5586.53,,,,,,,case rate,5586.53,5586.53,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Aetna,Aetna,255.42,,,,,,,per diem,255.42,255.42,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Aetna MGG,Aetna MGG,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,BCBS,BCBS,255.42,,,,,,,per diem,255.42,255.42,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,BCBS MGG,BCBS MGG,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Cigna,Cigna,255.42,,,,,,,per diem,255.42,255.42,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Cigna MGG,Cigna MGG,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Humana,Humana,255.42,,,,,,,per diem,255.42,255.42,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Humana MGG,Humana MGG,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Optum VA,Optum VA,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,UHC,UHC,255.42,,,,,,,per diem,255.42,255.42,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,UHC MGG,UHC MGG,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,VA,VA,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Wellcare MGG,Wellcare MGG,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Bright Health - commercial,Bright Health - commercial,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,255.42,255.42,Bright Health MGG,Bright Health MGG,255.42,,,,,,,case rate,255.42,255.42,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Aetna,Aetna,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Aetna MGG,Aetna MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,BCBS,BCBS,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,BCBS MGG,BCBS MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Cigna,Cigna,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Cigna MGG,Cigna MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Humana,Humana,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Humana MGG,Humana MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Optum VA,Optum VA,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,UHC,UHC,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,UHC MGG,UHC MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,VA,VA,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Wellcare MGG,Wellcare MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Bright Health - commercial,Bright Health - commercial,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,84.33,84.33,Bright Health MGG,Bright Health MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Aetna,Aetna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Aetna MGG,Aetna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,BCBS,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS MGG,BCBS MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Cigna,Cigna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Cigna MGG,Cigna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Humana,Humana,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Humana MGG,Humana MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Optum VA,Optum VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,UHC,UHC,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,UHC MGG,UHC MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,VA,VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Wellcare MGG,Wellcare MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Bright Health - commercial,Bright Health - commercial,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,Bright Health MGG,Bright Health MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Aetna,Aetna,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Aetna MGG,Aetna MGG,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,BCBS,BCBS,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,BCBS MGG,BCBS MGG,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Cigna,Cigna,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Cigna MGG,Cigna MGG,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Humana,Humana,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Humana MGG,Humana MGG,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Optum VA,Optum VA,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,UHC,UHC,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,UHC MGG,UHC MGG,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,VA,VA,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Wellcare MGG,Wellcare MGG,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Bright Health - commercial,Bright Health - commercial,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,130.82,130.82,Bright Health MGG,Bright Health MGG,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Aetna,Aetna,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Aetna MGG,Aetna MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,BCBS,BCBS,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,BCBS MGG,BCBS MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Cigna,Cigna,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Cigna MGG,Cigna MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Humana,Humana,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Humana MGG,Humana MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Optum VA,Optum VA,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,UHC,UHC,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,UHC MGG,UHC MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,VA,VA,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Wellcare MGG,Wellcare MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Bright Health - commercial,Bright Health - commercial,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Bright Health MGG,Bright Health MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Aetna,Aetna,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Aetna MGG,Aetna MGG,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,BCBS,BCBS,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,BCBS MGG,BCBS MGG,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Cigna,Cigna,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Cigna MGG,Cigna MGG,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Humana,Humana,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Humana MGG,Humana MGG,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Optum VA,Optum VA,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,UHC,UHC,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,UHC MGG,UHC MGG,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,VA,VA,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Wellcare MGG,Wellcare MGG,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Bright Health - commercial,Bright Health - commercial,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,87.07,87.07,Bright Health MGG,Bright Health MGG,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Aetna,Aetna,201.63,,,,,,,per diem,201.63,201.63,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Aetna MGG,Aetna MGG,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,BCBS,BCBS,201.63,,,,,,,per diem,201.63,201.63,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,BCBS MGG,BCBS MGG,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Cigna,Cigna,201.63,,,,,,,per diem,201.63,201.63,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Cigna MGG,Cigna MGG,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Humana,Humana,201.63,,,,,,,per diem,201.63,201.63,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Humana MGG,Humana MGG,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Optum VA,Optum VA,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,UHC,UHC,201.63,,,,,,,per diem,201.63,201.63,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,UHC MGG,UHC MGG,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,VA,VA,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Wellcare MGG,Wellcare MGG,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Bright Health - commercial,Bright Health - commercial,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,201.63,201.63,Bright Health MGG,Bright Health MGG,201.63,,,,,,,case rate,201.63,201.63,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Aetna,Aetna,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Aetna MGG,Aetna MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,BCBS,BCBS,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,BCBS MGG,BCBS MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Cigna,Cigna,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Cigna MGG,Cigna MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Humana,Humana,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Humana MGG,Humana MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Optum VA,Optum VA,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,UHC,UHC,392.3,,,,,,,per diem,392.3,392.3,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,UHC MGG,UHC MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,VA,VA,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Wellcare MGG,Wellcare MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Bright Health - commercial,Bright Health - commercial,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,392.3,392.3,Bright Health MGG,Bright Health MGG,392.3,,,,,,,case rate,392.3,392.3,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Aetna,Aetna,274.84,,,,,,,per diem,274.84,274.84,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Aetna MGG,Aetna MGG,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,BCBS,BCBS,274.84,,,,,,,per diem,274.84,274.84,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,BCBS MGG,BCBS MGG,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Cigna,Cigna,274.84,,,,,,,per diem,274.84,274.84,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Cigna MGG,Cigna MGG,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Humana,Humana,274.84,,,,,,,per diem,274.84,274.84,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Humana MGG,Humana MGG,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Optum VA,Optum VA,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,UHC,UHC,274.84,,,,,,,per diem,274.84,274.84,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,UHC MGG,UHC MGG,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,VA,VA,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Wellcare MGG,Wellcare MGG,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Bright Health - commercial,Bright Health - commercial,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,274.84,274.84,Bright Health MGG,Bright Health MGG,274.84,,,,,,,case rate,274.84,274.84,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Aetna,Aetna,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Aetna MGG,Aetna MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,BCBS,BCBS,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,BCBS MGG,BCBS MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Cigna,Cigna,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Cigna MGG,Cigna MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Humana,Humana,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Humana MGG,Humana MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Optum VA,Optum VA,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,UHC,UHC,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,UHC MGG,UHC MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,VA,VA,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Wellcare MGG,Wellcare MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Bright Health - commercial,Bright Health - commercial,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,40.32,40.32,Bright Health MGG,Bright Health MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Aetna,Aetna,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Aetna MGG,Aetna MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,BCBS,BCBS,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,BCBS MGG,BCBS MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Cigna,Cigna,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Cigna MGG,Cigna MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Humana,Humana,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Humana MGG,Humana MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Optum VA,Optum VA,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,UHC,UHC,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,UHC MGG,UHC MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,VA,VA,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Wellcare MGG,Wellcare MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Bright Health - commercial,Bright Health - commercial,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Bright Health MGG,Bright Health MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Aetna,Aetna,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Aetna MGG,Aetna MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,BCBS,BCBS,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,BCBS MGG,BCBS MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Cigna,Cigna,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Cigna MGG,Cigna MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Humana,Humana,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Humana MGG,Humana MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Optum VA,Optum VA,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,UHC,UHC,941.85,,,,,,,per diem,941.85,941.85,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,UHC MGG,UHC MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,VA,VA,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Wellcare MGG,Wellcare MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Bright Health - commercial,Bright Health - commercial,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,941.85,941.85,Bright Health MGG,Bright Health MGG,941.85,,,,,,,case rate,941.85,941.85,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Aetna,Aetna,1873.34,,,,,,,per diem,1873.34,1873.34,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Aetna MGG,Aetna MGG,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,BCBS,BCBS,1873.34,,,,,,,per diem,1873.34,1873.34,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,BCBS MGG,BCBS MGG,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Cigna,Cigna,1873.34,,,,,,,per diem,1873.34,1873.34,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Cigna MGG,Cigna MGG,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Humana,Humana,1873.34,,,,,,,per diem,1873.34,1873.34,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Humana MGG,Humana MGG,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Optum VA,Optum VA,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,UHC,UHC,1873.34,,,,,,,per diem,1873.34,1873.34,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,UHC MGG,UHC MGG,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,VA,VA,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Wellcare MGG,Wellcare MGG,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Bright Health - commercial,Bright Health - commercial,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1873.34,1873.34,Bright Health MGG,Bright Health MGG,1873.34,,,,,,,case rate,1873.34,1873.34,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Aetna,Aetna,1199.27,,,,,,,per diem,1199.27,1199.27,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Aetna MGG,Aetna MGG,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,BCBS,BCBS,1199.27,,,,,,,per diem,1199.27,1199.27,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,BCBS MGG,BCBS MGG,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Cigna,Cigna,1199.27,,,,,,,per diem,1199.27,1199.27,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Cigna MGG,Cigna MGG,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Humana,Humana,1199.27,,,,,,,per diem,1199.27,1199.27,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Humana MGG,Humana MGG,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Optum VA,Optum VA,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,UHC,UHC,1199.27,,,,,,,per diem,1199.27,1199.27,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,UHC MGG,UHC MGG,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,VA,VA,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Wellcare MGG,Wellcare MGG,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Bright Health - commercial,Bright Health - commercial,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1199.27,1199.27,Bright Health MGG,Bright Health MGG,1199.27,,,,,,,case rate,1199.27,1199.27,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Aetna,Aetna,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Aetna MGG,Aetna MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,BCBS,BCBS,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,BCBS MGG,BCBS MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Cigna,Cigna,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Cigna MGG,Cigna MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Humana,Humana,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Humana MGG,Humana MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Optum VA,Optum VA,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,UHC,UHC,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,UHC MGG,UHC MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,VA,VA,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Wellcare MGG,Wellcare MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Bright Health - commercial,Bright Health - commercial,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Bright Health MGG,Bright Health MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Aetna,Aetna,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Aetna MGG,Aetna MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,BCBS,BCBS,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,BCBS MGG,BCBS MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Cigna,Cigna,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Cigna MGG,Cigna MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Humana,Humana,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Humana MGG,Humana MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Optum VA,Optum VA,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,UHC,UHC,340.07,,,,,,,per diem,340.07,340.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,UHC MGG,UHC MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,VA,VA,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Wellcare MGG,Wellcare MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Bright Health - commercial,Bright Health - commercial,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,340.07,340.07,Bright Health MGG,Bright Health MGG,340.07,,,,,,,case rate,340.07,340.07,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Aetna,Aetna,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Aetna MGG,Aetna MGG,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,BCBS,BCBS,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,BCBS MGG,BCBS MGG,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Cigna,Cigna,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Cigna MGG,Cigna MGG,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Humana,Humana,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Humana MGG,Humana MGG,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Optum VA,Optum VA,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,UHC,UHC,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,UHC MGG,UHC MGG,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,VA,VA,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Wellcare MGG,Wellcare MGG,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Bright Health - commercial,Bright Health - commercial,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,Bright Health MGG,Bright Health MGG,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Aetna,Aetna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Aetna MGG,Aetna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,BCBS,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,BCBS MGG,BCBS MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Cigna,Cigna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Cigna MGG,Cigna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Humana,Humana,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Humana MGG,Humana MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Optum VA,Optum VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,UHC,UHC,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,UHC MGG,UHC MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,VA,VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Wellcare MGG,Wellcare MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Bright Health - commercial,Bright Health - commercial,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,94.5,94.5,Bright Health MGG,Bright Health MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Aetna,Aetna,40.38,,,,,,,per diem,40.38,40.38,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Aetna MGG,Aetna MGG,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,BCBS,BCBS,40.38,,,,,,,per diem,40.38,40.38,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,BCBS MGG,BCBS MGG,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Cigna,Cigna,40.38,,,,,,,per diem,40.38,40.38,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Cigna MGG,Cigna MGG,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Humana,Humana,40.38,,,,,,,per diem,40.38,40.38,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Humana MGG,Humana MGG,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Optum VA,Optum VA,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,UHC,UHC,40.38,,,,,,,per diem,40.38,40.38,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,UHC MGG,UHC MGG,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,VA,VA,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Wellcare MGG,Wellcare MGG,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Bright Health - commercial,Bright Health - commercial,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,40.38,40.38,Bright Health MGG,Bright Health MGG,40.38,,,,,,,case rate,40.38,40.38,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Aetna,Aetna,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Aetna MGG,Aetna MGG,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,BCBS,BCBS,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,BCBS MGG,BCBS MGG,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Cigna,Cigna,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Cigna MGG,Cigna MGG,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Humana,Humana,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Humana MGG,Humana MGG,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Optum VA,Optum VA,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,UHC,UHC,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,UHC MGG,UHC MGG,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,VA,VA,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Wellcare MGG,Wellcare MGG,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Bright Health - commercial,Bright Health - commercial,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.03,8.03,Bright Health MGG,Bright Health MGG,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Aetna,Aetna,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Aetna MGG,Aetna MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,BCBS,BCBS,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,BCBS MGG,BCBS MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Cigna,Cigna,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Cigna MGG,Cigna MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Humana,Humana,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Humana MGG,Humana MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Optum VA,Optum VA,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,UHC,UHC,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,UHC MGG,UHC MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,VA,VA,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Wellcare MGG,Wellcare MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Bright Health - commercial,Bright Health - commercial,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,Bright Health MGG,Bright Health MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Aetna,Aetna,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Aetna MGG,Aetna MGG,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,BCBS,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,BCBS MGG,BCBS MGG,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Cigna,Cigna,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Cigna MGG,Cigna MGG,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Humana,Humana,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Humana MGG,Humana MGG,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Optum VA,Optum VA,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,UHC,UHC,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,UHC MGG,UHC MGG,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,VA,VA,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Wellcare MGG,Wellcare MGG,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Bright Health - commercial,Bright Health - commercial,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,Bright Health MGG,Bright Health MGG,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Aetna,Aetna,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Aetna MGG,Aetna MGG,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,BCBS,BCBS,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,BCBS MGG,BCBS MGG,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Cigna,Cigna,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Cigna MGG,Cigna MGG,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Humana,Humana,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Humana MGG,Humana MGG,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Optum VA,Optum VA,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,UHC,UHC,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,UHC MGG,UHC MGG,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,VA,VA,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Wellcare MGG,Wellcare MGG,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Bright Health - commercial,Bright Health - commercial,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,Bright Health MGG,Bright Health MGG,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Aetna,Aetna,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Aetna MGG,Aetna MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,BCBS,BCBS,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,BCBS MGG,BCBS MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Cigna,Cigna,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Cigna MGG,Cigna MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Humana,Humana,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Humana MGG,Humana MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Optum VA,Optum VA,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,UHC,UHC,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,UHC MGG,UHC MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,VA,VA,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Wellcare MGG,Wellcare MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Bright Health - commercial,Bright Health - commercial,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,15.66,15.66,Bright Health MGG,Bright Health MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Aetna,Aetna,55.09,,,,,,,per diem,55.09,55.09,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Aetna MGG,Aetna MGG,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,BCBS,BCBS,55.09,,,,,,,per diem,55.09,55.09,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,BCBS MGG,BCBS MGG,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Cigna,Cigna,55.09,,,,,,,per diem,55.09,55.09,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Cigna MGG,Cigna MGG,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Humana,Humana,55.09,,,,,,,per diem,55.09,55.09,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Humana MGG,Humana MGG,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Optum VA,Optum VA,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,UHC,UHC,55.09,,,,,,,per diem,55.09,55.09,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,UHC MGG,UHC MGG,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,VA,VA,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Wellcare MGG,Wellcare MGG,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Bright Health - commercial,Bright Health - commercial,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,55.09,55.09,Bright Health MGG,Bright Health MGG,55.09,,,,,,,case rate,55.09,55.09,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Aetna,Aetna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Aetna MGG,Aetna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,BCBS,BCBS,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,BCBS MGG,BCBS MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Cigna,Cigna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Cigna MGG,Cigna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Humana,Humana,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Humana MGG,Humana MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Optum VA,Optum VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,UHC,UHC,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,UHC MGG,UHC MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,VA,VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Wellcare MGG,Wellcare MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Bright Health - commercial,Bright Health - commercial,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,32.4,32.4,Bright Health MGG,Bright Health MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Aetna,Aetna,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Aetna MGG,Aetna MGG,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,BCBS,BCBS,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,BCBS MGG,BCBS MGG,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Cigna,Cigna,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Cigna MGG,Cigna MGG,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Humana,Humana,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Humana MGG,Humana MGG,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Optum VA,Optum VA,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,UHC,UHC,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,UHC MGG,UHC MGG,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,VA,VA,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Wellcare MGG,Wellcare MGG,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Bright Health - commercial,Bright Health - commercial,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,19.81,19.81,Bright Health MGG,Bright Health MGG,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Aetna,Aetna,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Aetna MGG,Aetna MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,BCBS,BCBS,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,BCBS MGG,BCBS MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Cigna,Cigna,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Cigna MGG,Cigna MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Humana,Humana,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Humana MGG,Humana MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Optum VA,Optum VA,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,UHC,UHC,42.36,,,,,,,per diem,42.36,42.36,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,UHC MGG,UHC MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,VA,VA,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Wellcare MGG,Wellcare MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Bright Health - commercial,Bright Health - commercial,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,42.36,42.36,Bright Health MGG,Bright Health MGG,42.36,,,,,,,case rate,42.36,42.36,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Aetna,Aetna,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Aetna MGG,Aetna MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,BCBS,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS MGG,BCBS MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Cigna,Cigna,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Cigna MGG,Cigna MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Humana,Humana,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Humana MGG,Humana MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Optum VA,Optum VA,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UHC,UHC,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UHC MGG,UHC MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA,VA,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Wellcare MGG,Wellcare MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Bright Health - commercial,Bright Health - commercial,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Bright Health MGG,Bright Health MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Aetna,Aetna,153.63,,,,,,,per diem,153.63,153.63,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Aetna MGG,Aetna MGG,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,BCBS,BCBS,153.63,,,,,,,per diem,153.63,153.63,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,BCBS MGG,BCBS MGG,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Cigna,Cigna,153.63,,,,,,,per diem,153.63,153.63,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Cigna MGG,Cigna MGG,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Humana,Humana,153.63,,,,,,,per diem,153.63,153.63,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Humana MGG,Humana MGG,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Optum VA,Optum VA,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,UHC,UHC,153.63,,,,,,,per diem,153.63,153.63,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,UHC MGG,UHC MGG,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,VA,VA,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Wellcare MGG,Wellcare MGG,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Bright Health - commercial,Bright Health - commercial,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,153.63,153.63,Bright Health MGG,Bright Health MGG,153.63,,,,,,,case rate,153.63,153.63,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Aetna,Aetna,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Aetna MGG,Aetna MGG,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,BCBS,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS MGG,BCBS MGG,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Cigna,Cigna,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Cigna MGG,Cigna MGG,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Humana,Humana,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Humana MGG,Humana MGG,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Optum VA,Optum VA,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,UHC,UHC,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,UHC MGG,UHC MGG,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,VA,VA,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Wellcare MGG,Wellcare MGG,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Bright Health - commercial,Bright Health - commercial,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,Bright Health MGG,Bright Health MGG,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Aetna,Aetna,44.38,,,,,,,per diem,44.38,44.38,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Aetna MGG,Aetna MGG,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,BCBS,BCBS,44.38,,,,,,,per diem,44.38,44.38,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,BCBS MGG,BCBS MGG,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Cigna,Cigna,44.38,,,,,,,per diem,44.38,44.38,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Cigna MGG,Cigna MGG,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Humana,Humana,44.38,,,,,,,per diem,44.38,44.38,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Humana MGG,Humana MGG,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Optum VA,Optum VA,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,UHC,UHC,44.38,,,,,,,per diem,44.38,44.38,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,UHC MGG,UHC MGG,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,VA,VA,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Wellcare MGG,Wellcare MGG,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Bright Health - commercial,Bright Health - commercial,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,44.38,44.38,Bright Health MGG,Bright Health MGG,44.38,,,,,,,case rate,44.38,44.38,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Aetna,Aetna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Aetna MGG,Aetna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,BCBS,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS MGG,BCBS MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Cigna,Cigna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Cigna MGG,Cigna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Humana,Humana,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Humana MGG,Humana MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Optum VA,Optum VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UHC,UHC,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UHC MGG,UHC MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA,VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Wellcare MGG,Wellcare MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Bright Health - commercial,Bright Health - commercial,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,Bright Health MGG,Bright Health MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Aetna,Aetna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Aetna MGG,Aetna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,BCBS,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS MGG,BCBS MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Cigna,Cigna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Cigna MGG,Cigna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Humana,Humana,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Humana MGG,Humana MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Optum VA,Optum VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,UHC,UHC,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,UHC MGG,UHC MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,VA,VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Wellcare MGG,Wellcare MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Bright Health - commercial,Bright Health - commercial,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,63,63,Bright Health MGG,Bright Health MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Aetna,Aetna,147.9,,,,,,,per diem,147.9,147.9,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Aetna MGG,Aetna MGG,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,BCBS,BCBS,147.9,,,,,,,per diem,147.9,147.9,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,BCBS MGG,BCBS MGG,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Cigna,Cigna,147.9,,,,,,,per diem,147.9,147.9,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Cigna MGG,Cigna MGG,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Humana,Humana,147.9,,,,,,,per diem,147.9,147.9,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Humana MGG,Humana MGG,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Optum VA,Optum VA,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,UHC,UHC,147.9,,,,,,,per diem,147.9,147.9,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,UHC MGG,UHC MGG,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,VA,VA,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Wellcare MGG,Wellcare MGG,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Bright Health - commercial,Bright Health - commercial,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,147.9,147.9,Bright Health MGG,Bright Health MGG,147.9,,,,,,,case rate,147.9,147.9,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Aetna,Aetna,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Aetna MGG,Aetna MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,BCBS,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS MGG,BCBS MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Cigna,Cigna,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Cigna MGG,Cigna MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Humana,Humana,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Humana MGG,Humana MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Optum VA,Optum VA,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UHC,UHC,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UHC MGG,UHC MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA,VA,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Wellcare MGG,Wellcare MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Bright Health - commercial,Bright Health - commercial,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,Bright Health MGG,Bright Health MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Aetna,Aetna,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Aetna MGG,Aetna MGG,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,BCBS,BCBS,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,BCBS MGG,BCBS MGG,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Cigna,Cigna,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Cigna MGG,Cigna MGG,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Humana,Humana,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Humana MGG,Humana MGG,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Optum VA,Optum VA,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,UHC,UHC,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,UHC MGG,UHC MGG,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,VA,VA,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Wellcare MGG,Wellcare MGG,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Bright Health - commercial,Bright Health - commercial,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,198.45,198.45,Bright Health MGG,Bright Health MGG,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Aetna,Aetna,206.85,,,,,,,per diem,206.85,206.85,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Aetna MGG,Aetna MGG,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,BCBS,BCBS,206.85,,,,,,,per diem,206.85,206.85,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,BCBS MGG,BCBS MGG,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Cigna,Cigna,206.85,,,,,,,per diem,206.85,206.85,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Cigna MGG,Cigna MGG,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Humana,Humana,206.85,,,,,,,per diem,206.85,206.85,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Humana MGG,Humana MGG,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Optum VA,Optum VA,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,UHC,UHC,206.85,,,,,,,per diem,206.85,206.85,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,UHC MGG,UHC MGG,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,VA,VA,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Wellcare MGG,Wellcare MGG,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Bright Health - commercial,Bright Health - commercial,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,206.85,206.85,Bright Health MGG,Bright Health MGG,206.85,,,,,,,case rate,206.85,206.85,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Aetna,Aetna,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Aetna MGG,Aetna MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,BCBS,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS MGG,BCBS MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Cigna,Cigna,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Cigna MGG,Cigna MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Humana,Humana,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Humana MGG,Humana MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Optum VA,Optum VA,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UHC,UHC,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UHC MGG,UHC MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA,VA,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Wellcare MGG,Wellcare MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Bright Health - commercial,Bright Health - commercial,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,Bright Health MGG,Bright Health MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Aetna,Aetna,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Aetna MGG,Aetna MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,BCBS,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,BCBS MGG,BCBS MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Cigna,Cigna,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Cigna MGG,Cigna MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Humana,Humana,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Humana MGG,Humana MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Optum VA,Optum VA,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,UHC,UHC,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,UHC MGG,UHC MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,VA,VA,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Wellcare MGG,Wellcare MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Bright Health - commercial,Bright Health - commercial,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Bright Health MGG,Bright Health MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Aetna,Aetna,1030.58,,,,,,,per diem,1030.58,1030.58,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Aetna MGG,Aetna MGG,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,BCBS,BCBS,1030.58,,,,,,,per diem,1030.58,1030.58,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,BCBS MGG,BCBS MGG,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Cigna,Cigna,1030.58,,,,,,,per diem,1030.58,1030.58,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Cigna MGG,Cigna MGG,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Humana,Humana,1030.58,,,,,,,per diem,1030.58,1030.58,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Humana MGG,Humana MGG,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Optum VA,Optum VA,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,UHC,UHC,1030.58,,,,,,,per diem,1030.58,1030.58,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,UHC MGG,UHC MGG,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,VA,VA,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Wellcare MGG,Wellcare MGG,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Bright Health - commercial,Bright Health - commercial,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1030.58,1030.58,Bright Health MGG,Bright Health MGG,1030.58,,,,,,,case rate,1030.58,1030.58,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Aetna,Aetna,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Aetna MGG,Aetna MGG,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,BCBS,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,BCBS MGG,BCBS MGG,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Cigna,Cigna,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Cigna MGG,Cigna MGG,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Humana,Humana,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Humana MGG,Humana MGG,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Optum VA,Optum VA,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,UHC,UHC,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,UHC MGG,UHC MGG,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,VA,VA,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Wellcare MGG,Wellcare MGG,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Bright Health - commercial,Bright Health - commercial,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,204.75,204.75,Bright Health MGG,Bright Health MGG,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Aetna,Aetna,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Aetna MGG,Aetna MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS,BCBS,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS MGG,BCBS MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Cigna,Cigna,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Cigna MGG,Cigna MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Humana,Humana,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Humana MGG,Humana MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Optum VA,Optum VA,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,UHC,UHC,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,UHC MGG,UHC MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,VA,VA,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Wellcare MGG,Wellcare MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Bright Health - commercial,Bright Health - commercial,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Bright Health MGG,Bright Health MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Aetna,Aetna,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Aetna MGG,Aetna MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS,BCBS,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS MGG,BCBS MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Cigna,Cigna,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Cigna MGG,Cigna MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Humana,Humana,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Humana MGG,Humana MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Optum VA,Optum VA,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,UHC,UHC,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,UHC MGG,UHC MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,VA,VA,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Wellcare MGG,Wellcare MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Bright Health - commercial,Bright Health - commercial,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,Bright Health MGG,Bright Health MGG,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Aetna,Aetna,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Aetna MGG,Aetna MGG,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,BCBS,BCBS,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,BCBS MGG,BCBS MGG,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Cigna,Cigna,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Cigna MGG,Cigna MGG,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Humana,Humana,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Humana MGG,Humana MGG,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Optum VA,Optum VA,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,UHC,UHC,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,UHC MGG,UHC MGG,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,VA,VA,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Wellcare MGG,Wellcare MGG,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Bright Health - commercial,Bright Health - commercial,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,195.04,195.04,Bright Health MGG,Bright Health MGG,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Aetna,Aetna,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Aetna MGG,Aetna MGG,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,BCBS,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,BCBS MGG,BCBS MGG,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Cigna,Cigna,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Cigna MGG,Cigna MGG,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Humana,Humana,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Humana MGG,Humana MGG,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Optum VA,Optum VA,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,UHC,UHC,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,UHC MGG,UHC MGG,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,VA,VA,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Wellcare MGG,Wellcare MGG,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Bright Health - commercial,Bright Health - commercial,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,66.15,66.15,Bright Health MGG,Bright Health MGG,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Aetna,Aetna,452.81,,,,,,,per diem,452.81,452.81,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Aetna MGG,Aetna MGG,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,BCBS,BCBS,452.81,,,,,,,per diem,452.81,452.81,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,BCBS MGG,BCBS MGG,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Cigna,Cigna,452.81,,,,,,,per diem,452.81,452.81,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Cigna MGG,Cigna MGG,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Humana,Humana,452.81,,,,,,,per diem,452.81,452.81,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Humana MGG,Humana MGG,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Optum VA,Optum VA,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,UHC,UHC,452.81,,,,,,,per diem,452.81,452.81,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,UHC MGG,UHC MGG,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,VA,VA,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Wellcare MGG,Wellcare MGG,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Bright Health - commercial,Bright Health - commercial,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,452.81,452.81,Bright Health MGG,Bright Health MGG,452.81,,,,,,,case rate,452.81,452.81,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Aetna,Aetna,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Aetna MGG,Aetna MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,BCBS,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,BCBS MGG,BCBS MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Cigna,Cigna,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Cigna MGG,Cigna MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Humana,Humana,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Humana MGG,Humana MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Optum VA,Optum VA,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,UHC,UHC,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,UHC MGG,UHC MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,VA,VA,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Wellcare MGG,Wellcare MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Bright Health - commercial,Bright Health - commercial,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Bright Health MGG,Bright Health MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Aetna,Aetna,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Aetna MGG,Aetna MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,BCBS,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,BCBS MGG,BCBS MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Cigna,Cigna,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Cigna MGG,Cigna MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Humana,Humana,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Humana MGG,Humana MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Optum VA,Optum VA,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,UHC,UHC,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,UHC MGG,UHC MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,VA,VA,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Wellcare MGG,Wellcare MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Bright Health - commercial,Bright Health - commercial,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Bright Health MGG,Bright Health MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Aetna,Aetna,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Aetna MGG,Aetna MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,BCBS,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,BCBS MGG,BCBS MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Cigna,Cigna,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Cigna MGG,Cigna MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Humana,Humana,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Humana MGG,Humana MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Optum VA,Optum VA,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,UHC,UHC,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,UHC MGG,UHC MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,VA,VA,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Wellcare MGG,Wellcare MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Bright Health - commercial,Bright Health - commercial,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,157.5,157.5,Bright Health MGG,Bright Health MGG,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Aetna,Aetna,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Aetna MGG,Aetna MGG,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,BCBS,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,BCBS MGG,BCBS MGG,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Cigna,Cigna,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Cigna MGG,Cigna MGG,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Humana,Humana,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Humana MGG,Humana MGG,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Optum VA,Optum VA,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,UHC,UHC,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,UHC MGG,UHC MGG,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,VA,VA,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Wellcare MGG,Wellcare MGG,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Bright Health - commercial,Bright Health - commercial,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,151.2,151.2,Bright Health MGG,Bright Health MGG,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Aetna,Aetna,173.03,,,,,,,per diem,173.03,173.03,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Aetna MGG,Aetna MGG,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,BCBS,BCBS,173.03,,,,,,,per diem,173.03,173.03,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,BCBS MGG,BCBS MGG,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Cigna,Cigna,173.03,,,,,,,per diem,173.03,173.03,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Cigna MGG,Cigna MGG,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Humana,Humana,173.03,,,,,,,per diem,173.03,173.03,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Humana MGG,Humana MGG,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Optum VA,Optum VA,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,UHC,UHC,173.03,,,,,,,per diem,173.03,173.03,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,UHC MGG,UHC MGG,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,VA,VA,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Wellcare MGG,Wellcare MGG,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Bright Health - commercial,Bright Health - commercial,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,173.03,173.03,Bright Health MGG,Bright Health MGG,173.03,,,,,,,case rate,173.03,173.03,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Aetna,Aetna,166.95,,,,,,,per diem,166.95,166.95,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Aetna MGG,Aetna MGG,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,BCBS,BCBS,166.95,,,,,,,per diem,166.95,166.95,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,BCBS MGG,BCBS MGG,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Cigna,Cigna,166.95,,,,,,,per diem,166.95,166.95,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Cigna MGG,Cigna MGG,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Humana,Humana,166.95,,,,,,,per diem,166.95,166.95,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Humana MGG,Humana MGG,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Optum VA,Optum VA,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,UHC,UHC,166.95,,,,,,,per diem,166.95,166.95,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,UHC MGG,UHC MGG,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,VA,VA,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Wellcare MGG,Wellcare MGG,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Bright Health - commercial,Bright Health - commercial,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,166.95,166.95,Bright Health MGG,Bright Health MGG,166.95,,,,,,,case rate,166.95,166.95,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Aetna,Aetna,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Aetna MGG,Aetna MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,BCBS,BCBS,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,BCBS MGG,BCBS MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Cigna,Cigna,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Cigna MGG,Cigna MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Humana,Humana,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Humana MGG,Humana MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Optum VA,Optum VA,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,UHC,UHC,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,UHC MGG,UHC MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,VA,VA,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Wellcare MGG,Wellcare MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Bright Health - commercial,Bright Health - commercial,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,37.96,37.96,Bright Health MGG,Bright Health MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Aetna,Aetna,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Aetna MGG,Aetna MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,BCBS,BCBS,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,BCBS MGG,BCBS MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Cigna,Cigna,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Cigna MGG,Cigna MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Humana,Humana,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Humana MGG,Humana MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Optum VA,Optum VA,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,UHC,UHC,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,UHC MGG,UHC MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,VA,VA,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Wellcare MGG,Wellcare MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Bright Health - commercial,Bright Health - commercial,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Bright Health MGG,Bright Health MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Aetna,Aetna,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Aetna MGG,Aetna MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,BCBS,BCBS,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,BCBS MGG,BCBS MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Cigna,Cigna,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Cigna MGG,Cigna MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Humana,Humana,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Humana MGG,Humana MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Optum VA,Optum VA,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,UHC,UHC,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,UHC MGG,UHC MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,VA,VA,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Wellcare MGG,Wellcare MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Bright Health - commercial,Bright Health - commercial,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Bright Health MGG,Bright Health MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Aetna,Aetna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Aetna MGG,Aetna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,BCBS,BCBS,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,BCBS MGG,BCBS MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Cigna,Cigna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Cigna MGG,Cigna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Humana,Humana,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Humana MGG,Humana MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Optum VA,Optum VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,UHC,UHC,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,UHC MGG,UHC MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,VA,VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Wellcare MGG,Wellcare MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Bright Health - commercial,Bright Health - commercial,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Bright Health MGG,Bright Health MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Aetna,Aetna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Aetna MGG,Aetna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,BCBS,BCBS,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,BCBS MGG,BCBS MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Cigna,Cigna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Cigna MGG,Cigna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Humana,Humana,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Humana MGG,Humana MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Optum VA,Optum VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,UHC,UHC,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,UHC MGG,UHC MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,VA,VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Wellcare MGG,Wellcare MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Bright Health - commercial,Bright Health - commercial,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Bright Health MGG,Bright Health MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna,Aetna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna MGG,Aetna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS,BCBS,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS MGG,BCBS MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna,Cigna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna MGG,Cigna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana,Humana,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana MGG,Humana MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Optum VA,Optum VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC,UHC,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC MGG,UHC MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,VA,VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Wellcare MGG,Wellcare MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health - commercial,Bright Health - commercial,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health MGG,Bright Health MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna,Aetna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna MGG,Aetna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS,BCBS,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS MGG,BCBS MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna,Cigna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna MGG,Cigna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana,Humana,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana MGG,Humana MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Optum VA,Optum VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC,UHC,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC MGG,UHC MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,VA,VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Wellcare MGG,Wellcare MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health - commercial,Bright Health - commercial,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health MGG,Bright Health MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna,Aetna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna MGG,Aetna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS,BCBS,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS MGG,BCBS MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna,Cigna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna MGG,Cigna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana,Humana,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana MGG,Humana MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Optum VA,Optum VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC,UHC,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC MGG,UHC MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,VA,VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Wellcare MGG,Wellcare MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health - commercial,Bright Health - commercial,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health MGG,Bright Health MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna,Aetna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna MGG,Aetna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS,BCBS,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS MGG,BCBS MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna,Cigna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna MGG,Cigna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana,Humana,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana MGG,Humana MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Optum VA,Optum VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC,UHC,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC MGG,UHC MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,VA,VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Wellcare MGG,Wellcare MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health - commercial,Bright Health - commercial,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health MGG,Bright Health MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Aetna,Aetna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Aetna MGG,Aetna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,BCBS,BCBS,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,BCBS MGG,BCBS MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Cigna,Cigna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Cigna MGG,Cigna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Humana,Humana,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Humana MGG,Humana MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Optum VA,Optum VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,UHC,UHC,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,UHC MGG,UHC MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,VA,VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Wellcare MGG,Wellcare MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Bright Health - commercial,Bright Health - commercial,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Bright Health MGG,Bright Health MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Aetna,Aetna,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Aetna MGG,Aetna MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,BCBS,BCBS,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,BCBS MGG,BCBS MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Cigna,Cigna,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Cigna MGG,Cigna MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Humana,Humana,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Humana MGG,Humana MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Optum VA,Optum VA,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,UHC,UHC,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,UHC MGG,UHC MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,VA,VA,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Wellcare MGG,Wellcare MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Bright Health - commercial,Bright Health - commercial,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Bright Health MGG,Bright Health MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Aetna,Aetna,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Aetna MGG,Aetna MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,BCBS,BCBS,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,BCBS MGG,BCBS MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Cigna,Cigna,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Cigna MGG,Cigna MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Humana,Humana,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Humana MGG,Humana MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Optum VA,Optum VA,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,UHC,UHC,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,UHC MGG,UHC MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,VA,VA,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Wellcare MGG,Wellcare MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Bright Health - commercial,Bright Health - commercial,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Bright Health MGG,Bright Health MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Aetna,Aetna,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Aetna MGG,Aetna MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,BCBS,BCBS,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,BCBS MGG,BCBS MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Cigna,Cigna,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Cigna MGG,Cigna MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Humana,Humana,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Humana MGG,Humana MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Optum VA,Optum VA,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,UHC,UHC,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,UHC MGG,UHC MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,VA,VA,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Wellcare MGG,Wellcare MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Bright Health - commercial,Bright Health - commercial,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Bright Health MGG,Bright Health MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Aetna,Aetna,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Aetna MGG,Aetna MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,BCBS,BCBS,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,BCBS MGG,BCBS MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Cigna,Cigna,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Cigna MGG,Cigna MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Humana,Humana,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Humana MGG,Humana MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Optum VA,Optum VA,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,UHC,UHC,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,UHC MGG,UHC MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,VA,VA,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Wellcare MGG,Wellcare MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Bright Health - commercial,Bright Health - commercial,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Bright Health MGG,Bright Health MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna,Aetna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Aetna MGG,Aetna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,BCBS,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS MGG,BCBS MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna,Cigna,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Cigna MGG,Cigna MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana,Humana,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Humana MGG,Humana MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Optum VA,Optum VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC,UHC,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UHC MGG,UHC MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,VA,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Wellcare MGG,Wellcare MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health - commercial,Bright Health - commercial,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,Bright Health MGG,Bright Health MGG,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Aetna,Aetna,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Aetna MGG,Aetna MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,BCBS,BCBS,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,BCBS MGG,BCBS MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Cigna,Cigna,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Cigna MGG,Cigna MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Humana,Humana,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Humana MGG,Humana MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Optum VA,Optum VA,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,UHC,UHC,16.57,,,,,,,per diem,16.57,16.57,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,UHC MGG,UHC MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,VA,VA,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Wellcare MGG,Wellcare MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Bright Health - commercial,Bright Health - commercial,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,16.57,16.57,Bright Health MGG,Bright Health MGG,16.57,,,,,,,case rate,16.57,16.57,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Aetna,Aetna,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Aetna MGG,Aetna MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,BCBS,BCBS,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,BCBS MGG,BCBS MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Cigna,Cigna,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Cigna MGG,Cigna MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Humana,Humana,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Humana MGG,Humana MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Optum VA,Optum VA,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,UHC,UHC,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,UHC MGG,UHC MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,VA,VA,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Wellcare MGG,Wellcare MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Bright Health - commercial,Bright Health - commercial,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,22.3,22.3,Bright Health MGG,Bright Health MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Aetna,Aetna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Aetna MGG,Aetna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,BCBS,BCBS,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,BCBS MGG,BCBS MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Cigna,Cigna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Cigna MGG,Cigna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Humana,Humana,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Humana MGG,Humana MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Optum VA,Optum VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,UHC,UHC,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,UHC MGG,UHC MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,VA,VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Wellcare MGG,Wellcare MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Bright Health - commercial,Bright Health - commercial,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Bright Health MGG,Bright Health MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Aetna,Aetna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Aetna MGG,Aetna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,BCBS,BCBS,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,BCBS MGG,BCBS MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Cigna,Cigna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Cigna MGG,Cigna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Humana,Humana,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Humana MGG,Humana MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Optum VA,Optum VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,UHC,UHC,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,UHC MGG,UHC MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,VA,VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Wellcare MGG,Wellcare MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Bright Health - commercial,Bright Health - commercial,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.15,15.15,Bright Health MGG,Bright Health MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna,Aetna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna MGG,Aetna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS,BCBS,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS MGG,BCBS MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna,Cigna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna MGG,Cigna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana,Humana,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana MGG,Humana MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Optum VA,Optum VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC,UHC,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC MGG,UHC MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,VA,VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Wellcare MGG,Wellcare MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health - commercial,Bright Health - commercial,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health MGG,Bright Health MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna,Aetna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna MGG,Aetna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS,BCBS,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS MGG,BCBS MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna,Cigna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna MGG,Cigna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana,Humana,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana MGG,Humana MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Optum VA,Optum VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC,UHC,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC MGG,UHC MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,VA,VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Wellcare MGG,Wellcare MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health - commercial,Bright Health - commercial,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health MGG,Bright Health MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna,Aetna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna MGG,Aetna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS,BCBS,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS MGG,BCBS MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna,Cigna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna MGG,Cigna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana,Humana,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana MGG,Humana MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Optum VA,Optum VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC,UHC,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC MGG,UHC MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,VA,VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Wellcare MGG,Wellcare MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health - commercial,Bright Health - commercial,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health MGG,Bright Health MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna,Aetna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Aetna MGG,Aetna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS,BCBS,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,BCBS MGG,BCBS MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna,Cigna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Cigna MGG,Cigna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana,Humana,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Humana MGG,Humana MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Optum VA,Optum VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC,UHC,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,UHC MGG,UHC MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,VA,VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Wellcare MGG,Wellcare MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health - commercial,Bright Health - commercial,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,15.72,15.72,Bright Health MGG,Bright Health MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Aetna,Aetna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Aetna MGG,Aetna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,BCBS,BCBS,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,BCBS MGG,BCBS MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Cigna,Cigna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Cigna MGG,Cigna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Humana,Humana,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Humana MGG,Humana MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Optum VA,Optum VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,UHC,UHC,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,UHC MGG,UHC MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,VA,VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Wellcare MGG,Wellcare MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Bright Health - commercial,Bright Health - commercial,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,8.79,8.79,Bright Health MGG,Bright Health MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Aetna,Aetna,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Aetna MGG,Aetna MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,BCBS,BCBS,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,BCBS MGG,BCBS MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Cigna,Cigna,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Cigna MGG,Cigna MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Humana,Humana,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Humana MGG,Humana MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Optum VA,Optum VA,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,UHC,UHC,46.37,,,,,,,per diem,46.37,46.37,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,UHC MGG,UHC MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,VA,VA,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Wellcare MGG,Wellcare MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Bright Health - commercial,Bright Health - commercial,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,46.37,46.37,Bright Health MGG,Bright Health MGG,46.37,,,,,,,case rate,46.37,46.37,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Aetna,Aetna,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Aetna MGG,Aetna MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,BCBS,BCBS,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,BCBS MGG,BCBS MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Cigna,Cigna,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Cigna MGG,Cigna MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Humana,Humana,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Humana MGG,Humana MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Optum VA,Optum VA,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,UHC,UHC,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,UHC MGG,UHC MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,VA,VA,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Wellcare MGG,Wellcare MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Bright Health - commercial,Bright Health - commercial,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Bright Health MGG,Bright Health MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Aetna,Aetna,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Aetna MGG,Aetna MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,BCBS,BCBS,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,BCBS MGG,BCBS MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Cigna,Cigna,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Cigna MGG,Cigna MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Humana,Humana,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Humana MGG,Humana MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Optum VA,Optum VA,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,UHC,UHC,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,UHC MGG,UHC MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,VA,VA,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Wellcare MGG,Wellcare MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Bright Health - commercial,Bright Health - commercial,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Bright Health MGG,Bright Health MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Aetna,Aetna,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Aetna MGG,Aetna MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,BCBS,BCBS,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,BCBS MGG,BCBS MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Cigna,Cigna,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Cigna MGG,Cigna MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Humana,Humana,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Humana MGG,Humana MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Optum VA,Optum VA,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,UHC,UHC,203.18,,,,,,,per diem,203.18,203.18,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,UHC MGG,UHC MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,VA,VA,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Wellcare MGG,Wellcare MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Bright Health - commercial,Bright Health - commercial,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,203.18,203.18,Bright Health MGG,Bright Health MGG,203.18,,,,,,,case rate,203.18,203.18,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Aetna,Aetna,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Aetna MGG,Aetna MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,BCBS,BCBS,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,BCBS MGG,BCBS MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Cigna,Cigna,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Cigna MGG,Cigna MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Humana,Humana,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Humana MGG,Humana MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Optum VA,Optum VA,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,UHC,UHC,280.35,,,,,,,per diem,280.35,280.35,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,UHC MGG,UHC MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,VA,VA,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Wellcare MGG,Wellcare MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Bright Health - commercial,Bright Health - commercial,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,280.35,280.35,Bright Health MGG,Bright Health MGG,280.35,,,,,,,case rate,280.35,280.35,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Aetna,Aetna,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Aetna MGG,Aetna MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,BCBS,BCBS,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,BCBS MGG,BCBS MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Cigna,Cigna,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Cigna MGG,Cigna MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Humana,Humana,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Humana MGG,Humana MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Optum VA,Optum VA,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,UHC,UHC,97.62,,,,,,,per diem,97.62,97.62,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,UHC MGG,UHC MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,VA,VA,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Wellcare MGG,Wellcare MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Bright Health - commercial,Bright Health - commercial,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,97.62,97.62,Bright Health MGG,Bright Health MGG,97.62,,,,,,,case rate,97.62,97.62,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Aetna,Aetna,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Aetna MGG,Aetna MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,BCBS,BCBS,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,BCBS MGG,BCBS MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Cigna,Cigna,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Cigna MGG,Cigna MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Humana,Humana,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Humana MGG,Humana MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Optum VA,Optum VA,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,UHC,UHC,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,UHC MGG,UHC MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,VA,VA,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Wellcare MGG,Wellcare MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Bright Health - commercial,Bright Health - commercial,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Bright Health MGG,Bright Health MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Aetna,Aetna,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Aetna MGG,Aetna MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,BCBS,BCBS,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,BCBS MGG,BCBS MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Cigna,Cigna,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Cigna MGG,Cigna MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Humana,Humana,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Humana MGG,Humana MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Optum VA,Optum VA,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,UHC,UHC,40.82,,,,,,,per diem,40.82,40.82,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,UHC MGG,UHC MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,VA,VA,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Wellcare MGG,Wellcare MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Bright Health - commercial,Bright Health - commercial,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,40.82,40.82,Bright Health MGG,Bright Health MGG,40.82,,,,,,,case rate,40.82,40.82,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Aetna,Aetna,3.9,,,,,,,per diem,3.9,3.9,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Aetna MGG,Aetna MGG,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,BCBS,BCBS,3.9,,,,,,,per diem,3.9,3.9,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,BCBS MGG,BCBS MGG,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Cigna,Cigna,3.9,,,,,,,per diem,3.9,3.9,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Cigna MGG,Cigna MGG,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Humana,Humana,3.9,,,,,,,per diem,3.9,3.9,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Humana MGG,Humana MGG,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Optum VA,Optum VA,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,UHC,UHC,3.9,,,,,,,per diem,3.9,3.9,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,UHC MGG,UHC MGG,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,VA,VA,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Wellcare MGG,Wellcare MGG,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Bright Health - commercial,Bright Health - commercial,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,3.9,3.9,Bright Health MGG,Bright Health MGG,3.9,,,,,,,case rate,3.9,3.9,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Aetna,Aetna,124.54,,,,,,,per diem,124.54,124.54,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Aetna MGG,Aetna MGG,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,BCBS,BCBS,124.54,,,,,,,per diem,124.54,124.54,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,BCBS MGG,BCBS MGG,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Cigna,Cigna,124.54,,,,,,,per diem,124.54,124.54,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Cigna MGG,Cigna MGG,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Humana,Humana,124.54,,,,,,,per diem,124.54,124.54,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Humana MGG,Humana MGG,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Optum VA,Optum VA,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,UHC,UHC,124.54,,,,,,,per diem,124.54,124.54,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,UHC MGG,UHC MGG,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,VA,VA,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Wellcare MGG,Wellcare MGG,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Bright Health - commercial,Bright Health - commercial,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,124.54,124.54,Bright Health MGG,Bright Health MGG,124.54,,,,,,,case rate,124.54,124.54,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Aetna,Aetna,18.98,,,,,,,per diem,18.98,18.98,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Aetna MGG,Aetna MGG,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,BCBS,BCBS,18.98,,,,,,,per diem,18.98,18.98,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,BCBS MGG,BCBS MGG,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Cigna,Cigna,18.98,,,,,,,per diem,18.98,18.98,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Cigna MGG,Cigna MGG,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Humana,Humana,18.98,,,,,,,per diem,18.98,18.98,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Humana MGG,Humana MGG,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Optum VA,Optum VA,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,UHC,UHC,18.98,,,,,,,per diem,18.98,18.98,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,UHC MGG,UHC MGG,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,VA,VA,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Wellcare MGG,Wellcare MGG,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Bright Health - commercial,Bright Health - commercial,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,18.98,18.98,Bright Health MGG,Bright Health MGG,18.98,,,,,,,case rate,18.98,18.98,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Aetna,Aetna,13,,,,,,,per diem,13,13,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Aetna MGG,Aetna MGG,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,BCBS,BCBS,13,,,,,,,per diem,13,13,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,BCBS MGG,BCBS MGG,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Cigna,Cigna,13,,,,,,,per diem,13,13,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Cigna MGG,Cigna MGG,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Humana,Humana,13,,,,,,,per diem,13,13,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Humana MGG,Humana MGG,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Optum VA,Optum VA,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,UHC,UHC,13,,,,,,,per diem,13,13,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,UHC MGG,UHC MGG,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,VA,VA,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Wellcare MGG,Wellcare MGG,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Bright Health - commercial,Bright Health - commercial,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13,13,Bright Health MGG,Bright Health MGG,13,,,,,,,case rate,13,13,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Aetna,Aetna,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Aetna MGG,Aetna MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,BCBS,BCBS,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,BCBS MGG,BCBS MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Cigna,Cigna,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Cigna MGG,Cigna MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Humana,Humana,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Humana MGG,Humana MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Optum VA,Optum VA,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,UHC,UHC,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,UHC MGG,UHC MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,VA,VA,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Wellcare MGG,Wellcare MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Bright Health - commercial,Bright Health - commercial,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.46,5.46,Bright Health MGG,Bright Health MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Aetna,Aetna,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Aetna MGG,Aetna MGG,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,BCBS,BCBS,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,BCBS MGG,BCBS MGG,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Cigna,Cigna,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Cigna MGG,Cigna MGG,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Humana,Humana,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Humana MGG,Humana MGG,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Optum VA,Optum VA,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,UHC,UHC,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,UHC MGG,UHC MGG,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,VA,VA,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Wellcare MGG,Wellcare MGG,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Bright Health - commercial,Bright Health - commercial,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,24.44,24.44,Bright Health MGG,Bright Health MGG,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Aetna,Aetna,134.68,,,,,,,per diem,134.68,134.68,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Aetna MGG,Aetna MGG,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,BCBS,BCBS,134.68,,,,,,,per diem,134.68,134.68,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,BCBS MGG,BCBS MGG,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Cigna,Cigna,134.68,,,,,,,per diem,134.68,134.68,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Cigna MGG,Cigna MGG,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Humana,Humana,134.68,,,,,,,per diem,134.68,134.68,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Humana MGG,Humana MGG,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Optum VA,Optum VA,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,UHC,UHC,134.68,,,,,,,per diem,134.68,134.68,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,UHC MGG,UHC MGG,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,VA,VA,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Wellcare MGG,Wellcare MGG,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Bright Health - commercial,Bright Health - commercial,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,134.68,134.68,Bright Health MGG,Bright Health MGG,134.68,,,,,,,case rate,134.68,134.68,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Aetna,Aetna,94.9,,,,,,,per diem,94.9,94.9,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Aetna MGG,Aetna MGG,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,BCBS,BCBS,94.9,,,,,,,per diem,94.9,94.9,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,BCBS MGG,BCBS MGG,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Cigna,Cigna,94.9,,,,,,,per diem,94.9,94.9,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Cigna MGG,Cigna MGG,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Humana,Humana,94.9,,,,,,,per diem,94.9,94.9,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Humana MGG,Humana MGG,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Optum VA,Optum VA,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,UHC,UHC,94.9,,,,,,,per diem,94.9,94.9,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,UHC MGG,UHC MGG,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,VA,VA,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Wellcare MGG,Wellcare MGG,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Bright Health - commercial,Bright Health - commercial,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,94.9,94.9,Bright Health MGG,Bright Health MGG,94.9,,,,,,,case rate,94.9,94.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Aetna,Aetna,88.66,,,,,,,per diem,88.66,88.66,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Aetna MGG,Aetna MGG,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,BCBS,BCBS,88.66,,,,,,,per diem,88.66,88.66,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,BCBS MGG,BCBS MGG,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Cigna,Cigna,88.66,,,,,,,per diem,88.66,88.66,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Cigna MGG,Cigna MGG,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Humana,Humana,88.66,,,,,,,per diem,88.66,88.66,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Humana MGG,Humana MGG,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Optum VA,Optum VA,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,UHC,UHC,88.66,,,,,,,per diem,88.66,88.66,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,UHC MGG,UHC MGG,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,VA,VA,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Wellcare MGG,Wellcare MGG,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Bright Health - commercial,Bright Health - commercial,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,88.66,88.66,Bright Health MGG,Bright Health MGG,88.66,,,,,,,case rate,88.66,88.66,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Aetna,Aetna,5.2,,,,,,,per diem,5.2,5.2,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Aetna MGG,Aetna MGG,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,BCBS,BCBS,5.2,,,,,,,per diem,5.2,5.2,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,BCBS MGG,BCBS MGG,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Cigna,Cigna,5.2,,,,,,,per diem,5.2,5.2,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Cigna MGG,Cigna MGG,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Humana,Humana,5.2,,,,,,,per diem,5.2,5.2,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Humana MGG,Humana MGG,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Optum VA,Optum VA,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,UHC,UHC,5.2,,,,,,,per diem,5.2,5.2,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,UHC MGG,UHC MGG,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,VA,VA,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Wellcare MGG,Wellcare MGG,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Bright Health - commercial,Bright Health - commercial,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.2,5.2,Bright Health MGG,Bright Health MGG,5.2,,,,,,,case rate,5.2,5.2,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Aetna,Aetna,30.16,,,,,,,per diem,30.16,30.16,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Aetna MGG,Aetna MGG,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,BCBS,BCBS,30.16,,,,,,,per diem,30.16,30.16,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,BCBS MGG,BCBS MGG,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Cigna,Cigna,30.16,,,,,,,per diem,30.16,30.16,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Cigna MGG,Cigna MGG,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Humana,Humana,30.16,,,,,,,per diem,30.16,30.16,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Humana MGG,Humana MGG,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Optum VA,Optum VA,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,UHC,UHC,30.16,,,,,,,per diem,30.16,30.16,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,UHC MGG,UHC MGG,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,VA,VA,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Wellcare MGG,Wellcare MGG,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Bright Health - commercial,Bright Health - commercial,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,30.16,30.16,Bright Health MGG,Bright Health MGG,30.16,,,,,,,case rate,30.16,30.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Aetna,Aetna,186.16,,,,,,,per diem,186.16,186.16,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Aetna MGG,Aetna MGG,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,BCBS,BCBS,186.16,,,,,,,per diem,186.16,186.16,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,BCBS MGG,BCBS MGG,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Cigna,Cigna,186.16,,,,,,,per diem,186.16,186.16,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Cigna MGG,Cigna MGG,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Humana,Humana,186.16,,,,,,,per diem,186.16,186.16,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Humana MGG,Humana MGG,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Optum VA,Optum VA,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,UHC,UHC,186.16,,,,,,,per diem,186.16,186.16,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,UHC MGG,UHC MGG,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,VA,VA,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Wellcare MGG,Wellcare MGG,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Bright Health - commercial,Bright Health - commercial,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,186.16,186.16,Bright Health MGG,Bright Health MGG,186.16,,,,,,,case rate,186.16,186.16,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Aetna,Aetna,21.06,,,,,,,per diem,21.06,21.06,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Aetna MGG,Aetna MGG,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,BCBS,BCBS,21.06,,,,,,,per diem,21.06,21.06,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,BCBS MGG,BCBS MGG,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Cigna,Cigna,21.06,,,,,,,per diem,21.06,21.06,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Cigna MGG,Cigna MGG,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Humana,Humana,21.06,,,,,,,per diem,21.06,21.06,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Humana MGG,Humana MGG,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Optum VA,Optum VA,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,UHC,UHC,21.06,,,,,,,per diem,21.06,21.06,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,UHC MGG,UHC MGG,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,VA,VA,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Wellcare MGG,Wellcare MGG,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Bright Health - commercial,Bright Health - commercial,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,21.06,21.06,Bright Health MGG,Bright Health MGG,21.06,,,,,,,case rate,21.06,21.06,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Aetna,Aetna,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Aetna MGG,Aetna MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,BCBS,BCBS,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,BCBS MGG,BCBS MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Cigna,Cigna,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Cigna MGG,Cigna MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Humana,Humana,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Humana MGG,Humana MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Optum VA,Optum VA,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,UHC,UHC,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,UHC MGG,UHC MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,VA,VA,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Wellcare MGG,Wellcare MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Bright Health - commercial,Bright Health - commercial,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,181.48,181.48,Bright Health MGG,Bright Health MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna,Aetna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna MGG,Aetna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,BCBS,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS MGG,BCBS MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna,Cigna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna MGG,Cigna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana,Humana,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana MGG,Humana MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Optum VA,Optum VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC,UHC,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC MGG,UHC MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,VA,VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Wellcare MGG,Wellcare MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health - commercial,Bright Health - commercial,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health MGG,Bright Health MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna,Aetna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna MGG,Aetna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,BCBS,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS MGG,BCBS MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna,Cigna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna MGG,Cigna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana,Humana,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana MGG,Humana MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Optum VA,Optum VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC,UHC,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC MGG,UHC MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,VA,VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Wellcare MGG,Wellcare MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health - commercial,Bright Health - commercial,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health MGG,Bright Health MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Aetna,Aetna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Aetna MGG,Aetna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,BCBS,BCBS,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,BCBS MGG,BCBS MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Cigna,Cigna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Cigna MGG,Cigna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Humana,Humana,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Humana MGG,Humana MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Optum VA,Optum VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,UHC,UHC,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,UHC MGG,UHC MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,VA,VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Wellcare MGG,Wellcare MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Bright Health - commercial,Bright Health - commercial,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.09,12.09,Bright Health MGG,Bright Health MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna,Aetna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna MGG,Aetna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,BCBS,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS MGG,BCBS MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna,Cigna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna MGG,Cigna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana,Humana,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana MGG,Humana MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Optum VA,Optum VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC,UHC,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC MGG,UHC MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,VA,VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Wellcare MGG,Wellcare MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health - commercial,Bright Health - commercial,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health MGG,Bright Health MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna,Aetna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna MGG,Aetna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,BCBS,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS MGG,BCBS MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna,Cigna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna MGG,Cigna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana,Humana,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana MGG,Humana MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Optum VA,Optum VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC,UHC,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC MGG,UHC MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,VA,VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Wellcare MGG,Wellcare MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health - commercial,Bright Health - commercial,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health MGG,Bright Health MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna,Aetna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna MGG,Aetna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,BCBS,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS MGG,BCBS MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna,Cigna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna MGG,Cigna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana,Humana,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana MGG,Humana MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Optum VA,Optum VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC,UHC,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC MGG,UHC MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,VA,VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Wellcare MGG,Wellcare MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health - commercial,Bright Health - commercial,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health MGG,Bright Health MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Aetna,Aetna,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Aetna MGG,Aetna MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,BCBS,BCBS,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,BCBS MGG,BCBS MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Cigna,Cigna,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Cigna MGG,Cigna MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Humana,Humana,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Humana MGG,Humana MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Optum VA,Optum VA,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,UHC,UHC,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,UHC MGG,UHC MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,VA,VA,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Wellcare MGG,Wellcare MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Bright Health - commercial,Bright Health - commercial,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.34,2.34,Bright Health MGG,Bright Health MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Aetna,Aetna,2.6,,,,,,,per diem,2.6,2.6,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Aetna MGG,Aetna MGG,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,BCBS,BCBS,2.6,,,,,,,per diem,2.6,2.6,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,BCBS MGG,BCBS MGG,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Cigna,Cigna,2.6,,,,,,,per diem,2.6,2.6,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Cigna MGG,Cigna MGG,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Humana,Humana,2.6,,,,,,,per diem,2.6,2.6,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Humana MGG,Humana MGG,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Optum VA,Optum VA,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,UHC,UHC,2.6,,,,,,,per diem,2.6,2.6,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,UHC MGG,UHC MGG,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,VA,VA,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Wellcare MGG,Wellcare MGG,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Bright Health - commercial,Bright Health - commercial,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.6,2.6,Bright Health MGG,Bright Health MGG,2.6,,,,,,,case rate,2.6,2.6,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Aetna,Aetna,454.22,,,,,,,per diem,454.22,454.22,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Aetna MGG,Aetna MGG,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,BCBS,BCBS,454.22,,,,,,,per diem,454.22,454.22,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,BCBS MGG,BCBS MGG,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Cigna,Cigna,454.22,,,,,,,per diem,454.22,454.22,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Cigna MGG,Cigna MGG,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Humana,Humana,454.22,,,,,,,per diem,454.22,454.22,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Humana MGG,Humana MGG,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Optum VA,Optum VA,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,UHC,UHC,454.22,,,,,,,per diem,454.22,454.22,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,UHC MGG,UHC MGG,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,VA,VA,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Wellcare MGG,Wellcare MGG,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Bright Health - commercial,Bright Health - commercial,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,454.22,454.22,Bright Health MGG,Bright Health MGG,454.22,,,,,,,case rate,454.22,454.22,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Aetna,Aetna,3.38,,,,,,,per diem,3.38,3.38,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Aetna MGG,Aetna MGG,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,BCBS,BCBS,3.38,,,,,,,per diem,3.38,3.38,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,BCBS MGG,BCBS MGG,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Cigna,Cigna,3.38,,,,,,,per diem,3.38,3.38,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Cigna MGG,Cigna MGG,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Humana,Humana,3.38,,,,,,,per diem,3.38,3.38,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Humana MGG,Humana MGG,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Optum VA,Optum VA,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,UHC,UHC,3.38,,,,,,,per diem,3.38,3.38,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,UHC MGG,UHC MGG,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,VA,VA,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Wellcare MGG,Wellcare MGG,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Bright Health - commercial,Bright Health - commercial,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.38,3.38,Bright Health MGG,Bright Health MGG,3.38,,,,,,,case rate,3.38,3.38,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Aetna,Aetna,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Aetna MGG,Aetna MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,BCBS,BCBS,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,BCBS MGG,BCBS MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Cigna,Cigna,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Cigna MGG,Cigna MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Humana,Humana,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Humana MGG,Humana MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Optum VA,Optum VA,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,UHC,UHC,81.12,,,,,,,per diem,81.12,81.12,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,UHC MGG,UHC MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,VA,VA,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Wellcare MGG,Wellcare MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Bright Health - commercial,Bright Health - commercial,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,81.12,81.12,Bright Health MGG,Bright Health MGG,81.12,,,,,,,case rate,81.12,81.12,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Aetna,Aetna,75.27,,,,,,,per diem,75.27,75.27,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Aetna MGG,Aetna MGG,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,BCBS,BCBS,75.27,,,,,,,per diem,75.27,75.27,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,BCBS MGG,BCBS MGG,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Cigna,Cigna,75.27,,,,,,,per diem,75.27,75.27,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Cigna MGG,Cigna MGG,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Humana,Humana,75.27,,,,,,,per diem,75.27,75.27,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Humana MGG,Humana MGG,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Optum VA,Optum VA,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,UHC,UHC,75.27,,,,,,,per diem,75.27,75.27,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,UHC MGG,UHC MGG,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,VA,VA,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Wellcare MGG,Wellcare MGG,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Bright Health - commercial,Bright Health - commercial,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,75.27,75.27,Bright Health MGG,Bright Health MGG,75.27,,,,,,,case rate,75.27,75.27,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Aetna,Aetna,14.56,,,,,,,per diem,14.56,14.56,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Aetna MGG,Aetna MGG,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,BCBS,BCBS,14.56,,,,,,,per diem,14.56,14.56,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,BCBS MGG,BCBS MGG,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Cigna,Cigna,14.56,,,,,,,per diem,14.56,14.56,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Cigna MGG,Cigna MGG,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Humana,Humana,14.56,,,,,,,per diem,14.56,14.56,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Humana MGG,Humana MGG,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Optum VA,Optum VA,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,UHC,UHC,14.56,,,,,,,per diem,14.56,14.56,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,UHC MGG,UHC MGG,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,VA,VA,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Wellcare MGG,Wellcare MGG,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Bright Health - commercial,Bright Health - commercial,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,14.56,14.56,Bright Health MGG,Bright Health MGG,14.56,,,,,,,case rate,14.56,14.56,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Aetna,Aetna,18.2,,,,,,,per diem,18.2,18.2,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Aetna MGG,Aetna MGG,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,BCBS,BCBS,18.2,,,,,,,per diem,18.2,18.2,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,BCBS MGG,BCBS MGG,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Cigna,Cigna,18.2,,,,,,,per diem,18.2,18.2,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Cigna MGG,Cigna MGG,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Humana,Humana,18.2,,,,,,,per diem,18.2,18.2,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Humana MGG,Humana MGG,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Optum VA,Optum VA,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,UHC,UHC,18.2,,,,,,,per diem,18.2,18.2,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,UHC MGG,UHC MGG,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,VA,VA,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Wellcare MGG,Wellcare MGG,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Bright Health - commercial,Bright Health - commercial,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,18.2,18.2,Bright Health MGG,Bright Health MGG,18.2,,,,,,,case rate,18.2,18.2,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Aetna,Aetna,431.34,,,,,,,per diem,431.34,431.34,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Aetna MGG,Aetna MGG,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,BCBS,BCBS,431.34,,,,,,,per diem,431.34,431.34,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,BCBS MGG,BCBS MGG,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Cigna,Cigna,431.34,,,,,,,per diem,431.34,431.34,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Cigna MGG,Cigna MGG,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Humana,Humana,431.34,,,,,,,per diem,431.34,431.34,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Humana MGG,Humana MGG,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Optum VA,Optum VA,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,UHC,UHC,431.34,,,,,,,per diem,431.34,431.34,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,UHC MGG,UHC MGG,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,VA,VA,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Wellcare MGG,Wellcare MGG,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Bright Health - commercial,Bright Health - commercial,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,431.34,431.34,Bright Health MGG,Bright Health MGG,431.34,,,,,,,case rate,431.34,431.34,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Aetna,Aetna,1565.2,,,,,,,per diem,1565.2,1565.2,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Aetna MGG,Aetna MGG,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,BCBS,BCBS,1565.2,,,,,,,per diem,1565.2,1565.2,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,BCBS MGG,BCBS MGG,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Cigna,Cigna,1565.2,,,,,,,per diem,1565.2,1565.2,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Cigna MGG,Cigna MGG,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Humana,Humana,1565.2,,,,,,,per diem,1565.2,1565.2,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Humana MGG,Humana MGG,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Optum VA,Optum VA,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,UHC,UHC,1565.2,,,,,,,per diem,1565.2,1565.2,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,UHC MGG,UHC MGG,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,VA,VA,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Wellcare MGG,Wellcare MGG,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Bright Health - commercial,Bright Health - commercial,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1565.2,1565.2,Bright Health MGG,Bright Health MGG,1565.2,,,,,,,case rate,1565.2,1565.2,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Aetna,Aetna,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Aetna MGG,Aetna MGG,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,BCBS,BCBS,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,BCBS MGG,BCBS MGG,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Cigna,Cigna,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Cigna MGG,Cigna MGG,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Humana,Humana,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Humana MGG,Humana MGG,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Optum VA,Optum VA,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,UHC,UHC,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,UHC MGG,UHC MGG,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,VA,VA,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Wellcare MGG,Wellcare MGG,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Bright Health - commercial,Bright Health - commercial,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,98.03,98.03,Bright Health MGG,Bright Health MGG,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Aetna,Aetna,270.45,,,,,,,per diem,270.45,270.45,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Aetna MGG,Aetna MGG,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,BCBS,BCBS,270.45,,,,,,,per diem,270.45,270.45,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,BCBS MGG,BCBS MGG,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Cigna,Cigna,270.45,,,,,,,per diem,270.45,270.45,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Cigna MGG,Cigna MGG,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Humana,Humana,270.45,,,,,,,per diem,270.45,270.45,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Humana MGG,Humana MGG,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Optum VA,Optum VA,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,UHC,UHC,270.45,,,,,,,per diem,270.45,270.45,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,UHC MGG,UHC MGG,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,VA,VA,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Wellcare MGG,Wellcare MGG,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Bright Health - commercial,Bright Health - commercial,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,270.45,270.45,Bright Health MGG,Bright Health MGG,270.45,,,,,,,case rate,270.45,270.45,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Aetna,Aetna,185.38,,,,,,,per diem,185.38,185.38,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Aetna MGG,Aetna MGG,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,BCBS,BCBS,185.38,,,,,,,per diem,185.38,185.38,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,BCBS MGG,BCBS MGG,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Cigna,Cigna,185.38,,,,,,,per diem,185.38,185.38,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Cigna MGG,Cigna MGG,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Humana,Humana,185.38,,,,,,,per diem,185.38,185.38,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Humana MGG,Humana MGG,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Optum VA,Optum VA,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,UHC,UHC,185.38,,,,,,,per diem,185.38,185.38,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,UHC MGG,UHC MGG,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,VA,VA,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Wellcare MGG,Wellcare MGG,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Bright Health - commercial,Bright Health - commercial,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,185.38,185.38,Bright Health MGG,Bright Health MGG,185.38,,,,,,,case rate,185.38,185.38,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Aetna,Aetna,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Aetna MGG,Aetna MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,BCBS,BCBS,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,BCBS MGG,BCBS MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Cigna,Cigna,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Cigna MGG,Cigna MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Humana,Humana,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Humana MGG,Humana MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Optum VA,Optum VA,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,UHC,UHC,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,UHC MGG,UHC MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,VA,VA,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Wellcare MGG,Wellcare MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Bright Health - commercial,Bright Health - commercial,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,42.12,42.12,Bright Health MGG,Bright Health MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Aetna,Aetna,1340,,,,,,,per diem,1340,1340,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Aetna MGG,Aetna MGG,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,BCBS,BCBS,1340,,,,,,,per diem,1340,1340,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,BCBS MGG,BCBS MGG,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Cigna,Cigna,1340,,,,,,,per diem,1340,1340,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Cigna MGG,Cigna MGG,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Humana,Humana,1340,,,,,,,per diem,1340,1340,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Humana MGG,Humana MGG,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Optum VA,Optum VA,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,UHC,UHC,1340,,,,,,,per diem,1340,1340,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,UHC MGG,UHC MGG,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,VA,VA,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Wellcare MGG,Wellcare MGG,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Bright Health - commercial,Bright Health - commercial,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1340,1340,Bright Health MGG,Bright Health MGG,1340,,,,,,,case rate,1340,1340,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Aetna,Aetna,1096,,,,,,,per diem,1096,1096,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Aetna MGG,Aetna MGG,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,BCBS,BCBS,1096,,,,,,,per diem,1096,1096,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,BCBS MGG,BCBS MGG,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Cigna,Cigna,1096,,,,,,,per diem,1096,1096,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Cigna MGG,Cigna MGG,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Humana,Humana,1096,,,,,,,per diem,1096,1096,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Humana MGG,Humana MGG,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Optum VA,Optum VA,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,UHC,UHC,1096,,,,,,,per diem,1096,1096,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,UHC MGG,UHC MGG,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,VA,VA,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Wellcare MGG,Wellcare MGG,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Bright Health - commercial,Bright Health - commercial,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1096,1096,Bright Health MGG,Bright Health MGG,1096,,,,,,,case rate,1096,1096,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Aetna,Aetna,1506,,,,,,,per diem,1506,1506,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Aetna MGG,Aetna MGG,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,BCBS,BCBS,1506,,,,,,,per diem,1506,1506,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,BCBS MGG,BCBS MGG,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Cigna,Cigna,1506,,,,,,,per diem,1506,1506,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Cigna MGG,Cigna MGG,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Humana,Humana,1506,,,,,,,per diem,1506,1506,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Humana MGG,Humana MGG,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Optum VA,Optum VA,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,UHC,UHC,1506,,,,,,,per diem,1506,1506,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,UHC MGG,UHC MGG,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,VA,VA,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Wellcare MGG,Wellcare MGG,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Bright Health - commercial,Bright Health - commercial,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1506,1506,Bright Health MGG,Bright Health MGG,1506,,,,,,,case rate,1506,1506,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Aetna,Aetna,92.09,,,,,,,per diem,92.09,92.09,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Aetna MGG,Aetna MGG,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,BCBS,BCBS,92.09,,,,,,,per diem,92.09,92.09,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,BCBS MGG,BCBS MGG,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Cigna,Cigna,92.09,,,,,,,per diem,92.09,92.09,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Cigna MGG,Cigna MGG,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Humana,Humana,92.09,,,,,,,per diem,92.09,92.09,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Humana MGG,Humana MGG,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Optum VA,Optum VA,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,UHC,UHC,92.09,,,,,,,per diem,92.09,92.09,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,UHC MGG,UHC MGG,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,VA,VA,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Wellcare MGG,Wellcare MGG,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Bright Health - commercial,Bright Health - commercial,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,92.09,92.09,Bright Health MGG,Bright Health MGG,92.09,,,,,,,case rate,92.09,92.09,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Aetna,Aetna,592.59,,,,,,,per diem,592.59,592.59,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Aetna MGG,Aetna MGG,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,BCBS,BCBS,592.59,,,,,,,per diem,592.59,592.59,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,BCBS MGG,BCBS MGG,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Cigna,Cigna,592.59,,,,,,,per diem,592.59,592.59,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Cigna MGG,Cigna MGG,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Humana,Humana,592.59,,,,,,,per diem,592.59,592.59,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Humana MGG,Humana MGG,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Optum VA,Optum VA,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,UHC,UHC,592.59,,,,,,,per diem,592.59,592.59,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,UHC MGG,UHC MGG,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,VA,VA,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Wellcare MGG,Wellcare MGG,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Bright Health - commercial,Bright Health - commercial,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,592.59,592.59,Bright Health MGG,Bright Health MGG,592.59,,,,,,,case rate,592.59,592.59,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Aetna,Aetna,436.5,,,,,,,per diem,436.5,436.5,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Aetna MGG,Aetna MGG,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,BCBS,BCBS,436.5,,,,,,,per diem,436.5,436.5,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,BCBS MGG,BCBS MGG,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Cigna,Cigna,436.5,,,,,,,per diem,436.5,436.5,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Cigna MGG,Cigna MGG,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Humana,Humana,436.5,,,,,,,per diem,436.5,436.5,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Humana MGG,Humana MGG,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Optum VA,Optum VA,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,UHC,UHC,436.5,,,,,,,per diem,436.5,436.5,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,UHC MGG,UHC MGG,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,VA,VA,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Wellcare MGG,Wellcare MGG,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Bright Health - commercial,Bright Health - commercial,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,436.5,436.5,Bright Health MGG,Bright Health MGG,436.5,,,,,,,case rate,436.5,436.5,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Aetna,Aetna,64.93,,,,,,,per diem,64.93,64.93,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Aetna MGG,Aetna MGG,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,BCBS,BCBS,64.93,,,,,,,per diem,64.93,64.93,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,BCBS MGG,BCBS MGG,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Cigna,Cigna,64.93,,,,,,,per diem,64.93,64.93,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Cigna MGG,Cigna MGG,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Humana,Humana,64.93,,,,,,,per diem,64.93,64.93,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Humana MGG,Humana MGG,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Optum VA,Optum VA,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,UHC,UHC,64.93,,,,,,,per diem,64.93,64.93,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,UHC MGG,UHC MGG,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,VA,VA,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Wellcare MGG,Wellcare MGG,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Bright Health - commercial,Bright Health - commercial,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,64.93,64.93,Bright Health MGG,Bright Health MGG,64.93,,,,,,,case rate,64.93,64.93,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Aetna,Aetna,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Aetna MGG,Aetna MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,BCBS,BCBS,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,BCBS MGG,BCBS MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Cigna,Cigna,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Cigna MGG,Cigna MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Humana,Humana,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Humana MGG,Humana MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Optum VA,Optum VA,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,UHC,UHC,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,UHC MGG,UHC MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,VA,VA,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Wellcare MGG,Wellcare MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Bright Health - commercial,Bright Health - commercial,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,111.3,111.3,Bright Health MGG,Bright Health MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Aetna,Aetna,1840,,,,,,,per diem,1840,1840,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Aetna MGG,Aetna MGG,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,BCBS,BCBS,1840,,,,,,,per diem,1840,1840,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,BCBS MGG,BCBS MGG,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Cigna,Cigna,1840,,,,,,,per diem,1840,1840,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Cigna MGG,Cigna MGG,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Humana,Humana,1840,,,,,,,per diem,1840,1840,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Humana MGG,Humana MGG,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Optum VA,Optum VA,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,UHC,UHC,1840,,,,,,,per diem,1840,1840,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,UHC MGG,UHC MGG,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,VA,VA,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Wellcare MGG,Wellcare MGG,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Bright Health - commercial,Bright Health - commercial,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1840,1840,Bright Health MGG,Bright Health MGG,1840,,,,,,,case rate,1840,1840,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Aetna,Aetna,101.15,,,,,,,per diem,101.15,101.15,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Aetna MGG,Aetna MGG,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,BCBS,BCBS,101.15,,,,,,,per diem,101.15,101.15,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,BCBS MGG,BCBS MGG,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Cigna,Cigna,101.15,,,,,,,per diem,101.15,101.15,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Cigna MGG,Cigna MGG,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Humana,Humana,101.15,,,,,,,per diem,101.15,101.15,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Humana MGG,Humana MGG,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Optum VA,Optum VA,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,UHC,UHC,101.15,,,,,,,per diem,101.15,101.15,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,UHC MGG,UHC MGG,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,VA,VA,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Wellcare MGG,Wellcare MGG,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Bright Health - commercial,Bright Health - commercial,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,101.15,101.15,Bright Health MGG,Bright Health MGG,101.15,,,,,,,case rate,101.15,101.15,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Aetna,Aetna,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Aetna MGG,Aetna MGG,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,BCBS,BCBS,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,BCBS MGG,BCBS MGG,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Cigna,Cigna,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Cigna MGG,Cigna MGG,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Humana,Humana,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Humana MGG,Humana MGG,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Optum VA,Optum VA,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,UHC,UHC,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,UHC MGG,UHC MGG,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,VA,VA,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Wellcare MGG,Wellcare MGG,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Bright Health - commercial,Bright Health - commercial,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,18.55,18.55,Bright Health MGG,Bright Health MGG,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Aetna,Aetna,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Aetna MGG,Aetna MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,BCBS,BCBS,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,BCBS MGG,BCBS MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Cigna,Cigna,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Cigna MGG,Cigna MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Humana,Humana,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Humana MGG,Humana MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Optum VA,Optum VA,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,UHC,UHC,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,UHC MGG,UHC MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,VA,VA,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Wellcare MGG,Wellcare MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Bright Health - commercial,Bright Health - commercial,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,74.55,74.55,Bright Health MGG,Bright Health MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Aetna,Aetna,413,,,,,,,per diem,413,413,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Aetna MGG,Aetna MGG,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,BCBS,BCBS,413,,,,,,,per diem,413,413,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,BCBS MGG,BCBS MGG,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Cigna,Cigna,413,,,,,,,per diem,413,413,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Cigna MGG,Cigna MGG,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Humana,Humana,413,,,,,,,per diem,413,413,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Humana MGG,Humana MGG,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Optum VA,Optum VA,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,UHC,UHC,413,,,,,,,per diem,413,413,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,UHC MGG,UHC MGG,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,VA,VA,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Wellcare MGG,Wellcare MGG,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Bright Health - commercial,Bright Health - commercial,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,413,413,Bright Health MGG,Bright Health MGG,413,,,,,,,case rate,413,413,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Aetna,Aetna,21.2,,,,,,,per diem,21.2,21.2,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Aetna MGG,Aetna MGG,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,BCBS,BCBS,21.2,,,,,,,per diem,21.2,21.2,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,BCBS MGG,BCBS MGG,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Cigna,Cigna,21.2,,,,,,,per diem,21.2,21.2,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Cigna MGG,Cigna MGG,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Humana,Humana,21.2,,,,,,,per diem,21.2,21.2,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Humana MGG,Humana MGG,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Optum VA,Optum VA,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,UHC,UHC,21.2,,,,,,,per diem,21.2,21.2,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,UHC MGG,UHC MGG,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,VA,VA,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Wellcare MGG,Wellcare MGG,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Bright Health - commercial,Bright Health - commercial,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,21.2,21.2,Bright Health MGG,Bright Health MGG,21.2,,,,,,,case rate,21.2,21.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Aetna,Aetna,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Aetna MGG,Aetna MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,BCBS,BCBS,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,BCBS MGG,BCBS MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Cigna,Cigna,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Cigna MGG,Cigna MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Humana,Humana,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Humana MGG,Humana MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Optum VA,Optum VA,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,UHC,UHC,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,UHC MGG,UHC MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,VA,VA,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Wellcare MGG,Wellcare MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Bright Health - commercial,Bright Health - commercial,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,22.74,22.74,Bright Health MGG,Bright Health MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Aetna,Aetna,69.09,,,,,,,per diem,69.09,69.09,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Aetna MGG,Aetna MGG,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,BCBS,BCBS,69.09,,,,,,,per diem,69.09,69.09,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,BCBS MGG,BCBS MGG,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Cigna,Cigna,69.09,,,,,,,per diem,69.09,69.09,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Cigna MGG,Cigna MGG,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Humana,Humana,69.09,,,,,,,per diem,69.09,69.09,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Humana MGG,Humana MGG,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Optum VA,Optum VA,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,UHC,UHC,69.09,,,,,,,per diem,69.09,69.09,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,UHC MGG,UHC MGG,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,VA,VA,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Wellcare MGG,Wellcare MGG,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Bright Health - commercial,Bright Health - commercial,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,69.09,69.09,Bright Health MGG,Bright Health MGG,69.09,,,,,,,case rate,69.09,69.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Aetna,Aetna,137.23,,,,,,,per diem,137.23,137.23,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Aetna MGG,Aetna MGG,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,BCBS,BCBS,137.23,,,,,,,per diem,137.23,137.23,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,BCBS MGG,BCBS MGG,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Cigna,Cigna,137.23,,,,,,,per diem,137.23,137.23,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Cigna MGG,Cigna MGG,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Humana,Humana,137.23,,,,,,,per diem,137.23,137.23,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Humana MGG,Humana MGG,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Optum VA,Optum VA,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,UHC,UHC,137.23,,,,,,,per diem,137.23,137.23,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,UHC MGG,UHC MGG,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,VA,VA,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Wellcare MGG,Wellcare MGG,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Bright Health - commercial,Bright Health - commercial,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,137.23,137.23,Bright Health MGG,Bright Health MGG,137.23,,,,,,,case rate,137.23,137.23,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Aetna,Aetna,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Aetna MGG,Aetna MGG,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,BCBS,BCBS,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,BCBS MGG,BCBS MGG,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Cigna,Cigna,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Cigna MGG,Cigna MGG,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Humana,Humana,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Humana MGG,Humana MGG,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Optum VA,Optum VA,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,UHC,UHC,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,UHC MGG,UHC MGG,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,VA,VA,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Wellcare MGG,Wellcare MGG,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Bright Health - commercial,Bright Health - commercial,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,Bright Health MGG,Bright Health MGG,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Aetna,Aetna,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Aetna MGG,Aetna MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,BCBS,BCBS,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,BCBS MGG,BCBS MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Cigna,Cigna,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Cigna MGG,Cigna MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Humana,Humana,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Humana MGG,Humana MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Optum VA,Optum VA,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,UHC,UHC,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,UHC MGG,UHC MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,VA,VA,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Wellcare MGG,Wellcare MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Bright Health - commercial,Bright Health - commercial,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Bright Health MGG,Bright Health MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Aetna,Aetna,291.49,,,,,,,per diem,291.49,291.49,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Aetna MGG,Aetna MGG,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,BCBS,BCBS,291.49,,,,,,,per diem,291.49,291.49,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,BCBS MGG,BCBS MGG,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Cigna,Cigna,291.49,,,,,,,per diem,291.49,291.49,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Cigna MGG,Cigna MGG,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Humana,Humana,291.49,,,,,,,per diem,291.49,291.49,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Humana MGG,Humana MGG,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Optum VA,Optum VA,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,UHC,UHC,291.49,,,,,,,per diem,291.49,291.49,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,UHC MGG,UHC MGG,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,VA,VA,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Wellcare MGG,Wellcare MGG,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Bright Health - commercial,Bright Health - commercial,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,291.49,291.49,Bright Health MGG,Bright Health MGG,291.49,,,,,,,case rate,291.49,291.49,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Aetna,Aetna,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Aetna MGG,Aetna MGG,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,BCBS,BCBS,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,BCBS MGG,BCBS MGG,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Cigna,Cigna,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Cigna MGG,Cigna MGG,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Humana,Humana,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Humana MGG,Humana MGG,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Optum VA,Optum VA,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,UHC,UHC,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,UHC MGG,UHC MGG,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,VA,VA,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Wellcare MGG,Wellcare MGG,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Bright Health - commercial,Bright Health - commercial,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,34.87,34.87,Bright Health MGG,Bright Health MGG,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Aetna,Aetna,99.34,,,,,,,per diem,99.34,99.34,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Aetna MGG,Aetna MGG,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,BCBS,BCBS,99.34,,,,,,,per diem,99.34,99.34,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,BCBS MGG,BCBS MGG,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Cigna,Cigna,99.34,,,,,,,per diem,99.34,99.34,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Cigna MGG,Cigna MGG,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Humana,Humana,99.34,,,,,,,per diem,99.34,99.34,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Humana MGG,Humana MGG,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Optum VA,Optum VA,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,UHC,UHC,99.34,,,,,,,per diem,99.34,99.34,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,UHC MGG,UHC MGG,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,VA,VA,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Wellcare MGG,Wellcare MGG,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Bright Health - commercial,Bright Health - commercial,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,99.34,99.34,Bright Health MGG,Bright Health MGG,99.34,,,,,,,case rate,99.34,99.34,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Aetna,Aetna,102.07,,,,,,,per diem,102.07,102.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Aetna MGG,Aetna MGG,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,BCBS,BCBS,102.07,,,,,,,per diem,102.07,102.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,BCBS MGG,BCBS MGG,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Cigna,Cigna,102.07,,,,,,,per diem,102.07,102.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Cigna MGG,Cigna MGG,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Humana,Humana,102.07,,,,,,,per diem,102.07,102.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Humana MGG,Humana MGG,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Optum VA,Optum VA,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,UHC,UHC,102.07,,,,,,,per diem,102.07,102.07,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,UHC MGG,UHC MGG,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,VA,VA,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Wellcare MGG,Wellcare MGG,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Bright Health - commercial,Bright Health - commercial,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,102.07,102.07,Bright Health MGG,Bright Health MGG,102.07,,,,,,,case rate,102.07,102.07,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Aetna,Aetna,163.57,,,,,,,per diem,163.57,163.57,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Aetna MGG,Aetna MGG,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,BCBS,BCBS,163.57,,,,,,,per diem,163.57,163.57,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,BCBS MGG,BCBS MGG,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Cigna,Cigna,163.57,,,,,,,per diem,163.57,163.57,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Cigna MGG,Cigna MGG,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Humana,Humana,163.57,,,,,,,per diem,163.57,163.57,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Humana MGG,Humana MGG,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Optum VA,Optum VA,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,UHC,UHC,163.57,,,,,,,per diem,163.57,163.57,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,UHC MGG,UHC MGG,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,VA,VA,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Wellcare MGG,Wellcare MGG,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Bright Health - commercial,Bright Health - commercial,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,163.57,163.57,Bright Health MGG,Bright Health MGG,163.57,,,,,,,case rate,163.57,163.57,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Aetna,Aetna,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Aetna MGG,Aetna MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,BCBS,BCBS,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,BCBS MGG,BCBS MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Cigna,Cigna,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Cigna MGG,Cigna MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Humana,Humana,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Humana MGG,Humana MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Optum VA,Optum VA,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,UHC,UHC,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,UHC MGG,UHC MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,VA,VA,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Wellcare MGG,Wellcare MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Bright Health - commercial,Bright Health - commercial,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,12.83,12.83,Bright Health MGG,Bright Health MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Aetna,Aetna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Aetna MGG,Aetna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,BCBS,BCBS,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,BCBS MGG,BCBS MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Cigna,Cigna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Cigna MGG,Cigna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Humana,Humana,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Humana MGG,Humana MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Optum VA,Optum VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,UHC,UHC,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,UHC MGG,UHC MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,VA,VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Wellcare MGG,Wellcare MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health - commercial,Bright Health - commercial,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health MGG,Bright Health MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Aetna,Aetna,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Aetna MGG,Aetna MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,BCBS,BCBS,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,BCBS MGG,BCBS MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Cigna,Cigna,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Cigna MGG,Cigna MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Humana,Humana,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Humana MGG,Humana MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Optum VA,Optum VA,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,UHC,UHC,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,UHC MGG,UHC MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,VA,VA,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Wellcare MGG,Wellcare MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Bright Health - commercial,Bright Health - commercial,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Bright Health MGG,Bright Health MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Aetna,Aetna,25.13,,,,,,,per diem,25.13,25.13,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Aetna MGG,Aetna MGG,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,BCBS,BCBS,25.13,,,,,,,per diem,25.13,25.13,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,BCBS MGG,BCBS MGG,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Cigna,Cigna,25.13,,,,,,,per diem,25.13,25.13,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Cigna MGG,Cigna MGG,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Humana,Humana,25.13,,,,,,,per diem,25.13,25.13,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Humana MGG,Humana MGG,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Optum VA,Optum VA,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,UHC,UHC,25.13,,,,,,,per diem,25.13,25.13,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,UHC MGG,UHC MGG,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,VA,VA,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Wellcare MGG,Wellcare MGG,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Bright Health - commercial,Bright Health - commercial,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,25.13,25.13,Bright Health MGG,Bright Health MGG,25.13,,,,,,,case rate,25.13,25.13,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Aetna,Aetna,152.31,,,,,,,per diem,152.31,152.31,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Aetna MGG,Aetna MGG,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,BCBS,BCBS,152.31,,,,,,,per diem,152.31,152.31,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,BCBS MGG,BCBS MGG,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Cigna,Cigna,152.31,,,,,,,per diem,152.31,152.31,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Cigna MGG,Cigna MGG,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Humana,Humana,152.31,,,,,,,per diem,152.31,152.31,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Humana MGG,Humana MGG,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Optum VA,Optum VA,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,UHC,UHC,152.31,,,,,,,per diem,152.31,152.31,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,UHC MGG,UHC MGG,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,VA,VA,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Wellcare MGG,Wellcare MGG,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Bright Health - commercial,Bright Health - commercial,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,152.31,152.31,Bright Health MGG,Bright Health MGG,152.31,,,,,,,case rate,152.31,152.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Aetna,Aetna,88.98,,,,,,,per diem,88.98,88.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Aetna MGG,Aetna MGG,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,BCBS,BCBS,88.98,,,,,,,per diem,88.98,88.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,BCBS MGG,BCBS MGG,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Cigna,Cigna,88.98,,,,,,,per diem,88.98,88.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Cigna MGG,Cigna MGG,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Humana,Humana,88.98,,,,,,,per diem,88.98,88.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Humana MGG,Humana MGG,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Optum VA,Optum VA,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,UHC,UHC,88.98,,,,,,,per diem,88.98,88.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,UHC MGG,UHC MGG,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,VA,VA,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Wellcare MGG,Wellcare MGG,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Bright Health - commercial,Bright Health - commercial,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,88.98,88.98,Bright Health MGG,Bright Health MGG,88.98,,,,,,,case rate,88.98,88.98,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna,Aetna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna MGG,Aetna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS,BCBS,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS MGG,BCBS MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna,Cigna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna MGG,Cigna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana,Humana,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana MGG,Humana MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Optum VA,Optum VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC,UHC,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC MGG,UHC MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,VA,VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Wellcare MGG,Wellcare MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health - commercial,Bright Health - commercial,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health MGG,Bright Health MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Aetna,Aetna,178.48,,,,,,,per diem,178.48,178.48,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Aetna MGG,Aetna MGG,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,BCBS,BCBS,178.48,,,,,,,per diem,178.48,178.48,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,BCBS MGG,BCBS MGG,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Cigna,Cigna,178.48,,,,,,,per diem,178.48,178.48,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Cigna MGG,Cigna MGG,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Humana,Humana,178.48,,,,,,,per diem,178.48,178.48,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Humana MGG,Humana MGG,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Optum VA,Optum VA,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,UHC,UHC,178.48,,,,,,,per diem,178.48,178.48,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,UHC MGG,UHC MGG,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,VA,VA,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Wellcare MGG,Wellcare MGG,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Bright Health - commercial,Bright Health - commercial,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,178.48,178.48,Bright Health MGG,Bright Health MGG,178.48,,,,,,,case rate,178.48,178.48,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Aetna,Aetna,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Aetna MGG,Aetna MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,BCBS,BCBS,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,BCBS MGG,BCBS MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Cigna,Cigna,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Cigna MGG,Cigna MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Humana,Humana,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Humana MGG,Humana MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Optum VA,Optum VA,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,UHC,UHC,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,UHC MGG,UHC MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,VA,VA,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Wellcare MGG,Wellcare MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Bright Health - commercial,Bright Health - commercial,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Bright Health MGG,Bright Health MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Aetna,Aetna,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Aetna MGG,Aetna MGG,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,BCBS,BCBS,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,BCBS MGG,BCBS MGG,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Cigna,Cigna,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Cigna MGG,Cigna MGG,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Humana,Humana,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Humana MGG,Humana MGG,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Optum VA,Optum VA,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,UHC,UHC,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,UHC MGG,UHC MGG,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,VA,VA,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Wellcare MGG,Wellcare MGG,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Bright Health - commercial,Bright Health - commercial,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.14,14.14,Bright Health MGG,Bright Health MGG,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Aetna,Aetna,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Aetna MGG,Aetna MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,BCBS,BCBS,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,BCBS MGG,BCBS MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Cigna,Cigna,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Cigna MGG,Cigna MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Humana,Humana,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Humana MGG,Humana MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Optum VA,Optum VA,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,UHC,UHC,113.85,,,,,,,per diem,113.85,113.85,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,UHC MGG,UHC MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,VA,VA,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Wellcare MGG,Wellcare MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Bright Health - commercial,Bright Health - commercial,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,113.85,113.85,Bright Health MGG,Bright Health MGG,113.85,,,,,,,case rate,113.85,113.85,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna,Aetna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna MGG,Aetna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS,BCBS,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS MGG,BCBS MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna,Cigna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna MGG,Cigna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana,Humana,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana MGG,Humana MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Optum VA,Optum VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC,UHC,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC MGG,UHC MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,VA,VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Wellcare MGG,Wellcare MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health - commercial,Bright Health - commercial,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health MGG,Bright Health MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Aetna,Aetna,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Aetna MGG,Aetna MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,BCBS,BCBS,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,BCBS MGG,BCBS MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Cigna,Cigna,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Cigna MGG,Cigna MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Humana,Humana,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Humana MGG,Humana MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Optum VA,Optum VA,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,UHC,UHC,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,UHC MGG,UHC MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,VA,VA,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Wellcare MGG,Wellcare MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Bright Health - commercial,Bright Health - commercial,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Bright Health MGG,Bright Health MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Aetna,Aetna,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Aetna MGG,Aetna MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,BCBS,BCBS,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,BCBS MGG,BCBS MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Cigna,Cigna,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Cigna MGG,Cigna MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Humana,Humana,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Humana MGG,Humana MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Optum VA,Optum VA,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,UHC,UHC,101.28,,,,,,,per diem,101.28,101.28,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,UHC MGG,UHC MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,VA,VA,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Wellcare MGG,Wellcare MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Bright Health - commercial,Bright Health - commercial,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,101.28,101.28,Bright Health MGG,Bright Health MGG,101.28,,,,,,,case rate,101.28,101.28,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Aetna,Aetna,203.08,,,,,,,per diem,203.08,203.08,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Aetna MGG,Aetna MGG,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,BCBS,BCBS,203.08,,,,,,,per diem,203.08,203.08,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,BCBS MGG,BCBS MGG,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Cigna,Cigna,203.08,,,,,,,per diem,203.08,203.08,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Cigna MGG,Cigna MGG,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Humana,Humana,203.08,,,,,,,per diem,203.08,203.08,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Humana MGG,Humana MGG,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Optum VA,Optum VA,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,UHC,UHC,203.08,,,,,,,per diem,203.08,203.08,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,UHC MGG,UHC MGG,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,VA,VA,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Wellcare MGG,Wellcare MGG,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Bright Health - commercial,Bright Health - commercial,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,203.08,203.08,Bright Health MGG,Bright Health MGG,203.08,,,,,,,case rate,203.08,203.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Aetna,Aetna,1671.06,,,,,,,per diem,1671.06,1671.06,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Aetna MGG,Aetna MGG,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,BCBS,BCBS,1671.06,,,,,,,per diem,1671.06,1671.06,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,BCBS MGG,BCBS MGG,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Cigna,Cigna,1671.06,,,,,,,per diem,1671.06,1671.06,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Cigna MGG,Cigna MGG,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Humana,Humana,1671.06,,,,,,,per diem,1671.06,1671.06,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Humana MGG,Humana MGG,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Optum VA,Optum VA,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,UHC,UHC,1671.06,,,,,,,per diem,1671.06,1671.06,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,UHC MGG,UHC MGG,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,VA,VA,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Wellcare MGG,Wellcare MGG,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Bright Health - commercial,Bright Health - commercial,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1671.06,1671.06,Bright Health MGG,Bright Health MGG,1671.06,,,,,,,case rate,1671.06,1671.06,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Aetna,Aetna,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Aetna MGG,Aetna MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,BCBS,BCBS,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,BCBS MGG,BCBS MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Cigna,Cigna,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Cigna MGG,Cigna MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Humana,Humana,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Humana MGG,Humana MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Optum VA,Optum VA,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,UHC,UHC,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,UHC MGG,UHC MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,VA,VA,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Wellcare MGG,Wellcare MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Bright Health - commercial,Bright Health - commercial,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,25.65,25.65,Bright Health MGG,Bright Health MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Aetna,Aetna,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Aetna MGG,Aetna MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,BCBS,BCBS,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,BCBS MGG,BCBS MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Cigna,Cigna,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Cigna MGG,Cigna MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Humana,Humana,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Humana MGG,Humana MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Optum VA,Optum VA,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,UHC,UHC,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,UHC MGG,UHC MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,VA,VA,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Wellcare MGG,Wellcare MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Bright Health - commercial,Bright Health - commercial,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Bright Health MGG,Bright Health MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Aetna,Aetna,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Aetna MGG,Aetna MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,BCBS,BCBS,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,BCBS MGG,BCBS MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Cigna,Cigna,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Cigna MGG,Cigna MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Humana,Humana,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Humana MGG,Humana MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Optum VA,Optum VA,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,UHC,UHC,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,UHC MGG,UHC MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,VA,VA,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Wellcare MGG,Wellcare MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Bright Health - commercial,Bright Health - commercial,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Bright Health MGG,Bright Health MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Aetna,Aetna,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Aetna MGG,Aetna MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,BCBS,BCBS,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,BCBS MGG,BCBS MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Cigna,Cigna,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Cigna MGG,Cigna MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Humana,Humana,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Humana MGG,Humana MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Optum VA,Optum VA,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,UHC,UHC,60.98,,,,,,,per diem,60.98,60.98,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,UHC MGG,UHC MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,VA,VA,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Wellcare MGG,Wellcare MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Bright Health - commercial,Bright Health - commercial,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,60.98,60.98,Bright Health MGG,Bright Health MGG,60.98,,,,,,,case rate,60.98,60.98,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Aetna,Aetna,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Aetna MGG,Aetna MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,BCBS,BCBS,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,BCBS MGG,BCBS MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Cigna,Cigna,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Cigna MGG,Cigna MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Humana,Humana,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Humana MGG,Humana MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Optum VA,Optum VA,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,UHC,UHC,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,UHC MGG,UHC MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,VA,VA,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Wellcare MGG,Wellcare MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Bright Health - commercial,Bright Health - commercial,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Bright Health MGG,Bright Health MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Aetna,Aetna,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Aetna MGG,Aetna MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,BCBS,BCBS,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,BCBS MGG,BCBS MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Cigna,Cigna,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Cigna MGG,Cigna MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Humana,Humana,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Humana MGG,Humana MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Optum VA,Optum VA,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,UHC,UHC,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,UHC MGG,UHC MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,VA,VA,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Wellcare MGG,Wellcare MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Bright Health - commercial,Bright Health - commercial,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,190,190,Bright Health MGG,Bright Health MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Aetna,Aetna,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Aetna MGG,Aetna MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,BCBS,BCBS,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,BCBS MGG,BCBS MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Cigna,Cigna,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Cigna MGG,Cigna MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Humana,Humana,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Humana MGG,Humana MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Optum VA,Optum VA,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,UHC,UHC,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,UHC MGG,UHC MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,VA,VA,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Wellcare MGG,Wellcare MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Bright Health - commercial,Bright Health - commercial,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Bright Health MGG,Bright Health MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Aetna,Aetna,20.15,,,,,,,per diem,20.15,20.15,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Aetna MGG,Aetna MGG,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,BCBS,BCBS,20.15,,,,,,,per diem,20.15,20.15,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,BCBS MGG,BCBS MGG,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Cigna,Cigna,20.15,,,,,,,per diem,20.15,20.15,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Cigna MGG,Cigna MGG,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Humana,Humana,20.15,,,,,,,per diem,20.15,20.15,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Humana MGG,Humana MGG,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Optum VA,Optum VA,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,UHC,UHC,20.15,,,,,,,per diem,20.15,20.15,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,UHC MGG,UHC MGG,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,VA,VA,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Wellcare MGG,Wellcare MGG,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Bright Health - commercial,Bright Health - commercial,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,20.15,20.15,Bright Health MGG,Bright Health MGG,20.15,,,,,,,case rate,20.15,20.15,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Aetna,Aetna,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Aetna MGG,Aetna MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,BCBS,BCBS,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,BCBS MGG,BCBS MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Cigna,Cigna,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Cigna MGG,Cigna MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Humana,Humana,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Humana MGG,Humana MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Optum VA,Optum VA,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,UHC,UHC,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,UHC MGG,UHC MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,VA,VA,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Wellcare MGG,Wellcare MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Bright Health - commercial,Bright Health - commercial,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Bright Health MGG,Bright Health MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Aetna,Aetna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Aetna MGG,Aetna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,BCBS,BCBS,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,BCBS MGG,BCBS MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Cigna,Cigna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Cigna MGG,Cigna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Humana,Humana,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Humana MGG,Humana MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Optum VA,Optum VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,UHC,UHC,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,UHC MGG,UHC MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,VA,VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Wellcare MGG,Wellcare MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Bright Health - commercial,Bright Health - commercial,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Bright Health MGG,Bright Health MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Aetna,Aetna,195.49,,,,,,,per diem,195.49,195.49,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Aetna MGG,Aetna MGG,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,BCBS,BCBS,195.49,,,,,,,per diem,195.49,195.49,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,BCBS MGG,BCBS MGG,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Cigna,Cigna,195.49,,,,,,,per diem,195.49,195.49,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Cigna MGG,Cigna MGG,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Humana,Humana,195.49,,,,,,,per diem,195.49,195.49,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Humana MGG,Humana MGG,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Optum VA,Optum VA,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,UHC,UHC,195.49,,,,,,,per diem,195.49,195.49,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,UHC MGG,UHC MGG,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,VA,VA,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Wellcare MGG,Wellcare MGG,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Bright Health - commercial,Bright Health - commercial,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,195.49,195.49,Bright Health MGG,Bright Health MGG,195.49,,,,,,,case rate,195.49,195.49,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Aetna,Aetna,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Aetna MGG,Aetna MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,BCBS,BCBS,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,BCBS MGG,BCBS MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Cigna,Cigna,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Cigna MGG,Cigna MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Humana,Humana,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Humana MGG,Humana MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Optum VA,Optum VA,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,UHC,UHC,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,UHC MGG,UHC MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,VA,VA,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Wellcare MGG,Wellcare MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Bright Health - commercial,Bright Health - commercial,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Bright Health MGG,Bright Health MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Aetna,Aetna,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Aetna MGG,Aetna MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,BCBS,BCBS,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,BCBS MGG,BCBS MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Cigna,Cigna,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Cigna MGG,Cigna MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Humana,Humana,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Humana MGG,Humana MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Optum VA,Optum VA,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,UHC,UHC,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,UHC MGG,UHC MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,VA,VA,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Wellcare MGG,Wellcare MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Bright Health - commercial,Bright Health - commercial,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Bright Health MGG,Bright Health MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Aetna,Aetna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Aetna MGG,Aetna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,BCBS,BCBS,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,BCBS MGG,BCBS MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Cigna,Cigna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Cigna MGG,Cigna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Humana,Humana,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Humana MGG,Humana MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Optum VA,Optum VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,UHC,UHC,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,UHC MGG,UHC MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,VA,VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Wellcare MGG,Wellcare MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Bright Health - commercial,Bright Health - commercial,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,8.64,8.64,Bright Health MGG,Bright Health MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Aetna,Aetna,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Aetna MGG,Aetna MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,BCBS,BCBS,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,BCBS MGG,BCBS MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Cigna,Cigna,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Cigna MGG,Cigna MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Humana,Humana,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Humana MGG,Humana MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Optum VA,Optum VA,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,UHC,UHC,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,UHC MGG,UHC MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,VA,VA,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Wellcare MGG,Wellcare MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Bright Health - commercial,Bright Health - commercial,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Bright Health MGG,Bright Health MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna,Aetna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna MGG,Aetna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS,BCBS,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS MGG,BCBS MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna,Cigna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna MGG,Cigna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana,Humana,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana MGG,Humana MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Optum VA,Optum VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC,UHC,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC MGG,UHC MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,VA,VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Wellcare MGG,Wellcare MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health - commercial,Bright Health - commercial,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health MGG,Bright Health MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Aetna,Aetna,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Aetna MGG,Aetna MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,BCBS,BCBS,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,BCBS MGG,BCBS MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Cigna,Cigna,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Cigna MGG,Cigna MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Humana,Humana,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Humana MGG,Humana MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Optum VA,Optum VA,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,UHC,UHC,40.83,,,,,,,per diem,40.83,40.83,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,UHC MGG,UHC MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,VA,VA,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Wellcare MGG,Wellcare MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Bright Health - commercial,Bright Health - commercial,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,40.83,40.83,Bright Health MGG,Bright Health MGG,40.83,,,,,,,case rate,40.83,40.83,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Aetna,Aetna,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Aetna MGG,Aetna MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,BCBS,BCBS,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,BCBS MGG,BCBS MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Cigna,Cigna,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Cigna MGG,Cigna MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Humana,Humana,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Humana MGG,Humana MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Optum VA,Optum VA,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,UHC,UHC,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,UHC MGG,UHC MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,VA,VA,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Wellcare MGG,Wellcare MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Bright Health - commercial,Bright Health - commercial,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Bright Health MGG,Bright Health MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Aetna,Aetna,304.1,,,,,,,per diem,304.1,304.1,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Aetna MGG,Aetna MGG,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,BCBS,BCBS,304.1,,,,,,,per diem,304.1,304.1,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,BCBS MGG,BCBS MGG,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Cigna,Cigna,304.1,,,,,,,per diem,304.1,304.1,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Cigna MGG,Cigna MGG,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Humana,Humana,304.1,,,,,,,per diem,304.1,304.1,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Humana MGG,Humana MGG,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Optum VA,Optum VA,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,UHC,UHC,304.1,,,,,,,per diem,304.1,304.1,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,UHC MGG,UHC MGG,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,VA,VA,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Wellcare MGG,Wellcare MGG,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Bright Health - commercial,Bright Health - commercial,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,304.1,304.1,Bright Health MGG,Bright Health MGG,304.1,,,,,,,case rate,304.1,304.1,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Aetna,Aetna,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Aetna MGG,Aetna MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,BCBS,BCBS,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,BCBS MGG,BCBS MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Cigna,Cigna,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Cigna MGG,Cigna MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Humana,Humana,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Humana MGG,Humana MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Optum VA,Optum VA,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,UHC,UHC,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,UHC MGG,UHC MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,VA,VA,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Wellcare MGG,Wellcare MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Bright Health - commercial,Bright Health - commercial,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,64.64,64.64,Bright Health MGG,Bright Health MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Aetna,Aetna,608.19,,,,,,,per diem,608.19,608.19,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Aetna MGG,Aetna MGG,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,BCBS,BCBS,608.19,,,,,,,per diem,608.19,608.19,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,BCBS MGG,BCBS MGG,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Cigna,Cigna,608.19,,,,,,,per diem,608.19,608.19,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Cigna MGG,Cigna MGG,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Humana,Humana,608.19,,,,,,,per diem,608.19,608.19,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Humana MGG,Humana MGG,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Optum VA,Optum VA,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,UHC,UHC,608.19,,,,,,,per diem,608.19,608.19,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,UHC MGG,UHC MGG,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,VA,VA,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Wellcare MGG,Wellcare MGG,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Bright Health - commercial,Bright Health - commercial,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,608.19,608.19,Bright Health MGG,Bright Health MGG,608.19,,,,,,,case rate,608.19,608.19,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Aetna,Aetna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Aetna MGG,Aetna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,BCBS,BCBS,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,BCBS MGG,BCBS MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Cigna,Cigna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Cigna MGG,Cigna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Humana,Humana,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Humana MGG,Humana MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Optum VA,Optum VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,UHC,UHC,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,UHC MGG,UHC MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,VA,VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Wellcare MGG,Wellcare MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health - commercial,Bright Health - commercial,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health MGG,Bright Health MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Aetna,Aetna,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Aetna MGG,Aetna MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,BCBS,BCBS,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,BCBS MGG,BCBS MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Cigna,Cigna,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Cigna MGG,Cigna MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Humana,Humana,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Humana MGG,Humana MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Optum VA,Optum VA,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,UHC,UHC,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,UHC MGG,UHC MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,VA,VA,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Wellcare MGG,Wellcare MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Bright Health - commercial,Bright Health - commercial,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Bright Health MGG,Bright Health MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Aetna,Aetna,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Aetna MGG,Aetna MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,BCBS,BCBS,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,BCBS MGG,BCBS MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Cigna,Cigna,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Cigna MGG,Cigna MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Humana,Humana,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Humana MGG,Humana MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Optum VA,Optum VA,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,UHC,UHC,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,UHC MGG,UHC MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,VA,VA,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Wellcare MGG,Wellcare MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Bright Health - commercial,Bright Health - commercial,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Bright Health MGG,Bright Health MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Aetna,Aetna,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Aetna MGG,Aetna MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,BCBS,BCBS,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,BCBS MGG,BCBS MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Cigna,Cigna,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Cigna MGG,Cigna MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Humana,Humana,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Humana MGG,Humana MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Optum VA,Optum VA,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,UHC,UHC,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,UHC MGG,UHC MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,VA,VA,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Wellcare MGG,Wellcare MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Bright Health - commercial,Bright Health - commercial,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Bright Health MGG,Bright Health MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Aetna,Aetna,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Aetna MGG,Aetna MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,BCBS,BCBS,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,BCBS MGG,BCBS MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Cigna,Cigna,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Cigna MGG,Cigna MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Humana,Humana,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Humana MGG,Humana MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Optum VA,Optum VA,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,UHC,UHC,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,UHC MGG,UHC MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,VA,VA,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Wellcare MGG,Wellcare MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Bright Health - commercial,Bright Health - commercial,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Bright Health MGG,Bright Health MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Aetna,Aetna,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Aetna MGG,Aetna MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,BCBS,BCBS,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,BCBS MGG,BCBS MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Cigna,Cigna,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Cigna MGG,Cigna MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Humana,Humana,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Humana MGG,Humana MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Optum VA,Optum VA,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,UHC,UHC,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,UHC MGG,UHC MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,VA,VA,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Wellcare MGG,Wellcare MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Bright Health - commercial,Bright Health - commercial,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Bright Health MGG,Bright Health MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Aetna,Aetna,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Aetna MGG,Aetna MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,BCBS,BCBS,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,BCBS MGG,BCBS MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Cigna,Cigna,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Cigna MGG,Cigna MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Humana,Humana,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Humana MGG,Humana MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Optum VA,Optum VA,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,UHC,UHC,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,UHC MGG,UHC MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,VA,VA,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Wellcare MGG,Wellcare MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Bright Health - commercial,Bright Health - commercial,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Bright Health MGG,Bright Health MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Aetna,Aetna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Aetna MGG,Aetna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,BCBS,BCBS,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,BCBS MGG,BCBS MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Cigna,Cigna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Cigna MGG,Cigna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Humana,Humana,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Humana MGG,Humana MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Optum VA,Optum VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,UHC,UHC,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,UHC MGG,UHC MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,VA,VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Wellcare MGG,Wellcare MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health - commercial,Bright Health - commercial,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health MGG,Bright Health MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Aetna,Aetna,95.26,,,,,,,per diem,95.26,95.26,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Aetna MGG,Aetna MGG,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,BCBS,BCBS,95.26,,,,,,,per diem,95.26,95.26,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,BCBS MGG,BCBS MGG,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Cigna,Cigna,95.26,,,,,,,per diem,95.26,95.26,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Cigna MGG,Cigna MGG,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Humana,Humana,95.26,,,,,,,per diem,95.26,95.26,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Humana MGG,Humana MGG,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Optum VA,Optum VA,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,UHC,UHC,95.26,,,,,,,per diem,95.26,95.26,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,UHC MGG,UHC MGG,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,VA,VA,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Wellcare MGG,Wellcare MGG,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Bright Health - commercial,Bright Health - commercial,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,95.26,95.26,Bright Health MGG,Bright Health MGG,95.26,,,,,,,case rate,95.26,95.26,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Aetna,Aetna,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Aetna MGG,Aetna MGG,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,BCBS,BCBS,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,BCBS MGG,BCBS MGG,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Cigna,Cigna,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Cigna MGG,Cigna MGG,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Humana,Humana,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Humana MGG,Humana MGG,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Optum VA,Optum VA,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,UHC,UHC,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,UHC MGG,UHC MGG,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,VA,VA,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Wellcare MGG,Wellcare MGG,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Bright Health - commercial,Bright Health - commercial,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,65.95,65.95,Bright Health MGG,Bright Health MGG,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Aetna,Aetna,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Aetna MGG,Aetna MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,BCBS,BCBS,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,BCBS MGG,BCBS MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Cigna,Cigna,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Cigna MGG,Cigna MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Humana,Humana,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Humana MGG,Humana MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Optum VA,Optum VA,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,UHC,UHC,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,UHC MGG,UHC MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,VA,VA,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Wellcare MGG,Wellcare MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Bright Health - commercial,Bright Health - commercial,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,93.69,93.69,Bright Health MGG,Bright Health MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Aetna,Aetna,52.87,,,,,,,per diem,52.87,52.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Aetna MGG,Aetna MGG,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,BCBS,BCBS,52.87,,,,,,,per diem,52.87,52.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,BCBS MGG,BCBS MGG,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Cigna,Cigna,52.87,,,,,,,per diem,52.87,52.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Cigna MGG,Cigna MGG,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Humana,Humana,52.87,,,,,,,per diem,52.87,52.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Humana MGG,Humana MGG,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Optum VA,Optum VA,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,UHC,UHC,52.87,,,,,,,per diem,52.87,52.87,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,UHC MGG,UHC MGG,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,VA,VA,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Wellcare MGG,Wellcare MGG,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Bright Health - commercial,Bright Health - commercial,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,52.87,52.87,Bright Health MGG,Bright Health MGG,52.87,,,,,,,case rate,52.87,52.87,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Aetna,Aetna,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Aetna MGG,Aetna MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,BCBS,BCBS,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,BCBS MGG,BCBS MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Cigna,Cigna,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Cigna MGG,Cigna MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Humana,Humana,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Humana MGG,Humana MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Optum VA,Optum VA,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,UHC,UHC,149.17,,,,,,,per diem,149.17,149.17,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,UHC MGG,UHC MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,VA,VA,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Wellcare MGG,Wellcare MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Bright Health - commercial,Bright Health - commercial,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,149.17,149.17,Bright Health MGG,Bright Health MGG,149.17,,,,,,,case rate,149.17,149.17,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Aetna,Aetna,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Aetna MGG,Aetna MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,BCBS,BCBS,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,BCBS MGG,BCBS MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Cigna,Cigna,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Cigna MGG,Cigna MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Humana,Humana,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Humana MGG,Humana MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Optum VA,Optum VA,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,UHC,UHC,68.05,,,,,,,per diem,68.05,68.05,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,UHC MGG,UHC MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,VA,VA,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Wellcare MGG,Wellcare MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Bright Health - commercial,Bright Health - commercial,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,68.05,68.05,Bright Health MGG,Bright Health MGG,68.05,,,,,,,case rate,68.05,68.05,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Aetna,Aetna,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Aetna MGG,Aetna MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,BCBS,BCBS,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,BCBS MGG,BCBS MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Cigna,Cigna,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Cigna MGG,Cigna MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Humana,Humana,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Humana MGG,Humana MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Optum VA,Optum VA,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,UHC,UHC,58.36,,,,,,,per diem,58.36,58.36,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,UHC MGG,UHC MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,VA,VA,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Wellcare MGG,Wellcare MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Bright Health - commercial,Bright Health - commercial,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,58.36,58.36,Bright Health MGG,Bright Health MGG,58.36,,,,,,,case rate,58.36,58.36,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Aetna,Aetna,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Aetna MGG,Aetna MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,BCBS,BCBS,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,BCBS MGG,BCBS MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Cigna,Cigna,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Cigna MGG,Cigna MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Humana,Humana,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Humana MGG,Humana MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Optum VA,Optum VA,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,UHC,UHC,153.62,,,,,,,per diem,153.62,153.62,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,UHC MGG,UHC MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,VA,VA,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Wellcare MGG,Wellcare MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Bright Health - commercial,Bright Health - commercial,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,153.62,153.62,Bright Health MGG,Bright Health MGG,153.62,,,,,,,case rate,153.62,153.62,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Aetna,Aetna,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Aetna MGG,Aetna MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,BCBS,BCBS,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,BCBS MGG,BCBS MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Cigna,Cigna,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Cigna MGG,Cigna MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Humana,Humana,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Humana MGG,Humana MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Optum VA,Optum VA,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,UHC,UHC,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,UHC MGG,UHC MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,VA,VA,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Wellcare MGG,Wellcare MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Bright Health - commercial,Bright Health - commercial,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Bright Health MGG,Bright Health MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Aetna,Aetna,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Aetna MGG,Aetna MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,BCBS,BCBS,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,BCBS MGG,BCBS MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Cigna,Cigna,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Cigna MGG,Cigna MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Humana,Humana,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Humana MGG,Humana MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Optum VA,Optum VA,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,UHC,UHC,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,UHC MGG,UHC MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,VA,VA,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Wellcare MGG,Wellcare MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Bright Health - commercial,Bright Health - commercial,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Bright Health MGG,Bright Health MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Aetna,Aetna,244.43,,,,,,,per diem,244.43,244.43,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Aetna MGG,Aetna MGG,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,BCBS,BCBS,244.43,,,,,,,per diem,244.43,244.43,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,BCBS MGG,BCBS MGG,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Cigna,Cigna,244.43,,,,,,,per diem,244.43,244.43,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Cigna MGG,Cigna MGG,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Humana,Humana,244.43,,,,,,,per diem,244.43,244.43,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Humana MGG,Humana MGG,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Optum VA,Optum VA,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,UHC,UHC,244.43,,,,,,,per diem,244.43,244.43,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,UHC MGG,UHC MGG,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,VA,VA,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Wellcare MGG,Wellcare MGG,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Bright Health - commercial,Bright Health - commercial,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,244.43,244.43,Bright Health MGG,Bright Health MGG,244.43,,,,,,,case rate,244.43,244.43,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Aetna,Aetna,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Aetna MGG,Aetna MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,BCBS,BCBS,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,BCBS MGG,BCBS MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Cigna,Cigna,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Cigna MGG,Cigna MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Humana,Humana,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Humana MGG,Humana MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Optum VA,Optum VA,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,UHC,UHC,50.51,,,,,,,per diem,50.51,50.51,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,UHC MGG,UHC MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,VA,VA,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Wellcare MGG,Wellcare MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Bright Health - commercial,Bright Health - commercial,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,50.51,50.51,Bright Health MGG,Bright Health MGG,50.51,,,,,,,case rate,50.51,50.51,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Aetna,Aetna,197.59,,,,,,,per diem,197.59,197.59,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Aetna MGG,Aetna MGG,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,BCBS,BCBS,197.59,,,,,,,per diem,197.59,197.59,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,BCBS MGG,BCBS MGG,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Cigna,Cigna,197.59,,,,,,,per diem,197.59,197.59,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Cigna MGG,Cigna MGG,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Humana,Humana,197.59,,,,,,,per diem,197.59,197.59,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Humana MGG,Humana MGG,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Optum VA,Optum VA,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,UHC,UHC,197.59,,,,,,,per diem,197.59,197.59,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,UHC MGG,UHC MGG,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,VA,VA,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Wellcare MGG,Wellcare MGG,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Bright Health - commercial,Bright Health - commercial,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,197.59,197.59,Bright Health MGG,Bright Health MGG,197.59,,,,,,,case rate,197.59,197.59,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Aetna,Aetna,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Aetna MGG,Aetna MGG,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,BCBS,BCBS,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,BCBS MGG,BCBS MGG,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Cigna,Cigna,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Cigna MGG,Cigna MGG,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Humana,Humana,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Humana MGG,Humana MGG,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Optum VA,Optum VA,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,UHC,UHC,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,UHC MGG,UHC MGG,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,VA,VA,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Wellcare MGG,Wellcare MGG,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Bright Health - commercial,Bright Health - commercial,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,156.24,156.24,Bright Health MGG,Bright Health MGG,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Aetna,Aetna,85.32,,,,,,,per diem,85.32,85.32,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Aetna MGG,Aetna MGG,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,BCBS,BCBS,85.32,,,,,,,per diem,85.32,85.32,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,BCBS MGG,BCBS MGG,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Cigna,Cigna,85.32,,,,,,,per diem,85.32,85.32,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Cigna MGG,Cigna MGG,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Humana,Humana,85.32,,,,,,,per diem,85.32,85.32,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Humana MGG,Humana MGG,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Optum VA,Optum VA,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,UHC,UHC,85.32,,,,,,,per diem,85.32,85.32,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,UHC MGG,UHC MGG,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,VA,VA,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Wellcare MGG,Wellcare MGG,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Bright Health - commercial,Bright Health - commercial,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,85.32,85.32,Bright Health MGG,Bright Health MGG,85.32,,,,,,,case rate,85.32,85.32,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Aetna,Aetna,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Aetna MGG,Aetna MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,BCBS,BCBS,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,BCBS MGG,BCBS MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Cigna,Cigna,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Cigna MGG,Cigna MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Humana,Humana,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Humana MGG,Humana MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Optum VA,Optum VA,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,UHC,UHC,87.68,,,,,,,per diem,87.68,87.68,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,UHC MGG,UHC MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,VA,VA,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Wellcare MGG,Wellcare MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Bright Health - commercial,Bright Health - commercial,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,87.68,87.68,Bright Health MGG,Bright Health MGG,87.68,,,,,,,case rate,87.68,87.68,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Aetna,Aetna,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Aetna MGG,Aetna MGG,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,BCBS,BCBS,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,BCBS MGG,BCBS MGG,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Cigna,Cigna,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Cigna MGG,Cigna MGG,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Humana,Humana,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Humana MGG,Humana MGG,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Optum VA,Optum VA,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,UHC,UHC,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,UHC MGG,UHC MGG,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,VA,VA,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Wellcare MGG,Wellcare MGG,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Bright Health - commercial,Bright Health - commercial,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,89.76,89.76,Bright Health MGG,Bright Health MGG,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Aetna,Aetna,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Aetna MGG,Aetna MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,BCBS,BCBS,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,BCBS MGG,BCBS MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Cigna,Cigna,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Cigna MGG,Cigna MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Humana,Humana,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Humana MGG,Humana MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Optum VA,Optum VA,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,UHC,UHC,164.35,,,,,,,per diem,164.35,164.35,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,UHC MGG,UHC MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,VA,VA,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Wellcare MGG,Wellcare MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Bright Health - commercial,Bright Health - commercial,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,164.35,164.35,Bright Health MGG,Bright Health MGG,164.35,,,,,,,case rate,164.35,164.35,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Aetna,Aetna,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Aetna MGG,Aetna MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,BCBS,BCBS,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,BCBS MGG,BCBS MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Cigna,Cigna,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Cigna MGG,Cigna MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Humana,Humana,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Humana MGG,Humana MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Optum VA,Optum VA,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,UHC,UHC,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,UHC MGG,UHC MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,VA,VA,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Wellcare MGG,Wellcare MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Bright Health - commercial,Bright Health - commercial,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Bright Health MGG,Bright Health MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Aetna,Aetna,77.99,,,,,,,per diem,77.99,77.99,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Aetna MGG,Aetna MGG,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,BCBS,BCBS,77.99,,,,,,,per diem,77.99,77.99,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,BCBS MGG,BCBS MGG,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Cigna,Cigna,77.99,,,,,,,per diem,77.99,77.99,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Cigna MGG,Cigna MGG,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Humana,Humana,77.99,,,,,,,per diem,77.99,77.99,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Humana MGG,Humana MGG,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Optum VA,Optum VA,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,UHC,UHC,77.99,,,,,,,per diem,77.99,77.99,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,UHC MGG,UHC MGG,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,VA,VA,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Wellcare MGG,Wellcare MGG,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Bright Health - commercial,Bright Health - commercial,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,77.99,77.99,Bright Health MGG,Bright Health MGG,77.99,,,,,,,case rate,77.99,77.99,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Aetna,Aetna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Aetna MGG,Aetna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,BCBS,BCBS,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,BCBS MGG,BCBS MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Cigna,Cigna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Cigna MGG,Cigna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Humana,Humana,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Humana MGG,Humana MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Optum VA,Optum VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,UHC,UHC,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,UHC MGG,UHC MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,VA,VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Wellcare MGG,Wellcare MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health - commercial,Bright Health - commercial,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health MGG,Bright Health MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Aetna,Aetna,761.55,,,,,,,per diem,761.55,761.55,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Aetna MGG,Aetna MGG,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,BCBS,BCBS,761.55,,,,,,,per diem,761.55,761.55,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,BCBS MGG,BCBS MGG,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Cigna,Cigna,761.55,,,,,,,per diem,761.55,761.55,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Cigna MGG,Cigna MGG,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Humana,Humana,761.55,,,,,,,per diem,761.55,761.55,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Humana MGG,Humana MGG,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Optum VA,Optum VA,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,UHC,UHC,761.55,,,,,,,per diem,761.55,761.55,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,UHC MGG,UHC MGG,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,VA,VA,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Wellcare MGG,Wellcare MGG,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Bright Health - commercial,Bright Health - commercial,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,761.55,761.55,Bright Health MGG,Bright Health MGG,761.55,,,,,,,case rate,761.55,761.55,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Aetna,Aetna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Aetna MGG,Aetna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,BCBS,BCBS,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,BCBS MGG,BCBS MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Cigna,Cigna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Cigna MGG,Cigna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Humana,Humana,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Humana MGG,Humana MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Optum VA,Optum VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,UHC,UHC,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,UHC MGG,UHC MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,VA,VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Wellcare MGG,Wellcare MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Bright Health - commercial,Bright Health - commercial,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Bright Health MGG,Bright Health MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Aetna,Aetna,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Aetna MGG,Aetna MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,BCBS,BCBS,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,BCBS MGG,BCBS MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Cigna,Cigna,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Cigna MGG,Cigna MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Humana,Humana,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Humana MGG,Humana MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Optum VA,Optum VA,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,UHC,UHC,3.67,,,,,,,per diem,3.67,3.67,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,UHC MGG,UHC MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,VA,VA,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Wellcare MGG,Wellcare MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Bright Health - commercial,Bright Health - commercial,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.67,3.67,Bright Health MGG,Bright Health MGG,3.67,,,,,,,case rate,3.67,3.67,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Aetna,Aetna,177.44,,,,,,,per diem,177.44,177.44,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Aetna MGG,Aetna MGG,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,BCBS,BCBS,177.44,,,,,,,per diem,177.44,177.44,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,BCBS MGG,BCBS MGG,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Cigna,Cigna,177.44,,,,,,,per diem,177.44,177.44,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Cigna MGG,Cigna MGG,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Humana,Humana,177.44,,,,,,,per diem,177.44,177.44,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Humana MGG,Humana MGG,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Optum VA,Optum VA,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,UHC,UHC,177.44,,,,,,,per diem,177.44,177.44,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,UHC MGG,UHC MGG,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,VA,VA,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Wellcare MGG,Wellcare MGG,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Bright Health - commercial,Bright Health - commercial,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,177.44,177.44,Bright Health MGG,Bright Health MGG,177.44,,,,,,,case rate,177.44,177.44,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna,Aetna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna MGG,Aetna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS,BCBS,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS MGG,BCBS MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna,Cigna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna MGG,Cigna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana,Humana,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana MGG,Humana MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Optum VA,Optum VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC,UHC,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC MGG,UHC MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,VA,VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Wellcare MGG,Wellcare MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health - commercial,Bright Health - commercial,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health MGG,Bright Health MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Aetna,Aetna,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Aetna MGG,Aetna MGG,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,BCBS,BCBS,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,BCBS MGG,BCBS MGG,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Cigna,Cigna,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Cigna MGG,Cigna MGG,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Humana,Humana,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Humana MGG,Humana MGG,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Optum VA,Optum VA,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,UHC,UHC,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,UHC MGG,UHC MGG,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,VA,VA,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Wellcare MGG,Wellcare MGG,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Bright Health - commercial,Bright Health - commercial,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,49.46,49.46,Bright Health MGG,Bright Health MGG,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Aetna,Aetna,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Aetna MGG,Aetna MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,BCBS,BCBS,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,BCBS MGG,BCBS MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Cigna,Cigna,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Cigna MGG,Cigna MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Humana,Humana,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Humana MGG,Humana MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Optum VA,Optum VA,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,UHC,UHC,26.7,,,,,,,per diem,26.7,26.7,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,UHC MGG,UHC MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,VA,VA,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Wellcare MGG,Wellcare MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Bright Health - commercial,Bright Health - commercial,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,26.7,26.7,Bright Health MGG,Bright Health MGG,26.7,,,,,,,case rate,26.7,26.7,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Aetna,Aetna,132.95,,,,,,,per diem,132.95,132.95,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Aetna MGG,Aetna MGG,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,BCBS,BCBS,132.95,,,,,,,per diem,132.95,132.95,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,BCBS MGG,BCBS MGG,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Cigna,Cigna,132.95,,,,,,,per diem,132.95,132.95,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Cigna MGG,Cigna MGG,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Humana,Humana,132.95,,,,,,,per diem,132.95,132.95,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Humana MGG,Humana MGG,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Optum VA,Optum VA,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,UHC,UHC,132.95,,,,,,,per diem,132.95,132.95,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,UHC MGG,UHC MGG,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,VA,VA,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Wellcare MGG,Wellcare MGG,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Bright Health - commercial,Bright Health - commercial,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,132.95,132.95,Bright Health MGG,Bright Health MGG,132.95,,,,,,,case rate,132.95,132.95,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Aetna,Aetna,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Aetna MGG,Aetna MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,BCBS,BCBS,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,BCBS MGG,BCBS MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Cigna,Cigna,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Cigna MGG,Cigna MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Humana,Humana,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Humana MGG,Humana MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Optum VA,Optum VA,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,UHC,UHC,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,UHC MGG,UHC MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,VA,VA,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Wellcare MGG,Wellcare MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Bright Health - commercial,Bright Health - commercial,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Bright Health MGG,Bright Health MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna,Aetna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Aetna MGG,Aetna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS,BCBS,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,BCBS MGG,BCBS MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna,Cigna,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Cigna MGG,Cigna MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana,Humana,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Humana MGG,Humana MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Optum VA,Optum VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC,UHC,37.69,,,,,,,per diem,37.69,37.69,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,UHC MGG,UHC MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,VA,VA,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Wellcare MGG,Wellcare MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health - commercial,Bright Health - commercial,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,37.69,37.69,Bright Health MGG,Bright Health MGG,37.69,,,,,,,case rate,37.69,37.69,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Aetna,Aetna,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Aetna MGG,Aetna MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,BCBS,BCBS,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,BCBS MGG,BCBS MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Cigna,Cigna,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Cigna MGG,Cigna MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Humana,Humana,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Humana MGG,Humana MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Optum VA,Optum VA,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,UHC,UHC,34.29,,,,,,,per diem,34.29,34.29,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,UHC MGG,UHC MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,VA,VA,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Wellcare MGG,Wellcare MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Bright Health - commercial,Bright Health - commercial,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,34.29,34.29,Bright Health MGG,Bright Health MGG,34.29,,,,,,,case rate,34.29,34.29,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Aetna,Aetna,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Aetna MGG,Aetna MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,BCBS,BCBS,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,BCBS MGG,BCBS MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Cigna,Cigna,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Cigna MGG,Cigna MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Humana,Humana,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Humana MGG,Humana MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Optum VA,Optum VA,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,UHC,UHC,190,,,,,,,per diem,190,190,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,UHC MGG,UHC MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,VA,VA,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Wellcare MGG,Wellcare MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Bright Health - commercial,Bright Health - commercial,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,190,190,Bright Health MGG,Bright Health MGG,190,,,,,,,case rate,190,190,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Aetna,Aetna,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Aetna MGG,Aetna MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,BCBS,BCBS,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,BCBS MGG,BCBS MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Cigna,Cigna,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Cigna MGG,Cigna MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Humana,Humana,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Humana MGG,Humana MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Optum VA,Optum VA,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,UHC,UHC,45.8,,,,,,,per diem,45.8,45.8,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,UHC MGG,UHC MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,VA,VA,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Wellcare MGG,Wellcare MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Bright Health - commercial,Bright Health - commercial,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,45.8,45.8,Bright Health MGG,Bright Health MGG,45.8,,,,,,,case rate,45.8,45.8,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Aetna,Aetna,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Aetna MGG,Aetna MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,BCBS,BCBS,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,BCBS MGG,BCBS MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Cigna,Cigna,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Cigna MGG,Cigna MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Humana,Humana,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Humana MGG,Humana MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Optum VA,Optum VA,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,UHC,UHC,22.51,,,,,,,per diem,22.51,22.51,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,UHC MGG,UHC MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,VA,VA,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Wellcare MGG,Wellcare MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Bright Health - commercial,Bright Health - commercial,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,22.51,22.51,Bright Health MGG,Bright Health MGG,22.51,,,,,,,case rate,22.51,22.51,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Aetna,Aetna,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Aetna MGG,Aetna MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,BCBS,BCBS,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,BCBS MGG,BCBS MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Cigna,Cigna,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Cigna MGG,Cigna MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Humana,Humana,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Humana MGG,Humana MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Optum VA,Optum VA,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,UHC,UHC,4.98,,,,,,,per diem,4.98,4.98,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,UHC MGG,UHC MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,VA,VA,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Wellcare MGG,Wellcare MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Bright Health - commercial,Bright Health - commercial,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,4.98,4.98,Bright Health MGG,Bright Health MGG,4.98,,,,,,,case rate,4.98,4.98,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Aetna,Aetna,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Aetna MGG,Aetna MGG,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,BCBS,BCBS,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,BCBS MGG,BCBS MGG,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Cigna,Cigna,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Cigna MGG,Cigna MGG,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Humana,Humana,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Humana MGG,Humana MGG,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Optum VA,Optum VA,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,UHC,UHC,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,UHC MGG,UHC MGG,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,VA,VA,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Wellcare MGG,Wellcare MGG,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Bright Health - commercial,Bright Health - commercial,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,Bright Health MGG,Bright Health MGG,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Aetna,Aetna,62.03,,,,,,,per diem,62.03,62.03,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Aetna MGG,Aetna MGG,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,BCBS,BCBS,62.03,,,,,,,per diem,62.03,62.03,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,BCBS MGG,BCBS MGG,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Cigna,Cigna,62.03,,,,,,,per diem,62.03,62.03,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Cigna MGG,Cigna MGG,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Humana,Humana,62.03,,,,,,,per diem,62.03,62.03,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Humana MGG,Humana MGG,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Optum VA,Optum VA,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,UHC,UHC,62.03,,,,,,,per diem,62.03,62.03,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,UHC MGG,UHC MGG,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,VA,VA,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Wellcare MGG,Wellcare MGG,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Bright Health - commercial,Bright Health - commercial,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,62.03,62.03,Bright Health MGG,Bright Health MGG,62.03,,,,,,,case rate,62.03,62.03,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Aetna,Aetna,39.02,,,,,,,per diem,39.02,39.02,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Aetna MGG,Aetna MGG,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,BCBS,BCBS,39.02,,,,,,,per diem,39.02,39.02,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,BCBS MGG,BCBS MGG,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Cigna,Cigna,39.02,,,,,,,per diem,39.02,39.02,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Cigna MGG,Cigna MGG,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Humana,Humana,39.02,,,,,,,per diem,39.02,39.02,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Humana MGG,Humana MGG,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Optum VA,Optum VA,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,UHC,UHC,39.02,,,,,,,per diem,39.02,39.02,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,UHC MGG,UHC MGG,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,VA,VA,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Wellcare MGG,Wellcare MGG,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Bright Health - commercial,Bright Health - commercial,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,39.02,39.02,Bright Health MGG,Bright Health MGG,39.02,,,,,,,case rate,39.02,39.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Aetna,Aetna,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Aetna MGG,Aetna MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,BCBS,BCBS,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,BCBS MGG,BCBS MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Cigna,Cigna,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Cigna MGG,Cigna MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Humana,Humana,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Humana MGG,Humana MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Optum VA,Optum VA,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,UHC,UHC,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,UHC MGG,UHC MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,VA,VA,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Wellcare MGG,Wellcare MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Bright Health - commercial,Bright Health - commercial,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Bright Health MGG,Bright Health MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Aetna,Aetna,182.94,,,,,,,per diem,182.94,182.94,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Aetna MGG,Aetna MGG,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,BCBS,BCBS,182.94,,,,,,,per diem,182.94,182.94,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,BCBS MGG,BCBS MGG,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Cigna,Cigna,182.94,,,,,,,per diem,182.94,182.94,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Cigna MGG,Cigna MGG,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Humana,Humana,182.94,,,,,,,per diem,182.94,182.94,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Humana MGG,Humana MGG,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Optum VA,Optum VA,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,UHC,UHC,182.94,,,,,,,per diem,182.94,182.94,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,UHC MGG,UHC MGG,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,VA,VA,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Wellcare MGG,Wellcare MGG,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Bright Health - commercial,Bright Health - commercial,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,182.94,182.94,Bright Health MGG,Bright Health MGG,182.94,,,,,,,case rate,182.94,182.94,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Aetna,Aetna,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Aetna MGG,Aetna MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,BCBS,BCBS,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,BCBS MGG,BCBS MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Cigna,Cigna,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Cigna MGG,Cigna MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Humana,Humana,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Humana MGG,Humana MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Optum VA,Optum VA,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,UHC,UHC,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,UHC MGG,UHC MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,VA,VA,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Wellcare MGG,Wellcare MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Bright Health - commercial,Bright Health - commercial,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,21.99,21.99,Bright Health MGG,Bright Health MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Aetna,Aetna,244.69,,,,,,,per diem,244.69,244.69,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Aetna MGG,Aetna MGG,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,BCBS,BCBS,244.69,,,,,,,per diem,244.69,244.69,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,BCBS MGG,BCBS MGG,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Cigna,Cigna,244.69,,,,,,,per diem,244.69,244.69,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Cigna MGG,Cigna MGG,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Humana,Humana,244.69,,,,,,,per diem,244.69,244.69,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Humana MGG,Humana MGG,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Optum VA,Optum VA,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,UHC,UHC,244.69,,,,,,,per diem,244.69,244.69,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,UHC MGG,UHC MGG,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,VA,VA,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Wellcare MGG,Wellcare MGG,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Bright Health - commercial,Bright Health - commercial,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,244.69,244.69,Bright Health MGG,Bright Health MGG,244.69,,,,,,,case rate,244.69,244.69,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Aetna,Aetna,20.42,,,,,,,per diem,20.42,20.42,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Aetna MGG,Aetna MGG,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,BCBS,BCBS,20.42,,,,,,,per diem,20.42,20.42,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,BCBS MGG,BCBS MGG,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Cigna,Cigna,20.42,,,,,,,per diem,20.42,20.42,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Cigna MGG,Cigna MGG,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Humana,Humana,20.42,,,,,,,per diem,20.42,20.42,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Humana MGG,Humana MGG,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Optum VA,Optum VA,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,UHC,UHC,20.42,,,,,,,per diem,20.42,20.42,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,UHC MGG,UHC MGG,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,VA,VA,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Wellcare MGG,Wellcare MGG,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Bright Health - commercial,Bright Health - commercial,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,20.42,20.42,Bright Health MGG,Bright Health MGG,20.42,,,,,,,case rate,20.42,20.42,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Aetna,Aetna,146.29,,,,,,,per diem,146.29,146.29,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Aetna MGG,Aetna MGG,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,BCBS,BCBS,146.29,,,,,,,per diem,146.29,146.29,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,BCBS MGG,BCBS MGG,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Cigna,Cigna,146.29,,,,,,,per diem,146.29,146.29,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Cigna MGG,Cigna MGG,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Humana,Humana,146.29,,,,,,,per diem,146.29,146.29,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Humana MGG,Humana MGG,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Optum VA,Optum VA,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,UHC,UHC,146.29,,,,,,,per diem,146.29,146.29,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,UHC MGG,UHC MGG,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,VA,VA,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Wellcare MGG,Wellcare MGG,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Bright Health - commercial,Bright Health - commercial,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,146.29,146.29,Bright Health MGG,Bright Health MGG,146.29,,,,,,,case rate,146.29,146.29,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Aetna,Aetna,230.3,,,,,,,per diem,230.3,230.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Aetna MGG,Aetna MGG,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,BCBS,BCBS,230.3,,,,,,,per diem,230.3,230.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,BCBS MGG,BCBS MGG,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Cigna,Cigna,230.3,,,,,,,per diem,230.3,230.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Cigna MGG,Cigna MGG,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Humana,Humana,230.3,,,,,,,per diem,230.3,230.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Humana MGG,Humana MGG,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Optum VA,Optum VA,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,UHC,UHC,230.3,,,,,,,per diem,230.3,230.3,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,UHC MGG,UHC MGG,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,VA,VA,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Wellcare MGG,Wellcare MGG,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Bright Health - commercial,Bright Health - commercial,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,230.3,230.3,Bright Health MGG,Bright Health MGG,230.3,,,,,,,case rate,230.3,230.3,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Aetna,Aetna,91.33,,,,,,,per diem,91.33,91.33,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Aetna MGG,Aetna MGG,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,BCBS,BCBS,91.33,,,,,,,per diem,91.33,91.33,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,BCBS MGG,BCBS MGG,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Cigna,Cigna,91.33,,,,,,,per diem,91.33,91.33,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Cigna MGG,Cigna MGG,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Humana,Humana,91.33,,,,,,,per diem,91.33,91.33,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Humana MGG,Humana MGG,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Optum VA,Optum VA,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,UHC,UHC,91.33,,,,,,,per diem,91.33,91.33,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,UHC MGG,UHC MGG,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,VA,VA,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Wellcare MGG,Wellcare MGG,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Bright Health - commercial,Bright Health - commercial,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,91.33,91.33,Bright Health MGG,Bright Health MGG,91.33,,,,,,,case rate,91.33,91.33,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Aetna,Aetna,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Aetna MGG,Aetna MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,BCBS,BCBS,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,BCBS MGG,BCBS MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Cigna,Cigna,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Cigna MGG,Cigna MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Humana,Humana,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Humana MGG,Humana MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Optum VA,Optum VA,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,UHC,UHC,73.02,,,,,,,per diem,73.02,73.02,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,UHC MGG,UHC MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,VA,VA,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Wellcare MGG,Wellcare MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Bright Health - commercial,Bright Health - commercial,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,73.02,73.02,Bright Health MGG,Bright Health MGG,73.02,,,,,,,case rate,73.02,73.02,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Aetna,Aetna,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Aetna MGG,Aetna MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,BCBS,BCBS,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,BCBS MGG,BCBS MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Cigna,Cigna,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Cigna MGG,Cigna MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Humana,Humana,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Humana MGG,Humana MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Optum VA,Optum VA,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,UHC,UHC,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,UHC MGG,UHC MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,VA,VA,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Wellcare MGG,Wellcare MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Bright Health - commercial,Bright Health - commercial,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,127.98,127.98,Bright Health MGG,Bright Health MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Aetna,Aetna,18.32,,,,,,,per diem,18.32,18.32,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Aetna MGG,Aetna MGG,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,BCBS,BCBS,18.32,,,,,,,per diem,18.32,18.32,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,BCBS MGG,BCBS MGG,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Cigna,Cigna,18.32,,,,,,,per diem,18.32,18.32,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Cigna MGG,Cigna MGG,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Humana,Humana,18.32,,,,,,,per diem,18.32,18.32,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Humana MGG,Humana MGG,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Optum VA,Optum VA,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,UHC,UHC,18.32,,,,,,,per diem,18.32,18.32,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,UHC MGG,UHC MGG,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,VA,VA,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Wellcare MGG,Wellcare MGG,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Bright Health - commercial,Bright Health - commercial,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,18.32,18.32,Bright Health MGG,Bright Health MGG,18.32,,,,,,,case rate,18.32,18.32,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Aetna,Aetna,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Aetna MGG,Aetna MGG,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,BCBS,BCBS,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,BCBS MGG,BCBS MGG,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Cigna,Cigna,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Cigna MGG,Cigna MGG,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Humana,Humana,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Humana MGG,Humana MGG,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Optum VA,Optum VA,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,UHC,UHC,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,UHC MGG,UHC MGG,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,VA,VA,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Wellcare MGG,Wellcare MGG,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Bright Health - commercial,Bright Health - commercial,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,35.81,35.81,Bright Health MGG,Bright Health MGG,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Aetna,Aetna,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Aetna MGG,Aetna MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,BCBS,BCBS,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,BCBS MGG,BCBS MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Cigna,Cigna,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Cigna MGG,Cigna MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Humana,Humana,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Humana MGG,Humana MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Optum VA,Optum VA,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,UHC,UHC,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,UHC MGG,UHC MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,VA,VA,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Wellcare MGG,Wellcare MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Bright Health - commercial,Bright Health - commercial,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Bright Health MGG,Bright Health MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Aetna,Aetna,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Aetna MGG,Aetna MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,BCBS,BCBS,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,BCBS MGG,BCBS MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Cigna,Cigna,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Cigna MGG,Cigna MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Humana,Humana,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Humana MGG,Humana MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Optum VA,Optum VA,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,UHC,UHC,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,UHC MGG,UHC MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,VA,VA,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Wellcare MGG,Wellcare MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Bright Health - commercial,Bright Health - commercial,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,6.89,6.89,Bright Health MGG,Bright Health MGG,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Aetna,Aetna,121.62,,,,,,,per diem,121.62,121.62,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Aetna MGG,Aetna MGG,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,BCBS,BCBS,121.62,,,,,,,per diem,121.62,121.62,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,BCBS MGG,BCBS MGG,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Cigna,Cigna,121.62,,,,,,,per diem,121.62,121.62,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Cigna MGG,Cigna MGG,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Humana,Humana,121.62,,,,,,,per diem,121.62,121.62,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Humana MGG,Humana MGG,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Optum VA,Optum VA,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,UHC,UHC,121.62,,,,,,,per diem,121.62,121.62,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,UHC MGG,UHC MGG,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,VA,VA,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Wellcare MGG,Wellcare MGG,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Bright Health - commercial,Bright Health - commercial,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,121.62,121.62,Bright Health MGG,Bright Health MGG,121.62,,,,,,,case rate,121.62,121.62,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Aetna,Aetna,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Aetna MGG,Aetna MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,BCBS,BCBS,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,BCBS MGG,BCBS MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Cigna,Cigna,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Cigna MGG,Cigna MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Humana,Humana,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Humana MGG,Humana MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Optum VA,Optum VA,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,UHC,UHC,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,UHC MGG,UHC MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,VA,VA,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Wellcare MGG,Wellcare MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Bright Health - commercial,Bright Health - commercial,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.3,9.3,Bright Health MGG,Bright Health MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Aetna,Aetna,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Aetna MGG,Aetna MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,BCBS,BCBS,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,BCBS MGG,BCBS MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Cigna,Cigna,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Cigna MGG,Cigna MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Humana,Humana,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Humana MGG,Humana MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Optum VA,Optum VA,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,UHC,UHC,17.54,,,,,,,per diem,17.54,17.54,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,UHC MGG,UHC MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,VA,VA,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Wellcare MGG,Wellcare MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Bright Health - commercial,Bright Health - commercial,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,17.54,17.54,Bright Health MGG,Bright Health MGG,17.54,,,,,,,case rate,17.54,17.54,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna,Aetna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna MGG,Aetna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS,BCBS,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS MGG,BCBS MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna,Cigna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna MGG,Cigna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana,Humana,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana MGG,Humana MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Optum VA,Optum VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC,UHC,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC MGG,UHC MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,VA,VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Wellcare MGG,Wellcare MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health - commercial,Bright Health - commercial,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health MGG,Bright Health MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Aetna,Aetna,3336,,,,,,,per diem,3336,3336,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Aetna MGG,Aetna MGG,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,BCBS,BCBS,3336,,,,,,,per diem,3336,3336,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,BCBS MGG,BCBS MGG,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Cigna,Cigna,3336,,,,,,,per diem,3336,3336,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Cigna MGG,Cigna MGG,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Humana,Humana,3336,,,,,,,per diem,3336,3336,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Humana MGG,Humana MGG,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Optum VA,Optum VA,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,UHC,UHC,3336,,,,,,,per diem,3336,3336,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,UHC MGG,UHC MGG,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,VA,VA,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Wellcare MGG,Wellcare MGG,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Bright Health - commercial,Bright Health - commercial,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3336,3336,Bright Health MGG,Bright Health MGG,3336,,,,,,,case rate,3336,3336,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Aetna,Aetna,58,,,,,,,per diem,58,58,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Aetna MGG,Aetna MGG,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,BCBS,BCBS,58,,,,,,,per diem,58,58,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,BCBS MGG,BCBS MGG,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Cigna,Cigna,58,,,,,,,per diem,58,58,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Cigna MGG,Cigna MGG,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Humana,Humana,58,,,,,,,per diem,58,58,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Humana MGG,Humana MGG,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Optum VA,Optum VA,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,UHC,UHC,58,,,,,,,per diem,58,58,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,UHC MGG,UHC MGG,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,VA,VA,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Wellcare MGG,Wellcare MGG,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Bright Health - commercial,Bright Health - commercial,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,58,58,Bright Health MGG,Bright Health MGG,58,,,,,,,case rate,58,58,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Aetna,Aetna,48.36,,,,,,,per diem,48.36,48.36,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Aetna MGG,Aetna MGG,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,BCBS,BCBS,48.36,,,,,,,per diem,48.36,48.36,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,BCBS MGG,BCBS MGG,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Cigna,Cigna,48.36,,,,,,,per diem,48.36,48.36,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Cigna MGG,Cigna MGG,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Humana,Humana,48.36,,,,,,,per diem,48.36,48.36,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Humana MGG,Humana MGG,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Optum VA,Optum VA,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,UHC,UHC,48.36,,,,,,,per diem,48.36,48.36,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,UHC MGG,UHC MGG,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,VA,VA,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Wellcare MGG,Wellcare MGG,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Bright Health - commercial,Bright Health - commercial,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,48.36,48.36,Bright Health MGG,Bright Health MGG,48.36,,,,,,,case rate,48.36,48.36,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Aetna,Aetna,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Aetna MGG,Aetna MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,BCBS,BCBS,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,BCBS MGG,BCBS MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Cigna,Cigna,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Cigna MGG,Cigna MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Humana,Humana,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Humana MGG,Humana MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Optum VA,Optum VA,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,UHC,UHC,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,UHC MGG,UHC MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,VA,VA,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Wellcare MGG,Wellcare MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Bright Health - commercial,Bright Health - commercial,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Bright Health MGG,Bright Health MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna,Aetna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna MGG,Aetna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS,BCBS,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS MGG,BCBS MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna,Cigna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna MGG,Cigna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana,Humana,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana MGG,Humana MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Optum VA,Optum VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC,UHC,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC MGG,UHC MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,VA,VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Wellcare MGG,Wellcare MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health - commercial,Bright Health - commercial,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health MGG,Bright Health MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Aetna,Aetna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Aetna MGG,Aetna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,BCBS,BCBS,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,BCBS MGG,BCBS MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Cigna,Cigna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Cigna MGG,Cigna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Humana,Humana,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Humana MGG,Humana MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Optum VA,Optum VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,UHC,UHC,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,UHC MGG,UHC MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,VA,VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Wellcare MGG,Wellcare MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Bright Health - commercial,Bright Health - commercial,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,60,60,Bright Health MGG,Bright Health MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Aetna,Aetna,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Aetna MGG,Aetna MGG,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,BCBS,BCBS,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,BCBS MGG,BCBS MGG,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Cigna,Cigna,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Cigna MGG,Cigna MGG,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Humana,Humana,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Humana MGG,Humana MGG,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Optum VA,Optum VA,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,UHC,UHC,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,UHC MGG,UHC MGG,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,VA,VA,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Wellcare MGG,Wellcare MGG,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Bright Health - commercial,Bright Health - commercial,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,6.13,6.13,Bright Health MGG,Bright Health MGG,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna,Aetna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna MGG,Aetna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS,BCBS,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS MGG,BCBS MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna,Cigna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna MGG,Cigna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana,Humana,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana MGG,Humana MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Optum VA,Optum VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC,UHC,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC MGG,UHC MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,VA,VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Wellcare MGG,Wellcare MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health - commercial,Bright Health - commercial,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health MGG,Bright Health MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Aetna,Aetna,46.25,,,,,,,per diem,46.25,46.25,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Aetna MGG,Aetna MGG,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,BCBS,BCBS,46.25,,,,,,,per diem,46.25,46.25,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,BCBS MGG,BCBS MGG,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Cigna,Cigna,46.25,,,,,,,per diem,46.25,46.25,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Cigna MGG,Cigna MGG,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Humana,Humana,46.25,,,,,,,per diem,46.25,46.25,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Humana MGG,Humana MGG,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Optum VA,Optum VA,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,UHC,UHC,46.25,,,,,,,per diem,46.25,46.25,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,UHC MGG,UHC MGG,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,VA,VA,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Wellcare MGG,Wellcare MGG,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Bright Health - commercial,Bright Health - commercial,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,46.25,46.25,Bright Health MGG,Bright Health MGG,46.25,,,,,,,case rate,46.25,46.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Aetna,Aetna,538.25,,,,,,,per diem,538.25,538.25,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Aetna MGG,Aetna MGG,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,BCBS,BCBS,538.25,,,,,,,per diem,538.25,538.25,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,BCBS MGG,BCBS MGG,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Cigna,Cigna,538.25,,,,,,,per diem,538.25,538.25,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Cigna MGG,Cigna MGG,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Humana,Humana,538.25,,,,,,,per diem,538.25,538.25,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Humana MGG,Humana MGG,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Optum VA,Optum VA,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,UHC,UHC,538.25,,,,,,,per diem,538.25,538.25,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,UHC MGG,UHC MGG,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,VA,VA,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Wellcare MGG,Wellcare MGG,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Bright Health - commercial,Bright Health - commercial,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,538.25,538.25,Bright Health MGG,Bright Health MGG,538.25,,,,,,,case rate,538.25,538.25,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna,Aetna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna MGG,Aetna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS,BCBS,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS MGG,BCBS MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna,Cigna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna MGG,Cigna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana,Humana,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana MGG,Humana MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Optum VA,Optum VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC,UHC,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC MGG,UHC MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,VA,VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Wellcare MGG,Wellcare MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health - commercial,Bright Health - commercial,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health MGG,Bright Health MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Aetna,Aetna,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Aetna MGG,Aetna MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,BCBS,BCBS,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,BCBS MGG,BCBS MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Cigna,Cigna,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Cigna MGG,Cigna MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Humana,Humana,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Humana MGG,Humana MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Optum VA,Optum VA,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,UHC,UHC,165.75,,,,,,,per diem,165.75,165.75,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,UHC MGG,UHC MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,VA,VA,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Wellcare MGG,Wellcare MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Bright Health - commercial,Bright Health - commercial,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,165.75,165.75,Bright Health MGG,Bright Health MGG,165.75,,,,,,,case rate,165.75,165.75,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna,Aetna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna MGG,Aetna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS,BCBS,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS MGG,BCBS MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna,Cigna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna MGG,Cigna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana,Humana,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana MGG,Humana MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Optum VA,Optum VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC,UHC,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC MGG,UHC MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,VA,VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Wellcare MGG,Wellcare MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health - commercial,Bright Health - commercial,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health MGG,Bright Health MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna,Aetna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna MGG,Aetna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS,BCBS,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS MGG,BCBS MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna,Cigna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna MGG,Cigna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana,Humana,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana MGG,Humana MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Optum VA,Optum VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC,UHC,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC MGG,UHC MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,VA,VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Wellcare MGG,Wellcare MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health - commercial,Bright Health - commercial,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health MGG,Bright Health MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Aetna,Aetna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Aetna MGG,Aetna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,BCBS,BCBS,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,BCBS MGG,BCBS MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Cigna,Cigna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Cigna MGG,Cigna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Humana,Humana,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Humana MGG,Humana MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Optum VA,Optum VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,UHC,UHC,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,UHC MGG,UHC MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,VA,VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Wellcare MGG,Wellcare MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Bright Health - commercial,Bright Health - commercial,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,60,60,Bright Health MGG,Bright Health MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Aetna,Aetna,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Aetna MGG,Aetna MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,BCBS,BCBS,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,BCBS MGG,BCBS MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Cigna,Cigna,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Cigna MGG,Cigna MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Humana,Humana,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Humana MGG,Humana MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Optum VA,Optum VA,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,UHC,UHC,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,UHC MGG,UHC MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,VA,VA,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Wellcare MGG,Wellcare MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Bright Health - commercial,Bright Health - commercial,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,11.07,11.07,Bright Health MGG,Bright Health MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna,Aetna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna MGG,Aetna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS,BCBS,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS MGG,BCBS MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna,Cigna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna MGG,Cigna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana,Humana,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana MGG,Humana MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Optum VA,Optum VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC,UHC,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC MGG,UHC MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,VA,VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Wellcare MGG,Wellcare MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health - commercial,Bright Health - commercial,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health MGG,Bright Health MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Aetna,Aetna,181.8,,,,,,,per diem,181.8,181.8,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Aetna MGG,Aetna MGG,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,BCBS,BCBS,181.8,,,,,,,per diem,181.8,181.8,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,BCBS MGG,BCBS MGG,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Cigna,Cigna,181.8,,,,,,,per diem,181.8,181.8,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Cigna MGG,Cigna MGG,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Humana,Humana,181.8,,,,,,,per diem,181.8,181.8,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Humana MGG,Humana MGG,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Optum VA,Optum VA,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,UHC,UHC,181.8,,,,,,,per diem,181.8,181.8,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,UHC MGG,UHC MGG,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,VA,VA,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Wellcare MGG,Wellcare MGG,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Bright Health - commercial,Bright Health - commercial,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,181.8,181.8,Bright Health MGG,Bright Health MGG,181.8,,,,,,,case rate,181.8,181.8,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna,Aetna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna MGG,Aetna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS,BCBS,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS MGG,BCBS MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna,Cigna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna MGG,Cigna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana,Humana,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana MGG,Humana MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Optum VA,Optum VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC,UHC,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC MGG,UHC MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,VA,VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Wellcare MGG,Wellcare MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health - commercial,Bright Health - commercial,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health MGG,Bright Health MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna,Aetna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna MGG,Aetna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS,BCBS,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS MGG,BCBS MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna,Cigna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna MGG,Cigna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana,Humana,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana MGG,Humana MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Optum VA,Optum VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC,UHC,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC MGG,UHC MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,VA,VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Wellcare MGG,Wellcare MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health - commercial,Bright Health - commercial,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health MGG,Bright Health MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna,Aetna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna MGG,Aetna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS,BCBS,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS MGG,BCBS MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna,Cigna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna MGG,Cigna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana,Humana,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana MGG,Humana MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Optum VA,Optum VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC,UHC,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC MGG,UHC MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,VA,VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Wellcare MGG,Wellcare MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health - commercial,Bright Health - commercial,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health MGG,Bright Health MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna,Aetna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna MGG,Aetna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS,BCBS,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS MGG,BCBS MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna,Cigna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna MGG,Cigna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana,Humana,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana MGG,Humana MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Optum VA,Optum VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC,UHC,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC MGG,UHC MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,VA,VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Wellcare MGG,Wellcare MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health - commercial,Bright Health - commercial,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health MGG,Bright Health MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna,Aetna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Aetna MGG,Aetna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS,BCBS,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,BCBS MGG,BCBS MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna,Cigna,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Cigna MGG,Cigna MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana,Humana,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Humana MGG,Humana MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Optum VA,Optum VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC,UHC,92.25,,,,,,,per diem,92.25,92.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,UHC MGG,UHC MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,VA,VA,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Wellcare MGG,Wellcare MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health - commercial,Bright Health - commercial,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,92.25,92.25,Bright Health MGG,Bright Health MGG,92.25,,,,,,,case rate,92.25,92.25,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Aetna,Aetna,138.5,,,,,,,per diem,138.5,138.5,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Aetna MGG,Aetna MGG,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,BCBS,BCBS,138.5,,,,,,,per diem,138.5,138.5,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,BCBS MGG,BCBS MGG,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Cigna,Cigna,138.5,,,,,,,per diem,138.5,138.5,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Cigna MGG,Cigna MGG,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Humana,Humana,138.5,,,,,,,per diem,138.5,138.5,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Humana MGG,Humana MGG,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Optum VA,Optum VA,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,UHC,UHC,138.5,,,,,,,per diem,138.5,138.5,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,UHC MGG,UHC MGG,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,VA,VA,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Wellcare MGG,Wellcare MGG,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Bright Health - commercial,Bright Health - commercial,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,138.5,138.5,Bright Health MGG,Bright Health MGG,138.5,,,,,,,case rate,138.5,138.5,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Aetna,Aetna,123,,,,,,,per diem,123,123,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Aetna MGG,Aetna MGG,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,BCBS,BCBS,123,,,,,,,per diem,123,123,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,BCBS MGG,BCBS MGG,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Cigna,Cigna,123,,,,,,,per diem,123,123,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Cigna MGG,Cigna MGG,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Humana,Humana,123,,,,,,,per diem,123,123,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Humana MGG,Humana MGG,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Optum VA,Optum VA,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,UHC,UHC,123,,,,,,,per diem,123,123,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,UHC MGG,UHC MGG,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,VA,VA,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Wellcare MGG,Wellcare MGG,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Bright Health - commercial,Bright Health - commercial,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,123,123,Bright Health MGG,Bright Health MGG,123,,,,,,,case rate,123,123,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Aetna,Aetna,1076.25,,,,,,,per diem,1076.25,1076.25,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Aetna MGG,Aetna MGG,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,BCBS,BCBS,1076.25,,,,,,,per diem,1076.25,1076.25,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,BCBS MGG,BCBS MGG,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Cigna,Cigna,1076.25,,,,,,,per diem,1076.25,1076.25,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Cigna MGG,Cigna MGG,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Humana,Humana,1076.25,,,,,,,per diem,1076.25,1076.25,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Humana MGG,Humana MGG,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Optum VA,Optum VA,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,UHC,UHC,1076.25,,,,,,,per diem,1076.25,1076.25,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,UHC MGG,UHC MGG,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,VA,VA,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Wellcare MGG,Wellcare MGG,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Bright Health - commercial,Bright Health - commercial,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1076.25,1076.25,Bright Health MGG,Bright Health MGG,1076.25,,,,,,,case rate,1076.25,1076.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Aetna,Aetna,44.25,,,,,,,per diem,44.25,44.25,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Aetna MGG,Aetna MGG,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,BCBS,BCBS,44.25,,,,,,,per diem,44.25,44.25,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,BCBS MGG,BCBS MGG,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Cigna,Cigna,44.25,,,,,,,per diem,44.25,44.25,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Cigna MGG,Cigna MGG,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Humana,Humana,44.25,,,,,,,per diem,44.25,44.25,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Humana MGG,Humana MGG,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Optum VA,Optum VA,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,UHC,UHC,44.25,,,,,,,per diem,44.25,44.25,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,UHC MGG,UHC MGG,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,VA,VA,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Wellcare MGG,Wellcare MGG,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Bright Health - commercial,Bright Health - commercial,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,44.25,44.25,Bright Health MGG,Bright Health MGG,44.25,,,,,,,case rate,44.25,44.25,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Aetna,Aetna,94.75,,,,,,,per diem,94.75,94.75,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Aetna MGG,Aetna MGG,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,BCBS,BCBS,94.75,,,,,,,per diem,94.75,94.75,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,BCBS MGG,BCBS MGG,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Cigna,Cigna,94.75,,,,,,,per diem,94.75,94.75,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Cigna MGG,Cigna MGG,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Humana,Humana,94.75,,,,,,,per diem,94.75,94.75,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Humana MGG,Humana MGG,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Optum VA,Optum VA,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,UHC,UHC,94.75,,,,,,,per diem,94.75,94.75,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,UHC MGG,UHC MGG,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,VA,VA,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Wellcare MGG,Wellcare MGG,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Bright Health - commercial,Bright Health - commercial,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,94.75,94.75,Bright Health MGG,Bright Health MGG,94.75,,,,,,,case rate,94.75,94.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Aetna,Aetna,2.75,,,,,,,per diem,2.75,2.75,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Aetna MGG,Aetna MGG,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,BCBS,BCBS,2.75,,,,,,,per diem,2.75,2.75,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,BCBS MGG,BCBS MGG,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Cigna,Cigna,2.75,,,,,,,per diem,2.75,2.75,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Cigna MGG,Cigna MGG,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Humana,Humana,2.75,,,,,,,per diem,2.75,2.75,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Humana MGG,Humana MGG,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Optum VA,Optum VA,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,UHC,UHC,2.75,,,,,,,per diem,2.75,2.75,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,UHC MGG,UHC MGG,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,VA,VA,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Wellcare MGG,Wellcare MGG,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Bright Health - commercial,Bright Health - commercial,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.75,2.75,Bright Health MGG,Bright Health MGG,2.75,,,,,,,case rate,2.75,2.75,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Aetna,Aetna,170.25,,,,,,,per diem,170.25,170.25,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Aetna MGG,Aetna MGG,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,BCBS,BCBS,170.25,,,,,,,per diem,170.25,170.25,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,BCBS MGG,BCBS MGG,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Cigna,Cigna,170.25,,,,,,,per diem,170.25,170.25,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Cigna MGG,Cigna MGG,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Humana,Humana,170.25,,,,,,,per diem,170.25,170.25,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Humana MGG,Humana MGG,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Optum VA,Optum VA,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,UHC,UHC,170.25,,,,,,,per diem,170.25,170.25,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,UHC MGG,UHC MGG,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,VA,VA,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Wellcare MGG,Wellcare MGG,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Bright Health - commercial,Bright Health - commercial,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,170.25,170.25,Bright Health MGG,Bright Health MGG,170.25,,,,,,,case rate,170.25,170.25,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Aetna,Aetna,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Aetna MGG,Aetna MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,BCBS,BCBS,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,BCBS MGG,BCBS MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Cigna,Cigna,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Cigna MGG,Cigna MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Humana,Humana,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Humana MGG,Humana MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Optum VA,Optum VA,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,UHC,UHC,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,UHC MGG,UHC MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,VA,VA,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Wellcare MGG,Wellcare MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Bright Health - commercial,Bright Health - commercial,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,28.3,28.3,Bright Health MGG,Bright Health MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Aetna,Aetna,89.95,,,,,,,per diem,89.95,89.95,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Aetna MGG,Aetna MGG,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,BCBS,BCBS,89.95,,,,,,,per diem,89.95,89.95,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,BCBS MGG,BCBS MGG,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Cigna,Cigna,89.95,,,,,,,per diem,89.95,89.95,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Cigna MGG,Cigna MGG,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Humana,Humana,89.95,,,,,,,per diem,89.95,89.95,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Humana MGG,Humana MGG,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Optum VA,Optum VA,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,UHC,UHC,89.95,,,,,,,per diem,89.95,89.95,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,UHC MGG,UHC MGG,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,VA,VA,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Wellcare MGG,Wellcare MGG,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Bright Health - commercial,Bright Health - commercial,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,89.95,89.95,Bright Health MGG,Bright Health MGG,89.95,,,,,,,case rate,89.95,89.95,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Aetna,Aetna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Aetna MGG,Aetna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,BCBS,BCBS,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,BCBS MGG,BCBS MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Cigna,Cigna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Cigna MGG,Cigna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Humana,Humana,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Humana MGG,Humana MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Optum VA,Optum VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,UHC,UHC,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,UHC MGG,UHC MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,VA,VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Wellcare MGG,Wellcare MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Bright Health - commercial,Bright Health - commercial,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15,15,Bright Health MGG,Bright Health MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Aetna,Aetna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Aetna MGG,Aetna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,BCBS,BCBS,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,BCBS MGG,BCBS MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Cigna,Cigna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Cigna MGG,Cigna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Humana,Humana,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Humana MGG,Humana MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Optum VA,Optum VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,UHC,UHC,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,UHC MGG,UHC MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,VA,VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Wellcare MGG,Wellcare MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Bright Health - commercial,Bright Health - commercial,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,30,30,Bright Health MGG,Bright Health MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Aetna,Aetna,1050,,,,,,,per diem,1050,1050,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Aetna MGG,Aetna MGG,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,BCBS,BCBS,1050,,,,,,,per diem,1050,1050,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,BCBS MGG,BCBS MGG,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Cigna,Cigna,1050,,,,,,,per diem,1050,1050,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Cigna MGG,Cigna MGG,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Humana,Humana,1050,,,,,,,per diem,1050,1050,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Humana MGG,Humana MGG,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Optum VA,Optum VA,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,UHC,UHC,1050,,,,,,,per diem,1050,1050,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,UHC MGG,UHC MGG,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,VA,VA,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Wellcare MGG,Wellcare MGG,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Bright Health - commercial,Bright Health - commercial,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1050,1050,Bright Health MGG,Bright Health MGG,1050,,,,,,,case rate,1050,1050,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna,Aetna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna MGG,Aetna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS,BCBS,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS MGG,BCBS MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna,Cigna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna MGG,Cigna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana,Humana,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana MGG,Humana MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Optum VA,Optum VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC,UHC,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC MGG,UHC MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,VA,VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Wellcare MGG,Wellcare MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health - commercial,Bright Health - commercial,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health MGG,Bright Health MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Aetna,Aetna,33,,,,,,,per diem,33,33,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Aetna MGG,Aetna MGG,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,BCBS,BCBS,33,,,,,,,per diem,33,33,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,BCBS MGG,BCBS MGG,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Cigna,Cigna,33,,,,,,,per diem,33,33,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Cigna MGG,Cigna MGG,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Humana,Humana,33,,,,,,,per diem,33,33,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Humana MGG,Humana MGG,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Optum VA,Optum VA,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,UHC,UHC,33,,,,,,,per diem,33,33,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,UHC MGG,UHC MGG,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,VA,VA,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Wellcare MGG,Wellcare MGG,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Bright Health - commercial,Bright Health - commercial,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,33,33,Bright Health MGG,Bright Health MGG,33,,,,,,,case rate,33,33,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Aetna,Aetna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Aetna MGG,Aetna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,BCBS,BCBS,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,BCBS MGG,BCBS MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Cigna,Cigna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Cigna MGG,Cigna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Humana,Humana,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Humana MGG,Humana MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Optum VA,Optum VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,UHC,UHC,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,UHC MGG,UHC MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,VA,VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Wellcare MGG,Wellcare MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Bright Health - commercial,Bright Health - commercial,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,60,60,Bright Health MGG,Bright Health MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Aetna,Aetna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Aetna MGG,Aetna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,BCBS,BCBS,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,BCBS MGG,BCBS MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Cigna,Cigna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Cigna MGG,Cigna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Humana,Humana,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Humana MGG,Humana MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Optum VA,Optum VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,UHC,UHC,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,UHC MGG,UHC MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,VA,VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Wellcare MGG,Wellcare MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Bright Health - commercial,Bright Health - commercial,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,180,180,Bright Health MGG,Bright Health MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Aetna,Aetna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Aetna MGG,Aetna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,BCBS,BCBS,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,BCBS MGG,BCBS MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Cigna,Cigna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Cigna MGG,Cigna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Humana,Humana,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Humana MGG,Humana MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Optum VA,Optum VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,UHC,UHC,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,UHC MGG,UHC MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,VA,VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Wellcare MGG,Wellcare MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Bright Health - commercial,Bright Health - commercial,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,60,60,Bright Health MGG,Bright Health MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Aetna,Aetna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Aetna MGG,Aetna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,BCBS,BCBS,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,BCBS MGG,BCBS MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Cigna,Cigna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Cigna MGG,Cigna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Humana,Humana,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Humana MGG,Humana MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Optum VA,Optum VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,UHC,UHC,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,UHC MGG,UHC MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,VA,VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Wellcare MGG,Wellcare MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Bright Health - commercial,Bright Health - commercial,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,180,180,Bright Health MGG,Bright Health MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna,Aetna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna MGG,Aetna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS,BCBS,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS MGG,BCBS MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna,Cigna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna MGG,Cigna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana,Humana,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana MGG,Humana MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Optum VA,Optum VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC,UHC,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC MGG,UHC MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,VA,VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Wellcare MGG,Wellcare MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health - commercial,Bright Health - commercial,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health MGG,Bright Health MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna,Aetna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna MGG,Aetna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS,BCBS,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS MGG,BCBS MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna,Cigna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna MGG,Cigna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana,Humana,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana MGG,Humana MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Optum VA,Optum VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC,UHC,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC MGG,UHC MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,VA,VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Wellcare MGG,Wellcare MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health - commercial,Bright Health - commercial,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health MGG,Bright Health MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna,Aetna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Aetna MGG,Aetna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS,BCBS,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,BCBS MGG,BCBS MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna,Cigna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Cigna MGG,Cigna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana,Humana,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Humana MGG,Humana MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Optum VA,Optum VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC,UHC,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,UHC MGG,UHC MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,VA,VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Wellcare MGG,Wellcare MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health - commercial,Bright Health - commercial,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,75,75,Bright Health MGG,Bright Health MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Aetna,Aetna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Aetna MGG,Aetna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,BCBS,BCBS,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,BCBS MGG,BCBS MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Cigna,Cigna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Cigna MGG,Cigna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Humana,Humana,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Humana MGG,Humana MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Optum VA,Optum VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,UHC,UHC,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,UHC MGG,UHC MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,VA,VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Wellcare MGG,Wellcare MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Bright Health - commercial,Bright Health - commercial,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,180,180,Bright Health MGG,Bright Health MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna,Aetna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna MGG,Aetna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS,BCBS,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS MGG,BCBS MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna,Cigna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna MGG,Cigna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana,Humana,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana MGG,Humana MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Optum VA,Optum VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC,UHC,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC MGG,UHC MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,VA,VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Wellcare MGG,Wellcare MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health - commercial,Bright Health - commercial,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health MGG,Bright Health MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna,Aetna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna MGG,Aetna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS,BCBS,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS MGG,BCBS MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna,Cigna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna MGG,Cigna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana,Humana,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana MGG,Humana MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Optum VA,Optum VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC,UHC,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC MGG,UHC MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,VA,VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Wellcare MGG,Wellcare MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health - commercial,Bright Health - commercial,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health MGG,Bright Health MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Aetna,Aetna,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Aetna MGG,Aetna MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,BCBS,BCBS,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,BCBS MGG,BCBS MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Cigna,Cigna,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Cigna MGG,Cigna MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Humana,Humana,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Humana MGG,Humana MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Optum VA,Optum VA,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,UHC,UHC,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,UHC MGG,UHC MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,VA,VA,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Wellcare MGG,Wellcare MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Bright Health - commercial,Bright Health - commercial,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,20,20,Bright Health MGG,Bright Health MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Aetna,Aetna,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Aetna MGG,Aetna MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,BCBS,BCBS,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,BCBS MGG,BCBS MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Cigna,Cigna,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Cigna MGG,Cigna MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Humana,Humana,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Humana MGG,Humana MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Optum VA,Optum VA,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,UHC,UHC,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,UHC MGG,UHC MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,VA,VA,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Wellcare MGG,Wellcare MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Bright Health - commercial,Bright Health - commercial,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,20,20,Bright Health MGG,Bright Health MGG,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Aetna,Aetna,85,,,,,,,per diem,85,85,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Aetna MGG,Aetna MGG,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,BCBS,BCBS,85,,,,,,,per diem,85,85,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,BCBS MGG,BCBS MGG,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Cigna,Cigna,85,,,,,,,per diem,85,85,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Cigna MGG,Cigna MGG,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Humana,Humana,85,,,,,,,per diem,85,85,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Humana MGG,Humana MGG,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Optum VA,Optum VA,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,UHC,UHC,85,,,,,,,per diem,85,85,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,UHC MGG,UHC MGG,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,VA,VA,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Wellcare MGG,Wellcare MGG,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Bright Health - commercial,Bright Health - commercial,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,85,85,Bright Health MGG,Bright Health MGG,85,,,,,,,case rate,85,85,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Aetna,Aetna,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Aetna MGG,Aetna MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,BCBS,BCBS,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,BCBS MGG,BCBS MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Cigna,Cigna,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Cigna MGG,Cigna MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Humana,Humana,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Humana MGG,Humana MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Optum VA,Optum VA,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,UHC,UHC,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,UHC MGG,UHC MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,VA,VA,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Wellcare MGG,Wellcare MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Bright Health - commercial,Bright Health - commercial,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Bright Health MGG,Bright Health MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Aetna,Aetna,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Aetna MGG,Aetna MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,BCBS,BCBS,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,BCBS MGG,BCBS MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Cigna,Cigna,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Cigna MGG,Cigna MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Humana,Humana,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Humana MGG,Humana MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Optum VA,Optum VA,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,UHC,UHC,4.5,,,,,,,per diem,4.5,4.5,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,UHC MGG,UHC MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,VA,VA,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Wellcare MGG,Wellcare MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Bright Health - commercial,Bright Health - commercial,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.5,4.5,Bright Health MGG,Bright Health MGG,4.5,,,,,,,case rate,4.5,4.5,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna,Aetna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna MGG,Aetna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS,BCBS,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS MGG,BCBS MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna,Cigna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna MGG,Cigna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana,Humana,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana MGG,Humana MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Optum VA,Optum VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC,UHC,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC MGG,UHC MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,VA,VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Wellcare MGG,Wellcare MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health - commercial,Bright Health - commercial,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health MGG,Bright Health MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna,Aetna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna MGG,Aetna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS,BCBS,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS MGG,BCBS MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna,Cigna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna MGG,Cigna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana,Humana,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana MGG,Humana MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Optum VA,Optum VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC,UHC,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC MGG,UHC MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,VA,VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Wellcare MGG,Wellcare MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health - commercial,Bright Health - commercial,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health MGG,Bright Health MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Aetna,Aetna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Aetna MGG,Aetna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,BCBS,BCBS,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,BCBS MGG,BCBS MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Cigna,Cigna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Cigna MGG,Cigna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Humana,Humana,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Humana MGG,Humana MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Optum VA,Optum VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,UHC,UHC,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,UHC MGG,UHC MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,VA,VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Wellcare MGG,Wellcare MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Bright Health - commercial,Bright Health - commercial,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Bright Health MGG,Bright Health MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Aetna,Aetna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Aetna MGG,Aetna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,BCBS,BCBS,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,BCBS MGG,BCBS MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Cigna,Cigna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Cigna MGG,Cigna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Humana,Humana,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Humana MGG,Humana MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Optum VA,Optum VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,UHC,UHC,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,UHC MGG,UHC MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,VA,VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Wellcare MGG,Wellcare MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Bright Health - commercial,Bright Health - commercial,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Bright Health MGG,Bright Health MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna,Aetna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Aetna MGG,Aetna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS,BCBS,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,BCBS MGG,BCBS MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna,Cigna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Cigna MGG,Cigna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana,Humana,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Humana MGG,Humana MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Optum VA,Optum VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC,UHC,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,UHC MGG,UHC MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,VA,VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Wellcare MGG,Wellcare MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health - commercial,Bright Health - commercial,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.55,5.55,Bright Health MGG,Bright Health MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Aetna,Aetna,750,,,,,,,per diem,750,750,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Aetna MGG,Aetna MGG,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,BCBS,BCBS,750,,,,,,,per diem,750,750,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,BCBS MGG,BCBS MGG,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Cigna,Cigna,750,,,,,,,per diem,750,750,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Cigna MGG,Cigna MGG,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Humana,Humana,750,,,,,,,per diem,750,750,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Humana MGG,Humana MGG,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Optum VA,Optum VA,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,UHC,UHC,750,,,,,,,per diem,750,750,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,UHC MGG,UHC MGG,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,VA,VA,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Wellcare MGG,Wellcare MGG,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Bright Health - commercial,Bright Health - commercial,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,750,750,Bright Health MGG,Bright Health MGG,750,,,,,,,case rate,750,750,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Aetna,Aetna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Aetna MGG,Aetna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,BCBS,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,BCBS MGG,BCBS MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Cigna,Cigna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Cigna MGG,Cigna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Humana,Humana,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Humana MGG,Humana MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Optum VA,Optum VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,UHC,UHC,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,UHC MGG,UHC MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,VA,VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Wellcare MGG,Wellcare MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Bright Health - commercial,Bright Health - commercial,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Bright Health MGG,Bright Health MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Aetna,Aetna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Aetna MGG,Aetna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,BCBS,BCBS,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,BCBS MGG,BCBS MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Cigna,Cigna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Cigna MGG,Cigna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Humana,Humana,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Humana MGG,Humana MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Optum VA,Optum VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,UHC,UHC,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,UHC MGG,UHC MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,VA,VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Wellcare MGG,Wellcare MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Bright Health - commercial,Bright Health - commercial,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15,15,Bright Health MGG,Bright Health MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Aetna,Aetna,229.5,,,,,,,per diem,229.5,229.5,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Aetna MGG,Aetna MGG,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,BCBS,BCBS,229.5,,,,,,,per diem,229.5,229.5,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,BCBS MGG,BCBS MGG,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Cigna,Cigna,229.5,,,,,,,per diem,229.5,229.5,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Cigna MGG,Cigna MGG,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Humana,Humana,229.5,,,,,,,per diem,229.5,229.5,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Humana MGG,Humana MGG,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Optum VA,Optum VA,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,UHC,UHC,229.5,,,,,,,per diem,229.5,229.5,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,UHC MGG,UHC MGG,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,VA,VA,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Wellcare MGG,Wellcare MGG,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Bright Health - commercial,Bright Health - commercial,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,229.5,229.5,Bright Health MGG,Bright Health MGG,229.5,,,,,,,case rate,229.5,229.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Aetna,Aetna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Aetna MGG,Aetna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,BCBS,BCBS,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,BCBS MGG,BCBS MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Cigna,Cigna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Cigna MGG,Cigna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Humana,Humana,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Humana MGG,Humana MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Optum VA,Optum VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,UHC,UHC,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,UHC MGG,UHC MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,VA,VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Wellcare MGG,Wellcare MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Bright Health - commercial,Bright Health - commercial,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,150,150,Bright Health MGG,Bright Health MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Aetna,Aetna,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Aetna MGG,Aetna MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,BCBS,BCBS,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,BCBS MGG,BCBS MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Cigna,Cigna,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Cigna MGG,Cigna MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Humana,Humana,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Humana MGG,Humana MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Optum VA,Optum VA,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,UHC,UHC,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,UHC MGG,UHC MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,VA,VA,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Wellcare MGG,Wellcare MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Bright Health - commercial,Bright Health - commercial,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,225,225,Bright Health MGG,Bright Health MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna,Aetna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna MGG,Aetna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS,BCBS,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS MGG,BCBS MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna,Cigna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna MGG,Cigna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana,Humana,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana MGG,Humana MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Optum VA,Optum VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC,UHC,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC MGG,UHC MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,VA,VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Wellcare MGG,Wellcare MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health - commercial,Bright Health - commercial,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health MGG,Bright Health MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Aetna,Aetna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Aetna MGG,Aetna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,BCBS,BCBS,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,BCBS MGG,BCBS MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Cigna,Cigna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Cigna MGG,Cigna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Humana,Humana,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Humana MGG,Humana MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Optum VA,Optum VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,UHC,UHC,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,UHC MGG,UHC MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,VA,VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Wellcare MGG,Wellcare MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Bright Health - commercial,Bright Health - commercial,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,75,75,Bright Health MGG,Bright Health MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Aetna,Aetna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Aetna MGG,Aetna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,BCBS,BCBS,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,BCBS MGG,BCBS MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Cigna,Cigna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Cigna MGG,Cigna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Humana,Humana,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Humana MGG,Humana MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Optum VA,Optum VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,UHC,UHC,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,UHC MGG,UHC MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,VA,VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Wellcare MGG,Wellcare MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Bright Health - commercial,Bright Health - commercial,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,75,75,Bright Health MGG,Bright Health MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna,Aetna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Aetna MGG,Aetna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS,BCBS,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,BCBS MGG,BCBS MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna,Cigna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Cigna MGG,Cigna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana,Humana,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Humana MGG,Humana MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Optum VA,Optum VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC,UHC,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,UHC MGG,UHC MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,VA,VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Wellcare MGG,Wellcare MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health - commercial,Bright Health - commercial,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,45,45,Bright Health MGG,Bright Health MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Aetna,Aetna,20.01,,,,,,,per diem,20.01,20.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Aetna MGG,Aetna MGG,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,BCBS,BCBS,20.01,,,,,,,per diem,20.01,20.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,BCBS MGG,BCBS MGG,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Cigna,Cigna,20.01,,,,,,,per diem,20.01,20.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Cigna MGG,Cigna MGG,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Humana,Humana,20.01,,,,,,,per diem,20.01,20.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Humana MGG,Humana MGG,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Optum VA,Optum VA,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,UHC,UHC,20.01,,,,,,,per diem,20.01,20.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,UHC MGG,UHC MGG,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,VA,VA,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Wellcare MGG,Wellcare MGG,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Bright Health - commercial,Bright Health - commercial,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,20.01,20.01,Bright Health MGG,Bright Health MGG,20.01,,,,,,,case rate,20.01,20.01,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna,Aetna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Aetna MGG,Aetna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS,BCBS,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,BCBS MGG,BCBS MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna,Cigna,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Cigna MGG,Cigna MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana,Humana,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Humana MGG,Humana MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Optum VA,Optum VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC,UHC,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,UHC MGG,UHC MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,VA,VA,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Wellcare MGG,Wellcare MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health - commercial,Bright Health - commercial,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,24,24,Bright Health MGG,Bright Health MGG,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Aetna,Aetna,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Aetna MGG,Aetna MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,BCBS,BCBS,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,BCBS MGG,BCBS MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Cigna,Cigna,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Cigna MGG,Cigna MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Humana,Humana,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Humana MGG,Humana MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Optum VA,Optum VA,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,UHC,UHC,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,UHC MGG,UHC MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,VA,VA,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Wellcare MGG,Wellcare MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Bright Health - commercial,Bright Health - commercial,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,375,375,Bright Health MGG,Bright Health MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Aetna,Aetna,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Aetna MGG,Aetna MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,BCBS,BCBS,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,BCBS MGG,BCBS MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Cigna,Cigna,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Cigna MGG,Cigna MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Humana,Humana,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Humana MGG,Humana MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Optum VA,Optum VA,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,UHC,UHC,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,UHC MGG,UHC MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,VA,VA,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Wellcare MGG,Wellcare MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Bright Health - commercial,Bright Health - commercial,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,165,165,Bright Health MGG,Bright Health MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Aetna,Aetna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Aetna MGG,Aetna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,BCBS,BCBS,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,BCBS MGG,BCBS MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Cigna,Cigna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Cigna MGG,Cigna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Humana,Humana,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Humana MGG,Humana MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Optum VA,Optum VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,UHC,UHC,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,UHC MGG,UHC MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,VA,VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Wellcare MGG,Wellcare MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Bright Health - commercial,Bright Health - commercial,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,150,150,Bright Health MGG,Bright Health MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Aetna,Aetna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Aetna MGG,Aetna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,BCBS,BCBS,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,BCBS MGG,BCBS MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Cigna,Cigna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Cigna MGG,Cigna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Humana,Humana,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Humana MGG,Humana MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Optum VA,Optum VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,UHC,UHC,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,UHC MGG,UHC MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,VA,VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Wellcare MGG,Wellcare MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Bright Health - commercial,Bright Health - commercial,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,9.75,9.75,Bright Health MGG,Bright Health MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Aetna,Aetna,3000,,,,,,,per diem,3000,3000,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Aetna MGG,Aetna MGG,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,BCBS,BCBS,3000,,,,,,,per diem,3000,3000,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,BCBS MGG,BCBS MGG,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Cigna,Cigna,3000,,,,,,,per diem,3000,3000,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Cigna MGG,Cigna MGG,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Humana,Humana,3000,,,,,,,per diem,3000,3000,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Humana MGG,Humana MGG,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Optum VA,Optum VA,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,UHC,UHC,3000,,,,,,,per diem,3000,3000,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,UHC MGG,UHC MGG,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,VA,VA,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Wellcare MGG,Wellcare MGG,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Bright Health - commercial,Bright Health - commercial,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3000,3000,Bright Health MGG,Bright Health MGG,3000,,,,,,,case rate,3000,3000,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna,Aetna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna MGG,Aetna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS,BCBS,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS MGG,BCBS MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna,Cigna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna MGG,Cigna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana,Humana,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana MGG,Humana MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Optum VA,Optum VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC,UHC,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC MGG,UHC MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,VA,VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Wellcare MGG,Wellcare MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health - commercial,Bright Health - commercial,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health MGG,Bright Health MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna,Aetna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna MGG,Aetna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS,BCBS,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS MGG,BCBS MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna,Cigna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna MGG,Cigna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana,Humana,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana MGG,Humana MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Optum VA,Optum VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC,UHC,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC MGG,UHC MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,VA,VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Wellcare MGG,Wellcare MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health - commercial,Bright Health - commercial,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health MGG,Bright Health MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna,Aetna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna MGG,Aetna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS,BCBS,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS MGG,BCBS MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna,Cigna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna MGG,Cigna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana,Humana,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana MGG,Humana MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Optum VA,Optum VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC,UHC,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC MGG,UHC MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,VA,VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Wellcare MGG,Wellcare MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health - commercial,Bright Health - commercial,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health MGG,Bright Health MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna,Aetna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna MGG,Aetna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS,BCBS,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS MGG,BCBS MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna,Cigna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna MGG,Cigna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana,Humana,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana MGG,Humana MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Optum VA,Optum VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC,UHC,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC MGG,UHC MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,VA,VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Wellcare MGG,Wellcare MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health - commercial,Bright Health - commercial,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health MGG,Bright Health MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna,Aetna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna MGG,Aetna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS,BCBS,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS MGG,BCBS MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna,Cigna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna MGG,Cigna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana,Humana,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana MGG,Humana MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Optum VA,Optum VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC,UHC,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC MGG,UHC MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,VA,VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Wellcare MGG,Wellcare MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health - commercial,Bright Health - commercial,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health MGG,Bright Health MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna,Aetna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Aetna MGG,Aetna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS,BCBS,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,BCBS MGG,BCBS MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna,Cigna,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Cigna MGG,Cigna MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana,Humana,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Humana MGG,Humana MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Optum VA,Optum VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC,UHC,65.43,,,,,,,per diem,65.43,65.43,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,UHC MGG,UHC MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,VA,VA,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Wellcare MGG,Wellcare MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health - commercial,Bright Health - commercial,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,65.43,65.43,Bright Health MGG,Bright Health MGG,65.43,,,,,,,case rate,65.43,65.43,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Aetna,Aetna,75.9,,,,,,,per diem,75.9,75.9,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Aetna MGG,Aetna MGG,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,BCBS,BCBS,75.9,,,,,,,per diem,75.9,75.9,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,BCBS MGG,BCBS MGG,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Cigna,Cigna,75.9,,,,,,,per diem,75.9,75.9,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Cigna MGG,Cigna MGG,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Humana,Humana,75.9,,,,,,,per diem,75.9,75.9,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Humana MGG,Humana MGG,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Optum VA,Optum VA,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,UHC,UHC,75.9,,,,,,,per diem,75.9,75.9,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,UHC MGG,UHC MGG,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,VA,VA,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Wellcare MGG,Wellcare MGG,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Bright Health - commercial,Bright Health - commercial,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,75.9,75.9,Bright Health MGG,Bright Health MGG,75.9,,,,,,,case rate,75.9,75.9,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Aetna,Aetna,140.8,,,,,,,per diem,140.8,140.8,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Aetna MGG,Aetna MGG,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,BCBS,BCBS,140.8,,,,,,,per diem,140.8,140.8,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,BCBS MGG,BCBS MGG,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Cigna,Cigna,140.8,,,,,,,per diem,140.8,140.8,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Cigna MGG,Cigna MGG,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Humana,Humana,140.8,,,,,,,per diem,140.8,140.8,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Humana MGG,Humana MGG,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Optum VA,Optum VA,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,UHC,UHC,140.8,,,,,,,per diem,140.8,140.8,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,UHC MGG,UHC MGG,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,VA,VA,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Wellcare MGG,Wellcare MGG,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Bright Health - commercial,Bright Health - commercial,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,140.8,140.8,Bright Health MGG,Bright Health MGG,140.8,,,,,,,case rate,140.8,140.8,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Aetna,Aetna,342.1,,,,,,,per diem,342.1,342.1,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Aetna MGG,Aetna MGG,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,BCBS,BCBS,342.1,,,,,,,per diem,342.1,342.1,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,BCBS MGG,BCBS MGG,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Cigna,Cigna,342.1,,,,,,,per diem,342.1,342.1,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Cigna MGG,Cigna MGG,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Humana,Humana,342.1,,,,,,,per diem,342.1,342.1,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Humana MGG,Humana MGG,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Optum VA,Optum VA,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,UHC,UHC,342.1,,,,,,,per diem,342.1,342.1,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,UHC MGG,UHC MGG,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,VA,VA,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Wellcare MGG,Wellcare MGG,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Bright Health - commercial,Bright Health - commercial,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,342.1,342.1,Bright Health MGG,Bright Health MGG,342.1,,,,,,,case rate,342.1,342.1,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Aetna,Aetna,133.98,,,,,,,per diem,133.98,133.98,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Aetna MGG,Aetna MGG,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,BCBS,BCBS,133.98,,,,,,,per diem,133.98,133.98,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,BCBS MGG,BCBS MGG,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Cigna,Cigna,133.98,,,,,,,per diem,133.98,133.98,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Cigna MGG,Cigna MGG,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Humana,Humana,133.98,,,,,,,per diem,133.98,133.98,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Humana MGG,Humana MGG,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Optum VA,Optum VA,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,UHC,UHC,133.98,,,,,,,per diem,133.98,133.98,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,UHC MGG,UHC MGG,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,VA,VA,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Wellcare MGG,Wellcare MGG,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Bright Health - commercial,Bright Health - commercial,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,133.98,133.98,Bright Health MGG,Bright Health MGG,133.98,,,,,,,case rate,133.98,133.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Aetna,Aetna,63.8,,,,,,,per diem,63.8,63.8,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Aetna MGG,Aetna MGG,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,BCBS,BCBS,63.8,,,,,,,per diem,63.8,63.8,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,BCBS MGG,BCBS MGG,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Cigna,Cigna,63.8,,,,,,,per diem,63.8,63.8,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Cigna MGG,Cigna MGG,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Humana,Humana,63.8,,,,,,,per diem,63.8,63.8,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Humana MGG,Humana MGG,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Optum VA,Optum VA,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,UHC,UHC,63.8,,,,,,,per diem,63.8,63.8,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,UHC MGG,UHC MGG,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,VA,VA,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Wellcare MGG,Wellcare MGG,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Bright Health - commercial,Bright Health - commercial,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,63.8,63.8,Bright Health MGG,Bright Health MGG,63.8,,,,,,,case rate,63.8,63.8,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Aetna,Aetna,655.6,,,,,,,per diem,655.6,655.6,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Aetna MGG,Aetna MGG,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,BCBS,BCBS,655.6,,,,,,,per diem,655.6,655.6,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,BCBS MGG,BCBS MGG,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Cigna,Cigna,655.6,,,,,,,per diem,655.6,655.6,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Cigna MGG,Cigna MGG,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Humana,Humana,655.6,,,,,,,per diem,655.6,655.6,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Humana MGG,Humana MGG,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Optum VA,Optum VA,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,UHC,UHC,655.6,,,,,,,per diem,655.6,655.6,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,UHC MGG,UHC MGG,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,VA,VA,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Wellcare MGG,Wellcare MGG,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Bright Health - commercial,Bright Health - commercial,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,655.6,655.6,Bright Health MGG,Bright Health MGG,655.6,,,,,,,case rate,655.6,655.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Aetna,Aetna,687.5,,,,,,,per diem,687.5,687.5,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Aetna MGG,Aetna MGG,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,BCBS,BCBS,687.5,,,,,,,per diem,687.5,687.5,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,BCBS MGG,BCBS MGG,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Cigna,Cigna,687.5,,,,,,,per diem,687.5,687.5,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Cigna MGG,Cigna MGG,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Humana,Humana,687.5,,,,,,,per diem,687.5,687.5,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Humana MGG,Humana MGG,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Optum VA,Optum VA,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,UHC,UHC,687.5,,,,,,,per diem,687.5,687.5,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,UHC MGG,UHC MGG,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,VA,VA,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Wellcare MGG,Wellcare MGG,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Bright Health - commercial,Bright Health - commercial,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,687.5,687.5,Bright Health MGG,Bright Health MGG,687.5,,,,,,,case rate,687.5,687.5,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Aetna,Aetna,721.6,,,,,,,per diem,721.6,721.6,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Aetna MGG,Aetna MGG,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,BCBS,BCBS,721.6,,,,,,,per diem,721.6,721.6,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,BCBS MGG,BCBS MGG,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Cigna,Cigna,721.6,,,,,,,per diem,721.6,721.6,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Cigna MGG,Cigna MGG,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Humana,Humana,721.6,,,,,,,per diem,721.6,721.6,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Humana MGG,Humana MGG,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Optum VA,Optum VA,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,UHC,UHC,721.6,,,,,,,per diem,721.6,721.6,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,UHC MGG,UHC MGG,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,VA,VA,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Wellcare MGG,Wellcare MGG,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Bright Health - commercial,Bright Health - commercial,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,721.6,721.6,Bright Health MGG,Bright Health MGG,721.6,,,,,,,case rate,721.6,721.6,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Aetna,Aetna,943.8,,,,,,,per diem,943.8,943.8,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Aetna MGG,Aetna MGG,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,BCBS,BCBS,943.8,,,,,,,per diem,943.8,943.8,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,BCBS MGG,BCBS MGG,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Cigna,Cigna,943.8,,,,,,,per diem,943.8,943.8,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Cigna MGG,Cigna MGG,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Humana,Humana,943.8,,,,,,,per diem,943.8,943.8,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Humana MGG,Humana MGG,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Optum VA,Optum VA,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,UHC,UHC,943.8,,,,,,,per diem,943.8,943.8,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,UHC MGG,UHC MGG,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,VA,VA,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Wellcare MGG,Wellcare MGG,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Bright Health - commercial,Bright Health - commercial,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,943.8,943.8,Bright Health MGG,Bright Health MGG,943.8,,,,,,,case rate,943.8,943.8,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Aetna,Aetna,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Aetna MGG,Aetna MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,BCBS,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,BCBS MGG,BCBS MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Cigna,Cigna,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Cigna MGG,Cigna MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Humana,Humana,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Humana MGG,Humana MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Optum VA,Optum VA,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,UHC,UHC,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,UHC MGG,UHC MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,VA,VA,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Wellcare MGG,Wellcare MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Bright Health - commercial,Bright Health - commercial,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Bright Health MGG,Bright Health MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Aetna,Aetna,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Aetna MGG,Aetna MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,BCBS,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,BCBS MGG,BCBS MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Cigna,Cigna,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Cigna MGG,Cigna MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Humana,Humana,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Humana MGG,Humana MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Optum VA,Optum VA,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,UHC,UHC,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,UHC MGG,UHC MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,VA,VA,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Wellcare MGG,Wellcare MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Bright Health - commercial,Bright Health - commercial,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,27.5,27.5,Bright Health MGG,Bright Health MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Aetna,Aetna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Aetna MGG,Aetna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,BCBS,BCBS,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,BCBS MGG,BCBS MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Cigna,Cigna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Cigna MGG,Cigna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Humana,Humana,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Humana MGG,Humana MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Optum VA,Optum VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,UHC,UHC,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,UHC MGG,UHC MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,VA,VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Wellcare MGG,Wellcare MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Bright Health - commercial,Bright Health - commercial,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,88,88,Bright Health MGG,Bright Health MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Aetna,Aetna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Aetna MGG,Aetna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,BCBS,BCBS,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,BCBS MGG,BCBS MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Cigna,Cigna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Cigna MGG,Cigna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Humana,Humana,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Humana MGG,Humana MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Optum VA,Optum VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,UHC,UHC,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,UHC MGG,UHC MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,VA,VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Wellcare MGG,Wellcare MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Bright Health - commercial,Bright Health - commercial,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,88,88,Bright Health MGG,Bright Health MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Aetna,Aetna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Aetna MGG,Aetna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,BCBS,BCBS,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,BCBS MGG,BCBS MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Cigna,Cigna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Cigna MGG,Cigna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Humana,Humana,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Humana MGG,Humana MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Optum VA,Optum VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,UHC,UHC,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,UHC MGG,UHC MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,VA,VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Wellcare MGG,Wellcare MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Bright Health - commercial,Bright Health - commercial,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,88,88,Bright Health MGG,Bright Health MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Aetna,Aetna,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Aetna MGG,Aetna MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,BCBS,BCBS,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,BCBS MGG,BCBS MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Cigna,Cigna,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Cigna MGG,Cigna MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Humana,Humana,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Humana MGG,Humana MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Optum VA,Optum VA,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,UHC,UHC,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,UHC MGG,UHC MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,VA,VA,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Wellcare MGG,Wellcare MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Bright Health - commercial,Bright Health - commercial,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Bright Health MGG,Bright Health MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Aetna,Aetna,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Aetna MGG,Aetna MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,BCBS,BCBS,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,BCBS MGG,BCBS MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Cigna,Cigna,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Cigna MGG,Cigna MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Humana,Humana,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Humana MGG,Humana MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Optum VA,Optum VA,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,UHC,UHC,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,UHC MGG,UHC MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,VA,VA,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Wellcare MGG,Wellcare MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Bright Health - commercial,Bright Health - commercial,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Bright Health MGG,Bright Health MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Aetna,Aetna,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Aetna MGG,Aetna MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,BCBS,BCBS,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,BCBS MGG,BCBS MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Cigna,Cigna,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Cigna MGG,Cigna MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Humana,Humana,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Humana MGG,Humana MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Optum VA,Optum VA,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,UHC,UHC,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,UHC MGG,UHC MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,VA,VA,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Wellcare MGG,Wellcare MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Bright Health - commercial,Bright Health - commercial,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Bright Health MGG,Bright Health MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Aetna,Aetna,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Aetna MGG,Aetna MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,BCBS,BCBS,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,BCBS MGG,BCBS MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Cigna,Cigna,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Cigna MGG,Cigna MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Humana,Humana,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Humana MGG,Humana MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Optum VA,Optum VA,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,UHC,UHC,18.7,,,,,,,per diem,18.7,18.7,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,UHC MGG,UHC MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,VA,VA,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Wellcare MGG,Wellcare MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Bright Health - commercial,Bright Health - commercial,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,18.7,18.7,Bright Health MGG,Bright Health MGG,18.7,,,,,,,case rate,18.7,18.7,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Aetna,Aetna,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Aetna MGG,Aetna MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,BCBS,BCBS,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,BCBS MGG,BCBS MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Cigna,Cigna,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Cigna MGG,Cigna MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Humana,Humana,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Humana MGG,Humana MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Optum VA,Optum VA,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,UHC,UHC,277.2,,,,,,,per diem,277.2,277.2,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,UHC MGG,UHC MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,VA,VA,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Wellcare MGG,Wellcare MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Bright Health - commercial,Bright Health - commercial,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,277.2,277.2,Bright Health MGG,Bright Health MGG,277.2,,,,,,,case rate,277.2,277.2,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Aetna,Aetna,53.31,,,,,,,per diem,53.31,53.31,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Aetna MGG,Aetna MGG,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,BCBS,BCBS,53.31,,,,,,,per diem,53.31,53.31,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,BCBS MGG,BCBS MGG,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Cigna,Cigna,53.31,,,,,,,per diem,53.31,53.31,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Cigna MGG,Cigna MGG,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Humana,Humana,53.31,,,,,,,per diem,53.31,53.31,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Humana MGG,Humana MGG,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Optum VA,Optum VA,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,UHC,UHC,53.31,,,,,,,per diem,53.31,53.31,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,UHC MGG,UHC MGG,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,VA,VA,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Wellcare MGG,Wellcare MGG,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Bright Health - commercial,Bright Health - commercial,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,53.31,53.31,Bright Health MGG,Bright Health MGG,53.31,,,,,,,case rate,53.31,53.31,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Aetna,Aetna,60.3,,,,,,,per diem,60.3,60.3,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Aetna MGG,Aetna MGG,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,BCBS,BCBS,60.3,,,,,,,per diem,60.3,60.3,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,BCBS MGG,BCBS MGG,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Cigna,Cigna,60.3,,,,,,,per diem,60.3,60.3,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Cigna MGG,Cigna MGG,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Humana,Humana,60.3,,,,,,,per diem,60.3,60.3,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Humana MGG,Humana MGG,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Optum VA,Optum VA,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,UHC,UHC,60.3,,,,,,,per diem,60.3,60.3,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,UHC MGG,UHC MGG,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,VA,VA,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Wellcare MGG,Wellcare MGG,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Bright Health - commercial,Bright Health - commercial,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,60.3,60.3,Bright Health MGG,Bright Health MGG,60.3,,,,,,,case rate,60.3,60.3,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Aetna,Aetna,15.4,,,,,,,per diem,15.4,15.4,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Aetna MGG,Aetna MGG,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,BCBS,BCBS,15.4,,,,,,,per diem,15.4,15.4,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,BCBS MGG,BCBS MGG,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Cigna,Cigna,15.4,,,,,,,per diem,15.4,15.4,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Cigna MGG,Cigna MGG,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Humana,Humana,15.4,,,,,,,per diem,15.4,15.4,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Humana MGG,Humana MGG,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Optum VA,Optum VA,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,UHC,UHC,15.4,,,,,,,per diem,15.4,15.4,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,UHC MGG,UHC MGG,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,VA,VA,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Wellcare MGG,Wellcare MGG,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Bright Health - commercial,Bright Health - commercial,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,15.4,15.4,Bright Health MGG,Bright Health MGG,15.4,,,,,,,case rate,15.4,15.4,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Aetna,Aetna,285.69,,,,,,,per diem,285.69,285.69,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Aetna MGG,Aetna MGG,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,BCBS,BCBS,285.69,,,,,,,per diem,285.69,285.69,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,BCBS MGG,BCBS MGG,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Cigna,Cigna,285.69,,,,,,,per diem,285.69,285.69,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Cigna MGG,Cigna MGG,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Humana,Humana,285.69,,,,,,,per diem,285.69,285.69,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Humana MGG,Humana MGG,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Optum VA,Optum VA,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,UHC,UHC,285.69,,,,,,,per diem,285.69,285.69,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,UHC MGG,UHC MGG,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,VA,VA,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Wellcare MGG,Wellcare MGG,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Bright Health - commercial,Bright Health - commercial,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,285.69,285.69,Bright Health MGG,Bright Health MGG,285.69,,,,,,,case rate,285.69,285.69,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Aetna,Aetna,85.53,,,,,,,per diem,85.53,85.53,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Aetna MGG,Aetna MGG,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,BCBS,BCBS,85.53,,,,,,,per diem,85.53,85.53,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,BCBS MGG,BCBS MGG,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Cigna,Cigna,85.53,,,,,,,per diem,85.53,85.53,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Cigna MGG,Cigna MGG,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Humana,Humana,85.53,,,,,,,per diem,85.53,85.53,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Humana MGG,Humana MGG,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Optum VA,Optum VA,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,UHC,UHC,85.53,,,,,,,per diem,85.53,85.53,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,UHC MGG,UHC MGG,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,VA,VA,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Wellcare MGG,Wellcare MGG,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Bright Health - commercial,Bright Health - commercial,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,85.53,85.53,Bright Health MGG,Bright Health MGG,85.53,,,,,,,case rate,85.53,85.53,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Aetna,Aetna,38.07,,,,,,,per diem,38.07,38.07,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Aetna MGG,Aetna MGG,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,BCBS,BCBS,38.07,,,,,,,per diem,38.07,38.07,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,BCBS MGG,BCBS MGG,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Cigna,Cigna,38.07,,,,,,,per diem,38.07,38.07,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Cigna MGG,Cigna MGG,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Humana,Humana,38.07,,,,,,,per diem,38.07,38.07,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Humana MGG,Humana MGG,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Optum VA,Optum VA,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,UHC,UHC,38.07,,,,,,,per diem,38.07,38.07,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,UHC MGG,UHC MGG,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,VA,VA,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Wellcare MGG,Wellcare MGG,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Bright Health - commercial,Bright Health - commercial,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,38.07,38.07,Bright Health MGG,Bright Health MGG,38.07,,,,,,,case rate,38.07,38.07,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Aetna,Aetna,38.37,,,,,,,per diem,38.37,38.37,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Aetna MGG,Aetna MGG,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,BCBS,BCBS,38.37,,,,,,,per diem,38.37,38.37,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,BCBS MGG,BCBS MGG,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Cigna,Cigna,38.37,,,,,,,per diem,38.37,38.37,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Cigna MGG,Cigna MGG,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Humana,Humana,38.37,,,,,,,per diem,38.37,38.37,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Humana MGG,Humana MGG,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Optum VA,Optum VA,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,UHC,UHC,38.37,,,,,,,per diem,38.37,38.37,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,UHC MGG,UHC MGG,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,VA,VA,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Wellcare MGG,Wellcare MGG,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Bright Health - commercial,Bright Health - commercial,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,38.37,38.37,Bright Health MGG,Bright Health MGG,38.37,,,,,,,case rate,38.37,38.37,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Aetna,Aetna,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Aetna MGG,Aetna MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,BCBS,BCBS,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,BCBS MGG,BCBS MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Cigna,Cigna,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Cigna MGG,Cigna MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Humana,Humana,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Humana MGG,Humana MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Optum VA,Optum VA,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,UHC,UHC,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,UHC MGG,UHC MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,VA,VA,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Wellcare MGG,Wellcare MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Bright Health - commercial,Bright Health - commercial,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Bright Health MGG,Bright Health MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Aetna,Aetna,39.99,,,,,,,per diem,39.99,39.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Aetna MGG,Aetna MGG,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,BCBS,BCBS,39.99,,,,,,,per diem,39.99,39.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,BCBS MGG,BCBS MGG,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Cigna,Cigna,39.99,,,,,,,per diem,39.99,39.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Cigna MGG,Cigna MGG,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Humana,Humana,39.99,,,,,,,per diem,39.99,39.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Humana MGG,Humana MGG,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Optum VA,Optum VA,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,UHC,UHC,39.99,,,,,,,per diem,39.99,39.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,UHC MGG,UHC MGG,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,VA,VA,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Wellcare MGG,Wellcare MGG,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Bright Health - commercial,Bright Health - commercial,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,39.99,39.99,Bright Health MGG,Bright Health MGG,39.99,,,,,,,case rate,39.99,39.99,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Aetna,Aetna,135.24,,,,,,,per diem,135.24,135.24,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Aetna MGG,Aetna MGG,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,BCBS,BCBS,135.24,,,,,,,per diem,135.24,135.24,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,BCBS MGG,BCBS MGG,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Cigna,Cigna,135.24,,,,,,,per diem,135.24,135.24,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Cigna MGG,Cigna MGG,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Humana,Humana,135.24,,,,,,,per diem,135.24,135.24,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Humana MGG,Humana MGG,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Optum VA,Optum VA,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,UHC,UHC,135.24,,,,,,,per diem,135.24,135.24,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,UHC MGG,UHC MGG,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,VA,VA,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Wellcare MGG,Wellcare MGG,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Bright Health - commercial,Bright Health - commercial,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,135.24,135.24,Bright Health MGG,Bright Health MGG,135.24,,,,,,,case rate,135.24,135.24,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Aetna,Aetna,346.5,,,,,,,per diem,346.5,346.5,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Aetna MGG,Aetna MGG,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,BCBS,BCBS,346.5,,,,,,,per diem,346.5,346.5,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,BCBS MGG,BCBS MGG,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Cigna,Cigna,346.5,,,,,,,per diem,346.5,346.5,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Cigna MGG,Cigna MGG,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Humana,Humana,346.5,,,,,,,per diem,346.5,346.5,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Humana MGG,Humana MGG,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Optum VA,Optum VA,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,UHC,UHC,346.5,,,,,,,per diem,346.5,346.5,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,UHC MGG,UHC MGG,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,VA,VA,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Wellcare MGG,Wellcare MGG,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Bright Health - commercial,Bright Health - commercial,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,346.5,346.5,Bright Health MGG,Bright Health MGG,346.5,,,,,,,case rate,346.5,346.5,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Aetna,Aetna,98.85,,,,,,,per diem,98.85,98.85,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Aetna MGG,Aetna MGG,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,BCBS,BCBS,98.85,,,,,,,per diem,98.85,98.85,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,BCBS MGG,BCBS MGG,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Cigna,Cigna,98.85,,,,,,,per diem,98.85,98.85,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Cigna MGG,Cigna MGG,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Humana,Humana,98.85,,,,,,,per diem,98.85,98.85,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Humana MGG,Humana MGG,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Optum VA,Optum VA,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,UHC,UHC,98.85,,,,,,,per diem,98.85,98.85,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,UHC MGG,UHC MGG,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,VA,VA,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Wellcare MGG,Wellcare MGG,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Bright Health - commercial,Bright Health - commercial,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,98.85,98.85,Bright Health MGG,Bright Health MGG,98.85,,,,,,,case rate,98.85,98.85,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Aetna,Aetna,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Aetna MGG,Aetna MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,BCBS,BCBS,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,BCBS MGG,BCBS MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Cigna,Cigna,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Cigna MGG,Cigna MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Humana,Humana,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Humana MGG,Humana MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Optum VA,Optum VA,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,UHC,UHC,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,UHC MGG,UHC MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,VA,VA,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Wellcare MGG,Wellcare MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Bright Health - commercial,Bright Health - commercial,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Bright Health MGG,Bright Health MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Aetna,Aetna,34.1,,,,,,,per diem,34.1,34.1,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Aetna MGG,Aetna MGG,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,BCBS,BCBS,34.1,,,,,,,per diem,34.1,34.1,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,BCBS MGG,BCBS MGG,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Cigna,Cigna,34.1,,,,,,,per diem,34.1,34.1,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Cigna MGG,Cigna MGG,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Humana,Humana,34.1,,,,,,,per diem,34.1,34.1,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Humana MGG,Humana MGG,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Optum VA,Optum VA,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,UHC,UHC,34.1,,,,,,,per diem,34.1,34.1,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,UHC MGG,UHC MGG,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,VA,VA,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Wellcare MGG,Wellcare MGG,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Bright Health - commercial,Bright Health - commercial,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,34.1,34.1,Bright Health MGG,Bright Health MGG,34.1,,,,,,,case rate,34.1,34.1,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Aetna,Aetna,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Aetna MGG,Aetna MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,BCBS,BCBS,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,BCBS MGG,BCBS MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Cigna,Cigna,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Cigna MGG,Cigna MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Humana,Humana,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Humana MGG,Humana MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Optum VA,Optum VA,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,UHC,UHC,85.8,,,,,,,per diem,85.8,85.8,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,UHC MGG,UHC MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,VA,VA,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Wellcare MGG,Wellcare MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Bright Health - commercial,Bright Health - commercial,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,85.8,85.8,Bright Health MGG,Bright Health MGG,85.8,,,,,,,case rate,85.8,85.8,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Aetna,Aetna,31.9,,,,,,,per diem,31.9,31.9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Aetna MGG,Aetna MGG,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,BCBS,BCBS,31.9,,,,,,,per diem,31.9,31.9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,BCBS MGG,BCBS MGG,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Cigna,Cigna,31.9,,,,,,,per diem,31.9,31.9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Cigna MGG,Cigna MGG,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Humana,Humana,31.9,,,,,,,per diem,31.9,31.9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Humana MGG,Humana MGG,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Optum VA,Optum VA,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,UHC,UHC,31.9,,,,,,,per diem,31.9,31.9,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,UHC MGG,UHC MGG,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,VA,VA,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Wellcare MGG,Wellcare MGG,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Bright Health - commercial,Bright Health - commercial,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,31.9,31.9,Bright Health MGG,Bright Health MGG,31.9,,,,,,,case rate,31.9,31.9,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Aetna,Aetna,50.6,,,,,,,per diem,50.6,50.6,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Aetna MGG,Aetna MGG,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,BCBS,BCBS,50.6,,,,,,,per diem,50.6,50.6,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,BCBS MGG,BCBS MGG,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Cigna,Cigna,50.6,,,,,,,per diem,50.6,50.6,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Cigna MGG,Cigna MGG,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Humana,Humana,50.6,,,,,,,per diem,50.6,50.6,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Humana MGG,Humana MGG,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Optum VA,Optum VA,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,UHC,UHC,50.6,,,,,,,per diem,50.6,50.6,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,UHC MGG,UHC MGG,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,VA,VA,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Wellcare MGG,Wellcare MGG,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Bright Health - commercial,Bright Health - commercial,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,50.6,50.6,Bright Health MGG,Bright Health MGG,50.6,,,,,,,case rate,50.6,50.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Aetna,Aetna,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Aetna MGG,Aetna MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,BCBS,BCBS,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,BCBS MGG,BCBS MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Cigna,Cigna,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Cigna MGG,Cigna MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Humana,Humana,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Humana MGG,Humana MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Optum VA,Optum VA,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,UHC,UHC,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,UHC MGG,UHC MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,VA,VA,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Wellcare MGG,Wellcare MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Bright Health - commercial,Bright Health - commercial,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,16.59,16.59,Bright Health MGG,Bright Health MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Aetna,Aetna,39.1,,,,,,,per diem,39.1,39.1,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Aetna MGG,Aetna MGG,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,BCBS,BCBS,39.1,,,,,,,per diem,39.1,39.1,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,BCBS MGG,BCBS MGG,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Cigna,Cigna,39.1,,,,,,,per diem,39.1,39.1,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Cigna MGG,Cigna MGG,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Humana,Humana,39.1,,,,,,,per diem,39.1,39.1,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Humana MGG,Humana MGG,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Optum VA,Optum VA,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,UHC,UHC,39.1,,,,,,,per diem,39.1,39.1,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,UHC MGG,UHC MGG,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,VA,VA,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Wellcare MGG,Wellcare MGG,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Bright Health - commercial,Bright Health - commercial,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,39.1,39.1,Bright Health MGG,Bright Health MGG,39.1,,,,,,,case rate,39.1,39.1,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Aetna,Aetna,5.75,,,,,,,per diem,5.75,5.75,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Aetna MGG,Aetna MGG,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,BCBS,BCBS,5.75,,,,,,,per diem,5.75,5.75,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,BCBS MGG,BCBS MGG,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Cigna,Cigna,5.75,,,,,,,per diem,5.75,5.75,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Cigna MGG,Cigna MGG,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Humana,Humana,5.75,,,,,,,per diem,5.75,5.75,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Humana MGG,Humana MGG,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Optum VA,Optum VA,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,UHC,UHC,5.75,,,,,,,per diem,5.75,5.75,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,UHC MGG,UHC MGG,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,VA,VA,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Wellcare MGG,Wellcare MGG,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Bright Health - commercial,Bright Health - commercial,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,5.75,5.75,Bright Health MGG,Bright Health MGG,5.75,,,,,,,case rate,5.75,5.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Aetna,Aetna,795,,,,,,,per diem,795,795,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Aetna MGG,Aetna MGG,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,BCBS,BCBS,795,,,,,,,per diem,795,795,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,BCBS MGG,BCBS MGG,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Cigna,Cigna,795,,,,,,,per diem,795,795,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Cigna MGG,Cigna MGG,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Humana,Humana,795,,,,,,,per diem,795,795,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Humana MGG,Humana MGG,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Optum VA,Optum VA,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,UHC,UHC,795,,,,,,,per diem,795,795,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,UHC MGG,UHC MGG,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,VA,VA,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Wellcare MGG,Wellcare MGG,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Bright Health - commercial,Bright Health - commercial,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,795,795,Bright Health MGG,Bright Health MGG,795,,,,,,,case rate,795,795,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Aetna,Aetna,1005,,,,,,,per diem,1005,1005,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Aetna MGG,Aetna MGG,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,BCBS,BCBS,1005,,,,,,,per diem,1005,1005,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,BCBS MGG,BCBS MGG,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Cigna,Cigna,1005,,,,,,,per diem,1005,1005,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Cigna MGG,Cigna MGG,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Humana,Humana,1005,,,,,,,per diem,1005,1005,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Humana MGG,Humana MGG,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Optum VA,Optum VA,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,UHC,UHC,1005,,,,,,,per diem,1005,1005,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,UHC MGG,UHC MGG,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,VA,VA,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Wellcare MGG,Wellcare MGG,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Bright Health - commercial,Bright Health - commercial,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1005,1005,Bright Health MGG,Bright Health MGG,1005,,,,,,,case rate,1005,1005,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Aetna,Aetna,499.13,,,,,,,per diem,499.13,499.13,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Aetna MGG,Aetna MGG,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,BCBS,BCBS,499.13,,,,,,,per diem,499.13,499.13,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,BCBS MGG,BCBS MGG,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Cigna,Cigna,499.13,,,,,,,per diem,499.13,499.13,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Cigna MGG,Cigna MGG,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Humana,Humana,499.13,,,,,,,per diem,499.13,499.13,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Humana MGG,Humana MGG,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Optum VA,Optum VA,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,UHC,UHC,499.13,,,,,,,per diem,499.13,499.13,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,UHC MGG,UHC MGG,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,VA,VA,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Wellcare MGG,Wellcare MGG,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Bright Health - commercial,Bright Health - commercial,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,499.13,499.13,Bright Health MGG,Bright Health MGG,499.13,,,,,,,case rate,499.13,499.13,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Aetna,Aetna,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Aetna MGG,Aetna MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,BCBS,BCBS,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,BCBS MGG,BCBS MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Cigna,Cigna,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Cigna MGG,Cigna MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Humana,Humana,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Humana MGG,Humana MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Optum VA,Optum VA,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,UHC,UHC,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,UHC MGG,UHC MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,VA,VA,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Wellcare MGG,Wellcare MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Bright Health - commercial,Bright Health - commercial,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Bright Health MGG,Bright Health MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Aetna,Aetna,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Aetna MGG,Aetna MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,BCBS,BCBS,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,BCBS MGG,BCBS MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Cigna,Cigna,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Cigna MGG,Cigna MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Humana,Humana,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Humana MGG,Humana MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Optum VA,Optum VA,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,UHC,UHC,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,UHC MGG,UHC MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,VA,VA,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Wellcare MGG,Wellcare MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Bright Health - commercial,Bright Health - commercial,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Bright Health MGG,Bright Health MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Aetna,Aetna,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Aetna MGG,Aetna MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,BCBS,BCBS,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,BCBS MGG,BCBS MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Cigna,Cigna,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Cigna MGG,Cigna MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Humana,Humana,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Humana MGG,Humana MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Optum VA,Optum VA,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,UHC,UHC,19.77,,,,,,,per diem,19.77,19.77,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,UHC MGG,UHC MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,VA,VA,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Wellcare MGG,Wellcare MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Bright Health - commercial,Bright Health - commercial,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,19.77,19.77,Bright Health MGG,Bright Health MGG,19.77,,,,,,,case rate,19.77,19.77,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Aetna,Aetna,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Aetna MGG,Aetna MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,BCBS,BCBS,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,BCBS MGG,BCBS MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Cigna,Cigna,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Cigna MGG,Cigna MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Humana,Humana,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Humana MGG,Humana MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Optum VA,Optum VA,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,UHC,UHC,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,UHC MGG,UHC MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,VA,VA,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Wellcare MGG,Wellcare MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Bright Health - commercial,Bright Health - commercial,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Bright Health MGG,Bright Health MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Aetna,Aetna,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Aetna MGG,Aetna MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,BCBS,BCBS,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,BCBS MGG,BCBS MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Cigna,Cigna,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Cigna MGG,Cigna MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Humana,Humana,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Humana MGG,Humana MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Optum VA,Optum VA,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,UHC,UHC,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,UHC MGG,UHC MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,VA,VA,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Wellcare MGG,Wellcare MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Bright Health - commercial,Bright Health - commercial,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Bright Health MGG,Bright Health MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Aetna,Aetna,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Aetna MGG,Aetna MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,BCBS,BCBS,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,BCBS MGG,BCBS MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Cigna,Cigna,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Cigna MGG,Cigna MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Humana,Humana,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Humana MGG,Humana MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Optum VA,Optum VA,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,UHC,UHC,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,UHC MGG,UHC MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,VA,VA,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Wellcare MGG,Wellcare MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Bright Health - commercial,Bright Health - commercial,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.21,9.21,Bright Health MGG,Bright Health MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Aetna,Aetna,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Aetna MGG,Aetna MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,BCBS,BCBS,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,BCBS MGG,BCBS MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Cigna,Cigna,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Cigna MGG,Cigna MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Humana,Humana,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Humana MGG,Humana MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Optum VA,Optum VA,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,UHC,UHC,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,UHC MGG,UHC MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,VA,VA,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Wellcare MGG,Wellcare MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Bright Health - commercial,Bright Health - commercial,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,44,44,Bright Health MGG,Bright Health MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Aetna,Aetna,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Aetna MGG,Aetna MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS,BCBS,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS MGG,BCBS MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Cigna,Cigna,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Cigna MGG,Cigna MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Humana,Humana,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Humana MGG,Humana MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Optum VA,Optum VA,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,UHC,UHC,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,UHC MGG,UHC MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,VA,VA,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Wellcare MGG,Wellcare MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Bright Health - commercial,Bright Health - commercial,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,51,51,Bright Health MGG,Bright Health MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Aetna,Aetna,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Aetna MGG,Aetna MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,BCBS,BCBS,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,BCBS MGG,BCBS MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Cigna,Cigna,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Cigna MGG,Cigna MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Humana,Humana,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Humana MGG,Humana MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Optum VA,Optum VA,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,UHC,UHC,59,,,,,,,per diem,59,59,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,UHC MGG,UHC MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,VA,VA,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Wellcare MGG,Wellcare MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Bright Health - commercial,Bright Health - commercial,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,59,59,Bright Health MGG,Bright Health MGG,59,,,,,,,case rate,59,59,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Aetna,Aetna,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Aetna MGG,Aetna MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,BCBS,BCBS,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,BCBS MGG,BCBS MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Cigna,Cigna,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Cigna MGG,Cigna MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Humana,Humana,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Humana MGG,Humana MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Optum VA,Optum VA,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,UHC,UHC,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,UHC MGG,UHC MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,VA,VA,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Wellcare MGG,Wellcare MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Bright Health - commercial,Bright Health - commercial,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,38,38,Bright Health MGG,Bright Health MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Aetna,Aetna,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Aetna MGG,Aetna MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS,BCBS,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS MGG,BCBS MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Cigna,Cigna,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Cigna MGG,Cigna MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Humana,Humana,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Humana MGG,Humana MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Optum VA,Optum VA,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,UHC,UHC,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,UHC MGG,UHC MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,VA,VA,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Wellcare MGG,Wellcare MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Bright Health - commercial,Bright Health - commercial,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,51,51,Bright Health MGG,Bright Health MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Aetna,Aetna,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Aetna MGG,Aetna MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,BCBS,BCBS,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,BCBS MGG,BCBS MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Cigna,Cigna,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Cigna MGG,Cigna MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Humana,Humana,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Humana MGG,Humana MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Optum VA,Optum VA,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,UHC,UHC,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,UHC MGG,UHC MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,VA,VA,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Wellcare MGG,Wellcare MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Bright Health - commercial,Bright Health - commercial,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,74,74,Bright Health MGG,Bright Health MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Aetna,Aetna,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Aetna MGG,Aetna MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,BCBS,BCBS,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,BCBS MGG,BCBS MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Cigna,Cigna,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Cigna MGG,Cigna MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Humana,Humana,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Humana MGG,Humana MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Optum VA,Optum VA,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,UHC,UHC,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,UHC MGG,UHC MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,VA,VA,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Wellcare MGG,Wellcare MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Bright Health - commercial,Bright Health - commercial,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,40,40,Bright Health MGG,Bright Health MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Aetna,Aetna,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Aetna MGG,Aetna MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,BCBS,BCBS,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,BCBS MGG,BCBS MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Cigna,Cigna,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Cigna MGG,Cigna MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Humana,Humana,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Humana MGG,Humana MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Optum VA,Optum VA,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,UHC,UHC,40,,,,,,,per diem,40,40,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,UHC MGG,UHC MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,VA,VA,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Wellcare MGG,Wellcare MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Bright Health - commercial,Bright Health - commercial,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,40,40,Bright Health MGG,Bright Health MGG,40,,,,,,,case rate,40,40,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Aetna,Aetna,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Aetna MGG,Aetna MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS,BCBS,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS MGG,BCBS MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Cigna,Cigna,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Cigna MGG,Cigna MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Humana,Humana,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Humana MGG,Humana MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Optum VA,Optum VA,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,UHC,UHC,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,UHC MGG,UHC MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,VA,VA,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Wellcare MGG,Wellcare MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Bright Health - commercial,Bright Health - commercial,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,43,43,Bright Health MGG,Bright Health MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Aetna,Aetna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Aetna MGG,Aetna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS,BCBS,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS MGG,BCBS MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Cigna,Cigna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Cigna MGG,Cigna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Humana,Humana,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Humana MGG,Humana MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Optum VA,Optum VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,UHC,UHC,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,UHC MGG,UHC MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,VA,VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Wellcare MGG,Wellcare MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Bright Health - commercial,Bright Health - commercial,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,21,21,Bright Health MGG,Bright Health MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Aetna,Aetna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Aetna MGG,Aetna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,BCBS,BCBS,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,BCBS MGG,BCBS MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Cigna,Cigna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Cigna MGG,Cigna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Humana,Humana,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Humana MGG,Humana MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Optum VA,Optum VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,UHC,UHC,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,UHC MGG,UHC MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,VA,VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Wellcare MGG,Wellcare MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Bright Health - commercial,Bright Health - commercial,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,28,28,Bright Health MGG,Bright Health MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Aetna,Aetna,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Aetna MGG,Aetna MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,BCBS,BCBS,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,BCBS MGG,BCBS MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Cigna,Cigna,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Cigna MGG,Cigna MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Humana,Humana,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Humana MGG,Humana MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Optum VA,Optum VA,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,UHC,UHC,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,UHC MGG,UHC MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,VA,VA,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Wellcare MGG,Wellcare MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Bright Health - commercial,Bright Health - commercial,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,65,65,Bright Health MGG,Bright Health MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Aetna,Aetna,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Aetna MGG,Aetna MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,BCBS,BCBS,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,BCBS MGG,BCBS MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Cigna,Cigna,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Cigna MGG,Cigna MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Humana,Humana,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Humana MGG,Humana MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Optum VA,Optum VA,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,UHC,UHC,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,UHC MGG,UHC MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,VA,VA,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Wellcare MGG,Wellcare MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Bright Health - commercial,Bright Health - commercial,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,68,68,Bright Health MGG,Bright Health MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Aetna,Aetna,155,,,,,,,per diem,155,155,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Aetna MGG,Aetna MGG,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,BCBS,BCBS,155,,,,,,,per diem,155,155,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,BCBS MGG,BCBS MGG,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Cigna,Cigna,155,,,,,,,per diem,155,155,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Cigna MGG,Cigna MGG,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Humana,Humana,155,,,,,,,per diem,155,155,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Humana MGG,Humana MGG,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Optum VA,Optum VA,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,UHC,UHC,155,,,,,,,per diem,155,155,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,UHC MGG,UHC MGG,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,VA,VA,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Wellcare MGG,Wellcare MGG,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Bright Health - commercial,Bright Health - commercial,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,155,155,Bright Health MGG,Bright Health MGG,155,,,,,,,case rate,155,155,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Aetna,Aetna,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Aetna MGG,Aetna MGG,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,BCBS,BCBS,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,BCBS MGG,BCBS MGG,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Cigna,Cigna,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Cigna MGG,Cigna MGG,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Humana,Humana,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Humana MGG,Humana MGG,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Optum VA,Optum VA,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,UHC,UHC,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,UHC MGG,UHC MGG,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,VA,VA,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Wellcare MGG,Wellcare MGG,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Bright Health - commercial,Bright Health - commercial,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.5,5.5,Bright Health MGG,Bright Health MGG,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Aetna,Aetna,214,,,,,,,per diem,214,214,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Aetna MGG,Aetna MGG,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,BCBS,BCBS,214,,,,,,,per diem,214,214,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,BCBS MGG,BCBS MGG,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Cigna,Cigna,214,,,,,,,per diem,214,214,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Cigna MGG,Cigna MGG,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Humana,Humana,214,,,,,,,per diem,214,214,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Humana MGG,Humana MGG,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Optum VA,Optum VA,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,UHC,UHC,214,,,,,,,per diem,214,214,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,UHC MGG,UHC MGG,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,VA,VA,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Wellcare MGG,Wellcare MGG,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Bright Health - commercial,Bright Health - commercial,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,214,214,Bright Health MGG,Bright Health MGG,214,,,,,,,case rate,214,214,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Aetna,Aetna,398,,,,,,,per diem,398,398,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Aetna MGG,Aetna MGG,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,BCBS,BCBS,398,,,,,,,per diem,398,398,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,BCBS MGG,BCBS MGG,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Cigna,Cigna,398,,,,,,,per diem,398,398,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Cigna MGG,Cigna MGG,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Humana,Humana,398,,,,,,,per diem,398,398,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Humana MGG,Humana MGG,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Optum VA,Optum VA,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,UHC,UHC,398,,,,,,,per diem,398,398,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,UHC MGG,UHC MGG,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,VA,VA,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Wellcare MGG,Wellcare MGG,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Bright Health - commercial,Bright Health - commercial,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,398,398,Bright Health MGG,Bright Health MGG,398,,,,,,,case rate,398,398,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Aetna,Aetna,612,,,,,,,per diem,612,612,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Aetna MGG,Aetna MGG,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,BCBS,BCBS,612,,,,,,,per diem,612,612,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,BCBS MGG,BCBS MGG,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Cigna,Cigna,612,,,,,,,per diem,612,612,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Cigna MGG,Cigna MGG,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Humana,Humana,612,,,,,,,per diem,612,612,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Humana MGG,Humana MGG,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Optum VA,Optum VA,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,UHC,UHC,612,,,,,,,per diem,612,612,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,UHC MGG,UHC MGG,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,VA,VA,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Wellcare MGG,Wellcare MGG,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Bright Health - commercial,Bright Health - commercial,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,612,612,Bright Health MGG,Bright Health MGG,612,,,,,,,case rate,612,612,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Aetna,Aetna,657,,,,,,,per diem,657,657,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Aetna MGG,Aetna MGG,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,BCBS,BCBS,657,,,,,,,per diem,657,657,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,BCBS MGG,BCBS MGG,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Cigna,Cigna,657,,,,,,,per diem,657,657,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Cigna MGG,Cigna MGG,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Humana,Humana,657,,,,,,,per diem,657,657,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Humana MGG,Humana MGG,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Optum VA,Optum VA,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,UHC,UHC,657,,,,,,,per diem,657,657,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,UHC MGG,UHC MGG,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,VA,VA,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Wellcare MGG,Wellcare MGG,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Bright Health - commercial,Bright Health - commercial,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,657,657,Bright Health MGG,Bright Health MGG,657,,,,,,,case rate,657,657,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Aetna,Aetna,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Aetna MGG,Aetna MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,BCBS,BCBS,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,BCBS MGG,BCBS MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Cigna,Cigna,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Cigna MGG,Cigna MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Humana,Humana,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Humana MGG,Humana MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Optum VA,Optum VA,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,UHC,UHC,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,UHC MGG,UHC MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,VA,VA,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Wellcare MGG,Wellcare MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Bright Health - commercial,Bright Health - commercial,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,878,878,Bright Health MGG,Bright Health MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Aetna,Aetna,1098,,,,,,,per diem,1098,1098,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Aetna MGG,Aetna MGG,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,BCBS,BCBS,1098,,,,,,,per diem,1098,1098,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,BCBS MGG,BCBS MGG,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Cigna,Cigna,1098,,,,,,,per diem,1098,1098,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Cigna MGG,Cigna MGG,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Humana,Humana,1098,,,,,,,per diem,1098,1098,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Humana MGG,Humana MGG,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Optum VA,Optum VA,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,UHC,UHC,1098,,,,,,,per diem,1098,1098,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,UHC MGG,UHC MGG,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,VA,VA,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Wellcare MGG,Wellcare MGG,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Bright Health - commercial,Bright Health - commercial,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1098,1098,Bright Health MGG,Bright Health MGG,1098,,,,,,,case rate,1098,1098,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Aetna,Aetna,1822,,,,,,,per diem,1822,1822,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Aetna MGG,Aetna MGG,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,BCBS,BCBS,1822,,,,,,,per diem,1822,1822,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,BCBS MGG,BCBS MGG,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Cigna,Cigna,1822,,,,,,,per diem,1822,1822,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Cigna MGG,Cigna MGG,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Humana,Humana,1822,,,,,,,per diem,1822,1822,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Humana MGG,Humana MGG,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Optum VA,Optum VA,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,UHC,UHC,1822,,,,,,,per diem,1822,1822,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,UHC MGG,UHC MGG,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,VA,VA,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Wellcare MGG,Wellcare MGG,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Bright Health - commercial,Bright Health - commercial,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1822,1822,Bright Health MGG,Bright Health MGG,1822,,,,,,,case rate,1822,1822,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Aetna,Aetna,2735,,,,,,,per diem,2735,2735,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Aetna MGG,Aetna MGG,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,BCBS,BCBS,2735,,,,,,,per diem,2735,2735,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,BCBS MGG,BCBS MGG,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Cigna,Cigna,2735,,,,,,,per diem,2735,2735,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Cigna MGG,Cigna MGG,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Humana,Humana,2735,,,,,,,per diem,2735,2735,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Humana MGG,Humana MGG,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Optum VA,Optum VA,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,UHC,UHC,2735,,,,,,,per diem,2735,2735,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,UHC MGG,UHC MGG,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,VA,VA,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Wellcare MGG,Wellcare MGG,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Bright Health - commercial,Bright Health - commercial,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2735,2735,Bright Health MGG,Bright Health MGG,2735,,,,,,,case rate,2735,2735,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Aetna,Aetna,3650,,,,,,,per diem,3650,3650,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Aetna MGG,Aetna MGG,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,BCBS,BCBS,3650,,,,,,,per diem,3650,3650,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,BCBS MGG,BCBS MGG,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Cigna,Cigna,3650,,,,,,,per diem,3650,3650,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Cigna MGG,Cigna MGG,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Humana,Humana,3650,,,,,,,per diem,3650,3650,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Humana MGG,Humana MGG,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Optum VA,Optum VA,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,UHC,UHC,3650,,,,,,,per diem,3650,3650,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,UHC MGG,UHC MGG,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,VA,VA,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Wellcare MGG,Wellcare MGG,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Bright Health - commercial,Bright Health - commercial,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3650,3650,Bright Health MGG,Bright Health MGG,3650,,,,,,,case rate,3650,3650,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Aetna,Aetna,3568,,,,,,,per diem,3568,3568,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Aetna MGG,Aetna MGG,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,BCBS,BCBS,3568,,,,,,,per diem,3568,3568,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,BCBS MGG,BCBS MGG,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Cigna,Cigna,3568,,,,,,,per diem,3568,3568,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Cigna MGG,Cigna MGG,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Humana,Humana,3568,,,,,,,per diem,3568,3568,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Humana MGG,Humana MGG,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Optum VA,Optum VA,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,UHC,UHC,3568,,,,,,,per diem,3568,3568,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,UHC MGG,UHC MGG,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,VA,VA,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Wellcare MGG,Wellcare MGG,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Bright Health - commercial,Bright Health - commercial,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3568,3568,Bright Health MGG,Bright Health MGG,3568,,,,,,,case rate,3568,3568,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Aetna,Aetna,403,,,,,,,per diem,403,403,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Aetna MGG,Aetna MGG,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,BCBS,BCBS,403,,,,,,,per diem,403,403,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,BCBS MGG,BCBS MGG,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Cigna,Cigna,403,,,,,,,per diem,403,403,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Cigna MGG,Cigna MGG,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Humana,Humana,403,,,,,,,per diem,403,403,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Humana MGG,Humana MGG,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Optum VA,Optum VA,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,UHC,UHC,403,,,,,,,per diem,403,403,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,UHC MGG,UHC MGG,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,VA,VA,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Wellcare MGG,Wellcare MGG,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Bright Health - commercial,Bright Health - commercial,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,403,403,Bright Health MGG,Bright Health MGG,403,,,,,,,case rate,403,403,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Aetna,Aetna,97,,,,,,,per diem,97,97,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Aetna MGG,Aetna MGG,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,BCBS,BCBS,97,,,,,,,per diem,97,97,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,BCBS MGG,BCBS MGG,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Cigna,Cigna,97,,,,,,,per diem,97,97,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Cigna MGG,Cigna MGG,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Humana,Humana,97,,,,,,,per diem,97,97,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Humana MGG,Humana MGG,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Optum VA,Optum VA,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,UHC,UHC,97,,,,,,,per diem,97,97,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,UHC MGG,UHC MGG,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,VA,VA,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Wellcare MGG,Wellcare MGG,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Bright Health - commercial,Bright Health - commercial,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,97,97,Bright Health MGG,Bright Health MGG,97,,,,,,,case rate,97,97,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Aetna,Aetna,295,,,,,,,per diem,295,295,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Aetna MGG,Aetna MGG,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,BCBS,BCBS,295,,,,,,,per diem,295,295,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,BCBS MGG,BCBS MGG,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Cigna,Cigna,295,,,,,,,per diem,295,295,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Cigna MGG,Cigna MGG,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Humana,Humana,295,,,,,,,per diem,295,295,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Humana MGG,Humana MGG,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Optum VA,Optum VA,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,UHC,UHC,295,,,,,,,per diem,295,295,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,UHC MGG,UHC MGG,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,VA,VA,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Wellcare MGG,Wellcare MGG,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Bright Health - commercial,Bright Health - commercial,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,295,295,Bright Health MGG,Bright Health MGG,295,,,,,,,case rate,295,295,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Aetna,Aetna,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Aetna MGG,Aetna MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,BCBS,BCBS,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,BCBS MGG,BCBS MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Cigna,Cigna,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Cigna MGG,Cigna MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Humana,Humana,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Humana MGG,Humana MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Optum VA,Optum VA,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,UHC,UHC,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,UHC MGG,UHC MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,VA,VA,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Wellcare MGG,Wellcare MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Bright Health - commercial,Bright Health - commercial,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,353,353,Bright Health MGG,Bright Health MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Aetna,Aetna,486,,,,,,,per diem,486,486,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Aetna MGG,Aetna MGG,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,BCBS,BCBS,486,,,,,,,per diem,486,486,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,BCBS MGG,BCBS MGG,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Cigna,Cigna,486,,,,,,,per diem,486,486,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Cigna MGG,Cigna MGG,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Humana,Humana,486,,,,,,,per diem,486,486,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Humana MGG,Humana MGG,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Optum VA,Optum VA,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,UHC,UHC,486,,,,,,,per diem,486,486,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,UHC MGG,UHC MGG,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,VA,VA,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Wellcare MGG,Wellcare MGG,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Bright Health - commercial,Bright Health - commercial,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,486,486,Bright Health MGG,Bright Health MGG,486,,,,,,,case rate,486,486,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Aetna,Aetna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Aetna MGG,Aetna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,BCBS,BCBS,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,BCBS MGG,BCBS MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Cigna,Cigna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Cigna MGG,Cigna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Humana,Humana,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Humana MGG,Humana MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Optum VA,Optum VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,UHC,UHC,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,UHC MGG,UHC MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,VA,VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Wellcare MGG,Wellcare MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Bright Health - commercial,Bright Health - commercial,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,171,171,Bright Health MGG,Bright Health MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Aetna,Aetna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Aetna MGG,Aetna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,BCBS,BCBS,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,BCBS MGG,BCBS MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Cigna,Cigna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Cigna MGG,Cigna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Humana,Humana,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Humana MGG,Humana MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Optum VA,Optum VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,UHC,UHC,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,UHC MGG,UHC MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,VA,VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Wellcare MGG,Wellcare MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Bright Health - commercial,Bright Health - commercial,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,19.5,19.5,Bright Health MGG,Bright Health MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Aetna,Aetna,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Aetna MGG,Aetna MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,BCBS,BCBS,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,BCBS MGG,BCBS MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Cigna,Cigna,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Cigna MGG,Cigna MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Humana,Humana,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Humana MGG,Humana MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Optum VA,Optum VA,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,UHC,UHC,149.5,,,,,,,per diem,149.5,149.5,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,UHC MGG,UHC MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,VA,VA,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Wellcare MGG,Wellcare MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Bright Health - commercial,Bright Health - commercial,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,149.5,149.5,Bright Health MGG,Bright Health MGG,149.5,,,,,,,case rate,149.5,149.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Aetna,Aetna,170,,,,,,,per diem,170,170,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Aetna MGG,Aetna MGG,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,BCBS,BCBS,170,,,,,,,per diem,170,170,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,BCBS MGG,BCBS MGG,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Cigna,Cigna,170,,,,,,,per diem,170,170,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Cigna MGG,Cigna MGG,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Humana,Humana,170,,,,,,,per diem,170,170,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Humana MGG,Humana MGG,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Optum VA,Optum VA,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,UHC,UHC,170,,,,,,,per diem,170,170,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,UHC MGG,UHC MGG,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,VA,VA,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Wellcare MGG,Wellcare MGG,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Bright Health - commercial,Bright Health - commercial,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,170,170,Bright Health MGG,Bright Health MGG,170,,,,,,,case rate,170,170,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Aetna,Aetna,112.75,,,,,,,per diem,112.75,112.75,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Aetna MGG,Aetna MGG,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,BCBS,BCBS,112.75,,,,,,,per diem,112.75,112.75,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,BCBS MGG,BCBS MGG,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Cigna,Cigna,112.75,,,,,,,per diem,112.75,112.75,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Cigna MGG,Cigna MGG,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Humana,Humana,112.75,,,,,,,per diem,112.75,112.75,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Humana MGG,Humana MGG,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Optum VA,Optum VA,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,UHC,UHC,112.75,,,,,,,per diem,112.75,112.75,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,UHC MGG,UHC MGG,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,VA,VA,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Wellcare MGG,Wellcare MGG,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Bright Health - commercial,Bright Health - commercial,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,112.75,112.75,Bright Health MGG,Bright Health MGG,112.75,,,,,,,case rate,112.75,112.75,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Aetna,Aetna,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Aetna MGG,Aetna MGG,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,BCBS,BCBS,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,BCBS MGG,BCBS MGG,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Cigna,Cigna,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Cigna MGG,Cigna MGG,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Humana,Humana,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Humana MGG,Humana MGG,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Optum VA,Optum VA,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,UHC,UHC,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,UHC MGG,UHC MGG,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,VA,VA,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Wellcare MGG,Wellcare MGG,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Bright Health - commercial,Bright Health - commercial,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,142,142,Bright Health MGG,Bright Health MGG,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Aetna,Aetna,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Aetna MGG,Aetna MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,BCBS,BCBS,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,BCBS MGG,BCBS MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Cigna,Cigna,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Cigna MGG,Cigna MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Humana,Humana,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Humana MGG,Humana MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Optum VA,Optum VA,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,UHC,UHC,65,,,,,,,per diem,65,65,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,UHC MGG,UHC MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,VA,VA,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Wellcare MGG,Wellcare MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Bright Health - commercial,Bright Health - commercial,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,65,65,Bright Health MGG,Bright Health MGG,65,,,,,,,case rate,65,65,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Aetna,Aetna,6.5,,,,,,,per diem,6.5,6.5,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Aetna MGG,Aetna MGG,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,BCBS,BCBS,6.5,,,,,,,per diem,6.5,6.5,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,BCBS MGG,BCBS MGG,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Cigna,Cigna,6.5,,,,,,,per diem,6.5,6.5,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Cigna MGG,Cigna MGG,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Humana,Humana,6.5,,,,,,,per diem,6.5,6.5,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Humana MGG,Humana MGG,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Optum VA,Optum VA,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,UHC,UHC,6.5,,,,,,,per diem,6.5,6.5,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,UHC MGG,UHC MGG,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,VA,VA,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Wellcare MGG,Wellcare MGG,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Bright Health - commercial,Bright Health - commercial,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.5,6.5,Bright Health MGG,Bright Health MGG,6.5,,,,,,,case rate,6.5,6.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Aetna,Aetna,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Aetna MGG,Aetna MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,BCBS,BCBS,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,BCBS MGG,BCBS MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Cigna,Cigna,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Cigna MGG,Cigna MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Humana,Humana,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Humana MGG,Humana MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Optum VA,Optum VA,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,UHC,UHC,991.5,,,,,,,per diem,991.5,991.5,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,UHC MGG,UHC MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,VA,VA,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Wellcare MGG,Wellcare MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Bright Health - commercial,Bright Health - commercial,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,991.5,991.5,Bright Health MGG,Bright Health MGG,991.5,,,,,,,case rate,991.5,991.5,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Aetna,Aetna,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Aetna MGG,Aetna MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,BCBS,BCBS,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,BCBS MGG,BCBS MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Cigna,Cigna,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Cigna MGG,Cigna MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Humana,Humana,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Humana MGG,Humana MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Optum VA,Optum VA,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,UHC,UHC,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,UHC MGG,UHC MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,VA,VA,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Wellcare MGG,Wellcare MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Bright Health - commercial,Bright Health - commercial,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,38,38,Bright Health MGG,Bright Health MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Aetna,Aetna,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Aetna MGG,Aetna MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS,BCBS,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS MGG,BCBS MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Cigna,Cigna,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Cigna MGG,Cigna MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Humana,Humana,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Humana MGG,Humana MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Optum VA,Optum VA,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,UHC,UHC,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,UHC MGG,UHC MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,VA,VA,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Wellcare MGG,Wellcare MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Bright Health - commercial,Bright Health - commercial,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,43,43,Bright Health MGG,Bright Health MGG,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Aetna,Aetna,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Aetna MGG,Aetna MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,BCBS,BCBS,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,BCBS MGG,BCBS MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Cigna,Cigna,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Cigna MGG,Cigna MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Humana,Humana,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Humana MGG,Humana MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Optum VA,Optum VA,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,UHC,UHC,38,,,,,,,per diem,38,38,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,UHC MGG,UHC MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,VA,VA,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Wellcare MGG,Wellcare MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Bright Health - commercial,Bright Health - commercial,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,38,38,Bright Health MGG,Bright Health MGG,38,,,,,,,case rate,38,38,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Aetna,Aetna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Aetna MGG,Aetna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,BCBS,BCBS,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,BCBS MGG,BCBS MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Cigna,Cigna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Cigna MGG,Cigna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Humana,Humana,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Humana MGG,Humana MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Optum VA,Optum VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,UHC,UHC,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,UHC MGG,UHC MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,VA,VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Wellcare MGG,Wellcare MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Bright Health - commercial,Bright Health - commercial,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,88,88,Bright Health MGG,Bright Health MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Aetna,Aetna,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Aetna MGG,Aetna MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,BCBS,BCBS,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,BCBS MGG,BCBS MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Cigna,Cigna,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Cigna MGG,Cigna MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Humana,Humana,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Humana MGG,Humana MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Optum VA,Optum VA,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,UHC,UHC,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,UHC MGG,UHC MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,VA,VA,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Wellcare MGG,Wellcare MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Bright Health - commercial,Bright Health - commercial,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,16.5,16.5,Bright Health MGG,Bright Health MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Aetna,Aetna,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Aetna MGG,Aetna MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,BCBS,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,BCBS MGG,BCBS MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Cigna,Cigna,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Cigna MGG,Cigna MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Humana,Humana,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Humana MGG,Humana MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Optum VA,Optum VA,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,UHC,UHC,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,UHC MGG,UHC MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,VA,VA,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Wellcare MGG,Wellcare MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Bright Health - commercial,Bright Health - commercial,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Bright Health MGG,Bright Health MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Aetna,Aetna,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Aetna MGG,Aetna MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,BCBS,BCBS,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,BCBS MGG,BCBS MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Cigna,Cigna,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Cigna MGG,Cigna MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Humana,Humana,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Humana MGG,Humana MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Optum VA,Optum VA,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,UHC,UHC,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,UHC MGG,UHC MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,VA,VA,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Wellcare MGG,Wellcare MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Bright Health - commercial,Bright Health - commercial,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,83,83,Bright Health MGG,Bright Health MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Aetna,Aetna,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Aetna MGG,Aetna MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,BCBS,BCBS,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,BCBS MGG,BCBS MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Cigna,Cigna,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Cigna MGG,Cigna MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Humana,Humana,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Humana MGG,Humana MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Optum VA,Optum VA,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,UHC,UHC,166.5,,,,,,,per diem,166.5,166.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,UHC MGG,UHC MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,VA,VA,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Wellcare MGG,Wellcare MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Bright Health - commercial,Bright Health - commercial,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,166.5,166.5,Bright Health MGG,Bright Health MGG,166.5,,,,,,,case rate,166.5,166.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Aetna,Aetna,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Aetna MGG,Aetna MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,BCBS,BCBS,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,BCBS MGG,BCBS MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Cigna,Cigna,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Cigna MGG,Cigna MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Humana,Humana,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Humana MGG,Humana MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Optum VA,Optum VA,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,UHC,UHC,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,UHC MGG,UHC MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,VA,VA,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Wellcare MGG,Wellcare MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Bright Health - commercial,Bright Health - commercial,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Bright Health MGG,Bright Health MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Aetna,Aetna,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Aetna MGG,Aetna MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,BCBS,BCBS,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,BCBS MGG,BCBS MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Cigna,Cigna,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Cigna MGG,Cigna MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Humana,Humana,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Humana MGG,Humana MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Optum VA,Optum VA,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,UHC,UHC,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,UHC MGG,UHC MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,VA,VA,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Wellcare MGG,Wellcare MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Bright Health - commercial,Bright Health - commercial,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,73,73,Bright Health MGG,Bright Health MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Aetna,Aetna,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Aetna MGG,Aetna MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,BCBS,BCBS,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,BCBS MGG,BCBS MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Cigna,Cigna,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Cigna MGG,Cigna MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Humana,Humana,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Humana MGG,Humana MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Optum VA,Optum VA,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,UHC,UHC,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,UHC MGG,UHC MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,VA,VA,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Wellcare MGG,Wellcare MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Bright Health - commercial,Bright Health - commercial,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Bright Health MGG,Bright Health MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Aetna,Aetna,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Aetna MGG,Aetna MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,BCBS,BCBS,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,BCBS MGG,BCBS MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Cigna,Cigna,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Cigna MGG,Cigna MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Humana,Humana,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Humana MGG,Humana MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Optum VA,Optum VA,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,UHC,UHC,20.5,,,,,,,per diem,20.5,20.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,UHC MGG,UHC MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,VA,VA,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Wellcare MGG,Wellcare MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Bright Health - commercial,Bright Health - commercial,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,20.5,20.5,Bright Health MGG,Bright Health MGG,20.5,,,,,,,case rate,20.5,20.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Aetna,Aetna,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Aetna MGG,Aetna MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,BCBS,BCBS,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,BCBS MGG,BCBS MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Cigna,Cigna,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Cigna MGG,Cigna MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Humana,Humana,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Humana MGG,Humana MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Optum VA,Optum VA,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,UHC,UHC,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,UHC MGG,UHC MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,VA,VA,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Wellcare MGG,Wellcare MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Bright Health - commercial,Bright Health - commercial,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,50,50,Bright Health MGG,Bright Health MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Aetna,Aetna,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Aetna MGG,Aetna MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,BCBS,BCBS,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,BCBS MGG,BCBS MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Cigna,Cigna,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Cigna MGG,Cigna MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Humana,Humana,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Humana MGG,Humana MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Optum VA,Optum VA,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,UHC,UHC,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,UHC MGG,UHC MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,VA,VA,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Wellcare MGG,Wellcare MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Bright Health - commercial,Bright Health - commercial,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4,4,Bright Health MGG,Bright Health MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Aetna,Aetna,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Aetna MGG,Aetna MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,BCBS,BCBS,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,BCBS MGG,BCBS MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Cigna,Cigna,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Cigna MGG,Cigna MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Humana,Humana,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Humana MGG,Humana MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Optum VA,Optum VA,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,UHC,UHC,50,,,,,,,per diem,50,50,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,UHC MGG,UHC MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,VA,VA,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Wellcare MGG,Wellcare MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Bright Health - commercial,Bright Health - commercial,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,50,50,Bright Health MGG,Bright Health MGG,50,,,,,,,case rate,50,50,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Aetna,Aetna,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Aetna MGG,Aetna MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,BCBS,BCBS,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,BCBS MGG,BCBS MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Cigna,Cigna,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Cigna MGG,Cigna MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Humana,Humana,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Humana MGG,Humana MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Optum VA,Optum VA,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,UHC,UHC,4,,,,,,,per diem,4,4,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,UHC MGG,UHC MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,VA,VA,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Wellcare MGG,Wellcare MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Bright Health - commercial,Bright Health - commercial,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4,4,Bright Health MGG,Bright Health MGG,4,,,,,,,case rate,4,4,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Aetna,Aetna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Aetna MGG,Aetna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,BCBS,BCBS,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,BCBS MGG,BCBS MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Cigna,Cigna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Cigna MGG,Cigna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Humana,Humana,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Humana MGG,Humana MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Optum VA,Optum VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,UHC,UHC,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,UHC MGG,UHC MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,VA,VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Wellcare MGG,Wellcare MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Bright Health - commercial,Bright Health - commercial,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,30,30,Bright Health MGG,Bright Health MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna,Aetna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna MGG,Aetna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS,BCBS,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS MGG,BCBS MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna,Cigna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna MGG,Cigna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana,Humana,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana MGG,Humana MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Optum VA,Optum VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC,UHC,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC MGG,UHC MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,VA,VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Wellcare MGG,Wellcare MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health - commercial,Bright Health - commercial,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health MGG,Bright Health MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Aetna,Aetna,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Aetna MGG,Aetna MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,BCBS,BCBS,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,BCBS MGG,BCBS MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Cigna,Cigna,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Cigna MGG,Cigna MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Humana,Humana,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Humana MGG,Humana MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Optum VA,Optum VA,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,UHC,UHC,44,,,,,,,per diem,44,44,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,UHC MGG,UHC MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,VA,VA,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Wellcare MGG,Wellcare MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Bright Health - commercial,Bright Health - commercial,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,44,44,Bright Health MGG,Bright Health MGG,44,,,,,,,case rate,44,44,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Aetna,Aetna,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Aetna MGG,Aetna MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,BCBS,BCBS,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,BCBS MGG,BCBS MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Cigna,Cigna,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Cigna MGG,Cigna MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Humana,Humana,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Humana MGG,Humana MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Optum VA,Optum VA,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,UHC,UHC,125,,,,,,,per diem,125,125,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,UHC MGG,UHC MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,VA,VA,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Wellcare MGG,Wellcare MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Bright Health - commercial,Bright Health - commercial,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,125,125,Bright Health MGG,Bright Health MGG,125,,,,,,,case rate,125,125,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Aetna,Aetna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Aetna MGG,Aetna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,BCBS,BCBS,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,BCBS MGG,BCBS MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Cigna,Cigna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Cigna MGG,Cigna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Humana,Humana,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Humana MGG,Humana MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Optum VA,Optum VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,UHC,UHC,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,UHC MGG,UHC MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,VA,VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Wellcare MGG,Wellcare MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Bright Health - commercial,Bright Health - commercial,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,156,156,Bright Health MGG,Bright Health MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Aetna,Aetna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Aetna MGG,Aetna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,BCBS,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,BCBS MGG,BCBS MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Cigna,Cigna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Cigna MGG,Cigna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Humana,Humana,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Humana MGG,Humana MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Optum VA,Optum VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,UHC,UHC,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,UHC MGG,UHC MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,VA,VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Wellcare MGG,Wellcare MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Bright Health - commercial,Bright Health - commercial,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,10.5,10.5,Bright Health MGG,Bright Health MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Aetna,Aetna,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Aetna MGG,Aetna MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,BCBS,BCBS,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,BCBS MGG,BCBS MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Cigna,Cigna,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Cigna MGG,Cigna MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Humana,Humana,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Humana MGG,Humana MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Optum VA,Optum VA,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,UHC,UHC,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,UHC MGG,UHC MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,VA,VA,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Wellcare MGG,Wellcare MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Bright Health - commercial,Bright Health - commercial,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Bright Health MGG,Bright Health MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Aetna,Aetna,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Aetna MGG,Aetna MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,BCBS,BCBS,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,BCBS MGG,BCBS MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Cigna,Cigna,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Cigna MGG,Cigna MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Humana,Humana,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Humana MGG,Humana MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Optum VA,Optum VA,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,UHC,UHC,53,,,,,,,per diem,53,53,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,UHC MGG,UHC MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,VA,VA,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Wellcare MGG,Wellcare MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Bright Health - commercial,Bright Health - commercial,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,53,53,Bright Health MGG,Bright Health MGG,53,,,,,,,case rate,53,53,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Aetna,Aetna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Aetna MGG,Aetna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,BCBS,BCBS,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,BCBS MGG,BCBS MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Cigna,Cigna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Cigna MGG,Cigna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Humana,Humana,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Humana MGG,Humana MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Optum VA,Optum VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,UHC,UHC,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,UHC MGG,UHC MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,VA,VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Wellcare MGG,Wellcare MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Bright Health - commercial,Bright Health - commercial,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,30,30,Bright Health MGG,Bright Health MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Aetna,Aetna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Aetna MGG,Aetna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,BCBS,BCBS,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,BCBS MGG,BCBS MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Cigna,Cigna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Cigna MGG,Cigna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Humana,Humana,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Humana MGG,Humana MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Optum VA,Optum VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,UHC,UHC,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,UHC MGG,UHC MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,VA,VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Wellcare MGG,Wellcare MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Bright Health - commercial,Bright Health - commercial,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,78,78,Bright Health MGG,Bright Health MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Aetna,Aetna,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Aetna MGG,Aetna MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,BCBS,BCBS,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,BCBS MGG,BCBS MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Cigna,Cigna,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Cigna MGG,Cigna MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Humana,Humana,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Humana MGG,Humana MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Optum VA,Optum VA,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,UHC,UHC,200.5,,,,,,,per diem,200.5,200.5,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,UHC MGG,UHC MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,VA,VA,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Wellcare MGG,Wellcare MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Bright Health - commercial,Bright Health - commercial,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,200.5,200.5,Bright Health MGG,Bright Health MGG,200.5,,,,,,,case rate,200.5,200.5,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Aetna,Aetna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Aetna MGG,Aetna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,BCBS,BCBS,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,BCBS MGG,BCBS MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Cigna,Cigna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Cigna MGG,Cigna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Humana,Humana,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Humana MGG,Humana MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Optum VA,Optum VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,UHC,UHC,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,UHC MGG,UHC MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,VA,VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Wellcare MGG,Wellcare MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Bright Health - commercial,Bright Health - commercial,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,77,77,Bright Health MGG,Bright Health MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Aetna,Aetna,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Aetna MGG,Aetna MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,BCBS,BCBS,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,BCBS MGG,BCBS MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Cigna,Cigna,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Cigna MGG,Cigna MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Humana,Humana,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Humana MGG,Humana MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Optum VA,Optum VA,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,UHC,UHC,43.5,,,,,,,per diem,43.5,43.5,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,UHC MGG,UHC MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,VA,VA,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Wellcare MGG,Wellcare MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Bright Health - commercial,Bright Health - commercial,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,43.5,43.5,Bright Health MGG,Bright Health MGG,43.5,,,,,,,case rate,43.5,43.5,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna,Aetna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna MGG,Aetna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS,BCBS,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS MGG,BCBS MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna,Cigna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna MGG,Cigna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana,Humana,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana MGG,Humana MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Optum VA,Optum VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC,UHC,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC MGG,UHC MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,VA,VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Wellcare MGG,Wellcare MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health - commercial,Bright Health - commercial,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health MGG,Bright Health MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Aetna,Aetna,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Aetna MGG,Aetna MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,BCBS,BCBS,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,BCBS MGG,BCBS MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Cigna,Cigna,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Cigna MGG,Cigna MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Humana,Humana,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Humana MGG,Humana MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Optum VA,Optum VA,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,UHC,UHC,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,UHC MGG,UHC MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,VA,VA,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Wellcare MGG,Wellcare MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Bright Health - commercial,Bright Health - commercial,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Bright Health MGG,Bright Health MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Aetna,Aetna,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Aetna MGG,Aetna MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,BCBS,BCBS,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,BCBS MGG,BCBS MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Cigna,Cigna,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Cigna MGG,Cigna MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Humana,Humana,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Humana MGG,Humana MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Optum VA,Optum VA,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,UHC,UHC,122.5,,,,,,,per diem,122.5,122.5,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,UHC MGG,UHC MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,VA,VA,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Wellcare MGG,Wellcare MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Bright Health - commercial,Bright Health - commercial,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,122.5,122.5,Bright Health MGG,Bright Health MGG,122.5,,,,,,,case rate,122.5,122.5,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Aetna,Aetna,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Aetna MGG,Aetna MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,BCBS,BCBS,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,BCBS MGG,BCBS MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Cigna,Cigna,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Cigna MGG,Cigna MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Humana,Humana,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Humana MGG,Humana MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Optum VA,Optum VA,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,UHC,UHC,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,UHC MGG,UHC MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,VA,VA,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Wellcare MGG,Wellcare MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Bright Health - commercial,Bright Health - commercial,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,56,56,Bright Health MGG,Bright Health MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Aetna,Aetna,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Aetna MGG,Aetna MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,BCBS,BCBS,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,BCBS MGG,BCBS MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Cigna,Cigna,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Cigna MGG,Cigna MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Humana,Humana,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Humana MGG,Humana MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Optum VA,Optum VA,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,UHC,UHC,56,,,,,,,per diem,56,56,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,UHC MGG,UHC MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,VA,VA,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Wellcare MGG,Wellcare MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Bright Health - commercial,Bright Health - commercial,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,56,56,Bright Health MGG,Bright Health MGG,56,,,,,,,case rate,56,56,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna,Aetna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna MGG,Aetna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS,BCBS,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS MGG,BCBS MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna,Cigna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna MGG,Cigna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana,Humana,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana MGG,Humana MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Optum VA,Optum VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC,UHC,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC MGG,UHC MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,VA,VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Wellcare MGG,Wellcare MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health - commercial,Bright Health - commercial,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health MGG,Bright Health MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna,Aetna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Aetna MGG,Aetna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS,BCBS,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,BCBS MGG,BCBS MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna,Cigna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Cigna MGG,Cigna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana,Humana,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Humana MGG,Humana MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Optum VA,Optum VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC,UHC,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,UHC MGG,UHC MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,VA,VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Wellcare MGG,Wellcare MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health - commercial,Bright Health - commercial,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,48,48,Bright Health MGG,Bright Health MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna,Aetna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna MGG,Aetna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,BCBS,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS MGG,BCBS MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna,Cigna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna MGG,Cigna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana,Humana,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana MGG,Humana MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Optum VA,Optum VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC,UHC,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC MGG,UHC MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Wellcare MGG,Wellcare MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health - commercial,Bright Health - commercial,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health MGG,Bright Health MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna,Aetna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna MGG,Aetna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,BCBS,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS MGG,BCBS MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna,Cigna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna MGG,Cigna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana,Humana,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana MGG,Humana MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Optum VA,Optum VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC,UHC,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC MGG,UHC MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Wellcare MGG,Wellcare MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health - commercial,Bright Health - commercial,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health MGG,Bright Health MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Aetna,Aetna,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Aetna MGG,Aetna MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,BCBS,BCBS,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,BCBS MGG,BCBS MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Cigna,Cigna,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Cigna MGG,Cigna MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Humana,Humana,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Humana MGG,Humana MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Optum VA,Optum VA,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,UHC,UHC,499,,,,,,,per diem,499,499,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,UHC MGG,UHC MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,VA,VA,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Wellcare MGG,Wellcare MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Bright Health - commercial,Bright Health - commercial,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,499,499,Bright Health MGG,Bright Health MGG,499,,,,,,,case rate,499,499,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Aetna,Aetna,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Aetna MGG,Aetna MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,BCBS,BCBS,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,BCBS MGG,BCBS MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Cigna,Cigna,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Cigna MGG,Cigna MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Humana,Humana,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Humana MGG,Humana MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Optum VA,Optum VA,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,UHC,UHC,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,UHC MGG,UHC MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,VA,VA,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Wellcare MGG,Wellcare MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Bright Health - commercial,Bright Health - commercial,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,11.5,11.5,Bright Health MGG,Bright Health MGG,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Aetna,Aetna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Aetna MGG,Aetna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,BCBS,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS MGG,BCBS MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Cigna,Cigna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Cigna MGG,Cigna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Humana,Humana,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Humana MGG,Humana MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Optum VA,Optum VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,UHC,UHC,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,UHC MGG,UHC MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,VA,VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Wellcare MGG,Wellcare MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Bright Health - commercial,Bright Health - commercial,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,21,21,Bright Health MGG,Bright Health MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Aetna,Aetna,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Aetna MGG,Aetna MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,BCBS,BCBS,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,BCBS MGG,BCBS MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Cigna,Cigna,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Cigna MGG,Cigna MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Humana,Humana,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Humana MGG,Humana MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Optum VA,Optum VA,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,UHC,UHC,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,UHC MGG,UHC MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,VA,VA,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Wellcare MGG,Wellcare MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Bright Health - commercial,Bright Health - commercial,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,74,74,Bright Health MGG,Bright Health MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Aetna,Aetna,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Aetna MGG,Aetna MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,BCBS,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS MGG,BCBS MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Cigna,Cigna,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Cigna MGG,Cigna MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Humana,Humana,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Humana MGG,Humana MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Optum VA,Optum VA,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,UHC,UHC,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,UHC MGG,UHC MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,VA,VA,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Wellcare MGG,Wellcare MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Bright Health - commercial,Bright Health - commercial,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7,7,Bright Health MGG,Bright Health MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna,Aetna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna MGG,Aetna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS,BCBS,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS MGG,BCBS MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna,Cigna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna MGG,Cigna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana,Humana,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana MGG,Humana MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Optum VA,Optum VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC,UHC,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC MGG,UHC MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,VA,VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Wellcare MGG,Wellcare MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health - commercial,Bright Health - commercial,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health MGG,Bright Health MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Aetna,Aetna,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Aetna MGG,Aetna MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,BCBS,BCBS,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,BCBS MGG,BCBS MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Cigna,Cigna,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Cigna MGG,Cigna MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Humana,Humana,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Humana MGG,Humana MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Optum VA,Optum VA,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,UHC,UHC,160.5,,,,,,,per diem,160.5,160.5,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,UHC MGG,UHC MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,VA,VA,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Wellcare MGG,Wellcare MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Bright Health - commercial,Bright Health - commercial,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,160.5,160.5,Bright Health MGG,Bright Health MGG,160.5,,,,,,,case rate,160.5,160.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna,Aetna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna MGG,Aetna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS,BCBS,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS MGG,BCBS MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna,Cigna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna MGG,Cigna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana,Humana,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana MGG,Humana MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Optum VA,Optum VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC,UHC,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC MGG,UHC MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,VA,VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Wellcare MGG,Wellcare MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health - commercial,Bright Health - commercial,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health MGG,Bright Health MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Aetna,Aetna,146.5,,,,,,,per diem,146.5,146.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Aetna MGG,Aetna MGG,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,BCBS,BCBS,146.5,,,,,,,per diem,146.5,146.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,BCBS MGG,BCBS MGG,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Cigna,Cigna,146.5,,,,,,,per diem,146.5,146.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Cigna MGG,Cigna MGG,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Humana,Humana,146.5,,,,,,,per diem,146.5,146.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Humana MGG,Humana MGG,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Optum VA,Optum VA,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,UHC,UHC,146.5,,,,,,,per diem,146.5,146.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,UHC MGG,UHC MGG,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,VA,VA,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Wellcare MGG,Wellcare MGG,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Bright Health - commercial,Bright Health - commercial,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,146.5,146.5,Bright Health MGG,Bright Health MGG,146.5,,,,,,,case rate,146.5,146.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Aetna,Aetna,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Aetna MGG,Aetna MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,BCBS,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS MGG,BCBS MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Cigna,Cigna,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Cigna MGG,Cigna MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Humana,Humana,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Humana MGG,Humana MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Optum VA,Optum VA,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,UHC,UHC,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,UHC MGG,UHC MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,VA,VA,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Wellcare MGG,Wellcare MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Bright Health - commercial,Bright Health - commercial,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,Bright Health MGG,Bright Health MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna,Aetna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna MGG,Aetna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS,BCBS,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS MGG,BCBS MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna,Cigna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna MGG,Cigna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana,Humana,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana MGG,Humana MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Optum VA,Optum VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC,UHC,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC MGG,UHC MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,VA,VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Wellcare MGG,Wellcare MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health - commercial,Bright Health - commercial,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health MGG,Bright Health MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Aetna,Aetna,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Aetna MGG,Aetna MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,BCBS,BCBS,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,BCBS MGG,BCBS MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Cigna,Cigna,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Cigna MGG,Cigna MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Humana,Humana,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Humana MGG,Humana MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Optum VA,Optum VA,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,UHC,UHC,83,,,,,,,per diem,83,83,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,UHC MGG,UHC MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,VA,VA,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Wellcare MGG,Wellcare MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Bright Health - commercial,Bright Health - commercial,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,83,83,Bright Health MGG,Bright Health MGG,83,,,,,,,case rate,83,83,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna,Aetna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Aetna MGG,Aetna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS,BCBS,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,BCBS MGG,BCBS MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna,Cigna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Cigna MGG,Cigna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana,Humana,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Humana MGG,Humana MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Optum VA,Optum VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC,UHC,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,UHC MGG,UHC MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,VA,VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Wellcare MGG,Wellcare MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health - commercial,Bright Health - commercial,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,72,72,Bright Health MGG,Bright Health MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Aetna,Aetna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Aetna MGG,Aetna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,BCBS,BCBS,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,BCBS MGG,BCBS MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Cigna,Cigna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Cigna MGG,Cigna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Humana,Humana,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Humana MGG,Humana MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Optum VA,Optum VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,UHC,UHC,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,UHC MGG,UHC MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,VA,VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Wellcare MGG,Wellcare MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Bright Health - commercial,Bright Health - commercial,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,28,28,Bright Health MGG,Bright Health MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Aetna,Aetna,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Aetna MGG,Aetna MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,BCBS,BCBS,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,BCBS MGG,BCBS MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Cigna,Cigna,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Cigna MGG,Cigna MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Humana,Humana,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Humana MGG,Humana MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Optum VA,Optum VA,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,UHC,UHC,145.5,,,,,,,per diem,145.5,145.5,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,UHC MGG,UHC MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,VA,VA,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Wellcare MGG,Wellcare MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Bright Health - commercial,Bright Health - commercial,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,145.5,145.5,Bright Health MGG,Bright Health MGG,145.5,,,,,,,case rate,145.5,145.5,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Aetna,Aetna,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Aetna MGG,Aetna MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,BCBS,BCBS,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,BCBS MGG,BCBS MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Cigna,Cigna,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Cigna MGG,Cigna MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Humana,Humana,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Humana MGG,Humana MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Optum VA,Optum VA,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,UHC,UHC,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,UHC MGG,UHC MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,VA,VA,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Wellcare MGG,Wellcare MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Bright Health - commercial,Bright Health - commercial,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,109,109,Bright Health MGG,Bright Health MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Aetna,Aetna,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Aetna MGG,Aetna MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,BCBS,BCBS,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,BCBS MGG,BCBS MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Cigna,Cigna,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Cigna MGG,Cigna MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Humana,Humana,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Humana MGG,Humana MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Optum VA,Optum VA,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,UHC,UHC,131,,,,,,,per diem,131,131,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,UHC MGG,UHC MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,VA,VA,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Wellcare MGG,Wellcare MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Bright Health - commercial,Bright Health - commercial,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,131,131,Bright Health MGG,Bright Health MGG,131,,,,,,,case rate,131,131,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Aetna,Aetna,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Aetna MGG,Aetna MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,BCBS,BCBS,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,BCBS MGG,BCBS MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Cigna,Cigna,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Cigna MGG,Cigna MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Humana,Humana,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Humana MGG,Humana MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Optum VA,Optum VA,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,UHC,UHC,18.5,,,,,,,per diem,18.5,18.5,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,UHC MGG,UHC MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,VA,VA,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Wellcare MGG,Wellcare MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Bright Health - commercial,Bright Health - commercial,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,18.5,18.5,Bright Health MGG,Bright Health MGG,18.5,,,,,,,case rate,18.5,18.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Aetna,Aetna,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Aetna MGG,Aetna MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,BCBS,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,BCBS MGG,BCBS MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Cigna,Cigna,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Cigna MGG,Cigna MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Humana,Humana,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Humana MGG,Humana MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Optum VA,Optum VA,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,UHC,UHC,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,UHC MGG,UHC MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,VA,VA,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Wellcare MGG,Wellcare MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Bright Health - commercial,Bright Health - commercial,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,33.5,33.5,Bright Health MGG,Bright Health MGG,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Aetna,Aetna,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Aetna MGG,Aetna MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,BCBS,BCBS,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,BCBS MGG,BCBS MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Cigna,Cigna,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Cigna MGG,Cigna MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Humana,Humana,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Humana MGG,Humana MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Optum VA,Optum VA,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,UHC,UHC,93.5,,,,,,,per diem,93.5,93.5,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,UHC MGG,UHC MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,VA,VA,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Wellcare MGG,Wellcare MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Bright Health - commercial,Bright Health - commercial,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,93.5,93.5,Bright Health MGG,Bright Health MGG,93.5,,,,,,,case rate,93.5,93.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Aetna,Aetna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Aetna MGG,Aetna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,BCBS,BCBS,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,BCBS MGG,BCBS MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Cigna,Cigna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Cigna MGG,Cigna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Humana,Humana,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Humana MGG,Humana MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Optum VA,Optum VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,UHC,UHC,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,UHC MGG,UHC MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,VA,VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Wellcare MGG,Wellcare MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Bright Health - commercial,Bright Health - commercial,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,28,28,Bright Health MGG,Bright Health MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Aetna,Aetna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Aetna MGG,Aetna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,BCBS,BCBS,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,BCBS MGG,BCBS MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Cigna,Cigna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Cigna MGG,Cigna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Humana,Humana,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Humana MGG,Humana MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Optum VA,Optum VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,UHC,UHC,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,UHC MGG,UHC MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,VA,VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Wellcare MGG,Wellcare MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Bright Health - commercial,Bright Health - commercial,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,22,22,Bright Health MGG,Bright Health MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Aetna,Aetna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Aetna MGG,Aetna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,BCBS,BCBS,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,BCBS MGG,BCBS MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Cigna,Cigna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Cigna MGG,Cigna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Humana,Humana,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Humana MGG,Humana MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Optum VA,Optum VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,UHC,UHC,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,UHC MGG,UHC MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,VA,VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Wellcare MGG,Wellcare MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Bright Health - commercial,Bright Health - commercial,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,40.5,40.5,Bright Health MGG,Bright Health MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Aetna,Aetna,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Aetna MGG,Aetna MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,BCBS,BCBS,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,BCBS MGG,BCBS MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Cigna,Cigna,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Cigna MGG,Cigna MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Humana,Humana,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Humana MGG,Humana MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Optum VA,Optum VA,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,UHC,UHC,128,,,,,,,per diem,128,128,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,UHC MGG,UHC MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,VA,VA,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Wellcare MGG,Wellcare MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Bright Health - commercial,Bright Health - commercial,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,128,128,Bright Health MGG,Bright Health MGG,128,,,,,,,case rate,128,128,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Aetna,Aetna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Aetna MGG,Aetna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,BCBS,BCBS,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,BCBS MGG,BCBS MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Cigna,Cigna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Cigna MGG,Cigna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Humana,Humana,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Humana MGG,Humana MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Optum VA,Optum VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,UHC,UHC,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,UHC MGG,UHC MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,VA,VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Wellcare MGG,Wellcare MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Bright Health - commercial,Bright Health - commercial,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,70,70,Bright Health MGG,Bright Health MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Aetna,Aetna,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Aetna MGG,Aetna MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,BCBS,BCBS,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,BCBS MGG,BCBS MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Cigna,Cigna,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Cigna MGG,Cigna MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Humana,Humana,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Humana MGG,Humana MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Optum VA,Optum VA,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,UHC,UHC,249.5,,,,,,,per diem,249.5,249.5,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,UHC MGG,UHC MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,VA,VA,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Wellcare MGG,Wellcare MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Bright Health - commercial,Bright Health - commercial,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,249.5,249.5,Bright Health MGG,Bright Health MGG,249.5,,,,,,,case rate,249.5,249.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Aetna,Aetna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Aetna MGG,Aetna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,BCBS,BCBS,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,BCBS MGG,BCBS MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Cigna,Cigna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Cigna MGG,Cigna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Humana,Humana,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Humana MGG,Humana MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Optum VA,Optum VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,UHC,UHC,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,UHC MGG,UHC MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,VA,VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Wellcare MGG,Wellcare MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Bright Health - commercial,Bright Health - commercial,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,156,156,Bright Health MGG,Bright Health MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Aetna,Aetna,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Aetna MGG,Aetna MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,BCBS,BCBS,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,BCBS MGG,BCBS MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Cigna,Cigna,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Cigna MGG,Cigna MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Humana,Humana,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Humana MGG,Humana MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Optum VA,Optum VA,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,UHC,UHC,3,,,,,,,per diem,3,3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,UHC MGG,UHC MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,VA,VA,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Wellcare MGG,Wellcare MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Bright Health - commercial,Bright Health - commercial,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3,3,Bright Health MGG,Bright Health MGG,3,,,,,,,case rate,3,3,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna,Aetna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Aetna MGG,Aetna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS,BCBS,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,BCBS MGG,BCBS MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna,Cigna,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Cigna MGG,Cigna MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana,Humana,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Humana MGG,Humana MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Optum VA,Optum VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC,UHC,41.5,,,,,,,per diem,41.5,41.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,UHC MGG,UHC MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,VA,VA,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Wellcare MGG,Wellcare MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health - commercial,Bright Health - commercial,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,41.5,41.5,Bright Health MGG,Bright Health MGG,41.5,,,,,,,case rate,41.5,41.5,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Aetna,Aetna,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Aetna MGG,Aetna MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,BCBS,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS MGG,BCBS MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Cigna,Cigna,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Cigna MGG,Cigna MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Humana,Humana,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Humana MGG,Humana MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Optum VA,Optum VA,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,UHC,UHC,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,UHC MGG,UHC MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,VA,VA,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Wellcare MGG,Wellcare MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Bright Health - commercial,Bright Health - commercial,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7,7,Bright Health MGG,Bright Health MGG,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Aetna,Aetna,132.5,,,,,,,per diem,132.5,132.5,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Aetna MGG,Aetna MGG,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,BCBS,BCBS,132.5,,,,,,,per diem,132.5,132.5,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,BCBS MGG,BCBS MGG,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Cigna,Cigna,132.5,,,,,,,per diem,132.5,132.5,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Cigna MGG,Cigna MGG,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Humana,Humana,132.5,,,,,,,per diem,132.5,132.5,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Humana MGG,Humana MGG,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Optum VA,Optum VA,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,UHC,UHC,132.5,,,,,,,per diem,132.5,132.5,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,UHC MGG,UHC MGG,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,VA,VA,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Wellcare MGG,Wellcare MGG,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Bright Health - commercial,Bright Health - commercial,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,132.5,132.5,Bright Health MGG,Bright Health MGG,132.5,,,,,,,case rate,132.5,132.5,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Aetna,Aetna,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Aetna MGG,Aetna MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,BCBS,BCBS,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,BCBS MGG,BCBS MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Cigna,Cigna,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Cigna MGG,Cigna MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Humana,Humana,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Humana MGG,Humana MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Optum VA,Optum VA,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,UHC,UHC,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,UHC MGG,UHC MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,VA,VA,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Wellcare MGG,Wellcare MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Bright Health - commercial,Bright Health - commercial,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,105,105,Bright Health MGG,Bright Health MGG,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Aetna,Aetna,115.75,,,,,,,per diem,115.75,115.75,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Aetna MGG,Aetna MGG,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,BCBS,BCBS,115.75,,,,,,,per diem,115.75,115.75,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,BCBS MGG,BCBS MGG,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Cigna,Cigna,115.75,,,,,,,per diem,115.75,115.75,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Cigna MGG,Cigna MGG,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Humana,Humana,115.75,,,,,,,per diem,115.75,115.75,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Humana MGG,Humana MGG,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Optum VA,Optum VA,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,UHC,UHC,115.75,,,,,,,per diem,115.75,115.75,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,UHC MGG,UHC MGG,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,VA,VA,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Wellcare MGG,Wellcare MGG,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Bright Health - commercial,Bright Health - commercial,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,115.75,115.75,Bright Health MGG,Bright Health MGG,115.75,,,,,,,case rate,115.75,115.75,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Aetna,Aetna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Aetna MGG,Aetna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,BCBS,BCBS,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,BCBS MGG,BCBS MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Cigna,Cigna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Cigna MGG,Cigna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Humana,Humana,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Humana MGG,Humana MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Optum VA,Optum VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,UHC,UHC,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,UHC MGG,UHC MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,VA,VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Wellcare MGG,Wellcare MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Bright Health - commercial,Bright Health - commercial,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,30,30,Bright Health MGG,Bright Health MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Aetna,Aetna,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Aetna MGG,Aetna MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,BCBS,BCBS,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,BCBS MGG,BCBS MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Cigna,Cigna,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Cigna MGG,Cigna MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Humana,Humana,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Humana MGG,Humana MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Optum VA,Optum VA,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,UHC,UHC,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,UHC MGG,UHC MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,VA,VA,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Wellcare MGG,Wellcare MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Bright Health - commercial,Bright Health - commercial,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,450,450,Bright Health MGG,Bright Health MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Aetna,Aetna,33.25,,,,,,,per diem,33.25,33.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Aetna MGG,Aetna MGG,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,BCBS,BCBS,33.25,,,,,,,per diem,33.25,33.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,BCBS MGG,BCBS MGG,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Cigna,Cigna,33.25,,,,,,,per diem,33.25,33.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Cigna MGG,Cigna MGG,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Humana,Humana,33.25,,,,,,,per diem,33.25,33.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Humana MGG,Humana MGG,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Optum VA,Optum VA,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,UHC,UHC,33.25,,,,,,,per diem,33.25,33.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,UHC MGG,UHC MGG,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,VA,VA,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Wellcare MGG,Wellcare MGG,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Bright Health - commercial,Bright Health - commercial,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,33.25,33.25,Bright Health MGG,Bright Health MGG,33.25,,,,,,,case rate,33.25,33.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Aetna,Aetna,66.25,,,,,,,per diem,66.25,66.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Aetna MGG,Aetna MGG,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,BCBS,BCBS,66.25,,,,,,,per diem,66.25,66.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,BCBS MGG,BCBS MGG,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Cigna,Cigna,66.25,,,,,,,per diem,66.25,66.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Cigna MGG,Cigna MGG,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Humana,Humana,66.25,,,,,,,per diem,66.25,66.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Humana MGG,Humana MGG,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Optum VA,Optum VA,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,UHC,UHC,66.25,,,,,,,per diem,66.25,66.25,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,UHC MGG,UHC MGG,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,VA,VA,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Wellcare MGG,Wellcare MGG,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Bright Health - commercial,Bright Health - commercial,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,66.25,66.25,Bright Health MGG,Bright Health MGG,66.25,,,,,,,case rate,66.25,66.25,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
PCH DRN SENSURA MIOFLEXMAX RED,33151838,CDM,270,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Aetna,Aetna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Aetna MGG,Aetna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,BCBS,BCBS,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,BCBS MGG,BCBS MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Cigna,Cigna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Cigna MGG,Cigna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Humana,Humana,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Humana MGG,Humana MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Optum VA,Optum VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,UHC,UHC,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,UHC MGG,UHC MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,VA,VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Wellcare MGG,Wellcare MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Bright Health - commercial,Bright Health - commercial,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,156,156,Bright Health MGG,Bright Health MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna,Aetna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna MGG,Aetna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS,BCBS,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS MGG,BCBS MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna,Cigna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna MGG,Cigna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana,Humana,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana MGG,Humana MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Optum VA,Optum VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC,UHC,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC MGG,UHC MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,VA,VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Wellcare MGG,Wellcare MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health - commercial,Bright Health - commercial,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health MGG,Bright Health MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna,Aetna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna MGG,Aetna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS,BCBS,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS MGG,BCBS MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna,Cigna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna MGG,Cigna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana,Humana,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana MGG,Humana MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Optum VA,Optum VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC,UHC,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC MGG,UHC MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,VA,VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Wellcare MGG,Wellcare MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health - commercial,Bright Health - commercial,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health MGG,Bright Health MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna,Aetna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna MGG,Aetna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS,BCBS,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS MGG,BCBS MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna,Cigna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna MGG,Cigna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana,Humana,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana MGG,Humana MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Optum VA,Optum VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC,UHC,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC MGG,UHC MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,VA,VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Wellcare MGG,Wellcare MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health - commercial,Bright Health - commercial,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health MGG,Bright Health MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna,Aetna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna MGG,Aetna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS,BCBS,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS MGG,BCBS MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna,Cigna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna MGG,Cigna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana,Humana,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana MGG,Humana MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Optum VA,Optum VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC,UHC,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC MGG,UHC MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,VA,VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Wellcare MGG,Wellcare MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health - commercial,Bright Health - commercial,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health MGG,Bright Health MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna,Aetna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna MGG,Aetna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS,BCBS,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS MGG,BCBS MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna,Cigna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna MGG,Cigna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana,Humana,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana MGG,Humana MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Optum VA,Optum VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC,UHC,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC MGG,UHC MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,VA,VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Wellcare MGG,Wellcare MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health - commercial,Bright Health - commercial,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health MGG,Bright Health MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna,Aetna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna MGG,Aetna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS,BCBS,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS MGG,BCBS MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna,Cigna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna MGG,Cigna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana,Humana,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana MGG,Humana MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Optum VA,Optum VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC,UHC,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC MGG,UHC MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,VA,VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Wellcare MGG,Wellcare MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health - commercial,Bright Health - commercial,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health MGG,Bright Health MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna,Aetna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna MGG,Aetna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS,BCBS,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS MGG,BCBS MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna,Cigna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna MGG,Cigna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana,Humana,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana MGG,Humana MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Optum VA,Optum VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC,UHC,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC MGG,UHC MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,VA,VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Wellcare MGG,Wellcare MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health - commercial,Bright Health - commercial,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health MGG,Bright Health MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna,Aetna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna MGG,Aetna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS,BCBS,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS MGG,BCBS MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna,Cigna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna MGG,Cigna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana,Humana,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana MGG,Humana MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Optum VA,Optum VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC,UHC,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC MGG,UHC MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,VA,VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Wellcare MGG,Wellcare MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health - commercial,Bright Health - commercial,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health MGG,Bright Health MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna,Aetna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Aetna MGG,Aetna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS,BCBS,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,BCBS MGG,BCBS MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna,Cigna,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Cigna MGG,Cigna MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana,Humana,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Humana MGG,Humana MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Optum VA,Optum VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC,UHC,29,,,,,,,per diem,29,29,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,UHC MGG,UHC MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,VA,VA,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Wellcare MGG,Wellcare MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health - commercial,Bright Health - commercial,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,29,29,Bright Health MGG,Bright Health MGG,29,,,,,,,case rate,29,29,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Aetna,Aetna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Aetna MGG,Aetna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,BCBS,BCBS,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,BCBS MGG,BCBS MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Cigna,Cigna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Cigna MGG,Cigna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Humana,Humana,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Humana MGG,Humana MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Optum VA,Optum VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,UHC,UHC,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,UHC MGG,UHC MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,VA,VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Wellcare MGG,Wellcare MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Bright Health - commercial,Bright Health - commercial,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,28,28,Bright Health MGG,Bright Health MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Aetna,Aetna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Aetna MGG,Aetna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,BCBS,BCBS,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,BCBS MGG,BCBS MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Cigna,Cigna,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Cigna MGG,Cigna MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Humana,Humana,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Humana MGG,Humana MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Optum VA,Optum VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,UHC,UHC,28,,,,,,,per diem,28,28,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,UHC MGG,UHC MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,VA,VA,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Wellcare MGG,Wellcare MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Bright Health - commercial,Bright Health - commercial,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,28,28,Bright Health MGG,Bright Health MGG,28,,,,,,,case rate,28,28,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Aetna,Aetna,26,,,,,,,per diem,26,26,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Aetna MGG,Aetna MGG,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,BCBS,BCBS,26,,,,,,,per diem,26,26,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,BCBS MGG,BCBS MGG,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Cigna,Cigna,26,,,,,,,per diem,26,26,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Cigna MGG,Cigna MGG,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Humana,Humana,26,,,,,,,per diem,26,26,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Humana MGG,Humana MGG,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Optum VA,Optum VA,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,UHC,UHC,26,,,,,,,per diem,26,26,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,UHC MGG,UHC MGG,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,VA,VA,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Wellcare MGG,Wellcare MGG,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Bright Health - commercial,Bright Health - commercial,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,26,26,Bright Health MGG,Bright Health MGG,26,,,,,,,case rate,26,26,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Aetna,Aetna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Aetna MGG,Aetna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,BCBS,BCBS,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,BCBS MGG,BCBS MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Cigna,Cigna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Cigna MGG,Cigna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Humana,Humana,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Humana MGG,Humana MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Optum VA,Optum VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,UHC,UHC,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,UHC MGG,UHC MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,VA,VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Wellcare MGG,Wellcare MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Bright Health - commercial,Bright Health - commercial,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,152,152,Bright Health MGG,Bright Health MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Aetna,Aetna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Aetna MGG,Aetna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,BCBS,BCBS,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,BCBS MGG,BCBS MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Cigna,Cigna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Cigna MGG,Cigna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Humana,Humana,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Humana MGG,Humana MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Optum VA,Optum VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,UHC,UHC,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,UHC MGG,UHC MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,VA,VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Wellcare MGG,Wellcare MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Bright Health - commercial,Bright Health - commercial,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,152,152,Bright Health MGG,Bright Health MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Aetna,Aetna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Aetna MGG,Aetna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,BCBS,BCBS,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,BCBS MGG,BCBS MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Cigna,Cigna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Cigna MGG,Cigna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Humana,Humana,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Humana MGG,Humana MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Optum VA,Optum VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,UHC,UHC,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,UHC MGG,UHC MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,VA,VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Wellcare MGG,Wellcare MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Bright Health - commercial,Bright Health - commercial,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,152,152,Bright Health MGG,Bright Health MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Aetna,Aetna,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Aetna MGG,Aetna MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,BCBS,BCBS,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,BCBS MGG,BCBS MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Cigna,Cigna,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Cigna MGG,Cigna MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Humana,Humana,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Humana MGG,Humana MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Optum VA,Optum VA,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,UHC,UHC,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,UHC MGG,UHC MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,VA,VA,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Wellcare MGG,Wellcare MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Bright Health - commercial,Bright Health - commercial,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,476,476,Bright Health MGG,Bright Health MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Aetna,Aetna,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Aetna MGG,Aetna MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,BCBS,BCBS,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,BCBS MGG,BCBS MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Cigna,Cigna,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Cigna MGG,Cigna MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Humana,Humana,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Humana MGG,Humana MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Optum VA,Optum VA,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,UHC,UHC,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,UHC MGG,UHC MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,VA,VA,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Wellcare MGG,Wellcare MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Bright Health - commercial,Bright Health - commercial,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,476,476,Bright Health MGG,Bright Health MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Aetna,Aetna,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Aetna MGG,Aetna MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,BCBS,BCBS,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,BCBS MGG,BCBS MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Cigna,Cigna,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Cigna MGG,Cigna MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Humana,Humana,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Humana MGG,Humana MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Optum VA,Optum VA,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,UHC,UHC,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,UHC MGG,UHC MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,VA,VA,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Wellcare MGG,Wellcare MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Bright Health - commercial,Bright Health - commercial,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,476,476,Bright Health MGG,Bright Health MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Aetna,Aetna,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Aetna MGG,Aetna MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,BCBS,BCBS,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,BCBS MGG,BCBS MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Cigna,Cigna,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Cigna MGG,Cigna MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Humana,Humana,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Humana MGG,Humana MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Optum VA,Optum VA,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,UHC,UHC,476,,,,,,,per diem,476,476,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,UHC MGG,UHC MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,VA,VA,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Wellcare MGG,Wellcare MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Bright Health - commercial,Bright Health - commercial,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,476,476,Bright Health MGG,Bright Health MGG,476,,,,,,,case rate,476,476,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Aetna,Aetna,186,,,,,,,per diem,186,186,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Aetna MGG,Aetna MGG,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,BCBS,BCBS,186,,,,,,,per diem,186,186,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,BCBS MGG,BCBS MGG,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Cigna,Cigna,186,,,,,,,per diem,186,186,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Cigna MGG,Cigna MGG,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Humana,Humana,186,,,,,,,per diem,186,186,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Humana MGG,Humana MGG,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Optum VA,Optum VA,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,UHC,UHC,186,,,,,,,per diem,186,186,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,UHC MGG,UHC MGG,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,VA,VA,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Wellcare MGG,Wellcare MGG,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Bright Health - commercial,Bright Health - commercial,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,186,186,Bright Health MGG,Bright Health MGG,186,,,,,,,case rate,186,186,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Aetna,Aetna,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Aetna MGG,Aetna MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,BCBS,BCBS,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,BCBS MGG,BCBS MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Cigna,Cigna,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Cigna MGG,Cigna MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Humana,Humana,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Humana MGG,Humana MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Optum VA,Optum VA,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,UHC,UHC,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,UHC MGG,UHC MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,VA,VA,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Wellcare MGG,Wellcare MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Bright Health - commercial,Bright Health - commercial,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16,16,Bright Health MGG,Bright Health MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Aetna,Aetna,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Aetna MGG,Aetna MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,BCBS,BCBS,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,BCBS MGG,BCBS MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Cigna,Cigna,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Cigna MGG,Cigna MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Humana,Humana,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Humana MGG,Humana MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Optum VA,Optum VA,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,UHC,UHC,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,UHC MGG,UHC MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,VA,VA,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Wellcare MGG,Wellcare MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Bright Health - commercial,Bright Health - commercial,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,341,341,Bright Health MGG,Bright Health MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Aetna,Aetna,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Aetna MGG,Aetna MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,BCBS,BCBS,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,BCBS MGG,BCBS MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Cigna,Cigna,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Cigna MGG,Cigna MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Humana,Humana,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Humana MGG,Humana MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Optum VA,Optum VA,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,UHC,UHC,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,UHC MGG,UHC MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,VA,VA,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Wellcare MGG,Wellcare MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Bright Health - commercial,Bright Health - commercial,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,341,341,Bright Health MGG,Bright Health MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Aetna,Aetna,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Aetna MGG,Aetna MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,BCBS,BCBS,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,BCBS MGG,BCBS MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Cigna,Cigna,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Cigna MGG,Cigna MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Humana,Humana,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Humana MGG,Humana MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Optum VA,Optum VA,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,UHC,UHC,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,UHC MGG,UHC MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,VA,VA,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Wellcare MGG,Wellcare MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Bright Health - commercial,Bright Health - commercial,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,341,341,Bright Health MGG,Bright Health MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Aetna,Aetna,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Aetna MGG,Aetna MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,BCBS,BCBS,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,BCBS MGG,BCBS MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Cigna,Cigna,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Cigna MGG,Cigna MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Humana,Humana,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Humana MGG,Humana MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Optum VA,Optum VA,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,UHC,UHC,341,,,,,,,per diem,341,341,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,UHC MGG,UHC MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,VA,VA,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Wellcare MGG,Wellcare MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Bright Health - commercial,Bright Health - commercial,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,341,341,Bright Health MGG,Bright Health MGG,341,,,,,,,case rate,341,341,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Aetna,Aetna,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Aetna MGG,Aetna MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,BCBS,BCBS,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,BCBS MGG,BCBS MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Cigna,Cigna,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Cigna MGG,Cigna MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Humana,Humana,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Humana MGG,Humana MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Optum VA,Optum VA,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,UHC,UHC,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,UHC MGG,UHC MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,VA,VA,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Wellcare MGG,Wellcare MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Bright Health - commercial,Bright Health - commercial,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,100,100,Bright Health MGG,Bright Health MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Aetna,Aetna,24.59,,,,,,,per diem,24.59,24.59,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Aetna MGG,Aetna MGG,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,BCBS,BCBS,24.59,,,,,,,per diem,24.59,24.59,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,BCBS MGG,BCBS MGG,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Cigna,Cigna,24.59,,,,,,,per diem,24.59,24.59,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Cigna MGG,Cigna MGG,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Humana,Humana,24.59,,,,,,,per diem,24.59,24.59,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Humana MGG,Humana MGG,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Optum VA,Optum VA,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,UHC,UHC,24.59,,,,,,,per diem,24.59,24.59,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,UHC MGG,UHC MGG,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,VA,VA,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Wellcare MGG,Wellcare MGG,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Bright Health - commercial,Bright Health - commercial,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,24.59,24.59,Bright Health MGG,Bright Health MGG,24.59,,,,,,,case rate,24.59,24.59,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Aetna,Aetna,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Aetna MGG,Aetna MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,BCBS,BCBS,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,BCBS MGG,BCBS MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Cigna,Cigna,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Cigna MGG,Cigna MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Humana,Humana,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Humana MGG,Humana MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Optum VA,Optum VA,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,UHC,UHC,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,UHC MGG,UHC MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,VA,VA,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Wellcare MGG,Wellcare MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Bright Health - commercial,Bright Health - commercial,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,256,256,Bright Health MGG,Bright Health MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Aetna,Aetna,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Aetna MGG,Aetna MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,BCBS,BCBS,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,BCBS MGG,BCBS MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Cigna,Cigna,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Cigna MGG,Cigna MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Humana,Humana,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Humana MGG,Humana MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Optum VA,Optum VA,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,UHC,UHC,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,UHC MGG,UHC MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,VA,VA,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Wellcare MGG,Wellcare MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Bright Health - commercial,Bright Health - commercial,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,49,49,Bright Health MGG,Bright Health MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Aetna,Aetna,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Aetna MGG,Aetna MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,BCBS,BCBS,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,BCBS MGG,BCBS MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Cigna,Cigna,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Cigna MGG,Cigna MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Humana,Humana,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Humana MGG,Humana MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Optum VA,Optum VA,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,UHC,UHC,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,UHC MGG,UHC MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,VA,VA,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Wellcare MGG,Wellcare MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Bright Health - commercial,Bright Health - commercial,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,64,64,Bright Health MGG,Bright Health MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Aetna,Aetna,262,,,,,,,per diem,262,262,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Aetna MGG,Aetna MGG,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,BCBS,BCBS,262,,,,,,,per diem,262,262,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,BCBS MGG,BCBS MGG,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Cigna,Cigna,262,,,,,,,per diem,262,262,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Cigna MGG,Cigna MGG,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Humana,Humana,262,,,,,,,per diem,262,262,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Humana MGG,Humana MGG,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Optum VA,Optum VA,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,UHC,UHC,262,,,,,,,per diem,262,262,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,UHC MGG,UHC MGG,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,VA,VA,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Wellcare MGG,Wellcare MGG,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Bright Health - commercial,Bright Health - commercial,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,262,262,Bright Health MGG,Bright Health MGG,262,,,,,,,case rate,262,262,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna,Aetna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna MGG,Aetna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS,BCBS,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS MGG,BCBS MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna,Cigna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna MGG,Cigna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana,Humana,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana MGG,Humana MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Optum VA,Optum VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC,UHC,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC MGG,UHC MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,VA,VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Wellcare MGG,Wellcare MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health - commercial,Bright Health - commercial,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health MGG,Bright Health MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna,Aetna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna MGG,Aetna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS,BCBS,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS MGG,BCBS MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna,Cigna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna MGG,Cigna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana,Humana,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana MGG,Humana MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Optum VA,Optum VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC,UHC,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC MGG,UHC MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,VA,VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Wellcare MGG,Wellcare MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health - commercial,Bright Health - commercial,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health MGG,Bright Health MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna,Aetna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna MGG,Aetna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS,BCBS,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS MGG,BCBS MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna,Cigna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna MGG,Cigna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana,Humana,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana MGG,Humana MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Optum VA,Optum VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC,UHC,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC MGG,UHC MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,VA,VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Wellcare MGG,Wellcare MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health - commercial,Bright Health - commercial,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health MGG,Bright Health MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna,Aetna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna MGG,Aetna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS,BCBS,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS MGG,BCBS MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna,Cigna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna MGG,Cigna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana,Humana,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana MGG,Humana MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Optum VA,Optum VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC,UHC,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC MGG,UHC MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,VA,VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Wellcare MGG,Wellcare MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health - commercial,Bright Health - commercial,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health MGG,Bright Health MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna,Aetna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Aetna MGG,Aetna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS,BCBS,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,BCBS MGG,BCBS MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna,Cigna,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Cigna MGG,Cigna MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana,Humana,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Humana MGG,Humana MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Optum VA,Optum VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC,UHC,77,,,,,,,per diem,77,77,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,UHC MGG,UHC MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,VA,VA,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Wellcare MGG,Wellcare MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health - commercial,Bright Health - commercial,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,77,77,Bright Health MGG,Bright Health MGG,77,,,,,,,case rate,77,77,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Aetna,Aetna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Aetna MGG,Aetna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,BCBS,BCBS,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,BCBS MGG,BCBS MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Cigna,Cigna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Cigna MGG,Cigna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Humana,Humana,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Humana MGG,Humana MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Optum VA,Optum VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,UHC,UHC,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,UHC MGG,UHC MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,VA,VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Wellcare MGG,Wellcare MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Bright Health - commercial,Bright Health - commercial,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,12.57,12.57,Bright Health MGG,Bright Health MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Aetna,Aetna,4.68,,,,,,,per diem,4.68,4.68,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Aetna MGG,Aetna MGG,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,BCBS,BCBS,4.68,,,,,,,per diem,4.68,4.68,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,BCBS MGG,BCBS MGG,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Cigna,Cigna,4.68,,,,,,,per diem,4.68,4.68,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Cigna MGG,Cigna MGG,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Humana,Humana,4.68,,,,,,,per diem,4.68,4.68,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Humana MGG,Humana MGG,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Optum VA,Optum VA,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,UHC,UHC,4.68,,,,,,,per diem,4.68,4.68,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,UHC MGG,UHC MGG,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,VA,VA,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Wellcare MGG,Wellcare MGG,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Bright Health - commercial,Bright Health - commercial,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.68,4.68,Bright Health MGG,Bright Health MGG,4.68,,,,,,,case rate,4.68,4.68,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Aetna,Aetna,3.51,,,,,,,per diem,3.51,3.51,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Aetna MGG,Aetna MGG,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,BCBS,BCBS,3.51,,,,,,,per diem,3.51,3.51,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,BCBS MGG,BCBS MGG,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Cigna,Cigna,3.51,,,,,,,per diem,3.51,3.51,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Cigna MGG,Cigna MGG,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Humana,Humana,3.51,,,,,,,per diem,3.51,3.51,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Humana MGG,Humana MGG,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Optum VA,Optum VA,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,UHC,UHC,3.51,,,,,,,per diem,3.51,3.51,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,UHC MGG,UHC MGG,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,VA,VA,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Wellcare MGG,Wellcare MGG,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Bright Health - commercial,Bright Health - commercial,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.51,3.51,Bright Health MGG,Bright Health MGG,3.51,,,,,,,case rate,3.51,3.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Aetna,Aetna,11.3,,,,,,,per diem,11.3,11.3,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Aetna MGG,Aetna MGG,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,BCBS,BCBS,11.3,,,,,,,per diem,11.3,11.3,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,BCBS MGG,BCBS MGG,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Cigna,Cigna,11.3,,,,,,,per diem,11.3,11.3,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Cigna MGG,Cigna MGG,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Humana,Humana,11.3,,,,,,,per diem,11.3,11.3,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Humana MGG,Humana MGG,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Optum VA,Optum VA,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,UHC,UHC,11.3,,,,,,,per diem,11.3,11.3,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,UHC MGG,UHC MGG,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,VA,VA,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Wellcare MGG,Wellcare MGG,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Bright Health - commercial,Bright Health - commercial,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.3,11.3,Bright Health MGG,Bright Health MGG,11.3,,,,,,,case rate,11.3,11.3,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Aetna,Aetna,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Aetna MGG,Aetna MGG,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,BCBS,BCBS,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,BCBS MGG,BCBS MGG,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Cigna,Cigna,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Cigna MGG,Cigna MGG,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Humana,Humana,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Humana MGG,Humana MGG,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Optum VA,Optum VA,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,UHC,UHC,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,UHC MGG,UHC MGG,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,VA,VA,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Wellcare MGG,Wellcare MGG,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Bright Health - commercial,Bright Health - commercial,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,88.48,88.48,Bright Health MGG,Bright Health MGG,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Aetna,Aetna,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Aetna MGG,Aetna MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,BCBS,BCBS,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,BCBS MGG,BCBS MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Cigna,Cigna,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Cigna MGG,Cigna MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Humana,Humana,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Humana MGG,Humana MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Optum VA,Optum VA,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,UHC,UHC,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,UHC MGG,UHC MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,VA,VA,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Wellcare MGG,Wellcare MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Bright Health - commercial,Bright Health - commercial,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,Bright Health MGG,Bright Health MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Aetna,Aetna,23.16,,,,,,,per diem,23.16,23.16,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Aetna MGG,Aetna MGG,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,BCBS,BCBS,23.16,,,,,,,per diem,23.16,23.16,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,BCBS MGG,BCBS MGG,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Cigna,Cigna,23.16,,,,,,,per diem,23.16,23.16,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Cigna MGG,Cigna MGG,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Humana,Humana,23.16,,,,,,,per diem,23.16,23.16,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Humana MGG,Humana MGG,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Optum VA,Optum VA,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,UHC,UHC,23.16,,,,,,,per diem,23.16,23.16,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,UHC MGG,UHC MGG,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,VA,VA,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Wellcare MGG,Wellcare MGG,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Bright Health - commercial,Bright Health - commercial,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,23.16,23.16,Bright Health MGG,Bright Health MGG,23.16,,,,,,,case rate,23.16,23.16,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Aetna,Aetna,17.77,,,,,,,per diem,17.77,17.77,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Aetna MGG,Aetna MGG,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,BCBS,BCBS,17.77,,,,,,,per diem,17.77,17.77,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,BCBS MGG,BCBS MGG,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Cigna,Cigna,17.77,,,,,,,per diem,17.77,17.77,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Cigna MGG,Cigna MGG,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Humana,Humana,17.77,,,,,,,per diem,17.77,17.77,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Humana MGG,Humana MGG,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Optum VA,Optum VA,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,UHC,UHC,17.77,,,,,,,per diem,17.77,17.77,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,UHC MGG,UHC MGG,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,VA,VA,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Wellcare MGG,Wellcare MGG,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Bright Health - commercial,Bright Health - commercial,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,17.77,17.77,Bright Health MGG,Bright Health MGG,17.77,,,,,,,case rate,17.77,17.77,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna,Aetna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Aetna MGG,Aetna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,BCBS,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS MGG,BCBS MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna,Cigna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Cigna MGG,Cigna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana,Humana,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Humana MGG,Humana MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Optum VA,Optum VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC,UHC,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,UHC MGG,UHC MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Wellcare MGG,Wellcare MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health - commercial,Bright Health - commercial,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,126,126,Bright Health MGG,Bright Health MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna,Aetna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna MGG,Aetna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS,BCBS,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS MGG,BCBS MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna,Cigna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna MGG,Cigna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana,Humana,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana MGG,Humana MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Optum VA,Optum VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC,UHC,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC MGG,UHC MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,VA,VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Wellcare MGG,Wellcare MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health - commercial,Bright Health - commercial,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health MGG,Bright Health MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna,Aetna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna MGG,Aetna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS,BCBS,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS MGG,BCBS MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna,Cigna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna MGG,Cigna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana,Humana,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana MGG,Humana MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Optum VA,Optum VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC,UHC,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC MGG,UHC MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,VA,VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Wellcare MGG,Wellcare MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health - commercial,Bright Health - commercial,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health MGG,Bright Health MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna,Aetna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna MGG,Aetna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS,BCBS,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS MGG,BCBS MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna,Cigna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna MGG,Cigna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana,Humana,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana MGG,Humana MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Optum VA,Optum VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC,UHC,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC MGG,UHC MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,VA,VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Wellcare MGG,Wellcare MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health - commercial,Bright Health - commercial,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health MGG,Bright Health MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna,Aetna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna MGG,Aetna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS,BCBS,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS MGG,BCBS MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna,Cigna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna MGG,Cigna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana,Humana,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana MGG,Humana MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Optum VA,Optum VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC,UHC,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC MGG,UHC MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,VA,VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Wellcare MGG,Wellcare MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health - commercial,Bright Health - commercial,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health MGG,Bright Health MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Aetna,Aetna,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Aetna MGG,Aetna MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,BCBS,BCBS,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,BCBS MGG,BCBS MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Cigna,Cigna,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Cigna MGG,Cigna MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Humana,Humana,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Humana MGG,Humana MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Optum VA,Optum VA,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,UHC,UHC,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,UHC MGG,UHC MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,VA,VA,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Wellcare MGG,Wellcare MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Bright Health - commercial,Bright Health - commercial,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,99,99,Bright Health MGG,Bright Health MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Aetna,Aetna,60.54,,,,,,,per diem,60.54,60.54,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Aetna MGG,Aetna MGG,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,BCBS,BCBS,60.54,,,,,,,per diem,60.54,60.54,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,BCBS MGG,BCBS MGG,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Cigna,Cigna,60.54,,,,,,,per diem,60.54,60.54,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Cigna MGG,Cigna MGG,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Humana,Humana,60.54,,,,,,,per diem,60.54,60.54,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Humana MGG,Humana MGG,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Optum VA,Optum VA,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,UHC,UHC,60.54,,,,,,,per diem,60.54,60.54,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,UHC MGG,UHC MGG,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,VA,VA,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Wellcare MGG,Wellcare MGG,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Bright Health - commercial,Bright Health - commercial,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,60.54,60.54,Bright Health MGG,Bright Health MGG,60.54,,,,,,,case rate,60.54,60.54,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Aetna,Aetna,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Aetna MGG,Aetna MGG,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,BCBS,BCBS,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,BCBS MGG,BCBS MGG,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Cigna,Cigna,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Cigna MGG,Cigna MGG,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Humana,Humana,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Humana MGG,Humana MGG,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Optum VA,Optum VA,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,UHC,UHC,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,UHC MGG,UHC MGG,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,VA,VA,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Wellcare MGG,Wellcare MGG,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Bright Health - commercial,Bright Health - commercial,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,269.85,269.85,Bright Health MGG,Bright Health MGG,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Aetna,Aetna,64.74,,,,,,,per diem,64.74,64.74,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Aetna MGG,Aetna MGG,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,BCBS,BCBS,64.74,,,,,,,per diem,64.74,64.74,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,BCBS MGG,BCBS MGG,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Cigna,Cigna,64.74,,,,,,,per diem,64.74,64.74,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Cigna MGG,Cigna MGG,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Humana,Humana,64.74,,,,,,,per diem,64.74,64.74,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Humana MGG,Humana MGG,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Optum VA,Optum VA,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,UHC,UHC,64.74,,,,,,,per diem,64.74,64.74,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,UHC MGG,UHC MGG,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,VA,VA,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Wellcare MGG,Wellcare MGG,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Bright Health - commercial,Bright Health - commercial,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,64.74,64.74,Bright Health MGG,Bright Health MGG,64.74,,,,,,,case rate,64.74,64.74,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Aetna,Aetna,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Aetna MGG,Aetna MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,BCBS,BCBS,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,BCBS MGG,BCBS MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Cigna,Cigna,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Cigna MGG,Cigna MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Humana,Humana,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Humana MGG,Humana MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Optum VA,Optum VA,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,UHC,UHC,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,UHC MGG,UHC MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,VA,VA,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Wellcare MGG,Wellcare MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Bright Health - commercial,Bright Health - commercial,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Bright Health MGG,Bright Health MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Aetna,Aetna,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Aetna MGG,Aetna MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,BCBS,BCBS,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,BCBS MGG,BCBS MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Cigna,Cigna,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Cigna MGG,Cigna MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Humana,Humana,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Humana MGG,Humana MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Optum VA,Optum VA,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,UHC,UHC,53.85,,,,,,,per diem,53.85,53.85,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,UHC MGG,UHC MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,VA,VA,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Wellcare MGG,Wellcare MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Bright Health - commercial,Bright Health - commercial,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,53.85,53.85,Bright Health MGG,Bright Health MGG,53.85,,,,,,,case rate,53.85,53.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Aetna,Aetna,26.85,,,,,,,per diem,26.85,26.85,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Aetna MGG,Aetna MGG,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,BCBS,BCBS,26.85,,,,,,,per diem,26.85,26.85,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,BCBS MGG,BCBS MGG,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Cigna,Cigna,26.85,,,,,,,per diem,26.85,26.85,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Cigna MGG,Cigna MGG,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Humana,Humana,26.85,,,,,,,per diem,26.85,26.85,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Humana MGG,Humana MGG,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Optum VA,Optum VA,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,UHC,UHC,26.85,,,,,,,per diem,26.85,26.85,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,UHC MGG,UHC MGG,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,VA,VA,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Wellcare MGG,Wellcare MGG,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Bright Health - commercial,Bright Health - commercial,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,26.85,26.85,Bright Health MGG,Bright Health MGG,26.85,,,,,,,case rate,26.85,26.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Aetna,Aetna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Aetna MGG,Aetna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,BCBS,BCBS,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,BCBS MGG,BCBS MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Cigna,Cigna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Cigna MGG,Cigna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Humana,Humana,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Humana MGG,Humana MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Optum VA,Optum VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,UHC,UHC,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,UHC MGG,UHC MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,VA,VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Wellcare MGG,Wellcare MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Bright Health - commercial,Bright Health - commercial,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Bright Health MGG,Bright Health MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Aetna,Aetna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Aetna MGG,Aetna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,BCBS,BCBS,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,BCBS MGG,BCBS MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Cigna,Cigna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Cigna MGG,Cigna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Humana,Humana,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Humana MGG,Humana MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Optum VA,Optum VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,UHC,UHC,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,UHC MGG,UHC MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,VA,VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Wellcare MGG,Wellcare MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Bright Health - commercial,Bright Health - commercial,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Bright Health MGG,Bright Health MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Aetna,Aetna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Aetna MGG,Aetna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,BCBS,BCBS,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,BCBS MGG,BCBS MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Cigna,Cigna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Cigna MGG,Cigna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Humana,Humana,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Humana MGG,Humana MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Optum VA,Optum VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,UHC,UHC,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,UHC MGG,UHC MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,VA,VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Wellcare MGG,Wellcare MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Bright Health - commercial,Bright Health - commercial,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,17.85,17.85,Bright Health MGG,Bright Health MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Aetna,Aetna,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Aetna MGG,Aetna MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,BCBS,BCBS,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,BCBS MGG,BCBS MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Cigna,Cigna,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Cigna MGG,Cigna MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Humana,Humana,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Humana MGG,Humana MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Optum VA,Optum VA,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,UHC,UHC,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,UHC MGG,UHC MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,VA,VA,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Wellcare MGG,Wellcare MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Bright Health - commercial,Bright Health - commercial,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Bright Health MGG,Bright Health MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Aetna,Aetna,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Aetna MGG,Aetna MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,BCBS,BCBS,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,BCBS MGG,BCBS MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Cigna,Cigna,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Cigna MGG,Cigna MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Humana,Humana,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Humana MGG,Humana MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Optum VA,Optum VA,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,UHC,UHC,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,UHC MGG,UHC MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,VA,VA,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Wellcare MGG,Wellcare MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Bright Health - commercial,Bright Health - commercial,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Bright Health MGG,Bright Health MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna,Aetna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna MGG,Aetna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS,BCBS,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS MGG,BCBS MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna,Cigna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna MGG,Cigna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana,Humana,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana MGG,Humana MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Optum VA,Optum VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC,UHC,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC MGG,UHC MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,VA,VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Wellcare MGG,Wellcare MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health - commercial,Bright Health - commercial,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health MGG,Bright Health MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Aetna,Aetna,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Aetna MGG,Aetna MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,BCBS,BCBS,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,BCBS MGG,BCBS MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Cigna,Cigna,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Cigna MGG,Cigna MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Humana,Humana,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Humana MGG,Humana MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Optum VA,Optum VA,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,UHC,UHC,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,UHC MGG,UHC MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,VA,VA,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Wellcare MGG,Wellcare MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Bright Health - commercial,Bright Health - commercial,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,210,210,Bright Health MGG,Bright Health MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Aetna,Aetna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Aetna MGG,Aetna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,BCBS,BCBS,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,BCBS MGG,BCBS MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Cigna,Cigna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Cigna MGG,Cigna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Humana,Humana,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Humana MGG,Humana MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Optum VA,Optum VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,UHC,UHC,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,UHC MGG,UHC MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,VA,VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Wellcare MGG,Wellcare MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Bright Health - commercial,Bright Health - commercial,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,78,78,Bright Health MGG,Bright Health MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Aetna,Aetna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Aetna MGG,Aetna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,BCBS,BCBS,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,BCBS MGG,BCBS MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Cigna,Cigna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Cigna MGG,Cigna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Humana,Humana,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Humana MGG,Humana MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Optum VA,Optum VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,UHC,UHC,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,UHC MGG,UHC MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,VA,VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Wellcare MGG,Wellcare MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Bright Health - commercial,Bright Health - commercial,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,78,78,Bright Health MGG,Bright Health MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Aetna,Aetna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Aetna MGG,Aetna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,BCBS,BCBS,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,BCBS MGG,BCBS MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Cigna,Cigna,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Cigna MGG,Cigna MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Humana,Humana,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Humana MGG,Humana MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Optum VA,Optum VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,UHC,UHC,78,,,,,,,per diem,78,78,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,UHC MGG,UHC MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,VA,VA,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Wellcare MGG,Wellcare MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Bright Health - commercial,Bright Health - commercial,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,78,78,Bright Health MGG,Bright Health MGG,78,,,,,,,case rate,78,78,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Aetna,Aetna,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Aetna MGG,Aetna MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,BCBS,BCBS,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,BCBS MGG,BCBS MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Cigna,Cigna,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Cigna MGG,Cigna MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Humana,Humana,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Humana MGG,Humana MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Optum VA,Optum VA,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,UHC,UHC,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,UHC MGG,UHC MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,VA,VA,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Wellcare MGG,Wellcare MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Bright Health - commercial,Bright Health - commercial,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,81,81,Bright Health MGG,Bright Health MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Aetna,Aetna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Aetna MGG,Aetna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,BCBS,BCBS,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,BCBS MGG,BCBS MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Cigna,Cigna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Cigna MGG,Cigna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Humana,Humana,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Humana MGG,Humana MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Optum VA,Optum VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,UHC,UHC,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,UHC MGG,UHC MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,VA,VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Wellcare MGG,Wellcare MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Bright Health - commercial,Bright Health - commercial,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,60,60,Bright Health MGG,Bright Health MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Aetna,Aetna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Aetna MGG,Aetna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,BCBS,BCBS,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,BCBS MGG,BCBS MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Cigna,Cigna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Cigna MGG,Cigna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Humana,Humana,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Humana MGG,Humana MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Optum VA,Optum VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,UHC,UHC,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,UHC MGG,UHC MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,VA,VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Wellcare MGG,Wellcare MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Bright Health - commercial,Bright Health - commercial,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,60,60,Bright Health MGG,Bright Health MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna,Aetna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna MGG,Aetna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS,BCBS,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS MGG,BCBS MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna,Cigna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna MGG,Cigna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana,Humana,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana MGG,Humana MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Optum VA,Optum VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC,UHC,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC MGG,UHC MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,VA,VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Wellcare MGG,Wellcare MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health - commercial,Bright Health - commercial,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health MGG,Bright Health MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna,Aetna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna MGG,Aetna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS,BCBS,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS MGG,BCBS MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna,Cigna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna MGG,Cigna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana,Humana,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana MGG,Humana MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Optum VA,Optum VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC,UHC,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC MGG,UHC MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,VA,VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Wellcare MGG,Wellcare MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health - commercial,Bright Health - commercial,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health MGG,Bright Health MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna,Aetna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna MGG,Aetna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS,BCBS,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS MGG,BCBS MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna,Cigna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna MGG,Cigna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana,Humana,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana MGG,Humana MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Optum VA,Optum VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC,UHC,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC MGG,UHC MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,VA,VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Wellcare MGG,Wellcare MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health - commercial,Bright Health - commercial,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health MGG,Bright Health MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna,Aetna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna MGG,Aetna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS,BCBS,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS MGG,BCBS MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna,Cigna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna MGG,Cigna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana,Humana,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana MGG,Humana MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Optum VA,Optum VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC,UHC,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC MGG,UHC MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,VA,VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Wellcare MGG,Wellcare MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health - commercial,Bright Health - commercial,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health MGG,Bright Health MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna,Aetna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna MGG,Aetna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS,BCBS,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS MGG,BCBS MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna,Cigna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna MGG,Cigna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana,Humana,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana MGG,Humana MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Optum VA,Optum VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC,UHC,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC MGG,UHC MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,VA,VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Wellcare MGG,Wellcare MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health - commercial,Bright Health - commercial,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health MGG,Bright Health MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna,Aetna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Aetna MGG,Aetna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS,BCBS,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,BCBS MGG,BCBS MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna,Cigna,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Cigna MGG,Cigna MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana,Humana,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Humana MGG,Humana MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Optum VA,Optum VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC,UHC,179.85,,,,,,,per diem,179.85,179.85,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,UHC MGG,UHC MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,VA,VA,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Wellcare MGG,Wellcare MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health - commercial,Bright Health - commercial,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,179.85,179.85,Bright Health MGG,Bright Health MGG,179.85,,,,,,,case rate,179.85,179.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Aetna,Aetna,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Aetna MGG,Aetna MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,BCBS,BCBS,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,BCBS MGG,BCBS MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Cigna,Cigna,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Cigna MGG,Cigna MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Humana,Humana,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Humana MGG,Humana MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Optum VA,Optum VA,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,UHC,UHC,149.85,,,,,,,per diem,149.85,149.85,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,UHC MGG,UHC MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,VA,VA,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Wellcare MGG,Wellcare MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Bright Health - commercial,Bright Health - commercial,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,149.85,149.85,Bright Health MGG,Bright Health MGG,149.85,,,,,,,case rate,149.85,149.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Aetna,Aetna,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Aetna MGG,Aetna MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,BCBS,BCBS,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,BCBS MGG,BCBS MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Cigna,Cigna,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Cigna MGG,Cigna MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Humana,Humana,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Humana MGG,Humana MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Optum VA,Optum VA,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,UHC,UHC,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,UHC MGG,UHC MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,VA,VA,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Wellcare MGG,Wellcare MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Bright Health - commercial,Bright Health - commercial,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,20.85,20.85,Bright Health MGG,Bright Health MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Aetna,Aetna,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Aetna MGG,Aetna MGG,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,BCBS,BCBS,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,BCBS MGG,BCBS MGG,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Cigna,Cigna,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Cigna MGG,Cigna MGG,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Humana,Humana,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Humana MGG,Humana MGG,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Optum VA,Optum VA,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,UHC,UHC,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,UHC MGG,UHC MGG,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,VA,VA,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Wellcare MGG,Wellcare MGG,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Bright Health - commercial,Bright Health - commercial,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,20.55,20.55,Bright Health MGG,Bright Health MGG,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Aetna,Aetna,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Aetna MGG,Aetna MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,BCBS,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,BCBS MGG,BCBS MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Cigna,Cigna,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Cigna MGG,Cigna MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Humana,Humana,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Humana MGG,Humana MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Optum VA,Optum VA,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,UHC,UHC,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,UHC MGG,UHC MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,VA,VA,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Wellcare MGG,Wellcare MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Bright Health - commercial,Bright Health - commercial,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,Bright Health MGG,Bright Health MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Aetna,Aetna,41.85,,,,,,,per diem,41.85,41.85,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Aetna MGG,Aetna MGG,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,BCBS,BCBS,41.85,,,,,,,per diem,41.85,41.85,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,BCBS MGG,BCBS MGG,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Cigna,Cigna,41.85,,,,,,,per diem,41.85,41.85,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Cigna MGG,Cigna MGG,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Humana,Humana,41.85,,,,,,,per diem,41.85,41.85,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Humana MGG,Humana MGG,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Optum VA,Optum VA,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,UHC,UHC,41.85,,,,,,,per diem,41.85,41.85,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,UHC MGG,UHC MGG,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,VA,VA,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Wellcare MGG,Wellcare MGG,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Bright Health - commercial,Bright Health - commercial,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,41.85,41.85,Bright Health MGG,Bright Health MGG,41.85,,,,,,,case rate,41.85,41.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Aetna,Aetna,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Aetna MGG,Aetna MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,BCBS,BCBS,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,BCBS MGG,BCBS MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Cigna,Cigna,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Cigna MGG,Cigna MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Humana,Humana,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Humana MGG,Humana MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Optum VA,Optum VA,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,UHC,UHC,39.09,,,,,,,per diem,39.09,39.09,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,UHC MGG,UHC MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,VA,VA,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Wellcare MGG,Wellcare MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Bright Health - commercial,Bright Health - commercial,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,39.09,39.09,Bright Health MGG,Bright Health MGG,39.09,,,,,,,case rate,39.09,39.09,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Aetna,Aetna,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Aetna MGG,Aetna MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,BCBS,BCBS,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,BCBS MGG,BCBS MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Cigna,Cigna,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Cigna MGG,Cigna MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Humana,Humana,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Humana MGG,Humana MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Optum VA,Optum VA,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,UHC,UHC,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,UHC MGG,UHC MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,VA,VA,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Wellcare MGG,Wellcare MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Bright Health - commercial,Bright Health - commercial,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,20.94,20.94,Bright Health MGG,Bright Health MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna,Aetna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Aetna MGG,Aetna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS,BCBS,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,BCBS MGG,BCBS MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna,Cigna,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Cigna MGG,Cigna MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana,Humana,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Humana MGG,Humana MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Optum VA,Optum VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC,UHC,23.85,,,,,,,per diem,23.85,23.85,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,UHC MGG,UHC MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,VA,VA,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Wellcare MGG,Wellcare MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health - commercial,Bright Health - commercial,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,23.85,23.85,Bright Health MGG,Bright Health MGG,23.85,,,,,,,case rate,23.85,23.85,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Aetna,Aetna,48.39,,,,,,,per diem,48.39,48.39,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Aetna MGG,Aetna MGG,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,BCBS,BCBS,48.39,,,,,,,per diem,48.39,48.39,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,BCBS MGG,BCBS MGG,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Cigna,Cigna,48.39,,,,,,,per diem,48.39,48.39,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Cigna MGG,Cigna MGG,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Humana,Humana,48.39,,,,,,,per diem,48.39,48.39,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Humana MGG,Humana MGG,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Optum VA,Optum VA,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,UHC,UHC,48.39,,,,,,,per diem,48.39,48.39,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,UHC MGG,UHC MGG,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,VA,VA,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Wellcare MGG,Wellcare MGG,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Bright Health - commercial,Bright Health - commercial,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,48.39,48.39,Bright Health MGG,Bright Health MGG,48.39,,,,,,,case rate,48.39,48.39,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Aetna,Aetna,140.25,,,,,,,per diem,140.25,140.25,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Aetna MGG,Aetna MGG,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,BCBS,BCBS,140.25,,,,,,,per diem,140.25,140.25,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,BCBS MGG,BCBS MGG,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Cigna,Cigna,140.25,,,,,,,per diem,140.25,140.25,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Cigna MGG,Cigna MGG,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Humana,Humana,140.25,,,,,,,per diem,140.25,140.25,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Humana MGG,Humana MGG,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Optum VA,Optum VA,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,UHC,UHC,140.25,,,,,,,per diem,140.25,140.25,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,UHC MGG,UHC MGG,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,VA,VA,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Wellcare MGG,Wellcare MGG,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Bright Health - commercial,Bright Health - commercial,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,140.25,140.25,Bright Health MGG,Bright Health MGG,140.25,,,,,,,case rate,140.25,140.25,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Aetna,Aetna,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Aetna MGG,Aetna MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,BCBS,BCBS,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,BCBS MGG,BCBS MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Cigna,Cigna,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Cigna MGG,Cigna MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Humana,Humana,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Humana MGG,Humana MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Optum VA,Optum VA,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,UHC,UHC,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,UHC MGG,UHC MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,VA,VA,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Wellcare MGG,Wellcare MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Bright Health - commercial,Bright Health - commercial,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Bright Health MGG,Bright Health MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Aetna,Aetna,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Aetna MGG,Aetna MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,BCBS,BCBS,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,BCBS MGG,BCBS MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Cigna,Cigna,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Cigna MGG,Cigna MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Humana,Humana,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Humana MGG,Humana MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Optum VA,Optum VA,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,UHC,UHC,209.85,,,,,,,per diem,209.85,209.85,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,UHC MGG,UHC MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,VA,VA,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Wellcare MGG,Wellcare MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Bright Health - commercial,Bright Health - commercial,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,209.85,209.85,Bright Health MGG,Bright Health MGG,209.85,,,,,,,case rate,209.85,209.85,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Aetna,Aetna,68.07,,,,,,,per diem,68.07,68.07,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Aetna MGG,Aetna MGG,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,BCBS,BCBS,68.07,,,,,,,per diem,68.07,68.07,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,BCBS MGG,BCBS MGG,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Cigna,Cigna,68.07,,,,,,,per diem,68.07,68.07,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Cigna MGG,Cigna MGG,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Humana,Humana,68.07,,,,,,,per diem,68.07,68.07,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Humana MGG,Humana MGG,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Optum VA,Optum VA,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,UHC,UHC,68.07,,,,,,,per diem,68.07,68.07,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,UHC MGG,UHC MGG,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,VA,VA,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Wellcare MGG,Wellcare MGG,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Bright Health - commercial,Bright Health - commercial,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,68.07,68.07,Bright Health MGG,Bright Health MGG,68.07,,,,,,,case rate,68.07,68.07,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Aetna,Aetna,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Aetna MGG,Aetna MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,BCBS,BCBS,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,BCBS MGG,BCBS MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Cigna,Cigna,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Cigna MGG,Cigna MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Humana,Humana,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Humana MGG,Humana MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Optum VA,Optum VA,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,UHC,UHC,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,UHC MGG,UHC MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,VA,VA,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Wellcare MGG,Wellcare MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Bright Health - commercial,Bright Health - commercial,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,111,111,Bright Health MGG,Bright Health MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Aetna,Aetna,44.85,,,,,,,per diem,44.85,44.85,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Aetna MGG,Aetna MGG,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,BCBS,BCBS,44.85,,,,,,,per diem,44.85,44.85,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,BCBS MGG,BCBS MGG,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Cigna,Cigna,44.85,,,,,,,per diem,44.85,44.85,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Cigna MGG,Cigna MGG,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Humana,Humana,44.85,,,,,,,per diem,44.85,44.85,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Humana MGG,Humana MGG,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Optum VA,Optum VA,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,UHC,UHC,44.85,,,,,,,per diem,44.85,44.85,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,UHC MGG,UHC MGG,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,VA,VA,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Wellcare MGG,Wellcare MGG,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Bright Health - commercial,Bright Health - commercial,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,44.85,44.85,Bright Health MGG,Bright Health MGG,44.85,,,,,,,case rate,44.85,44.85,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Aetna,Aetna,327,,,,,,,per diem,327,327,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Aetna MGG,Aetna MGG,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,BCBS,BCBS,327,,,,,,,per diem,327,327,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,BCBS MGG,BCBS MGG,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Cigna,Cigna,327,,,,,,,per diem,327,327,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Cigna MGG,Cigna MGG,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Humana,Humana,327,,,,,,,per diem,327,327,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Humana MGG,Humana MGG,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Optum VA,Optum VA,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,UHC,UHC,327,,,,,,,per diem,327,327,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,UHC MGG,UHC MGG,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,VA,VA,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Wellcare MGG,Wellcare MGG,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Bright Health - commercial,Bright Health - commercial,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,327,327,Bright Health MGG,Bright Health MGG,327,,,,,,,case rate,327,327,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Aetna,Aetna,16.01,,,,,,,per diem,16.01,16.01,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Aetna MGG,Aetna MGG,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,BCBS,BCBS,16.01,,,,,,,per diem,16.01,16.01,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,BCBS MGG,BCBS MGG,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Cigna,Cigna,16.01,,,,,,,per diem,16.01,16.01,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Cigna MGG,Cigna MGG,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Humana,Humana,16.01,,,,,,,per diem,16.01,16.01,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Humana MGG,Humana MGG,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Optum VA,Optum VA,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,UHC,UHC,16.01,,,,,,,per diem,16.01,16.01,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,UHC MGG,UHC MGG,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,VA,VA,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Wellcare MGG,Wellcare MGG,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Bright Health - commercial,Bright Health - commercial,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.01,16.01,Bright Health MGG,Bright Health MGG,16.01,,,,,,,case rate,16.01,16.01,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Aetna,Aetna,162.06,,,,,,,per diem,162.06,162.06,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Aetna MGG,Aetna MGG,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,BCBS,BCBS,162.06,,,,,,,per diem,162.06,162.06,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,BCBS MGG,BCBS MGG,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Cigna,Cigna,162.06,,,,,,,per diem,162.06,162.06,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Cigna MGG,Cigna MGG,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Humana,Humana,162.06,,,,,,,per diem,162.06,162.06,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Humana MGG,Humana MGG,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Optum VA,Optum VA,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,UHC,UHC,162.06,,,,,,,per diem,162.06,162.06,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,UHC MGG,UHC MGG,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,VA,VA,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Wellcare MGG,Wellcare MGG,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Bright Health - commercial,Bright Health - commercial,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,162.06,162.06,Bright Health MGG,Bright Health MGG,162.06,,,,,,,case rate,162.06,162.06,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Aetna,Aetna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Aetna MGG,Aetna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,BCBS,BCBS,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,BCBS MGG,BCBS MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Cigna,Cigna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Cigna MGG,Cigna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Humana,Humana,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Humana MGG,Humana MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Optum VA,Optum VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,UHC,UHC,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,UHC MGG,UHC MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,VA,VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Wellcare MGG,Wellcare MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Bright Health - commercial,Bright Health - commercial,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
HOLDER BODY UTIL ADJ 5X72     ,33170754,CDM,270,RC,,,,,,Inpatient,,,15,15,Bright Health MGG,Bright Health MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Aetna,Aetna,21.15,,,,,,,per diem,21.15,21.15,"Per diem rate, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Aetna MGG,Aetna MGG,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,BCBS,BCBS,21.15,,,,,,,per diem,21.15,21.15,"Per diem rate, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,BCBS MGG,BCBS MGG,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Cigna,Cigna,21.15,,,,,,,per diem,21.15,21.15,"Per diem rate, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Cigna MGG,Cigna MGG,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Humana,Humana,21.15,,,,,,,per diem,21.15,21.15,"Per diem rate, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Humana MGG,Humana MGG,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Optum VA,Optum VA,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,UHC,UHC,21.15,,,,,,,per diem,21.15,21.15,"Per diem rate, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,UHC MGG,UHC MGG,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,VA,VA,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Wellcare MGG,Wellcare MGG,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Bright Health - commercial,Bright Health - commercial,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABDOM 3 PANEL UP TO 45 ,33174650,CDM,270,RC,,,,,,Inpatient,,,21.15,21.15,Bright Health MGG,Bright Health MGG,21.15,,,,,,,case rate,21.15,21.15,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Aetna,Aetna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Aetna MGG,Aetna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,BCBS,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS MGG,BCBS MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Cigna,Cigna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Cigna MGG,Cigna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Humana,Humana,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Humana MGG,Humana MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Optum VA,Optum VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,UHC,UHC,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,UHC MGG,UHC MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,VA,VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Wellcare MGG,Wellcare MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Bright Health - commercial,Bright Health - commercial,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,63,63,Bright Health MGG,Bright Health MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Aetna,Aetna,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Aetna MGG,Aetna MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,BCBS,BCBS,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,BCBS MGG,BCBS MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Cigna,Cigna,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Cigna MGG,Cigna MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Humana,Humana,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Humana MGG,Humana MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Optum VA,Optum VA,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,UHC,UHC,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,UHC MGG,UHC MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,VA,VA,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Wellcare MGG,Wellcare MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Bright Health - commercial,Bright Health - commercial,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Bright Health MGG,Bright Health MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Aetna,Aetna,19,,,,,,,per diem,19,19,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Aetna MGG,Aetna MGG,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,BCBS,BCBS,19,,,,,,,per diem,19,19,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,BCBS MGG,BCBS MGG,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Cigna,Cigna,19,,,,,,,per diem,19,19,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Cigna MGG,Cigna MGG,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Humana,Humana,19,,,,,,,per diem,19,19,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Humana MGG,Humana MGG,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Optum VA,Optum VA,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,UHC,UHC,19,,,,,,,per diem,19,19,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,UHC MGG,UHC MGG,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,VA,VA,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Wellcare MGG,Wellcare MGG,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Bright Health - commercial,Bright Health - commercial,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19,19,Bright Health MGG,Bright Health MGG,19,,,,,,,case rate,19,19,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna,Aetna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Aetna MGG,Aetna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,BCBS,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS MGG,BCBS MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna,Cigna,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Cigna MGG,Cigna MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana,Humana,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Humana MGG,Humana MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Optum VA,Optum VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC,UHC,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UHC MGG,UHC MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,VA,VA,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Wellcare MGG,Wellcare MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health - commercial,Bright Health - commercial,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 16""",33176507,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,Bright Health MGG,Bright Health MGG,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Aetna,Aetna,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Aetna MGG,Aetna MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,BCBS,BCBS,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,BCBS MGG,BCBS MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Cigna,Cigna,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Cigna MGG,Cigna MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Humana,Humana,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Humana MGG,Humana MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Optum VA,Optum VA,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,UHC,UHC,27.99,,,,,,,per diem,27.99,27.99,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,UHC MGG,UHC MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,VA,VA,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Wellcare MGG,Wellcare MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Bright Health - commercial,Bright Health - commercial,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE UNIVERSAL 19""",33176508,CDM,270,RC,,,,,,Inpatient,,,27.99,27.99,Bright Health MGG,Bright Health MGG,27.99,,,,,,,case rate,27.99,27.99,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna,Aetna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Aetna MGG,Aetna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS,BCBS,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,BCBS MGG,BCBS MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna,Cigna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Cigna MGG,Cigna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana,Humana,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Humana MGG,Humana MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Optum VA,Optum VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC,UHC,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,UHC MGG,UHC MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,VA,VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Wellcare MGG,Wellcare MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health - commercial,Bright Health - commercial,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,195,195,Bright Health MGG,Bright Health MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Aetna,Aetna,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Aetna MGG,Aetna MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,BCBS,BCBS,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,BCBS MGG,BCBS MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Cigna,Cigna,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Cigna MGG,Cigna MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Humana,Humana,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Humana MGG,Humana MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Optum VA,Optum VA,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,UHC,UHC,25.02,,,,,,,per diem,25.02,25.02,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,UHC MGG,UHC MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,VA,VA,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Wellcare MGG,Wellcare MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Bright Health - commercial,Bright Health - commercial,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW XLG      ,33176804,CDM,270,RC,,,,,,Inpatient,,,25.02,25.02,Bright Health MGG,Bright Health MGG,25.02,,,,,,,case rate,25.02,25.02,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Aetna,Aetna,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Aetna MGG,Aetna MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,BCBS,BCBS,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,BCBS MGG,BCBS MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Cigna,Cigna,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Cigna MGG,Cigna MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Humana,Humana,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Humana MGG,Humana MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Optum VA,Optum VA,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,UHC,UHC,17.6,,,,,,,per diem,17.6,17.6,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,UHC MGG,UHC MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,VA,VA,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Wellcare MGG,Wellcare MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Bright Health - commercial,Bright Health - commercial,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,17.6,17.6,Bright Health MGG,Bright Health MGG,17.6,,,,,,,case rate,17.6,17.6,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Aetna,Aetna,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Aetna MGG,Aetna MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,BCBS,BCBS,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,BCBS MGG,BCBS MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Cigna,Cigna,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Cigna MGG,Cigna MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Humana,Humana,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Humana MGG,Humana MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Optum VA,Optum VA,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,UHC,UHC,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,UHC MGG,UHC MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,VA,VA,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Wellcare MGG,Wellcare MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Bright Health - commercial,Bright Health - commercial,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,257,257,Bright Health MGG,Bright Health MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Aetna,Aetna,185,,,,,,,per diem,185,185,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Aetna MGG,Aetna MGG,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,BCBS,BCBS,185,,,,,,,per diem,185,185,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,BCBS MGG,BCBS MGG,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Cigna,Cigna,185,,,,,,,per diem,185,185,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Cigna MGG,Cigna MGG,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Humana,Humana,185,,,,,,,per diem,185,185,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Humana MGG,Humana MGG,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Optum VA,Optum VA,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,UHC,UHC,185,,,,,,,per diem,185,185,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,UHC MGG,UHC MGG,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,VA,VA,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Wellcare MGG,Wellcare MGG,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Bright Health - commercial,Bright Health - commercial,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,185,185,Bright Health MGG,Bright Health MGG,185,,,,,,,case rate,185,185,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Aetna,Aetna,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Aetna MGG,Aetna MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,BCBS,BCBS,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,BCBS MGG,BCBS MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Cigna,Cigna,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Cigna MGG,Cigna MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Humana,Humana,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Humana MGG,Humana MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Optum VA,Optum VA,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,UHC,UHC,64,,,,,,,per diem,64,64,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,UHC MGG,UHC MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,VA,VA,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Wellcare MGG,Wellcare MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Bright Health - commercial,Bright Health - commercial,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,64,64,Bright Health MGG,Bright Health MGG,64,,,,,,,case rate,64,64,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Aetna,Aetna,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Aetna MGG,Aetna MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,BCBS,BCBS,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,BCBS MGG,BCBS MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Cigna,Cigna,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Cigna MGG,Cigna MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Humana,Humana,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Humana MGG,Humana MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Optum VA,Optum VA,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,UHC,UHC,194,,,,,,,per diem,194,194,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,UHC MGG,UHC MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,VA,VA,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Wellcare MGG,Wellcare MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Bright Health - commercial,Bright Health - commercial,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,194,194,Bright Health MGG,Bright Health MGG,194,,,,,,,case rate,194,194,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Aetna,Aetna,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Aetna MGG,Aetna MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,BCBS,BCBS,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,BCBS MGG,BCBS MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Cigna,Cigna,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Cigna MGG,Cigna MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Humana,Humana,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Humana MGG,Humana MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Optum VA,Optum VA,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,UHC,UHC,340.2,,,,,,,per diem,340.2,340.2,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,UHC MGG,UHC MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,VA,VA,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Wellcare MGG,Wellcare MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Bright Health - commercial,Bright Health - commercial,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,340.2,340.2,Bright Health MGG,Bright Health MGG,340.2,,,,,,,case rate,340.2,340.2,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Aetna,Aetna,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Aetna MGG,Aetna MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,BCBS,BCBS,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,BCBS MGG,BCBS MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Cigna,Cigna,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Cigna MGG,Cigna MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Humana,Humana,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Humana MGG,Humana MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Optum VA,Optum VA,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,UHC,UHC,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,UHC MGG,UHC MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,VA,VA,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Wellcare MGG,Wellcare MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Bright Health - commercial,Bright Health - commercial,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,210,210,Bright Health MGG,Bright Health MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Aetna,Aetna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Aetna MGG,Aetna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,BCBS,BCBS,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,BCBS MGG,BCBS MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Cigna,Cigna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Cigna MGG,Cigna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Humana,Humana,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Humana MGG,Humana MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Optum VA,Optum VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,UHC,UHC,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,UHC MGG,UHC MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,VA,VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Wellcare MGG,Wellcare MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Bright Health - commercial,Bright Health - commercial,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,113.4,113.4,Bright Health MGG,Bright Health MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Aetna,Aetna,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Aetna MGG,Aetna MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,BCBS,BCBS,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,BCBS MGG,BCBS MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Cigna,Cigna,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Cigna MGG,Cigna MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Humana,Humana,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Humana MGG,Humana MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Optum VA,Optum VA,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,UHC,UHC,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,UHC MGG,UHC MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,VA,VA,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Wellcare MGG,Wellcare MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Bright Health - commercial,Bright Health - commercial,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,243.6,243.6,Bright Health MGG,Bright Health MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Aetna,Aetna,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Aetna MGG,Aetna MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,BCBS,BCBS,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,BCBS MGG,BCBS MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Cigna,Cigna,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Cigna MGG,Cigna MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Humana,Humana,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Humana MGG,Humana MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Optum VA,Optum VA,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,UHC,UHC,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,UHC MGG,UHC MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,VA,VA,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Wellcare MGG,Wellcare MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Bright Health - commercial,Bright Health - commercial,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,210,210,Bright Health MGG,Bright Health MGG,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Aetna,Aetna,113,,,,,,,per diem,113,113,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Aetna MGG,Aetna MGG,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,BCBS,BCBS,113,,,,,,,per diem,113,113,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,BCBS MGG,BCBS MGG,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Cigna,Cigna,113,,,,,,,per diem,113,113,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Cigna MGG,Cigna MGG,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Humana,Humana,113,,,,,,,per diem,113,113,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Humana MGG,Humana MGG,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Optum VA,Optum VA,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,UHC,UHC,113,,,,,,,per diem,113,113,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,UHC MGG,UHC MGG,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,VA,VA,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Wellcare MGG,Wellcare MGG,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Bright Health - commercial,Bright Health - commercial,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,113,113,Bright Health MGG,Bright Health MGG,113,,,,,,,case rate,113,113,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Aetna,Aetna,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Aetna MGG,Aetna MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,BCBS,BCBS,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,BCBS MGG,BCBS MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Cigna,Cigna,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Cigna MGG,Cigna MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Humana,Humana,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Humana MGG,Humana MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Optum VA,Optum VA,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,UHC,UHC,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,UHC MGG,UHC MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,VA,VA,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Wellcare MGG,Wellcare MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Bright Health - commercial,Bright Health - commercial,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,243.6,243.6,Bright Health MGG,Bright Health MGG,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Aetna,Aetna,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Aetna MGG,Aetna MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,BCBS,BCBS,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,BCBS MGG,BCBS MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Cigna,Cigna,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Cigna MGG,Cigna MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Humana,Humana,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Humana MGG,Humana MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Optum VA,Optum VA,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,UHC,UHC,130.2,,,,,,,per diem,130.2,130.2,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,UHC MGG,UHC MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,VA,VA,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Wellcare MGG,Wellcare MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Bright Health - commercial,Bright Health - commercial,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,130.2,130.2,Bright Health MGG,Bright Health MGG,130.2,,,,,,,case rate,130.2,130.2,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Aetna,Aetna,331,,,,,,,per diem,331,331,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Aetna MGG,Aetna MGG,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,BCBS,BCBS,331,,,,,,,per diem,331,331,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,BCBS MGG,BCBS MGG,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Cigna,Cigna,331,,,,,,,per diem,331,331,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Cigna MGG,Cigna MGG,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Humana,Humana,331,,,,,,,per diem,331,331,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Humana MGG,Humana MGG,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Optum VA,Optum VA,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,UHC,UHC,331,,,,,,,per diem,331,331,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,UHC MGG,UHC MGG,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,VA,VA,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Wellcare MGG,Wellcare MGG,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Bright Health - commercial,Bright Health - commercial,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,331,331,Bright Health MGG,Bright Health MGG,331,,,,,,,case rate,331,331,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Aetna,Aetna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Aetna MGG,Aetna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,BCBS,BCBS,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,BCBS MGG,BCBS MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Cigna,Cigna,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Cigna MGG,Cigna MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Humana,Humana,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Humana MGG,Humana MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Optum VA,Optum VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,UHC,UHC,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,UHC MGG,UHC MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,VA,VA,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Wellcare MGG,Wellcare MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Bright Health - commercial,Bright Health - commercial,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,113.4,113.4,Bright Health MGG,Bright Health MGG,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Aetna,Aetna,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Aetna MGG,Aetna MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,BCBS,BCBS,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,BCBS MGG,BCBS MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Cigna,Cigna,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Cigna MGG,Cigna MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Humana,Humana,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Humana MGG,Humana MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Optum VA,Optum VA,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,UHC,UHC,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,UHC MGG,UHC MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,VA,VA,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Wellcare MGG,Wellcare MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Bright Health - commercial,Bright Health - commercial,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Bright Health MGG,Bright Health MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Aetna,Aetna,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Aetna MGG,Aetna MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,BCBS,BCBS,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,BCBS MGG,BCBS MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Cigna,Cigna,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Cigna MGG,Cigna MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Humana,Humana,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Humana MGG,Humana MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Optum VA,Optum VA,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,UHC,UHC,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,UHC MGG,UHC MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,VA,VA,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Wellcare MGG,Wellcare MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Bright Health - commercial,Bright Health - commercial,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO                    ,33199109,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Bright Health MGG,Bright Health MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Aetna,Aetna,14,,,,,,,per diem,14,14,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Aetna MGG,Aetna MGG,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,BCBS,BCBS,14,,,,,,,per diem,14,14,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,BCBS MGG,BCBS MGG,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Cigna,Cigna,14,,,,,,,per diem,14,14,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Cigna MGG,Cigna MGG,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Humana,Humana,14,,,,,,,per diem,14,14,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Humana MGG,Humana MGG,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Optum VA,Optum VA,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,UHC,UHC,14,,,,,,,per diem,14,14,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,UHC MGG,UHC MGG,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,VA,VA,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Wellcare MGG,Wellcare MGG,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Bright Health - commercial,Bright Health - commercial,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14,14,Bright Health MGG,Bright Health MGG,14,,,,,,,case rate,14,14,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Aetna,Aetna,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Aetna MGG,Aetna MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,BCBS,BCBS,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,BCBS MGG,BCBS MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Cigna,Cigna,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Cigna MGG,Cigna MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Humana,Humana,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Humana MGG,Humana MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Optum VA,Optum VA,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,UHC,UHC,14.25,,,,,,,per diem,14.25,14.25,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,UHC MGG,UHC MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,VA,VA,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Wellcare MGG,Wellcare MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Bright Health - commercial,Bright Health - commercial,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.25,14.25,Bright Health MGG,Bright Health MGG,14.25,,,,,,,case rate,14.25,14.25,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Aetna,Aetna,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Aetna MGG,Aetna MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,BCBS,BCBS,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,BCBS MGG,BCBS MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Cigna,Cigna,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Cigna MGG,Cigna MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Humana,Humana,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Humana MGG,Humana MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Optum VA,Optum VA,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,UHC,UHC,417.12,,,,,,,per diem,417.12,417.12,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,UHC MGG,UHC MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,VA,VA,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Wellcare MGG,Wellcare MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Bright Health - commercial,Bright Health - commercial,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,417.12,417.12,Bright Health MGG,Bright Health MGG,417.12,,,,,,,case rate,417.12,417.12,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Aetna,Aetna,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Aetna MGG,Aetna MGG,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,BCBS,BCBS,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,BCBS MGG,BCBS MGG,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Cigna,Cigna,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Cigna MGG,Cigna MGG,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Humana,Humana,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Humana MGG,Humana MGG,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Optum VA,Optum VA,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,UHC,UHC,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,UHC MGG,UHC MGG,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,VA,VA,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Wellcare MGG,Wellcare MGG,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Bright Health - commercial,Bright Health - commercial,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,166.53,166.53,Bright Health MGG,Bright Health MGG,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna,Aetna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Aetna MGG,Aetna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS,BCBS,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,BCBS MGG,BCBS MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna,Cigna,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Cigna MGG,Cigna MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana,Humana,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Humana MGG,Humana MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Optum VA,Optum VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC,UHC,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,UHC MGG,UHC MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,VA,VA,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Wellcare MGG,Wellcare MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health - commercial,Bright Health - commercial,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8,8,Bright Health MGG,Bright Health MGG,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Aetna,Aetna,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Aetna MGG,Aetna MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,BCBS,BCBS,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,BCBS MGG,BCBS MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Cigna,Cigna,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Cigna MGG,Cigna MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Humana,Humana,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Humana MGG,Humana MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Optum VA,Optum VA,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,UHC,UHC,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,UHC MGG,UHC MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,VA,VA,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Wellcare MGG,Wellcare MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Bright Health - commercial,Bright Health - commercial,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Bright Health MGG,Bright Health MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Aetna,Aetna,37.14,,,,,,,per diem,37.14,37.14,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Aetna MGG,Aetna MGG,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,BCBS,BCBS,37.14,,,,,,,per diem,37.14,37.14,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,BCBS MGG,BCBS MGG,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Cigna,Cigna,37.14,,,,,,,per diem,37.14,37.14,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Cigna MGG,Cigna MGG,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Humana,Humana,37.14,,,,,,,per diem,37.14,37.14,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Humana MGG,Humana MGG,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Optum VA,Optum VA,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,UHC,UHC,37.14,,,,,,,per diem,37.14,37.14,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,UHC MGG,UHC MGG,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,VA,VA,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Wellcare MGG,Wellcare MGG,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Bright Health - commercial,Bright Health - commercial,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,37.14,37.14,Bright Health MGG,Bright Health MGG,37.14,,,,,,,case rate,37.14,37.14,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Aetna,Aetna,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Aetna MGG,Aetna MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,BCBS,BCBS,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,BCBS MGG,BCBS MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Cigna,Cigna,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Cigna MGG,Cigna MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Humana,Humana,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Humana MGG,Humana MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Optum VA,Optum VA,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,UHC,UHC,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,UHC MGG,UHC MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,VA,VA,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Wellcare MGG,Wellcare MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Bright Health - commercial,Bright Health - commercial,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,14.49,14.49,Bright Health MGG,Bright Health MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Aetna,Aetna,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Aetna MGG,Aetna MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,BCBS,BCBS,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,BCBS MGG,BCBS MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Cigna,Cigna,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Cigna MGG,Cigna MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Humana,Humana,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Humana MGG,Humana MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Optum VA,Optum VA,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,UHC,UHC,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,UHC MGG,UHC MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,VA,VA,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Wellcare MGG,Wellcare MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Bright Health - commercial,Bright Health - commercial,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,21.72,21.72,Bright Health MGG,Bright Health MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Aetna,Aetna,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Aetna MGG,Aetna MGG,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,BCBS,BCBS,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,BCBS MGG,BCBS MGG,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Cigna,Cigna,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Cigna MGG,Cigna MGG,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Humana,Humana,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Humana MGG,Humana MGG,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Optum VA,Optum VA,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,UHC,UHC,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,UHC MGG,UHC MGG,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,VA,VA,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Wellcare MGG,Wellcare MGG,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Bright Health - commercial,Bright Health - commercial,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.25,9.25,Bright Health MGG,Bright Health MGG,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Aetna,Aetna,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Aetna MGG,Aetna MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,BCBS,BCBS,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,BCBS MGG,BCBS MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Cigna,Cigna,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Cigna MGG,Cigna MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Humana,Humana,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Humana MGG,Humana MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Optum VA,Optum VA,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,UHC,UHC,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,UHC MGG,UHC MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,VA,VA,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Wellcare MGG,Wellcare MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Bright Health - commercial,Bright Health - commercial,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Bright Health MGG,Bright Health MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Aetna,Aetna,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Aetna MGG,Aetna MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,BCBS,BCBS,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,BCBS MGG,BCBS MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Cigna,Cigna,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Cigna MGG,Cigna MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Humana,Humana,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Humana MGG,Humana MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Optum VA,Optum VA,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,UHC,UHC,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,UHC MGG,UHC MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,VA,VA,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Wellcare MGG,Wellcare MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Bright Health - commercial,Bright Health - commercial,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Bright Health MGG,Bright Health MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Aetna,Aetna,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Aetna MGG,Aetna MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,BCBS,BCBS,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,BCBS MGG,BCBS MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Cigna,Cigna,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Cigna MGG,Cigna MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Humana,Humana,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Humana MGG,Humana MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Optum VA,Optum VA,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,UHC,UHC,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,UHC MGG,UHC MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,VA,VA,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Wellcare MGG,Wellcare MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Bright Health - commercial,Bright Health - commercial,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.04,8.04,Bright Health MGG,Bright Health MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Aetna,Aetna,151.71,,,,,,,per diem,151.71,151.71,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Aetna MGG,Aetna MGG,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,BCBS,BCBS,151.71,,,,,,,per diem,151.71,151.71,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,BCBS MGG,BCBS MGG,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Cigna,Cigna,151.71,,,,,,,per diem,151.71,151.71,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Cigna MGG,Cigna MGG,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Humana,Humana,151.71,,,,,,,per diem,151.71,151.71,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Humana MGG,Humana MGG,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Optum VA,Optum VA,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,UHC,UHC,151.71,,,,,,,per diem,151.71,151.71,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,UHC MGG,UHC MGG,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,VA,VA,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Wellcare MGG,Wellcare MGG,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Bright Health - commercial,Bright Health - commercial,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,151.71,151.71,Bright Health MGG,Bright Health MGG,151.71,,,,,,,case rate,151.71,151.71,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Aetna,Aetna,33.75,,,,,,,per diem,33.75,33.75,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Aetna MGG,Aetna MGG,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,BCBS,BCBS,33.75,,,,,,,per diem,33.75,33.75,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,BCBS MGG,BCBS MGG,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Cigna,Cigna,33.75,,,,,,,per diem,33.75,33.75,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Cigna MGG,Cigna MGG,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Humana,Humana,33.75,,,,,,,per diem,33.75,33.75,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Humana MGG,Humana MGG,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Optum VA,Optum VA,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,UHC,UHC,33.75,,,,,,,per diem,33.75,33.75,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,UHC MGG,UHC MGG,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,VA,VA,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Wellcare MGG,Wellcare MGG,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Bright Health - commercial,Bright Health - commercial,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,33.75,33.75,Bright Health MGG,Bright Health MGG,33.75,,,,,,,case rate,33.75,33.75,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Aetna,Aetna,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Aetna MGG,Aetna MGG,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,BCBS,BCBS,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,BCBS MGG,BCBS MGG,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Cigna,Cigna,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Cigna MGG,Cigna MGG,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Humana,Humana,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Humana MGG,Humana MGG,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Optum VA,Optum VA,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,UHC,UHC,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,UHC MGG,UHC MGG,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,VA,VA,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Wellcare MGG,Wellcare MGG,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Bright Health - commercial,Bright Health - commercial,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,53.08,53.08,Bright Health MGG,Bright Health MGG,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Aetna,Aetna,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Aetna MGG,Aetna MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,BCBS,BCBS,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,BCBS MGG,BCBS MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Cigna,Cigna,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Cigna MGG,Cigna MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Humana,Humana,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Humana MGG,Humana MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Optum VA,Optum VA,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,UHC,UHC,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,UHC MGG,UHC MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,VA,VA,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Wellcare MGG,Wellcare MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Bright Health - commercial,Bright Health - commercial,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,11.43,11.43,Bright Health MGG,Bright Health MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Aetna,Aetna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Aetna MGG,Aetna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,BCBS,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,BCBS MGG,BCBS MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Cigna,Cigna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Cigna MGG,Cigna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Humana,Humana,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Humana MGG,Humana MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Optum VA,Optum VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,UHC,UHC,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,UHC MGG,UHC MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,VA,VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Wellcare MGG,Wellcare MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Bright Health - commercial,Bright Health - commercial,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,Bright Health MGG,Bright Health MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Aetna,Aetna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Aetna MGG,Aetna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,BCBS,BCBS,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,BCBS MGG,BCBS MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Cigna,Cigna,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Cigna MGG,Cigna MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Humana,Humana,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Humana MGG,Humana MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Optum VA,Optum VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,UHC,UHC,30.36,,,,,,,per diem,30.36,30.36,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,UHC MGG,UHC MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,VA,VA,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Wellcare MGG,Wellcare MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health - commercial,Bright Health - commercial,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,30.36,30.36,Bright Health MGG,Bright Health MGG,30.36,,,,,,,case rate,30.36,30.36,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Aetna,Aetna,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Aetna MGG,Aetna MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,BCBS,BCBS,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,BCBS MGG,BCBS MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Cigna,Cigna,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Cigna MGG,Cigna MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Humana,Humana,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Humana MGG,Humana MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Optum VA,Optum VA,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,UHC,UHC,11.27,,,,,,,per diem,11.27,11.27,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,UHC MGG,UHC MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,VA,VA,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Wellcare MGG,Wellcare MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Bright Health - commercial,Bright Health - commercial,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.27,11.27,Bright Health MGG,Bright Health MGG,11.27,,,,,,,case rate,11.27,11.27,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Aetna,Aetna,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Aetna MGG,Aetna MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,BCBS,BCBS,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,BCBS MGG,BCBS MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Cigna,Cigna,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Cigna MGG,Cigna MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Humana,Humana,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Humana MGG,Humana MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Optum VA,Optum VA,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,UHC,UHC,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,UHC MGG,UHC MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,VA,VA,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Wellcare MGG,Wellcare MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Bright Health - commercial,Bright Health - commercial,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,27.54,27.54,Bright Health MGG,Bright Health MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Aetna,Aetna,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Aetna MGG,Aetna MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,BCBS,BCBS,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,BCBS MGG,BCBS MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Cigna,Cigna,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Cigna MGG,Cigna MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Humana,Humana,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Humana MGG,Humana MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Optum VA,Optum VA,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,UHC,UHC,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,UHC MGG,UHC MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,VA,VA,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Wellcare MGG,Wellcare MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Bright Health - commercial,Bright Health - commercial,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,98.64,98.64,Bright Health MGG,Bright Health MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Aetna,Aetna,337.31,,,,,,,per diem,337.31,337.31,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Aetna MGG,Aetna MGG,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,BCBS,BCBS,337.31,,,,,,,per diem,337.31,337.31,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,BCBS MGG,BCBS MGG,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Cigna,Cigna,337.31,,,,,,,per diem,337.31,337.31,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Cigna MGG,Cigna MGG,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Humana,Humana,337.31,,,,,,,per diem,337.31,337.31,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Humana MGG,Humana MGG,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Optum VA,Optum VA,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,UHC,UHC,337.31,,,,,,,per diem,337.31,337.31,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,UHC MGG,UHC MGG,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,VA,VA,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Wellcare MGG,Wellcare MGG,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Bright Health - commercial,Bright Health - commercial,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,337.31,337.31,Bright Health MGG,Bright Health MGG,337.31,,,,,,,case rate,337.31,337.31,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Aetna,Aetna,245.79,,,,,,,per diem,245.79,245.79,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Aetna MGG,Aetna MGG,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,BCBS,BCBS,245.79,,,,,,,per diem,245.79,245.79,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,BCBS MGG,BCBS MGG,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Cigna,Cigna,245.79,,,,,,,per diem,245.79,245.79,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Cigna MGG,Cigna MGG,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Humana,Humana,245.79,,,,,,,per diem,245.79,245.79,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Humana MGG,Humana MGG,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Optum VA,Optum VA,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,UHC,UHC,245.79,,,,,,,per diem,245.79,245.79,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,UHC MGG,UHC MGG,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,VA,VA,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Wellcare MGG,Wellcare MGG,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Bright Health - commercial,Bright Health - commercial,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,245.79,245.79,Bright Health MGG,Bright Health MGG,245.79,,,,,,,case rate,245.79,245.79,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Aetna,Aetna,919.6,,,,,,,per diem,919.6,919.6,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Aetna MGG,Aetna MGG,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,BCBS,BCBS,919.6,,,,,,,per diem,919.6,919.6,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,BCBS MGG,BCBS MGG,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Cigna,Cigna,919.6,,,,,,,per diem,919.6,919.6,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Cigna MGG,Cigna MGG,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Humana,Humana,919.6,,,,,,,per diem,919.6,919.6,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Humana MGG,Humana MGG,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Optum VA,Optum VA,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,UHC,UHC,919.6,,,,,,,per diem,919.6,919.6,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,UHC MGG,UHC MGG,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,VA,VA,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Wellcare MGG,Wellcare MGG,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Bright Health - commercial,Bright Health - commercial,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,919.6,919.6,Bright Health MGG,Bright Health MGG,919.6,,,,,,,case rate,919.6,919.6,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Aetna,Aetna,173.67,,,,,,,per diem,173.67,173.67,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Aetna MGG,Aetna MGG,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,BCBS,BCBS,173.67,,,,,,,per diem,173.67,173.67,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,BCBS MGG,BCBS MGG,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Cigna,Cigna,173.67,,,,,,,per diem,173.67,173.67,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Cigna MGG,Cigna MGG,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Humana,Humana,173.67,,,,,,,per diem,173.67,173.67,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Humana MGG,Humana MGG,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Optum VA,Optum VA,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,UHC,UHC,173.67,,,,,,,per diem,173.67,173.67,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,UHC MGG,UHC MGG,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,VA,VA,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Wellcare MGG,Wellcare MGG,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Bright Health - commercial,Bright Health - commercial,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,173.67,173.67,Bright Health MGG,Bright Health MGG,173.67,,,,,,,case rate,173.67,173.67,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Aetna,Aetna,334.64,,,,,,,per diem,334.64,334.64,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Aetna MGG,Aetna MGG,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,BCBS,BCBS,334.64,,,,,,,per diem,334.64,334.64,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,BCBS MGG,BCBS MGG,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Cigna,Cigna,334.64,,,,,,,per diem,334.64,334.64,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Cigna MGG,Cigna MGG,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Humana,Humana,334.64,,,,,,,per diem,334.64,334.64,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Humana MGG,Humana MGG,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Optum VA,Optum VA,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,UHC,UHC,334.64,,,,,,,per diem,334.64,334.64,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,UHC MGG,UHC MGG,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,VA,VA,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Wellcare MGG,Wellcare MGG,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Bright Health - commercial,Bright Health - commercial,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,334.64,334.64,Bright Health MGG,Bright Health MGG,334.64,,,,,,,case rate,334.64,334.64,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Aetna,Aetna,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Aetna MGG,Aetna MGG,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,BCBS,BCBS,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,BCBS MGG,BCBS MGG,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Cigna,Cigna,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Cigna MGG,Cigna MGG,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Humana,Humana,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Humana MGG,Humana MGG,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Optum VA,Optum VA,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,UHC,UHC,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,UHC MGG,UHC MGG,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,VA,VA,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Wellcare MGG,Wellcare MGG,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Bright Health - commercial,Bright Health - commercial,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,GP,Inpatient,,,343.88,343.88,Bright Health MGG,Bright Health MGG,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,GP,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Aetna,Aetna,221.19,,,,,,,per diem,221.19,221.19,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Aetna MGG,Aetna MGG,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,BCBS,BCBS,221.19,,,,,,,per diem,221.19,221.19,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,BCBS MGG,BCBS MGG,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Cigna,Cigna,221.19,,,,,,,per diem,221.19,221.19,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Cigna MGG,Cigna MGG,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Humana,Humana,221.19,,,,,,,per diem,221.19,221.19,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Humana MGG,Humana MGG,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Optum VA,Optum VA,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,UHC,UHC,221.19,,,,,,,per diem,221.19,221.19,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,UHC MGG,UHC MGG,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,VA,VA,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Wellcare MGG,Wellcare MGG,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Bright Health - commercial,Bright Health - commercial,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,221.19,221.19,Bright Health MGG,Bright Health MGG,221.19,,,,,,,case rate,221.19,221.19,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Aetna,Aetna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Aetna MGG,Aetna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,BCBS,BCBS,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,BCBS MGG,BCBS MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Cigna,Cigna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Cigna MGG,Cigna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Humana,Humana,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Humana MGG,Humana MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Optum VA,Optum VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,UHC,UHC,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,UHC MGG,UHC MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,VA,VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Wellcare MGG,Wellcare MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Bright Health - commercial,Bright Health - commercial,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Bright Health MGG,Bright Health MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Aetna,Aetna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Aetna MGG,Aetna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,BCBS,BCBS,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,BCBS MGG,BCBS MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Cigna,Cigna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Cigna MGG,Cigna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Humana,Humana,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Humana MGG,Humana MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Optum VA,Optum VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,UHC,UHC,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,UHC MGG,UHC MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,VA,VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Wellcare MGG,Wellcare MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Bright Health - commercial,Bright Health - commercial,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Bright Health MGG,Bright Health MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Aetna,Aetna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Aetna MGG,Aetna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,BCBS,BCBS,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,BCBS MGG,BCBS MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Cigna,Cigna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Cigna MGG,Cigna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Humana,Humana,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Humana MGG,Humana MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Optum VA,Optum VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,UHC,UHC,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,UHC MGG,UHC MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,VA,VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Wellcare MGG,Wellcare MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Bright Health - commercial,Bright Health - commercial,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Bright Health MGG,Bright Health MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Aetna,Aetna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Aetna MGG,Aetna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,BCBS,BCBS,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,BCBS MGG,BCBS MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Cigna,Cigna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Cigna MGG,Cigna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Humana,Humana,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Humana MGG,Humana MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Optum VA,Optum VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,UHC,UHC,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,UHC MGG,UHC MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,VA,VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Wellcare MGG,Wellcare MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Bright Health - commercial,Bright Health - commercial,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,632.07,632.07,Bright Health MGG,Bright Health MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Aetna,Aetna,71.89,,,,,,,per diem,71.89,71.89,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Aetna MGG,Aetna MGG,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,BCBS,BCBS,71.89,,,,,,,per diem,71.89,71.89,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,BCBS MGG,BCBS MGG,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Cigna,Cigna,71.89,,,,,,,per diem,71.89,71.89,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Cigna MGG,Cigna MGG,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Humana,Humana,71.89,,,,,,,per diem,71.89,71.89,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Humana MGG,Humana MGG,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Optum VA,Optum VA,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,UHC,UHC,71.89,,,,,,,per diem,71.89,71.89,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,UHC MGG,UHC MGG,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,VA,VA,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Wellcare MGG,Wellcare MGG,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Bright Health - commercial,Bright Health - commercial,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,71.89,71.89,Bright Health MGG,Bright Health MGG,71.89,,,,,,,case rate,71.89,71.89,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Aetna,Aetna,42.96,,,,,,,per diem,42.96,42.96,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Aetna MGG,Aetna MGG,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,BCBS,BCBS,42.96,,,,,,,per diem,42.96,42.96,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,BCBS MGG,BCBS MGG,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Cigna,Cigna,42.96,,,,,,,per diem,42.96,42.96,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Cigna MGG,Cigna MGG,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Humana,Humana,42.96,,,,,,,per diem,42.96,42.96,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Humana MGG,Humana MGG,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Optum VA,Optum VA,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,UHC,UHC,42.96,,,,,,,per diem,42.96,42.96,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,UHC MGG,UHC MGG,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,VA,VA,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Wellcare MGG,Wellcare MGG,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Bright Health - commercial,Bright Health - commercial,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,42.96,42.96,Bright Health MGG,Bright Health MGG,42.96,,,,,,,case rate,42.96,42.96,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Aetna,Aetna,102.71,,,,,,,per diem,102.71,102.71,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Aetna MGG,Aetna MGG,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,BCBS,BCBS,102.71,,,,,,,per diem,102.71,102.71,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,BCBS MGG,BCBS MGG,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Cigna,Cigna,102.71,,,,,,,per diem,102.71,102.71,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Cigna MGG,Cigna MGG,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Humana,Humana,102.71,,,,,,,per diem,102.71,102.71,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Humana MGG,Humana MGG,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Optum VA,Optum VA,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,UHC,UHC,102.71,,,,,,,per diem,102.71,102.71,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,UHC MGG,UHC MGG,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,VA,VA,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Wellcare MGG,Wellcare MGG,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Bright Health - commercial,Bright Health - commercial,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,102.71,102.71,Bright Health MGG,Bright Health MGG,102.71,,,,,,,case rate,102.71,102.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Aetna,Aetna,84.49,,,,,,,per diem,84.49,84.49,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Aetna MGG,Aetna MGG,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,BCBS,BCBS,84.49,,,,,,,per diem,84.49,84.49,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,BCBS MGG,BCBS MGG,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Cigna,Cigna,84.49,,,,,,,per diem,84.49,84.49,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Cigna MGG,Cigna MGG,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Humana,Humana,84.49,,,,,,,per diem,84.49,84.49,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Humana MGG,Humana MGG,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Optum VA,Optum VA,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,UHC,UHC,84.49,,,,,,,per diem,84.49,84.49,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,UHC MGG,UHC MGG,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,VA,VA,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Wellcare MGG,Wellcare MGG,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Bright Health - commercial,Bright Health - commercial,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,84.49,84.49,Bright Health MGG,Bright Health MGG,84.49,,,,,,,case rate,84.49,84.49,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Aetna,Aetna,203.68,,,,,,,per diem,203.68,203.68,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Aetna MGG,Aetna MGG,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,BCBS,BCBS,203.68,,,,,,,per diem,203.68,203.68,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,BCBS MGG,BCBS MGG,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Cigna,Cigna,203.68,,,,,,,per diem,203.68,203.68,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Cigna MGG,Cigna MGG,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Humana,Humana,203.68,,,,,,,per diem,203.68,203.68,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Humana MGG,Humana MGG,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Optum VA,Optum VA,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,UHC,UHC,203.68,,,,,,,per diem,203.68,203.68,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,UHC MGG,UHC MGG,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,VA,VA,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Wellcare MGG,Wellcare MGG,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Bright Health - commercial,Bright Health - commercial,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,203.68,203.68,Bright Health MGG,Bright Health MGG,203.68,,,,,,,case rate,203.68,203.68,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Aetna,Aetna,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Aetna MGG,Aetna MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,BCBS,BCBS,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,BCBS MGG,BCBS MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Cigna,Cigna,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Cigna MGG,Cigna MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Humana,Humana,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Humana MGG,Humana MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Optum VA,Optum VA,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,UHC,UHC,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,UHC MGG,UHC MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,VA,VA,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Wellcare MGG,Wellcare MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Bright Health - commercial,Bright Health - commercial,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Bright Health MGG,Bright Health MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Aetna,Aetna,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Aetna MGG,Aetna MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,BCBS,BCBS,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,BCBS MGG,BCBS MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Cigna,Cigna,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Cigna MGG,Cigna MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Humana,Humana,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Humana MGG,Humana MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Optum VA,Optum VA,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,UHC,UHC,181.17,,,,,,,per diem,181.17,181.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,UHC MGG,UHC MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,VA,VA,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Wellcare MGG,Wellcare MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Bright Health - commercial,Bright Health - commercial,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,181.17,181.17,Bright Health MGG,Bright Health MGG,181.17,,,,,,,case rate,181.17,181.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Aetna,Aetna,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Aetna MGG,Aetna MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,BCBS,BCBS,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,BCBS MGG,BCBS MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Cigna,Cigna,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Cigna MGG,Cigna MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Humana,Humana,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Humana MGG,Humana MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Optum VA,Optum VA,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,UHC,UHC,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,UHC MGG,UHC MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,VA,VA,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Wellcare MGG,Wellcare MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Bright Health - commercial,Bright Health - commercial,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,95.33,95.33,Bright Health MGG,Bright Health MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Aetna,Aetna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Aetna MGG,Aetna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,BCBS,BCBS,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,BCBS MGG,BCBS MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Cigna,Cigna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Cigna MGG,Cigna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Humana,Humana,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Humana MGG,Humana MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Optum VA,Optum VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,UHC,UHC,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,UHC MGG,UHC MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,VA,VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Wellcare MGG,Wellcare MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Bright Health - commercial,Bright Health - commercial,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,83.72,83.72,Bright Health MGG,Bright Health MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Aetna,Aetna,85.72,,,,,,,per diem,85.72,85.72,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Aetna MGG,Aetna MGG,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,BCBS,BCBS,85.72,,,,,,,per diem,85.72,85.72,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,BCBS MGG,BCBS MGG,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Cigna,Cigna,85.72,,,,,,,per diem,85.72,85.72,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Cigna MGG,Cigna MGG,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Humana,Humana,85.72,,,,,,,per diem,85.72,85.72,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Humana MGG,Humana MGG,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Optum VA,Optum VA,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,UHC,UHC,85.72,,,,,,,per diem,85.72,85.72,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,UHC MGG,UHC MGG,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,VA,VA,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Wellcare MGG,Wellcare MGG,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Bright Health - commercial,Bright Health - commercial,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,85.72,85.72,Bright Health MGG,Bright Health MGG,85.72,,,,,,,case rate,85.72,85.72,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna,Aetna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna MGG,Aetna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS,BCBS,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS MGG,BCBS MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna,Cigna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna MGG,Cigna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Humana,Humana,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Humana MGG,Humana MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Optum VA,Optum VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,UHC,UHC,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,UHC MGG,UHC MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,VA,VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Wellcare MGG,Wellcare MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health - commercial,Bright Health - commercial,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health MGG,Bright Health MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Aetna,Aetna,110.26,,,,,,,per diem,110.26,110.26,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Aetna MGG,Aetna MGG,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,BCBS,BCBS,110.26,,,,,,,per diem,110.26,110.26,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,BCBS MGG,BCBS MGG,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Cigna,Cigna,110.26,,,,,,,per diem,110.26,110.26,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Cigna MGG,Cigna MGG,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Humana,Humana,110.26,,,,,,,per diem,110.26,110.26,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Humana MGG,Humana MGG,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Optum VA,Optum VA,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,UHC,UHC,110.26,,,,,,,per diem,110.26,110.26,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,UHC MGG,UHC MGG,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,VA,VA,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Wellcare MGG,Wellcare MGG,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Bright Health - commercial,Bright Health - commercial,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,110.26,110.26,Bright Health MGG,Bright Health MGG,110.26,,,,,,,case rate,110.26,110.26,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Aetna,Aetna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Aetna MGG,Aetna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,BCBS,BCBS,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,BCBS MGG,BCBS MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Cigna,Cigna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Cigna MGG,Cigna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Humana,Humana,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Humana MGG,Humana MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Optum VA,Optum VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,UHC,UHC,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,UHC MGG,UHC MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,VA,VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Wellcare MGG,Wellcare MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Bright Health - commercial,Bright Health - commercial,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,234.77,234.77,Bright Health MGG,Bright Health MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Aetna,Aetna,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Aetna MGG,Aetna MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,BCBS,BCBS,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,BCBS MGG,BCBS MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Cigna,Cigna,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Cigna MGG,Cigna MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Humana,Humana,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Humana MGG,Humana MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Optum VA,Optum VA,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,UHC,UHC,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,UHC MGG,UHC MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,VA,VA,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Wellcare MGG,Wellcare MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Bright Health - commercial,Bright Health - commercial,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,85.48,85.48,Bright Health MGG,Bright Health MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna,Aetna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna MGG,Aetna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS,BCBS,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS MGG,BCBS MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna,Cigna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna MGG,Cigna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Humana,Humana,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Humana MGG,Humana MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Optum VA,Optum VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,UHC,UHC,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,UHC MGG,UHC MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,VA,VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Wellcare MGG,Wellcare MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health - commercial,Bright Health - commercial,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health MGG,Bright Health MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Aetna,Aetna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Aetna MGG,Aetna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,BCBS,BCBS,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,BCBS MGG,BCBS MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Cigna,Cigna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Cigna MGG,Cigna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Humana,Humana,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Humana MGG,Humana MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Optum VA,Optum VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,UHC,UHC,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,UHC MGG,UHC MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,VA,VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Wellcare MGG,Wellcare MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Bright Health - commercial,Bright Health - commercial,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,234.77,234.77,Bright Health MGG,Bright Health MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Aetna,Aetna,89.73,,,,,,,per diem,89.73,89.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Aetna MGG,Aetna MGG,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,BCBS,BCBS,89.73,,,,,,,per diem,89.73,89.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,BCBS MGG,BCBS MGG,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Cigna,Cigna,89.73,,,,,,,per diem,89.73,89.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Cigna MGG,Cigna MGG,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Humana,Humana,89.73,,,,,,,per diem,89.73,89.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Humana MGG,Humana MGG,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Optum VA,Optum VA,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,UHC,UHC,89.73,,,,,,,per diem,89.73,89.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,UHC MGG,UHC MGG,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,VA,VA,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Wellcare MGG,Wellcare MGG,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Bright Health - commercial,Bright Health - commercial,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,89.73,89.73,Bright Health MGG,Bright Health MGG,89.73,,,,,,,case rate,89.73,89.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Aetna,Aetna,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Aetna MGG,Aetna MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,BCBS,BCBS,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,BCBS MGG,BCBS MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Cigna,Cigna,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Cigna MGG,Cigna MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Humana,Humana,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Humana MGG,Humana MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Optum VA,Optum VA,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,UHC,UHC,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,UHC MGG,UHC MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,VA,VA,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Wellcare MGG,Wellcare MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Bright Health - commercial,Bright Health - commercial,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,85.37,85.37,Bright Health MGG,Bright Health MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Aetna,Aetna,104.17,,,,,,,per diem,104.17,104.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Aetna MGG,Aetna MGG,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,BCBS,BCBS,104.17,,,,,,,per diem,104.17,104.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,BCBS MGG,BCBS MGG,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Cigna,Cigna,104.17,,,,,,,per diem,104.17,104.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Cigna MGG,Cigna MGG,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Humana,Humana,104.17,,,,,,,per diem,104.17,104.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Humana MGG,Humana MGG,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Optum VA,Optum VA,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,UHC,UHC,104.17,,,,,,,per diem,104.17,104.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,UHC MGG,UHC MGG,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,VA,VA,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Wellcare MGG,Wellcare MGG,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Bright Health - commercial,Bright Health - commercial,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,104.17,104.17,Bright Health MGG,Bright Health MGG,104.17,,,,,,,case rate,104.17,104.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Aetna,Aetna,114.21,,,,,,,per diem,114.21,114.21,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Aetna MGG,Aetna MGG,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,BCBS,BCBS,114.21,,,,,,,per diem,114.21,114.21,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,BCBS MGG,BCBS MGG,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Cigna,Cigna,114.21,,,,,,,per diem,114.21,114.21,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Cigna MGG,Cigna MGG,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Humana,Humana,114.21,,,,,,,per diem,114.21,114.21,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Humana MGG,Humana MGG,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Optum VA,Optum VA,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,UHC,UHC,114.21,,,,,,,per diem,114.21,114.21,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,UHC MGG,UHC MGG,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,VA,VA,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Wellcare MGG,Wellcare MGG,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Bright Health - commercial,Bright Health - commercial,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,114.21,114.21,Bright Health MGG,Bright Health MGG,114.21,,,,,,,case rate,114.21,114.21,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Aetna,Aetna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Aetna MGG,Aetna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,BCBS,BCBS,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,BCBS MGG,BCBS MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Cigna,Cigna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Cigna MGG,Cigna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Humana,Humana,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Humana MGG,Humana MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Optum VA,Optum VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,UHC,UHC,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,UHC MGG,UHC MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,VA,VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Wellcare MGG,Wellcare MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Bright Health - commercial,Bright Health - commercial,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,83.72,83.72,Bright Health MGG,Bright Health MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Aetna,Aetna,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Aetna MGG,Aetna MGG,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,BCBS,BCBS,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,BCBS MGG,BCBS MGG,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Cigna,Cigna,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Cigna MGG,Cigna MGG,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Humana,Humana,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Humana MGG,Humana MGG,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Optum VA,Optum VA,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,UHC,UHC,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,UHC MGG,UHC MGG,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,VA,VA,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Wellcare MGG,Wellcare MGG,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Bright Health - commercial,Bright Health - commercial,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,71.27,71.27,Bright Health MGG,Bright Health MGG,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Aetna,Aetna,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Aetna MGG,Aetna MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,BCBS,BCBS,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,BCBS MGG,BCBS MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Cigna,Cigna,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Cigna MGG,Cigna MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Humana,Humana,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Humana MGG,Humana MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Optum VA,Optum VA,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,UHC,UHC,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,UHC MGG,UHC MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,VA,VA,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Wellcare MGG,Wellcare MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Bright Health - commercial,Bright Health - commercial,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,108.53,108.53,Bright Health MGG,Bright Health MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Aetna,Aetna,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Aetna MGG,Aetna MGG,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,BCBS,BCBS,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,BCBS MGG,BCBS MGG,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Cigna,Cigna,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Cigna MGG,Cigna MGG,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Humana,Humana,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Humana MGG,Humana MGG,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Optum VA,Optum VA,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,UHC,UHC,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,UHC MGG,UHC MGG,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,VA,VA,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Wellcare MGG,Wellcare MGG,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Bright Health - commercial,Bright Health - commercial,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,102.21,102.21,Bright Health MGG,Bright Health MGG,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Aetna,Aetna,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Aetna MGG,Aetna MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,BCBS,BCBS,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,BCBS MGG,BCBS MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Cigna,Cigna,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Cigna MGG,Cigna MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Humana,Humana,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Humana MGG,Humana MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Optum VA,Optum VA,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,UHC,UHC,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,UHC MGG,UHC MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,VA,VA,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Wellcare MGG,Wellcare MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Bright Health - commercial,Bright Health - commercial,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,108.53,108.53,Bright Health MGG,Bright Health MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Aetna,Aetna,194.84,,,,,,,per diem,194.84,194.84,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Aetna MGG,Aetna MGG,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,BCBS,BCBS,194.84,,,,,,,per diem,194.84,194.84,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,BCBS MGG,BCBS MGG,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Cigna,Cigna,194.84,,,,,,,per diem,194.84,194.84,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Cigna MGG,Cigna MGG,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Humana,Humana,194.84,,,,,,,per diem,194.84,194.84,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Humana MGG,Humana MGG,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Optum VA,Optum VA,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,UHC,UHC,194.84,,,,,,,per diem,194.84,194.84,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,UHC MGG,UHC MGG,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,VA,VA,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Wellcare MGG,Wellcare MGG,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Bright Health - commercial,Bright Health - commercial,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34010156,CDM,420,RC,97763,CPT,,,GP,Inpatient,,,194.84,194.84,Bright Health MGG,Bright Health MGG,194.84,,,,,,,case rate,194.84,194.84,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Aetna,Aetna,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Aetna MGG,Aetna MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,BCBS,BCBS,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,BCBS MGG,BCBS MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Cigna,Cigna,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Cigna MGG,Cigna MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Humana,Humana,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Humana MGG,Humana MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Optum VA,Optum VA,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,UHC,UHC,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,UHC MGG,UHC MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,VA,VA,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Wellcare MGG,Wellcare MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Bright Health - commercial,Bright Health - commercial,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,98.31,98.31,Bright Health MGG,Bright Health MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna,Aetna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna MGG,Aetna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS,BCBS,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS MGG,BCBS MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna,Cigna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna MGG,Cigna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Humana,Humana,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Humana MGG,Humana MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Optum VA,Optum VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,UHC,UHC,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,UHC MGG,UHC MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,VA,VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Wellcare MGG,Wellcare MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health - commercial,Bright Health - commercial,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health MGG,Bright Health MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Aetna,Aetna,167.42,,,,,,,per diem,167.42,167.42,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Aetna MGG,Aetna MGG,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,BCBS,BCBS,167.42,,,,,,,per diem,167.42,167.42,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,BCBS MGG,BCBS MGG,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Cigna,Cigna,167.42,,,,,,,per diem,167.42,167.42,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Cigna MGG,Cigna MGG,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Humana,Humana,167.42,,,,,,,per diem,167.42,167.42,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Humana MGG,Humana MGG,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Optum VA,Optum VA,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,UHC,UHC,167.42,,,,,,,per diem,167.42,167.42,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,UHC MGG,UHC MGG,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,VA,VA,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Wellcare MGG,Wellcare MGG,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Bright Health - commercial,Bright Health - commercial,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,167.42,167.42,Bright Health MGG,Bright Health MGG,167.42,,,,,,,case rate,167.42,167.42,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Aetna,Aetna,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Aetna MGG,Aetna MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,BCBS,BCBS,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,BCBS MGG,BCBS MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Cigna,Cigna,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Cigna MGG,Cigna MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Humana,Humana,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Humana MGG,Humana MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Optum VA,Optum VA,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,UHC,UHC,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,UHC MGG,UHC MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,VA,VA,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Wellcare MGG,Wellcare MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Bright Health - commercial,Bright Health - commercial,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,174.03,174.03,Bright Health MGG,Bright Health MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Aetna,Aetna,216.71,,,,,,,per diem,216.71,216.71,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Aetna MGG,Aetna MGG,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,BCBS,BCBS,216.71,,,,,,,per diem,216.71,216.71,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,BCBS MGG,BCBS MGG,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Cigna,Cigna,216.71,,,,,,,per diem,216.71,216.71,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Cigna MGG,Cigna MGG,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Humana,Humana,216.71,,,,,,,per diem,216.71,216.71,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Humana MGG,Humana MGG,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Optum VA,Optum VA,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,UHC,UHC,216.71,,,,,,,per diem,216.71,216.71,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,UHC MGG,UHC MGG,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,VA,VA,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Wellcare MGG,Wellcare MGG,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Bright Health - commercial,Bright Health - commercial,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,216.71,216.71,Bright Health MGG,Bright Health MGG,216.71,,,,,,,case rate,216.71,216.71,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Aetna,Aetna,129.6,,,,,,,per diem,129.6,129.6,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Aetna MGG,Aetna MGG,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,BCBS,BCBS,129.6,,,,,,,per diem,129.6,129.6,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,BCBS MGG,BCBS MGG,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Cigna,Cigna,129.6,,,,,,,per diem,129.6,129.6,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Cigna MGG,Cigna MGG,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Humana,Humana,129.6,,,,,,,per diem,129.6,129.6,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Humana MGG,Humana MGG,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Optum VA,Optum VA,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,UHC,UHC,129.6,,,,,,,per diem,129.6,129.6,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,UHC MGG,UHC MGG,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,VA,VA,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Wellcare MGG,Wellcare MGG,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Bright Health - commercial,Bright Health - commercial,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,129.6,129.6,Bright Health MGG,Bright Health MGG,129.6,,,,,,,case rate,129.6,129.6,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Aetna,Aetna,171.93,,,,,,,per diem,171.93,171.93,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Aetna MGG,Aetna MGG,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,BCBS,BCBS,171.93,,,,,,,per diem,171.93,171.93,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,BCBS MGG,BCBS MGG,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Cigna,Cigna,171.93,,,,,,,per diem,171.93,171.93,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Cigna MGG,Cigna MGG,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Humana,Humana,171.93,,,,,,,per diem,171.93,171.93,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Humana MGG,Humana MGG,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Optum VA,Optum VA,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,UHC,UHC,171.93,,,,,,,per diem,171.93,171.93,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,UHC MGG,UHC MGG,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,VA,VA,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Wellcare MGG,Wellcare MGG,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Bright Health - commercial,Bright Health - commercial,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,171.93,171.93,Bright Health MGG,Bright Health MGG,171.93,,,,,,,case rate,171.93,171.93,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Aetna,Aetna,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Aetna MGG,Aetna MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,BCBS,BCBS,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,BCBS MGG,BCBS MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Cigna,Cigna,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Cigna MGG,Cigna MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Humana,Humana,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Humana MGG,Humana MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Optum VA,Optum VA,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,UHC,UHC,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,UHC MGG,UHC MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,VA,VA,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Wellcare MGG,Wellcare MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Bright Health - commercial,Bright Health - commercial,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,186.69,186.69,Bright Health MGG,Bright Health MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Aetna,Aetna,160.61,,,,,,,per diem,160.61,160.61,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Aetna MGG,Aetna MGG,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,BCBS,BCBS,160.61,,,,,,,per diem,160.61,160.61,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,BCBS MGG,BCBS MGG,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Cigna,Cigna,160.61,,,,,,,per diem,160.61,160.61,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Cigna MGG,Cigna MGG,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Humana,Humana,160.61,,,,,,,per diem,160.61,160.61,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Humana MGG,Humana MGG,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Optum VA,Optum VA,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,UHC,UHC,160.61,,,,,,,per diem,160.61,160.61,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,UHC MGG,UHC MGG,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,VA,VA,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Wellcare MGG,Wellcare MGG,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Bright Health - commercial,Bright Health - commercial,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,160.61,160.61,Bright Health MGG,Bright Health MGG,160.61,,,,,,,case rate,160.61,160.61,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Aetna,Aetna,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Aetna MGG,Aetna MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,BCBS,BCBS,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,BCBS MGG,BCBS MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Cigna,Cigna,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Cigna MGG,Cigna MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Humana,Humana,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Humana MGG,Humana MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Optum VA,Optum VA,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,UHC,UHC,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,UHC MGG,UHC MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,VA,VA,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Wellcare MGG,Wellcare MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Bright Health - commercial,Bright Health - commercial,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,157.4,157.4,Bright Health MGG,Bright Health MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Aetna,Aetna,75.21,,,,,,,per diem,75.21,75.21,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Aetna MGG,Aetna MGG,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,BCBS,BCBS,75.21,,,,,,,per diem,75.21,75.21,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,BCBS MGG,BCBS MGG,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Cigna,Cigna,75.21,,,,,,,per diem,75.21,75.21,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Cigna MGG,Cigna MGG,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Humana,Humana,75.21,,,,,,,per diem,75.21,75.21,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Humana MGG,Humana MGG,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Optum VA,Optum VA,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,UHC,UHC,75.21,,,,,,,per diem,75.21,75.21,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,UHC MGG,UHC MGG,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,VA,VA,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Wellcare MGG,Wellcare MGG,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Bright Health - commercial,Bright Health - commercial,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,75.21,75.21,Bright Health MGG,Bright Health MGG,75.21,,,,,,,case rate,75.21,75.21,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Aetna,Aetna,103.54,,,,,,,per diem,103.54,103.54,"Per diem rate, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Aetna MGG,Aetna MGG,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,BCBS,BCBS,103.54,,,,,,,per diem,103.54,103.54,"Per diem rate, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,BCBS MGG,BCBS MGG,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Cigna,Cigna,103.54,,,,,,,per diem,103.54,103.54,"Per diem rate, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Cigna MGG,Cigna MGG,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Humana,Humana,103.54,,,,,,,per diem,103.54,103.54,"Per diem rate, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Humana MGG,Humana MGG,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Optum VA,Optum VA,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,UHC,UHC,103.54,,,,,,,per diem,103.54,103.54,"Per diem rate, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,UHC MGG,UHC MGG,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,VA,VA,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Wellcare MGG,Wellcare MGG,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Bright Health - commercial,Bright Health - commercial,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
ELECTROMAGNETIC TX ULCERS     ,34010275,CDM,420,RC,G0329,HCPCS,,,,Inpatient,,,103.54,103.54,Bright Health MGG,Bright Health MGG,103.54,,,,,,,case rate,103.54,103.54,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Aetna,Aetna,216.1,,,,,,,per diem,216.1,216.1,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Aetna MGG,Aetna MGG,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,BCBS,BCBS,216.1,,,,,,,per diem,216.1,216.1,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,BCBS MGG,BCBS MGG,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Cigna,Cigna,216.1,,,,,,,per diem,216.1,216.1,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Cigna MGG,Cigna MGG,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Humana,Humana,216.1,,,,,,,per diem,216.1,216.1,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Humana MGG,Humana MGG,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Optum VA,Optum VA,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,UHC,UHC,216.1,,,,,,,per diem,216.1,216.1,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,UHC MGG,UHC MGG,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,VA,VA,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Wellcare MGG,Wellcare MGG,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Bright Health - commercial,Bright Health - commercial,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,216.1,216.1,Bright Health MGG,Bright Health MGG,216.1,,,,,,,case rate,216.1,216.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna,Aetna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna MGG,Aetna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS,BCBS,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS MGG,BCBS MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna,Cigna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna MGG,Cigna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Humana,Humana,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Humana MGG,Humana MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Optum VA,Optum VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,UHC,UHC,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,UHC MGG,UHC MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,VA,VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Wellcare MGG,Wellcare MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health - commercial,Bright Health - commercial,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health MGG,Bright Health MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Aetna,Aetna,241.96,,,,,,,per diem,241.96,241.96,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Aetna MGG,Aetna MGG,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,BCBS,BCBS,241.96,,,,,,,per diem,241.96,241.96,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,BCBS MGG,BCBS MGG,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Cigna,Cigna,241.96,,,,,,,per diem,241.96,241.96,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Cigna MGG,Cigna MGG,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Humana,Humana,241.96,,,,,,,per diem,241.96,241.96,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Humana MGG,Humana MGG,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Optum VA,Optum VA,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,UHC,UHC,241.96,,,,,,,per diem,241.96,241.96,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,UHC MGG,UHC MGG,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,VA,VA,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Wellcare MGG,Wellcare MGG,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Bright Health - commercial,Bright Health - commercial,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,241.96,241.96,Bright Health MGG,Bright Health MGG,241.96,,,,,,,case rate,241.96,241.96,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Aetna,Aetna,164.01,,,,,,,per diem,164.01,164.01,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Aetna MGG,Aetna MGG,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,BCBS,BCBS,164.01,,,,,,,per diem,164.01,164.01,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,BCBS MGG,BCBS MGG,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Cigna,Cigna,164.01,,,,,,,per diem,164.01,164.01,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Cigna MGG,Cigna MGG,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Humana,Humana,164.01,,,,,,,per diem,164.01,164.01,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Humana MGG,Humana MGG,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Optum VA,Optum VA,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,UHC,UHC,164.01,,,,,,,per diem,164.01,164.01,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,UHC MGG,UHC MGG,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,VA,VA,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Wellcare MGG,Wellcare MGG,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Bright Health - commercial,Bright Health - commercial,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,164.01,164.01,Bright Health MGG,Bright Health MGG,164.01,,,,,,,case rate,164.01,164.01,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Aetna,Aetna,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Aetna MGG,Aetna MGG,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,BCBS,BCBS,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,BCBS MGG,BCBS MGG,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Cigna,Cigna,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Cigna MGG,Cigna MGG,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Humana,Humana,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Humana MGG,Humana MGG,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Optum VA,Optum VA,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,UHC,UHC,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,UHC MGG,UHC MGG,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,VA,VA,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Wellcare MGG,Wellcare MGG,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Bright Health - commercial,Bright Health - commercial,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,78.5,78.5,Bright Health MGG,Bright Health MGG,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Aetna,Aetna,239.25,,,,,,,per diem,239.25,239.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Aetna MGG,Aetna MGG,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,BCBS,BCBS,239.25,,,,,,,per diem,239.25,239.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,BCBS MGG,BCBS MGG,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Cigna,Cigna,239.25,,,,,,,per diem,239.25,239.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Cigna MGG,Cigna MGG,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Humana,Humana,239.25,,,,,,,per diem,239.25,239.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Humana MGG,Humana MGG,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Optum VA,Optum VA,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,UHC,UHC,239.25,,,,,,,per diem,239.25,239.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,UHC MGG,UHC MGG,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,VA,VA,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Wellcare MGG,Wellcare MGG,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Bright Health - commercial,Bright Health - commercial,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,239.25,239.25,Bright Health MGG,Bright Health MGG,239.25,,,,,,,case rate,239.25,239.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Aetna,Aetna,211.25,,,,,,,per diem,211.25,211.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Aetna MGG,Aetna MGG,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,BCBS,BCBS,211.25,,,,,,,per diem,211.25,211.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,BCBS MGG,BCBS MGG,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Cigna,Cigna,211.25,,,,,,,per diem,211.25,211.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Cigna MGG,Cigna MGG,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Humana,Humana,211.25,,,,,,,per diem,211.25,211.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Humana MGG,Humana MGG,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Optum VA,Optum VA,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,UHC,UHC,211.25,,,,,,,per diem,211.25,211.25,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,UHC MGG,UHC MGG,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,VA,VA,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Wellcare MGG,Wellcare MGG,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Bright Health - commercial,Bright Health - commercial,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,211.25,211.25,Bright Health MGG,Bright Health MGG,211.25,,,,,,,case rate,211.25,211.25,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Aetna,Aetna,248.86,,,,,,,per diem,248.86,248.86,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Aetna MGG,Aetna MGG,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,BCBS,BCBS,248.86,,,,,,,per diem,248.86,248.86,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,BCBS MGG,BCBS MGG,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Cigna,Cigna,248.86,,,,,,,per diem,248.86,248.86,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Cigna MGG,Cigna MGG,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Humana,Humana,248.86,,,,,,,per diem,248.86,248.86,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Humana MGG,Humana MGG,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Optum VA,Optum VA,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,UHC,UHC,248.86,,,,,,,per diem,248.86,248.86,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,UHC MGG,UHC MGG,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,VA,VA,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Wellcare MGG,Wellcare MGG,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Bright Health - commercial,Bright Health - commercial,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,248.86,248.86,Bright Health MGG,Bright Health MGG,248.86,,,,,,,case rate,248.86,248.86,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Aetna,Aetna,2.47,,,,,,,per diem,2.47,2.47,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Aetna MGG,Aetna MGG,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,BCBS,BCBS,2.47,,,,,,,per diem,2.47,2.47,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,BCBS MGG,BCBS MGG,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Cigna,Cigna,2.47,,,,,,,per diem,2.47,2.47,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Cigna MGG,Cigna MGG,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Humana,Humana,2.47,,,,,,,per diem,2.47,2.47,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Humana MGG,Humana MGG,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Optum VA,Optum VA,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,UHC,UHC,2.47,,,,,,,per diem,2.47,2.47,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,UHC MGG,UHC MGG,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,VA,VA,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Wellcare MGG,Wellcare MGG,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Bright Health - commercial,Bright Health - commercial,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.47,2.47,Bright Health MGG,Bright Health MGG,2.47,,,,,,,case rate,2.47,2.47,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Aetna,Aetna,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Aetna MGG,Aetna MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,BCBS,BCBS,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,BCBS MGG,BCBS MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Cigna,Cigna,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Cigna MGG,Cigna MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Humana,Humana,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Humana MGG,Humana MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Optum VA,Optum VA,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,UHC,UHC,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,UHC MGG,UHC MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,VA,VA,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Wellcare MGG,Wellcare MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Bright Health - commercial,Bright Health - commercial,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,220.36,220.36,Bright Health MGG,Bright Health MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Aetna,Aetna,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Aetna MGG,Aetna MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,BCBS,BCBS,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,BCBS MGG,BCBS MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Cigna,Cigna,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Cigna MGG,Cigna MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Humana,Humana,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Humana MGG,Humana MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Optum VA,Optum VA,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,UHC,UHC,220.36,,,,,,,per diem,220.36,220.36,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,UHC MGG,UHC MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,VA,VA,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Wellcare MGG,Wellcare MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Bright Health - commercial,Bright Health - commercial,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,220.36,220.36,Bright Health MGG,Bright Health MGG,220.36,,,,,,,case rate,220.36,220.36,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Aetna,Aetna,127.1,,,,,,,per diem,127.1,127.1,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Aetna MGG,Aetna MGG,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,BCBS,BCBS,127.1,,,,,,,per diem,127.1,127.1,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,BCBS MGG,BCBS MGG,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Cigna,Cigna,127.1,,,,,,,per diem,127.1,127.1,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Cigna MGG,Cigna MGG,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Humana,Humana,127.1,,,,,,,per diem,127.1,127.1,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Humana MGG,Humana MGG,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Optum VA,Optum VA,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,UHC,UHC,127.1,,,,,,,per diem,127.1,127.1,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,UHC MGG,UHC MGG,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,VA,VA,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Wellcare MGG,Wellcare MGG,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Bright Health - commercial,Bright Health - commercial,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,127.1,127.1,Bright Health MGG,Bright Health MGG,127.1,,,,,,,case rate,127.1,127.1,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Aetna,Aetna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Aetna MGG,Aetna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,BCBS,BCBS,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,BCBS MGG,BCBS MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Cigna,Cigna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Cigna MGG,Cigna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Humana,Humana,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Humana MGG,Humana MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Optum VA,Optum VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,UHC,UHC,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,UHC MGG,UHC MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,VA,VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Wellcare MGG,Wellcare MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Bright Health - commercial,Bright Health - commercial,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,97535,CPT,,,,Inpatient,,,234.77,234.77,Bright Health MGG,Bright Health MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Aetna,Aetna,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Aetna MGG,Aetna MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,BCBS,BCBS,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,BCBS MGG,BCBS MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Cigna,Cigna,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Cigna MGG,Cigna MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Humana,Humana,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Humana MGG,Humana MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Optum VA,Optum VA,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,UHC,UHC,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,UHC MGG,UHC MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,VA,VA,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Wellcare MGG,Wellcare MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Bright Health - commercial,Bright Health - commercial,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,156.89,156.89,Bright Health MGG,Bright Health MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Aetna,Aetna,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Aetna MGG,Aetna MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,BCBS,BCBS,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,BCBS MGG,BCBS MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Cigna,Cigna,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Cigna MGG,Cigna MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Humana,Humana,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Humana MGG,Humana MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Optum VA,Optum VA,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,UHC,UHC,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,UHC MGG,UHC MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,VA,VA,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Wellcare MGG,Wellcare MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Bright Health - commercial,Bright Health - commercial,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,181.87,181.87,Bright Health MGG,Bright Health MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Aetna,Aetna,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Aetna MGG,Aetna MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,BCBS,BCBS,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,BCBS MGG,BCBS MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Cigna,Cigna,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Cigna MGG,Cigna MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Humana,Humana,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Humana MGG,Humana MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Optum VA,Optum VA,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,UHC,UHC,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,UHC MGG,UHC MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,VA,VA,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Wellcare MGG,Wellcare MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Bright Health - commercial,Bright Health - commercial,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Bright Health MGG,Bright Health MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Aetna,Aetna,205.34,,,,,,,per diem,205.34,205.34,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Aetna MGG,Aetna MGG,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,BCBS,BCBS,205.34,,,,,,,per diem,205.34,205.34,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,BCBS MGG,BCBS MGG,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Cigna,Cigna,205.34,,,,,,,per diem,205.34,205.34,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Cigna MGG,Cigna MGG,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Humana,Humana,205.34,,,,,,,per diem,205.34,205.34,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Humana MGG,Humana MGG,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Optum VA,Optum VA,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,UHC,UHC,205.34,,,,,,,per diem,205.34,205.34,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,UHC MGG,UHC MGG,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,VA,VA,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Wellcare MGG,Wellcare MGG,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Bright Health - commercial,Bright Health - commercial,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,205.34,205.34,Bright Health MGG,Bright Health MGG,205.34,,,,,,,case rate,205.34,205.34,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Aetna,Aetna,224.44,,,,,,,per diem,224.44,224.44,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Aetna MGG,Aetna MGG,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,BCBS,BCBS,224.44,,,,,,,per diem,224.44,224.44,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,BCBS MGG,BCBS MGG,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Cigna,Cigna,224.44,,,,,,,per diem,224.44,224.44,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Cigna MGG,Cigna MGG,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Humana,Humana,224.44,,,,,,,per diem,224.44,224.44,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Humana MGG,Humana MGG,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Optum VA,Optum VA,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,UHC,UHC,224.44,,,,,,,per diem,224.44,224.44,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,UHC MGG,UHC MGG,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,VA,VA,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Wellcare MGG,Wellcare MGG,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Bright Health - commercial,Bright Health - commercial,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,224.44,224.44,Bright Health MGG,Bright Health MGG,224.44,,,,,,,case rate,224.44,224.44,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Aetna,Aetna,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Aetna MGG,Aetna MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,BCBS,BCBS,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,BCBS MGG,BCBS MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Cigna,Cigna,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Cigna MGG,Cigna MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Humana,Humana,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Humana MGG,Humana MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Optum VA,Optum VA,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,UHC,UHC,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,UHC MGG,UHC MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,VA,VA,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Wellcare MGG,Wellcare MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Bright Health - commercial,Bright Health - commercial,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Bright Health MGG,Bright Health MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Aetna,Aetna,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Aetna MGG,Aetna MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,BCBS,BCBS,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,BCBS MGG,BCBS MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Cigna,Cigna,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Cigna MGG,Cigna MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Humana,Humana,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Humana MGG,Humana MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Optum VA,Optum VA,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,UHC,UHC,185.93,,,,,,,per diem,185.93,185.93,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,UHC MGG,UHC MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,VA,VA,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Wellcare MGG,Wellcare MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Bright Health - commercial,Bright Health - commercial,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,185.93,185.93,Bright Health MGG,Bright Health MGG,185.93,,,,,,,case rate,185.93,185.93,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Aetna,Aetna,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Aetna MGG,Aetna MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,BCBS,BCBS,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,BCBS MGG,BCBS MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Cigna,Cigna,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Cigna MGG,Cigna MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Humana,Humana,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Humana MGG,Humana MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Optum VA,Optum VA,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,UHC,UHC,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,UHC MGG,UHC MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,VA,VA,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Wellcare MGG,Wellcare MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Bright Health - commercial,Bright Health - commercial,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Bright Health MGG,Bright Health MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Aetna,Aetna,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Aetna MGG,Aetna MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,BCBS,BCBS,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,BCBS MGG,BCBS MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Cigna,Cigna,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Cigna MGG,Cigna MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Humana,Humana,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Humana MGG,Humana MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Optum VA,Optum VA,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,UHC,UHC,230.07,,,,,,,per diem,230.07,230.07,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,UHC MGG,UHC MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,VA,VA,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Wellcare MGG,Wellcare MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Bright Health - commercial,Bright Health - commercial,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,230.07,230.07,Bright Health MGG,Bright Health MGG,230.07,,,,,,,case rate,230.07,230.07,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Aetna,Aetna,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Aetna MGG,Aetna MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,BCBS,BCBS,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,BCBS MGG,BCBS MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Cigna,Cigna,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Cigna MGG,Cigna MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Humana,Humana,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Humana MGG,Humana MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Optum VA,Optum VA,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,UHC,UHC,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,UHC MGG,UHC MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,VA,VA,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Wellcare MGG,Wellcare MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Bright Health - commercial,Bright Health - commercial,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,330.75,330.75,Bright Health MGG,Bright Health MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Aetna,Aetna,275.64,,,,,,,per diem,275.64,275.64,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Aetna MGG,Aetna MGG,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,BCBS,BCBS,275.64,,,,,,,per diem,275.64,275.64,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,BCBS MGG,BCBS MGG,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Cigna,Cigna,275.64,,,,,,,per diem,275.64,275.64,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Cigna MGG,Cigna MGG,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Humana,Humana,275.64,,,,,,,per diem,275.64,275.64,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Humana MGG,Humana MGG,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Optum VA,Optum VA,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,UHC,UHC,275.64,,,,,,,per diem,275.64,275.64,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,UHC MGG,UHC MGG,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,VA,VA,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Wellcare MGG,Wellcare MGG,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Bright Health - commercial,Bright Health - commercial,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,275.64,275.64,Bright Health MGG,Bright Health MGG,275.64,,,,,,,case rate,275.64,275.64,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Aetna,Aetna,55.13,,,,,,,per diem,55.13,55.13,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Aetna MGG,Aetna MGG,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,BCBS,BCBS,55.13,,,,,,,per diem,55.13,55.13,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,BCBS MGG,BCBS MGG,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Cigna,Cigna,55.13,,,,,,,per diem,55.13,55.13,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Cigna MGG,Cigna MGG,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Humana,Humana,55.13,,,,,,,per diem,55.13,55.13,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Humana MGG,Humana MGG,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Optum VA,Optum VA,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,UHC,UHC,55.13,,,,,,,per diem,55.13,55.13,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,UHC MGG,UHC MGG,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,VA,VA,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Wellcare MGG,Wellcare MGG,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Bright Health - commercial,Bright Health - commercial,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,55.13,55.13,Bright Health MGG,Bright Health MGG,55.13,,,,,,,case rate,55.13,55.13,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Aetna,Aetna,182.93,,,,,,,per diem,182.93,182.93,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Aetna MGG,Aetna MGG,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,BCBS,BCBS,182.93,,,,,,,per diem,182.93,182.93,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,BCBS MGG,BCBS MGG,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Cigna,Cigna,182.93,,,,,,,per diem,182.93,182.93,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Cigna MGG,Cigna MGG,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Humana,Humana,182.93,,,,,,,per diem,182.93,182.93,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Humana MGG,Humana MGG,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Optum VA,Optum VA,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,UHC,UHC,182.93,,,,,,,per diem,182.93,182.93,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,UHC MGG,UHC MGG,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,VA,VA,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Wellcare MGG,Wellcare MGG,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Bright Health - commercial,Bright Health - commercial,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,182.93,182.93,Bright Health MGG,Bright Health MGG,182.93,,,,,,,case rate,182.93,182.93,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Aetna,Aetna,165.36,,,,,,,per diem,165.36,165.36,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Aetna MGG,Aetna MGG,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,BCBS,BCBS,165.36,,,,,,,per diem,165.36,165.36,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,BCBS MGG,BCBS MGG,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Cigna,Cigna,165.36,,,,,,,per diem,165.36,165.36,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Cigna MGG,Cigna MGG,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Humana,Humana,165.36,,,,,,,per diem,165.36,165.36,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Humana MGG,Humana MGG,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Optum VA,Optum VA,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,UHC,UHC,165.36,,,,,,,per diem,165.36,165.36,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,UHC MGG,UHC MGG,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,VA,VA,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Wellcare MGG,Wellcare MGG,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Bright Health - commercial,Bright Health - commercial,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,165.36,165.36,Bright Health MGG,Bright Health MGG,165.36,,,,,,,case rate,165.36,165.36,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Aetna,Aetna,311.55,,,,,,,per diem,311.55,311.55,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Aetna MGG,Aetna MGG,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,BCBS,BCBS,311.55,,,,,,,per diem,311.55,311.55,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,BCBS MGG,BCBS MGG,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Cigna,Cigna,311.55,,,,,,,per diem,311.55,311.55,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Cigna MGG,Cigna MGG,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Humana,Humana,311.55,,,,,,,per diem,311.55,311.55,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Humana MGG,Humana MGG,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Optum VA,Optum VA,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,UHC,UHC,311.55,,,,,,,per diem,311.55,311.55,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,UHC MGG,UHC MGG,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,VA,VA,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Wellcare MGG,Wellcare MGG,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Bright Health - commercial,Bright Health - commercial,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,311.55,311.55,Bright Health MGG,Bright Health MGG,311.55,,,,,,,case rate,311.55,311.55,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Aetna,Aetna,380.82,,,,,,,per diem,380.82,380.82,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Aetna MGG,Aetna MGG,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,BCBS,BCBS,380.82,,,,,,,per diem,380.82,380.82,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,BCBS MGG,BCBS MGG,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Cigna,Cigna,380.82,,,,,,,per diem,380.82,380.82,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Cigna MGG,Cigna MGG,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Humana,Humana,380.82,,,,,,,per diem,380.82,380.82,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Humana MGG,Humana MGG,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Optum VA,Optum VA,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,UHC,UHC,380.82,,,,,,,per diem,380.82,380.82,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,UHC MGG,UHC MGG,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,VA,VA,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Wellcare MGG,Wellcare MGG,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Bright Health - commercial,Bright Health - commercial,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,380.82,380.82,Bright Health MGG,Bright Health MGG,380.82,,,,,,,case rate,380.82,380.82,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Aetna,Aetna,450.09,,,,,,,per diem,450.09,450.09,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Aetna MGG,Aetna MGG,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,BCBS,BCBS,450.09,,,,,,,per diem,450.09,450.09,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,BCBS MGG,BCBS MGG,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Cigna,Cigna,450.09,,,,,,,per diem,450.09,450.09,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Cigna MGG,Cigna MGG,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Humana,Humana,450.09,,,,,,,per diem,450.09,450.09,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Humana MGG,Humana MGG,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Optum VA,Optum VA,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,UHC,UHC,450.09,,,,,,,per diem,450.09,450.09,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,UHC MGG,UHC MGG,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,VA,VA,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Wellcare MGG,Wellcare MGG,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Bright Health - commercial,Bright Health - commercial,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,450.09,450.09,Bright Health MGG,Bright Health MGG,450.09,,,,,,,case rate,450.09,450.09,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Aetna,Aetna,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Aetna MGG,Aetna MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,BCBS,BCBS,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,BCBS MGG,BCBS MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Cigna,Cigna,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Cigna MGG,Cigna MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Humana,Humana,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Humana MGG,Humana MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Optum VA,Optum VA,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,UHC,UHC,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,UHC MGG,UHC MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,VA,VA,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Wellcare MGG,Wellcare MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Bright Health - commercial,Bright Health - commercial,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,173.41,173.41,Bright Health MGG,Bright Health MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Aetna,Aetna,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Aetna MGG,Aetna MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,BCBS,BCBS,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,BCBS MGG,BCBS MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Cigna,Cigna,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Cigna MGG,Cigna MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Humana,Humana,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Humana MGG,Humana MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Optum VA,Optum VA,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,UHC,UHC,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,UHC MGG,UHC MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,VA,VA,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Wellcare MGG,Wellcare MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Bright Health - commercial,Bright Health - commercial,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Bright Health MGG,Bright Health MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Aetna,Aetna,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Aetna MGG,Aetna MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,BCBS,BCBS,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,BCBS MGG,BCBS MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Cigna,Cigna,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Cigna MGG,Cigna MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Humana,Humana,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Humana MGG,Humana MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Optum VA,Optum VA,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,UHC,UHC,406.31,,,,,,,per diem,406.31,406.31,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,UHC MGG,UHC MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,VA,VA,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Wellcare MGG,Wellcare MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Bright Health - commercial,Bright Health - commercial,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,406.31,406.31,Bright Health MGG,Bright Health MGG,406.31,,,,,,,case rate,406.31,406.31,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Aetna,Aetna,379.55,,,,,,,per diem,379.55,379.55,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Aetna MGG,Aetna MGG,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,BCBS,BCBS,379.55,,,,,,,per diem,379.55,379.55,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,BCBS MGG,BCBS MGG,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Cigna,Cigna,379.55,,,,,,,per diem,379.55,379.55,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Cigna MGG,Cigna MGG,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Humana,Humana,379.55,,,,,,,per diem,379.55,379.55,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Humana MGG,Humana MGG,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Optum VA,Optum VA,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,UHC,UHC,379.55,,,,,,,per diem,379.55,379.55,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,UHC MGG,UHC MGG,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,VA,VA,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Wellcare MGG,Wellcare MGG,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Bright Health - commercial,Bright Health - commercial,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,379.55,379.55,Bright Health MGG,Bright Health MGG,379.55,,,,,,,case rate,379.55,379.55,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Aetna,Aetna,278.69,,,,,,,per diem,278.69,278.69,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Aetna MGG,Aetna MGG,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,BCBS,BCBS,278.69,,,,,,,per diem,278.69,278.69,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,BCBS MGG,BCBS MGG,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Cigna,Cigna,278.69,,,,,,,per diem,278.69,278.69,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Cigna MGG,Cigna MGG,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Humana,Humana,278.69,,,,,,,per diem,278.69,278.69,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Humana MGG,Humana MGG,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Optum VA,Optum VA,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,UHC,UHC,278.69,,,,,,,per diem,278.69,278.69,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,UHC MGG,UHC MGG,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,VA,VA,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Wellcare MGG,Wellcare MGG,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Bright Health - commercial,Bright Health - commercial,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,278.69,278.69,Bright Health MGG,Bright Health MGG,278.69,,,,,,,case rate,278.69,278.69,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Aetna,Aetna,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Aetna MGG,Aetna MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,BCBS,BCBS,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,BCBS MGG,BCBS MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Cigna,Cigna,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Cigna MGG,Cigna MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Humana,Humana,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Humana MGG,Humana MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Optum VA,Optum VA,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,UHC,UHC,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,UHC MGG,UHC MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,VA,VA,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Wellcare MGG,Wellcare MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Bright Health - commercial,Bright Health - commercial,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,169.05,169.05,Bright Health MGG,Bright Health MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Aetna,Aetna,131.69,,,,,,,per diem,131.69,131.69,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Aetna MGG,Aetna MGG,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,BCBS,BCBS,131.69,,,,,,,per diem,131.69,131.69,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,BCBS MGG,BCBS MGG,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Cigna,Cigna,131.69,,,,,,,per diem,131.69,131.69,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Cigna MGG,Cigna MGG,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Humana,Humana,131.69,,,,,,,per diem,131.69,131.69,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Humana MGG,Humana MGG,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Optum VA,Optum VA,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,UHC,UHC,131.69,,,,,,,per diem,131.69,131.69,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,UHC MGG,UHC MGG,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,VA,VA,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Wellcare MGG,Wellcare MGG,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Bright Health - commercial,Bright Health - commercial,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,131.69,131.69,Bright Health MGG,Bright Health MGG,131.69,,,,,,,case rate,131.69,131.69,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Aetna,Aetna,126.61,,,,,,,per diem,126.61,126.61,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Aetna MGG,Aetna MGG,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,BCBS,BCBS,126.61,,,,,,,per diem,126.61,126.61,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,BCBS MGG,BCBS MGG,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Cigna,Cigna,126.61,,,,,,,per diem,126.61,126.61,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Cigna MGG,Cigna MGG,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Humana,Humana,126.61,,,,,,,per diem,126.61,126.61,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Humana MGG,Humana MGG,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Optum VA,Optum VA,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,UHC,UHC,126.61,,,,,,,per diem,126.61,126.61,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,UHC MGG,UHC MGG,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,VA,VA,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Wellcare MGG,Wellcare MGG,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Bright Health - commercial,Bright Health - commercial,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,126.61,126.61,Bright Health MGG,Bright Health MGG,126.61,,,,,,,case rate,126.61,126.61,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Aetna,Aetna,542.3,,,,,,,per diem,542.3,542.3,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Aetna MGG,Aetna MGG,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,BCBS,BCBS,542.3,,,,,,,per diem,542.3,542.3,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,BCBS MGG,BCBS MGG,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Cigna,Cigna,542.3,,,,,,,per diem,542.3,542.3,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Cigna MGG,Cigna MGG,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Humana,Humana,542.3,,,,,,,per diem,542.3,542.3,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Humana MGG,Humana MGG,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Optum VA,Optum VA,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,UHC,UHC,542.3,,,,,,,per diem,542.3,542.3,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,UHC MGG,UHC MGG,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,VA,VA,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Wellcare MGG,Wellcare MGG,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Bright Health - commercial,Bright Health - commercial,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,542.3,542.3,Bright Health MGG,Bright Health MGG,542.3,,,,,,,case rate,542.3,542.3,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Aetna,Aetna,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Aetna MGG,Aetna MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,BCBS,BCBS,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,BCBS MGG,BCBS MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Cigna,Cigna,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Cigna MGG,Cigna MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Humana,Humana,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Humana MGG,Humana MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Optum VA,Optum VA,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,UHC,UHC,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,UHC MGG,UHC MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,VA,VA,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Wellcare MGG,Wellcare MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Bright Health - commercial,Bright Health - commercial,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,122.09,122.09,Bright Health MGG,Bright Health MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Aetna,Aetna,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Aetna MGG,Aetna MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,BCBS,BCBS,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,BCBS MGG,BCBS MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Cigna,Cigna,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Cigna MGG,Cigna MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Humana,Humana,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Humana MGG,Humana MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Optum VA,Optum VA,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,UHC,UHC,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,UHC MGG,UHC MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,VA,VA,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Wellcare MGG,Wellcare MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Bright Health - commercial,Bright Health - commercial,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Bright Health MGG,Bright Health MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Aetna,Aetna,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Aetna MGG,Aetna MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,BCBS,BCBS,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,BCBS MGG,BCBS MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Cigna,Cigna,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Cigna MGG,Cigna MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Humana,Humana,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Humana MGG,Humana MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Optum VA,Optum VA,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,UHC,UHC,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,UHC MGG,UHC MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,VA,VA,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Wellcare MGG,Wellcare MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Bright Health - commercial,Bright Health - commercial,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Bright Health MGG,Bright Health MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Aetna,Aetna,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Aetna MGG,Aetna MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,BCBS,BCBS,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,BCBS MGG,BCBS MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Cigna,Cigna,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Cigna MGG,Cigna MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Humana,Humana,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Humana MGG,Humana MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Optum VA,Optum VA,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,UHC,UHC,368.5,,,,,,,per diem,368.5,368.5,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,UHC MGG,UHC MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,VA,VA,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Wellcare MGG,Wellcare MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Bright Health - commercial,Bright Health - commercial,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,368.5,368.5,Bright Health MGG,Bright Health MGG,368.5,,,,,,,case rate,368.5,368.5,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Aetna,Aetna,113.9,,,,,,,per diem,113.9,113.9,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Aetna MGG,Aetna MGG,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,BCBS,BCBS,113.9,,,,,,,per diem,113.9,113.9,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,BCBS MGG,BCBS MGG,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Cigna,Cigna,113.9,,,,,,,per diem,113.9,113.9,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Cigna MGG,Cigna MGG,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Humana,Humana,113.9,,,,,,,per diem,113.9,113.9,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Humana MGG,Humana MGG,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Optum VA,Optum VA,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,UHC,UHC,113.9,,,,,,,per diem,113.9,113.9,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,UHC MGG,UHC MGG,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,VA,VA,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Wellcare MGG,Wellcare MGG,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Bright Health - commercial,Bright Health - commercial,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,113.9,113.9,Bright Health MGG,Bright Health MGG,113.9,,,,,,,case rate,113.9,113.9,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Aetna,Aetna,97.51,,,,,,,per diem,97.51,97.51,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Aetna MGG,Aetna MGG,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,BCBS,BCBS,97.51,,,,,,,per diem,97.51,97.51,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,BCBS MGG,BCBS MGG,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Cigna,Cigna,97.51,,,,,,,per diem,97.51,97.51,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Cigna MGG,Cigna MGG,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Humana,Humana,97.51,,,,,,,per diem,97.51,97.51,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Humana MGG,Humana MGG,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Optum VA,Optum VA,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,UHC,UHC,97.51,,,,,,,per diem,97.51,97.51,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,UHC MGG,UHC MGG,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,VA,VA,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Wellcare MGG,Wellcare MGG,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Bright Health - commercial,Bright Health - commercial,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,97.51,97.51,Bright Health MGG,Bright Health MGG,97.51,,,,,,,case rate,97.51,97.51,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Aetna,Aetna,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Aetna MGG,Aetna MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,BCBS,BCBS,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,BCBS MGG,BCBS MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Cigna,Cigna,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Cigna MGG,Cigna MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Humana,Humana,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Humana MGG,Humana MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Optum VA,Optum VA,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,UHC,UHC,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,UHC MGG,UHC MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,VA,VA,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Wellcare MGG,Wellcare MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Bright Health - commercial,Bright Health - commercial,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,30.1,30.1,Bright Health MGG,Bright Health MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Aetna,Aetna,1054.64,,,,,,,per diem,1054.64,1054.64,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Aetna MGG,Aetna MGG,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,BCBS,BCBS,1054.64,,,,,,,per diem,1054.64,1054.64,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,BCBS MGG,BCBS MGG,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Cigna,Cigna,1054.64,,,,,,,per diem,1054.64,1054.64,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Cigna MGG,Cigna MGG,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Humana,Humana,1054.64,,,,,,,per diem,1054.64,1054.64,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Humana MGG,Humana MGG,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Optum VA,Optum VA,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,UHC,UHC,1054.64,,,,,,,per diem,1054.64,1054.64,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,UHC MGG,UHC MGG,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,VA,VA,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Wellcare MGG,Wellcare MGG,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Bright Health - commercial,Bright Health - commercial,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,1054.64,1054.64,Bright Health MGG,Bright Health MGG,1054.64,,,,,,,case rate,1054.64,1054.64,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Aetna,Aetna,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Aetna MGG,Aetna MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,BCBS,BCBS,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,BCBS MGG,BCBS MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Cigna,Cigna,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Cigna MGG,Cigna MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Humana,Humana,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Humana MGG,Humana MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Optum VA,Optum VA,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,UHC,UHC,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,UHC MGG,UHC MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,VA,VA,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Wellcare MGG,Wellcare MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Bright Health - commercial,Bright Health - commercial,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Bright Health MGG,Bright Health MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Aetna,Aetna,117.16,,,,,,,per diem,117.16,117.16,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Aetna MGG,Aetna MGG,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,BCBS,BCBS,117.16,,,,,,,per diem,117.16,117.16,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,BCBS MGG,BCBS MGG,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Cigna,Cigna,117.16,,,,,,,per diem,117.16,117.16,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Cigna MGG,Cigna MGG,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Humana,Humana,117.16,,,,,,,per diem,117.16,117.16,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Humana MGG,Humana MGG,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Optum VA,Optum VA,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,UHC,UHC,117.16,,,,,,,per diem,117.16,117.16,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,UHC MGG,UHC MGG,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,VA,VA,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Wellcare MGG,Wellcare MGG,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Bright Health - commercial,Bright Health - commercial,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,117.16,117.16,Bright Health MGG,Bright Health MGG,117.16,,,,,,,case rate,117.16,117.16,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Aetna,Aetna,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Aetna MGG,Aetna MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,BCBS,BCBS,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,BCBS MGG,BCBS MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Cigna,Cigna,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Cigna MGG,Cigna MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Humana,Humana,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Humana MGG,Humana MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Optum VA,Optum VA,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,UHC,UHC,156.89,,,,,,,per diem,156.89,156.89,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,UHC MGG,UHC MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,VA,VA,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Wellcare MGG,Wellcare MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Bright Health - commercial,Bright Health - commercial,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,156.89,156.89,Bright Health MGG,Bright Health MGG,156.89,,,,,,,case rate,156.89,156.89,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Aetna,Aetna,510.47,,,,,,,per diem,510.47,510.47,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Aetna MGG,Aetna MGG,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,BCBS,BCBS,510.47,,,,,,,per diem,510.47,510.47,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,BCBS MGG,BCBS MGG,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Cigna,Cigna,510.47,,,,,,,per diem,510.47,510.47,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Cigna MGG,Cigna MGG,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Humana,Humana,510.47,,,,,,,per diem,510.47,510.47,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Humana MGG,Humana MGG,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Optum VA,Optum VA,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,UHC,UHC,510.47,,,,,,,per diem,510.47,510.47,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,UHC MGG,UHC MGG,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,VA,VA,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Wellcare MGG,Wellcare MGG,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Bright Health - commercial,Bright Health - commercial,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,510.47,510.47,Bright Health MGG,Bright Health MGG,510.47,,,,,,,case rate,510.47,510.47,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Aetna,Aetna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Aetna MGG,Aetna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,BCBS,BCBS,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,BCBS MGG,BCBS MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Cigna,Cigna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Cigna MGG,Cigna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Humana,Humana,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Humana MGG,Humana MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Optum VA,Optum VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,UHC,UHC,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,UHC MGG,UHC MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,VA,VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Wellcare MGG,Wellcare MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Bright Health - commercial,Bright Health - commercial,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,83.72,83.72,Bright Health MGG,Bright Health MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna,Aetna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Aetna MGG,Aetna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS,BCBS,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,BCBS MGG,BCBS MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna,Cigna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Cigna MGG,Cigna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Humana,Humana,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Humana MGG,Humana MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Optum VA,Optum VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,UHC,UHC,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,UHC MGG,UHC MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,VA,VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Wellcare MGG,Wellcare MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health - commercial,Bright Health - commercial,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,79.82,79.82,Bright Health MGG,Bright Health MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Aetna,Aetna,277.73,,,,,,,per diem,277.73,277.73,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Aetna MGG,Aetna MGG,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,BCBS,BCBS,277.73,,,,,,,per diem,277.73,277.73,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,BCBS MGG,BCBS MGG,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Cigna,Cigna,277.73,,,,,,,per diem,277.73,277.73,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Cigna MGG,Cigna MGG,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Humana,Humana,277.73,,,,,,,per diem,277.73,277.73,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Humana MGG,Humana MGG,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Optum VA,Optum VA,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,UHC,UHC,277.73,,,,,,,per diem,277.73,277.73,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,UHC MGG,UHC MGG,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,VA,VA,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Wellcare MGG,Wellcare MGG,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Bright Health - commercial,Bright Health - commercial,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,277.73,277.73,Bright Health MGG,Bright Health MGG,277.73,,,,,,,case rate,277.73,277.73,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Aetna,Aetna,554.65,,,,,,,per diem,554.65,554.65,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Aetna MGG,Aetna MGG,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,BCBS,BCBS,554.65,,,,,,,per diem,554.65,554.65,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,BCBS MGG,BCBS MGG,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Cigna,Cigna,554.65,,,,,,,per diem,554.65,554.65,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Cigna MGG,Cigna MGG,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Humana,Humana,554.65,,,,,,,per diem,554.65,554.65,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Humana MGG,Humana MGG,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Optum VA,Optum VA,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,UHC,UHC,554.65,,,,,,,per diem,554.65,554.65,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,UHC MGG,UHC MGG,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,VA,VA,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Wellcare MGG,Wellcare MGG,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Bright Health - commercial,Bright Health - commercial,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,554.65,554.65,Bright Health MGG,Bright Health MGG,554.65,,,,,,,case rate,554.65,554.65,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Aetna,Aetna,107.22,,,,,,,per diem,107.22,107.22,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Aetna MGG,Aetna MGG,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,BCBS,BCBS,107.22,,,,,,,per diem,107.22,107.22,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,BCBS MGG,BCBS MGG,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Cigna,Cigna,107.22,,,,,,,per diem,107.22,107.22,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Cigna MGG,Cigna MGG,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Humana,Humana,107.22,,,,,,,per diem,107.22,107.22,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Humana MGG,Humana MGG,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Optum VA,Optum VA,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,UHC,UHC,107.22,,,,,,,per diem,107.22,107.22,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,UHC MGG,UHC MGG,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,VA,VA,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Wellcare MGG,Wellcare MGG,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Bright Health - commercial,Bright Health - commercial,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,107.22,107.22,Bright Health MGG,Bright Health MGG,107.22,,,,,,,case rate,107.22,107.22,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Aetna,Aetna,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Aetna MGG,Aetna MGG,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,BCBS,BCBS,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,BCBS MGG,BCBS MGG,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Cigna,Cigna,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Cigna MGG,Cigna MGG,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Humana,Humana,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Humana MGG,Humana MGG,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Optum VA,Optum VA,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,UHC,UHC,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,UHC MGG,UHC MGG,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,VA,VA,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Wellcare MGG,Wellcare MGG,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Bright Health - commercial,Bright Health - commercial,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,76.58,76.58,Bright Health MGG,Bright Health MGG,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Aetna,Aetna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Aetna MGG,Aetna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,BCBS,BCBS,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,BCBS MGG,BCBS MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Cigna,Cigna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Cigna MGG,Cigna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Humana,Humana,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Humana MGG,Humana MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Optum VA,Optum VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,UHC,UHC,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,UHC MGG,UHC MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,VA,VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Wellcare MGG,Wellcare MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Bright Health - commercial,Bright Health - commercial,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,79.82,79.82,Bright Health MGG,Bright Health MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Aetna,Aetna,97.2,,,,,,,per diem,97.2,97.2,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Aetna MGG,Aetna MGG,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,BCBS,BCBS,97.2,,,,,,,per diem,97.2,97.2,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,BCBS MGG,BCBS MGG,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Cigna,Cigna,97.2,,,,,,,per diem,97.2,97.2,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Cigna MGG,Cigna MGG,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Humana,Humana,97.2,,,,,,,per diem,97.2,97.2,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Humana MGG,Humana MGG,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Optum VA,Optum VA,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,UHC,UHC,97.2,,,,,,,per diem,97.2,97.2,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,UHC MGG,UHC MGG,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,VA,VA,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Wellcare MGG,Wellcare MGG,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Bright Health - commercial,Bright Health - commercial,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,97.2,97.2,Bright Health MGG,Bright Health MGG,97.2,,,,,,,case rate,97.2,97.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Aetna,Aetna,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Aetna MGG,Aetna MGG,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,BCBS,BCBS,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,BCBS MGG,BCBS MGG,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Cigna,Cigna,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Cigna MGG,Cigna MGG,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Humana,Humana,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Humana MGG,Humana MGG,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Optum VA,Optum VA,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,UHC,UHC,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,UHC MGG,UHC MGG,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,VA,VA,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Wellcare MGG,Wellcare MGG,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Bright Health - commercial,Bright Health - commercial,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,165.11,165.11,Bright Health MGG,Bright Health MGG,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Aetna,Aetna,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Aetna MGG,Aetna MGG,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,BCBS,BCBS,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,BCBS MGG,BCBS MGG,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Cigna,Cigna,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Cigna MGG,Cigna MGG,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Humana,Humana,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Humana MGG,Humana MGG,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Optum VA,Optum VA,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,UHC,UHC,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,UHC MGG,UHC MGG,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,VA,VA,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Wellcare MGG,Wellcare MGG,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Bright Health - commercial,Bright Health - commercial,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,143.51,143.51,Bright Health MGG,Bright Health MGG,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Aetna,Aetna,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Aetna MGG,Aetna MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,BCBS,BCBS,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,BCBS MGG,BCBS MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Cigna,Cigna,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Cigna MGG,Cigna MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Humana,Humana,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Humana MGG,Humana MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Optum VA,Optum VA,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,UHC,UHC,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,UHC MGG,UHC MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,VA,VA,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Wellcare MGG,Wellcare MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Bright Health - commercial,Bright Health - commercial,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,95.76,95.76,Bright Health MGG,Bright Health MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Aetna,Aetna,140.35,,,,,,,per diem,140.35,140.35,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Aetna MGG,Aetna MGG,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,BCBS,BCBS,140.35,,,,,,,per diem,140.35,140.35,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,BCBS MGG,BCBS MGG,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Cigna,Cigna,140.35,,,,,,,per diem,140.35,140.35,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Cigna MGG,Cigna MGG,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Humana,Humana,140.35,,,,,,,per diem,140.35,140.35,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Humana MGG,Humana MGG,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Optum VA,Optum VA,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,UHC,UHC,140.35,,,,,,,per diem,140.35,140.35,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,UHC MGG,UHC MGG,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,VA,VA,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Wellcare MGG,Wellcare MGG,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Bright Health - commercial,Bright Health - commercial,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,140.35,140.35,Bright Health MGG,Bright Health MGG,140.35,,,,,,,case rate,140.35,140.35,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Aetna,Aetna,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Aetna MGG,Aetna MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,BCBS,BCBS,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,BCBS MGG,BCBS MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Cigna,Cigna,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Cigna MGG,Cigna MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Humana,Humana,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Humana MGG,Humana MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Optum VA,Optum VA,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,UHC,UHC,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,UHC MGG,UHC MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,VA,VA,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Wellcare MGG,Wellcare MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Bright Health - commercial,Bright Health - commercial,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.83,25.83,Bright Health MGG,Bright Health MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Aetna,Aetna,143.25,,,,,,,per diem,143.25,143.25,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Aetna MGG,Aetna MGG,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,BCBS,BCBS,143.25,,,,,,,per diem,143.25,143.25,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,BCBS MGG,BCBS MGG,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Cigna,Cigna,143.25,,,,,,,per diem,143.25,143.25,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Cigna MGG,Cigna MGG,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Humana,Humana,143.25,,,,,,,per diem,143.25,143.25,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Humana MGG,Humana MGG,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Optum VA,Optum VA,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,UHC,UHC,143.25,,,,,,,per diem,143.25,143.25,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,UHC MGG,UHC MGG,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,VA,VA,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Wellcare MGG,Wellcare MGG,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Bright Health - commercial,Bright Health - commercial,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,143.25,143.25,Bright Health MGG,Bright Health MGG,143.25,,,,,,,case rate,143.25,143.25,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Aetna,Aetna,88.17,,,,,,,per diem,88.17,88.17,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Aetna MGG,Aetna MGG,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,BCBS,BCBS,88.17,,,,,,,per diem,88.17,88.17,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,BCBS MGG,BCBS MGG,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Cigna,Cigna,88.17,,,,,,,per diem,88.17,88.17,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Cigna MGG,Cigna MGG,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Humana,Humana,88.17,,,,,,,per diem,88.17,88.17,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Humana MGG,Humana MGG,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Optum VA,Optum VA,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,UHC,UHC,88.17,,,,,,,per diem,88.17,88.17,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,UHC MGG,UHC MGG,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,VA,VA,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Wellcare MGG,Wellcare MGG,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Bright Health - commercial,Bright Health - commercial,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,88.17,88.17,Bright Health MGG,Bright Health MGG,88.17,,,,,,,case rate,88.17,88.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Aetna,Aetna,206.63,,,,,,,per diem,206.63,206.63,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Aetna MGG,Aetna MGG,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,BCBS,BCBS,206.63,,,,,,,per diem,206.63,206.63,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,BCBS MGG,BCBS MGG,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Cigna,Cigna,206.63,,,,,,,per diem,206.63,206.63,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Cigna MGG,Cigna MGG,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Humana,Humana,206.63,,,,,,,per diem,206.63,206.63,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Humana MGG,Humana MGG,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Optum VA,Optum VA,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,UHC,UHC,206.63,,,,,,,per diem,206.63,206.63,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,UHC MGG,UHC MGG,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,VA,VA,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Wellcare MGG,Wellcare MGG,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Bright Health - commercial,Bright Health - commercial,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,206.63,206.63,Bright Health MGG,Bright Health MGG,206.63,,,,,,,case rate,206.63,206.63,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Aetna,Aetna,134.01,,,,,,,per diem,134.01,134.01,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Aetna MGG,Aetna MGG,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,BCBS,BCBS,134.01,,,,,,,per diem,134.01,134.01,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,BCBS MGG,BCBS MGG,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Cigna,Cigna,134.01,,,,,,,per diem,134.01,134.01,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Cigna MGG,Cigna MGG,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Humana,Humana,134.01,,,,,,,per diem,134.01,134.01,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Humana MGG,Humana MGG,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Optum VA,Optum VA,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,UHC,UHC,134.01,,,,,,,per diem,134.01,134.01,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,UHC MGG,UHC MGG,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,VA,VA,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Wellcare MGG,Wellcare MGG,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Bright Health - commercial,Bright Health - commercial,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,134.01,134.01,Bright Health MGG,Bright Health MGG,134.01,,,,,,,case rate,134.01,134.01,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Aetna,Aetna,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Aetna MGG,Aetna MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,BCBS,BCBS,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,BCBS MGG,BCBS MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Cigna,Cigna,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Cigna MGG,Cigna MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Humana,Humana,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Humana MGG,Humana MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Optum VA,Optum VA,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,UHC,UHC,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,UHC MGG,UHC MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,VA,VA,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Wellcare MGG,Wellcare MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Bright Health - commercial,Bright Health - commercial,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,75.24,75.24,Bright Health MGG,Bright Health MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Aetna,Aetna,196.89,,,,,,,per diem,196.89,196.89,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Aetna MGG,Aetna MGG,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,BCBS,BCBS,196.89,,,,,,,per diem,196.89,196.89,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,BCBS MGG,BCBS MGG,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Cigna,Cigna,196.89,,,,,,,per diem,196.89,196.89,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Cigna MGG,Cigna MGG,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Humana,Humana,196.89,,,,,,,per diem,196.89,196.89,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Humana MGG,Humana MGG,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Optum VA,Optum VA,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,UHC,UHC,196.89,,,,,,,per diem,196.89,196.89,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,UHC MGG,UHC MGG,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,VA,VA,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Wellcare MGG,Wellcare MGG,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Bright Health - commercial,Bright Health - commercial,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,196.89,196.89,Bright Health MGG,Bright Health MGG,196.89,,,,,,,case rate,196.89,196.89,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Aetna,Aetna,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Aetna MGG,Aetna MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,BCBS,BCBS,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,BCBS MGG,BCBS MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Cigna,Cigna,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Cigna MGG,Cigna MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Humana,Humana,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Humana MGG,Humana MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Optum VA,Optum VA,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,UHC,UHC,181.87,,,,,,,per diem,181.87,181.87,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,UHC MGG,UHC MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,VA,VA,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Wellcare MGG,Wellcare MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Bright Health - commercial,Bright Health - commercial,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,181.87,181.87,Bright Health MGG,Bright Health MGG,181.87,,,,,,,case rate,181.87,181.87,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Aetna,Aetna,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Aetna MGG,Aetna MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,BCBS,BCBS,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,BCBS MGG,BCBS MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Cigna,Cigna,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Cigna MGG,Cigna MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Humana,Humana,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Humana MGG,Humana MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Optum VA,Optum VA,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,UHC,UHC,173.41,,,,,,,per diem,173.41,173.41,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,UHC MGG,UHC MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,VA,VA,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Wellcare MGG,Wellcare MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Bright Health - commercial,Bright Health - commercial,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,173.41,173.41,Bright Health MGG,Bright Health MGG,173.41,,,,,,,case rate,173.41,173.41,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Aetna,Aetna,195.64,,,,,,,per diem,195.64,195.64,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Aetna MGG,Aetna MGG,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,BCBS,BCBS,195.64,,,,,,,per diem,195.64,195.64,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,BCBS MGG,BCBS MGG,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Cigna,Cigna,195.64,,,,,,,per diem,195.64,195.64,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Cigna MGG,Cigna MGG,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Humana,Humana,195.64,,,,,,,per diem,195.64,195.64,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Humana MGG,Humana MGG,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Optum VA,Optum VA,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,UHC,UHC,195.64,,,,,,,per diem,195.64,195.64,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,UHC MGG,UHC MGG,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,VA,VA,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Wellcare MGG,Wellcare MGG,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Bright Health - commercial,Bright Health - commercial,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,195.64,195.64,Bright Health MGG,Bright Health MGG,195.64,,,,,,,case rate,195.64,195.64,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Aetna,Aetna,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Aetna MGG,Aetna MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,BCBS,BCBS,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,BCBS MGG,BCBS MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Cigna,Cigna,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Cigna MGG,Cigna MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Humana,Humana,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Humana MGG,Humana MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Optum VA,Optum VA,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,UHC,UHC,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,UHC MGG,UHC MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,VA,VA,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Wellcare MGG,Wellcare MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Bright Health - commercial,Bright Health - commercial,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Bright Health MGG,Bright Health MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Aetna,Aetna,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Aetna MGG,Aetna MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,BCBS,BCBS,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,BCBS MGG,BCBS MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Cigna,Cigna,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Cigna MGG,Cigna MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Humana,Humana,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Humana MGG,Humana MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Optum VA,Optum VA,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,UHC,UHC,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,UHC MGG,UHC MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,VA,VA,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Wellcare MGG,Wellcare MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Bright Health - commercial,Bright Health - commercial,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Bright Health MGG,Bright Health MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Aetna,Aetna,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Aetna MGG,Aetna MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,BCBS,BCBS,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,BCBS MGG,BCBS MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Cigna,Cigna,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Cigna MGG,Cigna MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Humana,Humana,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Humana MGG,Humana MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Optum VA,Optum VA,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,UHC,UHC,219.11,,,,,,,per diem,219.11,219.11,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,UHC MGG,UHC MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,VA,VA,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Wellcare MGG,Wellcare MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Bright Health - commercial,Bright Health - commercial,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,219.11,219.11,Bright Health MGG,Bright Health MGG,219.11,,,,,,,case rate,219.11,219.11,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Aetna,Aetna,540.18,,,,,,,per diem,540.18,540.18,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Aetna MGG,Aetna MGG,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,BCBS,BCBS,540.18,,,,,,,per diem,540.18,540.18,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,BCBS MGG,BCBS MGG,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Cigna,Cigna,540.18,,,,,,,per diem,540.18,540.18,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Cigna MGG,Cigna MGG,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Humana,Humana,540.18,,,,,,,per diem,540.18,540.18,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Humana MGG,Humana MGG,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Optum VA,Optum VA,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,UHC,UHC,540.18,,,,,,,per diem,540.18,540.18,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,UHC MGG,UHC MGG,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,VA,VA,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Wellcare MGG,Wellcare MGG,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Bright Health - commercial,Bright Health - commercial,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,540.18,540.18,Bright Health MGG,Bright Health MGG,540.18,,,,,,,case rate,540.18,540.18,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Aetna,Aetna,612.14,,,,,,,per diem,612.14,612.14,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Aetna MGG,Aetna MGG,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,BCBS,BCBS,612.14,,,,,,,per diem,612.14,612.14,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,BCBS MGG,BCBS MGG,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Cigna,Cigna,612.14,,,,,,,per diem,612.14,612.14,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Cigna MGG,Cigna MGG,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Humana,Humana,612.14,,,,,,,per diem,612.14,612.14,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Humana MGG,Humana MGG,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Optum VA,Optum VA,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,UHC,UHC,612.14,,,,,,,per diem,612.14,612.14,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,UHC MGG,UHC MGG,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,VA,VA,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Wellcare MGG,Wellcare MGG,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Bright Health - commercial,Bright Health - commercial,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,612.14,612.14,Bright Health MGG,Bright Health MGG,612.14,,,,,,,case rate,612.14,612.14,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Aetna,Aetna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Aetna MGG,Aetna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,BCBS,BCBS,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,BCBS MGG,BCBS MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Cigna,Cigna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Cigna MGG,Cigna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Humana,Humana,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Humana MGG,Humana MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Optum VA,Optum VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,UHC,UHC,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,UHC MGG,UHC MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,VA,VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Wellcare MGG,Wellcare MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Bright Health - commercial,Bright Health - commercial,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,632.07,632.07,Bright Health MGG,Bright Health MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Aetna,Aetna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Aetna MGG,Aetna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,BCBS,BCBS,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,BCBS MGG,BCBS MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Cigna,Cigna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Cigna MGG,Cigna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Humana,Humana,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Humana MGG,Humana MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Optum VA,Optum VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,UHC,UHC,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,UHC MGG,UHC MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,VA,VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Wellcare MGG,Wellcare MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Bright Health - commercial,Bright Health - commercial,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,632.07,632.07,Bright Health MGG,Bright Health MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Aetna,Aetna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Aetna MGG,Aetna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,BCBS,BCBS,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,BCBS MGG,BCBS MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Cigna,Cigna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Cigna MGG,Cigna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Humana,Humana,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Humana MGG,Humana MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Optum VA,Optum VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,UHC,UHC,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,UHC MGG,UHC MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,VA,VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Wellcare MGG,Wellcare MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Bright Health - commercial,Bright Health - commercial,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Bright Health MGG,Bright Health MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Aetna,Aetna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Aetna MGG,Aetna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,BCBS,BCBS,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,BCBS MGG,BCBS MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Cigna,Cigna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Cigna MGG,Cigna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Humana,Humana,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Humana MGG,Humana MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Optum VA,Optum VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,UHC,UHC,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,UHC MGG,UHC MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,VA,VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Wellcare MGG,Wellcare MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Bright Health - commercial,Bright Health - commercial,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,632.07,632.07,Bright Health MGG,Bright Health MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Aetna,Aetna,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Aetna MGG,Aetna MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,BCBS,BCBS,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,BCBS MGG,BCBS MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Cigna,Cigna,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Cigna MGG,Cigna MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Humana,Humana,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Humana MGG,Humana MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Optum VA,Optum VA,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,UHC,UHC,127.98,,,,,,,per diem,127.98,127.98,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,UHC MGG,UHC MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,VA,VA,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Wellcare MGG,Wellcare MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Bright Health - commercial,Bright Health - commercial,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,127.98,127.98,Bright Health MGG,Bright Health MGG,127.98,,,,,,,case rate,127.98,127.98,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Aetna,Aetna,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Aetna MGG,Aetna MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,BCBS,BCBS,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,BCBS MGG,BCBS MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Cigna,Cigna,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Cigna MGG,Cigna MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Humana,Humana,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Humana MGG,Humana MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Optum VA,Optum VA,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,UHC,UHC,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,UHC MGG,UHC MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,VA,VA,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Wellcare MGG,Wellcare MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Bright Health - commercial,Bright Health - commercial,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Bright Health MGG,Bright Health MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Aetna,Aetna,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Aetna MGG,Aetna MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,BCBS,BCBS,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,BCBS MGG,BCBS MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Cigna,Cigna,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Cigna MGG,Cigna MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Humana,Humana,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Humana MGG,Humana MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Optum VA,Optum VA,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,UHC,UHC,30.1,,,,,,,per diem,30.1,30.1,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,UHC MGG,UHC MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,VA,VA,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Wellcare MGG,Wellcare MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Bright Health - commercial,Bright Health - commercial,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,30.1,30.1,Bright Health MGG,Bright Health MGG,30.1,,,,,,,case rate,30.1,30.1,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Aetna,Aetna,365.66,,,,,,,per diem,365.66,365.66,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Aetna MGG,Aetna MGG,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,BCBS,BCBS,365.66,,,,,,,per diem,365.66,365.66,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,BCBS MGG,BCBS MGG,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Cigna,Cigna,365.66,,,,,,,per diem,365.66,365.66,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Cigna MGG,Cigna MGG,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Humana,Humana,365.66,,,,,,,per diem,365.66,365.66,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Humana MGG,Humana MGG,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Optum VA,Optum VA,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,UHC,UHC,365.66,,,,,,,per diem,365.66,365.66,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,UHC MGG,UHC MGG,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,VA,VA,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Wellcare MGG,Wellcare MGG,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Bright Health - commercial,Bright Health - commercial,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,365.66,365.66,Bright Health MGG,Bright Health MGG,365.66,,,,,,,case rate,365.66,365.66,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Aetna,Aetna,398.2,,,,,,,per diem,398.2,398.2,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Aetna MGG,Aetna MGG,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,BCBS,BCBS,398.2,,,,,,,per diem,398.2,398.2,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,BCBS MGG,BCBS MGG,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Cigna,Cigna,398.2,,,,,,,per diem,398.2,398.2,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Cigna MGG,Cigna MGG,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Humana,Humana,398.2,,,,,,,per diem,398.2,398.2,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Humana MGG,Humana MGG,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Optum VA,Optum VA,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,UHC,UHC,398.2,,,,,,,per diem,398.2,398.2,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,UHC MGG,UHC MGG,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,VA,VA,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Wellcare MGG,Wellcare MGG,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Bright Health - commercial,Bright Health - commercial,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,398.2,398.2,Bright Health MGG,Bright Health MGG,398.2,,,,,,,case rate,398.2,398.2,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Aetna,Aetna,112.82,,,,,,,per diem,112.82,112.82,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Aetna MGG,Aetna MGG,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,BCBS,BCBS,112.82,,,,,,,per diem,112.82,112.82,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,BCBS MGG,BCBS MGG,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Cigna,Cigna,112.82,,,,,,,per diem,112.82,112.82,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Cigna MGG,Cigna MGG,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Humana,Humana,112.82,,,,,,,per diem,112.82,112.82,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Humana MGG,Humana MGG,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Optum VA,Optum VA,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,UHC,UHC,112.82,,,,,,,per diem,112.82,112.82,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,UHC MGG,UHC MGG,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,VA,VA,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Wellcare MGG,Wellcare MGG,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Bright Health - commercial,Bright Health - commercial,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,112.82,112.82,Bright Health MGG,Bright Health MGG,112.82,,,,,,,case rate,112.82,112.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Aetna,Aetna,114.08,,,,,,,per diem,114.08,114.08,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Aetna MGG,Aetna MGG,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,BCBS,BCBS,114.08,,,,,,,per diem,114.08,114.08,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,BCBS MGG,BCBS MGG,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Cigna,Cigna,114.08,,,,,,,per diem,114.08,114.08,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Cigna MGG,Cigna MGG,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Humana,Humana,114.08,,,,,,,per diem,114.08,114.08,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Humana MGG,Humana MGG,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Optum VA,Optum VA,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,UHC,UHC,114.08,,,,,,,per diem,114.08,114.08,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,UHC MGG,UHC MGG,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,VA,VA,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Wellcare MGG,Wellcare MGG,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Bright Health - commercial,Bright Health - commercial,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,114.08,114.08,Bright Health MGG,Bright Health MGG,114.08,,,,,,,case rate,114.08,114.08,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Aetna,Aetna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Aetna MGG,Aetna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,BCBS,BCBS,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,BCBS MGG,BCBS MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Cigna,Cigna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Cigna MGG,Cigna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Humana,Humana,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Humana MGG,Humana MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Optum VA,Optum VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,UHC,UHC,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,UHC MGG,UHC MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,VA,VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Wellcare MGG,Wellcare MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Bright Health - commercial,Bright Health - commercial,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Bright Health MGG,Bright Health MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Aetna,Aetna,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Aetna MGG,Aetna MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,BCBS,BCBS,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,BCBS MGG,BCBS MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Cigna,Cigna,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Cigna MGG,Cigna MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Humana,Humana,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Humana MGG,Humana MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Optum VA,Optum VA,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,UHC,UHC,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,UHC MGG,UHC MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,VA,VA,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Wellcare MGG,Wellcare MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Bright Health - commercial,Bright Health - commercial,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,43.29,43.29,Bright Health MGG,Bright Health MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Aetna,Aetna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Aetna MGG,Aetna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,BCBS,BCBS,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,BCBS MGG,BCBS MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Cigna,Cigna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Cigna MGG,Cigna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Humana,Humana,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Humana MGG,Humana MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Optum VA,Optum VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,UHC,UHC,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,UHC MGG,UHC MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,VA,VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Wellcare MGG,Wellcare MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Bright Health - commercial,Bright Health - commercial,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,234.77,234.77,Bright Health MGG,Bright Health MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Aetna,Aetna,238.82,,,,,,,per diem,238.82,238.82,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Aetna MGG,Aetna MGG,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,BCBS,BCBS,238.82,,,,,,,per diem,238.82,238.82,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,BCBS MGG,BCBS MGG,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Cigna,Cigna,238.82,,,,,,,per diem,238.82,238.82,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Cigna MGG,Cigna MGG,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Humana,Humana,238.82,,,,,,,per diem,238.82,238.82,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Humana MGG,Humana MGG,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Optum VA,Optum VA,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,UHC,UHC,238.82,,,,,,,per diem,238.82,238.82,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,UHC MGG,UHC MGG,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,VA,VA,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Wellcare MGG,Wellcare MGG,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Bright Health - commercial,Bright Health - commercial,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,238.82,238.82,Bright Health MGG,Bright Health MGG,238.82,,,,,,,case rate,238.82,238.82,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Aetna,Aetna,100.53,,,,,,,per diem,100.53,100.53,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Aetna MGG,Aetna MGG,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,BCBS,BCBS,100.53,,,,,,,per diem,100.53,100.53,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,BCBS MGG,BCBS MGG,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Cigna,Cigna,100.53,,,,,,,per diem,100.53,100.53,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Cigna MGG,Cigna MGG,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Humana,Humana,100.53,,,,,,,per diem,100.53,100.53,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Humana MGG,Humana MGG,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Optum VA,Optum VA,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,UHC,UHC,100.53,,,,,,,per diem,100.53,100.53,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,UHC MGG,UHC MGG,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,VA,VA,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Wellcare MGG,Wellcare MGG,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Bright Health - commercial,Bright Health - commercial,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,100.53,100.53,Bright Health MGG,Bright Health MGG,100.53,,,,,,,case rate,100.53,100.53,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Aetna,Aetna,105.35,,,,,,,per diem,105.35,105.35,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Aetna MGG,Aetna MGG,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,BCBS,BCBS,105.35,,,,,,,per diem,105.35,105.35,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,BCBS MGG,BCBS MGG,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Cigna,Cigna,105.35,,,,,,,per diem,105.35,105.35,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Cigna MGG,Cigna MGG,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Humana,Humana,105.35,,,,,,,per diem,105.35,105.35,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Humana MGG,Humana MGG,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Optum VA,Optum VA,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,UHC,UHC,105.35,,,,,,,per diem,105.35,105.35,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,UHC MGG,UHC MGG,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,VA,VA,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Wellcare MGG,Wellcare MGG,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Bright Health - commercial,Bright Health - commercial,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,105.35,105.35,Bright Health MGG,Bright Health MGG,105.35,,,,,,,case rate,105.35,105.35,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Aetna,Aetna,94.93,,,,,,,per diem,94.93,94.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Aetna MGG,Aetna MGG,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,BCBS,BCBS,94.93,,,,,,,per diem,94.93,94.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,BCBS MGG,BCBS MGG,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Cigna,Cigna,94.93,,,,,,,per diem,94.93,94.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Cigna MGG,Cigna MGG,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Humana,Humana,94.93,,,,,,,per diem,94.93,94.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Humana MGG,Humana MGG,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Optum VA,Optum VA,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,UHC,UHC,94.93,,,,,,,per diem,94.93,94.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,UHC MGG,UHC MGG,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,VA,VA,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Wellcare MGG,Wellcare MGG,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Bright Health - commercial,Bright Health - commercial,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,94.93,94.93,Bright Health MGG,Bright Health MGG,94.93,,,,,,,case rate,94.93,94.93,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Aetna,Aetna,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Aetna MGG,Aetna MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,BCBS,BCBS,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,BCBS MGG,BCBS MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Cigna,Cigna,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Cigna MGG,Cigna MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Humana,Humana,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Humana MGG,Humana MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Optum VA,Optum VA,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,UHC,UHC,144.04,,,,,,,per diem,144.04,144.04,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,UHC MGG,UHC MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,VA,VA,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Wellcare MGG,Wellcare MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Bright Health - commercial,Bright Health - commercial,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,144.04,144.04,Bright Health MGG,Bright Health MGG,144.04,,,,,,,case rate,144.04,144.04,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Aetna,Aetna,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Aetna MGG,Aetna MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,BCBS,BCBS,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,BCBS MGG,BCBS MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Cigna,Cigna,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Cigna MGG,Cigna MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Humana,Humana,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Humana MGG,Humana MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Optum VA,Optum VA,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,UHC,UHC,98.31,,,,,,,per diem,98.31,98.31,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,UHC MGG,UHC MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,VA,VA,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Wellcare MGG,Wellcare MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Bright Health - commercial,Bright Health - commercial,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,98.31,98.31,Bright Health MGG,Bright Health MGG,98.31,,,,,,,case rate,98.31,98.31,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Aetna,Aetna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Aetna MGG,Aetna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,BCBS,BCBS,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,BCBS MGG,BCBS MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Cigna,Cigna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Cigna MGG,Cigna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Humana,Humana,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Humana MGG,Humana MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Optum VA,Optum VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,UHC,UHC,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,UHC MGG,UHC MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,VA,VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Wellcare MGG,Wellcare MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Bright Health - commercial,Bright Health - commercial,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,83.72,83.72,Bright Health MGG,Bright Health MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Aetna,Aetna,121.7,,,,,,,per diem,121.7,121.7,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Aetna MGG,Aetna MGG,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,BCBS,BCBS,121.7,,,,,,,per diem,121.7,121.7,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,BCBS MGG,BCBS MGG,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Cigna,Cigna,121.7,,,,,,,per diem,121.7,121.7,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Cigna MGG,Cigna MGG,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Humana,Humana,121.7,,,,,,,per diem,121.7,121.7,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Humana MGG,Humana MGG,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Optum VA,Optum VA,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,UHC,UHC,121.7,,,,,,,per diem,121.7,121.7,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,UHC MGG,UHC MGG,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,VA,VA,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Wellcare MGG,Wellcare MGG,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Bright Health - commercial,Bright Health - commercial,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,121.7,121.7,Bright Health MGG,Bright Health MGG,121.7,,,,,,,case rate,121.7,121.7,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Aetna,Aetna,106.19,,,,,,,per diem,106.19,106.19,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Aetna MGG,Aetna MGG,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,BCBS,BCBS,106.19,,,,,,,per diem,106.19,106.19,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,BCBS MGG,BCBS MGG,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Cigna,Cigna,106.19,,,,,,,per diem,106.19,106.19,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Cigna MGG,Cigna MGG,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Humana,Humana,106.19,,,,,,,per diem,106.19,106.19,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Humana MGG,Humana MGG,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Optum VA,Optum VA,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,UHC,UHC,106.19,,,,,,,per diem,106.19,106.19,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,UHC MGG,UHC MGG,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,VA,VA,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Wellcare MGG,Wellcare MGG,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Bright Health - commercial,Bright Health - commercial,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,106.19,106.19,Bright Health MGG,Bright Health MGG,106.19,,,,,,,case rate,106.19,106.19,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Aetna,Aetna,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Aetna MGG,Aetna MGG,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,BCBS,BCBS,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,BCBS MGG,BCBS MGG,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Cigna,Cigna,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Cigna MGG,Cigna MGG,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Humana,Humana,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Humana MGG,Humana MGG,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Optum VA,Optum VA,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,UHC,UHC,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,UHC MGG,UHC MGG,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,VA,VA,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Wellcare MGG,Wellcare MGG,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Bright Health - commercial,Bright Health - commercial,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,Bright Health MGG,Bright Health MGG,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Aetna,Aetna,112.22,,,,,,,per diem,112.22,112.22,"Per diem rate, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Aetna MGG,Aetna MGG,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,BCBS,BCBS,112.22,,,,,,,per diem,112.22,112.22,"Per diem rate, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,BCBS MGG,BCBS MGG,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Cigna,Cigna,112.22,,,,,,,per diem,112.22,112.22,"Per diem rate, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Cigna MGG,Cigna MGG,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Humana,Humana,112.22,,,,,,,per diem,112.22,112.22,"Per diem rate, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Humana MGG,Humana MGG,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Optum VA,Optum VA,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,UHC,UHC,112.22,,,,,,,per diem,112.22,112.22,"Per diem rate, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,UHC MGG,UHC MGG,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,VA,VA,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Wellcare MGG,Wellcare MGG,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Bright Health - commercial,Bright Health - commercial,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
THER INT COG FUNC EAADDL 15MIN,34210054,CDM,430,RC,97130,CPT,,,GO,Inpatient,,,112.22,112.22,Bright Health MGG,Bright Health MGG,112.22,,,,,,,case rate,112.22,112.22,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Aetna,Aetna,79.76,,,,,,,per diem,79.76,79.76,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Aetna MGG,Aetna MGG,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,BCBS,BCBS,79.76,,,,,,,per diem,79.76,79.76,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,BCBS MGG,BCBS MGG,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Cigna,Cigna,79.76,,,,,,,per diem,79.76,79.76,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Cigna MGG,Cigna MGG,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Humana,Humana,79.76,,,,,,,per diem,79.76,79.76,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Humana MGG,Humana MGG,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Optum VA,Optum VA,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,UHC,UHC,79.76,,,,,,,per diem,79.76,79.76,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,UHC MGG,UHC MGG,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,VA,VA,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Wellcare MGG,Wellcare MGG,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Bright Health - commercial,Bright Health - commercial,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,79.76,79.76,Bright Health MGG,Bright Health MGG,79.76,,,,,,,case rate,79.76,79.76,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Aetna,Aetna,94.47,,,,,,,per diem,94.47,94.47,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Aetna MGG,Aetna MGG,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,BCBS,BCBS,94.47,,,,,,,per diem,94.47,94.47,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,BCBS MGG,BCBS MGG,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Cigna,Cigna,94.47,,,,,,,per diem,94.47,94.47,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Cigna MGG,Cigna MGG,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Humana,Humana,94.47,,,,,,,per diem,94.47,94.47,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Humana MGG,Humana MGG,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Optum VA,Optum VA,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,UHC,UHC,94.47,,,,,,,per diem,94.47,94.47,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,UHC MGG,UHC MGG,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,VA,VA,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Wellcare MGG,Wellcare MGG,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Bright Health - commercial,Bright Health - commercial,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,94.47,94.47,Bright Health MGG,Bright Health MGG,94.47,,,,,,,case rate,94.47,94.47,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Aetna,Aetna,530.62,,,,,,,per diem,530.62,530.62,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Aetna MGG,Aetna MGG,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,BCBS,BCBS,530.62,,,,,,,per diem,530.62,530.62,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,BCBS MGG,BCBS MGG,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Cigna,Cigna,530.62,,,,,,,per diem,530.62,530.62,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Cigna MGG,Cigna MGG,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Humana,Humana,530.62,,,,,,,per diem,530.62,530.62,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Humana MGG,Humana MGG,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Optum VA,Optum VA,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,UHC,UHC,530.62,,,,,,,per diem,530.62,530.62,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,UHC MGG,UHC MGG,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,VA,VA,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Wellcare MGG,Wellcare MGG,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Bright Health - commercial,Bright Health - commercial,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,530.62,530.62,Bright Health MGG,Bright Health MGG,530.62,,,,,,,case rate,530.62,530.62,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Aetna,Aetna,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Aetna MGG,Aetna MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,BCBS,BCBS,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,BCBS MGG,BCBS MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Cigna,Cigna,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Cigna MGG,Cigna MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Humana,Humana,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Humana MGG,Humana MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Optum VA,Optum VA,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,UHC,UHC,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,UHC MGG,UHC MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,VA,VA,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Wellcare MGG,Wellcare MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Bright Health - commercial,Bright Health - commercial,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.96,50.96,Bright Health MGG,Bright Health MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna,Aetna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Aetna MGG,Aetna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS,BCBS,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,BCBS MGG,BCBS MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna,Cigna,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Cigna MGG,Cigna MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Humana,Humana,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Humana MGG,Humana MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Optum VA,Optum VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,UHC,UHC,261.3,,,,,,,per diem,261.3,261.3,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,UHC MGG,UHC MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,VA,VA,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Wellcare MGG,Wellcare MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health - commercial,Bright Health - commercial,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,261.3,261.3,Bright Health MGG,Bright Health MGG,261.3,,,,,,,case rate,261.3,261.3,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Aetna,Aetna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Aetna MGG,Aetna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,BCBS,BCBS,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,BCBS MGG,BCBS MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Cigna,Cigna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Cigna MGG,Cigna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Humana,Humana,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Humana MGG,Humana MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Optum VA,Optum VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,UHC,UHC,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,UHC MGG,UHC MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,VA,VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Wellcare MGG,Wellcare MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Bright Health - commercial,Bright Health - commercial,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,79.82,79.82,Bright Health MGG,Bright Health MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Aetna,Aetna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Aetna MGG,Aetna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,BCBS,BCBS,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,BCBS MGG,BCBS MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Cigna,Cigna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Cigna MGG,Cigna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Humana,Humana,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Humana MGG,Humana MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Optum VA,Optum VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,UHC,UHC,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,UHC MGG,UHC MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,VA,VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Wellcare MGG,Wellcare MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Bright Health - commercial,Bright Health - commercial,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,180.54,180.54,Bright Health MGG,Bright Health MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Aetna,Aetna,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Aetna MGG,Aetna MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,BCBS,BCBS,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,BCBS MGG,BCBS MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Cigna,Cigna,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Cigna MGG,Cigna MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Humana,Humana,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Humana MGG,Humana MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Optum VA,Optum VA,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,UHC,UHC,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,UHC MGG,UHC MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,VA,VA,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Wellcare MGG,Wellcare MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Bright Health - commercial,Bright Health - commercial,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,174.03,174.03,Bright Health MGG,Bright Health MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Aetna,Aetna,135.51,,,,,,,per diem,135.51,135.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Aetna MGG,Aetna MGG,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,BCBS,BCBS,135.51,,,,,,,per diem,135.51,135.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,BCBS MGG,BCBS MGG,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Cigna,Cigna,135.51,,,,,,,per diem,135.51,135.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Cigna MGG,Cigna MGG,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Humana,Humana,135.51,,,,,,,per diem,135.51,135.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Humana MGG,Humana MGG,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Optum VA,Optum VA,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,UHC,UHC,135.51,,,,,,,per diem,135.51,135.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,UHC MGG,UHC MGG,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,VA,VA,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Wellcare MGG,Wellcare MGG,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Bright Health - commercial,Bright Health - commercial,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,135.51,135.51,Bright Health MGG,Bright Health MGG,135.51,,,,,,,case rate,135.51,135.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Aetna,Aetna,142.47,,,,,,,per diem,142.47,142.47,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Aetna MGG,Aetna MGG,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,BCBS,BCBS,142.47,,,,,,,per diem,142.47,142.47,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,BCBS MGG,BCBS MGG,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Cigna,Cigna,142.47,,,,,,,per diem,142.47,142.47,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Cigna MGG,Cigna MGG,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Humana,Humana,142.47,,,,,,,per diem,142.47,142.47,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Humana MGG,Humana MGG,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Optum VA,Optum VA,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,UHC,UHC,142.47,,,,,,,per diem,142.47,142.47,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,UHC MGG,UHC MGG,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,VA,VA,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Wellcare MGG,Wellcare MGG,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Bright Health - commercial,Bright Health - commercial,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,142.47,142.47,Bright Health MGG,Bright Health MGG,142.47,,,,,,,case rate,142.47,142.47,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Aetna,Aetna,139.05,,,,,,,per diem,139.05,139.05,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Aetna MGG,Aetna MGG,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,BCBS,BCBS,139.05,,,,,,,per diem,139.05,139.05,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,BCBS MGG,BCBS MGG,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Cigna,Cigna,139.05,,,,,,,per diem,139.05,139.05,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Cigna MGG,Cigna MGG,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Humana,Humana,139.05,,,,,,,per diem,139.05,139.05,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Humana MGG,Humana MGG,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Optum VA,Optum VA,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,UHC,UHC,139.05,,,,,,,per diem,139.05,139.05,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,UHC MGG,UHC MGG,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,VA,VA,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Wellcare MGG,Wellcare MGG,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Bright Health - commercial,Bright Health - commercial,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,139.05,139.05,Bright Health MGG,Bright Health MGG,139.05,,,,,,,case rate,139.05,139.05,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Aetna,Aetna,138.96,,,,,,,per diem,138.96,138.96,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Aetna MGG,Aetna MGG,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,BCBS,BCBS,138.96,,,,,,,per diem,138.96,138.96,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,BCBS MGG,BCBS MGG,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Cigna,Cigna,138.96,,,,,,,per diem,138.96,138.96,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Cigna MGG,Cigna MGG,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Humana,Humana,138.96,,,,,,,per diem,138.96,138.96,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Humana MGG,Humana MGG,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Optum VA,Optum VA,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,UHC,UHC,138.96,,,,,,,per diem,138.96,138.96,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,UHC MGG,UHC MGG,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,VA,VA,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Wellcare MGG,Wellcare MGG,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Bright Health - commercial,Bright Health - commercial,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,138.96,138.96,Bright Health MGG,Bright Health MGG,138.96,,,,,,,case rate,138.96,138.96,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Aetna,Aetna,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Aetna MGG,Aetna MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,BCBS,BCBS,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,BCBS MGG,BCBS MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Cigna,Cigna,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Cigna MGG,Cigna MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Humana,Humana,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Humana MGG,Humana MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Optum VA,Optum VA,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,UHC,UHC,157.4,,,,,,,per diem,157.4,157.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,UHC MGG,UHC MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,VA,VA,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Wellcare MGG,Wellcare MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Bright Health - commercial,Bright Health - commercial,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,157.4,157.4,Bright Health MGG,Bright Health MGG,157.4,,,,,,,case rate,157.4,157.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Aetna,Aetna,170.52,,,,,,,per diem,170.52,170.52,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Aetna MGG,Aetna MGG,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,BCBS,BCBS,170.52,,,,,,,per diem,170.52,170.52,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,BCBS MGG,BCBS MGG,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Cigna,Cigna,170.52,,,,,,,per diem,170.52,170.52,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Cigna MGG,Cigna MGG,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Humana,Humana,170.52,,,,,,,per diem,170.52,170.52,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Humana MGG,Humana MGG,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Optum VA,Optum VA,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,UHC,UHC,170.52,,,,,,,per diem,170.52,170.52,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,UHC MGG,UHC MGG,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,VA,VA,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Wellcare MGG,Wellcare MGG,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Bright Health - commercial,Bright Health - commercial,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,170.52,170.52,Bright Health MGG,Bright Health MGG,170.52,,,,,,,case rate,170.52,170.52,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Aetna,Aetna,70.86,,,,,,,per diem,70.86,70.86,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Aetna MGG,Aetna MGG,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,BCBS,BCBS,70.86,,,,,,,per diem,70.86,70.86,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,BCBS MGG,BCBS MGG,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Cigna,Cigna,70.86,,,,,,,per diem,70.86,70.86,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Cigna MGG,Cigna MGG,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Humana,Humana,70.86,,,,,,,per diem,70.86,70.86,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Humana MGG,Humana MGG,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Optum VA,Optum VA,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,UHC,UHC,70.86,,,,,,,per diem,70.86,70.86,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,UHC MGG,UHC MGG,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,VA,VA,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Wellcare MGG,Wellcare MGG,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Bright Health - commercial,Bright Health - commercial,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,70.86,70.86,Bright Health MGG,Bright Health MGG,70.86,,,,,,,case rate,70.86,70.86,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Aetna,Aetna,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Aetna MGG,Aetna MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,BCBS,BCBS,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,BCBS MGG,BCBS MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Cigna,Cigna,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Cigna MGG,Cigna MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Humana,Humana,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Humana MGG,Humana MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Optum VA,Optum VA,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,UHC,UHC,64.64,,,,,,,per diem,64.64,64.64,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,UHC MGG,UHC MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,VA,VA,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Wellcare MGG,Wellcare MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Bright Health - commercial,Bright Health - commercial,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,64.64,64.64,Bright Health MGG,Bright Health MGG,64.64,,,,,,,case rate,64.64,64.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Aetna,Aetna,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Aetna MGG,Aetna MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,BCBS,BCBS,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,BCBS MGG,BCBS MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Cigna,Cigna,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Cigna MGG,Cigna MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Humana,Humana,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Humana MGG,Humana MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Optum VA,Optum VA,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,UHC,UHC,84.33,,,,,,,per diem,84.33,84.33,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,UHC MGG,UHC MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,VA,VA,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Wellcare MGG,Wellcare MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Bright Health - commercial,Bright Health - commercial,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,84.33,84.33,Bright Health MGG,Bright Health MGG,84.33,,,,,,,case rate,84.33,84.33,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Aetna,Aetna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Aetna MGG,Aetna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,BCBS,BCBS,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,BCBS MGG,BCBS MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Cigna,Cigna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Cigna MGG,Cigna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Humana,Humana,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Humana MGG,Humana MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Optum VA,Optum VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,UHC,UHC,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,UHC MGG,UHC MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,VA,VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Wellcare MGG,Wellcare MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Bright Health - commercial,Bright Health - commercial,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,83.72,83.72,Bright Health MGG,Bright Health MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Aetna,Aetna,83.77,,,,,,,per diem,83.77,83.77,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Aetna MGG,Aetna MGG,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,BCBS,BCBS,83.77,,,,,,,per diem,83.77,83.77,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,BCBS MGG,BCBS MGG,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Cigna,Cigna,83.77,,,,,,,per diem,83.77,83.77,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Cigna MGG,Cigna MGG,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Humana,Humana,83.77,,,,,,,per diem,83.77,83.77,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Humana MGG,Humana MGG,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Optum VA,Optum VA,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,UHC,UHC,83.77,,,,,,,per diem,83.77,83.77,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,UHC MGG,UHC MGG,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,VA,VA,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Wellcare MGG,Wellcare MGG,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Bright Health - commercial,Bright Health - commercial,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,83.77,83.77,Bright Health MGG,Bright Health MGG,83.77,,,,,,,case rate,83.77,83.77,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Aetna,Aetna,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Aetna MGG,Aetna MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,BCBS,BCBS,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,BCBS MGG,BCBS MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Cigna,Cigna,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Cigna MGG,Cigna MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Humana,Humana,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Humana MGG,Humana MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Optum VA,Optum VA,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,UHC,UHC,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,UHC MGG,UHC MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,VA,VA,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Wellcare MGG,Wellcare MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Bright Health - commercial,Bright Health - commercial,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,319.28,319.28,Bright Health MGG,Bright Health MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Aetna,Aetna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Aetna MGG,Aetna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,BCBS,BCBS,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,BCBS MGG,BCBS MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Cigna,Cigna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Cigna MGG,Cigna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Humana,Humana,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Humana MGG,Humana MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Optum VA,Optum VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,UHC,UHC,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,UHC MGG,UHC MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,VA,VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Wellcare MGG,Wellcare MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Bright Health - commercial,Bright Health - commercial,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,83.72,83.72,Bright Health MGG,Bright Health MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Aetna,Aetna,102.7,,,,,,,per diem,102.7,102.7,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Aetna MGG,Aetna MGG,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,BCBS,BCBS,102.7,,,,,,,per diem,102.7,102.7,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,BCBS MGG,BCBS MGG,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Cigna,Cigna,102.7,,,,,,,per diem,102.7,102.7,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Cigna MGG,Cigna MGG,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Humana,Humana,102.7,,,,,,,per diem,102.7,102.7,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Humana MGG,Humana MGG,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Optum VA,Optum VA,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,UHC,UHC,102.7,,,,,,,per diem,102.7,102.7,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,UHC MGG,UHC MGG,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,VA,VA,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Wellcare MGG,Wellcare MGG,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Bright Health - commercial,Bright Health - commercial,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,102.7,102.7,Bright Health MGG,Bright Health MGG,102.7,,,,,,,case rate,102.7,102.7,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Aetna,Aetna,80.18,,,,,,,per diem,80.18,80.18,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Aetna MGG,Aetna MGG,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,BCBS,BCBS,80.18,,,,,,,per diem,80.18,80.18,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,BCBS MGG,BCBS MGG,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Cigna,Cigna,80.18,,,,,,,per diem,80.18,80.18,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Cigna MGG,Cigna MGG,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Humana,Humana,80.18,,,,,,,per diem,80.18,80.18,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Humana MGG,Humana MGG,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Optum VA,Optum VA,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,UHC,UHC,80.18,,,,,,,per diem,80.18,80.18,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,UHC MGG,UHC MGG,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,VA,VA,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Wellcare MGG,Wellcare MGG,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Bright Health - commercial,Bright Health - commercial,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,80.18,80.18,Bright Health MGG,Bright Health MGG,80.18,,,,,,,case rate,80.18,80.18,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Aetna,Aetna,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Aetna MGG,Aetna MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,BCBS,BCBS,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,BCBS MGG,BCBS MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Cigna,Cigna,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Cigna MGG,Cigna MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Humana,Humana,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Humana MGG,Humana MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Optum VA,Optum VA,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,UHC,UHC,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,UHC MGG,UHC MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,VA,VA,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Wellcare MGG,Wellcare MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Bright Health - commercial,Bright Health - commercial,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,319.28,319.28,Bright Health MGG,Bright Health MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Aetna,Aetna,610.19,,,,,,,per diem,610.19,610.19,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Aetna MGG,Aetna MGG,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,BCBS,BCBS,610.19,,,,,,,per diem,610.19,610.19,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,BCBS MGG,BCBS MGG,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Cigna,Cigna,610.19,,,,,,,per diem,610.19,610.19,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Cigna MGG,Cigna MGG,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Humana,Humana,610.19,,,,,,,per diem,610.19,610.19,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Humana MGG,Humana MGG,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Optum VA,Optum VA,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,UHC,UHC,610.19,,,,,,,per diem,610.19,610.19,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,UHC MGG,UHC MGG,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,VA,VA,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Wellcare MGG,Wellcare MGG,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Bright Health - commercial,Bright Health - commercial,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,610.19,610.19,Bright Health MGG,Bright Health MGG,610.19,,,,,,,case rate,610.19,610.19,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Aetna,Aetna,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Aetna MGG,Aetna MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,BCBS,BCBS,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,BCBS MGG,BCBS MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Cigna,Cigna,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Cigna MGG,Cigna MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Humana,Humana,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Humana MGG,Humana MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Optum VA,Optum VA,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,UHC,UHC,319.28,,,,,,,per diem,319.28,319.28,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,UHC MGG,UHC MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,VA,VA,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Wellcare MGG,Wellcare MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Bright Health - commercial,Bright Health - commercial,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,319.28,319.28,Bright Health MGG,Bright Health MGG,319.28,,,,,,,case rate,319.28,319.28,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Aetna,Aetna,76.09,,,,,,,per diem,76.09,76.09,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Aetna MGG,Aetna MGG,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,BCBS,BCBS,76.09,,,,,,,per diem,76.09,76.09,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,BCBS MGG,BCBS MGG,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Cigna,Cigna,76.09,,,,,,,per diem,76.09,76.09,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Cigna MGG,Cigna MGG,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Humana,Humana,76.09,,,,,,,per diem,76.09,76.09,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Humana MGG,Humana MGG,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Optum VA,Optum VA,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,UHC,UHC,76.09,,,,,,,per diem,76.09,76.09,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,UHC MGG,UHC MGG,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,VA,VA,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Wellcare MGG,Wellcare MGG,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Bright Health - commercial,Bright Health - commercial,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,76.09,76.09,Bright Health MGG,Bright Health MGG,76.09,,,,,,,case rate,76.09,76.09,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Aetna,Aetna,80.66,,,,,,,per diem,80.66,80.66,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Aetna MGG,Aetna MGG,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,BCBS,BCBS,80.66,,,,,,,per diem,80.66,80.66,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,BCBS MGG,BCBS MGG,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Cigna,Cigna,80.66,,,,,,,per diem,80.66,80.66,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Cigna MGG,Cigna MGG,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Humana,Humana,80.66,,,,,,,per diem,80.66,80.66,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Humana MGG,Humana MGG,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Optum VA,Optum VA,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,UHC,UHC,80.66,,,,,,,per diem,80.66,80.66,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,UHC MGG,UHC MGG,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,VA,VA,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Wellcare MGG,Wellcare MGG,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Bright Health - commercial,Bright Health - commercial,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,80.66,80.66,Bright Health MGG,Bright Health MGG,80.66,,,,,,,case rate,80.66,80.66,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Aetna,Aetna,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Aetna MGG,Aetna MGG,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,BCBS,BCBS,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,BCBS MGG,BCBS MGG,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Cigna,Cigna,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Cigna MGG,Cigna MGG,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Humana,Humana,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Humana MGG,Humana MGG,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Optum VA,Optum VA,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,UHC,UHC,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,UHC MGG,UHC MGG,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,VA,VA,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Wellcare MGG,Wellcare MGG,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Bright Health - commercial,Bright Health - commercial,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,86.52,86.52,Bright Health MGG,Bright Health MGG,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Aetna,Aetna,219.91,,,,,,,per diem,219.91,219.91,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Aetna MGG,Aetna MGG,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,BCBS,BCBS,219.91,,,,,,,per diem,219.91,219.91,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,BCBS MGG,BCBS MGG,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Cigna,Cigna,219.91,,,,,,,per diem,219.91,219.91,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Cigna MGG,Cigna MGG,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Humana,Humana,219.91,,,,,,,per diem,219.91,219.91,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Humana MGG,Humana MGG,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Optum VA,Optum VA,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,UHC,UHC,219.91,,,,,,,per diem,219.91,219.91,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,UHC MGG,UHC MGG,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,VA,VA,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Wellcare MGG,Wellcare MGG,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Bright Health - commercial,Bright Health - commercial,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,219.91,219.91,Bright Health MGG,Bright Health MGG,219.91,,,,,,,case rate,219.91,219.91,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Aetna,Aetna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Aetna MGG,Aetna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,BCBS,BCBS,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,BCBS MGG,BCBS MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Cigna,Cigna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Cigna MGG,Cigna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Humana,Humana,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Humana MGG,Humana MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Optum VA,Optum VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,UHC,UHC,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,UHC MGG,UHC MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,VA,VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Wellcare MGG,Wellcare MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Bright Health - commercial,Bright Health - commercial,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,234.77,234.77,Bright Health MGG,Bright Health MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Aetna,Aetna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Aetna MGG,Aetna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,BCBS,BCBS,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,BCBS MGG,BCBS MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Cigna,Cigna,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Cigna MGG,Cigna MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Humana,Humana,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Humana MGG,Humana MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Optum VA,Optum VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,UHC,UHC,159.64,,,,,,,per diem,159.64,159.64,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,UHC MGG,UHC MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,VA,VA,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Wellcare MGG,Wellcare MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Bright Health - commercial,Bright Health - commercial,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,159.64,159.64,Bright Health MGG,Bright Health MGG,159.64,,,,,,,case rate,159.64,159.64,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Aetna,Aetna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Aetna MGG,Aetna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,BCBS,BCBS,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,BCBS MGG,BCBS MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Cigna,Cigna,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Cigna MGG,Cigna MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Humana,Humana,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Humana MGG,Humana MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Optum VA,Optum VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,UHC,UHC,79.82,,,,,,,per diem,79.82,79.82,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,UHC MGG,UHC MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,VA,VA,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Wellcare MGG,Wellcare MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Bright Health - commercial,Bright Health - commercial,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,79.82,79.82,Bright Health MGG,Bright Health MGG,79.82,,,,,,,case rate,79.82,79.82,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Aetna,Aetna,110.11,,,,,,,per diem,110.11,110.11,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Aetna MGG,Aetna MGG,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,BCBS,BCBS,110.11,,,,,,,per diem,110.11,110.11,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,BCBS MGG,BCBS MGG,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Cigna,Cigna,110.11,,,,,,,per diem,110.11,110.11,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Cigna MGG,Cigna MGG,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Humana,Humana,110.11,,,,,,,per diem,110.11,110.11,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Humana MGG,Humana MGG,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Optum VA,Optum VA,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,UHC,UHC,110.11,,,,,,,per diem,110.11,110.11,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,UHC MGG,UHC MGG,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,VA,VA,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Wellcare MGG,Wellcare MGG,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Bright Health - commercial,Bright Health - commercial,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,110.11,110.11,Bright Health MGG,Bright Health MGG,110.11,,,,,,,case rate,110.11,110.11,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Aetna,Aetna,314.78,,,,,,,per diem,314.78,314.78,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Aetna MGG,Aetna MGG,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,BCBS,BCBS,314.78,,,,,,,per diem,314.78,314.78,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,BCBS MGG,BCBS MGG,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Cigna,Cigna,314.78,,,,,,,per diem,314.78,314.78,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Cigna MGG,Cigna MGG,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Humana,Humana,314.78,,,,,,,per diem,314.78,314.78,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Humana MGG,Humana MGG,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Optum VA,Optum VA,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,UHC,UHC,314.78,,,,,,,per diem,314.78,314.78,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,UHC MGG,UHC MGG,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,VA,VA,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Wellcare MGG,Wellcare MGG,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Bright Health - commercial,Bright Health - commercial,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,314.78,314.78,Bright Health MGG,Bright Health MGG,314.78,,,,,,,case rate,314.78,314.78,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Aetna,Aetna,356.13,,,,,,,per diem,356.13,356.13,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Aetna MGG,Aetna MGG,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,BCBS,BCBS,356.13,,,,,,,per diem,356.13,356.13,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,BCBS MGG,BCBS MGG,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Cigna,Cigna,356.13,,,,,,,per diem,356.13,356.13,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Cigna MGG,Cigna MGG,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Humana,Humana,356.13,,,,,,,per diem,356.13,356.13,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Humana MGG,Humana MGG,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Optum VA,Optum VA,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,UHC,UHC,356.13,,,,,,,per diem,356.13,356.13,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,UHC MGG,UHC MGG,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,VA,VA,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Wellcare MGG,Wellcare MGG,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Bright Health - commercial,Bright Health - commercial,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,356.13,356.13,Bright Health MGG,Bright Health MGG,356.13,,,,,,,case rate,356.13,356.13,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Aetna,Aetna,313.18,,,,,,,per diem,313.18,313.18,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Aetna MGG,Aetna MGG,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,BCBS,BCBS,313.18,,,,,,,per diem,313.18,313.18,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,BCBS MGG,BCBS MGG,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Cigna,Cigna,313.18,,,,,,,per diem,313.18,313.18,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Cigna MGG,Cigna MGG,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Humana,Humana,313.18,,,,,,,per diem,313.18,313.18,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Humana MGG,Humana MGG,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Optum VA,Optum VA,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,UHC,UHC,313.18,,,,,,,per diem,313.18,313.18,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,UHC MGG,UHC MGG,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,VA,VA,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Wellcare MGG,Wellcare MGG,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Bright Health - commercial,Bright Health - commercial,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,313.18,313.18,Bright Health MGG,Bright Health MGG,313.18,,,,,,,case rate,313.18,313.18,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Aetna,Aetna,317.61,,,,,,,per diem,317.61,317.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Aetna MGG,Aetna MGG,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,BCBS,BCBS,317.61,,,,,,,per diem,317.61,317.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,BCBS MGG,BCBS MGG,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Cigna,Cigna,317.61,,,,,,,per diem,317.61,317.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Cigna MGG,Cigna MGG,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Humana,Humana,317.61,,,,,,,per diem,317.61,317.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Humana MGG,Humana MGG,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Optum VA,Optum VA,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,UHC,UHC,317.61,,,,,,,per diem,317.61,317.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,UHC MGG,UHC MGG,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,VA,VA,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Wellcare MGG,Wellcare MGG,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Bright Health - commercial,Bright Health - commercial,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,317.61,317.61,Bright Health MGG,Bright Health MGG,317.61,,,,,,,case rate,317.61,317.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Aetna,Aetna,366.49,,,,,,,per diem,366.49,366.49,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Aetna MGG,Aetna MGG,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,BCBS,BCBS,366.49,,,,,,,per diem,366.49,366.49,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,BCBS MGG,BCBS MGG,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Cigna,Cigna,366.49,,,,,,,per diem,366.49,366.49,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Cigna MGG,Cigna MGG,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Humana,Humana,366.49,,,,,,,per diem,366.49,366.49,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Humana MGG,Humana MGG,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Optum VA,Optum VA,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,UHC,UHC,366.49,,,,,,,per diem,366.49,366.49,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,UHC MGG,UHC MGG,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,VA,VA,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Wellcare MGG,Wellcare MGG,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Bright Health - commercial,Bright Health - commercial,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,366.49,366.49,Bright Health MGG,Bright Health MGG,366.49,,,,,,,case rate,366.49,366.49,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Aetna,Aetna,309.53,,,,,,,per diem,309.53,309.53,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Aetna MGG,Aetna MGG,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,BCBS,BCBS,309.53,,,,,,,per diem,309.53,309.53,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,BCBS MGG,BCBS MGG,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Cigna,Cigna,309.53,,,,,,,per diem,309.53,309.53,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Cigna MGG,Cigna MGG,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Humana,Humana,309.53,,,,,,,per diem,309.53,309.53,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Humana MGG,Humana MGG,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Optum VA,Optum VA,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,UHC,UHC,309.53,,,,,,,per diem,309.53,309.53,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,UHC MGG,UHC MGG,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,VA,VA,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Wellcare MGG,Wellcare MGG,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Bright Health - commercial,Bright Health - commercial,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,309.53,309.53,Bright Health MGG,Bright Health MGG,309.53,,,,,,,case rate,309.53,309.53,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Aetna,Aetna,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Aetna MGG,Aetna MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,BCBS,BCBS,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,BCBS MGG,BCBS MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Cigna,Cigna,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Cigna MGG,Cigna MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Humana,Humana,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Humana MGG,Humana MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Optum VA,Optum VA,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,UHC,UHC,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,UHC MGG,UHC MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,VA,VA,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Wellcare MGG,Wellcare MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Bright Health - commercial,Bright Health - commercial,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,117.33,117.33,Bright Health MGG,Bright Health MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Aetna,Aetna,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Aetna MGG,Aetna MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,BCBS,BCBS,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,BCBS MGG,BCBS MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Cigna,Cigna,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Cigna MGG,Cigna MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Humana,Humana,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Humana MGG,Humana MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Optum VA,Optum VA,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,UHC,UHC,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,UHC MGG,UHC MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,VA,VA,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Wellcare MGG,Wellcare MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Bright Health - commercial,Bright Health - commercial,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,108.53,108.53,Bright Health MGG,Bright Health MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Aetna,Aetna,531.26,,,,,,,per diem,531.26,531.26,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Aetna MGG,Aetna MGG,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,BCBS,BCBS,531.26,,,,,,,per diem,531.26,531.26,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,BCBS MGG,BCBS MGG,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Cigna,Cigna,531.26,,,,,,,per diem,531.26,531.26,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Cigna MGG,Cigna MGG,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Humana,Humana,531.26,,,,,,,per diem,531.26,531.26,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Humana MGG,Humana MGG,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Optum VA,Optum VA,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,UHC,UHC,531.26,,,,,,,per diem,531.26,531.26,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,UHC MGG,UHC MGG,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,VA,VA,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Wellcare MGG,Wellcare MGG,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Bright Health - commercial,Bright Health - commercial,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,531.26,531.26,Bright Health MGG,Bright Health MGG,531.26,,,,,,,case rate,531.26,531.26,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Aetna,Aetna,159,,,,,,,per diem,159,159,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Aetna MGG,Aetna MGG,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,BCBS,BCBS,159,,,,,,,per diem,159,159,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,BCBS MGG,BCBS MGG,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Cigna,Cigna,159,,,,,,,per diem,159,159,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Cigna MGG,Cigna MGG,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Humana,Humana,159,,,,,,,per diem,159,159,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Humana MGG,Humana MGG,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Optum VA,Optum VA,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,UHC,UHC,159,,,,,,,per diem,159,159,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,UHC MGG,UHC MGG,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,VA,VA,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Wellcare MGG,Wellcare MGG,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Bright Health - commercial,Bright Health - commercial,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,159,159,Bright Health MGG,Bright Health MGG,159,,,,,,,case rate,159,159,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Aetna,Aetna,84.91,,,,,,,per diem,84.91,84.91,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Aetna MGG,Aetna MGG,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,BCBS,BCBS,84.91,,,,,,,per diem,84.91,84.91,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,BCBS MGG,BCBS MGG,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Cigna,Cigna,84.91,,,,,,,per diem,84.91,84.91,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Cigna MGG,Cigna MGG,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Humana,Humana,84.91,,,,,,,per diem,84.91,84.91,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Humana MGG,Humana MGG,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Optum VA,Optum VA,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,UHC,UHC,84.91,,,,,,,per diem,84.91,84.91,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,UHC MGG,UHC MGG,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,VA,VA,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Wellcare MGG,Wellcare MGG,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Bright Health - commercial,Bright Health - commercial,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,84.91,84.91,Bright Health MGG,Bright Health MGG,84.91,,,,,,,case rate,84.91,84.91,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Aetna,Aetna,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Aetna MGG,Aetna MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,BCBS,BCBS,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,BCBS MGG,BCBS MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Cigna,Cigna,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Cigna MGG,Cigna MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Humana,Humana,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Humana MGG,Humana MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Optum VA,Optum VA,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,UHC,UHC,75.24,,,,,,,per diem,75.24,75.24,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,UHC MGG,UHC MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,VA,VA,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Wellcare MGG,Wellcare MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Bright Health - commercial,Bright Health - commercial,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,75.24,75.24,Bright Health MGG,Bright Health MGG,75.24,,,,,,,case rate,75.24,75.24,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Aetna,Aetna,93.27,,,,,,,per diem,93.27,93.27,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Aetna MGG,Aetna MGG,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,BCBS,BCBS,93.27,,,,,,,per diem,93.27,93.27,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,BCBS MGG,BCBS MGG,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Cigna,Cigna,93.27,,,,,,,per diem,93.27,93.27,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Cigna MGG,Cigna MGG,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Humana,Humana,93.27,,,,,,,per diem,93.27,93.27,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Humana MGG,Humana MGG,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Optum VA,Optum VA,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,UHC,UHC,93.27,,,,,,,per diem,93.27,93.27,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,UHC MGG,UHC MGG,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,VA,VA,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Wellcare MGG,Wellcare MGG,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Bright Health - commercial,Bright Health - commercial,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,93.27,93.27,Bright Health MGG,Bright Health MGG,93.27,,,,,,,case rate,93.27,93.27,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Aetna,Aetna,334.94,,,,,,,per diem,334.94,334.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Aetna MGG,Aetna MGG,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,BCBS,BCBS,334.94,,,,,,,per diem,334.94,334.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,BCBS MGG,BCBS MGG,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Cigna,Cigna,334.94,,,,,,,per diem,334.94,334.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Cigna MGG,Cigna MGG,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Humana,Humana,334.94,,,,,,,per diem,334.94,334.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Humana MGG,Humana MGG,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Optum VA,Optum VA,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,UHC,UHC,334.94,,,,,,,per diem,334.94,334.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,UHC MGG,UHC MGG,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,VA,VA,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Wellcare MGG,Wellcare MGG,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Bright Health - commercial,Bright Health - commercial,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,334.94,334.94,Bright Health MGG,Bright Health MGG,334.94,,,,,,,case rate,334.94,334.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Aetna,Aetna,31.91,,,,,,,per diem,31.91,31.91,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Aetna MGG,Aetna MGG,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,BCBS,BCBS,31.91,,,,,,,per diem,31.91,31.91,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,BCBS MGG,BCBS MGG,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Cigna,Cigna,31.91,,,,,,,per diem,31.91,31.91,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Cigna MGG,Cigna MGG,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Humana,Humana,31.91,,,,,,,per diem,31.91,31.91,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Humana MGG,Humana MGG,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Optum VA,Optum VA,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,UHC,UHC,31.91,,,,,,,per diem,31.91,31.91,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,UHC MGG,UHC MGG,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,VA,VA,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Wellcare MGG,Wellcare MGG,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Bright Health - commercial,Bright Health - commercial,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,31.91,31.91,Bright Health MGG,Bright Health MGG,31.91,,,,,,,case rate,31.91,31.91,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Aetna,Aetna,570.83,,,,,,,per diem,570.83,570.83,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Aetna MGG,Aetna MGG,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,BCBS,BCBS,570.83,,,,,,,per diem,570.83,570.83,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,BCBS MGG,BCBS MGG,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Cigna,Cigna,570.83,,,,,,,per diem,570.83,570.83,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Cigna MGG,Cigna MGG,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Humana,Humana,570.83,,,,,,,per diem,570.83,570.83,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Humana MGG,Humana MGG,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Optum VA,Optum VA,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,UHC,UHC,570.83,,,,,,,per diem,570.83,570.83,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,UHC MGG,UHC MGG,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,VA,VA,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Wellcare MGG,Wellcare MGG,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Bright Health - commercial,Bright Health - commercial,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,570.83,570.83,Bright Health MGG,Bright Health MGG,570.83,,,,,,,case rate,570.83,570.83,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Aetna,Aetna,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Aetna MGG,Aetna MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,BCBS,BCBS,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,BCBS MGG,BCBS MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Cigna,Cigna,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Cigna MGG,Cigna MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Humana,Humana,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Humana MGG,Humana MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Optum VA,Optum VA,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,UHC,UHC,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,UHC MGG,UHC MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,VA,VA,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Wellcare MGG,Wellcare MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Bright Health - commercial,Bright Health - commercial,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH EVALUATION             ,34600130,CDM,444,RC,92506,CPT,,,GN,Inpatient,,,243.36,243.36,Bright Health MGG,Bright Health MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Aetna,Aetna,109.8,,,,,,,per diem,109.8,109.8,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Aetna MGG,Aetna MGG,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,BCBS,BCBS,109.8,,,,,,,per diem,109.8,109.8,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,BCBS MGG,BCBS MGG,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Cigna,Cigna,109.8,,,,,,,per diem,109.8,109.8,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Cigna MGG,Cigna MGG,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Humana,Humana,109.8,,,,,,,per diem,109.8,109.8,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Humana MGG,Humana MGG,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Optum VA,Optum VA,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,UHC,UHC,109.8,,,,,,,per diem,109.8,109.8,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,UHC MGG,UHC MGG,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,VA,VA,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Wellcare MGG,Wellcare MGG,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Bright Health - commercial,Bright Health - commercial,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,109.8,109.8,Bright Health MGG,Bright Health MGG,109.8,,,,,,,case rate,109.8,109.8,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Aetna,Aetna,78.9,,,,,,,per diem,78.9,78.9,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Aetna MGG,Aetna MGG,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,BCBS,BCBS,78.9,,,,,,,per diem,78.9,78.9,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,BCBS MGG,BCBS MGG,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Cigna,Cigna,78.9,,,,,,,per diem,78.9,78.9,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Cigna MGG,Cigna MGG,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Humana,Humana,78.9,,,,,,,per diem,78.9,78.9,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Humana MGG,Humana MGG,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Optum VA,Optum VA,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,UHC,UHC,78.9,,,,,,,per diem,78.9,78.9,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,UHC MGG,UHC MGG,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,VA,VA,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Wellcare MGG,Wellcare MGG,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Bright Health - commercial,Bright Health - commercial,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,78.9,78.9,Bright Health MGG,Bright Health MGG,78.9,,,,,,,case rate,78.9,78.9,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Aetna,Aetna,238.9,,,,,,,per diem,238.9,238.9,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Aetna MGG,Aetna MGG,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,BCBS,BCBS,238.9,,,,,,,per diem,238.9,238.9,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,BCBS MGG,BCBS MGG,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Cigna,Cigna,238.9,,,,,,,per diem,238.9,238.9,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Cigna MGG,Cigna MGG,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Humana,Humana,238.9,,,,,,,per diem,238.9,238.9,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Humana MGG,Humana MGG,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Optum VA,Optum VA,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,UHC,UHC,238.9,,,,,,,per diem,238.9,238.9,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,UHC MGG,UHC MGG,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,VA,VA,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Wellcare MGG,Wellcare MGG,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Bright Health - commercial,Bright Health - commercial,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,238.9,238.9,Bright Health MGG,Bright Health MGG,238.9,,,,,,,case rate,238.9,238.9,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Aetna,Aetna,174.75,,,,,,,per diem,174.75,174.75,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Aetna MGG,Aetna MGG,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,BCBS,BCBS,174.75,,,,,,,per diem,174.75,174.75,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,BCBS MGG,BCBS MGG,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Cigna,Cigna,174.75,,,,,,,per diem,174.75,174.75,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Cigna MGG,Cigna MGG,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Humana,Humana,174.75,,,,,,,per diem,174.75,174.75,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Humana MGG,Humana MGG,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Optum VA,Optum VA,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,UHC,UHC,174.75,,,,,,,per diem,174.75,174.75,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,UHC MGG,UHC MGG,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,VA,VA,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Wellcare MGG,Wellcare MGG,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Bright Health - commercial,Bright Health - commercial,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,174.75,174.75,Bright Health MGG,Bright Health MGG,174.75,,,,,,,case rate,174.75,174.75,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Aetna,Aetna,278.04,,,,,,,per diem,278.04,278.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Aetna MGG,Aetna MGG,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,BCBS,BCBS,278.04,,,,,,,per diem,278.04,278.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,BCBS MGG,BCBS MGG,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Cigna,Cigna,278.04,,,,,,,per diem,278.04,278.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Cigna MGG,Cigna MGG,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Humana,Humana,278.04,,,,,,,per diem,278.04,278.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Humana MGG,Humana MGG,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Optum VA,Optum VA,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,UHC,UHC,278.04,,,,,,,per diem,278.04,278.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,UHC MGG,UHC MGG,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,VA,VA,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Wellcare MGG,Wellcare MGG,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Bright Health - commercial,Bright Health - commercial,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,278.04,278.04,Bright Health MGG,Bright Health MGG,278.04,,,,,,,case rate,278.04,278.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Aetna,Aetna,293.78,,,,,,,per diem,293.78,293.78,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Aetna MGG,Aetna MGG,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,BCBS,BCBS,293.78,,,,,,,per diem,293.78,293.78,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,BCBS MGG,BCBS MGG,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Cigna,Cigna,293.78,,,,,,,per diem,293.78,293.78,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Cigna MGG,Cigna MGG,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Humana,Humana,293.78,,,,,,,per diem,293.78,293.78,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Humana MGG,Humana MGG,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Optum VA,Optum VA,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,UHC,UHC,293.78,,,,,,,per diem,293.78,293.78,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,UHC MGG,UHC MGG,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,VA,VA,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Wellcare MGG,Wellcare MGG,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Bright Health - commercial,Bright Health - commercial,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,293.78,293.78,Bright Health MGG,Bright Health MGG,293.78,,,,,,,case rate,293.78,293.78,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Aetna,Aetna,473.15,,,,,,,per diem,473.15,473.15,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Aetna MGG,Aetna MGG,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,BCBS,BCBS,473.15,,,,,,,per diem,473.15,473.15,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,BCBS MGG,BCBS MGG,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Cigna,Cigna,473.15,,,,,,,per diem,473.15,473.15,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Cigna MGG,Cigna MGG,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Humana,Humana,473.15,,,,,,,per diem,473.15,473.15,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Humana MGG,Humana MGG,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Optum VA,Optum VA,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,UHC,UHC,473.15,,,,,,,per diem,473.15,473.15,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,UHC MGG,UHC MGG,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,VA,VA,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Wellcare MGG,Wellcare MGG,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Bright Health - commercial,Bright Health - commercial,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,473.15,473.15,Bright Health MGG,Bright Health MGG,473.15,,,,,,,case rate,473.15,473.15,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Aetna,Aetna,465.92,,,,,,,per diem,465.92,465.92,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Aetna MGG,Aetna MGG,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,BCBS,BCBS,465.92,,,,,,,per diem,465.92,465.92,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,BCBS MGG,BCBS MGG,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Cigna,Cigna,465.92,,,,,,,per diem,465.92,465.92,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Cigna MGG,Cigna MGG,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Humana,Humana,465.92,,,,,,,per diem,465.92,465.92,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Humana MGG,Humana MGG,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Optum VA,Optum VA,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,UHC,UHC,465.92,,,,,,,per diem,465.92,465.92,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,UHC MGG,UHC MGG,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,VA,VA,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Wellcare MGG,Wellcare MGG,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Bright Health - commercial,Bright Health - commercial,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,465.92,465.92,Bright Health MGG,Bright Health MGG,465.92,,,,,,,case rate,465.92,465.92,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Aetna,Aetna,142.39,,,,,,,per diem,142.39,142.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Aetna MGG,Aetna MGG,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,BCBS,BCBS,142.39,,,,,,,per diem,142.39,142.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,BCBS MGG,BCBS MGG,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Cigna,Cigna,142.39,,,,,,,per diem,142.39,142.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Cigna MGG,Cigna MGG,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Humana,Humana,142.39,,,,,,,per diem,142.39,142.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Humana MGG,Humana MGG,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Optum VA,Optum VA,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,UHC,UHC,142.39,,,,,,,per diem,142.39,142.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,UHC MGG,UHC MGG,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,VA,VA,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Wellcare MGG,Wellcare MGG,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Bright Health - commercial,Bright Health - commercial,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,142.39,142.39,Bright Health MGG,Bright Health MGG,142.39,,,,,,,case rate,142.39,142.39,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Aetna,Aetna,161.34,,,,,,,per diem,161.34,161.34,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Aetna MGG,Aetna MGG,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,BCBS,BCBS,161.34,,,,,,,per diem,161.34,161.34,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,BCBS MGG,BCBS MGG,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Cigna,Cigna,161.34,,,,,,,per diem,161.34,161.34,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Cigna MGG,Cigna MGG,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Humana,Humana,161.34,,,,,,,per diem,161.34,161.34,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Humana MGG,Humana MGG,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Optum VA,Optum VA,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,UHC,UHC,161.34,,,,,,,per diem,161.34,161.34,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,UHC MGG,UHC MGG,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,VA,VA,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Wellcare MGG,Wellcare MGG,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Bright Health - commercial,Bright Health - commercial,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,161.34,161.34,Bright Health MGG,Bright Health MGG,161.34,,,,,,,case rate,161.34,161.34,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Aetna,Aetna,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Aetna MGG,Aetna MGG,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,BCBS,BCBS,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,BCBS MGG,BCBS MGG,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Cigna,Cigna,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Cigna MGG,Cigna MGG,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Humana,Humana,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Humana MGG,Humana MGG,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Optum VA,Optum VA,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,UHC,UHC,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,UHC MGG,UHC MGG,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,VA,VA,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Wellcare MGG,Wellcare MGG,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Bright Health - commercial,Bright Health - commercial,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,324.51,324.51,Bright Health MGG,Bright Health MGG,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Aetna,Aetna,304.36,,,,,,,per diem,304.36,304.36,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Aetna MGG,Aetna MGG,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,BCBS,BCBS,304.36,,,,,,,per diem,304.36,304.36,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,BCBS MGG,BCBS MGG,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Cigna,Cigna,304.36,,,,,,,per diem,304.36,304.36,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Cigna MGG,Cigna MGG,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Humana,Humana,304.36,,,,,,,per diem,304.36,304.36,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Humana MGG,Humana MGG,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Optum VA,Optum VA,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,UHC,UHC,304.36,,,,,,,per diem,304.36,304.36,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,UHC MGG,UHC MGG,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,VA,VA,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Wellcare MGG,Wellcare MGG,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Bright Health - commercial,Bright Health - commercial,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,304.36,304.36,Bright Health MGG,Bright Health MGG,304.36,,,,,,,case rate,304.36,304.36,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Aetna,Aetna,480.1,,,,,,,per diem,480.1,480.1,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Aetna MGG,Aetna MGG,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,BCBS,BCBS,480.1,,,,,,,per diem,480.1,480.1,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,BCBS MGG,BCBS MGG,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Cigna,Cigna,480.1,,,,,,,per diem,480.1,480.1,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Cigna MGG,Cigna MGG,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Humana,Humana,480.1,,,,,,,per diem,480.1,480.1,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Humana MGG,Humana MGG,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Optum VA,Optum VA,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,UHC,UHC,480.1,,,,,,,per diem,480.1,480.1,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,UHC MGG,UHC MGG,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,VA,VA,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Wellcare MGG,Wellcare MGG,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Bright Health - commercial,Bright Health - commercial,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,480.1,480.1,Bright Health MGG,Bright Health MGG,480.1,,,,,,,case rate,480.1,480.1,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Aetna,Aetna,256.05,,,,,,,per diem,256.05,256.05,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Aetna MGG,Aetna MGG,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,BCBS,BCBS,256.05,,,,,,,per diem,256.05,256.05,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,BCBS MGG,BCBS MGG,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Cigna,Cigna,256.05,,,,,,,per diem,256.05,256.05,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Cigna MGG,Cigna MGG,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Humana,Humana,256.05,,,,,,,per diem,256.05,256.05,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Humana MGG,Humana MGG,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Optum VA,Optum VA,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,UHC,UHC,256.05,,,,,,,per diem,256.05,256.05,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,UHC MGG,UHC MGG,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,VA,VA,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Wellcare MGG,Wellcare MGG,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Bright Health - commercial,Bright Health - commercial,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,256.05,256.05,Bright Health MGG,Bright Health MGG,256.05,,,,,,,case rate,256.05,256.05,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna,Aetna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna MGG,Aetna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS,BCBS,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS MGG,BCBS MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna,Cigna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna MGG,Cigna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana,Humana,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana MGG,Humana MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Optum VA,Optum VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC,UHC,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC MGG,UHC MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,VA,VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Wellcare MGG,Wellcare MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health - commercial,Bright Health - commercial,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health MGG,Bright Health MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna,Aetna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna MGG,Aetna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS,BCBS,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS MGG,BCBS MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna,Cigna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna MGG,Cigna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana,Humana,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana MGG,Humana MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Optum VA,Optum VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC,UHC,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC MGG,UHC MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,VA,VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Wellcare MGG,Wellcare MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health - commercial,Bright Health - commercial,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health MGG,Bright Health MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna,Aetna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna MGG,Aetna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS,BCBS,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS MGG,BCBS MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna,Cigna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna MGG,Cigna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana,Humana,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana MGG,Humana MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Optum VA,Optum VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC,UHC,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC MGG,UHC MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,VA,VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Wellcare MGG,Wellcare MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health - commercial,Bright Health - commercial,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health MGG,Bright Health MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna,Aetna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna MGG,Aetna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS,BCBS,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS MGG,BCBS MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna,Cigna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna MGG,Cigna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana,Humana,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana MGG,Humana MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Optum VA,Optum VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC,UHC,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC MGG,UHC MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,VA,VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Wellcare MGG,Wellcare MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health - commercial,Bright Health - commercial,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health MGG,Bright Health MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna,Aetna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna MGG,Aetna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS,BCBS,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS MGG,BCBS MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna,Cigna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna MGG,Cigna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana,Humana,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana MGG,Humana MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Optum VA,Optum VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC,UHC,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC MGG,UHC MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,VA,VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Wellcare MGG,Wellcare MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health - commercial,Bright Health - commercial,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health MGG,Bright Health MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna,Aetna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna MGG,Aetna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS,BCBS,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS MGG,BCBS MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna,Cigna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna MGG,Cigna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana,Humana,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana MGG,Humana MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Optum VA,Optum VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC,UHC,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC MGG,UHC MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,VA,VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Wellcare MGG,Wellcare MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health - commercial,Bright Health - commercial,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health MGG,Bright Health MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna,Aetna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Aetna MGG,Aetna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS,BCBS,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,BCBS MGG,BCBS MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna,Cigna,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Cigna MGG,Cigna MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana,Humana,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Humana MGG,Humana MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Optum VA,Optum VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC,UHC,529.01,,,,,,,per diem,529.01,529.01,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,UHC MGG,UHC MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,VA,VA,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Wellcare MGG,Wellcare MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health - commercial,Bright Health - commercial,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,529.01,529.01,Bright Health MGG,Bright Health MGG,529.01,,,,,,,case rate,529.01,529.01,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Aetna,Aetna,192.19,,,,,,,per diem,192.19,192.19,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Aetna MGG,Aetna MGG,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,BCBS,BCBS,192.19,,,,,,,per diem,192.19,192.19,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,BCBS MGG,BCBS MGG,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Cigna,Cigna,192.19,,,,,,,per diem,192.19,192.19,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Cigna MGG,Cigna MGG,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Humana,Humana,192.19,,,,,,,per diem,192.19,192.19,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Humana MGG,Humana MGG,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Optum VA,Optum VA,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,UHC,UHC,192.19,,,,,,,per diem,192.19,192.19,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,UHC MGG,UHC MGG,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,VA,VA,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Wellcare MGG,Wellcare MGG,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Bright Health - commercial,Bright Health - commercial,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,192.19,192.19,Bright Health MGG,Bright Health MGG,192.19,,,,,,,case rate,192.19,192.19,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Aetna,Aetna,174.07,,,,,,,per diem,174.07,174.07,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Aetna MGG,Aetna MGG,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,BCBS,BCBS,174.07,,,,,,,per diem,174.07,174.07,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,BCBS MGG,BCBS MGG,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Cigna,Cigna,174.07,,,,,,,per diem,174.07,174.07,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Cigna MGG,Cigna MGG,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Humana,Humana,174.07,,,,,,,per diem,174.07,174.07,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Humana MGG,Humana MGG,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Optum VA,Optum VA,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,UHC,UHC,174.07,,,,,,,per diem,174.07,174.07,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,UHC MGG,UHC MGG,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,VA,VA,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Wellcare MGG,Wellcare MGG,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Bright Health - commercial,Bright Health - commercial,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,174.07,174.07,Bright Health MGG,Bright Health MGG,174.07,,,,,,,case rate,174.07,174.07,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Aetna,Aetna,164.25,,,,,,,per diem,164.25,164.25,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Aetna MGG,Aetna MGG,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,BCBS,BCBS,164.25,,,,,,,per diem,164.25,164.25,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,BCBS MGG,BCBS MGG,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Cigna,Cigna,164.25,,,,,,,per diem,164.25,164.25,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Cigna MGG,Cigna MGG,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Humana,Humana,164.25,,,,,,,per diem,164.25,164.25,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Humana MGG,Humana MGG,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Optum VA,Optum VA,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,UHC,UHC,164.25,,,,,,,per diem,164.25,164.25,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,UHC MGG,UHC MGG,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,VA,VA,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Wellcare MGG,Wellcare MGG,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Bright Health - commercial,Bright Health - commercial,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,164.25,164.25,Bright Health MGG,Bright Health MGG,164.25,,,,,,,case rate,164.25,164.25,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Aetna,Aetna,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Aetna MGG,Aetna MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,BCBS,BCBS,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,BCBS MGG,BCBS MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Cigna,Cigna,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Cigna MGG,Cigna MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Humana,Humana,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Humana MGG,Humana MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Optum VA,Optum VA,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,UHC,UHC,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,UHC MGG,UHC MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,VA,VA,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Wellcare MGG,Wellcare MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Bright Health - commercial,Bright Health - commercial,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,75.85,75.85,Bright Health MGG,Bright Health MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Aetna,Aetna,66.21,,,,,,,per diem,66.21,66.21,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Aetna MGG,Aetna MGG,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,BCBS,BCBS,66.21,,,,,,,per diem,66.21,66.21,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,BCBS MGG,BCBS MGG,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Cigna,Cigna,66.21,,,,,,,per diem,66.21,66.21,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Cigna MGG,Cigna MGG,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Humana,Humana,66.21,,,,,,,per diem,66.21,66.21,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Humana MGG,Humana MGG,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Optum VA,Optum VA,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,UHC,UHC,66.21,,,,,,,per diem,66.21,66.21,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,UHC MGG,UHC MGG,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,VA,VA,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Wellcare MGG,Wellcare MGG,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Bright Health - commercial,Bright Health - commercial,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,66.21,66.21,Bright Health MGG,Bright Health MGG,66.21,,,,,,,case rate,66.21,66.21,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Aetna,Aetna,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Aetna MGG,Aetna MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,BCBS,BCBS,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,BCBS MGG,BCBS MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Cigna,Cigna,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Cigna MGG,Cigna MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Humana,Humana,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Humana MGG,Humana MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Optum VA,Optum VA,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,UHC,UHC,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,UHC MGG,UHC MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,VA,VA,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Wellcare MGG,Wellcare MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Bright Health - commercial,Bright Health - commercial,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,99.87,99.87,Bright Health MGG,Bright Health MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Aetna,Aetna,564.07,,,,,,,per diem,564.07,564.07,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Aetna MGG,Aetna MGG,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,BCBS,BCBS,564.07,,,,,,,per diem,564.07,564.07,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,BCBS MGG,BCBS MGG,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Cigna,Cigna,564.07,,,,,,,per diem,564.07,564.07,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Cigna MGG,Cigna MGG,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Humana,Humana,564.07,,,,,,,per diem,564.07,564.07,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Humana MGG,Humana MGG,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Optum VA,Optum VA,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,UHC,UHC,564.07,,,,,,,per diem,564.07,564.07,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,UHC MGG,UHC MGG,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,VA,VA,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Wellcare MGG,Wellcare MGG,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Bright Health - commercial,Bright Health - commercial,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,564.07,564.07,Bright Health MGG,Bright Health MGG,564.07,,,,,,,case rate,564.07,564.07,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Aetna,Aetna,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Aetna MGG,Aetna MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,BCBS,BCBS,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,BCBS MGG,BCBS MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Cigna,Cigna,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Cigna MGG,Cigna MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Humana,Humana,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Humana MGG,Humana MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Optum VA,Optum VA,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,UHC,UHC,99.87,,,,,,,per diem,99.87,99.87,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,UHC MGG,UHC MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,VA,VA,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Wellcare MGG,Wellcare MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Bright Health - commercial,Bright Health - commercial,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,99.87,99.87,Bright Health MGG,Bright Health MGG,99.87,,,,,,,case rate,99.87,99.87,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Aetna,Aetna,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Aetna MGG,Aetna MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,BCBS,BCBS,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,BCBS MGG,BCBS MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Cigna,Cigna,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Cigna MGG,Cigna MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Humana,Humana,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Humana MGG,Humana MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Optum VA,Optum VA,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,UHC,UHC,243.36,,,,,,,per diem,243.36,243.36,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,UHC MGG,UHC MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,VA,VA,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Wellcare MGG,Wellcare MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Bright Health - commercial,Bright Health - commercial,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,243.36,243.36,Bright Health MGG,Bright Health MGG,243.36,,,,,,,case rate,243.36,243.36,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Aetna,Aetna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Aetna MGG,Aetna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,BCBS,BCBS,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,BCBS MGG,BCBS MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Cigna,Cigna,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Cigna MGG,Cigna MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Humana,Humana,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Humana MGG,Humana MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Optum VA,Optum VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,UHC,UHC,33.51,,,,,,,per diem,33.51,33.51,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,UHC MGG,UHC MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,VA,VA,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Wellcare MGG,Wellcare MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Bright Health - commercial,Bright Health - commercial,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,33.51,33.51,Bright Health MGG,Bright Health MGG,33.51,,,,,,,case rate,33.51,33.51,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Aetna,Aetna,824.08,,,,,,,per diem,824.08,824.08,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Aetna MGG,Aetna MGG,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,BCBS,BCBS,824.08,,,,,,,per diem,824.08,824.08,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,BCBS MGG,BCBS MGG,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Cigna,Cigna,824.08,,,,,,,per diem,824.08,824.08,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Cigna MGG,Cigna MGG,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Humana,Humana,824.08,,,,,,,per diem,824.08,824.08,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Humana MGG,Humana MGG,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Optum VA,Optum VA,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,UHC,UHC,824.08,,,,,,,per diem,824.08,824.08,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,UHC MGG,UHC MGG,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,VA,VA,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Wellcare MGG,Wellcare MGG,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Bright Health - commercial,Bright Health - commercial,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,824.08,824.08,Bright Health MGG,Bright Health MGG,824.08,,,,,,,case rate,824.08,824.08,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Aetna,Aetna,209.3,,,,,,,per diem,209.3,209.3,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Aetna MGG,Aetna MGG,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,BCBS,BCBS,209.3,,,,,,,per diem,209.3,209.3,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,BCBS MGG,BCBS MGG,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Cigna,Cigna,209.3,,,,,,,per diem,209.3,209.3,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Cigna MGG,Cigna MGG,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Humana,Humana,209.3,,,,,,,per diem,209.3,209.3,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Humana MGG,Humana MGG,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Optum VA,Optum VA,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,UHC,UHC,209.3,,,,,,,per diem,209.3,209.3,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,UHC MGG,UHC MGG,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,VA,VA,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Wellcare MGG,Wellcare MGG,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Bright Health - commercial,Bright Health - commercial,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,209.3,209.3,Bright Health MGG,Bright Health MGG,209.3,,,,,,,case rate,209.3,209.3,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Aetna,Aetna,388.4,,,,,,,per diem,388.4,388.4,"Per diem rate, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Aetna MGG,Aetna MGG,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,BCBS,BCBS,388.4,,,,,,,per diem,388.4,388.4,"Per diem rate, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,BCBS MGG,BCBS MGG,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Cigna,Cigna,388.4,,,,,,,per diem,388.4,388.4,"Per diem rate, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Cigna MGG,Cigna MGG,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Humana,Humana,388.4,,,,,,,per diem,388.4,388.4,"Per diem rate, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Humana MGG,Humana MGG,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Optum VA,Optum VA,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,UHC,UHC,388.4,,,,,,,per diem,388.4,388.4,"Per diem rate, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,UHC MGG,UHC MGG,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,VA,VA,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Wellcare MGG,Wellcare MGG,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Bright Health - commercial,Bright Health - commercial,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
CLINICAL/BEDSIDE EVALUATION   ,34600419,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,388.4,388.4,Bright Health MGG,Bright Health MGG,388.4,,,,,,,case rate,388.4,388.4,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Aetna,Aetna,518.56,,,,,,,per diem,518.56,518.56,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Aetna MGG,Aetna MGG,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,BCBS,BCBS,518.56,,,,,,,per diem,518.56,518.56,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,BCBS MGG,BCBS MGG,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Cigna,Cigna,518.56,,,,,,,per diem,518.56,518.56,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Cigna MGG,Cigna MGG,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Humana,Humana,518.56,,,,,,,per diem,518.56,518.56,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Humana MGG,Humana MGG,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Optum VA,Optum VA,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,UHC,UHC,518.56,,,,,,,per diem,518.56,518.56,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,UHC MGG,UHC MGG,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,VA,VA,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Wellcare MGG,Wellcare MGG,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Bright Health - commercial,Bright Health - commercial,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,518.56,518.56,Bright Health MGG,Bright Health MGG,518.56,,,,,,,case rate,518.56,518.56,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Aetna,Aetna,295.62,,,,,,,per diem,295.62,295.62,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Aetna MGG,Aetna MGG,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,BCBS,BCBS,295.62,,,,,,,per diem,295.62,295.62,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,BCBS MGG,BCBS MGG,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Cigna,Cigna,295.62,,,,,,,per diem,295.62,295.62,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Cigna MGG,Cigna MGG,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Humana,Humana,295.62,,,,,,,per diem,295.62,295.62,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Humana MGG,Humana MGG,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Optum VA,Optum VA,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,UHC,UHC,295.62,,,,,,,per diem,295.62,295.62,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,UHC MGG,UHC MGG,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,VA,VA,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Wellcare MGG,Wellcare MGG,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Bright Health - commercial,Bright Health - commercial,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,295.62,295.62,Bright Health MGG,Bright Health MGG,295.62,,,,,,,case rate,295.62,295.62,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Aetna,Aetna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Aetna MGG,Aetna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,BCBS,BCBS,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,BCBS MGG,BCBS MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Cigna,Cigna,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Cigna MGG,Cigna MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Humana,Humana,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Humana MGG,Humana MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Optum VA,Optum VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,UHC,UHC,703.49,,,,,,,per diem,703.49,703.49,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,UHC MGG,UHC MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,VA,VA,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Wellcare MGG,Wellcare MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Bright Health - commercial,Bright Health - commercial,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,703.49,703.49,Bright Health MGG,Bright Health MGG,703.49,,,,,,,case rate,703.49,703.49,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Aetna,Aetna,398.94,,,,,,,per diem,398.94,398.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Aetna MGG,Aetna MGG,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,BCBS,BCBS,398.94,,,,,,,per diem,398.94,398.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,BCBS MGG,BCBS MGG,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Cigna,Cigna,398.94,,,,,,,per diem,398.94,398.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Cigna MGG,Cigna MGG,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Humana,Humana,398.94,,,,,,,per diem,398.94,398.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Humana MGG,Humana MGG,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Optum VA,Optum VA,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,UHC,UHC,398.94,,,,,,,per diem,398.94,398.94,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,UHC MGG,UHC MGG,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,VA,VA,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Wellcare MGG,Wellcare MGG,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Bright Health - commercial,Bright Health - commercial,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,398.94,398.94,Bright Health MGG,Bright Health MGG,398.94,,,,,,,case rate,398.94,398.94,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Aetna,Aetna,153.99,,,,,,,per diem,153.99,153.99,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Aetna MGG,Aetna MGG,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,BCBS,BCBS,153.99,,,,,,,per diem,153.99,153.99,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,BCBS MGG,BCBS MGG,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Cigna,Cigna,153.99,,,,,,,per diem,153.99,153.99,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Cigna MGG,Cigna MGG,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Humana,Humana,153.99,,,,,,,per diem,153.99,153.99,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Humana MGG,Humana MGG,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Optum VA,Optum VA,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,UHC,UHC,153.99,,,,,,,per diem,153.99,153.99,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,UHC MGG,UHC MGG,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,VA,VA,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Wellcare MGG,Wellcare MGG,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Bright Health - commercial,Bright Health - commercial,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,153.99,153.99,Bright Health MGG,Bright Health MGG,153.99,,,,,,,case rate,153.99,153.99,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Aetna,Aetna,31.61,,,,,,,per diem,31.61,31.61,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Aetna MGG,Aetna MGG,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,BCBS,BCBS,31.61,,,,,,,per diem,31.61,31.61,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,BCBS MGG,BCBS MGG,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Cigna,Cigna,31.61,,,,,,,per diem,31.61,31.61,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Cigna MGG,Cigna MGG,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Humana,Humana,31.61,,,,,,,per diem,31.61,31.61,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Humana MGG,Humana MGG,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Optum VA,Optum VA,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,UHC,UHC,31.61,,,,,,,per diem,31.61,31.61,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,UHC MGG,UHC MGG,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,VA,VA,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Wellcare MGG,Wellcare MGG,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Bright Health - commercial,Bright Health - commercial,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,31.61,31.61,Bright Health MGG,Bright Health MGG,31.61,,,,,,,case rate,31.61,31.61,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Aetna,Aetna,116.84,,,,,,,per diem,116.84,116.84,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Aetna MGG,Aetna MGG,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,BCBS,BCBS,116.84,,,,,,,per diem,116.84,116.84,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,BCBS MGG,BCBS MGG,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Cigna,Cigna,116.84,,,,,,,per diem,116.84,116.84,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Cigna MGG,Cigna MGG,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Humana,Humana,116.84,,,,,,,per diem,116.84,116.84,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Humana MGG,Humana MGG,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Optum VA,Optum VA,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,UHC,UHC,116.84,,,,,,,per diem,116.84,116.84,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,UHC MGG,UHC MGG,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,VA,VA,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Wellcare MGG,Wellcare MGG,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Bright Health - commercial,Bright Health - commercial,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,116.84,116.84,Bright Health MGG,Bright Health MGG,116.84,,,,,,,case rate,116.84,116.84,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Aetna,Aetna,366.54,,,,,,,per diem,366.54,366.54,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Aetna MGG,Aetna MGG,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,BCBS,BCBS,366.54,,,,,,,per diem,366.54,366.54,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,BCBS MGG,BCBS MGG,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Cigna,Cigna,366.54,,,,,,,per diem,366.54,366.54,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Cigna MGG,Cigna MGG,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Humana,Humana,366.54,,,,,,,per diem,366.54,366.54,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Humana MGG,Humana MGG,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Optum VA,Optum VA,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,UHC,UHC,366.54,,,,,,,per diem,366.54,366.54,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,UHC MGG,UHC MGG,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,VA,VA,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Wellcare MGG,Wellcare MGG,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Bright Health - commercial,Bright Health - commercial,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,366.54,366.54,Bright Health MGG,Bright Health MGG,366.54,,,,,,,case rate,366.54,366.54,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Aetna,Aetna,170.61,,,,,,,per diem,170.61,170.61,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Aetna MGG,Aetna MGG,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,BCBS,BCBS,170.61,,,,,,,per diem,170.61,170.61,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,BCBS MGG,BCBS MGG,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Cigna,Cigna,170.61,,,,,,,per diem,170.61,170.61,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Cigna MGG,Cigna MGG,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Humana,Humana,170.61,,,,,,,per diem,170.61,170.61,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Humana MGG,Humana MGG,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Optum VA,Optum VA,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,UHC,UHC,170.61,,,,,,,per diem,170.61,170.61,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,UHC MGG,UHC MGG,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,VA,VA,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Wellcare MGG,Wellcare MGG,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Bright Health - commercial,Bright Health - commercial,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,170.61,170.61,Bright Health MGG,Bright Health MGG,170.61,,,,,,,case rate,170.61,170.61,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Aetna,Aetna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Aetna MGG,Aetna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,BCBS,BCBS,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,BCBS MGG,BCBS MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Cigna,Cigna,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Cigna MGG,Cigna MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Humana,Humana,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Humana MGG,Humana MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Optum VA,Optum VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,UHC,UHC,83.72,,,,,,,per diem,83.72,83.72,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,UHC MGG,UHC MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,VA,VA,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Wellcare MGG,Wellcare MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Bright Health - commercial,Bright Health - commercial,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,83.72,83.72,Bright Health MGG,Bright Health MGG,83.72,,,,,,,case rate,83.72,83.72,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Aetna,Aetna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Aetna MGG,Aetna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,BCBS,BCBS,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,BCBS MGG,BCBS MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Cigna,Cigna,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Cigna MGG,Cigna MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Humana,Humana,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Humana MGG,Humana MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Optum VA,Optum VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,UHC,UHC,234.77,,,,,,,per diem,234.77,234.77,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,UHC MGG,UHC MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,VA,VA,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Wellcare MGG,Wellcare MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Bright Health - commercial,Bright Health - commercial,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,234.77,234.77,Bright Health MGG,Bright Health MGG,234.77,,,,,,,case rate,234.77,234.77,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Aetna,Aetna,421.38,,,,,,,per diem,421.38,421.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Aetna MGG,Aetna MGG,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,BCBS,BCBS,421.38,,,,,,,per diem,421.38,421.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,BCBS MGG,BCBS MGG,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Cigna,Cigna,421.38,,,,,,,per diem,421.38,421.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Cigna MGG,Cigna MGG,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Humana,Humana,421.38,,,,,,,per diem,421.38,421.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Humana MGG,Humana MGG,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Optum VA,Optum VA,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,UHC,UHC,421.38,,,,,,,per diem,421.38,421.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,UHC MGG,UHC MGG,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,VA,VA,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Wellcare MGG,Wellcare MGG,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Bright Health - commercial,Bright Health - commercial,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,421.38,421.38,Bright Health MGG,Bright Health MGG,421.38,,,,,,,case rate,421.38,421.38,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Aetna,Aetna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Aetna MGG,Aetna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,BCBS,BCBS,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,BCBS MGG,BCBS MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Cigna,Cigna,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Cigna MGG,Cigna MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Humana,Humana,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Humana MGG,Humana MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Optum VA,Optum VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,UHC,UHC,632.07,,,,,,,per diem,632.07,632.07,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,UHC MGG,UHC MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,VA,VA,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Wellcare MGG,Wellcare MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Bright Health - commercial,Bright Health - commercial,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,632.07,632.07,Bright Health MGG,Bright Health MGG,632.07,,,,,,,case rate,632.07,632.07,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Aetna,Aetna,359.59,,,,,,,per diem,359.59,359.59,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Aetna MGG,Aetna MGG,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,BCBS,BCBS,359.59,,,,,,,per diem,359.59,359.59,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,BCBS MGG,BCBS MGG,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Cigna,Cigna,359.59,,,,,,,per diem,359.59,359.59,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Cigna MGG,Cigna MGG,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Humana,Humana,359.59,,,,,,,per diem,359.59,359.59,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Humana MGG,Humana MGG,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Optum VA,Optum VA,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,UHC,UHC,359.59,,,,,,,per diem,359.59,359.59,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,UHC MGG,UHC MGG,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,VA,VA,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Wellcare MGG,Wellcare MGG,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Bright Health - commercial,Bright Health - commercial,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,359.59,359.59,Bright Health MGG,Bright Health MGG,359.59,,,,,,,case rate,359.59,359.59,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Aetna,Aetna,257.96,,,,,,,per diem,257.96,257.96,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Aetna MGG,Aetna MGG,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,BCBS,BCBS,257.96,,,,,,,per diem,257.96,257.96,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,BCBS MGG,BCBS MGG,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Cigna,Cigna,257.96,,,,,,,per diem,257.96,257.96,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Cigna MGG,Cigna MGG,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Humana,Humana,257.96,,,,,,,per diem,257.96,257.96,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Humana MGG,Humana MGG,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Optum VA,Optum VA,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,UHC,UHC,257.96,,,,,,,per diem,257.96,257.96,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,UHC MGG,UHC MGG,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,VA,VA,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Wellcare MGG,Wellcare MGG,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Bright Health - commercial,Bright Health - commercial,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,257.96,257.96,Bright Health MGG,Bright Health MGG,257.96,,,,,,,case rate,257.96,257.96,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Aetna,Aetna,765.43,,,,,,,per diem,765.43,765.43,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Aetna MGG,Aetna MGG,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,BCBS,BCBS,765.43,,,,,,,per diem,765.43,765.43,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,BCBS MGG,BCBS MGG,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Cigna,Cigna,765.43,,,,,,,per diem,765.43,765.43,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Cigna MGG,Cigna MGG,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Humana,Humana,765.43,,,,,,,per diem,765.43,765.43,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Humana MGG,Humana MGG,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Optum VA,Optum VA,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,UHC,UHC,765.43,,,,,,,per diem,765.43,765.43,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,UHC MGG,UHC MGG,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,VA,VA,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Wellcare MGG,Wellcare MGG,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Bright Health - commercial,Bright Health - commercial,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,765.43,765.43,Bright Health MGG,Bright Health MGG,765.43,,,,,,,case rate,765.43,765.43,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Aetna,Aetna,546.59,,,,,,,per diem,546.59,546.59,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Aetna MGG,Aetna MGG,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,BCBS,BCBS,546.59,,,,,,,per diem,546.59,546.59,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,BCBS MGG,BCBS MGG,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Cigna,Cigna,546.59,,,,,,,per diem,546.59,546.59,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Cigna MGG,Cigna MGG,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Humana,Humana,546.59,,,,,,,per diem,546.59,546.59,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Humana MGG,Humana MGG,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Optum VA,Optum VA,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,UHC,UHC,546.59,,,,,,,per diem,546.59,546.59,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,UHC MGG,UHC MGG,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,VA,VA,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Wellcare MGG,Wellcare MGG,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Bright Health - commercial,Bright Health - commercial,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,546.59,546.59,Bright Health MGG,Bright Health MGG,546.59,,,,,,,case rate,546.59,546.59,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Aetna,Aetna,96.32,,,,,,,per diem,96.32,96.32,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Aetna MGG,Aetna MGG,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,BCBS,BCBS,96.32,,,,,,,per diem,96.32,96.32,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,BCBS MGG,BCBS MGG,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Cigna,Cigna,96.32,,,,,,,per diem,96.32,96.32,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Cigna MGG,Cigna MGG,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Humana,Humana,96.32,,,,,,,per diem,96.32,96.32,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Humana MGG,Humana MGG,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Optum VA,Optum VA,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,UHC,UHC,96.32,,,,,,,per diem,96.32,96.32,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,UHC MGG,UHC MGG,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,VA,VA,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Wellcare MGG,Wellcare MGG,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Bright Health - commercial,Bright Health - commercial,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,96.32,96.32,Bright Health MGG,Bright Health MGG,96.32,,,,,,,case rate,96.32,96.32,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Aetna,Aetna,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Aetna MGG,Aetna MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,BCBS,BCBS,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,BCBS MGG,BCBS MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Cigna,Cigna,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Cigna MGG,Cigna MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Humana,Humana,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Humana MGG,Humana MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Optum VA,Optum VA,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,UHC,UHC,93.69,,,,,,,per diem,93.69,93.69,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,UHC MGG,UHC MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,VA,VA,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Wellcare MGG,Wellcare MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Bright Health - commercial,Bright Health - commercial,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,93.69,93.69,Bright Health MGG,Bright Health MGG,93.69,,,,,,,case rate,93.69,93.69,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Aetna,Aetna,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Aetna MGG,Aetna MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,BCBS,BCBS,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,BCBS MGG,BCBS MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Cigna,Cigna,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Cigna MGG,Cigna MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Humana,Humana,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Humana MGG,Humana MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Optum VA,Optum VA,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,UHC,UHC,108.53,,,,,,,per diem,108.53,108.53,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,UHC MGG,UHC MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,VA,VA,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Wellcare MGG,Wellcare MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Bright Health - commercial,Bright Health - commercial,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,108.53,108.53,Bright Health MGG,Bright Health MGG,108.53,,,,,,,case rate,108.53,108.53,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Aetna,Aetna,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Aetna MGG,Aetna MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,BCBS,BCBS,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,BCBS MGG,BCBS MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Cigna,Cigna,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Cigna MGG,Cigna MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Humana,Humana,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Humana MGG,Humana MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Optum VA,Optum VA,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,UHC,UHC,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,UHC MGG,UHC MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,VA,VA,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Wellcare MGG,Wellcare MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Bright Health - commercial,Bright Health - commercial,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,165.9,165.9,Bright Health MGG,Bright Health MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Aetna,Aetna,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Aetna MGG,Aetna MGG,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,BCBS,BCBS,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,BCBS MGG,BCBS MGG,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Cigna,Cigna,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Cigna MGG,Cigna MGG,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Humana,Humana,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Humana MGG,Humana MGG,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Optum VA,Optum VA,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,UHC,UHC,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,UHC MGG,UHC MGG,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,VA,VA,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Wellcare MGG,Wellcare MGG,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Bright Health - commercial,Bright Health - commercial,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,Bright Health MGG,Bright Health MGG,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Aetna,Aetna,190.05,,,,,,,per diem,190.05,190.05,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Aetna MGG,Aetna MGG,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,BCBS,BCBS,190.05,,,,,,,per diem,190.05,190.05,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,BCBS MGG,BCBS MGG,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Cigna,Cigna,190.05,,,,,,,per diem,190.05,190.05,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Cigna MGG,Cigna MGG,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Humana,Humana,190.05,,,,,,,per diem,190.05,190.05,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Humana MGG,Humana MGG,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Optum VA,Optum VA,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,UHC,UHC,190.05,,,,,,,per diem,190.05,190.05,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,UHC MGG,UHC MGG,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,VA,VA,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Wellcare MGG,Wellcare MGG,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Bright Health - commercial,Bright Health - commercial,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,190.05,190.05,Bright Health MGG,Bright Health MGG,190.05,,,,,,,case rate,190.05,190.05,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Aetna,Aetna,103.09,,,,,,,per diem,103.09,103.09,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Aetna MGG,Aetna MGG,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,BCBS,BCBS,103.09,,,,,,,per diem,103.09,103.09,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,BCBS MGG,BCBS MGG,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Cigna,Cigna,103.09,,,,,,,per diem,103.09,103.09,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Cigna MGG,Cigna MGG,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Humana,Humana,103.09,,,,,,,per diem,103.09,103.09,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Humana MGG,Humana MGG,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Optum VA,Optum VA,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,UHC,UHC,103.09,,,,,,,per diem,103.09,103.09,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,UHC MGG,UHC MGG,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,VA,VA,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Wellcare MGG,Wellcare MGG,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Bright Health - commercial,Bright Health - commercial,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,103.09,103.09,Bright Health MGG,Bright Health MGG,103.09,,,,,,,case rate,103.09,103.09,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Aetna,Aetna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Aetna MGG,Aetna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,BCBS,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,BCBS MGG,BCBS MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Cigna,Cigna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Cigna MGG,Cigna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Humana,Humana,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Humana MGG,Humana MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Optum VA,Optum VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,UHC,UHC,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,UHC MGG,UHC MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,VA,VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Wellcare MGG,Wellcare MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Bright Health - commercial,Bright Health - commercial,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,Bright Health MGG,Bright Health MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Aetna,Aetna,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Aetna MGG,Aetna MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,BCBS,BCBS,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,BCBS MGG,BCBS MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Cigna,Cigna,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Cigna MGG,Cigna MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Humana,Humana,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Humana MGG,Humana MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Optum VA,Optum VA,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,UHC,UHC,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,UHC MGG,UHC MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,VA,VA,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Wellcare MGG,Wellcare MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Bright Health - commercial,Bright Health - commercial,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,86.63,86.63,Bright Health MGG,Bright Health MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Aetna,Aetna,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Aetna MGG,Aetna MGG,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,BCBS,BCBS,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,BCBS MGG,BCBS MGG,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Cigna,Cigna,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Cigna MGG,Cigna MGG,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Humana,Humana,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Humana MGG,Humana MGG,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Optum VA,Optum VA,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,UHC,UHC,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,UHC MGG,UHC MGG,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,VA,VA,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Wellcare MGG,Wellcare MGG,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Bright Health - commercial,Bright Health - commercial,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,40.75,40.75,Bright Health MGG,Bright Health MGG,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Aetna,Aetna,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Aetna MGG,Aetna MGG,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,BCBS,BCBS,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,BCBS MGG,BCBS MGG,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Cigna,Cigna,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Cigna MGG,Cigna MGG,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Humana,Humana,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Humana MGG,Humana MGG,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Optum VA,Optum VA,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,UHC,UHC,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,UHC MGG,UHC MGG,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,VA,VA,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Wellcare MGG,Wellcare MGG,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Bright Health - commercial,Bright Health - commercial,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,Bright Health MGG,Bright Health MGG,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Aetna,Aetna,517.46,,,,,,,per diem,517.46,517.46,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Aetna MGG,Aetna MGG,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,BCBS,BCBS,517.46,,,,,,,per diem,517.46,517.46,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,BCBS MGG,BCBS MGG,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Cigna,Cigna,517.46,,,,,,,per diem,517.46,517.46,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Cigna MGG,Cigna MGG,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Humana,Humana,517.46,,,,,,,per diem,517.46,517.46,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Humana MGG,Humana MGG,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Optum VA,Optum VA,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,UHC,UHC,517.46,,,,,,,per diem,517.46,517.46,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,UHC MGG,UHC MGG,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,VA,VA,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Wellcare MGG,Wellcare MGG,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Bright Health - commercial,Bright Health - commercial,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,517.46,517.46,Bright Health MGG,Bright Health MGG,517.46,,,,,,,case rate,517.46,517.46,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Aetna,Aetna,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Aetna MGG,Aetna MGG,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,BCBS,BCBS,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,BCBS MGG,BCBS MGG,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Cigna,Cigna,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Cigna MGG,Cigna MGG,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Humana,Humana,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Humana MGG,Humana MGG,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Optum VA,Optum VA,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,UHC,UHC,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,UHC MGG,UHC MGG,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,VA,VA,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Wellcare MGG,Wellcare MGG,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Bright Health - commercial,Bright Health - commercial,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,Bright Health MGG,Bright Health MGG,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Aetna,Aetna,424.57,,,,,,,per diem,424.57,424.57,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Aetna MGG,Aetna MGG,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,BCBS,BCBS,424.57,,,,,,,per diem,424.57,424.57,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,BCBS MGG,BCBS MGG,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Cigna,Cigna,424.57,,,,,,,per diem,424.57,424.57,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Cigna MGG,Cigna MGG,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Humana,Humana,424.57,,,,,,,per diem,424.57,424.57,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Humana MGG,Humana MGG,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Optum VA,Optum VA,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,UHC,UHC,424.57,,,,,,,per diem,424.57,424.57,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,UHC MGG,UHC MGG,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,VA,VA,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Wellcare MGG,Wellcare MGG,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Bright Health - commercial,Bright Health - commercial,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,424.57,424.57,Bright Health MGG,Bright Health MGG,424.57,,,,,,,case rate,424.57,424.57,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Aetna,Aetna,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Aetna MGG,Aetna MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,BCBS,BCBS,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,BCBS MGG,BCBS MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Cigna,Cigna,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Cigna MGG,Cigna MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Humana,Humana,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Humana MGG,Humana MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Optum VA,Optum VA,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,UHC,UHC,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,UHC MGG,UHC MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,VA,VA,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Wellcare MGG,Wellcare MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Bright Health - commercial,Bright Health - commercial,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,Bright Health MGG,Bright Health MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Aetna,Aetna,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Aetna MGG,Aetna MGG,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,BCBS,BCBS,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,BCBS MGG,BCBS MGG,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Cigna,Cigna,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Cigna MGG,Cigna MGG,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Humana,Humana,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Humana MGG,Humana MGG,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Optum VA,Optum VA,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,UHC,UHC,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,UHC MGG,UHC MGG,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,VA,VA,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Wellcare MGG,Wellcare MGG,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Bright Health - commercial,Bright Health - commercial,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,Bright Health MGG,Bright Health MGG,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Aetna,Aetna,397.3,,,,,,,per diem,397.3,397.3,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Aetna MGG,Aetna MGG,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,BCBS,BCBS,397.3,,,,,,,per diem,397.3,397.3,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,BCBS MGG,BCBS MGG,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Cigna,Cigna,397.3,,,,,,,per diem,397.3,397.3,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Cigna MGG,Cigna MGG,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Humana,Humana,397.3,,,,,,,per diem,397.3,397.3,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Humana MGG,Humana MGG,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Optum VA,Optum VA,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,UHC,UHC,397.3,,,,,,,per diem,397.3,397.3,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,UHC MGG,UHC MGG,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,VA,VA,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Wellcare MGG,Wellcare MGG,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Bright Health - commercial,Bright Health - commercial,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,397.3,397.3,Bright Health MGG,Bright Health MGG,397.3,,,,,,,case rate,397.3,397.3,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Aetna,Aetna,91.11,,,,,,,per diem,91.11,91.11,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Aetna MGG,Aetna MGG,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,BCBS,BCBS,91.11,,,,,,,per diem,91.11,91.11,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,BCBS MGG,BCBS MGG,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Cigna,Cigna,91.11,,,,,,,per diem,91.11,91.11,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Cigna MGG,Cigna MGG,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Humana,Humana,91.11,,,,,,,per diem,91.11,91.11,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Humana MGG,Humana MGG,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Optum VA,Optum VA,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,UHC,UHC,91.11,,,,,,,per diem,91.11,91.11,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,UHC MGG,UHC MGG,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,VA,VA,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Wellcare MGG,Wellcare MGG,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Bright Health - commercial,Bright Health - commercial,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,91.11,91.11,Bright Health MGG,Bright Health MGG,91.11,,,,,,,case rate,91.11,91.11,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Aetna,Aetna,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Aetna MGG,Aetna MGG,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,BCBS,BCBS,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,BCBS MGG,BCBS MGG,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Cigna,Cigna,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Cigna MGG,Cigna MGG,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Humana,Humana,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Humana MGG,Humana MGG,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Optum VA,Optum VA,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,UHC,UHC,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,UHC MGG,UHC MGG,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,VA,VA,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Wellcare MGG,Wellcare MGG,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Bright Health - commercial,Bright Health - commercial,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,Bright Health MGG,Bright Health MGG,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Aetna,Aetna,102.77,,,,,,,per diem,102.77,102.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Aetna MGG,Aetna MGG,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,BCBS,BCBS,102.77,,,,,,,per diem,102.77,102.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,BCBS MGG,BCBS MGG,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Cigna,Cigna,102.77,,,,,,,per diem,102.77,102.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Cigna MGG,Cigna MGG,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Humana,Humana,102.77,,,,,,,per diem,102.77,102.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Humana MGG,Humana MGG,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Optum VA,Optum VA,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,UHC,UHC,102.77,,,,,,,per diem,102.77,102.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,UHC MGG,UHC MGG,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,VA,VA,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Wellcare MGG,Wellcare MGG,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Bright Health - commercial,Bright Health - commercial,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,102.77,102.77,Bright Health MGG,Bright Health MGG,102.77,,,,,,,case rate,102.77,102.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Aetna,Aetna,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Aetna MGG,Aetna MGG,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,BCBS,BCBS,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,BCBS MGG,BCBS MGG,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Cigna,Cigna,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Cigna MGG,Cigna MGG,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Humana,Humana,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Humana MGG,Humana MGG,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Optum VA,Optum VA,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,UHC,UHC,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,UHC MGG,UHC MGG,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,VA,VA,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Wellcare MGG,Wellcare MGG,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Bright Health - commercial,Bright Health - commercial,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,74.62,74.62,Bright Health MGG,Bright Health MGG,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Aetna,Aetna,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Aetna MGG,Aetna MGG,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,BCBS,BCBS,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,BCBS MGG,BCBS MGG,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Cigna,Cigna,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Cigna MGG,Cigna MGG,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Humana,Humana,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Humana MGG,Humana MGG,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Optum VA,Optum VA,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,UHC,UHC,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,UHC MGG,UHC MGG,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,VA,VA,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Wellcare MGG,Wellcare MGG,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Bright Health - commercial,Bright Health - commercial,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,Bright Health MGG,Bright Health MGG,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Aetna,Aetna,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Aetna MGG,Aetna MGG,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,BCBS,BCBS,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,BCBS MGG,BCBS MGG,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Cigna,Cigna,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Cigna MGG,Cigna MGG,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Humana,Humana,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Humana MGG,Humana MGG,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Optum VA,Optum VA,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,UHC,UHC,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,UHC MGG,UHC MGG,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,VA,VA,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Wellcare MGG,Wellcare MGG,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Bright Health - commercial,Bright Health - commercial,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,319.2,319.2,Bright Health MGG,Bright Health MGG,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Aetna,Aetna,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Aetna MGG,Aetna MGG,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,BCBS,BCBS,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,BCBS MGG,BCBS MGG,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Cigna,Cigna,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Cigna MGG,Cigna MGG,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Humana,Humana,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Humana MGG,Humana MGG,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Optum VA,Optum VA,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,UHC,UHC,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,UHC MGG,UHC MGG,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,VA,VA,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Wellcare MGG,Wellcare MGG,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Bright Health - commercial,Bright Health - commercial,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,Bright Health MGG,Bright Health MGG,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Aetna,Aetna,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Aetna MGG,Aetna MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,BCBS,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS MGG,BCBS MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Cigna,Cigna,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Cigna MGG,Cigna MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Humana,Humana,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Humana MGG,Humana MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Optum VA,Optum VA,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,UHC,UHC,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,UHC MGG,UHC MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,VA,VA,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Wellcare MGG,Wellcare MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Bright Health - commercial,Bright Health - commercial,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,Bright Health MGG,Bright Health MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Aetna,Aetna,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Aetna MGG,Aetna MGG,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,BCBS,BCBS,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,BCBS MGG,BCBS MGG,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Cigna,Cigna,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Cigna MGG,Cigna MGG,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Humana,Humana,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Humana MGG,Humana MGG,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Optum VA,Optum VA,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,UHC,UHC,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,UHC MGG,UHC MGG,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,VA,VA,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Wellcare MGG,Wellcare MGG,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Bright Health - commercial,Bright Health - commercial,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,Bright Health MGG,Bright Health MGG,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Aetna,Aetna,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Aetna MGG,Aetna MGG,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,BCBS,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,BCBS MGG,BCBS MGG,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Cigna,Cigna,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Cigna MGG,Cigna MGG,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Humana,Humana,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Humana MGG,Humana MGG,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Optum VA,Optum VA,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,UHC,UHC,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,UHC MGG,UHC MGG,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,VA,VA,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Wellcare MGG,Wellcare MGG,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Bright Health - commercial,Bright Health - commercial,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,Bright Health MGG,Bright Health MGG,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Aetna,Aetna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Aetna MGG,Aetna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,BCBS,BCBS,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,BCBS MGG,BCBS MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Cigna,Cigna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Cigna MGG,Cigna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Humana,Humana,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Humana MGG,Humana MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Optum VA,Optum VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,UHC,UHC,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,UHC MGG,UHC MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,VA,VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Wellcare MGG,Wellcare MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Bright Health - commercial,Bright Health - commercial,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,Bright Health MGG,Bright Health MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Aetna,Aetna,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Aetna MGG,Aetna MGG,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,BCBS,BCBS,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,BCBS MGG,BCBS MGG,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Cigna,Cigna,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Cigna MGG,Cigna MGG,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Humana,Humana,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Humana MGG,Humana MGG,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Optum VA,Optum VA,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,UHC,UHC,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,UHC MGG,UHC MGG,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,VA,VA,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Wellcare MGG,Wellcare MGG,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Bright Health - commercial,Bright Health - commercial,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,Bright Health MGG,Bright Health MGG,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Aetna,Aetna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Aetna MGG,Aetna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,BCBS,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,BCBS MGG,BCBS MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Cigna,Cigna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Cigna MGG,Cigna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Humana,Humana,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Humana MGG,Humana MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Optum VA,Optum VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,UHC,UHC,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,UHC MGG,UHC MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,VA,VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Wellcare MGG,Wellcare MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Bright Health - commercial,Bright Health - commercial,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,Bright Health MGG,Bright Health MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Aetna,Aetna,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Aetna MGG,Aetna MGG,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,BCBS,BCBS,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,BCBS MGG,BCBS MGG,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Cigna,Cigna,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Cigna MGG,Cigna MGG,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Humana,Humana,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Humana MGG,Humana MGG,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Optum VA,Optum VA,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,UHC,UHC,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,UHC MGG,UHC MGG,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,VA,VA,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Wellcare MGG,Wellcare MGG,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Bright Health - commercial,Bright Health - commercial,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,Bright Health MGG,Bright Health MGG,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Aetna,Aetna,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Aetna MGG,Aetna MGG,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,BCBS,BCBS,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,BCBS MGG,BCBS MGG,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Cigna,Cigna,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Cigna MGG,Cigna MGG,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Humana,Humana,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Humana MGG,Humana MGG,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Optum VA,Optum VA,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,UHC,UHC,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,UHC MGG,UHC MGG,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,VA,VA,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Wellcare MGG,Wellcare MGG,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Bright Health - commercial,Bright Health - commercial,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,Bright Health MGG,Bright Health MGG,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Aetna,Aetna,159.61,,,,,,,per diem,159.61,159.61,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Aetna MGG,Aetna MGG,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,BCBS,BCBS,159.61,,,,,,,per diem,159.61,159.61,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,BCBS MGG,BCBS MGG,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Cigna,Cigna,159.61,,,,,,,per diem,159.61,159.61,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Cigna MGG,Cigna MGG,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Humana,Humana,159.61,,,,,,,per diem,159.61,159.61,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Humana MGG,Humana MGG,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Optum VA,Optum VA,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,UHC,UHC,159.61,,,,,,,per diem,159.61,159.61,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,UHC MGG,UHC MGG,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,VA,VA,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Wellcare MGG,Wellcare MGG,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Bright Health - commercial,Bright Health - commercial,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,159.61,159.61,Bright Health MGG,Bright Health MGG,159.61,,,,,,,case rate,159.61,159.61,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Aetna,Aetna,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Aetna MGG,Aetna MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,BCBS,BCBS,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,BCBS MGG,BCBS MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Cigna,Cigna,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Cigna MGG,Cigna MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Humana,Humana,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Humana MGG,Humana MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Optum VA,Optum VA,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,UHC,UHC,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,UHC MGG,UHC MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,VA,VA,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Wellcare MGG,Wellcare MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Bright Health - commercial,Bright Health - commercial,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,Bright Health MGG,Bright Health MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Aetna,Aetna,353.71,,,,,,,per diem,353.71,353.71,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Aetna MGG,Aetna MGG,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,BCBS,BCBS,353.71,,,,,,,per diem,353.71,353.71,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,BCBS MGG,BCBS MGG,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Cigna,Cigna,353.71,,,,,,,per diem,353.71,353.71,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Cigna MGG,Cigna MGG,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Humana,Humana,353.71,,,,,,,per diem,353.71,353.71,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Humana MGG,Humana MGG,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Optum VA,Optum VA,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,UHC,UHC,353.71,,,,,,,per diem,353.71,353.71,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,UHC MGG,UHC MGG,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,VA,VA,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Wellcare MGG,Wellcare MGG,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Bright Health - commercial,Bright Health - commercial,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,353.71,353.71,Bright Health MGG,Bright Health MGG,353.71,,,,,,,case rate,353.71,353.71,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Aetna,Aetna,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Aetna MGG,Aetna MGG,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,BCBS,BCBS,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,BCBS MGG,BCBS MGG,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Cigna,Cigna,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Cigna MGG,Cigna MGG,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Humana,Humana,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Humana MGG,Humana MGG,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Optum VA,Optum VA,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,UHC,UHC,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,UHC MGG,UHC MGG,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,VA,VA,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Wellcare MGG,Wellcare MGG,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Bright Health - commercial,Bright Health - commercial,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,Bright Health MGG,Bright Health MGG,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Aetna,Aetna,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Aetna MGG,Aetna MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,BCBS,BCBS,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,BCBS MGG,BCBS MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Cigna,Cigna,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Cigna MGG,Cigna MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Humana,Humana,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Humana MGG,Humana MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Optum VA,Optum VA,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,UHC,UHC,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,UHC MGG,UHC MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,VA,VA,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Wellcare MGG,Wellcare MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Bright Health - commercial,Bright Health - commercial,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,Bright Health MGG,Bright Health MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Aetna,Aetna,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Aetna MGG,Aetna MGG,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,BCBS,BCBS,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,BCBS MGG,BCBS MGG,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Cigna,Cigna,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Cigna MGG,Cigna MGG,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Humana,Humana,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Humana MGG,Humana MGG,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Optum VA,Optum VA,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,UHC,UHC,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,UHC MGG,UHC MGG,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,VA,VA,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Wellcare MGG,Wellcare MGG,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Bright Health - commercial,Bright Health - commercial,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,Bright Health MGG,Bright Health MGG,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Aetna,Aetna,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Aetna MGG,Aetna MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,BCBS,BCBS,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,BCBS MGG,BCBS MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Cigna,Cigna,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Cigna MGG,Cigna MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Humana,Humana,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Humana MGG,Humana MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Optum VA,Optum VA,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,UHC,UHC,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,UHC MGG,UHC MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,VA,VA,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Wellcare MGG,Wellcare MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Bright Health - commercial,Bright Health - commercial,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,Bright Health MGG,Bright Health MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Aetna,Aetna,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Aetna MGG,Aetna MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,BCBS,BCBS,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,BCBS MGG,BCBS MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Cigna,Cigna,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Cigna MGG,Cigna MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Humana,Humana,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Humana MGG,Humana MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Optum VA,Optum VA,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,UHC,UHC,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,UHC MGG,UHC MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,VA,VA,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Wellcare MGG,Wellcare MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Bright Health - commercial,Bright Health - commercial,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,Bright Health MGG,Bright Health MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Aetna,Aetna,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Aetna MGG,Aetna MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,BCBS,BCBS,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,BCBS MGG,BCBS MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Cigna,Cigna,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Cigna MGG,Cigna MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Humana,Humana,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Humana MGG,Humana MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Optum VA,Optum VA,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,UHC,UHC,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,UHC MGG,UHC MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,VA,VA,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Wellcare MGG,Wellcare MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Bright Health - commercial,Bright Health - commercial,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,Bright Health MGG,Bright Health MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Aetna,Aetna,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Aetna MGG,Aetna MGG,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,BCBS,BCBS,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,BCBS MGG,BCBS MGG,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Cigna,Cigna,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Cigna MGG,Cigna MGG,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Humana,Humana,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Humana MGG,Humana MGG,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Optum VA,Optum VA,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,UHC,UHC,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,UHC MGG,UHC MGG,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,VA,VA,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Wellcare MGG,Wellcare MGG,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Bright Health - commercial,Bright Health - commercial,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,Bright Health MGG,Bright Health MGG,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Aetna,Aetna,59.38,,,,,,,per diem,59.38,59.38,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Aetna MGG,Aetna MGG,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,BCBS,BCBS,59.38,,,,,,,per diem,59.38,59.38,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,BCBS MGG,BCBS MGG,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Cigna,Cigna,59.38,,,,,,,per diem,59.38,59.38,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Cigna MGG,Cigna MGG,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Humana,Humana,59.38,,,,,,,per diem,59.38,59.38,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Humana MGG,Humana MGG,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Optum VA,Optum VA,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,UHC,UHC,59.38,,,,,,,per diem,59.38,59.38,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,UHC MGG,UHC MGG,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,VA,VA,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Wellcare MGG,Wellcare MGG,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Bright Health - commercial,Bright Health - commercial,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,59.38,59.38,Bright Health MGG,Bright Health MGG,59.38,,,,,,,case rate,59.38,59.38,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Aetna,Aetna,93.02,,,,,,,per diem,93.02,93.02,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Aetna MGG,Aetna MGG,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,BCBS,BCBS,93.02,,,,,,,per diem,93.02,93.02,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,BCBS MGG,BCBS MGG,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Cigna,Cigna,93.02,,,,,,,per diem,93.02,93.02,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Cigna MGG,Cigna MGG,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Humana,Humana,93.02,,,,,,,per diem,93.02,93.02,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Humana MGG,Humana MGG,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Optum VA,Optum VA,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,UHC,UHC,93.02,,,,,,,per diem,93.02,93.02,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,UHC MGG,UHC MGG,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,VA,VA,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Wellcare MGG,Wellcare MGG,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Bright Health - commercial,Bright Health - commercial,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,93.02,93.02,Bright Health MGG,Bright Health MGG,93.02,,,,,,,case rate,93.02,93.02,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Aetna,Aetna,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Aetna MGG,Aetna MGG,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,BCBS,BCBS,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,BCBS MGG,BCBS MGG,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Cigna,Cigna,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Cigna MGG,Cigna MGG,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Humana,Humana,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Humana MGG,Humana MGG,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Optum VA,Optum VA,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,UHC,UHC,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,UHC MGG,UHC MGG,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,VA,VA,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Wellcare MGG,Wellcare MGG,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Bright Health - commercial,Bright Health - commercial,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,Bright Health MGG,Bright Health MGG,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Aetna,Aetna,506.82,,,,,,,per diem,506.82,506.82,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Aetna MGG,Aetna MGG,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,BCBS,BCBS,506.82,,,,,,,per diem,506.82,506.82,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,BCBS MGG,BCBS MGG,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Cigna,Cigna,506.82,,,,,,,per diem,506.82,506.82,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Cigna MGG,Cigna MGG,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Humana,Humana,506.82,,,,,,,per diem,506.82,506.82,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Humana MGG,Humana MGG,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Optum VA,Optum VA,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,UHC,UHC,506.82,,,,,,,per diem,506.82,506.82,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,UHC MGG,UHC MGG,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,VA,VA,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Wellcare MGG,Wellcare MGG,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Bright Health - commercial,Bright Health - commercial,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,506.82,506.82,Bright Health MGG,Bright Health MGG,506.82,,,,,,,case rate,506.82,506.82,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Aetna,Aetna,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Aetna MGG,Aetna MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,BCBS,BCBS,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,BCBS MGG,BCBS MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Cigna,Cigna,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Cigna MGG,Cigna MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Humana,Humana,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Humana MGG,Humana MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Optum VA,Optum VA,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,UHC,UHC,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,UHC MGG,UHC MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,VA,VA,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Wellcare MGG,Wellcare MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Bright Health - commercial,Bright Health - commercial,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SPIROMETRY/1                  ,36000239,CDM,460,RC,94010,CPT,,,,Inpatient,,,220.5,220.5,Bright Health MGG,Bright Health MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Aetna,Aetna,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Aetna MGG,Aetna MGG,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,BCBS,BCBS,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,BCBS MGG,BCBS MGG,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Cigna,Cigna,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Cigna MGG,Cigna MGG,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Humana,Humana,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Humana MGG,Humana MGG,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Optum VA,Optum VA,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,UHC,UHC,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,UHC MGG,UHC MGG,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,VA,VA,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Wellcare MGG,Wellcare MGG,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Bright Health - commercial,Bright Health - commercial,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT TREATMENT      ,36000289,CDM,410,RC,94640,CPT,,,76,Inpatient,,,98.18,98.18,Bright Health MGG,Bright Health MGG,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Aetna,Aetna,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Aetna MGG,Aetna MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,BCBS,BCBS,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,BCBS MGG,BCBS MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Cigna,Cigna,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Cigna MGG,Cigna MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Humana,Humana,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Humana MGG,Humana MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Optum VA,Optum VA,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,UHC,UHC,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,UHC MGG,UHC MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,VA,VA,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Wellcare MGG,Wellcare MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Bright Health - commercial,Bright Health - commercial,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,G0238,CPT,,,,Inpatient,,,106.05,106.05,Bright Health MGG,Bright Health MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Aetna,Aetna,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Aetna MGG,Aetna MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,BCBS,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,BCBS MGG,BCBS MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Cigna,Cigna,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Cigna MGG,Cigna MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Humana,Humana,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Humana MGG,Humana MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Optum VA,Optum VA,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,UHC,UHC,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,UHC MGG,UHC MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,VA,VA,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Wellcare MGG,Wellcare MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Bright Health - commercial,Bright Health - commercial,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,Bright Health MGG,Bright Health MGG,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Aetna,Aetna,82.61,,,,,,,per diem,82.61,82.61,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Aetna MGG,Aetna MGG,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,BCBS,BCBS,82.61,,,,,,,per diem,82.61,82.61,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,BCBS MGG,BCBS MGG,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Cigna,Cigna,82.61,,,,,,,per diem,82.61,82.61,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Cigna MGG,Cigna MGG,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Humana,Humana,82.61,,,,,,,per diem,82.61,82.61,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Humana MGG,Humana MGG,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Optum VA,Optum VA,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,UHC,UHC,82.61,,,,,,,per diem,82.61,82.61,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,UHC MGG,UHC MGG,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,VA,VA,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Wellcare MGG,Wellcare MGG,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Bright Health - commercial,Bright Health - commercial,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,82.61,82.61,Bright Health MGG,Bright Health MGG,82.61,,,,,,,case rate,82.61,82.61,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Aetna,Aetna,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Aetna MGG,Aetna MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,BCBS,BCBS,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,BCBS MGG,BCBS MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Cigna,Cigna,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Cigna MGG,Cigna MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Humana,Humana,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Humana MGG,Humana MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Optum VA,Optum VA,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,UHC,UHC,38.51,,,,,,,per diem,38.51,38.51,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,UHC MGG,UHC MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,VA,VA,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Wellcare MGG,Wellcare MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Bright Health - commercial,Bright Health - commercial,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.51,38.51,Bright Health MGG,Bright Health MGG,38.51,,,,,,,case rate,38.51,38.51,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Aetna,Aetna,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Aetna MGG,Aetna MGG,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,BCBS,BCBS,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,BCBS MGG,BCBS MGG,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Cigna,Cigna,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Cigna MGG,Cigna MGG,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Humana,Humana,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Humana MGG,Humana MGG,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Optum VA,Optum VA,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,UHC,UHC,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,UHC MGG,UHC MGG,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,VA,VA,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Wellcare MGG,Wellcare MGG,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Bright Health - commercial,Bright Health - commercial,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.38,79.38,Bright Health MGG,Bright Health MGG,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Aetna,Aetna,88.82,,,,,,,per diem,88.82,88.82,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Aetna MGG,Aetna MGG,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,BCBS,BCBS,88.82,,,,,,,per diem,88.82,88.82,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,BCBS MGG,BCBS MGG,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Cigna,Cigna,88.82,,,,,,,per diem,88.82,88.82,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Cigna MGG,Cigna MGG,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Humana,Humana,88.82,,,,,,,per diem,88.82,88.82,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Humana MGG,Humana MGG,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Optum VA,Optum VA,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,UHC,UHC,88.82,,,,,,,per diem,88.82,88.82,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,UHC MGG,UHC MGG,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,VA,VA,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Wellcare MGG,Wellcare MGG,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Bright Health - commercial,Bright Health - commercial,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,88.82,88.82,Bright Health MGG,Bright Health MGG,88.82,,,,,,,case rate,88.82,88.82,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Aetna,Aetna,185.2,,,,,,,per diem,185.2,185.2,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Aetna MGG,Aetna MGG,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,BCBS,BCBS,185.2,,,,,,,per diem,185.2,185.2,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,BCBS MGG,BCBS MGG,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Cigna,Cigna,185.2,,,,,,,per diem,185.2,185.2,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Cigna MGG,Cigna MGG,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Humana,Humana,185.2,,,,,,,per diem,185.2,185.2,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Humana MGG,Humana MGG,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Optum VA,Optum VA,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,UHC,UHC,185.2,,,,,,,per diem,185.2,185.2,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,UHC MGG,UHC MGG,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,VA,VA,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Wellcare MGG,Wellcare MGG,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Bright Health - commercial,Bright Health - commercial,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,185.2,185.2,Bright Health MGG,Bright Health MGG,185.2,,,,,,,case rate,185.2,185.2,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Aetna,Aetna,290.49,,,,,,,per diem,290.49,290.49,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Aetna MGG,Aetna MGG,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,BCBS,BCBS,290.49,,,,,,,per diem,290.49,290.49,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,BCBS MGG,BCBS MGG,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Cigna,Cigna,290.49,,,,,,,per diem,290.49,290.49,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Cigna MGG,Cigna MGG,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Humana,Humana,290.49,,,,,,,per diem,290.49,290.49,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Humana MGG,Humana MGG,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Optum VA,Optum VA,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,UHC,UHC,290.49,,,,,,,per diem,290.49,290.49,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,UHC MGG,UHC MGG,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,VA,VA,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Wellcare MGG,Wellcare MGG,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Bright Health - commercial,Bright Health - commercial,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,290.49,290.49,Bright Health MGG,Bright Health MGG,290.49,,,,,,,case rate,290.49,290.49,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Aetna,Aetna,119.57,,,,,,,per diem,119.57,119.57,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Aetna MGG,Aetna MGG,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,BCBS,BCBS,119.57,,,,,,,per diem,119.57,119.57,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,BCBS MGG,BCBS MGG,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Cigna,Cigna,119.57,,,,,,,per diem,119.57,119.57,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Cigna MGG,Cigna MGG,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Humana,Humana,119.57,,,,,,,per diem,119.57,119.57,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Humana MGG,Humana MGG,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Optum VA,Optum VA,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,UHC,UHC,119.57,,,,,,,per diem,119.57,119.57,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,UHC MGG,UHC MGG,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,VA,VA,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Wellcare MGG,Wellcare MGG,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Bright Health - commercial,Bright Health - commercial,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,119.57,119.57,Bright Health MGG,Bright Health MGG,119.57,,,,,,,case rate,119.57,119.57,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Aetna,Aetna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Aetna MGG,Aetna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,BCBS,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS MGG,BCBS MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Cigna,Cigna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Cigna MGG,Cigna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Humana,Humana,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Humana MGG,Humana MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Optum VA,Optum VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UHC,UHC,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UHC MGG,UHC MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA,VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Wellcare MGG,Wellcare MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Bright Health - commercial,Bright Health - commercial,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,Bright Health MGG,Bright Health MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Aetna,Aetna,248.84,,,,,,,per diem,248.84,248.84,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Aetna MGG,Aetna MGG,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,BCBS,BCBS,248.84,,,,,,,per diem,248.84,248.84,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,BCBS MGG,BCBS MGG,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Cigna,Cigna,248.84,,,,,,,per diem,248.84,248.84,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Cigna MGG,Cigna MGG,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Humana,Humana,248.84,,,,,,,per diem,248.84,248.84,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Humana MGG,Humana MGG,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Optum VA,Optum VA,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,UHC,UHC,248.84,,,,,,,per diem,248.84,248.84,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,UHC MGG,UHC MGG,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,VA,VA,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Wellcare MGG,Wellcare MGG,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Bright Health - commercial,Bright Health - commercial,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,248.84,248.84,Bright Health MGG,Bright Health MGG,248.84,,,,,,,case rate,248.84,248.84,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Aetna,Aetna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Aetna MGG,Aetna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,BCBS,BCBS,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,BCBS MGG,BCBS MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Cigna,Cigna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Cigna MGG,Cigna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Humana,Humana,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Humana MGG,Humana MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Optum VA,Optum VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,UHC,UHC,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,UHC MGG,UHC MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,VA,VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Wellcare MGG,Wellcare MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Bright Health - commercial,Bright Health - commercial,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,Bright Health MGG,Bright Health MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Aetna,Aetna,232.62,,,,,,,per diem,232.62,232.62,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Aetna MGG,Aetna MGG,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,BCBS,BCBS,232.62,,,,,,,per diem,232.62,232.62,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,BCBS MGG,BCBS MGG,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Cigna,Cigna,232.62,,,,,,,per diem,232.62,232.62,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Cigna MGG,Cigna MGG,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Humana,Humana,232.62,,,,,,,per diem,232.62,232.62,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Humana MGG,Humana MGG,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Optum VA,Optum VA,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,UHC,UHC,232.62,,,,,,,per diem,232.62,232.62,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,UHC MGG,UHC MGG,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,VA,VA,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Wellcare MGG,Wellcare MGG,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Bright Health - commercial,Bright Health - commercial,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,232.62,232.62,Bright Health MGG,Bright Health MGG,232.62,,,,,,,case rate,232.62,232.62,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Aetna,Aetna,486.16,,,,,,,per diem,486.16,486.16,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Aetna MGG,Aetna MGG,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,BCBS,BCBS,486.16,,,,,,,per diem,486.16,486.16,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,BCBS MGG,BCBS MGG,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Cigna,Cigna,486.16,,,,,,,per diem,486.16,486.16,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Cigna MGG,Cigna MGG,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Humana,Humana,486.16,,,,,,,per diem,486.16,486.16,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Humana MGG,Humana MGG,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Optum VA,Optum VA,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,UHC,UHC,486.16,,,,,,,per diem,486.16,486.16,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,UHC MGG,UHC MGG,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,VA,VA,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Wellcare MGG,Wellcare MGG,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Bright Health - commercial,Bright Health - commercial,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,486.16,486.16,Bright Health MGG,Bright Health MGG,486.16,,,,,,,case rate,486.16,486.16,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Aetna,Aetna,102.44,,,,,,,per diem,102.44,102.44,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Aetna MGG,Aetna MGG,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,BCBS,BCBS,102.44,,,,,,,per diem,102.44,102.44,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,BCBS MGG,BCBS MGG,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Cigna,Cigna,102.44,,,,,,,per diem,102.44,102.44,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Cigna MGG,Cigna MGG,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Humana,Humana,102.44,,,,,,,per diem,102.44,102.44,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Humana MGG,Humana MGG,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Optum VA,Optum VA,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,UHC,UHC,102.44,,,,,,,per diem,102.44,102.44,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,UHC MGG,UHC MGG,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,VA,VA,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Wellcare MGG,Wellcare MGG,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Bright Health - commercial,Bright Health - commercial,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,102.44,102.44,Bright Health MGG,Bright Health MGG,102.44,,,,,,,case rate,102.44,102.44,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Aetna,Aetna,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Aetna MGG,Aetna MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,BCBS,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS MGG,BCBS MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Cigna,Cigna,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Cigna MGG,Cigna MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Humana,Humana,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Humana MGG,Humana MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Optum VA,Optum VA,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,UHC,UHC,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,UHC MGG,UHC MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,VA,VA,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Wellcare MGG,Wellcare MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Bright Health - commercial,Bright Health - commercial,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Bright Health MGG,Bright Health MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Aetna,Aetna,184.45,,,,,,,per diem,184.45,184.45,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Aetna MGG,Aetna MGG,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,BCBS,BCBS,184.45,,,,,,,per diem,184.45,184.45,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,BCBS MGG,BCBS MGG,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Cigna,Cigna,184.45,,,,,,,per diem,184.45,184.45,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Cigna MGG,Cigna MGG,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Humana,Humana,184.45,,,,,,,per diem,184.45,184.45,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Humana MGG,Humana MGG,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Optum VA,Optum VA,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,UHC,UHC,184.45,,,,,,,per diem,184.45,184.45,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,UHC MGG,UHC MGG,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,VA,VA,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Wellcare MGG,Wellcare MGG,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Bright Health - commercial,Bright Health - commercial,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE GROUP   ,36000673,CDM,410,RC,G0239,HCPCS,,,,Inpatient,,,184.45,184.45,Bright Health MGG,Bright Health MGG,184.45,,,,,,,case rate,184.45,184.45,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Aetna,Aetna,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Aetna MGG,Aetna MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,BCBS,BCBS,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,BCBS MGG,BCBS MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Cigna,Cigna,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Cigna MGG,Cigna MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Humana,Humana,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Humana MGG,Humana MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Optum VA,Optum VA,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,UHC,UHC,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,UHC MGG,UHC MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,VA,VA,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Wellcare MGG,Wellcare MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Bright Health - commercial,Bright Health - commercial,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,Bright Health MGG,Bright Health MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Aetna,Aetna,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Aetna MGG,Aetna MGG,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,BCBS,BCBS,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,BCBS MGG,BCBS MGG,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Cigna,Cigna,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Cigna MGG,Cigna MGG,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Humana,Humana,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Humana MGG,Humana MGG,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Optum VA,Optum VA,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,UHC,UHC,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,UHC MGG,UHC MGG,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,VA,VA,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Wellcare MGG,Wellcare MGG,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Bright Health - commercial,Bright Health - commercial,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,Bright Health MGG,Bright Health MGG,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Aetna,Aetna,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Aetna MGG,Aetna MGG,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,BCBS,BCBS,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,BCBS MGG,BCBS MGG,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Cigna,Cigna,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Cigna MGG,Cigna MGG,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Humana,Humana,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Humana MGG,Humana MGG,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Optum VA,Optum VA,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,UHC,UHC,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,UHC MGG,UHC MGG,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,VA,VA,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Wellcare MGG,Wellcare MGG,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Bright Health - commercial,Bright Health - commercial,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,Bright Health MGG,Bright Health MGG,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Aetna,Aetna,87.65,,,,,,,per diem,87.65,87.65,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Aetna MGG,Aetna MGG,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,BCBS,BCBS,87.65,,,,,,,per diem,87.65,87.65,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,BCBS MGG,BCBS MGG,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Cigna,Cigna,87.65,,,,,,,per diem,87.65,87.65,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Cigna MGG,Cigna MGG,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Humana,Humana,87.65,,,,,,,per diem,87.65,87.65,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Humana MGG,Humana MGG,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Optum VA,Optum VA,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,UHC,UHC,87.65,,,,,,,per diem,87.65,87.65,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,UHC MGG,UHC MGG,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,VA,VA,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Wellcare MGG,Wellcare MGG,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Bright Health - commercial,Bright Health - commercial,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,87.65,87.65,Bright Health MGG,Bright Health MGG,87.65,,,,,,,case rate,87.65,87.65,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Aetna,Aetna,234.69,,,,,,,per diem,234.69,234.69,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Aetna MGG,Aetna MGG,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,BCBS,BCBS,234.69,,,,,,,per diem,234.69,234.69,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,BCBS MGG,BCBS MGG,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Cigna,Cigna,234.69,,,,,,,per diem,234.69,234.69,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Cigna MGG,Cigna MGG,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Humana,Humana,234.69,,,,,,,per diem,234.69,234.69,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Humana MGG,Humana MGG,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Optum VA,Optum VA,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,UHC,UHC,234.69,,,,,,,per diem,234.69,234.69,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,UHC MGG,UHC MGG,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,VA,VA,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Wellcare MGG,Wellcare MGG,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Bright Health - commercial,Bright Health - commercial,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,234.69,234.69,Bright Health MGG,Bright Health MGG,234.69,,,,,,,case rate,234.69,234.69,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Aetna,Aetna,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Aetna MGG,Aetna MGG,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,BCBS,BCBS,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,BCBS MGG,BCBS MGG,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Cigna,Cigna,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Cigna MGG,Cigna MGG,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Humana,Humana,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Humana MGG,Humana MGG,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Optum VA,Optum VA,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,UHC,UHC,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,UHC MGG,UHC MGG,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,VA,VA,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Wellcare MGG,Wellcare MGG,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Bright Health - commercial,Bright Health - commercial,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,89.9,89.9,Bright Health MGG,Bright Health MGG,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Aetna,Aetna,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Aetna MGG,Aetna MGG,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,BCBS,BCBS,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,BCBS MGG,BCBS MGG,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Cigna,Cigna,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Cigna MGG,Cigna MGG,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Humana,Humana,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Humana MGG,Humana MGG,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Optum VA,Optum VA,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,UHC,UHC,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,UHC MGG,UHC MGG,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,VA,VA,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Wellcare MGG,Wellcare MGG,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Bright Health - commercial,Bright Health - commercial,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,Bright Health MGG,Bright Health MGG,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Aetna,Aetna,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Aetna MGG,Aetna MGG,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,BCBS,BCBS,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,BCBS MGG,BCBS MGG,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Cigna,Cigna,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Cigna MGG,Cigna MGG,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Humana,Humana,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Humana MGG,Humana MGG,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Optum VA,Optum VA,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,UHC,UHC,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,UHC MGG,UHC MGG,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,VA,VA,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Wellcare MGG,Wellcare MGG,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Bright Health - commercial,Bright Health - commercial,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,Bright Health MGG,Bright Health MGG,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Aetna,Aetna,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Aetna MGG,Aetna MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,BCBS,BCBS,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,BCBS MGG,BCBS MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Cigna,Cigna,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Cigna MGG,Cigna MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Humana,Humana,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Humana MGG,Humana MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Optum VA,Optum VA,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,UHC,UHC,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,UHC MGG,UHC MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,VA,VA,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Wellcare MGG,Wellcare MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Bright Health - commercial,Bright Health - commercial,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,Bright Health MGG,Bright Health MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Aetna,Aetna,84.59,,,,,,,per diem,84.59,84.59,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Aetna MGG,Aetna MGG,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,BCBS,BCBS,84.59,,,,,,,per diem,84.59,84.59,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,BCBS MGG,BCBS MGG,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Cigna,Cigna,84.59,,,,,,,per diem,84.59,84.59,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Cigna MGG,Cigna MGG,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Humana,Humana,84.59,,,,,,,per diem,84.59,84.59,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Humana MGG,Humana MGG,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Optum VA,Optum VA,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,UHC,UHC,84.59,,,,,,,per diem,84.59,84.59,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,UHC MGG,UHC MGG,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,VA,VA,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Wellcare MGG,Wellcare MGG,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Bright Health - commercial,Bright Health - commercial,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,84.59,84.59,Bright Health MGG,Bright Health MGG,84.59,,,,,,,case rate,84.59,84.59,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Aetna,Aetna,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Aetna MGG,Aetna MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,BCBS,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS MGG,BCBS MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Cigna,Cigna,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Cigna MGG,Cigna MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Humana,Humana,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Humana MGG,Humana MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Optum VA,Optum VA,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,UHC,UHC,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,UHC MGG,UHC MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,VA,VA,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Wellcare MGG,Wellcare MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Bright Health - commercial,Bright Health - commercial,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,Bright Health MGG,Bright Health MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Aetna,Aetna,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Aetna MGG,Aetna MGG,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,BCBS,BCBS,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,BCBS MGG,BCBS MGG,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Cigna,Cigna,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Cigna MGG,Cigna MGG,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Humana,Humana,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Humana MGG,Humana MGG,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Optum VA,Optum VA,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,UHC,UHC,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,UHC MGG,UHC MGG,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,VA,VA,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Wellcare MGG,Wellcare MGG,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Bright Health - commercial,Bright Health - commercial,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,Bright Health MGG,Bright Health MGG,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Aetna,Aetna,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Aetna MGG,Aetna MGG,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,BCBS,BCBS,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,BCBS MGG,BCBS MGG,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Cigna,Cigna,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Cigna MGG,Cigna MGG,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Humana,Humana,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Humana MGG,Humana MGG,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Optum VA,Optum VA,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,UHC,UHC,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,UHC MGG,UHC MGG,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,VA,VA,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Wellcare MGG,Wellcare MGG,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Bright Health - commercial,Bright Health - commercial,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,Bright Health MGG,Bright Health MGG,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Aetna,Aetna,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Aetna MGG,Aetna MGG,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,BCBS,BCBS,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,BCBS MGG,BCBS MGG,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Cigna,Cigna,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Cigna MGG,Cigna MGG,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Humana,Humana,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Humana MGG,Humana MGG,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Optum VA,Optum VA,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,UHC,UHC,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,UHC MGG,UHC MGG,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,VA,VA,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Wellcare MGG,Wellcare MGG,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Bright Health - commercial,Bright Health - commercial,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
OTHER RT                      ,36099999,CDM,410,RC,,,,,,Inpatient,,,64.05,64.05,Bright Health MGG,Bright Health MGG,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Aetna,Aetna,323.4,,,,,,,per diem,323.4,323.4,"Per diem rate, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Aetna MGG,Aetna MGG,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,BCBS,BCBS,323.4,,,,,,,per diem,323.4,323.4,"Per diem rate, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,BCBS MGG,BCBS MGG,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Cigna,Cigna,323.4,,,,,,,per diem,323.4,323.4,"Per diem rate, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Cigna MGG,Cigna MGG,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Humana,Humana,323.4,,,,,,,per diem,323.4,323.4,"Per diem rate, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Humana MGG,Humana MGG,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Optum VA,Optum VA,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,UHC,UHC,323.4,,,,,,,per diem,323.4,323.4,"Per diem rate, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,UHC MGG,UHC MGG,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,VA,VA,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Wellcare MGG,Wellcare MGG,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Bright Health - commercial,Bright Health - commercial,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
CO DIFFUSION CAPACITY         ,36200120,CDM,460,RC,94729,CPT,,,,Inpatient,,,323.4,323.4,Bright Health MGG,Bright Health MGG,323.4,,,,,,,case rate,323.4,323.4,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Aetna,Aetna,111.45,,,,,,,per diem,111.45,111.45,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Aetna MGG,Aetna MGG,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,BCBS,BCBS,111.45,,,,,,,per diem,111.45,111.45,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,BCBS MGG,BCBS MGG,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Cigna,Cigna,111.45,,,,,,,per diem,111.45,111.45,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Cigna MGG,Cigna MGG,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Humana,Humana,111.45,,,,,,,per diem,111.45,111.45,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Humana MGG,Humana MGG,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Optum VA,Optum VA,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,UHC,UHC,111.45,,,,,,,per diem,111.45,111.45,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,UHC MGG,UHC MGG,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,VA,VA,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Wellcare MGG,Wellcare MGG,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Bright Health - commercial,Bright Health - commercial,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,111.45,111.45,Bright Health MGG,Bright Health MGG,111.45,,,,,,,case rate,111.45,111.45,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Aetna,Aetna,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Aetna MGG,Aetna MGG,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,BCBS,BCBS,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,BCBS MGG,BCBS MGG,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Cigna,Cigna,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Cigna MGG,Cigna MGG,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Humana,Humana,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Humana MGG,Humana MGG,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Optum VA,Optum VA,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,UHC,UHC,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,UHC MGG,UHC MGG,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,VA,VA,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Wellcare MGG,Wellcare MGG,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Bright Health - commercial,Bright Health - commercial,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,Bright Health MGG,Bright Health MGG,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Aetna,Aetna,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Aetna MGG,Aetna MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,BCBS,BCBS,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,BCBS MGG,BCBS MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Cigna,Cigna,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Cigna MGG,Cigna MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Humana,Humana,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Humana MGG,Humana MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Optum VA,Optum VA,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,UHC,UHC,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,UHC MGG,UHC MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,VA,VA,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Wellcare MGG,Wellcare MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Bright Health - commercial,Bright Health - commercial,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,Bright Health MGG,Bright Health MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Aetna,Aetna,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Aetna MGG,Aetna MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,BCBS,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS MGG,BCBS MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Cigna,Cigna,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Cigna MGG,Cigna MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Humana,Humana,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Humana MGG,Humana MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Optum VA,Optum VA,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,UHC,UHC,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,UHC MGG,UHC MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,VA,VA,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Wellcare MGG,Wellcare MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Bright Health - commercial,Bright Health - commercial,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,Bright Health MGG,Bright Health MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Aetna,Aetna,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Aetna MGG,Aetna MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,BCBS,BCBS,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,BCBS MGG,BCBS MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Cigna,Cigna,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Cigna MGG,Cigna MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Humana,Humana,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Humana MGG,Humana MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Optum VA,Optum VA,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,UHC,UHC,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,UHC MGG,UHC MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,VA,VA,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Wellcare MGG,Wellcare MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Bright Health - commercial,Bright Health - commercial,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,Bright Health MGG,Bright Health MGG,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Aetna,Aetna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Aetna MGG,Aetna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,BCBS,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS MGG,BCBS MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Cigna,Cigna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Cigna MGG,Cigna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Humana,Humana,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Humana MGG,Humana MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Optum VA,Optum VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,UHC,UHC,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,UHC MGG,UHC MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,VA,VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Wellcare MGG,Wellcare MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Bright Health - commercial,Bright Health - commercial,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Bright Health MGG,Bright Health MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Aetna,Aetna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Aetna MGG,Aetna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,BCBS,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS MGG,BCBS MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Cigna,Cigna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Cigna MGG,Cigna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Humana,Humana,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Humana MGG,Humana MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Optum VA,Optum VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,UHC,UHC,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,UHC MGG,UHC MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,VA,VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Wellcare MGG,Wellcare MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Bright Health - commercial,Bright Health - commercial,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,Bright Health MGG,Bright Health MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Aetna,Aetna,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Aetna MGG,Aetna MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,BCBS,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,BCBS MGG,BCBS MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Cigna,Cigna,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Cigna MGG,Cigna MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Humana,Humana,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Humana MGG,Humana MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Optum VA,Optum VA,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,UHC,UHC,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,UHC MGG,UHC MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,VA,VA,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Wellcare MGG,Wellcare MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Bright Health - commercial,Bright Health - commercial,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,Bright Health MGG,Bright Health MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Aetna,Aetna,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Aetna MGG,Aetna MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,BCBS,BCBS,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,BCBS MGG,BCBS MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Cigna,Cigna,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Cigna MGG,Cigna MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Humana,Humana,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Humana MGG,Humana MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Optum VA,Optum VA,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,UHC,UHC,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,UHC MGG,UHC MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,VA,VA,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Wellcare MGG,Wellcare MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Bright Health - commercial,Bright Health - commercial,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,Bright Health MGG,Bright Health MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Aetna,Aetna,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Aetna MGG,Aetna MGG,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,BCBS,BCBS,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,BCBS MGG,BCBS MGG,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Cigna,Cigna,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Cigna MGG,Cigna MGG,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Humana,Humana,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Humana MGG,Humana MGG,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Optum VA,Optum VA,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,UHC,UHC,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,UHC MGG,UHC MGG,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,VA,VA,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Wellcare MGG,Wellcare MGG,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Bright Health - commercial,Bright Health - commercial,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,Bright Health MGG,Bright Health MGG,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Aetna,Aetna,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Aetna MGG,Aetna MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,BCBS,BCBS,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,BCBS MGG,BCBS MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Cigna,Cigna,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Cigna MGG,Cigna MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Humana,Humana,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Humana MGG,Humana MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Optum VA,Optum VA,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,UHC,UHC,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,UHC MGG,UHC MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,VA,VA,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Wellcare MGG,Wellcare MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Bright Health - commercial,Bright Health - commercial,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,Bright Health MGG,Bright Health MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Aetna,Aetna,379.05,,,,,,,per diem,379.05,379.05,"Per diem rate, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Aetna MGG,Aetna MGG,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,BCBS,BCBS,379.05,,,,,,,per diem,379.05,379.05,"Per diem rate, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,BCBS MGG,BCBS MGG,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Cigna,Cigna,379.05,,,,,,,per diem,379.05,379.05,"Per diem rate, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Cigna MGG,Cigna MGG,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Humana,Humana,379.05,,,,,,,per diem,379.05,379.05,"Per diem rate, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Humana MGG,Humana MGG,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Optum VA,Optum VA,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,UHC,UHC,379.05,,,,,,,per diem,379.05,379.05,"Per diem rate, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,UHC MGG,UHC MGG,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,VA,VA,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Wellcare MGG,Wellcare MGG,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Bright Health - commercial,Bright Health - commercial,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM REHAB W/EXER 1 HR/SESSION,36203000,CDM,948,RC,G0424,HCPCS,,,,Inpatient,,,379.05,379.05,Bright Health MGG,Bright Health MGG,379.05,,,,,,,case rate,379.05,379.05,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Aetna,Aetna,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Aetna MGG,Aetna MGG,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,BCBS,BCBS,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,BCBS MGG,BCBS MGG,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Cigna,Cigna,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Cigna MGG,Cigna MGG,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Humana,Humana,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Humana MGG,Humana MGG,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Optum VA,Optum VA,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,UHC,UHC,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,UHC MGG,UHC MGG,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,VA,VA,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Wellcare MGG,Wellcare MGG,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Bright Health - commercial,Bright Health - commercial,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,,,,,,Inpatient,,,455.7,455.7,Bright Health MGG,Bright Health MGG,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Aetna,Aetna,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Aetna MGG,Aetna MGG,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,BCBS,BCBS,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,BCBS MGG,BCBS MGG,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Cigna,Cigna,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Cigna MGG,Cigna MGG,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Humana,Humana,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Humana MGG,Humana MGG,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Optum VA,Optum VA,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,UHC,UHC,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,UHC MGG,UHC MGG,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,VA,VA,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Wellcare MGG,Wellcare MGG,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Bright Health - commercial,Bright Health - commercial,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,Bright Health MGG,Bright Health MGG,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Aetna,Aetna,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Aetna MGG,Aetna MGG,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,BCBS,BCBS,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,BCBS MGG,BCBS MGG,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Cigna,Cigna,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Cigna MGG,Cigna MGG,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Humana,Humana,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Humana MGG,Humana MGG,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Optum VA,Optum VA,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,UHC,UHC,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,UHC MGG,UHC MGG,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,VA,VA,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Wellcare MGG,Wellcare MGG,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Bright Health - commercial,Bright Health - commercial,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,Bright Health MGG,Bright Health MGG,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Aetna,Aetna,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Aetna MGG,Aetna MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,BCBS,BCBS,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,BCBS MGG,BCBS MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Cigna,Cigna,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Cigna MGG,Cigna MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Humana,Humana,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Humana MGG,Humana MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Optum VA,Optum VA,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,UHC,UHC,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,UHC MGG,UHC MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,VA,VA,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Wellcare MGG,Wellcare MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Bright Health - commercial,Bright Health - commercial,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,Bright Health MGG,Bright Health MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Aetna,Aetna,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Aetna MGG,Aetna MGG,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,BCBS,BCBS,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,BCBS MGG,BCBS MGG,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Cigna,Cigna,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Cigna MGG,Cigna MGG,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Humana,Humana,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Humana MGG,Humana MGG,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Optum VA,Optum VA,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,UHC,UHC,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,UHC MGG,UHC MGG,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,VA,VA,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Wellcare MGG,Wellcare MGG,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Bright Health - commercial,Bright Health - commercial,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,Bright Health MGG,Bright Health MGG,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Aetna,Aetna,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Aetna MGG,Aetna MGG,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,BCBS,BCBS,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,BCBS MGG,BCBS MGG,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Cigna,Cigna,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Cigna MGG,Cigna MGG,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Humana,Humana,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Humana MGG,Humana MGG,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Optum VA,Optum VA,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,UHC,UHC,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,UHC MGG,UHC MGG,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,VA,VA,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Wellcare MGG,Wellcare MGG,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Bright Health - commercial,Bright Health - commercial,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,Bright Health MGG,Bright Health MGG,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Aetna,Aetna,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Aetna MGG,Aetna MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,BCBS,BCBS,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,BCBS MGG,BCBS MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Cigna,Cigna,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Cigna MGG,Cigna MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Humana,Humana,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Humana MGG,Humana MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Optum VA,Optum VA,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,UHC,UHC,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,UHC MGG,UHC MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,VA,VA,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Wellcare MGG,Wellcare MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Bright Health - commercial,Bright Health - commercial,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,Bright Health MGG,Bright Health MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Aetna,Aetna,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Aetna MGG,Aetna MGG,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,BCBS,BCBS,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,BCBS MGG,BCBS MGG,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Cigna,Cigna,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Cigna MGG,Cigna MGG,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Humana,Humana,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Humana MGG,Humana MGG,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Optum VA,Optum VA,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,UHC,UHC,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,UHC MGG,UHC MGG,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,VA,VA,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Wellcare MGG,Wellcare MGG,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Bright Health - commercial,Bright Health - commercial,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,Bright Health MGG,Bright Health MGG,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Aetna,Aetna,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Aetna MGG,Aetna MGG,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,BCBS,BCBS,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,BCBS MGG,BCBS MGG,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Cigna,Cigna,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Cigna MGG,Cigna MGG,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Humana,Humana,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Humana MGG,Humana MGG,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Optum VA,Optum VA,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,UHC,UHC,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,UHC MGG,UHC MGG,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,VA,VA,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Wellcare MGG,Wellcare MGG,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Bright Health - commercial,Bright Health - commercial,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,Bright Health MGG,Bright Health MGG,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Aetna,Aetna,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Aetna MGG,Aetna MGG,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,BCBS,BCBS,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,BCBS MGG,BCBS MGG,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Cigna,Cigna,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Cigna MGG,Cigna MGG,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Humana,Humana,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Humana MGG,Humana MGG,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Optum VA,Optum VA,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,UHC,UHC,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,UHC MGG,UHC MGG,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,VA,VA,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Wellcare MGG,Wellcare MGG,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Bright Health - commercial,Bright Health - commercial,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,Bright Health MGG,Bright Health MGG,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Aetna,Aetna,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Aetna MGG,Aetna MGG,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,BCBS,BCBS,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,BCBS MGG,BCBS MGG,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Cigna,Cigna,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Cigna MGG,Cigna MGG,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Humana,Humana,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Humana MGG,Humana MGG,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Optum VA,Optum VA,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,UHC,UHC,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,UHC MGG,UHC MGG,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,VA,VA,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Wellcare MGG,Wellcare MGG,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Bright Health - commercial,Bright Health - commercial,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,Bright Health MGG,Bright Health MGG,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Aetna,Aetna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Aetna MGG,Aetna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,BCBS,BCBS,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,BCBS MGG,BCBS MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Cigna,Cigna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Cigna MGG,Cigna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Humana,Humana,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Humana MGG,Humana MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Optum VA,Optum VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,UHC,UHC,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,UHC MGG,UHC MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,VA,VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Wellcare MGG,Wellcare MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Bright Health - commercial,Bright Health - commercial,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,,,,,,Inpatient,,,5.25,5.25,Bright Health MGG,Bright Health MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Aetna,Aetna,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Aetna MGG,Aetna MGG,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,BCBS,BCBS,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,BCBS MGG,BCBS MGG,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Cigna,Cigna,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Cigna MGG,Cigna MGG,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Humana,Humana,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Humana MGG,Humana MGG,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Optum VA,Optum VA,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,UHC,UHC,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,UHC MGG,UHC MGG,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,VA,VA,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Wellcare MGG,Wellcare MGG,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Bright Health - commercial,Bright Health - commercial,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,Bright Health MGG,Bright Health MGG,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Aetna,Aetna,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Aetna MGG,Aetna MGG,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,BCBS,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS MGG,BCBS MGG,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Cigna,Cigna,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Cigna MGG,Cigna MGG,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Humana,Humana,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Humana MGG,Humana MGG,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Optum VA,Optum VA,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,UHC,UHC,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,UHC MGG,UHC MGG,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,VA,VA,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Wellcare MGG,Wellcare MGG,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Bright Health - commercial,Bright Health - commercial,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,Bright Health MGG,Bright Health MGG,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Aetna,Aetna,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Aetna MGG,Aetna MGG,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,BCBS,BCBS,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,BCBS MGG,BCBS MGG,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Cigna,Cigna,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Cigna MGG,Cigna MGG,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Humana,Humana,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Humana MGG,Humana MGG,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Optum VA,Optum VA,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,UHC,UHC,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,UHC MGG,UHC MGG,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,VA,VA,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Wellcare MGG,Wellcare MGG,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Bright Health - commercial,Bright Health - commercial,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,Bright Health MGG,Bright Health MGG,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Aetna,Aetna,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Aetna MGG,Aetna MGG,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,BCBS,BCBS,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,BCBS MGG,BCBS MGG,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Cigna,Cigna,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Cigna MGG,Cigna MGG,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Humana,Humana,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Humana MGG,Humana MGG,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Optum VA,Optum VA,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,UHC,UHC,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,UHC MGG,UHC MGG,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,VA,VA,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Wellcare MGG,Wellcare MGG,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Bright Health - commercial,Bright Health - commercial,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,Bright Health MGG,Bright Health MGG,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Aetna,Aetna,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Aetna MGG,Aetna MGG,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,BCBS,BCBS,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,BCBS MGG,BCBS MGG,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Cigna,Cigna,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Cigna MGG,Cigna MGG,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Humana,Humana,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Humana MGG,Humana MGG,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Optum VA,Optum VA,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,UHC,UHC,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,UHC MGG,UHC MGG,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,VA,VA,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Wellcare MGG,Wellcare MGG,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Bright Health - commercial,Bright Health - commercial,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,Bright Health MGG,Bright Health MGG,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Aetna,Aetna,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Aetna MGG,Aetna MGG,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,BCBS,BCBS,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,BCBS MGG,BCBS MGG,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Cigna,Cigna,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Cigna MGG,Cigna MGG,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Humana,Humana,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Humana MGG,Humana MGG,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Optum VA,Optum VA,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,UHC,UHC,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,UHC MGG,UHC MGG,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,VA,VA,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Wellcare MGG,Wellcare MGG,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Bright Health - commercial,Bright Health - commercial,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,Bright Health MGG,Bright Health MGG,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Aetna,Aetna,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Aetna MGG,Aetna MGG,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,BCBS,BCBS,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,BCBS MGG,BCBS MGG,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Cigna,Cigna,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Cigna MGG,Cigna MGG,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Humana,Humana,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Humana MGG,Humana MGG,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Optum VA,Optum VA,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,UHC,UHC,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,UHC MGG,UHC MGG,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,VA,VA,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Wellcare MGG,Wellcare MGG,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Bright Health - commercial,Bright Health - commercial,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,Bright Health MGG,Bright Health MGG,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Aetna,Aetna,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Aetna MGG,Aetna MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS,BCBS,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS MGG,BCBS MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Cigna,Cigna,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Cigna MGG,Cigna MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Humana,Humana,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Humana MGG,Humana MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Optum VA,Optum VA,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,UHC,UHC,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,UHC MGG,UHC MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,VA,VA,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Wellcare MGG,Wellcare MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Bright Health - commercial,Bright Health - commercial,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,Bright Health MGG,Bright Health MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Aetna,Aetna,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Aetna MGG,Aetna MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS,BCBS,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS MGG,BCBS MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Cigna,Cigna,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Cigna MGG,Cigna MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Humana,Humana,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Humana MGG,Humana MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Optum VA,Optum VA,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,UHC,UHC,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,UHC MGG,UHC MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,VA,VA,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Wellcare MGG,Wellcare MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Bright Health - commercial,Bright Health - commercial,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Bright Health MGG,Bright Health MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Aetna,Aetna,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Aetna MGG,Aetna MGG,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,BCBS,BCBS,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,BCBS MGG,BCBS MGG,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Cigna,Cigna,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Cigna MGG,Cigna MGG,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Humana,Humana,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Humana MGG,Humana MGG,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Optum VA,Optum VA,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,UHC,UHC,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,UHC MGG,UHC MGG,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,VA,VA,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Wellcare MGG,Wellcare MGG,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Bright Health - commercial,Bright Health - commercial,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,Bright Health MGG,Bright Health MGG,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Aetna,Aetna,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Aetna MGG,Aetna MGG,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,BCBS,BCBS,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,BCBS MGG,BCBS MGG,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Cigna,Cigna,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Cigna MGG,Cigna MGG,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Humana,Humana,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Humana MGG,Humana MGG,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Optum VA,Optum VA,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,UHC,UHC,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,UHC MGG,UHC MGG,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,VA,VA,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Wellcare MGG,Wellcare MGG,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Bright Health - commercial,Bright Health - commercial,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,161.44,161.44,Bright Health MGG,Bright Health MGG,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Aetna,Aetna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Aetna MGG,Aetna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS,BCBS,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS MGG,BCBS MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Cigna,Cigna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Cigna MGG,Cigna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Humana,Humana,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Humana MGG,Humana MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Optum VA,Optum VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,UHC,UHC,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,UHC MGG,UHC MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,VA,VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Wellcare MGG,Wellcare MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Bright Health - commercial,Bright Health - commercial,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Bright Health MGG,Bright Health MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Aetna,Aetna,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Aetna MGG,Aetna MGG,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,BCBS,BCBS,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,BCBS MGG,BCBS MGG,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Cigna,Cigna,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Cigna MGG,Cigna MGG,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Humana,Humana,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Humana MGG,Humana MGG,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Optum VA,Optum VA,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,UHC,UHC,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,UHC MGG,UHC MGG,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,VA,VA,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Wellcare MGG,Wellcare MGG,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Bright Health - commercial,Bright Health - commercial,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,Bright Health MGG,Bright Health MGG,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Aetna,Aetna,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Aetna MGG,Aetna MGG,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,BCBS,BCBS,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,BCBS MGG,BCBS MGG,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Cigna,Cigna,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Cigna MGG,Cigna MGG,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Humana,Humana,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Humana MGG,Humana MGG,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Optum VA,Optum VA,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,UHC,UHC,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,UHC MGG,UHC MGG,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,VA,VA,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Wellcare MGG,Wellcare MGG,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Bright Health - commercial,Bright Health - commercial,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,Bright Health MGG,Bright Health MGG,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Aetna,Aetna,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Aetna MGG,Aetna MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,BCBS,BCBS,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,BCBS MGG,BCBS MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Cigna,Cigna,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Cigna MGG,Cigna MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Humana,Humana,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Humana MGG,Humana MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Optum VA,Optum VA,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,UHC,UHC,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,UHC MGG,UHC MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,VA,VA,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Wellcare MGG,Wellcare MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Bright Health - commercial,Bright Health - commercial,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,Bright Health MGG,Bright Health MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Aetna,Aetna,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Aetna MGG,Aetna MGG,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,BCBS,BCBS,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,BCBS MGG,BCBS MGG,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Cigna,Cigna,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Cigna MGG,Cigna MGG,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Humana,Humana,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Humana MGG,Humana MGG,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Optum VA,Optum VA,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,UHC,UHC,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,UHC MGG,UHC MGG,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,VA,VA,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Wellcare MGG,Wellcare MGG,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Bright Health - commercial,Bright Health - commercial,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,Bright Health MGG,Bright Health MGG,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Aetna,Aetna,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Aetna MGG,Aetna MGG,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,BCBS,BCBS,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,BCBS MGG,BCBS MGG,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Cigna,Cigna,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Cigna MGG,Cigna MGG,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Humana,Humana,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Humana MGG,Humana MGG,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Optum VA,Optum VA,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,UHC,UHC,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,UHC MGG,UHC MGG,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,VA,VA,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Wellcare MGG,Wellcare MGG,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Bright Health - commercial,Bright Health - commercial,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,Bright Health MGG,Bright Health MGG,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Aetna,Aetna,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Aetna MGG,Aetna MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,BCBS,BCBS,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,BCBS MGG,BCBS MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Cigna,Cigna,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Cigna MGG,Cigna MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Humana,Humana,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Humana MGG,Humana MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Optum VA,Optum VA,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,UHC,UHC,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,UHC MGG,UHC MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,VA,VA,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Wellcare MGG,Wellcare MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Bright Health - commercial,Bright Health - commercial,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,Bright Health MGG,Bright Health MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Aetna,Aetna,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Aetna MGG,Aetna MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,BCBS,BCBS,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,BCBS MGG,BCBS MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Cigna,Cigna,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Cigna MGG,Cigna MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Humana,Humana,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Humana MGG,Humana MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Optum VA,Optum VA,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,UHC,UHC,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,UHC MGG,UHC MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,VA,VA,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Wellcare MGG,Wellcare MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Bright Health - commercial,Bright Health - commercial,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,Bright Health MGG,Bright Health MGG,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Aetna,Aetna,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Aetna MGG,Aetna MGG,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,BCBS,BCBS,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,BCBS MGG,BCBS MGG,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Cigna,Cigna,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Cigna MGG,Cigna MGG,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Humana,Humana,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Humana MGG,Humana MGG,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Optum VA,Optum VA,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,UHC,UHC,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,UHC MGG,UHC MGG,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,VA,VA,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Wellcare MGG,Wellcare MGG,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Bright Health - commercial,Bright Health - commercial,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,Bright Health MGG,Bright Health MGG,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Aetna,Aetna,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Aetna MGG,Aetna MGG,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,BCBS,BCBS,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,BCBS MGG,BCBS MGG,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Cigna,Cigna,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Cigna MGG,Cigna MGG,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Humana,Humana,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Humana MGG,Humana MGG,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Optum VA,Optum VA,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,UHC,UHC,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,UHC MGG,UHC MGG,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,VA,VA,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Wellcare MGG,Wellcare MGG,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Bright Health - commercial,Bright Health - commercial,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,Bright Health MGG,Bright Health MGG,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Aetna,Aetna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Aetna MGG,Aetna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,BCBS,BCBS,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,BCBS MGG,BCBS MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Cigna,Cigna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Cigna MGG,Cigna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Humana,Humana,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Humana MGG,Humana MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Optum VA,Optum VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,UHC,UHC,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,UHC MGG,UHC MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,VA,VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Wellcare MGG,Wellcare MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Bright Health - commercial,Bright Health - commercial,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,Bright Health MGG,Bright Health MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Aetna,Aetna,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Aetna MGG,Aetna MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,BCBS,BCBS,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,BCBS MGG,BCBS MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Cigna,Cigna,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Cigna MGG,Cigna MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Humana,Humana,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Humana MGG,Humana MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Optum VA,Optum VA,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,UHC,UHC,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,UHC MGG,UHC MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,VA,VA,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Wellcare MGG,Wellcare MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Bright Health - commercial,Bright Health - commercial,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,Bright Health MGG,Bright Health MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Aetna,Aetna,1618.05,,,,,,,per diem,1618.05,1618.05,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Aetna MGG,Aetna MGG,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,BCBS,BCBS,1618.05,,,,,,,per diem,1618.05,1618.05,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,BCBS MGG,BCBS MGG,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Cigna,Cigna,1618.05,,,,,,,per diem,1618.05,1618.05,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Cigna MGG,Cigna MGG,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Humana,Humana,1618.05,,,,,,,per diem,1618.05,1618.05,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Humana MGG,Humana MGG,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Optum VA,Optum VA,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,UHC,UHC,1618.05,,,,,,,per diem,1618.05,1618.05,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,UHC MGG,UHC MGG,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,VA,VA,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Wellcare MGG,Wellcare MGG,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Bright Health - commercial,Bright Health - commercial,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-16> MRK-INTERP ,38000750,CDM,300,RC,88189,CPT,,,,Inpatient,,,1618.05,1618.05,Bright Health MGG,Bright Health MGG,1618.05,,,,,,,case rate,1618.05,1618.05,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Aetna,Aetna,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Aetna MGG,Aetna MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,BCBS,BCBS,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,BCBS MGG,BCBS MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Cigna,Cigna,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Cigna MGG,Cigna MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Humana,Humana,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Humana MGG,Humana MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Optum VA,Optum VA,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,UHC,UHC,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,UHC MGG,UHC MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,VA,VA,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Wellcare MGG,Wellcare MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Bright Health - commercial,Bright Health - commercial,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,Bright Health MGG,Bright Health MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Aetna,Aetna,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Aetna MGG,Aetna MGG,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,BCBS,BCBS,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,BCBS MGG,BCBS MGG,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Cigna,Cigna,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Cigna MGG,Cigna MGG,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Humana,Humana,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Humana MGG,Humana MGG,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Optum VA,Optum VA,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,UHC,UHC,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,UHC MGG,UHC MGG,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,VA,VA,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Wellcare MGG,Wellcare MGG,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Bright Health - commercial,Bright Health - commercial,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,Bright Health MGG,Bright Health MGG,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Aetna,Aetna,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Aetna MGG,Aetna MGG,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,BCBS,BCBS,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,BCBS MGG,BCBS MGG,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Cigna,Cigna,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Cigna MGG,Cigna MGG,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Humana,Humana,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Humana MGG,Humana MGG,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Optum VA,Optum VA,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,UHC,UHC,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,UHC MGG,UHC MGG,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,VA,VA,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Wellcare MGG,Wellcare MGG,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Bright Health - commercial,Bright Health - commercial,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,88172,CPT,,,,Inpatient,,,711.14,711.14,Bright Health MGG,Bright Health MGG,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Aetna,Aetna,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Aetna MGG,Aetna MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,BCBS,BCBS,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,BCBS MGG,BCBS MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Cigna,Cigna,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Cigna MGG,Cigna MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Humana,Humana,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Humana MGG,Humana MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Optum VA,Optum VA,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,UHC,UHC,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,UHC MGG,UHC MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,VA,VA,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Wellcare MGG,Wellcare MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Bright Health - commercial,Bright Health - commercial,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,88342,CPT,,,,Inpatient,,,198.14,198.14,Bright Health MGG,Bright Health MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,88342,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Aetna,Aetna,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Aetna MGG,Aetna MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,BCBS,BCBS,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,BCBS MGG,BCBS MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Cigna,Cigna,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Cigna MGG,Cigna MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Humana,Humana,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Humana MGG,Humana MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Optum VA,Optum VA,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,UHC,UHC,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,UHC MGG,UHC MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,VA,VA,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Wellcare MGG,Wellcare MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Bright Health - commercial,Bright Health - commercial,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,88342,CPT,,,,Inpatient,,,244.19,244.19,Bright Health MGG,Bright Health MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Aetna,Aetna,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Aetna MGG,Aetna MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,BCBS,BCBS,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,BCBS MGG,BCBS MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Cigna,Cigna,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Cigna MGG,Cigna MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Humana,Humana,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Humana MGG,Humana MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Optum VA,Optum VA,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,UHC,UHC,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,UHC MGG,UHC MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,VA,VA,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Wellcare MGG,Wellcare MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Bright Health - commercial,Bright Health - commercial,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,88342,CPT,,,,Inpatient,,,1311.98,1311.98,Bright Health MGG,Bright Health MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Aetna,Aetna,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Aetna MGG,Aetna MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS,BCBS,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS MGG,BCBS MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Cigna,Cigna,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Cigna MGG,Cigna MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Humana,Humana,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Humana MGG,Humana MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Optum VA,Optum VA,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,UHC,UHC,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,UHC MGG,UHC MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,VA,VA,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Wellcare MGG,Wellcare MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Bright Health - commercial,Bright Health - commercial,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,Bright Health MGG,Bright Health MGG,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Aetna,Aetna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Aetna MGG,Aetna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS,BCBS,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS MGG,BCBS MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Cigna,Cigna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Cigna MGG,Cigna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Humana,Humana,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Humana MGG,Humana MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Optum VA,Optum VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,UHC,UHC,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,UHC MGG,UHC MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,VA,VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Wellcare MGG,Wellcare MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Bright Health - commercial,Bright Health - commercial,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Bright Health MGG,Bright Health MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Aetna,Aetna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Aetna MGG,Aetna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS,BCBS,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS MGG,BCBS MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Cigna,Cigna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Cigna MGG,Cigna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Humana,Humana,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Humana MGG,Humana MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Optum VA,Optum VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,UHC,UHC,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,UHC MGG,UHC MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,VA,VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Wellcare MGG,Wellcare MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Bright Health - commercial,Bright Health - commercial,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,Bright Health MGG,Bright Health MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Aetna,Aetna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Aetna MGG,Aetna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS,BCBS,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS MGG,BCBS MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Cigna,Cigna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Cigna MGG,Cigna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Humana,Humana,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Humana MGG,Humana MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Optum VA,Optum VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,UHC,UHC,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,UHC MGG,UHC MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,VA,VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Wellcare MGG,Wellcare MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Bright Health - commercial,Bright Health - commercial,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,Bright Health MGG,Bright Health MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Aetna,Aetna,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Aetna MGG,Aetna MGG,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,BCBS,BCBS,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,BCBS MGG,BCBS MGG,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Cigna,Cigna,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Cigna MGG,Cigna MGG,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Humana,Humana,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Humana MGG,Humana MGG,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Optum VA,Optum VA,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,UHC,UHC,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,UHC MGG,UHC MGG,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,VA,VA,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Wellcare MGG,Wellcare MGG,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Bright Health - commercial,Bright Health - commercial,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,88173,CPT,,,,Inpatient,,,339.51,339.51,Bright Health MGG,Bright Health MGG,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Aetna,Aetna,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Aetna MGG,Aetna MGG,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,BCBS,BCBS,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,BCBS MGG,BCBS MGG,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Cigna,Cigna,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Cigna MGG,Cigna MGG,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Humana,Humana,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Humana MGG,Humana MGG,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Optum VA,Optum VA,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,UHC,UHC,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,UHC MGG,UHC MGG,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,VA,VA,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Wellcare MGG,Wellcare MGG,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Bright Health - commercial,Bright Health - commercial,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,88184,CPT,,,,Inpatient,,,265.61,265.61,Bright Health MGG,Bright Health MGG,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Aetna,Aetna,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Aetna MGG,Aetna MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,BCBS,BCBS,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,BCBS MGG,BCBS MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Cigna,Cigna,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Cigna MGG,Cigna MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Humana,Humana,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Humana MGG,Humana MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Optum VA,Optum VA,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,UHC,UHC,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,UHC MGG,UHC MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,VA,VA,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Wellcare MGG,Wellcare MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Bright Health - commercial,Bright Health - commercial,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,88185,CPT,,,,Inpatient,,,160.65,160.65,Bright Health MGG,Bright Health MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Aetna,Aetna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Aetna MGG,Aetna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,BCBS,BCBS,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,BCBS MGG,BCBS MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Cigna,Cigna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Cigna MGG,Cigna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Humana,Humana,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Humana MGG,Humana MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Optum VA,Optum VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,UHC,UHC,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,UHC MGG,UHC MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,VA,VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Wellcare MGG,Wellcare MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Bright Health - commercial,Bright Health - commercial,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,82150,CPT,,,,Inpatient,,,35.34,35.34,Bright Health MGG,Bright Health MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Aetna,Aetna,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Aetna MGG,Aetna MGG,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,BCBS,BCBS,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,BCBS MGG,BCBS MGG,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Cigna,Cigna,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Cigna MGG,Cigna MGG,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Humana,Humana,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Humana MGG,Humana MGG,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Optum VA,Optum VA,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,UHC,UHC,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,UHC MGG,UHC MGG,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,VA,VA,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Wellcare MGG,Wellcare MGG,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Bright Health - commercial,Bright Health - commercial,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,83540,CPT,,,,Inpatient,,,724,724,Bright Health MGG,Bright Health MGG,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Aetna,Aetna,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Aetna MGG,Aetna MGG,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,BCBS,BCBS,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,BCBS MGG,BCBS MGG,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Cigna,Cigna,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Cigna MGG,Cigna MGG,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Humana,Humana,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Humana MGG,Humana MGG,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Optum VA,Optum VA,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,UHC,UHC,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,UHC MGG,UHC MGG,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,VA,VA,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Wellcare MGG,Wellcare MGG,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Bright Health - commercial,Bright Health - commercial,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,84999,CPT,,,,Inpatient,,,13136.89,13136.89,Bright Health MGG,Bright Health MGG,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Aetna,Aetna,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Aetna MGG,Aetna MGG,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,BCBS,BCBS,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,BCBS MGG,BCBS MGG,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Cigna,Cigna,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Cigna MGG,Cigna MGG,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Humana,Humana,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Humana MGG,Humana MGG,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Optum VA,Optum VA,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,UHC,UHC,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,UHC MGG,UHC MGG,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,VA,VA,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Wellcare MGG,Wellcare MGG,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Bright Health - commercial,Bright Health - commercial,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,81401,CPT,,,,Inpatient,,,345.93,345.93,Bright Health MGG,Bright Health MGG,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Aetna,Aetna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Aetna MGG,Aetna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,BCBS,BCBS,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,BCBS MGG,BCBS MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Cigna,Cigna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Cigna MGG,Cigna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Humana,Humana,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Humana MGG,Humana MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Optum VA,Optum VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,UHC,UHC,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,UHC MGG,UHC MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,VA,VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Wellcare MGG,Wellcare MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Bright Health - commercial,Bright Health - commercial,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Bright Health MGG,Bright Health MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Aetna,Aetna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Aetna MGG,Aetna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,BCBS,BCBS,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,BCBS MGG,BCBS MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Cigna,Cigna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Cigna MGG,Cigna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Humana,Humana,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Humana MGG,Humana MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Optum VA,Optum VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,UHC,UHC,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,UHC MGG,UHC MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,VA,VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Wellcare MGG,Wellcare MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Bright Health - commercial,Bright Health - commercial,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Bright Health MGG,Bright Health MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Aetna,Aetna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Aetna MGG,Aetna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,BCBS,BCBS,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,BCBS MGG,BCBS MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Cigna,Cigna,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Cigna MGG,Cigna MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Humana,Humana,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Humana MGG,Humana MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Optum VA,Optum VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,UHC,UHC,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,UHC MGG,UHC MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,VA,VA,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Wellcare MGG,Wellcare MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Bright Health - commercial,Bright Health - commercial,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,88365,CPT,,,,Inpatient,,,518.36,518.36,Bright Health MGG,Bright Health MGG,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Aetna,Aetna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Aetna MGG,Aetna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,BCBS,BCBS,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,BCBS MGG,BCBS MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Cigna,Cigna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Cigna MGG,Cigna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Humana,Humana,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Humana MGG,Humana MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Optum VA,Optum VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,UHC,UHC,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,UHC MGG,UHC MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,VA,VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Wellcare MGG,Wellcare MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Bright Health - commercial,Bright Health - commercial,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Bright Health MGG,Bright Health MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Aetna,Aetna,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Aetna MGG,Aetna MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,BCBS,BCBS,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,BCBS MGG,BCBS MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Cigna,Cigna,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Cigna MGG,Cigna MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Humana,Humana,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Humana MGG,Humana MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Optum VA,Optum VA,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,UHC,UHC,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,UHC MGG,UHC MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,VA,VA,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Wellcare MGG,Wellcare MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Bright Health - commercial,Bright Health - commercial,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,81272,CPT,,,,Inpatient,,,439.11,439.11,Bright Health MGG,Bright Health MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Aetna,Aetna,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Aetna MGG,Aetna MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,BCBS,BCBS,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,BCBS MGG,BCBS MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Cigna,Cigna,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Cigna MGG,Cigna MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Humana,Humana,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Humana MGG,Humana MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Optum VA,Optum VA,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,UHC,UHC,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,UHC MGG,UHC MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,VA,VA,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Wellcare MGG,Wellcare MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Bright Health - commercial,Bright Health - commercial,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,81314,CPT,,,,Inpatient,,,439.11,439.11,Bright Health MGG,Bright Health MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Aetna,Aetna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Aetna MGG,Aetna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,BCBS,BCBS,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,BCBS MGG,BCBS MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Cigna,Cigna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Cigna MGG,Cigna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Humana,Humana,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Humana MGG,Humana MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Optum VA,Optum VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,UHC,UHC,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,UHC MGG,UHC MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,VA,VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Wellcare MGG,Wellcare MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Bright Health - commercial,Bright Health - commercial,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,88381,CPT,,,,Inpatient,,,168.15,168.15,Bright Health MGG,Bright Health MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Aetna,Aetna,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Aetna MGG,Aetna MGG,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,BCBS,BCBS,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,BCBS MGG,BCBS MGG,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Cigna,Cigna,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Cigna MGG,Cigna MGG,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Humana,Humana,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Humana MGG,Humana MGG,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Optum VA,Optum VA,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,UHC,UHC,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,UHC MGG,UHC MGG,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,VA,VA,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Wellcare MGG,Wellcare MGG,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Bright Health - commercial,Bright Health - commercial,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,81235,CPT,,,,Inpatient,,,900.71,900.71,Bright Health MGG,Bright Health MGG,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Aetna,Aetna,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Aetna MGG,Aetna MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,BCBS,BCBS,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,BCBS MGG,BCBS MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Cigna,Cigna,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Cigna MGG,Cigna MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Humana,Humana,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Humana MGG,Humana MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Optum VA,Optum VA,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,UHC,UHC,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,UHC MGG,UHC MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,VA,VA,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Wellcare MGG,Wellcare MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Bright Health - commercial,Bright Health - commercial,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,88274,CPT,,,,Inpatient,,,501.23,501.23,Bright Health MGG,Bright Health MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Aetna,Aetna,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Aetna MGG,Aetna MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,BCBS,BCBS,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,BCBS MGG,BCBS MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Cigna,Cigna,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Cigna MGG,Cigna MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Humana,Humana,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Humana MGG,Humana MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Optum VA,Optum VA,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,UHC,UHC,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,UHC MGG,UHC MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,VA,VA,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Wellcare MGG,Wellcare MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Bright Health - commercial,Bright Health - commercial,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,88291,CPT,,,,Inpatient,,,539.78,539.78,Bright Health MGG,Bright Health MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Aetna,Aetna,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Aetna MGG,Aetna MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,BCBS,BCBS,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,BCBS MGG,BCBS MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Cigna,Cigna,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Cigna MGG,Cigna MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Humana,Humana,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Humana MGG,Humana MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Optum VA,Optum VA,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,UHC,UHC,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,UHC MGG,UHC MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,VA,VA,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Wellcare MGG,Wellcare MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Bright Health - commercial,Bright Health - commercial,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,81400,CPT,,,,Inpatient,,,400.55,400.55,Bright Health MGG,Bright Health MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Aetna,Aetna,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Aetna MGG,Aetna MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,BCBS,BCBS,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,BCBS MGG,BCBS MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Cigna,Cigna,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Cigna MGG,Cigna MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Humana,Humana,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Humana MGG,Humana MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Optum VA,Optum VA,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,UHC,UHC,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,UHC MGG,UHC MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,VA,VA,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Wellcare MGG,Wellcare MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Bright Health - commercial,Bright Health - commercial,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,81401,CPT,,,,Inpatient,,,400.55,400.55,Bright Health MGG,Bright Health MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Aetna,Aetna,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Aetna MGG,Aetna MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,BCBS,BCBS,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,BCBS MGG,BCBS MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Cigna,Cigna,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Cigna MGG,Cigna MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Humana,Humana,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Humana MGG,Humana MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Optum VA,Optum VA,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,UHC,UHC,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,UHC MGG,UHC MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,VA,VA,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Wellcare MGG,Wellcare MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Bright Health - commercial,Bright Health - commercial,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,Bright Health MGG,Bright Health MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Aetna,Aetna,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Aetna MGG,Aetna MGG,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,BCBS,BCBS,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,BCBS MGG,BCBS MGG,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Cigna,Cigna,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Cigna MGG,Cigna MGG,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Humana,Humana,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Humana MGG,Humana MGG,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Optum VA,Optum VA,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,UHC,UHC,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,UHC MGG,UHC MGG,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,VA,VA,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Wellcare MGG,Wellcare MGG,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Bright Health - commercial,Bright Health - commercial,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,81479,CPT,,,,Inpatient,,,187.43,187.43,Bright Health MGG,Bright Health MGG,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Aetna,Aetna,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Aetna MGG,Aetna MGG,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,BCBS,BCBS,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,BCBS MGG,BCBS MGG,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Cigna,Cigna,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Cigna MGG,Cigna MGG,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Humana,Humana,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Humana MGG,Humana MGG,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Optum VA,Optum VA,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,UHC,UHC,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,UHC MGG,UHC MGG,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,VA,VA,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Wellcare MGG,Wellcare MGG,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Bright Health - commercial,Bright Health - commercial,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,88361,CPT,,,,Inpatient,,,309.52,309.52,Bright Health MGG,Bright Health MGG,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Aetna,Aetna,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Aetna MGG,Aetna MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,BCBS,BCBS,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,BCBS MGG,BCBS MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Cigna,Cigna,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Cigna MGG,Cigna MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Humana,Humana,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Humana MGG,Humana MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Optum VA,Optum VA,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,UHC,UHC,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,UHC MGG,UHC MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,VA,VA,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Wellcare MGG,Wellcare MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Bright Health - commercial,Bright Health - commercial,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,88367,CPT,,,,Inpatient,,,508.73,508.73,Bright Health MGG,Bright Health MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Aetna,Aetna,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Aetna MGG,Aetna MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,BCBS,BCBS,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,BCBS MGG,BCBS MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Cigna,Cigna,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Cigna MGG,Cigna MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Humana,Humana,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Humana MGG,Humana MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Optum VA,Optum VA,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,UHC,UHC,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,UHC MGG,UHC MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,VA,VA,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Wellcare MGG,Wellcare MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Bright Health - commercial,Bright Health - commercial,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,88177,CPT,,,,Inpatient,,,112.46,112.46,Bright Health MGG,Bright Health MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Aetna,Aetna,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Aetna MGG,Aetna MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,BCBS,BCBS,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,BCBS MGG,BCBS MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Cigna,Cigna,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Cigna MGG,Cigna MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Humana,Humana,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Humana MGG,Humana MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Optum VA,Optum VA,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,UHC,UHC,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,UHC MGG,UHC MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,VA,VA,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Wellcare MGG,Wellcare MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Bright Health - commercial,Bright Health - commercial,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,88333,CPT,,,,Inpatient,,,317.02,317.02,Bright Health MGG,Bright Health MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Aetna,Aetna,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Aetna MGG,Aetna MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,BCBS,BCBS,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,BCBS MGG,BCBS MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Cigna,Cigna,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Cigna MGG,Cigna MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Humana,Humana,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Humana MGG,Humana MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Optum VA,Optum VA,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,UHC,UHC,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,UHC MGG,UHC MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,VA,VA,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Wellcare MGG,Wellcare MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Bright Health - commercial,Bright Health - commercial,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,88162,CPT,,,,Inpatient,,,400.55,400.55,Bright Health MGG,Bright Health MGG,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Aetna,Aetna,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Aetna MGG,Aetna MGG,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,BCBS,BCBS,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,BCBS MGG,BCBS MGG,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Cigna,Cigna,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Cigna MGG,Cigna MGG,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Humana,Humana,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Humana MGG,Humana MGG,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Optum VA,Optum VA,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,UHC,UHC,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,UHC MGG,UHC MGG,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,VA,VA,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Wellcare MGG,Wellcare MGG,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Bright Health - commercial,Bright Health - commercial,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,88341,CPT,,,,Inpatient,,,169.22,169.22,Bright Health MGG,Bright Health MGG,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Aetna,Aetna,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Aetna MGG,Aetna MGG,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,BCBS,BCBS,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,BCBS MGG,BCBS MGG,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Cigna,Cigna,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Cigna MGG,Cigna MGG,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Humana,Humana,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Humana MGG,Humana MGG,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Optum VA,Optum VA,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,UHC,UHC,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,UHC MGG,UHC MGG,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,VA,VA,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Wellcare MGG,Wellcare MGG,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Bright Health - commercial,Bright Health - commercial,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,G0416,CPT,,,,Inpatient,,,1466.2,1466.2,Bright Health MGG,Bright Health MGG,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Aetna,Aetna,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Aetna MGG,Aetna MGG,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,BCBS,BCBS,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,BCBS MGG,BCBS MGG,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Cigna,Cigna,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Cigna MGG,Cigna MGG,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Humana,Humana,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Humana MGG,Humana MGG,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Optum VA,Optum VA,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,UHC,UHC,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,UHC MGG,UHC MGG,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,VA,VA,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Wellcare MGG,Wellcare MGG,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Bright Health - commercial,Bright Health - commercial,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,G0416,CPT,,,,Inpatient,,,2939.9,2939.9,Bright Health MGG,Bright Health MGG,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Aetna,Aetna,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Aetna MGG,Aetna MGG,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,BCBS,BCBS,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,BCBS MGG,BCBS MGG,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Cigna,Cigna,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Cigna MGG,Cigna MGG,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Humana,Humana,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Humana MGG,Humana MGG,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Optum VA,Optum VA,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,UHC,UHC,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,UHC MGG,UHC MGG,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,VA,VA,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Wellcare MGG,Wellcare MGG,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Bright Health - commercial,Bright Health - commercial,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,G0416,CPT,,,,Inpatient,,,4911.61,4911.61,Bright Health MGG,Bright Health MGG,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Aetna,Aetna,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Aetna MGG,Aetna MGG,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,BCBS,BCBS,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,BCBS MGG,BCBS MGG,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Cigna,Cigna,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Cigna MGG,Cigna MGG,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Humana,Humana,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Humana MGG,Humana MGG,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Optum VA,Optum VA,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,UHC,UHC,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,UHC MGG,UHC MGG,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,VA,VA,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Wellcare MGG,Wellcare MGG,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Bright Health - commercial,Bright Health - commercial,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,G0416,CPT,,,,Inpatient,,,5730.92,5730.92,Bright Health MGG,Bright Health MGG,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Aetna,Aetna,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Aetna MGG,Aetna MGG,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,BCBS,BCBS,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,BCBS MGG,BCBS MGG,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Cigna,Cigna,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Cigna MGG,Cigna MGG,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Humana,Humana,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Humana MGG,Humana MGG,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Optum VA,Optum VA,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,UHC,UHC,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,UHC MGG,UHC MGG,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,VA,VA,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Wellcare MGG,Wellcare MGG,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Bright Health - commercial,Bright Health - commercial,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,88344,CPT,,,,Inpatient,,,217.41,217.41,Bright Health MGG,Bright Health MGG,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Aetna,Aetna,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Aetna MGG,Aetna MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,BCBS,BCBS,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,BCBS MGG,BCBS MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Cigna,Cigna,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Cigna MGG,Cigna MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Humana,Humana,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Humana MGG,Humana MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Optum VA,Optum VA,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,UHC,UHC,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,UHC MGG,UHC MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,VA,VA,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Wellcare MGG,Wellcare MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Bright Health - commercial,Bright Health - commercial,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,88365,CPT,,,,Inpatient,,,318.09,318.09,Bright Health MGG,Bright Health MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Aetna,Aetna,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Aetna MGG,Aetna MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,BCBS,BCBS,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,BCBS MGG,BCBS MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Cigna,Cigna,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Cigna MGG,Cigna MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Humana,Humana,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Humana MGG,Humana MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Optum VA,Optum VA,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,UHC,UHC,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,UHC MGG,UHC MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,VA,VA,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Wellcare MGG,Wellcare MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Bright Health - commercial,Bright Health - commercial,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,88364,CPT,,,,Inpatient,,,141.37,141.37,Bright Health MGG,Bright Health MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Aetna,Aetna,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Aetna MGG,Aetna MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,BCBS,BCBS,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,BCBS MGG,BCBS MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Cigna,Cigna,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Cigna MGG,Cigna MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Humana,Humana,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Humana MGG,Humana MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Optum VA,Optum VA,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,UHC,UHC,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,UHC MGG,UHC MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,VA,VA,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Wellcare MGG,Wellcare MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Bright Health - commercial,Bright Health - commercial,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,Bright Health MGG,Bright Health MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Aetna,Aetna,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Aetna MGG,Aetna MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,BCBS,BCBS,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,BCBS MGG,BCBS MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Cigna,Cigna,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Cigna MGG,Cigna MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Humana,Humana,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Humana MGG,Humana MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Optum VA,Optum VA,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,UHC,UHC,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,UHC MGG,UHC MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,VA,VA,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Wellcare MGG,Wellcare MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Bright Health - commercial,Bright Health - commercial,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,88373,CPT,,,,Inpatient,,,511.94,511.94,Bright Health MGG,Bright Health MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Aetna,Aetna,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Aetna MGG,Aetna MGG,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,BCBS,BCBS,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,BCBS MGG,BCBS MGG,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Cigna,Cigna,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Cigna MGG,Cigna MGG,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Humana,Humana,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Humana MGG,Humana MGG,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Optum VA,Optum VA,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,UHC,UHC,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,UHC MGG,UHC MGG,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,VA,VA,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Wellcare MGG,Wellcare MGG,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Bright Health - commercial,Bright Health - commercial,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,88374,CPT,,,,Inpatient,,,969.26,969.26,Bright Health MGG,Bright Health MGG,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Aetna,Aetna,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Aetna MGG,Aetna MGG,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,BCBS,BCBS,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,BCBS MGG,BCBS MGG,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Cigna,Cigna,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Cigna MGG,Cigna MGG,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Humana,Humana,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Humana MGG,Humana MGG,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Optum VA,Optum VA,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,UHC,UHC,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,UHC MGG,UHC MGG,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,VA,VA,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Wellcare MGG,Wellcare MGG,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Bright Health - commercial,Bright Health - commercial,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,88377,CPT,,,,Inpatient,,,936.05,936.05,Bright Health MGG,Bright Health MGG,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Aetna,Aetna,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Aetna MGG,Aetna MGG,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,BCBS,BCBS,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,BCBS MGG,BCBS MGG,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Cigna,Cigna,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Cigna MGG,Cigna MGG,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Humana,Humana,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Humana MGG,Humana MGG,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Optum VA,Optum VA,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,UHC,UHC,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,UHC MGG,UHC MGG,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,VA,VA,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Wellcare MGG,Wellcare MGG,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Bright Health - commercial,Bright Health - commercial,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,88350,CPT,,,,Inpatient,,,151.01,151.01,Bright Health MGG,Bright Health MGG,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Aetna,Aetna,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Aetna MGG,Aetna MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,BCBS,BCBS,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,BCBS MGG,BCBS MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Cigna,Cigna,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Cigna MGG,Cigna MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Humana,Humana,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Humana MGG,Humana MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Optum VA,Optum VA,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,UHC,UHC,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,UHC MGG,UHC MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,VA,VA,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Wellcare MGG,Wellcare MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Bright Health - commercial,Bright Health - commercial,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,Bright Health MGG,Bright Health MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Aetna,Aetna,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Aetna MGG,Aetna MGG,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,BCBS,BCBS,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,BCBS MGG,BCBS MGG,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Cigna,Cigna,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Cigna MGG,Cigna MGG,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Humana,Humana,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Humana MGG,Humana MGG,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Optum VA,Optum VA,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,UHC,UHC,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,UHC MGG,UHC MGG,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,VA,VA,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Wellcare MGG,Wellcare MGG,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Bright Health - commercial,Bright Health - commercial,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,Bright Health MGG,Bright Health MGG,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Aetna,Aetna,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Aetna MGG,Aetna MGG,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,BCBS,BCBS,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,BCBS MGG,BCBS MGG,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Cigna,Cigna,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Cigna MGG,Cigna MGG,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Humana,Humana,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Humana MGG,Humana MGG,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Optum VA,Optum VA,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,UHC,UHC,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,UHC MGG,UHC MGG,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,VA,VA,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Wellcare MGG,Wellcare MGG,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Bright Health - commercial,Bright Health - commercial,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,Bright Health MGG,Bright Health MGG,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Aetna,Aetna,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Aetna MGG,Aetna MGG,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,BCBS,BCBS,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,BCBS MGG,BCBS MGG,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Cigna,Cigna,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Cigna MGG,Cigna MGG,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Humana,Humana,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Humana MGG,Humana MGG,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Optum VA,Optum VA,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,UHC,UHC,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,UHC MGG,UHC MGG,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,VA,VA,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Wellcare MGG,Wellcare MGG,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Bright Health - commercial,Bright Health - commercial,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,Bright Health MGG,Bright Health MGG,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Aetna,Aetna,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Aetna MGG,Aetna MGG,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,BCBS,BCBS,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,BCBS MGG,BCBS MGG,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Cigna,Cigna,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Cigna MGG,Cigna MGG,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Humana,Humana,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Humana MGG,Humana MGG,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Optum VA,Optum VA,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,UHC,UHC,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,UHC MGG,UHC MGG,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,VA,VA,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Wellcare MGG,Wellcare MGG,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Bright Health - commercial,Bright Health - commercial,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,Bright Health MGG,Bright Health MGG,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Aetna,Aetna,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Aetna MGG,Aetna MGG,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,BCBS,BCBS,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,BCBS MGG,BCBS MGG,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Cigna,Cigna,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Cigna MGG,Cigna MGG,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Humana,Humana,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Humana MGG,Humana MGG,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Optum VA,Optum VA,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,UHC,UHC,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,UHC MGG,UHC MGG,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,VA,VA,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Wellcare MGG,Wellcare MGG,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Bright Health - commercial,Bright Health - commercial,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,Bright Health MGG,Bright Health MGG,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Aetna,Aetna,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Aetna MGG,Aetna MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,BCBS,BCBS,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,BCBS MGG,BCBS MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Cigna,Cigna,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Cigna MGG,Cigna MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Humana,Humana,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Humana MGG,Humana MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Optum VA,Optum VA,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,UHC,UHC,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,UHC MGG,UHC MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,VA,VA,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Wellcare MGG,Wellcare MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Bright Health - commercial,Bright Health - commercial,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,Bright Health MGG,Bright Health MGG,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Aetna,Aetna,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Aetna MGG,Aetna MGG,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,BCBS,BCBS,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,BCBS MGG,BCBS MGG,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Cigna,Cigna,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Cigna MGG,Cigna MGG,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Humana,Humana,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Humana MGG,Humana MGG,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Optum VA,Optum VA,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,UHC,UHC,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,UHC MGG,UHC MGG,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,VA,VA,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Wellcare MGG,Wellcare MGG,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Bright Health - commercial,Bright Health - commercial,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,116.2,116.2,Bright Health MGG,Bright Health MGG,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Aetna,Aetna,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Aetna MGG,Aetna MGG,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,BCBS,BCBS,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,BCBS MGG,BCBS MGG,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Cigna,Cigna,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Cigna MGG,Cigna MGG,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Humana,Humana,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Humana MGG,Humana MGG,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Optum VA,Optum VA,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,UHC,UHC,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,UHC MGG,UHC MGG,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,VA,VA,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Wellcare MGG,Wellcare MGG,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Bright Health - commercial,Bright Health - commercial,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,Bright Health MGG,Bright Health MGG,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Aetna,Aetna,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Aetna MGG,Aetna MGG,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,BCBS,BCBS,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,BCBS MGG,BCBS MGG,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Cigna,Cigna,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Cigna MGG,Cigna MGG,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Humana,Humana,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Humana MGG,Humana MGG,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Optum VA,Optum VA,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,UHC,UHC,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,UHC MGG,UHC MGG,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,VA,VA,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Wellcare MGG,Wellcare MGG,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Bright Health - commercial,Bright Health - commercial,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,Bright Health MGG,Bright Health MGG,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Aetna,Aetna,96.79,,,,,,,per diem,96.79,96.79,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Aetna MGG,Aetna MGG,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,BCBS,BCBS,96.79,,,,,,,per diem,96.79,96.79,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,BCBS MGG,BCBS MGG,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Cigna,Cigna,96.79,,,,,,,per diem,96.79,96.79,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Cigna MGG,Cigna MGG,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Humana,Humana,96.79,,,,,,,per diem,96.79,96.79,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Humana MGG,Humana MGG,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Optum VA,Optum VA,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,UHC,UHC,96.79,,,,,,,per diem,96.79,96.79,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,UHC MGG,UHC MGG,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,VA,VA,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Wellcare MGG,Wellcare MGG,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Bright Health - commercial,Bright Health - commercial,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,96.79,96.79,Bright Health MGG,Bright Health MGG,96.79,,,,,,,case rate,96.79,96.79,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Aetna,Aetna,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Aetna MGG,Aetna MGG,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,BCBS,BCBS,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,BCBS MGG,BCBS MGG,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Cigna,Cigna,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Cigna MGG,Cigna MGG,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Humana,Humana,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Humana MGG,Humana MGG,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Optum VA,Optum VA,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,UHC,UHC,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,UHC MGG,UHC MGG,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,VA,VA,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Wellcare MGG,Wellcare MGG,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Bright Health - commercial,Bright Health - commercial,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,Bright Health MGG,Bright Health MGG,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Aetna,Aetna,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Aetna MGG,Aetna MGG,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,BCBS,BCBS,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,BCBS MGG,BCBS MGG,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Cigna,Cigna,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Cigna MGG,Cigna MGG,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Humana,Humana,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Humana MGG,Humana MGG,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Optum VA,Optum VA,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,UHC,UHC,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,UHC MGG,UHC MGG,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,VA,VA,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Wellcare MGG,Wellcare MGG,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Bright Health - commercial,Bright Health - commercial,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,Bright Health MGG,Bright Health MGG,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Aetna,Aetna,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Aetna MGG,Aetna MGG,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,BCBS,BCBS,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,BCBS MGG,BCBS MGG,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Cigna,Cigna,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Cigna MGG,Cigna MGG,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Humana,Humana,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Humana MGG,Humana MGG,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Optum VA,Optum VA,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,UHC,UHC,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,UHC MGG,UHC MGG,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,VA,VA,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Wellcare MGG,Wellcare MGG,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Bright Health - commercial,Bright Health - commercial,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,Bright Health MGG,Bright Health MGG,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Aetna,Aetna,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Aetna MGG,Aetna MGG,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,BCBS,BCBS,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,BCBS MGG,BCBS MGG,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Cigna,Cigna,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Cigna MGG,Cigna MGG,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Humana,Humana,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Humana MGG,Humana MGG,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Optum VA,Optum VA,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,UHC,UHC,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,UHC MGG,UHC MGG,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,VA,VA,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Wellcare MGG,Wellcare MGG,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Bright Health - commercial,Bright Health - commercial,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,Bright Health MGG,Bright Health MGG,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Aetna,Aetna,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Aetna MGG,Aetna MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,BCBS,BCBS,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,BCBS MGG,BCBS MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Cigna,Cigna,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Cigna MGG,Cigna MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Humana,Humana,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Humana MGG,Humana MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Optum VA,Optum VA,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,UHC,UHC,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,UHC MGG,UHC MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,VA,VA,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Wellcare MGG,Wellcare MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Bright Health - commercial,Bright Health - commercial,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,12.11,12.11,Bright Health MGG,Bright Health MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Aetna,Aetna,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Aetna MGG,Aetna MGG,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,BCBS,BCBS,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,BCBS MGG,BCBS MGG,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Cigna,Cigna,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Cigna MGG,Cigna MGG,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Humana,Humana,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Humana MGG,Humana MGG,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Optum VA,Optum VA,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,UHC,UHC,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,UHC MGG,UHC MGG,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,VA,VA,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Wellcare MGG,Wellcare MGG,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Bright Health - commercial,Bright Health - commercial,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,Bright Health MGG,Bright Health MGG,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Aetna,Aetna,128.48,,,,,,,per diem,128.48,128.48,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Aetna MGG,Aetna MGG,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,BCBS,BCBS,128.48,,,,,,,per diem,128.48,128.48,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,BCBS MGG,BCBS MGG,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Cigna,Cigna,128.48,,,,,,,per diem,128.48,128.48,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Cigna MGG,Cigna MGG,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Humana,Humana,128.48,,,,,,,per diem,128.48,128.48,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Humana MGG,Humana MGG,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Optum VA,Optum VA,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,UHC,UHC,128.48,,,,,,,per diem,128.48,128.48,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,UHC MGG,UHC MGG,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,VA,VA,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Wellcare MGG,Wellcare MGG,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Bright Health - commercial,Bright Health - commercial,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,128.48,128.48,Bright Health MGG,Bright Health MGG,128.48,,,,,,,case rate,128.48,128.48,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Aetna,Aetna,120.02,,,,,,,per diem,120.02,120.02,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Aetna MGG,Aetna MGG,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,BCBS,BCBS,120.02,,,,,,,per diem,120.02,120.02,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,BCBS MGG,BCBS MGG,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Cigna,Cigna,120.02,,,,,,,per diem,120.02,120.02,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Cigna MGG,Cigna MGG,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Humana,Humana,120.02,,,,,,,per diem,120.02,120.02,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Humana MGG,Humana MGG,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Optum VA,Optum VA,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,UHC,UHC,120.02,,,,,,,per diem,120.02,120.02,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,UHC MGG,UHC MGG,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,VA,VA,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Wellcare MGG,Wellcare MGG,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Bright Health - commercial,Bright Health - commercial,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,120.02,120.02,Bright Health MGG,Bright Health MGG,120.02,,,,,,,case rate,120.02,120.02,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Aetna,Aetna,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Aetna MGG,Aetna MGG,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,BCBS,BCBS,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,BCBS MGG,BCBS MGG,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Cigna,Cigna,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Cigna MGG,Cigna MGG,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Humana,Humana,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Humana MGG,Humana MGG,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Optum VA,Optum VA,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,UHC,UHC,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,UHC MGG,UHC MGG,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,VA,VA,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Wellcare MGG,Wellcare MGG,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Bright Health - commercial,Bright Health - commercial,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,Bright Health MGG,Bright Health MGG,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Aetna,Aetna,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Aetna MGG,Aetna MGG,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,BCBS,BCBS,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,BCBS MGG,BCBS MGG,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Cigna,Cigna,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Cigna MGG,Cigna MGG,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Humana,Humana,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Humana MGG,Humana MGG,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Optum VA,Optum VA,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,UHC,UHC,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,UHC MGG,UHC MGG,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,VA,VA,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Wellcare MGG,Wellcare MGG,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Bright Health - commercial,Bright Health - commercial,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,Bright Health MGG,Bright Health MGG,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Aetna,Aetna,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Aetna MGG,Aetna MGG,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,BCBS,BCBS,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,BCBS MGG,BCBS MGG,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Cigna,Cigna,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Cigna MGG,Cigna MGG,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Humana,Humana,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Humana MGG,Humana MGG,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Optum VA,Optum VA,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,UHC,UHC,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,UHC MGG,UHC MGG,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,VA,VA,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Wellcare MGG,Wellcare MGG,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Bright Health - commercial,Bright Health - commercial,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,Bright Health MGG,Bright Health MGG,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Aetna,Aetna,163.96,,,,,,,per diem,163.96,163.96,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Aetna MGG,Aetna MGG,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,BCBS,BCBS,163.96,,,,,,,per diem,163.96,163.96,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,BCBS MGG,BCBS MGG,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Cigna,Cigna,163.96,,,,,,,per diem,163.96,163.96,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Cigna MGG,Cigna MGG,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Humana,Humana,163.96,,,,,,,per diem,163.96,163.96,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Humana MGG,Humana MGG,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Optum VA,Optum VA,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,UHC,UHC,163.96,,,,,,,per diem,163.96,163.96,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,UHC MGG,UHC MGG,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,VA,VA,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Wellcare MGG,Wellcare MGG,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Bright Health - commercial,Bright Health - commercial,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,163.96,163.96,Bright Health MGG,Bright Health MGG,163.96,,,,,,,case rate,163.96,163.96,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Aetna,Aetna,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Aetna MGG,Aetna MGG,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,BCBS,BCBS,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,BCBS MGG,BCBS MGG,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Cigna,Cigna,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Cigna MGG,Cigna MGG,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Humana,Humana,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Humana MGG,Humana MGG,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Optum VA,Optum VA,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,UHC,UHC,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,UHC MGG,UHC MGG,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,VA,VA,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Wellcare MGG,Wellcare MGG,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Bright Health - commercial,Bright Health - commercial,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,,,,,,Inpatient,,,135.98,135.98,Bright Health MGG,Bright Health MGG,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Aetna,Aetna,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Aetna MGG,Aetna MGG,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,BCBS,BCBS,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,BCBS MGG,BCBS MGG,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Cigna,Cigna,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Cigna MGG,Cigna MGG,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Humana,Humana,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Humana MGG,Humana MGG,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Optum VA,Optum VA,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,UHC,UHC,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,UHC MGG,UHC MGG,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,VA,VA,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Wellcare MGG,Wellcare MGG,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Bright Health - commercial,Bright Health - commercial,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,Bright Health MGG,Bright Health MGG,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Aetna,Aetna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Aetna MGG,Aetna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,BCBS,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS MGG,BCBS MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Cigna,Cigna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Cigna MGG,Cigna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Humana,Humana,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Humana MGG,Humana MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Optum VA,Optum VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,UHC,UHC,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,UHC MGG,UHC MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,VA,VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Wellcare MGG,Wellcare MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Bright Health - commercial,Bright Health - commercial,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Bright Health MGG,Bright Health MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Aetna,Aetna,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Aetna MGG,Aetna MGG,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,BCBS,BCBS,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,BCBS MGG,BCBS MGG,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Cigna,Cigna,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Cigna MGG,Cigna MGG,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Humana,Humana,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Humana MGG,Humana MGG,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Optum VA,Optum VA,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,UHC,UHC,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,UHC MGG,UHC MGG,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,VA,VA,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Wellcare MGG,Wellcare MGG,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Bright Health - commercial,Bright Health - commercial,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,Bright Health MGG,Bright Health MGG,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Aetna,Aetna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Aetna MGG,Aetna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,BCBS,BCBS,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,BCBS MGG,BCBS MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Cigna,Cigna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Cigna MGG,Cigna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Humana,Humana,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Humana MGG,Humana MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Optum VA,Optum VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,UHC,UHC,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,UHC MGG,UHC MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,VA,VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Wellcare MGG,Wellcare MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Bright Health - commercial,Bright Health - commercial,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,Bright Health MGG,Bright Health MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Aetna,Aetna,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Aetna MGG,Aetna MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,BCBS,BCBS,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,BCBS MGG,BCBS MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Cigna,Cigna,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Cigna MGG,Cigna MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Humana,Humana,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Humana MGG,Humana MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Optum VA,Optum VA,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,UHC,UHC,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,UHC MGG,UHC MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,VA,VA,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Wellcare MGG,Wellcare MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Bright Health - commercial,Bright Health - commercial,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,Bright Health MGG,Bright Health MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Aetna,Aetna,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Aetna MGG,Aetna MGG,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,BCBS,BCBS,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,BCBS MGG,BCBS MGG,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Cigna,Cigna,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Cigna MGG,Cigna MGG,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Humana,Humana,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Humana MGG,Humana MGG,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Optum VA,Optum VA,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,UHC,UHC,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,UHC MGG,UHC MGG,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,VA,VA,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Wellcare MGG,Wellcare MGG,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Bright Health - commercial,Bright Health - commercial,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,Bright Health MGG,Bright Health MGG,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Aetna,Aetna,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Aetna MGG,Aetna MGG,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,BCBS,BCBS,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,BCBS MGG,BCBS MGG,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Cigna,Cigna,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Cigna MGG,Cigna MGG,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Humana,Humana,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Humana MGG,Humana MGG,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Optum VA,Optum VA,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,UHC,UHC,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,UHC MGG,UHC MGG,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,VA,VA,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Wellcare MGG,Wellcare MGG,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Bright Health - commercial,Bright Health - commercial,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,Bright Health MGG,Bright Health MGG,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Aetna,Aetna,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Aetna MGG,Aetna MGG,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,BCBS,BCBS,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,BCBS MGG,BCBS MGG,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Cigna,Cigna,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Cigna MGG,Cigna MGG,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Humana,Humana,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Humana MGG,Humana MGG,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Optum VA,Optum VA,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,UHC,UHC,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,UHC MGG,UHC MGG,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,VA,VA,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Wellcare MGG,Wellcare MGG,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Bright Health - commercial,Bright Health - commercial,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,Bright Health MGG,Bright Health MGG,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Aetna,Aetna,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Aetna MGG,Aetna MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,BCBS,BCBS,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,BCBS MGG,BCBS MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Cigna,Cigna,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Cigna MGG,Cigna MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Humana,Humana,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Humana MGG,Humana MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Optum VA,Optum VA,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,UHC,UHC,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,UHC MGG,UHC MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,VA,VA,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Wellcare MGG,Wellcare MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Bright Health - commercial,Bright Health - commercial,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,42,42,Bright Health MGG,Bright Health MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Aetna,Aetna,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Aetna MGG,Aetna MGG,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,BCBS,BCBS,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,BCBS MGG,BCBS MGG,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Cigna,Cigna,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Cigna MGG,Cigna MGG,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Humana,Humana,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Humana MGG,Humana MGG,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Optum VA,Optum VA,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,UHC,UHC,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,UHC MGG,UHC MGG,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,VA,VA,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Wellcare MGG,Wellcare MGG,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Bright Health - commercial,Bright Health - commercial,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,Bright Health MGG,Bright Health MGG,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Aetna,Aetna,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Aetna MGG,Aetna MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,BCBS,BCBS,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,BCBS MGG,BCBS MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Cigna,Cigna,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Cigna MGG,Cigna MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Humana,Humana,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Humana MGG,Humana MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Optum VA,Optum VA,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,UHC,UHC,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,UHC MGG,UHC MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,VA,VA,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Wellcare MGG,Wellcare MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Bright Health - commercial,Bright Health - commercial,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,Bright Health MGG,Bright Health MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Aetna,Aetna,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Aetna MGG,Aetna MGG,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,BCBS,BCBS,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,BCBS MGG,BCBS MGG,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Cigna,Cigna,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Cigna MGG,Cigna MGG,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Humana,Humana,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Humana MGG,Humana MGG,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Optum VA,Optum VA,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,UHC,UHC,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,UHC MGG,UHC MGG,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,VA,VA,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Wellcare MGG,Wellcare MGG,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Bright Health - commercial,Bright Health - commercial,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,Bright Health MGG,Bright Health MGG,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Aetna,Aetna,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Aetna MGG,Aetna MGG,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,BCBS,BCBS,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,BCBS MGG,BCBS MGG,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Cigna,Cigna,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Cigna MGG,Cigna MGG,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Humana,Humana,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Humana MGG,Humana MGG,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Optum VA,Optum VA,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,UHC,UHC,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,UHC MGG,UHC MGG,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,VA,VA,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Wellcare MGG,Wellcare MGG,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Bright Health - commercial,Bright Health - commercial,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,Bright Health MGG,Bright Health MGG,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Aetna,Aetna,21.55,,,,,,,per diem,21.55,21.55,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Aetna MGG,Aetna MGG,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,BCBS,BCBS,21.55,,,,,,,per diem,21.55,21.55,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,BCBS MGG,BCBS MGG,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Cigna,Cigna,21.55,,,,,,,per diem,21.55,21.55,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Cigna MGG,Cigna MGG,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Humana,Humana,21.55,,,,,,,per diem,21.55,21.55,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Humana MGG,Humana MGG,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Optum VA,Optum VA,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,UHC,UHC,21.55,,,,,,,per diem,21.55,21.55,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,UHC MGG,UHC MGG,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,VA,VA,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Wellcare MGG,Wellcare MGG,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Bright Health - commercial,Bright Health - commercial,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,21.55,21.55,Bright Health MGG,Bright Health MGG,21.55,,,,,,,case rate,21.55,21.55,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Aetna,Aetna,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Aetna MGG,Aetna MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,BCBS,BCBS,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,BCBS MGG,BCBS MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Cigna,Cigna,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Cigna MGG,Cigna MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Humana,Humana,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Humana MGG,Humana MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Optum VA,Optum VA,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,UHC,UHC,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,UHC MGG,UHC MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,VA,VA,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Wellcare MGG,Wellcare MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Bright Health - commercial,Bright Health - commercial,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR BLOCKING AB SERUM        ,38200077,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Bright Health MGG,Bright Health MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Aetna,Aetna,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Aetna MGG,Aetna MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,BCBS,BCBS,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,BCBS MGG,BCBS MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Cigna,Cigna,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Cigna MGG,Cigna MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Humana,Humana,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Humana MGG,Humana MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Optum VA,Optum VA,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,UHC,UHC,300.3,,,,,,,per diem,300.3,300.3,"Per diem rate, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,UHC MGG,UHC MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,VA,VA,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Wellcare MGG,Wellcare MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Bright Health - commercial,Bright Health - commercial,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ACHR MODULATION AB SERUM      ,38200078,CDM,300,RC,83519,CPT,,,,Inpatient,,,300.3,300.3,Bright Health MGG,Bright Health MGG,300.3,,,,,,,case rate,300.3,300.3,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Aetna,Aetna,53.9,,,,,,,per diem,53.9,53.9,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Aetna MGG,Aetna MGG,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,BCBS,BCBS,53.9,,,,,,,per diem,53.9,53.9,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,BCBS MGG,BCBS MGG,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Cigna,Cigna,53.9,,,,,,,per diem,53.9,53.9,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Cigna MGG,Cigna MGG,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Humana,Humana,53.9,,,,,,,per diem,53.9,53.9,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Humana MGG,Humana MGG,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Optum VA,Optum VA,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,UHC,UHC,53.9,,,,,,,per diem,53.9,53.9,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,UHC MGG,UHC MGG,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,VA,VA,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Wellcare MGG,Wellcare MGG,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Bright Health - commercial,Bright Health - commercial,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,53.9,53.9,Bright Health MGG,Bright Health MGG,53.9,,,,,,,case rate,53.9,53.9,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Aetna,Aetna,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Aetna MGG,Aetna MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,BCBS,BCBS,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,BCBS MGG,BCBS MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Cigna,Cigna,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Cigna MGG,Cigna MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Humana,Humana,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Humana MGG,Humana MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Optum VA,Optum VA,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,UHC,UHC,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,UHC MGG,UHC MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,VA,VA,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Wellcare MGG,Wellcare MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Bright Health - commercial,Bright Health - commercial,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,Bright Health MGG,Bright Health MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Aetna,Aetna,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Aetna MGG,Aetna MGG,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,BCBS,BCBS,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,BCBS MGG,BCBS MGG,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Cigna,Cigna,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Cigna MGG,Cigna MGG,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Humana,Humana,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Humana MGG,Humana MGG,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Optum VA,Optum VA,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,UHC,UHC,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,UHC MGG,UHC MGG,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,VA,VA,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Wellcare MGG,Wellcare MGG,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Bright Health - commercial,Bright Health - commercial,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,,,,,,Inpatient,,,172.7,172.7,Bright Health MGG,Bright Health MGG,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Aetna,Aetna,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Aetna MGG,Aetna MGG,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,BCBS,BCBS,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,BCBS MGG,BCBS MGG,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Cigna,Cigna,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Cigna MGG,Cigna MGG,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Humana,Humana,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Humana MGG,Humana MGG,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Optum VA,Optum VA,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,UHC,UHC,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,UHC MGG,UHC MGG,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,VA,VA,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Wellcare MGG,Wellcare MGG,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Bright Health - commercial,Bright Health - commercial,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,Bright Health MGG,Bright Health MGG,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Aetna,Aetna,401.16,,,,,,,per diem,401.16,401.16,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Aetna MGG,Aetna MGG,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,BCBS,BCBS,401.16,,,,,,,per diem,401.16,401.16,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,BCBS MGG,BCBS MGG,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Cigna,Cigna,401.16,,,,,,,per diem,401.16,401.16,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Cigna MGG,Cigna MGG,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Humana,Humana,401.16,,,,,,,per diem,401.16,401.16,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Humana MGG,Humana MGG,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Optum VA,Optum VA,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,UHC,UHC,401.16,,,,,,,per diem,401.16,401.16,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,UHC MGG,UHC MGG,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,VA,VA,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Wellcare MGG,Wellcare MGG,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Bright Health - commercial,Bright Health - commercial,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,401.16,401.16,Bright Health MGG,Bright Health MGG,401.16,,,,,,,case rate,401.16,401.16,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Aetna,Aetna,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Aetna MGG,Aetna MGG,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,BCBS,BCBS,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,BCBS MGG,BCBS MGG,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Cigna,Cigna,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Cigna MGG,Cigna MGG,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Humana,Humana,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Humana MGG,Humana MGG,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Optum VA,Optum VA,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,UHC,UHC,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,UHC MGG,UHC MGG,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,VA,VA,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Wellcare MGG,Wellcare MGG,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Bright Health - commercial,Bright Health - commercial,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,Bright Health MGG,Bright Health MGG,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Aetna,Aetna,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Aetna MGG,Aetna MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,BCBS,BCBS,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,BCBS MGG,BCBS MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Cigna,Cigna,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Cigna MGG,Cigna MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Humana,Humana,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Humana MGG,Humana MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Optum VA,Optum VA,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,UHC,UHC,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,UHC MGG,UHC MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,VA,VA,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Wellcare MGG,Wellcare MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Bright Health - commercial,Bright Health - commercial,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,Bright Health MGG,Bright Health MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Aetna,Aetna,102.78,,,,,,,per diem,102.78,102.78,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Aetna MGG,Aetna MGG,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,BCBS,BCBS,102.78,,,,,,,per diem,102.78,102.78,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,BCBS MGG,BCBS MGG,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Cigna,Cigna,102.78,,,,,,,per diem,102.78,102.78,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Cigna MGG,Cigna MGG,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Humana,Humana,102.78,,,,,,,per diem,102.78,102.78,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Humana MGG,Humana MGG,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Optum VA,Optum VA,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,UHC,UHC,102.78,,,,,,,per diem,102.78,102.78,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,UHC MGG,UHC MGG,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,VA,VA,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Wellcare MGG,Wellcare MGG,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Bright Health - commercial,Bright Health - commercial,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,102.78,102.78,Bright Health MGG,Bright Health MGG,102.78,,,,,,,case rate,102.78,102.78,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Aetna,Aetna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Aetna MGG,Aetna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,BCBS,BCBS,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,BCBS MGG,BCBS MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Cigna,Cigna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Cigna MGG,Cigna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Humana,Humana,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Humana MGG,Humana MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Optum VA,Optum VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,UHC,UHC,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,UHC MGG,UHC MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,VA,VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Wellcare MGG,Wellcare MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Bright Health - commercial,Bright Health - commercial,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,Bright Health MGG,Bright Health MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna,Aetna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna MGG,Aetna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,BCBS,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS MGG,BCBS MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna,Cigna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna MGG,Cigna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana,Humana,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana MGG,Humana MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Optum VA,Optum VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC,UHC,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC MGG,UHC MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Wellcare MGG,Wellcare MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health - commercial,Bright Health - commercial,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health MGG,Bright Health MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Aetna,Aetna,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Aetna MGG,Aetna MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,BCBS,BCBS,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,BCBS MGG,BCBS MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Cigna,Cigna,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Cigna MGG,Cigna MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Humana,Humana,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Humana MGG,Humana MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Optum VA,Optum VA,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,UHC,UHC,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,UHC MGG,UHC MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,VA,VA,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Wellcare MGG,Wellcare MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Bright Health - commercial,Bright Health - commercial,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,Bright Health MGG,Bright Health MGG,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Aetna,Aetna,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Aetna MGG,Aetna MGG,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,BCBS,BCBS,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,BCBS MGG,BCBS MGG,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Cigna,Cigna,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Cigna MGG,Cigna MGG,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Humana,Humana,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Humana MGG,Humana MGG,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Optum VA,Optum VA,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,UHC,UHC,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,UHC MGG,UHC MGG,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,VA,VA,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Wellcare MGG,Wellcare MGG,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Bright Health - commercial,Bright Health - commercial,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,Bright Health MGG,Bright Health MGG,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Aetna,Aetna,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Aetna MGG,Aetna MGG,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,BCBS,BCBS,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,BCBS MGG,BCBS MGG,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Cigna,Cigna,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Cigna MGG,Cigna MGG,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Humana,Humana,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Humana MGG,Humana MGG,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Optum VA,Optum VA,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,UHC,UHC,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,UHC MGG,UHC MGG,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,VA,VA,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Wellcare MGG,Wellcare MGG,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Bright Health - commercial,Bright Health - commercial,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,Bright Health MGG,Bright Health MGG,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Aetna,Aetna,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Aetna MGG,Aetna MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,BCBS,BCBS,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,BCBS MGG,BCBS MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Cigna,Cigna,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Cigna MGG,Cigna MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Humana,Humana,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Humana MGG,Humana MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Optum VA,Optum VA,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,UHC,UHC,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,UHC MGG,UHC MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,VA,VA,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Wellcare MGG,Wellcare MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Bright Health - commercial,Bright Health - commercial,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,Bright Health MGG,Bright Health MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Aetna,Aetna,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Aetna MGG,Aetna MGG,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,BCBS,BCBS,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,BCBS MGG,BCBS MGG,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Cigna,Cigna,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Cigna MGG,Cigna MGG,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Humana,Humana,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Humana MGG,Humana MGG,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Optum VA,Optum VA,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,UHC,UHC,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,UHC MGG,UHC MGG,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,VA,VA,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Wellcare MGG,Wellcare MGG,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Bright Health - commercial,Bright Health - commercial,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,Bright Health MGG,Bright Health MGG,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Aetna,Aetna,31.78,,,,,,,per diem,31.78,31.78,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Aetna MGG,Aetna MGG,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,BCBS,BCBS,31.78,,,,,,,per diem,31.78,31.78,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,BCBS MGG,BCBS MGG,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Cigna,Cigna,31.78,,,,,,,per diem,31.78,31.78,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Cigna MGG,Cigna MGG,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Humana,Humana,31.78,,,,,,,per diem,31.78,31.78,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Humana MGG,Humana MGG,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Optum VA,Optum VA,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,UHC,UHC,31.78,,,,,,,per diem,31.78,31.78,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,UHC MGG,UHC MGG,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,VA,VA,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Wellcare MGG,Wellcare MGG,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Bright Health - commercial,Bright Health - commercial,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,31.78,31.78,Bright Health MGG,Bright Health MGG,31.78,,,,,,,case rate,31.78,31.78,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Aetna,Aetna,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Aetna MGG,Aetna MGG,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,BCBS,BCBS,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,BCBS MGG,BCBS MGG,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Cigna,Cigna,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Cigna MGG,Cigna MGG,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Humana,Humana,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Humana MGG,Humana MGG,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Optum VA,Optum VA,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,UHC,UHC,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,UHC MGG,UHC MGG,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,VA,VA,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Wellcare MGG,Wellcare MGG,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Bright Health - commercial,Bright Health - commercial,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,Bright Health MGG,Bright Health MGG,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Aetna,Aetna,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Aetna MGG,Aetna MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS,BCBS,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS MGG,BCBS MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Cigna,Cigna,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Cigna MGG,Cigna MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Humana,Humana,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Humana MGG,Humana MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Optum VA,Optum VA,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,UHC,UHC,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,UHC MGG,UHC MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,VA,VA,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Wellcare MGG,Wellcare MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Bright Health - commercial,Bright Health - commercial,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Bright Health MGG,Bright Health MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Aetna,Aetna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Aetna MGG,Aetna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS,BCBS,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS MGG,BCBS MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Cigna,Cigna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Cigna MGG,Cigna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Humana,Humana,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Humana MGG,Humana MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Optum VA,Optum VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,UHC,UHC,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,UHC MGG,UHC MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,VA,VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Wellcare MGG,Wellcare MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Bright Health - commercial,Bright Health - commercial,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Bright Health MGG,Bright Health MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Aetna,Aetna,149.44,,,,,,,per diem,149.44,149.44,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Aetna MGG,Aetna MGG,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,BCBS,BCBS,149.44,,,,,,,per diem,149.44,149.44,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,BCBS MGG,BCBS MGG,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Cigna,Cigna,149.44,,,,,,,per diem,149.44,149.44,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Cigna MGG,Cigna MGG,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Humana,Humana,149.44,,,,,,,per diem,149.44,149.44,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Humana MGG,Humana MGG,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Optum VA,Optum VA,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,UHC,UHC,149.44,,,,,,,per diem,149.44,149.44,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,UHC MGG,UHC MGG,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,VA,VA,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Wellcare MGG,Wellcare MGG,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Bright Health - commercial,Bright Health - commercial,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,149.44,149.44,Bright Health MGG,Bright Health MGG,149.44,,,,,,,case rate,149.44,149.44,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Aetna,Aetna,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Aetna MGG,Aetna MGG,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,BCBS,BCBS,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,BCBS MGG,BCBS MGG,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Cigna,Cigna,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Cigna MGG,Cigna MGG,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Humana,Humana,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Humana MGG,Humana MGG,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Optum VA,Optum VA,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,UHC,UHC,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,UHC MGG,UHC MGG,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,VA,VA,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Wellcare MGG,Wellcare MGG,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Bright Health - commercial,Bright Health - commercial,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,Bright Health MGG,Bright Health MGG,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Aetna,Aetna,421.87,,,,,,,per diem,421.87,421.87,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Aetna MGG,Aetna MGG,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,BCBS,BCBS,421.87,,,,,,,per diem,421.87,421.87,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,BCBS MGG,BCBS MGG,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Cigna,Cigna,421.87,,,,,,,per diem,421.87,421.87,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Cigna MGG,Cigna MGG,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Humana,Humana,421.87,,,,,,,per diem,421.87,421.87,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Humana MGG,Humana MGG,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Optum VA,Optum VA,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,UHC,UHC,421.87,,,,,,,per diem,421.87,421.87,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,UHC MGG,UHC MGG,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,VA,VA,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Wellcare MGG,Wellcare MGG,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Bright Health - commercial,Bright Health - commercial,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,421.87,421.87,Bright Health MGG,Bright Health MGG,421.87,,,,,,,case rate,421.87,421.87,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Aetna,Aetna,109.75,,,,,,,per diem,109.75,109.75,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Aetna MGG,Aetna MGG,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,BCBS,BCBS,109.75,,,,,,,per diem,109.75,109.75,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,BCBS MGG,BCBS MGG,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Cigna,Cigna,109.75,,,,,,,per diem,109.75,109.75,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Cigna MGG,Cigna MGG,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Humana,Humana,109.75,,,,,,,per diem,109.75,109.75,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Humana MGG,Humana MGG,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Optum VA,Optum VA,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,UHC,UHC,109.75,,,,,,,per diem,109.75,109.75,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,UHC MGG,UHC MGG,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,VA,VA,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Wellcare MGG,Wellcare MGG,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Bright Health - commercial,Bright Health - commercial,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,109.75,109.75,Bright Health MGG,Bright Health MGG,109.75,,,,,,,case rate,109.75,109.75,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Aetna,Aetna,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Aetna MGG,Aetna MGG,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,BCBS,BCBS,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,BCBS MGG,BCBS MGG,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Cigna,Cigna,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Cigna MGG,Cigna MGG,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Humana,Humana,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Humana MGG,Humana MGG,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Optum VA,Optum VA,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,UHC,UHC,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,UHC MGG,UHC MGG,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,VA,VA,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Wellcare MGG,Wellcare MGG,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Bright Health - commercial,Bright Health - commercial,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,Bright Health MGG,Bright Health MGG,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Aetna,Aetna,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Aetna MGG,Aetna MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,BCBS,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS MGG,BCBS MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Cigna,Cigna,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Cigna MGG,Cigna MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Humana,Humana,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Humana MGG,Humana MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Optum VA,Optum VA,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UHC,UHC,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UHC MGG,UHC MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,VA,VA,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Wellcare MGG,Wellcare MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Bright Health - commercial,Bright Health - commercial,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Bright Health MGG,Bright Health MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Aetna,Aetna,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Aetna MGG,Aetna MGG,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,BCBS,BCBS,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,BCBS MGG,BCBS MGG,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Cigna,Cigna,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Cigna MGG,Cigna MGG,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Humana,Humana,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Humana MGG,Humana MGG,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Optum VA,Optum VA,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,UHC,UHC,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,UHC MGG,UHC MGG,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,VA,VA,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Wellcare MGG,Wellcare MGG,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Bright Health - commercial,Bright Health - commercial,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,Bright Health MGG,Bright Health MGG,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Aetna,Aetna,145.61,,,,,,,per diem,145.61,145.61,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Aetna MGG,Aetna MGG,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,BCBS,BCBS,145.61,,,,,,,per diem,145.61,145.61,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,BCBS MGG,BCBS MGG,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Cigna,Cigna,145.61,,,,,,,per diem,145.61,145.61,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Cigna MGG,Cigna MGG,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Humana,Humana,145.61,,,,,,,per diem,145.61,145.61,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Humana MGG,Humana MGG,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Optum VA,Optum VA,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,UHC,UHC,145.61,,,,,,,per diem,145.61,145.61,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,UHC MGG,UHC MGG,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,VA,VA,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Wellcare MGG,Wellcare MGG,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Bright Health - commercial,Bright Health - commercial,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,145.61,145.61,Bright Health MGG,Bright Health MGG,145.61,,,,,,,case rate,145.61,145.61,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Aetna,Aetna,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Aetna MGG,Aetna MGG,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,BCBS,BCBS,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,BCBS MGG,BCBS MGG,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Cigna,Cigna,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Cigna MGG,Cigna MGG,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Humana,Humana,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Humana MGG,Humana MGG,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Optum VA,Optum VA,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,UHC,UHC,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,UHC MGG,UHC MGG,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,VA,VA,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Wellcare MGG,Wellcare MGG,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Bright Health - commercial,Bright Health - commercial,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,Bright Health MGG,Bright Health MGG,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Aetna,Aetna,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Aetna MGG,Aetna MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,BCBS,BCBS,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,BCBS MGG,BCBS MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Cigna,Cigna,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Cigna MGG,Cigna MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Humana,Humana,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Humana MGG,Humana MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Optum VA,Optum VA,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,UHC,UHC,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,UHC MGG,UHC MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,VA,VA,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Wellcare MGG,Wellcare MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Bright Health - commercial,Bright Health - commercial,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,Bright Health MGG,Bright Health MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Aetna,Aetna,208.22,,,,,,,per diem,208.22,208.22,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Aetna MGG,Aetna MGG,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,BCBS,BCBS,208.22,,,,,,,per diem,208.22,208.22,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,BCBS MGG,BCBS MGG,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Cigna,Cigna,208.22,,,,,,,per diem,208.22,208.22,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Cigna MGG,Cigna MGG,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Humana,Humana,208.22,,,,,,,per diem,208.22,208.22,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Humana MGG,Humana MGG,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Optum VA,Optum VA,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,UHC,UHC,208.22,,,,,,,per diem,208.22,208.22,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,UHC MGG,UHC MGG,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,VA,VA,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Wellcare MGG,Wellcare MGG,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Bright Health - commercial,Bright Health - commercial,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,208.22,208.22,Bright Health MGG,Bright Health MGG,208.22,,,,,,,case rate,208.22,208.22,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Aetna,Aetna,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Aetna MGG,Aetna MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,BCBS,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS MGG,BCBS MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Cigna,Cigna,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Cigna MGG,Cigna MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Humana,Humana,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Humana MGG,Humana MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Optum VA,Optum VA,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UHC,UHC,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UHC MGG,UHC MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,VA,VA,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Wellcare MGG,Wellcare MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Bright Health - commercial,Bright Health - commercial,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Bright Health MGG,Bright Health MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Aetna,Aetna,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Aetna MGG,Aetna MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,BCBS,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS MGG,BCBS MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Cigna,Cigna,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Cigna MGG,Cigna MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Humana,Humana,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Humana MGG,Humana MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Optum VA,Optum VA,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UHC,UHC,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UHC MGG,UHC MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,VA,VA,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Wellcare MGG,Wellcare MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Bright Health - commercial,Bright Health - commercial,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,Bright Health MGG,Bright Health MGG,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Aetna,Aetna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Aetna MGG,Aetna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS,BCBS,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS MGG,BCBS MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Cigna,Cigna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Cigna MGG,Cigna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Humana,Humana,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Humana MGG,Humana MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Optum VA,Optum VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,UHC,UHC,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,UHC MGG,UHC MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,VA,VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Wellcare MGG,Wellcare MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Bright Health - commercial,Bright Health - commercial,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Bright Health MGG,Bright Health MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Aetna,Aetna,427.21,,,,,,,per diem,427.21,427.21,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Aetna MGG,Aetna MGG,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,BCBS,BCBS,427.21,,,,,,,per diem,427.21,427.21,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,BCBS MGG,BCBS MGG,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Cigna,Cigna,427.21,,,,,,,per diem,427.21,427.21,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Cigna MGG,Cigna MGG,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Humana,Humana,427.21,,,,,,,per diem,427.21,427.21,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Humana MGG,Humana MGG,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Optum VA,Optum VA,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,UHC,UHC,427.21,,,,,,,per diem,427.21,427.21,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,UHC MGG,UHC MGG,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,VA,VA,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Wellcare MGG,Wellcare MGG,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Bright Health - commercial,Bright Health - commercial,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,427.21,427.21,Bright Health MGG,Bright Health MGG,427.21,,,,,,,case rate,427.21,427.21,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Aetna,Aetna,116.57,,,,,,,per diem,116.57,116.57,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Aetna MGG,Aetna MGG,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,BCBS,BCBS,116.57,,,,,,,per diem,116.57,116.57,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,BCBS MGG,BCBS MGG,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Cigna,Cigna,116.57,,,,,,,per diem,116.57,116.57,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Cigna MGG,Cigna MGG,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Humana,Humana,116.57,,,,,,,per diem,116.57,116.57,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Humana MGG,Humana MGG,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Optum VA,Optum VA,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,UHC,UHC,116.57,,,,,,,per diem,116.57,116.57,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,UHC MGG,UHC MGG,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,VA,VA,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Wellcare MGG,Wellcare MGG,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Bright Health - commercial,Bright Health - commercial,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,116.57,116.57,Bright Health MGG,Bright Health MGG,116.57,,,,,,,case rate,116.57,116.57,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Aetna,Aetna,505.05,,,,,,,per diem,505.05,505.05,"Per diem rate, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Aetna MGG,Aetna MGG,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,BCBS,BCBS,505.05,,,,,,,per diem,505.05,505.05,"Per diem rate, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,BCBS MGG,BCBS MGG,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Cigna,Cigna,505.05,,,,,,,per diem,505.05,505.05,"Per diem rate, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Cigna MGG,Cigna MGG,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Humana,Humana,505.05,,,,,,,per diem,505.05,505.05,"Per diem rate, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Humana MGG,Humana MGG,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Optum VA,Optum VA,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,UHC,UHC,505.05,,,,,,,per diem,505.05,505.05,"Per diem rate, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,UHC MGG,UHC MGG,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,VA,VA,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Wellcare MGG,Wellcare MGG,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Bright Health - commercial,Bright Health - commercial,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI NEUTROPHILIC ANTIBODY    ,38200196,CDM,302,RC,86255,CPT,,,,Inpatient,,,505.05,505.05,Bright Health MGG,Bright Health MGG,505.05,,,,,,,case rate,505.05,505.05,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Aetna,Aetna,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Aetna MGG,Aetna MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,BCBS,BCBS,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,BCBS MGG,BCBS MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Cigna,Cigna,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Cigna MGG,Cigna MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Humana,Humana,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Humana MGG,Humana MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Optum VA,Optum VA,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,UHC,UHC,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,UHC MGG,UHC MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,VA,VA,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Wellcare MGG,Wellcare MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Bright Health - commercial,Bright Health - commercial,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,Bright Health MGG,Bright Health MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Aetna,Aetna,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Aetna MGG,Aetna MGG,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,BCBS,BCBS,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,BCBS MGG,BCBS MGG,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Cigna,Cigna,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Cigna MGG,Cigna MGG,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Humana,Humana,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Humana MGG,Humana MGG,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Optum VA,Optum VA,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,UHC,UHC,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,UHC MGG,UHC MGG,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,VA,VA,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Wellcare MGG,Wellcare MGG,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Bright Health - commercial,Bright Health - commercial,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,Bright Health MGG,Bright Health MGG,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Aetna,Aetna,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Aetna MGG,Aetna MGG,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,BCBS,BCBS,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,BCBS MGG,BCBS MGG,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Cigna,Cigna,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Cigna MGG,Cigna MGG,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Humana,Humana,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Humana MGG,Humana MGG,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Optum VA,Optum VA,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,UHC,UHC,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,UHC MGG,UHC MGG,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,VA,VA,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Wellcare MGG,Wellcare MGG,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Bright Health - commercial,Bright Health - commercial,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,Bright Health MGG,Bright Health MGG,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Aetna,Aetna,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Aetna MGG,Aetna MGG,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,BCBS,BCBS,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,BCBS MGG,BCBS MGG,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Cigna,Cigna,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Cigna MGG,Cigna MGG,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Humana,Humana,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Humana MGG,Humana MGG,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Optum VA,Optum VA,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,UHC,UHC,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,UHC MGG,UHC MGG,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,VA,VA,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Wellcare MGG,Wellcare MGG,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Bright Health - commercial,Bright Health - commercial,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,Bright Health MGG,Bright Health MGG,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Aetna,Aetna,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Aetna MGG,Aetna MGG,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,BCBS,BCBS,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,BCBS MGG,BCBS MGG,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Cigna,Cigna,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Cigna MGG,Cigna MGG,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Humana,Humana,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Humana MGG,Humana MGG,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Optum VA,Optum VA,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,UHC,UHC,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,UHC MGG,UHC MGG,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,VA,VA,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Wellcare MGG,Wellcare MGG,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Bright Health - commercial,Bright Health - commercial,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,Bright Health MGG,Bright Health MGG,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Aetna,Aetna,373.17,,,,,,,per diem,373.17,373.17,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Aetna MGG,Aetna MGG,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,BCBS,BCBS,373.17,,,,,,,per diem,373.17,373.17,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,BCBS MGG,BCBS MGG,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Cigna,Cigna,373.17,,,,,,,per diem,373.17,373.17,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Cigna MGG,Cigna MGG,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Humana,Humana,373.17,,,,,,,per diem,373.17,373.17,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Humana MGG,Humana MGG,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Optum VA,Optum VA,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,UHC,UHC,373.17,,,,,,,per diem,373.17,373.17,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,UHC MGG,UHC MGG,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,VA,VA,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Wellcare MGG,Wellcare MGG,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Bright Health - commercial,Bright Health - commercial,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,373.17,373.17,Bright Health MGG,Bright Health MGG,373.17,,,,,,,case rate,373.17,373.17,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Aetna,Aetna,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Aetna MGG,Aetna MGG,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,BCBS,BCBS,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,BCBS MGG,BCBS MGG,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Cigna,Cigna,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Cigna MGG,Cigna MGG,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Humana,Humana,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Humana MGG,Humana MGG,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Optum VA,Optum VA,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,UHC,UHC,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,UHC MGG,UHC MGG,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,VA,VA,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Wellcare MGG,Wellcare MGG,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Bright Health - commercial,Bright Health - commercial,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,Bright Health MGG,Bright Health MGG,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Aetna,Aetna,272.14,,,,,,,per diem,272.14,272.14,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Aetna MGG,Aetna MGG,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,BCBS,BCBS,272.14,,,,,,,per diem,272.14,272.14,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,BCBS MGG,BCBS MGG,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Cigna,Cigna,272.14,,,,,,,per diem,272.14,272.14,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Cigna MGG,Cigna MGG,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Humana,Humana,272.14,,,,,,,per diem,272.14,272.14,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Humana MGG,Humana MGG,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Optum VA,Optum VA,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,UHC,UHC,272.14,,,,,,,per diem,272.14,272.14,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,UHC MGG,UHC MGG,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,VA,VA,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Wellcare MGG,Wellcare MGG,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Bright Health - commercial,Bright Health - commercial,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,272.14,272.14,Bright Health MGG,Bright Health MGG,272.14,,,,,,,case rate,272.14,272.14,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Aetna,Aetna,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Aetna MGG,Aetna MGG,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,BCBS,BCBS,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,BCBS MGG,BCBS MGG,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Cigna,Cigna,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Cigna MGG,Cigna MGG,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Humana,Humana,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Humana MGG,Humana MGG,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Optum VA,Optum VA,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,UHC,UHC,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,UHC MGG,UHC MGG,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,VA,VA,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Wellcare MGG,Wellcare MGG,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Bright Health - commercial,Bright Health - commercial,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,Bright Health MGG,Bright Health MGG,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Aetna,Aetna,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Aetna MGG,Aetna MGG,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,BCBS,BCBS,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,BCBS MGG,BCBS MGG,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Cigna,Cigna,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Cigna MGG,Cigna MGG,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Humana,Humana,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Humana MGG,Humana MGG,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Optum VA,Optum VA,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,UHC,UHC,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,UHC MGG,UHC MGG,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,VA,VA,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Wellcare MGG,Wellcare MGG,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Bright Health - commercial,Bright Health - commercial,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,Bright Health MGG,Bright Health MGG,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Aetna,Aetna,351.33,,,,,,,per diem,351.33,351.33,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Aetna MGG,Aetna MGG,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,BCBS,BCBS,351.33,,,,,,,per diem,351.33,351.33,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,BCBS MGG,BCBS MGG,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Cigna,Cigna,351.33,,,,,,,per diem,351.33,351.33,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Cigna MGG,Cigna MGG,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Humana,Humana,351.33,,,,,,,per diem,351.33,351.33,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Humana MGG,Humana MGG,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Optum VA,Optum VA,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,UHC,UHC,351.33,,,,,,,per diem,351.33,351.33,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,UHC MGG,UHC MGG,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,VA,VA,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Wellcare MGG,Wellcare MGG,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Bright Health - commercial,Bright Health - commercial,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,351.33,351.33,Bright Health MGG,Bright Health MGG,351.33,,,,,,,case rate,351.33,351.33,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Aetna,Aetna,91.59,,,,,,,per diem,91.59,91.59,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Aetna MGG,Aetna MGG,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,BCBS,BCBS,91.59,,,,,,,per diem,91.59,91.59,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,BCBS MGG,BCBS MGG,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Cigna,Cigna,91.59,,,,,,,per diem,91.59,91.59,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Cigna MGG,Cigna MGG,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Humana,Humana,91.59,,,,,,,per diem,91.59,91.59,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Humana MGG,Humana MGG,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Optum VA,Optum VA,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,UHC,UHC,91.59,,,,,,,per diem,91.59,91.59,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,UHC MGG,UHC MGG,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,VA,VA,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Wellcare MGG,Wellcare MGG,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Bright Health - commercial,Bright Health - commercial,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,91.59,91.59,Bright Health MGG,Bright Health MGG,91.59,,,,,,,case rate,91.59,91.59,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Aetna,Aetna,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Aetna MGG,Aetna MGG,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,BCBS,BCBS,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,BCBS MGG,BCBS MGG,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Cigna,Cigna,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Cigna MGG,Cigna MGG,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Humana,Humana,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Humana MGG,Humana MGG,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Optum VA,Optum VA,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,UHC,UHC,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,UHC MGG,UHC MGG,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,VA,VA,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Wellcare MGG,Wellcare MGG,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Bright Health - commercial,Bright Health - commercial,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,Bright Health MGG,Bright Health MGG,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Aetna,Aetna,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Aetna MGG,Aetna MGG,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,BCBS,BCBS,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,BCBS MGG,BCBS MGG,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Cigna,Cigna,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Cigna MGG,Cigna MGG,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Humana,Humana,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Humana MGG,Humana MGG,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Optum VA,Optum VA,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,UHC,UHC,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,UHC MGG,UHC MGG,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,VA,VA,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Wellcare MGG,Wellcare MGG,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Bright Health - commercial,Bright Health - commercial,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,Bright Health MGG,Bright Health MGG,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Aetna,Aetna,187.74,,,,,,,per diem,187.74,187.74,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Aetna MGG,Aetna MGG,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,BCBS,BCBS,187.74,,,,,,,per diem,187.74,187.74,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,BCBS MGG,BCBS MGG,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Cigna,Cigna,187.74,,,,,,,per diem,187.74,187.74,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Cigna MGG,Cigna MGG,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Humana,Humana,187.74,,,,,,,per diem,187.74,187.74,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Humana MGG,Humana MGG,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Optum VA,Optum VA,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,UHC,UHC,187.74,,,,,,,per diem,187.74,187.74,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,UHC MGG,UHC MGG,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,VA,VA,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Wellcare MGG,Wellcare MGG,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Bright Health - commercial,Bright Health - commercial,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,187.74,187.74,Bright Health MGG,Bright Health MGG,187.74,,,,,,,case rate,187.74,187.74,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Aetna,Aetna,219.88,,,,,,,per diem,219.88,219.88,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Aetna MGG,Aetna MGG,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,BCBS,BCBS,219.88,,,,,,,per diem,219.88,219.88,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,BCBS MGG,BCBS MGG,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Cigna,Cigna,219.88,,,,,,,per diem,219.88,219.88,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Cigna MGG,Cigna MGG,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Humana,Humana,219.88,,,,,,,per diem,219.88,219.88,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Humana MGG,Humana MGG,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Optum VA,Optum VA,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,UHC,UHC,219.88,,,,,,,per diem,219.88,219.88,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,UHC MGG,UHC MGG,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,VA,VA,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Wellcare MGG,Wellcare MGG,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Bright Health - commercial,Bright Health - commercial,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,219.88,219.88,Bright Health MGG,Bright Health MGG,219.88,,,,,,,case rate,219.88,219.88,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Aetna,Aetna,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Aetna MGG,Aetna MGG,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,BCBS,BCBS,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,BCBS MGG,BCBS MGG,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Cigna,Cigna,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Cigna MGG,Cigna MGG,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Humana,Humana,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Humana MGG,Humana MGG,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Optum VA,Optum VA,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,UHC,UHC,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,UHC MGG,UHC MGG,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,VA,VA,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Wellcare MGG,Wellcare MGG,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Bright Health - commercial,Bright Health - commercial,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,Bright Health MGG,Bright Health MGG,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Aetna,Aetna,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Aetna MGG,Aetna MGG,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,BCBS,BCBS,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,BCBS MGG,BCBS MGG,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Cigna,Cigna,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Cigna MGG,Cigna MGG,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Humana,Humana,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Humana MGG,Humana MGG,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Optum VA,Optum VA,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,UHC,UHC,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,UHC MGG,UHC MGG,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,VA,VA,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Wellcare MGG,Wellcare MGG,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Bright Health - commercial,Bright Health - commercial,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,Bright Health MGG,Bright Health MGG,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Aetna,Aetna,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Aetna MGG,Aetna MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,BCBS,BCBS,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,BCBS MGG,BCBS MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Cigna,Cigna,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Cigna MGG,Cigna MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Humana,Humana,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Humana MGG,Humana MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Optum VA,Optum VA,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,UHC,UHC,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,UHC MGG,UHC MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,VA,VA,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Wellcare MGG,Wellcare MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Bright Health - commercial,Bright Health - commercial,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,Bright Health MGG,Bright Health MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Aetna,Aetna,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Aetna MGG,Aetna MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,BCBS,BCBS,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,BCBS MGG,BCBS MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Cigna,Cigna,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Cigna MGG,Cigna MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Humana,Humana,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Humana MGG,Humana MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Optum VA,Optum VA,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,UHC,UHC,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,UHC MGG,UHC MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,VA,VA,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Wellcare MGG,Wellcare MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Bright Health - commercial,Bright Health - commercial,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,Bright Health MGG,Bright Health MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Aetna,Aetna,84.81,,,,,,,per diem,84.81,84.81,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Aetna MGG,Aetna MGG,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,BCBS,BCBS,84.81,,,,,,,per diem,84.81,84.81,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,BCBS MGG,BCBS MGG,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Cigna,Cigna,84.81,,,,,,,per diem,84.81,84.81,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Cigna MGG,Cigna MGG,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Humana,Humana,84.81,,,,,,,per diem,84.81,84.81,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Humana MGG,Humana MGG,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Optum VA,Optum VA,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,UHC,UHC,84.81,,,,,,,per diem,84.81,84.81,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,UHC MGG,UHC MGG,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,VA,VA,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Wellcare MGG,Wellcare MGG,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Bright Health - commercial,Bright Health - commercial,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,84.81,84.81,Bright Health MGG,Bright Health MGG,84.81,,,,,,,case rate,84.81,84.81,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Aetna,Aetna,90.15,,,,,,,per diem,90.15,90.15,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Aetna MGG,Aetna MGG,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,BCBS,BCBS,90.15,,,,,,,per diem,90.15,90.15,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,BCBS MGG,BCBS MGG,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Cigna,Cigna,90.15,,,,,,,per diem,90.15,90.15,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Cigna MGG,Cigna MGG,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Humana,Humana,90.15,,,,,,,per diem,90.15,90.15,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Humana MGG,Humana MGG,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Optum VA,Optum VA,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,UHC,UHC,90.15,,,,,,,per diem,90.15,90.15,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,UHC MGG,UHC MGG,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,VA,VA,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Wellcare MGG,Wellcare MGG,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Bright Health - commercial,Bright Health - commercial,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,90.15,90.15,Bright Health MGG,Bright Health MGG,90.15,,,,,,,case rate,90.15,90.15,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Aetna,Aetna,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Aetna MGG,Aetna MGG,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,BCBS,BCBS,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,BCBS MGG,BCBS MGG,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Cigna,Cigna,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Cigna MGG,Cigna MGG,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Humana,Humana,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Humana MGG,Humana MGG,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Optum VA,Optum VA,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,UHC,UHC,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,UHC MGG,UHC MGG,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,VA,VA,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Wellcare MGG,Wellcare MGG,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Bright Health - commercial,Bright Health - commercial,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,Bright Health MGG,Bright Health MGG,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Aetna,Aetna,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Aetna MGG,Aetna MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,BCBS,BCBS,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,BCBS MGG,BCBS MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Cigna,Cigna,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Cigna MGG,Cigna MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Humana,Humana,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Humana MGG,Humana MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Optum VA,Optum VA,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,UHC,UHC,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,UHC MGG,UHC MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,VA,VA,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Wellcare MGG,Wellcare MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Bright Health - commercial,Bright Health - commercial,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,Bright Health MGG,Bright Health MGG,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Aetna,Aetna,126.04,,,,,,,per diem,126.04,126.04,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Aetna MGG,Aetna MGG,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,BCBS,BCBS,126.04,,,,,,,per diem,126.04,126.04,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,BCBS MGG,BCBS MGG,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Cigna,Cigna,126.04,,,,,,,per diem,126.04,126.04,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Cigna MGG,Cigna MGG,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Humana,Humana,126.04,,,,,,,per diem,126.04,126.04,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Humana MGG,Humana MGG,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Optum VA,Optum VA,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,UHC,UHC,126.04,,,,,,,per diem,126.04,126.04,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,UHC MGG,UHC MGG,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,VA,VA,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Wellcare MGG,Wellcare MGG,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Bright Health - commercial,Bright Health - commercial,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,126.04,126.04,Bright Health MGG,Bright Health MGG,126.04,,,,,,,case rate,126.04,126.04,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Aetna,Aetna,106.96,,,,,,,per diem,106.96,106.96,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Aetna MGG,Aetna MGG,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,BCBS,BCBS,106.96,,,,,,,per diem,106.96,106.96,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,BCBS MGG,BCBS MGG,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Cigna,Cigna,106.96,,,,,,,per diem,106.96,106.96,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Cigna MGG,Cigna MGG,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Humana,Humana,106.96,,,,,,,per diem,106.96,106.96,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Humana MGG,Humana MGG,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Optum VA,Optum VA,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,UHC,UHC,106.96,,,,,,,per diem,106.96,106.96,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,UHC MGG,UHC MGG,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,VA,VA,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Wellcare MGG,Wellcare MGG,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Bright Health - commercial,Bright Health - commercial,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,106.96,106.96,Bright Health MGG,Bright Health MGG,106.96,,,,,,,case rate,106.96,106.96,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Aetna,Aetna,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Aetna MGG,Aetna MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,BCBS,BCBS,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,BCBS MGG,BCBS MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Cigna,Cigna,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Cigna MGG,Cigna MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Humana,Humana,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Humana MGG,Humana MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Optum VA,Optum VA,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,UHC,UHC,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,UHC MGG,UHC MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,VA,VA,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Wellcare MGG,Wellcare MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Bright Health - commercial,Bright Health - commercial,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,195.18,195.18,Bright Health MGG,Bright Health MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Aetna,Aetna,58.15,,,,,,,per diem,58.15,58.15,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Aetna MGG,Aetna MGG,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,BCBS,BCBS,58.15,,,,,,,per diem,58.15,58.15,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,BCBS MGG,BCBS MGG,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Cigna,Cigna,58.15,,,,,,,per diem,58.15,58.15,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Cigna MGG,Cigna MGG,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Humana,Humana,58.15,,,,,,,per diem,58.15,58.15,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Humana MGG,Humana MGG,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Optum VA,Optum VA,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,UHC,UHC,58.15,,,,,,,per diem,58.15,58.15,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,UHC MGG,UHC MGG,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,VA,VA,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Wellcare MGG,Wellcare MGG,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Bright Health - commercial,Bright Health - commercial,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,58.15,58.15,Bright Health MGG,Bright Health MGG,58.15,,,,,,,case rate,58.15,58.15,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Aetna,Aetna,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Aetna MGG,Aetna MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,BCBS,BCBS,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,BCBS MGG,BCBS MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Cigna,Cigna,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Cigna MGG,Cigna MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Humana,Humana,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Humana MGG,Humana MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Optum VA,Optum VA,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,UHC,UHC,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,UHC MGG,UHC MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,VA,VA,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Wellcare MGG,Wellcare MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Bright Health - commercial,Bright Health - commercial,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
C-DIFF ANTIGEN                ,38200345,CDM,300,RC,,,,,,Inpatient,,,99.75,99.75,Bright Health MGG,Bright Health MGG,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Aetna,Aetna,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Aetna MGG,Aetna MGG,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,BCBS,BCBS,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,BCBS MGG,BCBS MGG,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Cigna,Cigna,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Cigna MGG,Cigna MGG,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Humana,Humana,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Humana MGG,Humana MGG,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Optum VA,Optum VA,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,UHC,UHC,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,UHC MGG,UHC MGG,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,VA,VA,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Wellcare MGG,Wellcare MGG,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Bright Health - commercial,Bright Health - commercial,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,Bright Health MGG,Bright Health MGG,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Aetna,Aetna,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Aetna MGG,Aetna MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,BCBS,BCBS,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,BCBS MGG,BCBS MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Cigna,Cigna,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Cigna MGG,Cigna MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Humana,Humana,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Humana MGG,Humana MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Optum VA,Optum VA,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,UHC,UHC,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,UHC MGG,UHC MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,VA,VA,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Wellcare MGG,Wellcare MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Bright Health - commercial,Bright Health - commercial,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,Bright Health MGG,Bright Health MGG,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Aetna,Aetna,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Aetna MGG,Aetna MGG,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,BCBS,BCBS,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,BCBS MGG,BCBS MGG,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Cigna,Cigna,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Cigna MGG,Cigna MGG,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Humana,Humana,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Humana MGG,Humana MGG,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Optum VA,Optum VA,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,UHC,UHC,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,UHC MGG,UHC MGG,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,VA,VA,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Wellcare MGG,Wellcare MGG,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Bright Health - commercial,Bright Health - commercial,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
ANTI CENTROMERE ANTIBODY      ,38200357,CDM,302,RC,86039,CPT,,,,Inpatient,,,144.9,144.9,Bright Health MGG,Bright Health MGG,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Aetna,Aetna,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Aetna MGG,Aetna MGG,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,BCBS,BCBS,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,BCBS MGG,BCBS MGG,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Cigna,Cigna,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Cigna MGG,Cigna MGG,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Humana,Humana,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Humana MGG,Humana MGG,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Optum VA,Optum VA,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,UHC,UHC,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,UHC MGG,UHC MGG,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,VA,VA,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Wellcare MGG,Wellcare MGG,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Bright Health - commercial,Bright Health - commercial,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,Bright Health MGG,Bright Health MGG,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Aetna,Aetna,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Aetna MGG,Aetna MGG,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,BCBS,BCBS,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,BCBS MGG,BCBS MGG,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Cigna,Cigna,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Cigna MGG,Cigna MGG,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Humana,Humana,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Humana MGG,Humana MGG,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Optum VA,Optum VA,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,UHC,UHC,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,UHC MGG,UHC MGG,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,VA,VA,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Wellcare MGG,Wellcare MGG,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Bright Health - commercial,Bright Health - commercial,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,Bright Health MGG,Bright Health MGG,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Aetna,Aetna,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Aetna MGG,Aetna MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,BCBS,BCBS,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,BCBS MGG,BCBS MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Cigna,Cigna,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Cigna MGG,Cigna MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Humana,Humana,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Humana MGG,Humana MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Optum VA,Optum VA,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,UHC,UHC,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,UHC MGG,UHC MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,VA,VA,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Wellcare MGG,Wellcare MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Bright Health - commercial,Bright Health - commercial,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,106.05,106.05,Bright Health MGG,Bright Health MGG,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Aetna,Aetna,182.25,,,,,,,per diem,182.25,182.25,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Aetna MGG,Aetna MGG,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,BCBS,BCBS,182.25,,,,,,,per diem,182.25,182.25,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,BCBS MGG,BCBS MGG,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Cigna,Cigna,182.25,,,,,,,per diem,182.25,182.25,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Cigna MGG,Cigna MGG,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Humana,Humana,182.25,,,,,,,per diem,182.25,182.25,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Humana MGG,Humana MGG,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Optum VA,Optum VA,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,UHC,UHC,182.25,,,,,,,per diem,182.25,182.25,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,UHC MGG,UHC MGG,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,VA,VA,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Wellcare MGG,Wellcare MGG,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Bright Health - commercial,Bright Health - commercial,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,182.25,182.25,Bright Health MGG,Bright Health MGG,182.25,,,,,,,case rate,182.25,182.25,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Aetna,Aetna,100.12,,,,,,,per diem,100.12,100.12,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Aetna MGG,Aetna MGG,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,BCBS,BCBS,100.12,,,,,,,per diem,100.12,100.12,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,BCBS MGG,BCBS MGG,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Cigna,Cigna,100.12,,,,,,,per diem,100.12,100.12,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Cigna MGG,Cigna MGG,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Humana,Humana,100.12,,,,,,,per diem,100.12,100.12,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Humana MGG,Humana MGG,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Optum VA,Optum VA,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,UHC,UHC,100.12,,,,,,,per diem,100.12,100.12,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,UHC MGG,UHC MGG,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,VA,VA,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Wellcare MGG,Wellcare MGG,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Bright Health - commercial,Bright Health - commercial,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,100.12,100.12,Bright Health MGG,Bright Health MGG,100.12,,,,,,,case rate,100.12,100.12,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Aetna,Aetna,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Aetna MGG,Aetna MGG,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,BCBS,BCBS,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,BCBS MGG,BCBS MGG,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Cigna,Cigna,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Cigna MGG,Cigna MGG,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Humana,Humana,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Humana MGG,Humana MGG,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Optum VA,Optum VA,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,UHC,UHC,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,UHC MGG,UHC MGG,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,VA,VA,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Wellcare MGG,Wellcare MGG,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Bright Health - commercial,Bright Health - commercial,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,Bright Health MGG,Bright Health MGG,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Aetna,Aetna,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Aetna MGG,Aetna MGG,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,BCBS,BCBS,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,BCBS MGG,BCBS MGG,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Cigna,Cigna,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Cigna MGG,Cigna MGG,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Humana,Humana,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Humana MGG,Humana MGG,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Optum VA,Optum VA,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,UHC,UHC,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,UHC MGG,UHC MGG,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,VA,VA,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Wellcare MGG,Wellcare MGG,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Bright Health - commercial,Bright Health - commercial,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,Bright Health MGG,Bright Health MGG,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Aetna,Aetna,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Aetna MGG,Aetna MGG,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,BCBS,BCBS,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,BCBS MGG,BCBS MGG,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Cigna,Cigna,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Cigna MGG,Cigna MGG,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Humana,Humana,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Humana MGG,Humana MGG,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Optum VA,Optum VA,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,UHC,UHC,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,UHC MGG,UHC MGG,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,VA,VA,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Wellcare MGG,Wellcare MGG,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Bright Health - commercial,Bright Health - commercial,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,Bright Health MGG,Bright Health MGG,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Aetna,Aetna,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Aetna MGG,Aetna MGG,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,BCBS,BCBS,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,BCBS MGG,BCBS MGG,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Cigna,Cigna,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Cigna MGG,Cigna MGG,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Humana,Humana,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Humana MGG,Humana MGG,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Optum VA,Optum VA,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,UHC,UHC,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,UHC MGG,UHC MGG,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,VA,VA,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Wellcare MGG,Wellcare MGG,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Bright Health - commercial,Bright Health - commercial,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,Bright Health MGG,Bright Health MGG,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Aetna,Aetna,137.6,,,,,,,per diem,137.6,137.6,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Aetna MGG,Aetna MGG,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,BCBS,BCBS,137.6,,,,,,,per diem,137.6,137.6,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,BCBS MGG,BCBS MGG,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Cigna,Cigna,137.6,,,,,,,per diem,137.6,137.6,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Cigna MGG,Cigna MGG,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Humana,Humana,137.6,,,,,,,per diem,137.6,137.6,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Humana MGG,Humana MGG,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Optum VA,Optum VA,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,UHC,UHC,137.6,,,,,,,per diem,137.6,137.6,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,UHC MGG,UHC MGG,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,VA,VA,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Wellcare MGG,Wellcare MGG,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Bright Health - commercial,Bright Health - commercial,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,137.6,137.6,Bright Health MGG,Bright Health MGG,137.6,,,,,,,case rate,137.6,137.6,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Aetna,Aetna,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Aetna MGG,Aetna MGG,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,BCBS,BCBS,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,BCBS MGG,BCBS MGG,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Cigna,Cigna,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Cigna MGG,Cigna MGG,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Humana,Humana,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Humana MGG,Humana MGG,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Optum VA,Optum VA,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,UHC,UHC,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,UHC MGG,UHC MGG,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,VA,VA,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Wellcare MGG,Wellcare MGG,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Bright Health - commercial,Bright Health - commercial,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,Bright Health MGG,Bright Health MGG,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Aetna,Aetna,63.74,,,,,,,per diem,63.74,63.74,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Aetna MGG,Aetna MGG,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,BCBS,BCBS,63.74,,,,,,,per diem,63.74,63.74,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,BCBS MGG,BCBS MGG,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Cigna,Cigna,63.74,,,,,,,per diem,63.74,63.74,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Cigna MGG,Cigna MGG,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Humana,Humana,63.74,,,,,,,per diem,63.74,63.74,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Humana MGG,Humana MGG,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Optum VA,Optum VA,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,UHC,UHC,63.74,,,,,,,per diem,63.74,63.74,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,UHC MGG,UHC MGG,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,VA,VA,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Wellcare MGG,Wellcare MGG,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Bright Health - commercial,Bright Health - commercial,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,63.74,63.74,Bright Health MGG,Bright Health MGG,63.74,,,,,,,case rate,63.74,63.74,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Aetna,Aetna,192.41,,,,,,,per diem,192.41,192.41,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Aetna MGG,Aetna MGG,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,BCBS,BCBS,192.41,,,,,,,per diem,192.41,192.41,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,BCBS MGG,BCBS MGG,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Cigna,Cigna,192.41,,,,,,,per diem,192.41,192.41,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Cigna MGG,Cigna MGG,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Humana,Humana,192.41,,,,,,,per diem,192.41,192.41,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Humana MGG,Humana MGG,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Optum VA,Optum VA,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,UHC,UHC,192.41,,,,,,,per diem,192.41,192.41,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,UHC MGG,UHC MGG,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,VA,VA,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Wellcare MGG,Wellcare MGG,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Bright Health - commercial,Bright Health - commercial,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,192.41,192.41,Bright Health MGG,Bright Health MGG,192.41,,,,,,,case rate,192.41,192.41,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Aetna,Aetna,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Aetna MGG,Aetna MGG,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,BCBS,BCBS,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,BCBS MGG,BCBS MGG,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Cigna,Cigna,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Cigna MGG,Cigna MGG,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Humana,Humana,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Humana MGG,Humana MGG,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Optum VA,Optum VA,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,UHC,UHC,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,UHC MGG,UHC MGG,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,VA,VA,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Wellcare MGG,Wellcare MGG,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Bright Health - commercial,Bright Health - commercial,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,88.2,88.2,Bright Health MGG,Bright Health MGG,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Aetna,Aetna,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Aetna MGG,Aetna MGG,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,BCBS,BCBS,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,BCBS MGG,BCBS MGG,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Cigna,Cigna,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Cigna MGG,Cigna MGG,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Humana,Humana,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Humana MGG,Humana MGG,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Optum VA,Optum VA,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,UHC,UHC,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,UHC MGG,UHC MGG,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,VA,VA,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Wellcare MGG,Wellcare MGG,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Bright Health - commercial,Bright Health - commercial,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,Bright Health MGG,Bright Health MGG,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Aetna,Aetna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Aetna MGG,Aetna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,BCBS,BCBS,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,BCBS MGG,BCBS MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Cigna,Cigna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Cigna MGG,Cigna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Humana,Humana,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Humana MGG,Humana MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Optum VA,Optum VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,UHC,UHC,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,UHC MGG,UHC MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,VA,VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Wellcare MGG,Wellcare MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Bright Health - commercial,Bright Health - commercial,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,Bright Health MGG,Bright Health MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Aetna,Aetna,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Aetna MGG,Aetna MGG,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,BCBS,BCBS,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,BCBS MGG,BCBS MGG,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Cigna,Cigna,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Cigna MGG,Cigna MGG,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Humana,Humana,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Humana MGG,Humana MGG,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Optum VA,Optum VA,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,UHC,UHC,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,UHC MGG,UHC MGG,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,VA,VA,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Wellcare MGG,Wellcare MGG,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Bright Health - commercial,Bright Health - commercial,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,Bright Health MGG,Bright Health MGG,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Aetna,Aetna,157.55,,,,,,,per diem,157.55,157.55,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Aetna MGG,Aetna MGG,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,BCBS,BCBS,157.55,,,,,,,per diem,157.55,157.55,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,BCBS MGG,BCBS MGG,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Cigna,Cigna,157.55,,,,,,,per diem,157.55,157.55,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Cigna MGG,Cigna MGG,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Humana,Humana,157.55,,,,,,,per diem,157.55,157.55,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Humana MGG,Humana MGG,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Optum VA,Optum VA,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,UHC,UHC,157.55,,,,,,,per diem,157.55,157.55,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,UHC MGG,UHC MGG,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,VA,VA,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Wellcare MGG,Wellcare MGG,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Bright Health - commercial,Bright Health - commercial,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,157.55,157.55,Bright Health MGG,Bright Health MGG,157.55,,,,,,,case rate,157.55,157.55,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Aetna,Aetna,227.69,,,,,,,per diem,227.69,227.69,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Aetna MGG,Aetna MGG,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,BCBS,BCBS,227.69,,,,,,,per diem,227.69,227.69,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,BCBS MGG,BCBS MGG,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Cigna,Cigna,227.69,,,,,,,per diem,227.69,227.69,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Cigna MGG,Cigna MGG,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Humana,Humana,227.69,,,,,,,per diem,227.69,227.69,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Humana MGG,Humana MGG,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Optum VA,Optum VA,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,UHC,UHC,227.69,,,,,,,per diem,227.69,227.69,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,UHC MGG,UHC MGG,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,VA,VA,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Wellcare MGG,Wellcare MGG,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Bright Health - commercial,Bright Health - commercial,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,227.69,227.69,Bright Health MGG,Bright Health MGG,227.69,,,,,,,case rate,227.69,227.69,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Aetna,Aetna,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Aetna MGG,Aetna MGG,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,BCBS,BCBS,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,BCBS MGG,BCBS MGG,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Cigna,Cigna,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Cigna MGG,Cigna MGG,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Humana,Humana,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Humana MGG,Humana MGG,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Optum VA,Optum VA,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,UHC,UHC,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,UHC MGG,UHC MGG,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,VA,VA,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Wellcare MGG,Wellcare MGG,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Bright Health - commercial,Bright Health - commercial,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,Bright Health MGG,Bright Health MGG,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Aetna,Aetna,321.57,,,,,,,per diem,321.57,321.57,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Aetna MGG,Aetna MGG,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,BCBS,BCBS,321.57,,,,,,,per diem,321.57,321.57,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,BCBS MGG,BCBS MGG,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Cigna,Cigna,321.57,,,,,,,per diem,321.57,321.57,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Cigna MGG,Cigna MGG,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Humana,Humana,321.57,,,,,,,per diem,321.57,321.57,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Humana MGG,Humana MGG,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Optum VA,Optum VA,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,UHC,UHC,321.57,,,,,,,per diem,321.57,321.57,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,UHC MGG,UHC MGG,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,VA,VA,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Wellcare MGG,Wellcare MGG,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Bright Health - commercial,Bright Health - commercial,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,321.57,321.57,Bright Health MGG,Bright Health MGG,321.57,,,,,,,case rate,321.57,321.57,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Aetna,Aetna,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Aetna MGG,Aetna MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,BCBS,BCBS,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,BCBS MGG,BCBS MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Cigna,Cigna,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Cigna MGG,Cigna MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Humana,Humana,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Humana MGG,Humana MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Optum VA,Optum VA,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,UHC,UHC,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,UHC MGG,UHC MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,VA,VA,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Wellcare MGG,Wellcare MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Bright Health - commercial,Bright Health - commercial,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,Bright Health MGG,Bright Health MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Aetna,Aetna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Aetna MGG,Aetna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS,BCBS,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS MGG,BCBS MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Cigna,Cigna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Cigna MGG,Cigna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Humana,Humana,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Humana MGG,Humana MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Optum VA,Optum VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,UHC,UHC,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,UHC MGG,UHC MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,VA,VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Wellcare MGG,Wellcare MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Bright Health - commercial,Bright Health - commercial,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Bright Health MGG,Bright Health MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Aetna,Aetna,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Aetna MGG,Aetna MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,BCBS,BCBS,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,BCBS MGG,BCBS MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Cigna,Cigna,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Cigna MGG,Cigna MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Humana,Humana,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Humana MGG,Humana MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Optum VA,Optum VA,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,UHC,UHC,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,UHC MGG,UHC MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,VA,VA,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Wellcare MGG,Wellcare MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Bright Health - commercial,Bright Health - commercial,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,Bright Health MGG,Bright Health MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Aetna,Aetna,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Aetna MGG,Aetna MGG,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,BCBS,BCBS,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,BCBS MGG,BCBS MGG,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Cigna,Cigna,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Cigna MGG,Cigna MGG,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Humana,Humana,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Humana MGG,Humana MGG,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Optum VA,Optum VA,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,UHC,UHC,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,UHC MGG,UHC MGG,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,VA,VA,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Wellcare MGG,Wellcare MGG,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Bright Health - commercial,Bright Health - commercial,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IGFBP-3                       ,38200512,CDM,301,RC,83520,CPT,,,,Inpatient,,,116.55,116.55,Bright Health MGG,Bright Health MGG,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Aetna,Aetna,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Aetna MGG,Aetna MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,BCBS,BCBS,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,BCBS MGG,BCBS MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Cigna,Cigna,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Cigna MGG,Cigna MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Humana,Humana,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Humana MGG,Humana MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Optum VA,Optum VA,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,UHC,UHC,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,UHC MGG,UHC MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,VA,VA,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Wellcare MGG,Wellcare MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Bright Health - commercial,Bright Health - commercial,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,22.49,22.49,Bright Health MGG,Bright Health MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Aetna,Aetna,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Aetna MGG,Aetna MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,BCBS,BCBS,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,BCBS MGG,BCBS MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Cigna,Cigna,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Cigna MGG,Cigna MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Humana,Humana,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Humana MGG,Humana MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Optum VA,Optum VA,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,UHC,UHC,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,UHC MGG,UHC MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,VA,VA,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Wellcare MGG,Wellcare MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Bright Health - commercial,Bright Health - commercial,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
MICROALBUMIN/CREATININE RATIO ,38200514,CDM,301,RC,82043,CPT,,,,Inpatient,,,154.35,154.35,Bright Health MGG,Bright Health MGG,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Aetna,Aetna,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Aetna MGG,Aetna MGG,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,BCBS,BCBS,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,BCBS MGG,BCBS MGG,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Cigna,Cigna,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Cigna MGG,Cigna MGG,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Humana,Humana,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Humana MGG,Humana MGG,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Optum VA,Optum VA,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,UHC,UHC,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,UHC MGG,UHC MGG,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,VA,VA,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Wellcare MGG,Wellcare MGG,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Bright Health - commercial,Bright Health - commercial,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,Bright Health MGG,Bright Health MGG,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Aetna,Aetna,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Aetna MGG,Aetna MGG,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,BCBS,BCBS,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,BCBS MGG,BCBS MGG,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Cigna,Cigna,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Cigna MGG,Cigna MGG,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Humana,Humana,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Humana MGG,Humana MGG,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Optum VA,Optum VA,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,UHC,UHC,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,UHC MGG,UHC MGG,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,VA,VA,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Wellcare MGG,Wellcare MGG,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Bright Health - commercial,Bright Health - commercial,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,Bright Health MGG,Bright Health MGG,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Aetna,Aetna,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Aetna MGG,Aetna MGG,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,BCBS,BCBS,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,BCBS MGG,BCBS MGG,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Cigna,Cigna,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Cigna MGG,Cigna MGG,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Humana,Humana,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Humana MGG,Humana MGG,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Optum VA,Optum VA,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,UHC,UHC,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,UHC MGG,UHC MGG,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,VA,VA,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Wellcare MGG,Wellcare MGG,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Bright Health - commercial,Bright Health - commercial,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,Bright Health MGG,Bright Health MGG,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Aetna,Aetna,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Aetna MGG,Aetna MGG,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,BCBS,BCBS,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,BCBS MGG,BCBS MGG,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Cigna,Cigna,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Cigna MGG,Cigna MGG,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Humana,Humana,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Humana MGG,Humana MGG,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Optum VA,Optum VA,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,UHC,UHC,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,UHC MGG,UHC MGG,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,VA,VA,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Wellcare MGG,Wellcare MGG,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Bright Health - commercial,Bright Health - commercial,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,Bright Health MGG,Bright Health MGG,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Aetna,Aetna,106.55,,,,,,,per diem,106.55,106.55,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Aetna MGG,Aetna MGG,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,BCBS,BCBS,106.55,,,,,,,per diem,106.55,106.55,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,BCBS MGG,BCBS MGG,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Cigna,Cigna,106.55,,,,,,,per diem,106.55,106.55,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Cigna MGG,Cigna MGG,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Humana,Humana,106.55,,,,,,,per diem,106.55,106.55,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Humana MGG,Humana MGG,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Optum VA,Optum VA,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,UHC,UHC,106.55,,,,,,,per diem,106.55,106.55,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,UHC MGG,UHC MGG,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,VA,VA,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Wellcare MGG,Wellcare MGG,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Bright Health - commercial,Bright Health - commercial,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,106.55,106.55,Bright Health MGG,Bright Health MGG,106.55,,,,,,,case rate,106.55,106.55,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Aetna,Aetna,87.77,,,,,,,per diem,87.77,87.77,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Aetna MGG,Aetna MGG,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,BCBS,BCBS,87.77,,,,,,,per diem,87.77,87.77,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,BCBS MGG,BCBS MGG,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Cigna,Cigna,87.77,,,,,,,per diem,87.77,87.77,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Cigna MGG,Cigna MGG,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Humana,Humana,87.77,,,,,,,per diem,87.77,87.77,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Humana MGG,Humana MGG,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Optum VA,Optum VA,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,UHC,UHC,87.77,,,,,,,per diem,87.77,87.77,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,UHC MGG,UHC MGG,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,VA,VA,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Wellcare MGG,Wellcare MGG,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Bright Health - commercial,Bright Health - commercial,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,87.77,87.77,Bright Health MGG,Bright Health MGG,87.77,,,,,,,case rate,87.77,87.77,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Aetna,Aetna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Aetna MGG,Aetna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,BCBS,BCBS,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,BCBS MGG,BCBS MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Cigna,Cigna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Cigna MGG,Cigna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Humana,Humana,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Humana MGG,Humana MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Optum VA,Optum VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,UHC,UHC,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,UHC MGG,UHC MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,VA,VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Wellcare MGG,Wellcare MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Bright Health - commercial,Bright Health - commercial,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,Bright Health MGG,Bright Health MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Aetna,Aetna,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Aetna MGG,Aetna MGG,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,BCBS,BCBS,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,BCBS MGG,BCBS MGG,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Cigna,Cigna,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Cigna MGG,Cigna MGG,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Humana,Humana,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Humana MGG,Humana MGG,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Optum VA,Optum VA,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,UHC,UHC,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,UHC MGG,UHC MGG,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,VA,VA,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Wellcare MGG,Wellcare MGG,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Bright Health - commercial,Bright Health - commercial,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,Bright Health MGG,Bright Health MGG,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Aetna,Aetna,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Aetna MGG,Aetna MGG,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,BCBS,BCBS,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,BCBS MGG,BCBS MGG,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Cigna,Cigna,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Cigna MGG,Cigna MGG,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Humana,Humana,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Humana MGG,Humana MGG,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Optum VA,Optum VA,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,UHC,UHC,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,UHC MGG,UHC MGG,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,VA,VA,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Wellcare MGG,Wellcare MGG,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Bright Health - commercial,Bright Health - commercial,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,Bright Health MGG,Bright Health MGG,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Aetna,Aetna,318.16,,,,,,,per diem,318.16,318.16,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Aetna MGG,Aetna MGG,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,BCBS,BCBS,318.16,,,,,,,per diem,318.16,318.16,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,BCBS MGG,BCBS MGG,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Cigna,Cigna,318.16,,,,,,,per diem,318.16,318.16,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Cigna MGG,Cigna MGG,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Humana,Humana,318.16,,,,,,,per diem,318.16,318.16,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Humana MGG,Humana MGG,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Optum VA,Optum VA,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,UHC,UHC,318.16,,,,,,,per diem,318.16,318.16,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,UHC MGG,UHC MGG,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,VA,VA,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Wellcare MGG,Wellcare MGG,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Bright Health - commercial,Bright Health - commercial,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,318.16,318.16,Bright Health MGG,Bright Health MGG,318.16,,,,,,,case rate,318.16,318.16,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Aetna,Aetna,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Aetna MGG,Aetna MGG,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,BCBS,BCBS,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,BCBS MGG,BCBS MGG,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Cigna,Cigna,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Cigna MGG,Cigna MGG,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Humana,Humana,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Humana MGG,Humana MGG,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Optum VA,Optum VA,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,UHC,UHC,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,UHC MGG,UHC MGG,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,VA,VA,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Wellcare MGG,Wellcare MGG,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Bright Health - commercial,Bright Health - commercial,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,Bright Health MGG,Bright Health MGG,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Aetna,Aetna,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Aetna MGG,Aetna MGG,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,BCBS,BCBS,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,BCBS MGG,BCBS MGG,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Cigna,Cigna,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Cigna MGG,Cigna MGG,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Humana,Humana,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Humana MGG,Humana MGG,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Optum VA,Optum VA,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,UHC,UHC,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,UHC MGG,UHC MGG,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,VA,VA,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Wellcare MGG,Wellcare MGG,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Bright Health - commercial,Bright Health - commercial,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,Bright Health MGG,Bright Health MGG,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Aetna,Aetna,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Aetna MGG,Aetna MGG,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,BCBS,BCBS,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,BCBS MGG,BCBS MGG,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Cigna,Cigna,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Cigna MGG,Cigna MGG,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Humana,Humana,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Humana MGG,Humana MGG,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Optum VA,Optum VA,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,UHC,UHC,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,UHC MGG,UHC MGG,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,VA,VA,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Wellcare MGG,Wellcare MGG,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Bright Health - commercial,Bright Health - commercial,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,Bright Health MGG,Bright Health MGG,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Aetna,Aetna,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Aetna MGG,Aetna MGG,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,BCBS,BCBS,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,BCBS MGG,BCBS MGG,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Cigna,Cigna,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Cigna MGG,Cigna MGG,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Humana,Humana,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Humana MGG,Humana MGG,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Optum VA,Optum VA,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,UHC,UHC,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,UHC MGG,UHC MGG,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,VA,VA,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Wellcare MGG,Wellcare MGG,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Bright Health - commercial,Bright Health - commercial,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,69.83,69.83,Bright Health MGG,Bright Health MGG,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Aetna,Aetna,134.79,,,,,,,per diem,134.79,134.79,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Aetna MGG,Aetna MGG,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,BCBS,BCBS,134.79,,,,,,,per diem,134.79,134.79,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,BCBS MGG,BCBS MGG,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Cigna,Cigna,134.79,,,,,,,per diem,134.79,134.79,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Cigna MGG,Cigna MGG,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Humana,Humana,134.79,,,,,,,per diem,134.79,134.79,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Humana MGG,Humana MGG,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Optum VA,Optum VA,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,UHC,UHC,134.79,,,,,,,per diem,134.79,134.79,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,UHC MGG,UHC MGG,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,VA,VA,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Wellcare MGG,Wellcare MGG,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Bright Health - commercial,Bright Health - commercial,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,134.79,134.79,Bright Health MGG,Bright Health MGG,134.79,,,,,,,case rate,134.79,134.79,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Aetna,Aetna,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Aetna MGG,Aetna MGG,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,BCBS,BCBS,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,BCBS MGG,BCBS MGG,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Cigna,Cigna,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Cigna MGG,Cigna MGG,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Humana,Humana,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Humana MGG,Humana MGG,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Optum VA,Optum VA,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,UHC,UHC,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,UHC MGG,UHC MGG,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,VA,VA,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Wellcare MGG,Wellcare MGG,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Bright Health - commercial,Bright Health - commercial,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,Bright Health MGG,Bright Health MGG,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Aetna,Aetna,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Aetna MGG,Aetna MGG,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,BCBS,BCBS,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,BCBS MGG,BCBS MGG,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Cigna,Cigna,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Cigna MGG,Cigna MGG,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Humana,Humana,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Humana MGG,Humana MGG,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Optum VA,Optum VA,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,UHC,UHC,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,UHC MGG,UHC MGG,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,VA,VA,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Wellcare MGG,Wellcare MGG,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Bright Health - commercial,Bright Health - commercial,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,Bright Health MGG,Bright Health MGG,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Aetna,Aetna,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Aetna MGG,Aetna MGG,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,BCBS,BCBS,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,BCBS MGG,BCBS MGG,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Cigna,Cigna,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Cigna MGG,Cigna MGG,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Humana,Humana,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Humana MGG,Humana MGG,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Optum VA,Optum VA,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,UHC,UHC,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,UHC MGG,UHC MGG,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,VA,VA,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Wellcare MGG,Wellcare MGG,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Bright Health - commercial,Bright Health - commercial,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,Bright Health MGG,Bright Health MGG,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Aetna,Aetna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Aetna MGG,Aetna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,BCBS,BCBS,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,BCBS MGG,BCBS MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Cigna,Cigna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Cigna MGG,Cigna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Humana,Humana,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Humana MGG,Humana MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Optum VA,Optum VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,UHC,UHC,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,UHC MGG,UHC MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,VA,VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Wellcare MGG,Wellcare MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Bright Health - commercial,Bright Health - commercial,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,70.69,70.69,Bright Health MGG,Bright Health MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Aetna,Aetna,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Aetna MGG,Aetna MGG,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,BCBS,BCBS,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,BCBS MGG,BCBS MGG,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Cigna,Cigna,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Cigna MGG,Cigna MGG,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Humana,Humana,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Humana MGG,Humana MGG,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Optum VA,Optum VA,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,UHC,UHC,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,UHC MGG,UHC MGG,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,VA,VA,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Wellcare MGG,Wellcare MGG,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Bright Health - commercial,Bright Health - commercial,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,Bright Health MGG,Bright Health MGG,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Aetna,Aetna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Aetna MGG,Aetna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,BCBS,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS MGG,BCBS MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Cigna,Cigna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Cigna MGG,Cigna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Humana,Humana,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Humana MGG,Humana MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Optum VA,Optum VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,UHC,UHC,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,UHC MGG,UHC MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,VA,VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Wellcare MGG,Wellcare MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Bright Health - commercial,Bright Health - commercial,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Bright Health MGG,Bright Health MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Aetna,Aetna,225.55,,,,,,,per diem,225.55,225.55,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Aetna MGG,Aetna MGG,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,BCBS,BCBS,225.55,,,,,,,per diem,225.55,225.55,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,BCBS MGG,BCBS MGG,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Cigna,Cigna,225.55,,,,,,,per diem,225.55,225.55,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Cigna MGG,Cigna MGG,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Humana,Humana,225.55,,,,,,,per diem,225.55,225.55,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Humana MGG,Humana MGG,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Optum VA,Optum VA,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,UHC,UHC,225.55,,,,,,,per diem,225.55,225.55,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,UHC MGG,UHC MGG,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,VA,VA,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Wellcare MGG,Wellcare MGG,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Bright Health - commercial,Bright Health - commercial,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,225.55,225.55,Bright Health MGG,Bright Health MGG,225.55,,,,,,,case rate,225.55,225.55,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Aetna,Aetna,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Aetna MGG,Aetna MGG,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,BCBS,BCBS,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,BCBS MGG,BCBS MGG,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Cigna,Cigna,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Cigna MGG,Cigna MGG,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Humana,Humana,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Humana MGG,Humana MGG,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Optum VA,Optum VA,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,UHC,UHC,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,UHC MGG,UHC MGG,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,VA,VA,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Wellcare MGG,Wellcare MGG,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Bright Health - commercial,Bright Health - commercial,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,Bright Health MGG,Bright Health MGG,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Aetna,Aetna,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Aetna MGG,Aetna MGG,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,BCBS,BCBS,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,BCBS MGG,BCBS MGG,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Cigna,Cigna,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Cigna MGG,Cigna MGG,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Humana,Humana,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Humana MGG,Humana MGG,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Optum VA,Optum VA,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,UHC,UHC,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,UHC MGG,UHC MGG,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,VA,VA,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Wellcare MGG,Wellcare MGG,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Bright Health - commercial,Bright Health - commercial,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,Bright Health MGG,Bright Health MGG,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Aetna,Aetna,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Aetna MGG,Aetna MGG,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,BCBS,BCBS,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,BCBS MGG,BCBS MGG,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Cigna,Cigna,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Cigna MGG,Cigna MGG,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Humana,Humana,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Humana MGG,Humana MGG,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Optum VA,Optum VA,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,UHC,UHC,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,UHC MGG,UHC MGG,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,VA,VA,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Wellcare MGG,Wellcare MGG,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Bright Health - commercial,Bright Health - commercial,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,Bright Health MGG,Bright Health MGG,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Aetna,Aetna,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Aetna MGG,Aetna MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,BCBS,BCBS,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,BCBS MGG,BCBS MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Cigna,Cigna,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Cigna MGG,Cigna MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Humana,Humana,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Humana MGG,Humana MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Optum VA,Optum VA,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,UHC,UHC,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,UHC MGG,UHC MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,VA,VA,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Wellcare MGG,Wellcare MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Bright Health - commercial,Bright Health - commercial,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,Bright Health MGG,Bright Health MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Aetna,Aetna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Aetna MGG,Aetna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS,BCBS,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS MGG,BCBS MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Cigna,Cigna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Cigna MGG,Cigna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Humana,Humana,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Humana MGG,Humana MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Optum VA,Optum VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,UHC,UHC,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,UHC MGG,UHC MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,VA,VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Wellcare MGG,Wellcare MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Bright Health - commercial,Bright Health - commercial,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Bright Health MGG,Bright Health MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Aetna,Aetna,74.78,,,,,,,per diem,74.78,74.78,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Aetna MGG,Aetna MGG,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,BCBS,BCBS,74.78,,,,,,,per diem,74.78,74.78,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,BCBS MGG,BCBS MGG,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Cigna,Cigna,74.78,,,,,,,per diem,74.78,74.78,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Cigna MGG,Cigna MGG,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Humana,Humana,74.78,,,,,,,per diem,74.78,74.78,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Humana MGG,Humana MGG,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Optum VA,Optum VA,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,UHC,UHC,74.78,,,,,,,per diem,74.78,74.78,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,UHC MGG,UHC MGG,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,VA,VA,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Wellcare MGG,Wellcare MGG,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Bright Health - commercial,Bright Health - commercial,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,74.78,74.78,Bright Health MGG,Bright Health MGG,74.78,,,,,,,case rate,74.78,74.78,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Aetna,Aetna,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Aetna MGG,Aetna MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,BCBS,BCBS,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,BCBS MGG,BCBS MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Cigna,Cigna,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Cigna MGG,Cigna MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Humana,Humana,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Humana MGG,Humana MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Optum VA,Optum VA,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,UHC,UHC,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,UHC MGG,UHC MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,VA,VA,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Wellcare MGG,Wellcare MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Bright Health - commercial,Bright Health - commercial,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,Bright Health MGG,Bright Health MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Aetna,Aetna,80.96,,,,,,,per diem,80.96,80.96,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Aetna MGG,Aetna MGG,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,BCBS,BCBS,80.96,,,,,,,per diem,80.96,80.96,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,BCBS MGG,BCBS MGG,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Cigna,Cigna,80.96,,,,,,,per diem,80.96,80.96,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Cigna MGG,Cigna MGG,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Humana,Humana,80.96,,,,,,,per diem,80.96,80.96,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Humana MGG,Humana MGG,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Optum VA,Optum VA,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,UHC,UHC,80.96,,,,,,,per diem,80.96,80.96,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,UHC MGG,UHC MGG,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,VA,VA,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Wellcare MGG,Wellcare MGG,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Bright Health - commercial,Bright Health - commercial,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,80.96,80.96,Bright Health MGG,Bright Health MGG,80.96,,,,,,,case rate,80.96,80.96,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Aetna,Aetna,95.54,,,,,,,per diem,95.54,95.54,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Aetna MGG,Aetna MGG,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,BCBS,BCBS,95.54,,,,,,,per diem,95.54,95.54,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,BCBS MGG,BCBS MGG,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Cigna,Cigna,95.54,,,,,,,per diem,95.54,95.54,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Cigna MGG,Cigna MGG,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Humana,Humana,95.54,,,,,,,per diem,95.54,95.54,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Humana MGG,Humana MGG,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Optum VA,Optum VA,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,UHC,UHC,95.54,,,,,,,per diem,95.54,95.54,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,UHC MGG,UHC MGG,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,VA,VA,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Wellcare MGG,Wellcare MGG,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Bright Health - commercial,Bright Health - commercial,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,95.54,95.54,Bright Health MGG,Bright Health MGG,95.54,,,,,,,case rate,95.54,95.54,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Aetna,Aetna,137.08,,,,,,,per diem,137.08,137.08,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Aetna MGG,Aetna MGG,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,BCBS,BCBS,137.08,,,,,,,per diem,137.08,137.08,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,BCBS MGG,BCBS MGG,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Cigna,Cigna,137.08,,,,,,,per diem,137.08,137.08,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Cigna MGG,Cigna MGG,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Humana,Humana,137.08,,,,,,,per diem,137.08,137.08,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Humana MGG,Humana MGG,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Optum VA,Optum VA,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,UHC,UHC,137.08,,,,,,,per diem,137.08,137.08,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,UHC MGG,UHC MGG,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,VA,VA,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Wellcare MGG,Wellcare MGG,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Bright Health - commercial,Bright Health - commercial,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,137.08,137.08,Bright Health MGG,Bright Health MGG,137.08,,,,,,,case rate,137.08,137.08,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Aetna,Aetna,256.35,,,,,,,per diem,256.35,256.35,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Aetna MGG,Aetna MGG,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,BCBS,BCBS,256.35,,,,,,,per diem,256.35,256.35,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,BCBS MGG,BCBS MGG,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Cigna,Cigna,256.35,,,,,,,per diem,256.35,256.35,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Cigna MGG,Cigna MGG,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Humana,Humana,256.35,,,,,,,per diem,256.35,256.35,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Humana MGG,Humana MGG,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Optum VA,Optum VA,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,UHC,UHC,256.35,,,,,,,per diem,256.35,256.35,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,UHC MGG,UHC MGG,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,VA,VA,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Wellcare MGG,Wellcare MGG,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Bright Health - commercial,Bright Health - commercial,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,256.35,256.35,Bright Health MGG,Bright Health MGG,256.35,,,,,,,case rate,256.35,256.35,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Aetna,Aetna,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Aetna MGG,Aetna MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,BCBS,BCBS,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,BCBS MGG,BCBS MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Cigna,Cigna,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Cigna MGG,Cigna MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Humana,Humana,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Humana MGG,Humana MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Optum VA,Optum VA,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,UHC,UHC,95.33,,,,,,,per diem,95.33,95.33,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,UHC MGG,UHC MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,VA,VA,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Wellcare MGG,Wellcare MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Bright Health - commercial,Bright Health - commercial,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,95.33,95.33,Bright Health MGG,Bright Health MGG,95.33,,,,,,,case rate,95.33,95.33,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Aetna,Aetna,231.59,,,,,,,per diem,231.59,231.59,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Aetna MGG,Aetna MGG,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,BCBS,BCBS,231.59,,,,,,,per diem,231.59,231.59,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,BCBS MGG,BCBS MGG,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Cigna,Cigna,231.59,,,,,,,per diem,231.59,231.59,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Cigna MGG,Cigna MGG,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Humana,Humana,231.59,,,,,,,per diem,231.59,231.59,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Humana MGG,Humana MGG,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Optum VA,Optum VA,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,UHC,UHC,231.59,,,,,,,per diem,231.59,231.59,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,UHC MGG,UHC MGG,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,VA,VA,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Wellcare MGG,Wellcare MGG,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Bright Health - commercial,Bright Health - commercial,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,231.59,231.59,Bright Health MGG,Bright Health MGG,231.59,,,,,,,case rate,231.59,231.59,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Aetna,Aetna,91.93,,,,,,,per diem,91.93,91.93,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Aetna MGG,Aetna MGG,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,BCBS,BCBS,91.93,,,,,,,per diem,91.93,91.93,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,BCBS MGG,BCBS MGG,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Cigna,Cigna,91.93,,,,,,,per diem,91.93,91.93,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Cigna MGG,Cigna MGG,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Humana,Humana,91.93,,,,,,,per diem,91.93,91.93,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Humana MGG,Humana MGG,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Optum VA,Optum VA,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,UHC,UHC,91.93,,,,,,,per diem,91.93,91.93,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,UHC MGG,UHC MGG,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,VA,VA,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Wellcare MGG,Wellcare MGG,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Bright Health - commercial,Bright Health - commercial,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,91.93,91.93,Bright Health MGG,Bright Health MGG,91.93,,,,,,,case rate,91.93,91.93,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Aetna,Aetna,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Aetna MGG,Aetna MGG,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,BCBS,BCBS,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,BCBS MGG,BCBS MGG,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Cigna,Cigna,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Cigna MGG,Cigna MGG,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Humana,Humana,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Humana MGG,Humana MGG,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Optum VA,Optum VA,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,UHC,UHC,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,UHC MGG,UHC MGG,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,VA,VA,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Wellcare MGG,Wellcare MGG,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Bright Health - commercial,Bright Health - commercial,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,Bright Health MGG,Bright Health MGG,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Aetna,Aetna,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Aetna MGG,Aetna MGG,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,BCBS,BCBS,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,BCBS MGG,BCBS MGG,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Cigna,Cigna,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Cigna MGG,Cigna MGG,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Humana,Humana,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Humana MGG,Humana MGG,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Optum VA,Optum VA,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,UHC,UHC,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,UHC MGG,UHC MGG,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,VA,VA,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Wellcare MGG,Wellcare MGG,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Bright Health - commercial,Bright Health - commercial,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,103.57,103.57,Bright Health MGG,Bright Health MGG,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Aetna,Aetna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Aetna MGG,Aetna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS,BCBS,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS MGG,BCBS MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Cigna,Cigna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Cigna MGG,Cigna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Humana,Humana,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Humana MGG,Humana MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Optum VA,Optum VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,UHC,UHC,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,UHC MGG,UHC MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,VA,VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Wellcare MGG,Wellcare MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Bright Health - commercial,Bright Health - commercial,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Bright Health MGG,Bright Health MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Aetna,Aetna,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Aetna MGG,Aetna MGG,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,BCBS,BCBS,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,BCBS MGG,BCBS MGG,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Cigna,Cigna,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Cigna MGG,Cigna MGG,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Humana,Humana,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Humana MGG,Humana MGG,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Optum VA,Optum VA,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,UHC,UHC,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,UHC MGG,UHC MGG,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,VA,VA,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Wellcare MGG,Wellcare MGG,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Bright Health - commercial,Bright Health - commercial,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,Bright Health MGG,Bright Health MGG,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Aetna,Aetna,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Aetna MGG,Aetna MGG,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,BCBS,BCBS,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,BCBS MGG,BCBS MGG,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Cigna,Cigna,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Cigna MGG,Cigna MGG,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Humana,Humana,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Humana MGG,Humana MGG,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Optum VA,Optum VA,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,UHC,UHC,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,UHC MGG,UHC MGG,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,VA,VA,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Wellcare MGG,Wellcare MGG,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Bright Health - commercial,Bright Health - commercial,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,Bright Health MGG,Bright Health MGG,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Aetna,Aetna,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Aetna MGG,Aetna MGG,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,BCBS,BCBS,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,BCBS MGG,BCBS MGG,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Cigna,Cigna,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Cigna MGG,Cigna MGG,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Humana,Humana,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Humana MGG,Humana MGG,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Optum VA,Optum VA,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,UHC,UHC,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,UHC MGG,UHC MGG,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,VA,VA,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Wellcare MGG,Wellcare MGG,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Bright Health - commercial,Bright Health - commercial,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,Bright Health MGG,Bright Health MGG,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Aetna,Aetna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Aetna MGG,Aetna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,BCBS,BCBS,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,BCBS MGG,BCBS MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Cigna,Cigna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Cigna MGG,Cigna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Humana,Humana,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Humana MGG,Humana MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Optum VA,Optum VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,UHC,UHC,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,UHC MGG,UHC MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,VA,VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Wellcare MGG,Wellcare MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Bright Health - commercial,Bright Health - commercial,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,Bright Health MGG,Bright Health MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Aetna,Aetna,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Aetna MGG,Aetna MGG,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,BCBS,BCBS,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,BCBS MGG,BCBS MGG,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Cigna,Cigna,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Cigna MGG,Cigna MGG,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Humana,Humana,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Humana MGG,Humana MGG,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Optum VA,Optum VA,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,UHC,UHC,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,UHC MGG,UHC MGG,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,VA,VA,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Wellcare MGG,Wellcare MGG,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Bright Health - commercial,Bright Health - commercial,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,Bright Health MGG,Bright Health MGG,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Aetna,Aetna,137.41,,,,,,,per diem,137.41,137.41,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Aetna MGG,Aetna MGG,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,BCBS,BCBS,137.41,,,,,,,per diem,137.41,137.41,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,BCBS MGG,BCBS MGG,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Cigna,Cigna,137.41,,,,,,,per diem,137.41,137.41,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Cigna MGG,Cigna MGG,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Humana,Humana,137.41,,,,,,,per diem,137.41,137.41,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Humana MGG,Humana MGG,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Optum VA,Optum VA,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,UHC,UHC,137.41,,,,,,,per diem,137.41,137.41,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,UHC MGG,UHC MGG,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,VA,VA,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Wellcare MGG,Wellcare MGG,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Bright Health - commercial,Bright Health - commercial,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,137.41,137.41,Bright Health MGG,Bright Health MGG,137.41,,,,,,,case rate,137.41,137.41,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Aetna,Aetna,239.6,,,,,,,per diem,239.6,239.6,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Aetna MGG,Aetna MGG,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,BCBS,BCBS,239.6,,,,,,,per diem,239.6,239.6,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,BCBS MGG,BCBS MGG,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Cigna,Cigna,239.6,,,,,,,per diem,239.6,239.6,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Cigna MGG,Cigna MGG,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Humana,Humana,239.6,,,,,,,per diem,239.6,239.6,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Humana MGG,Humana MGG,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Optum VA,Optum VA,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,UHC,UHC,239.6,,,,,,,per diem,239.6,239.6,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,UHC MGG,UHC MGG,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,VA,VA,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Wellcare MGG,Wellcare MGG,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Bright Health - commercial,Bright Health - commercial,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,239.6,239.6,Bright Health MGG,Bright Health MGG,239.6,,,,,,,case rate,239.6,239.6,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Aetna,Aetna,208.37,,,,,,,per diem,208.37,208.37,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Aetna MGG,Aetna MGG,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,BCBS,BCBS,208.37,,,,,,,per diem,208.37,208.37,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,BCBS MGG,BCBS MGG,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Cigna,Cigna,208.37,,,,,,,per diem,208.37,208.37,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Cigna MGG,Cigna MGG,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Humana,Humana,208.37,,,,,,,per diem,208.37,208.37,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Humana MGG,Humana MGG,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Optum VA,Optum VA,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,UHC,UHC,208.37,,,,,,,per diem,208.37,208.37,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,UHC MGG,UHC MGG,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,VA,VA,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Wellcare MGG,Wellcare MGG,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Bright Health - commercial,Bright Health - commercial,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,208.37,208.37,Bright Health MGG,Bright Health MGG,208.37,,,,,,,case rate,208.37,208.37,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Aetna,Aetna,71.41,,,,,,,per diem,71.41,71.41,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Aetna MGG,Aetna MGG,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,BCBS,BCBS,71.41,,,,,,,per diem,71.41,71.41,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,BCBS MGG,BCBS MGG,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Cigna,Cigna,71.41,,,,,,,per diem,71.41,71.41,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Cigna MGG,Cigna MGG,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Humana,Humana,71.41,,,,,,,per diem,71.41,71.41,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Humana MGG,Humana MGG,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Optum VA,Optum VA,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,UHC,UHC,71.41,,,,,,,per diem,71.41,71.41,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,UHC MGG,UHC MGG,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,VA,VA,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Wellcare MGG,Wellcare MGG,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Bright Health - commercial,Bright Health - commercial,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,71.41,71.41,Bright Health MGG,Bright Health MGG,71.41,,,,,,,case rate,71.41,71.41,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Aetna,Aetna,38.12,,,,,,,per diem,38.12,38.12,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Aetna MGG,Aetna MGG,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,BCBS,BCBS,38.12,,,,,,,per diem,38.12,38.12,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,BCBS MGG,BCBS MGG,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Cigna,Cigna,38.12,,,,,,,per diem,38.12,38.12,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Cigna MGG,Cigna MGG,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Humana,Humana,38.12,,,,,,,per diem,38.12,38.12,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Humana MGG,Humana MGG,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Optum VA,Optum VA,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,UHC,UHC,38.12,,,,,,,per diem,38.12,38.12,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,UHC MGG,UHC MGG,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,VA,VA,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Wellcare MGG,Wellcare MGG,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Bright Health - commercial,Bright Health - commercial,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,38.12,38.12,Bright Health MGG,Bright Health MGG,38.12,,,,,,,case rate,38.12,38.12,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Aetna,Aetna,122.96,,,,,,,per diem,122.96,122.96,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Aetna MGG,Aetna MGG,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,BCBS,BCBS,122.96,,,,,,,per diem,122.96,122.96,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,BCBS MGG,BCBS MGG,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Cigna,Cigna,122.96,,,,,,,per diem,122.96,122.96,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Cigna MGG,Cigna MGG,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Humana,Humana,122.96,,,,,,,per diem,122.96,122.96,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Humana MGG,Humana MGG,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Optum VA,Optum VA,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,UHC,UHC,122.96,,,,,,,per diem,122.96,122.96,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,UHC MGG,UHC MGG,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,VA,VA,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Wellcare MGG,Wellcare MGG,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Bright Health - commercial,Bright Health - commercial,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,122.96,122.96,Bright Health MGG,Bright Health MGG,122.96,,,,,,,case rate,122.96,122.96,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Aetna,Aetna,196.27,,,,,,,per diem,196.27,196.27,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Aetna MGG,Aetna MGG,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,BCBS,BCBS,196.27,,,,,,,per diem,196.27,196.27,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,BCBS MGG,BCBS MGG,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Cigna,Cigna,196.27,,,,,,,per diem,196.27,196.27,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Cigna MGG,Cigna MGG,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Humana,Humana,196.27,,,,,,,per diem,196.27,196.27,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Humana MGG,Humana MGG,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Optum VA,Optum VA,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,UHC,UHC,196.27,,,,,,,per diem,196.27,196.27,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,UHC MGG,UHC MGG,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,VA,VA,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Wellcare MGG,Wellcare MGG,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Bright Health - commercial,Bright Health - commercial,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,196.27,196.27,Bright Health MGG,Bright Health MGG,196.27,,,,,,,case rate,196.27,196.27,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Aetna,Aetna,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Aetna MGG,Aetna MGG,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,BCBS,BCBS,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,BCBS MGG,BCBS MGG,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Cigna,Cigna,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Cigna MGG,Cigna MGG,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Humana,Humana,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Humana MGG,Humana MGG,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Optum VA,Optum VA,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,UHC,UHC,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,UHC MGG,UHC MGG,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,VA,VA,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Wellcare MGG,Wellcare MGG,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Bright Health - commercial,Bright Health - commercial,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,Bright Health MGG,Bright Health MGG,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Aetna,Aetna,110.91,,,,,,,per diem,110.91,110.91,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Aetna MGG,Aetna MGG,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,BCBS,BCBS,110.91,,,,,,,per diem,110.91,110.91,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,BCBS MGG,BCBS MGG,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Cigna,Cigna,110.91,,,,,,,per diem,110.91,110.91,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Cigna MGG,Cigna MGG,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Humana,Humana,110.91,,,,,,,per diem,110.91,110.91,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Humana MGG,Humana MGG,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Optum VA,Optum VA,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,UHC,UHC,110.91,,,,,,,per diem,110.91,110.91,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,UHC MGG,UHC MGG,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,VA,VA,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Wellcare MGG,Wellcare MGG,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Bright Health - commercial,Bright Health - commercial,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,110.91,110.91,Bright Health MGG,Bright Health MGG,110.91,,,,,,,case rate,110.91,110.91,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Aetna,Aetna,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Aetna MGG,Aetna MGG,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,BCBS,BCBS,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,BCBS MGG,BCBS MGG,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Cigna,Cigna,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Cigna MGG,Cigna MGG,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Humana,Humana,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Humana MGG,Humana MGG,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Optum VA,Optum VA,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,UHC,UHC,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,UHC MGG,UHC MGG,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,VA,VA,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Wellcare MGG,Wellcare MGG,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Bright Health - commercial,Bright Health - commercial,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,Bright Health MGG,Bright Health MGG,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Aetna,Aetna,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Aetna MGG,Aetna MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,BCBS,BCBS,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,BCBS MGG,BCBS MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Cigna,Cigna,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Cigna MGG,Cigna MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Humana,Humana,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Humana MGG,Humana MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Optum VA,Optum VA,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,UHC,UHC,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,UHC MGG,UHC MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,VA,VA,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Wellcare MGG,Wellcare MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Bright Health - commercial,Bright Health - commercial,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,Bright Health MGG,Bright Health MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Aetna,Aetna,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Aetna MGG,Aetna MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,BCBS,BCBS,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,BCBS MGG,BCBS MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Cigna,Cigna,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Cigna MGG,Cigna MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Humana,Humana,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Humana MGG,Humana MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Optum VA,Optum VA,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,UHC,UHC,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,UHC MGG,UHC MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,VA,VA,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Wellcare MGG,Wellcare MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Bright Health - commercial,Bright Health - commercial,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,Bright Health MGG,Bright Health MGG,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Aetna,Aetna,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Aetna MGG,Aetna MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,BCBS,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS MGG,BCBS MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Cigna,Cigna,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Cigna MGG,Cigna MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Humana,Humana,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Humana MGG,Humana MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Optum VA,Optum VA,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,UHC,UHC,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,UHC MGG,UHC MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,VA,VA,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Wellcare MGG,Wellcare MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Bright Health - commercial,Bright Health - commercial,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Bright Health MGG,Bright Health MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Aetna,Aetna,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Aetna MGG,Aetna MGG,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,BCBS,BCBS,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,BCBS MGG,BCBS MGG,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Cigna,Cigna,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Cigna MGG,Cigna MGG,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Humana,Humana,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Humana MGG,Humana MGG,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Optum VA,Optum VA,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,UHC,UHC,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,UHC MGG,UHC MGG,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,VA,VA,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Wellcare MGG,Wellcare MGG,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Bright Health - commercial,Bright Health - commercial,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,Bright Health MGG,Bright Health MGG,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Aetna,Aetna,84.02,,,,,,,per diem,84.02,84.02,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Aetna MGG,Aetna MGG,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,BCBS,BCBS,84.02,,,,,,,per diem,84.02,84.02,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,BCBS MGG,BCBS MGG,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Cigna,Cigna,84.02,,,,,,,per diem,84.02,84.02,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Cigna MGG,Cigna MGG,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Humana,Humana,84.02,,,,,,,per diem,84.02,84.02,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Humana MGG,Humana MGG,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Optum VA,Optum VA,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,UHC,UHC,84.02,,,,,,,per diem,84.02,84.02,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,UHC MGG,UHC MGG,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,VA,VA,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Wellcare MGG,Wellcare MGG,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Bright Health - commercial,Bright Health - commercial,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,84.02,84.02,Bright Health MGG,Bright Health MGG,84.02,,,,,,,case rate,84.02,84.02,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Aetna,Aetna,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Aetna MGG,Aetna MGG,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,BCBS,BCBS,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,BCBS MGG,BCBS MGG,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Cigna,Cigna,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Cigna MGG,Cigna MGG,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Humana,Humana,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Humana MGG,Humana MGG,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Optum VA,Optum VA,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,UHC,UHC,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,UHC MGG,UHC MGG,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,VA,VA,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Wellcare MGG,Wellcare MGG,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Bright Health - commercial,Bright Health - commercial,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,Bright Health MGG,Bright Health MGG,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna,Aetna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna MGG,Aetna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,BCBS,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS MGG,BCBS MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna,Cigna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna MGG,Cigna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana,Humana,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana MGG,Humana MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Optum VA,Optum VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC,UHC,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC MGG,UHC MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Wellcare MGG,Wellcare MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health - commercial,Bright Health - commercial,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health MGG,Bright Health MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Aetna,Aetna,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Aetna MGG,Aetna MGG,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,BCBS,BCBS,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,BCBS MGG,BCBS MGG,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Cigna,Cigna,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Cigna MGG,Cigna MGG,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Humana,Humana,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Humana MGG,Humana MGG,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Optum VA,Optum VA,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,UHC,UHC,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,UHC MGG,UHC MGG,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,VA,VA,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Wellcare MGG,Wellcare MGG,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Bright Health - commercial,Bright Health - commercial,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,Bright Health MGG,Bright Health MGG,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna,Aetna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna MGG,Aetna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,BCBS,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS MGG,BCBS MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna,Cigna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna MGG,Cigna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana,Humana,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana MGG,Humana MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Optum VA,Optum VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC,UHC,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC MGG,UHC MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Wellcare MGG,Wellcare MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health - commercial,Bright Health - commercial,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health MGG,Bright Health MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Aetna,Aetna,142.85,,,,,,,per diem,142.85,142.85,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Aetna MGG,Aetna MGG,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,BCBS,BCBS,142.85,,,,,,,per diem,142.85,142.85,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,BCBS MGG,BCBS MGG,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Cigna,Cigna,142.85,,,,,,,per diem,142.85,142.85,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Cigna MGG,Cigna MGG,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Humana,Humana,142.85,,,,,,,per diem,142.85,142.85,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Humana MGG,Humana MGG,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Optum VA,Optum VA,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,UHC,UHC,142.85,,,,,,,per diem,142.85,142.85,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,UHC MGG,UHC MGG,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,VA,VA,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Wellcare MGG,Wellcare MGG,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Bright Health - commercial,Bright Health - commercial,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,142.85,142.85,Bright Health MGG,Bright Health MGG,142.85,,,,,,,case rate,142.85,142.85,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Aetna,Aetna,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Aetna MGG,Aetna MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,BCBS,BCBS,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,BCBS MGG,BCBS MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Cigna,Cigna,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Cigna MGG,Cigna MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Humana,Humana,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Humana MGG,Humana MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Optum VA,Optum VA,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,UHC,UHC,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,UHC MGG,UHC MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,VA,VA,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Wellcare MGG,Wellcare MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Bright Health - commercial,Bright Health - commercial,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87070,CPT,,,,Inpatient,,,27.15,27.15,Bright Health MGG,Bright Health MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Aetna,Aetna,70.18,,,,,,,per diem,70.18,70.18,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Aetna MGG,Aetna MGG,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,BCBS,BCBS,70.18,,,,,,,per diem,70.18,70.18,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,BCBS MGG,BCBS MGG,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Cigna,Cigna,70.18,,,,,,,per diem,70.18,70.18,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Cigna MGG,Cigna MGG,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Humana,Humana,70.18,,,,,,,per diem,70.18,70.18,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Humana MGG,Humana MGG,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Optum VA,Optum VA,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,UHC,UHC,70.18,,,,,,,per diem,70.18,70.18,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,UHC MGG,UHC MGG,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,VA,VA,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Wellcare MGG,Wellcare MGG,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Bright Health - commercial,Bright Health - commercial,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,70.18,70.18,Bright Health MGG,Bright Health MGG,70.18,,,,,,,case rate,70.18,70.18,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Aetna,Aetna,35.09,,,,,,,per diem,35.09,35.09,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Aetna MGG,Aetna MGG,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,BCBS,BCBS,35.09,,,,,,,per diem,35.09,35.09,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,BCBS MGG,BCBS MGG,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Cigna,Cigna,35.09,,,,,,,per diem,35.09,35.09,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Cigna MGG,Cigna MGG,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Humana,Humana,35.09,,,,,,,per diem,35.09,35.09,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Humana MGG,Humana MGG,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Optum VA,Optum VA,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,UHC,UHC,35.09,,,,,,,per diem,35.09,35.09,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,UHC MGG,UHC MGG,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,VA,VA,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Wellcare MGG,Wellcare MGG,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Bright Health - commercial,Bright Health - commercial,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,35.09,35.09,Bright Health MGG,Bright Health MGG,35.09,,,,,,,case rate,35.09,35.09,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Aetna,Aetna,114.59,,,,,,,per diem,114.59,114.59,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Aetna MGG,Aetna MGG,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,BCBS,BCBS,114.59,,,,,,,per diem,114.59,114.59,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,BCBS MGG,BCBS MGG,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Cigna,Cigna,114.59,,,,,,,per diem,114.59,114.59,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Cigna MGG,Cigna MGG,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Humana,Humana,114.59,,,,,,,per diem,114.59,114.59,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Humana MGG,Humana MGG,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Optum VA,Optum VA,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,UHC,UHC,114.59,,,,,,,per diem,114.59,114.59,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,UHC MGG,UHC MGG,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,VA,VA,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Wellcare MGG,Wellcare MGG,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Bright Health - commercial,Bright Health - commercial,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,114.59,114.59,Bright Health MGG,Bright Health MGG,114.59,,,,,,,case rate,114.59,114.59,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Aetna,Aetna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Aetna MGG,Aetna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS,BCBS,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS MGG,BCBS MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Cigna,Cigna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Cigna MGG,Cigna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Humana,Humana,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Humana MGG,Humana MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Optum VA,Optum VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,UHC,UHC,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,UHC MGG,UHC MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,VA,VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Wellcare MGG,Wellcare MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Bright Health - commercial,Bright Health - commercial,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Bright Health MGG,Bright Health MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Aetna,Aetna,263.04,,,,,,,per diem,263.04,263.04,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Aetna MGG,Aetna MGG,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,BCBS,BCBS,263.04,,,,,,,per diem,263.04,263.04,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,BCBS MGG,BCBS MGG,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Cigna,Cigna,263.04,,,,,,,per diem,263.04,263.04,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Cigna MGG,Cigna MGG,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Humana,Humana,263.04,,,,,,,per diem,263.04,263.04,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Humana MGG,Humana MGG,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Optum VA,Optum VA,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,UHC,UHC,263.04,,,,,,,per diem,263.04,263.04,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,UHC MGG,UHC MGG,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,VA,VA,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Wellcare MGG,Wellcare MGG,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Bright Health - commercial,Bright Health - commercial,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,263.04,263.04,Bright Health MGG,Bright Health MGG,263.04,,,,,,,case rate,263.04,263.04,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Aetna,Aetna,225.09,,,,,,,per diem,225.09,225.09,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Aetna MGG,Aetna MGG,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,BCBS,BCBS,225.09,,,,,,,per diem,225.09,225.09,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,BCBS MGG,BCBS MGG,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Cigna,Cigna,225.09,,,,,,,per diem,225.09,225.09,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Cigna MGG,Cigna MGG,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Humana,Humana,225.09,,,,,,,per diem,225.09,225.09,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Humana MGG,Humana MGG,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Optum VA,Optum VA,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,UHC,UHC,225.09,,,,,,,per diem,225.09,225.09,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,UHC MGG,UHC MGG,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,VA,VA,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Wellcare MGG,Wellcare MGG,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Bright Health - commercial,Bright Health - commercial,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,225.09,225.09,Bright Health MGG,Bright Health MGG,225.09,,,,,,,case rate,225.09,225.09,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Aetna,Aetna,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Aetna MGG,Aetna MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,BCBS,BCBS,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,BCBS MGG,BCBS MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Cigna,Cigna,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Cigna MGG,Cigna MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Humana,Humana,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Humana MGG,Humana MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Optum VA,Optum VA,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,UHC,UHC,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,UHC MGG,UHC MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,VA,VA,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Wellcare MGG,Wellcare MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Bright Health - commercial,Bright Health - commercial,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,Bright Health MGG,Bright Health MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Aetna,Aetna,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Aetna MGG,Aetna MGG,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,BCBS,BCBS,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,BCBS MGG,BCBS MGG,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Cigna,Cigna,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Cigna MGG,Cigna MGG,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Humana,Humana,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Humana MGG,Humana MGG,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Optum VA,Optum VA,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,UHC,UHC,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,UHC MGG,UHC MGG,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,VA,VA,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Wellcare MGG,Wellcare MGG,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Bright Health - commercial,Bright Health - commercial,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,Bright Health MGG,Bright Health MGG,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Aetna,Aetna,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Aetna MGG,Aetna MGG,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,BCBS,BCBS,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,BCBS MGG,BCBS MGG,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Cigna,Cigna,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Cigna MGG,Cigna MGG,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Humana,Humana,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Humana MGG,Humana MGG,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Optum VA,Optum VA,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,UHC,UHC,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,UHC MGG,UHC MGG,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,VA,VA,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Wellcare MGG,Wellcare MGG,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Bright Health - commercial,Bright Health - commercial,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,14.9,14.9,Bright Health MGG,Bright Health MGG,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Aetna,Aetna,130.97,,,,,,,per diem,130.97,130.97,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Aetna MGG,Aetna MGG,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,BCBS,BCBS,130.97,,,,,,,per diem,130.97,130.97,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,BCBS MGG,BCBS MGG,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Cigna,Cigna,130.97,,,,,,,per diem,130.97,130.97,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Cigna MGG,Cigna MGG,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Humana,Humana,130.97,,,,,,,per diem,130.97,130.97,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Humana MGG,Humana MGG,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Optum VA,Optum VA,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,UHC,UHC,130.97,,,,,,,per diem,130.97,130.97,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,UHC MGG,UHC MGG,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,VA,VA,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Wellcare MGG,Wellcare MGG,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Bright Health - commercial,Bright Health - commercial,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,130.97,130.97,Bright Health MGG,Bright Health MGG,130.97,,,,,,,case rate,130.97,130.97,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Aetna,Aetna,169.98,,,,,,,per diem,169.98,169.98,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Aetna MGG,Aetna MGG,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,BCBS,BCBS,169.98,,,,,,,per diem,169.98,169.98,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,BCBS MGG,BCBS MGG,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Cigna,Cigna,169.98,,,,,,,per diem,169.98,169.98,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Cigna MGG,Cigna MGG,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Humana,Humana,169.98,,,,,,,per diem,169.98,169.98,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Humana MGG,Humana MGG,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Optum VA,Optum VA,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,UHC,UHC,169.98,,,,,,,per diem,169.98,169.98,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,UHC MGG,UHC MGG,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,VA,VA,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Wellcare MGG,Wellcare MGG,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Bright Health - commercial,Bright Health - commercial,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,169.98,169.98,Bright Health MGG,Bright Health MGG,169.98,,,,,,,case rate,169.98,169.98,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Aetna,Aetna,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Aetna MGG,Aetna MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,BCBS,BCBS,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,BCBS MGG,BCBS MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Cigna,Cigna,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Cigna MGG,Cigna MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Humana,Humana,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Humana MGG,Humana MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Optum VA,Optum VA,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,UHC,UHC,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,UHC MGG,UHC MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,VA,VA,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Wellcare MGG,Wellcare MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Bright Health - commercial,Bright Health - commercial,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,Bright Health MGG,Bright Health MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Aetna,Aetna,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Aetna MGG,Aetna MGG,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,BCBS,BCBS,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,BCBS MGG,BCBS MGG,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Cigna,Cigna,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Cigna MGG,Cigna MGG,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Humana,Humana,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Humana MGG,Humana MGG,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Optum VA,Optum VA,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,UHC,UHC,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,UHC MGG,UHC MGG,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,VA,VA,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Wellcare MGG,Wellcare MGG,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Bright Health - commercial,Bright Health - commercial,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,G0431,HCPCS,,,,Inpatient,,,351.75,351.75,Bright Health MGG,Bright Health MGG,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Aetna,Aetna,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Aetna MGG,Aetna MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,BCBS,BCBS,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,BCBS MGG,BCBS MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Cigna,Cigna,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Cigna MGG,Cigna MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Humana,Humana,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Humana MGG,Humana MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Optum VA,Optum VA,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,UHC,UHC,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,UHC MGG,UHC MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,VA,VA,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Wellcare MGG,Wellcare MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Bright Health - commercial,Bright Health - commercial,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,,,,,,Inpatient,,,69.44,69.44,Bright Health MGG,Bright Health MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Aetna,Aetna,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Aetna MGG,Aetna MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,BCBS,BCBS,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,BCBS MGG,BCBS MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Cigna,Cigna,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Cigna MGG,Cigna MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Humana,Humana,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Humana MGG,Humana MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Optum VA,Optum VA,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,UHC,UHC,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,UHC MGG,UHC MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,VA,VA,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Wellcare MGG,Wellcare MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Bright Health - commercial,Bright Health - commercial,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/CONFIRMATION    ,38201082,CDM,301,RC,,,,,,Inpatient,,,165.9,165.9,Bright Health MGG,Bright Health MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Aetna,Aetna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Aetna MGG,Aetna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,BCBS,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,BCBS MGG,BCBS MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Cigna,Cigna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Cigna MGG,Cigna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Humana,Humana,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Humana MGG,Humana MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Optum VA,Optum VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,UHC,UHC,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,UHC MGG,UHC MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,VA,VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Wellcare MGG,Wellcare MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Bright Health - commercial,Bright Health - commercial,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,,,,,,Inpatient,,,12.6,12.6,Bright Health MGG,Bright Health MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Aetna,Aetna,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Aetna MGG,Aetna MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,BCBS,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS MGG,BCBS MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Cigna,Cigna,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Cigna MGG,Cigna MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Humana,Humana,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Humana MGG,Humana MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Optum VA,Optum VA,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UHC,UHC,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UHC MGG,UHC MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,VA,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Wellcare MGG,Wellcare MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Bright Health - commercial,Bright Health - commercial,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,Bright Health MGG,Bright Health MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Aetna,Aetna,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Aetna MGG,Aetna MGG,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,BCBS,BCBS,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,BCBS MGG,BCBS MGG,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Cigna,Cigna,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Cigna MGG,Cigna MGG,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Humana,Humana,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Humana MGG,Humana MGG,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Optum VA,Optum VA,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,UHC,UHC,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,UHC MGG,UHC MGG,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,VA,VA,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Wellcare MGG,Wellcare MGG,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Bright Health - commercial,Bright Health - commercial,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,Bright Health MGG,Bright Health MGG,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Aetna,Aetna,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Aetna MGG,Aetna MGG,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,BCBS,BCBS,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,BCBS MGG,BCBS MGG,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Cigna,Cigna,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Cigna MGG,Cigna MGG,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Humana,Humana,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Humana MGG,Humana MGG,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Optum VA,Optum VA,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,UHC,UHC,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,UHC MGG,UHC MGG,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,VA,VA,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Wellcare MGG,Wellcare MGG,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Bright Health - commercial,Bright Health - commercial,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,Bright Health MGG,Bright Health MGG,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Aetna,Aetna,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Aetna MGG,Aetna MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,BCBS,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS MGG,BCBS MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Cigna,Cigna,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Cigna MGG,Cigna MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Humana,Humana,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Humana MGG,Humana MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Optum VA,Optum VA,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,UHC,UHC,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,UHC MGG,UHC MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,VA,VA,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Wellcare MGG,Wellcare MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Bright Health - commercial,Bright Health - commercial,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,Bright Health MGG,Bright Health MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Aetna,Aetna,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Aetna MGG,Aetna MGG,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,BCBS,BCBS,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,BCBS MGG,BCBS MGG,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Cigna,Cigna,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Cigna MGG,Cigna MGG,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Humana,Humana,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Humana MGG,Humana MGG,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Optum VA,Optum VA,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,UHC,UHC,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,UHC MGG,UHC MGG,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,VA,VA,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Wellcare MGG,Wellcare MGG,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Bright Health - commercial,Bright Health - commercial,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,Bright Health MGG,Bright Health MGG,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Aetna,Aetna,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Aetna MGG,Aetna MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,BCBS,BCBS,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,BCBS MGG,BCBS MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Cigna,Cigna,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Cigna MGG,Cigna MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Humana,Humana,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Humana MGG,Humana MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Optum VA,Optum VA,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,UHC,UHC,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,UHC MGG,UHC MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,VA,VA,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Wellcare MGG,Wellcare MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Bright Health - commercial,Bright Health - commercial,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,214.2,214.2,Bright Health MGG,Bright Health MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Aetna,Aetna,107.95,,,,,,,per diem,107.95,107.95,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Aetna MGG,Aetna MGG,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,BCBS,BCBS,107.95,,,,,,,per diem,107.95,107.95,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,BCBS MGG,BCBS MGG,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Cigna,Cigna,107.95,,,,,,,per diem,107.95,107.95,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Cigna MGG,Cigna MGG,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Humana,Humana,107.95,,,,,,,per diem,107.95,107.95,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Humana MGG,Humana MGG,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Optum VA,Optum VA,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,UHC,UHC,107.95,,,,,,,per diem,107.95,107.95,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,UHC MGG,UHC MGG,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,VA,VA,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Wellcare MGG,Wellcare MGG,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Bright Health - commercial,Bright Health - commercial,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,107.95,107.95,Bright Health MGG,Bright Health MGG,107.95,,,,,,,case rate,107.95,107.95,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Aetna,Aetna,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Aetna MGG,Aetna MGG,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,BCBS,BCBS,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,BCBS MGG,BCBS MGG,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Cigna,Cigna,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Cigna MGG,Cigna MGG,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Humana,Humana,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Humana MGG,Humana MGG,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Optum VA,Optum VA,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,UHC,UHC,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,UHC MGG,UHC MGG,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,VA,VA,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Wellcare MGG,Wellcare MGG,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Bright Health - commercial,Bright Health - commercial,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,Bright Health MGG,Bright Health MGG,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Aetna,Aetna,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Aetna MGG,Aetna MGG,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,BCBS,BCBS,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,BCBS MGG,BCBS MGG,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Cigna,Cigna,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Cigna MGG,Cigna MGG,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Humana,Humana,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Humana MGG,Humana MGG,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Optum VA,Optum VA,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,UHC,UHC,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,UHC MGG,UHC MGG,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,VA,VA,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Wellcare MGG,Wellcare MGG,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Bright Health - commercial,Bright Health - commercial,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,Bright Health MGG,Bright Health MGG,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Aetna,Aetna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Aetna MGG,Aetna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,BCBS,BCBS,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,BCBS MGG,BCBS MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Cigna,Cigna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Cigna MGG,Cigna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Humana,Humana,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Humana MGG,Humana MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Optum VA,Optum VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,UHC,UHC,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,UHC MGG,UHC MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,VA,VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Wellcare MGG,Wellcare MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Bright Health - commercial,Bright Health - commercial,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,Bright Health MGG,Bright Health MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Aetna,Aetna,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Aetna MGG,Aetna MGG,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,BCBS,BCBS,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,BCBS MGG,BCBS MGG,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Cigna,Cigna,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Cigna MGG,Cigna MGG,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Humana,Humana,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Humana MGG,Humana MGG,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Optum VA,Optum VA,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,UHC,UHC,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,UHC MGG,UHC MGG,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,VA,VA,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Wellcare MGG,Wellcare MGG,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Bright Health - commercial,Bright Health - commercial,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,Bright Health MGG,Bright Health MGG,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Aetna,Aetna,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Aetna MGG,Aetna MGG,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,BCBS,BCBS,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,BCBS MGG,BCBS MGG,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Cigna,Cigna,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Cigna MGG,Cigna MGG,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Humana,Humana,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Humana MGG,Humana MGG,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Optum VA,Optum VA,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,UHC,UHC,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,UHC MGG,UHC MGG,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,VA,VA,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Wellcare MGG,Wellcare MGG,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Bright Health - commercial,Bright Health - commercial,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,Bright Health MGG,Bright Health MGG,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Aetna,Aetna,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Aetna MGG,Aetna MGG,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,BCBS,BCBS,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,BCBS MGG,BCBS MGG,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Cigna,Cigna,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Cigna MGG,Cigna MGG,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Humana,Humana,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Humana MGG,Humana MGG,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Optum VA,Optum VA,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,UHC,UHC,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,UHC MGG,UHC MGG,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,VA,VA,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Wellcare MGG,Wellcare MGG,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Bright Health - commercial,Bright Health - commercial,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,Bright Health MGG,Bright Health MGG,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Aetna,Aetna,120.26,,,,,,,per diem,120.26,120.26,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Aetna MGG,Aetna MGG,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,BCBS,BCBS,120.26,,,,,,,per diem,120.26,120.26,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,BCBS MGG,BCBS MGG,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Cigna,Cigna,120.26,,,,,,,per diem,120.26,120.26,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Cigna MGG,Cigna MGG,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Humana,Humana,120.26,,,,,,,per diem,120.26,120.26,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Humana MGG,Humana MGG,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Optum VA,Optum VA,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,UHC,UHC,120.26,,,,,,,per diem,120.26,120.26,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,UHC MGG,UHC MGG,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,VA,VA,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Wellcare MGG,Wellcare MGG,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Bright Health - commercial,Bright Health - commercial,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,120.26,120.26,Bright Health MGG,Bright Health MGG,120.26,,,,,,,case rate,120.26,120.26,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Aetna,Aetna,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Aetna MGG,Aetna MGG,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,BCBS,BCBS,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,BCBS MGG,BCBS MGG,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Cigna,Cigna,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Cigna MGG,Cigna MGG,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Humana,Humana,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Humana MGG,Humana MGG,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Optum VA,Optum VA,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,UHC,UHC,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,UHC MGG,UHC MGG,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,VA,VA,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Wellcare MGG,Wellcare MGG,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Bright Health - commercial,Bright Health - commercial,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,Bright Health MGG,Bright Health MGG,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Aetna,Aetna,125.98,,,,,,,per diem,125.98,125.98,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Aetna MGG,Aetna MGG,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,BCBS,BCBS,125.98,,,,,,,per diem,125.98,125.98,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,BCBS MGG,BCBS MGG,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Cigna,Cigna,125.98,,,,,,,per diem,125.98,125.98,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Cigna MGG,Cigna MGG,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Humana,Humana,125.98,,,,,,,per diem,125.98,125.98,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Humana MGG,Humana MGG,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Optum VA,Optum VA,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,UHC,UHC,125.98,,,,,,,per diem,125.98,125.98,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,UHC MGG,UHC MGG,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,VA,VA,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Wellcare MGG,Wellcare MGG,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Bright Health - commercial,Bright Health - commercial,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,125.98,125.98,Bright Health MGG,Bright Health MGG,125.98,,,,,,,case rate,125.98,125.98,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Aetna,Aetna,144.28,,,,,,,per diem,144.28,144.28,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Aetna MGG,Aetna MGG,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,BCBS,BCBS,144.28,,,,,,,per diem,144.28,144.28,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,BCBS MGG,BCBS MGG,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Cigna,Cigna,144.28,,,,,,,per diem,144.28,144.28,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Cigna MGG,Cigna MGG,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Humana,Humana,144.28,,,,,,,per diem,144.28,144.28,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Humana MGG,Humana MGG,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Optum VA,Optum VA,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,UHC,UHC,144.28,,,,,,,per diem,144.28,144.28,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,UHC MGG,UHC MGG,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,VA,VA,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Wellcare MGG,Wellcare MGG,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Bright Health - commercial,Bright Health - commercial,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,144.28,144.28,Bright Health MGG,Bright Health MGG,144.28,,,,,,,case rate,144.28,144.28,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Aetna,Aetna,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Aetna MGG,Aetna MGG,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,BCBS,BCBS,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,BCBS MGG,BCBS MGG,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Cigna,Cigna,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Cigna MGG,Cigna MGG,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Humana,Humana,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Humana MGG,Humana MGG,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Optum VA,Optum VA,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,UHC,UHC,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,UHC MGG,UHC MGG,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,VA,VA,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Wellcare MGG,Wellcare MGG,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Bright Health - commercial,Bright Health - commercial,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,Bright Health MGG,Bright Health MGG,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Aetna,Aetna,104.71,,,,,,,per diem,104.71,104.71,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Aetna MGG,Aetna MGG,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,BCBS,BCBS,104.71,,,,,,,per diem,104.71,104.71,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,BCBS MGG,BCBS MGG,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Cigna,Cigna,104.71,,,,,,,per diem,104.71,104.71,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Cigna MGG,Cigna MGG,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Humana,Humana,104.71,,,,,,,per diem,104.71,104.71,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Humana MGG,Humana MGG,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Optum VA,Optum VA,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,UHC,UHC,104.71,,,,,,,per diem,104.71,104.71,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,UHC MGG,UHC MGG,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,VA,VA,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Wellcare MGG,Wellcare MGG,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Bright Health - commercial,Bright Health - commercial,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,104.71,104.71,Bright Health MGG,Bright Health MGG,104.71,,,,,,,case rate,104.71,104.71,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Aetna,Aetna,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Aetna MGG,Aetna MGG,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,BCBS,BCBS,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,BCBS MGG,BCBS MGG,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Cigna,Cigna,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Cigna MGG,Cigna MGG,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Humana,Humana,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Humana MGG,Humana MGG,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Optum VA,Optum VA,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,UHC,UHC,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,UHC MGG,UHC MGG,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,VA,VA,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Wellcare MGG,Wellcare MGG,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Bright Health - commercial,Bright Health - commercial,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,Bright Health MGG,Bright Health MGG,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Aetna,Aetna,213.65,,,,,,,per diem,213.65,213.65,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Aetna MGG,Aetna MGG,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,BCBS,BCBS,213.65,,,,,,,per diem,213.65,213.65,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,BCBS MGG,BCBS MGG,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Cigna,Cigna,213.65,,,,,,,per diem,213.65,213.65,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Cigna MGG,Cigna MGG,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Humana,Humana,213.65,,,,,,,per diem,213.65,213.65,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Humana MGG,Humana MGG,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Optum VA,Optum VA,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,UHC,UHC,213.65,,,,,,,per diem,213.65,213.65,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,UHC MGG,UHC MGG,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,VA,VA,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Wellcare MGG,Wellcare MGG,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Bright Health - commercial,Bright Health - commercial,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,213.65,213.65,Bright Health MGG,Bright Health MGG,213.65,,,,,,,case rate,213.65,213.65,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Aetna,Aetna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Aetna MGG,Aetna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,BCBS,BCBS,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,BCBS MGG,BCBS MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Cigna,Cigna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Cigna MGG,Cigna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Humana,Humana,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Humana MGG,Humana MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Optum VA,Optum VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,UHC,UHC,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,UHC MGG,UHC MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,VA,VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Wellcare MGG,Wellcare MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Bright Health - commercial,Bright Health - commercial,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,Bright Health MGG,Bright Health MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Aetna,Aetna,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Aetna MGG,Aetna MGG,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,BCBS,BCBS,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,BCBS MGG,BCBS MGG,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Cigna,Cigna,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Cigna MGG,Cigna MGG,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Humana,Humana,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Humana MGG,Humana MGG,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Optum VA,Optum VA,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,UHC,UHC,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,UHC MGG,UHC MGG,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,VA,VA,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Wellcare MGG,Wellcare MGG,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Bright Health - commercial,Bright Health - commercial,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,Bright Health MGG,Bright Health MGG,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Aetna,Aetna,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Aetna MGG,Aetna MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,BCBS,BCBS,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,BCBS MGG,BCBS MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Cigna,Cigna,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Cigna MGG,Cigna MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Humana,Humana,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Humana MGG,Humana MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Optum VA,Optum VA,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,UHC,UHC,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,UHC MGG,UHC MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,VA,VA,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Wellcare MGG,Wellcare MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Bright Health - commercial,Bright Health - commercial,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,Bright Health MGG,Bright Health MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Aetna,Aetna,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Aetna MGG,Aetna MGG,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,BCBS,BCBS,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,BCBS MGG,BCBS MGG,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Cigna,Cigna,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Cigna MGG,Cigna MGG,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Humana,Humana,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Humana MGG,Humana MGG,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Optum VA,Optum VA,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,UHC,UHC,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,UHC MGG,UHC MGG,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,VA,VA,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Wellcare MGG,Wellcare MGG,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Bright Health - commercial,Bright Health - commercial,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,Bright Health MGG,Bright Health MGG,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Aetna,Aetna,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Aetna MGG,Aetna MGG,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,BCBS,BCBS,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,BCBS MGG,BCBS MGG,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Cigna,Cigna,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Cigna MGG,Cigna MGG,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Humana,Humana,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Humana MGG,Humana MGG,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Optum VA,Optum VA,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,UHC,UHC,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,UHC MGG,UHC MGG,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,VA,VA,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Wellcare MGG,Wellcare MGG,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Bright Health - commercial,Bright Health - commercial,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,Bright Health MGG,Bright Health MGG,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Aetna,Aetna,106.54,,,,,,,per diem,106.54,106.54,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Aetna MGG,Aetna MGG,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,BCBS,BCBS,106.54,,,,,,,per diem,106.54,106.54,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,BCBS MGG,BCBS MGG,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Cigna,Cigna,106.54,,,,,,,per diem,106.54,106.54,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Cigna MGG,Cigna MGG,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Humana,Humana,106.54,,,,,,,per diem,106.54,106.54,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Humana MGG,Humana MGG,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Optum VA,Optum VA,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,UHC,UHC,106.54,,,,,,,per diem,106.54,106.54,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,UHC MGG,UHC MGG,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,VA,VA,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Wellcare MGG,Wellcare MGG,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Bright Health - commercial,Bright Health - commercial,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,106.54,106.54,Bright Health MGG,Bright Health MGG,106.54,,,,,,,case rate,106.54,106.54,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Aetna,Aetna,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Aetna MGG,Aetna MGG,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,BCBS,BCBS,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,BCBS MGG,BCBS MGG,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Cigna,Cigna,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Cigna MGG,Cigna MGG,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Humana,Humana,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Humana MGG,Humana MGG,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Optum VA,Optum VA,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,UHC,UHC,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,UHC MGG,UHC MGG,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,VA,VA,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Wellcare MGG,Wellcare MGG,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Bright Health - commercial,Bright Health - commercial,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,Bright Health MGG,Bright Health MGG,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Aetna,Aetna,92.07,,,,,,,per diem,92.07,92.07,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Aetna MGG,Aetna MGG,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,BCBS,BCBS,92.07,,,,,,,per diem,92.07,92.07,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,BCBS MGG,BCBS MGG,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Cigna,Cigna,92.07,,,,,,,per diem,92.07,92.07,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Cigna MGG,Cigna MGG,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Humana,Humana,92.07,,,,,,,per diem,92.07,92.07,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Humana MGG,Humana MGG,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Optum VA,Optum VA,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,UHC,UHC,92.07,,,,,,,per diem,92.07,92.07,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,UHC MGG,UHC MGG,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,VA,VA,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Wellcare MGG,Wellcare MGG,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Bright Health - commercial,Bright Health - commercial,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,92.07,92.07,Bright Health MGG,Bright Health MGG,92.07,,,,,,,case rate,92.07,92.07,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Aetna,Aetna,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Aetna MGG,Aetna MGG,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,BCBS,BCBS,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,BCBS MGG,BCBS MGG,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Cigna,Cigna,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Cigna MGG,Cigna MGG,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Humana,Humana,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Humana MGG,Humana MGG,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Optum VA,Optum VA,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,UHC,UHC,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,UHC MGG,UHC MGG,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,VA,VA,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Wellcare MGG,Wellcare MGG,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Bright Health - commercial,Bright Health - commercial,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,Bright Health MGG,Bright Health MGG,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Aetna,Aetna,168.36,,,,,,,per diem,168.36,168.36,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Aetna MGG,Aetna MGG,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,BCBS,BCBS,168.36,,,,,,,per diem,168.36,168.36,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,BCBS MGG,BCBS MGG,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Cigna,Cigna,168.36,,,,,,,per diem,168.36,168.36,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Cigna MGG,Cigna MGG,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Humana,Humana,168.36,,,,,,,per diem,168.36,168.36,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Humana MGG,Humana MGG,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Optum VA,Optum VA,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,UHC,UHC,168.36,,,,,,,per diem,168.36,168.36,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,UHC MGG,UHC MGG,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,VA,VA,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Wellcare MGG,Wellcare MGG,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Bright Health - commercial,Bright Health - commercial,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,168.36,168.36,Bright Health MGG,Bright Health MGG,168.36,,,,,,,case rate,168.36,168.36,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Aetna,Aetna,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Aetna MGG,Aetna MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,BCBS,BCBS,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,BCBS MGG,BCBS MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Cigna,Cigna,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Cigna MGG,Cigna MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Humana,Humana,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Humana MGG,Humana MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Optum VA,Optum VA,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,UHC,UHC,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,UHC MGG,UHC MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,VA,VA,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Wellcare MGG,Wellcare MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Bright Health - commercial,Bright Health - commercial,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,Bright Health MGG,Bright Health MGG,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Aetna,Aetna,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Aetna MGG,Aetna MGG,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,BCBS,BCBS,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,BCBS MGG,BCBS MGG,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Cigna,Cigna,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Cigna MGG,Cigna MGG,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Humana,Humana,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Humana MGG,Humana MGG,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Optum VA,Optum VA,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,UHC,UHC,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,UHC MGG,UHC MGG,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,VA,VA,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Wellcare MGG,Wellcare MGG,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Bright Health - commercial,Bright Health - commercial,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,Bright Health MGG,Bright Health MGG,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Aetna,Aetna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Aetna MGG,Aetna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,BCBS,BCBS,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,BCBS MGG,BCBS MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Cigna,Cigna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Cigna MGG,Cigna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Humana,Humana,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Humana MGG,Humana MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Optum VA,Optum VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,UHC,UHC,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,UHC MGG,UHC MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,VA,VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Wellcare MGG,Wellcare MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Bright Health - commercial,Bright Health - commercial,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,7.47,7.47,Bright Health MGG,Bright Health MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Aetna,Aetna,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Aetna MGG,Aetna MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,BCBS,BCBS,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,BCBS MGG,BCBS MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Cigna,Cigna,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Cigna MGG,Cigna MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Humana,Humana,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Humana MGG,Humana MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Optum VA,Optum VA,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,UHC,UHC,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,UHC MGG,UHC MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,VA,VA,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Wellcare MGG,Wellcare MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Bright Health - commercial,Bright Health - commercial,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,Bright Health MGG,Bright Health MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Aetna,Aetna,58.43,,,,,,,per diem,58.43,58.43,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Aetna MGG,Aetna MGG,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,BCBS,BCBS,58.43,,,,,,,per diem,58.43,58.43,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,BCBS MGG,BCBS MGG,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Cigna,Cigna,58.43,,,,,,,per diem,58.43,58.43,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Cigna MGG,Cigna MGG,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Humana,Humana,58.43,,,,,,,per diem,58.43,58.43,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Humana MGG,Humana MGG,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Optum VA,Optum VA,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,UHC,UHC,58.43,,,,,,,per diem,58.43,58.43,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,UHC MGG,UHC MGG,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,VA,VA,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Wellcare MGG,Wellcare MGG,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Bright Health - commercial,Bright Health - commercial,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,58.43,58.43,Bright Health MGG,Bright Health MGG,58.43,,,,,,,case rate,58.43,58.43,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Aetna,Aetna,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Aetna MGG,Aetna MGG,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,BCBS,BCBS,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,BCBS MGG,BCBS MGG,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Cigna,Cigna,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Cigna MGG,Cigna MGG,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Humana,Humana,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Humana MGG,Humana MGG,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Optum VA,Optum VA,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,UHC,UHC,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,UHC MGG,UHC MGG,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,VA,VA,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Wellcare MGG,Wellcare MGG,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Bright Health - commercial,Bright Health - commercial,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,Bright Health MGG,Bright Health MGG,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Aetna,Aetna,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Aetna MGG,Aetna MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,BCBS,BCBS,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,BCBS MGG,BCBS MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Cigna,Cigna,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Cigna MGG,Cigna MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Humana,Humana,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Humana MGG,Humana MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Optum VA,Optum VA,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,UHC,UHC,97.85,,,,,,,per diem,97.85,97.85,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,UHC MGG,UHC MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,VA,VA,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Wellcare MGG,Wellcare MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Bright Health - commercial,Bright Health - commercial,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,97.85,97.85,Bright Health MGG,Bright Health MGG,97.85,,,,,,,case rate,97.85,97.85,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Aetna,Aetna,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Aetna MGG,Aetna MGG,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,BCBS,BCBS,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,BCBS MGG,BCBS MGG,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Cigna,Cigna,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Cigna MGG,Cigna MGG,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Humana,Humana,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Humana MGG,Humana MGG,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Optum VA,Optum VA,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,UHC,UHC,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,UHC MGG,UHC MGG,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,VA,VA,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Wellcare MGG,Wellcare MGG,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Bright Health - commercial,Bright Health - commercial,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,Bright Health MGG,Bright Health MGG,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Aetna,Aetna,115.49,,,,,,,per diem,115.49,115.49,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Aetna MGG,Aetna MGG,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,BCBS,BCBS,115.49,,,,,,,per diem,115.49,115.49,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,BCBS MGG,BCBS MGG,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Cigna,Cigna,115.49,,,,,,,per diem,115.49,115.49,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Cigna MGG,Cigna MGG,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Humana,Humana,115.49,,,,,,,per diem,115.49,115.49,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Humana MGG,Humana MGG,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Optum VA,Optum VA,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,UHC,UHC,115.49,,,,,,,per diem,115.49,115.49,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,UHC MGG,UHC MGG,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,VA,VA,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Wellcare MGG,Wellcare MGG,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Bright Health - commercial,Bright Health - commercial,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,115.49,115.49,Bright Health MGG,Bright Health MGG,115.49,,,,,,,case rate,115.49,115.49,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Aetna,Aetna,153.8,,,,,,,per diem,153.8,153.8,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Aetna MGG,Aetna MGG,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,BCBS,BCBS,153.8,,,,,,,per diem,153.8,153.8,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,BCBS MGG,BCBS MGG,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Cigna,Cigna,153.8,,,,,,,per diem,153.8,153.8,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Cigna MGG,Cigna MGG,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Humana,Humana,153.8,,,,,,,per diem,153.8,153.8,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Humana MGG,Humana MGG,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Optum VA,Optum VA,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,UHC,UHC,153.8,,,,,,,per diem,153.8,153.8,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,UHC MGG,UHC MGG,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,VA,VA,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Wellcare MGG,Wellcare MGG,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Bright Health - commercial,Bright Health - commercial,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,153.8,153.8,Bright Health MGG,Bright Health MGG,153.8,,,,,,,case rate,153.8,153.8,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Aetna,Aetna,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Aetna MGG,Aetna MGG,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,BCBS,BCBS,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,BCBS MGG,BCBS MGG,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Cigna,Cigna,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Cigna MGG,Cigna MGG,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Humana,Humana,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Humana MGG,Humana MGG,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Optum VA,Optum VA,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,UHC,UHC,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,UHC MGG,UHC MGG,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,VA,VA,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Wellcare MGG,Wellcare MGG,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Bright Health - commercial,Bright Health - commercial,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,13.45,13.45,Bright Health MGG,Bright Health MGG,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Aetna,Aetna,109.41,,,,,,,per diem,109.41,109.41,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Aetna MGG,Aetna MGG,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,BCBS,BCBS,109.41,,,,,,,per diem,109.41,109.41,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,BCBS MGG,BCBS MGG,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Cigna,Cigna,109.41,,,,,,,per diem,109.41,109.41,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Cigna MGG,Cigna MGG,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Humana,Humana,109.41,,,,,,,per diem,109.41,109.41,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Humana MGG,Humana MGG,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Optum VA,Optum VA,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,UHC,UHC,109.41,,,,,,,per diem,109.41,109.41,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,UHC MGG,UHC MGG,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,VA,VA,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Wellcare MGG,Wellcare MGG,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Bright Health - commercial,Bright Health - commercial,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,109.41,109.41,Bright Health MGG,Bright Health MGG,109.41,,,,,,,case rate,109.41,109.41,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Aetna,Aetna,133.79,,,,,,,per diem,133.79,133.79,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Aetna MGG,Aetna MGG,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,BCBS,BCBS,133.79,,,,,,,per diem,133.79,133.79,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,BCBS MGG,BCBS MGG,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Cigna,Cigna,133.79,,,,,,,per diem,133.79,133.79,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Cigna MGG,Cigna MGG,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Humana,Humana,133.79,,,,,,,per diem,133.79,133.79,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Humana MGG,Humana MGG,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Optum VA,Optum VA,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,UHC,UHC,133.79,,,,,,,per diem,133.79,133.79,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,UHC MGG,UHC MGG,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,VA,VA,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Wellcare MGG,Wellcare MGG,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Bright Health - commercial,Bright Health - commercial,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,133.79,133.79,Bright Health MGG,Bright Health MGG,133.79,,,,,,,case rate,133.79,133.79,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Aetna,Aetna,153.66,,,,,,,per diem,153.66,153.66,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Aetna MGG,Aetna MGG,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,BCBS,BCBS,153.66,,,,,,,per diem,153.66,153.66,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,BCBS MGG,BCBS MGG,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Cigna,Cigna,153.66,,,,,,,per diem,153.66,153.66,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Cigna MGG,Cigna MGG,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Humana,Humana,153.66,,,,,,,per diem,153.66,153.66,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Humana MGG,Humana MGG,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Optum VA,Optum VA,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,UHC,UHC,153.66,,,,,,,per diem,153.66,153.66,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,UHC MGG,UHC MGG,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,VA,VA,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Wellcare MGG,Wellcare MGG,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Bright Health - commercial,Bright Health - commercial,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,153.66,153.66,Bright Health MGG,Bright Health MGG,153.66,,,,,,,case rate,153.66,153.66,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Aetna,Aetna,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Aetna MGG,Aetna MGG,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,BCBS,BCBS,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,BCBS MGG,BCBS MGG,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Cigna,Cigna,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Cigna MGG,Cigna MGG,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Humana,Humana,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Humana MGG,Humana MGG,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Optum VA,Optum VA,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,UHC,UHC,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,UHC MGG,UHC MGG,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,VA,VA,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Wellcare MGG,Wellcare MGG,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Bright Health - commercial,Bright Health - commercial,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,Bright Health MGG,Bright Health MGG,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Aetna,Aetna,165.09,,,,,,,per diem,165.09,165.09,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Aetna MGG,Aetna MGG,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,BCBS,BCBS,165.09,,,,,,,per diem,165.09,165.09,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,BCBS MGG,BCBS MGG,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Cigna,Cigna,165.09,,,,,,,per diem,165.09,165.09,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Cigna MGG,Cigna MGG,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Humana,Humana,165.09,,,,,,,per diem,165.09,165.09,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Humana MGG,Humana MGG,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Optum VA,Optum VA,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,UHC,UHC,165.09,,,,,,,per diem,165.09,165.09,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,UHC MGG,UHC MGG,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,VA,VA,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Wellcare MGG,Wellcare MGG,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Bright Health - commercial,Bright Health - commercial,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,165.09,165.09,Bright Health MGG,Bright Health MGG,165.09,,,,,,,case rate,165.09,165.09,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Aetna,Aetna,441.08,,,,,,,per diem,441.08,441.08,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Aetna MGG,Aetna MGG,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,BCBS,BCBS,441.08,,,,,,,per diem,441.08,441.08,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,BCBS MGG,BCBS MGG,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Cigna,Cigna,441.08,,,,,,,per diem,441.08,441.08,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Cigna MGG,Cigna MGG,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Humana,Humana,441.08,,,,,,,per diem,441.08,441.08,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Humana MGG,Humana MGG,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Optum VA,Optum VA,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,UHC,UHC,441.08,,,,,,,per diem,441.08,441.08,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,UHC MGG,UHC MGG,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,VA,VA,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Wellcare MGG,Wellcare MGG,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Bright Health - commercial,Bright Health - commercial,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,441.08,441.08,Bright Health MGG,Bright Health MGG,441.08,,,,,,,case rate,441.08,441.08,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Aetna,Aetna,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Aetna MGG,Aetna MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,BCBS,BCBS,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,BCBS MGG,BCBS MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Cigna,Cigna,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Cigna MGG,Cigna MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Humana,Humana,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Humana MGG,Humana MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Optum VA,Optum VA,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,UHC,UHC,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,UHC MGG,UHC MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,VA,VA,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Wellcare MGG,Wellcare MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Bright Health - commercial,Bright Health - commercial,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,Bright Health MGG,Bright Health MGG,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Aetna,Aetna,327.06,,,,,,,per diem,327.06,327.06,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Aetna MGG,Aetna MGG,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,BCBS,BCBS,327.06,,,,,,,per diem,327.06,327.06,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,BCBS MGG,BCBS MGG,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Cigna,Cigna,327.06,,,,,,,per diem,327.06,327.06,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Cigna MGG,Cigna MGG,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Humana,Humana,327.06,,,,,,,per diem,327.06,327.06,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Humana MGG,Humana MGG,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Optum VA,Optum VA,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,UHC,UHC,327.06,,,,,,,per diem,327.06,327.06,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,UHC MGG,UHC MGG,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,VA,VA,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Wellcare MGG,Wellcare MGG,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Bright Health - commercial,Bright Health - commercial,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,327.06,327.06,Bright Health MGG,Bright Health MGG,327.06,,,,,,,case rate,327.06,327.06,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Aetna,Aetna,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Aetna MGG,Aetna MGG,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,BCBS,BCBS,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,BCBS MGG,BCBS MGG,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Cigna,Cigna,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Cigna MGG,Cigna MGG,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Humana,Humana,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Humana MGG,Humana MGG,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Optum VA,Optum VA,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,UHC,UHC,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,UHC MGG,UHC MGG,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,VA,VA,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Wellcare MGG,Wellcare MGG,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Bright Health - commercial,Bright Health - commercial,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,Bright Health MGG,Bright Health MGG,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Aetna,Aetna,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Aetna MGG,Aetna MGG,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,BCBS,BCBS,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,BCBS MGG,BCBS MGG,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Cigna,Cigna,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Cigna MGG,Cigna MGG,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Humana,Humana,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Humana MGG,Humana MGG,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Optum VA,Optum VA,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,UHC,UHC,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,UHC MGG,UHC MGG,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,VA,VA,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Wellcare MGG,Wellcare MGG,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Bright Health - commercial,Bright Health - commercial,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,Bright Health MGG,Bright Health MGG,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Aetna,Aetna,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Aetna MGG,Aetna MGG,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,BCBS,BCBS,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,BCBS MGG,BCBS MGG,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Cigna,Cigna,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Cigna MGG,Cigna MGG,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Humana,Humana,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Humana MGG,Humana MGG,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Optum VA,Optum VA,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,UHC,UHC,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,UHC MGG,UHC MGG,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,VA,VA,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Wellcare MGG,Wellcare MGG,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Bright Health - commercial,Bright Health - commercial,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,Bright Health MGG,Bright Health MGG,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Aetna,Aetna,381.54,,,,,,,per diem,381.54,381.54,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Aetna MGG,Aetna MGG,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,BCBS,BCBS,381.54,,,,,,,per diem,381.54,381.54,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,BCBS MGG,BCBS MGG,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Cigna,Cigna,381.54,,,,,,,per diem,381.54,381.54,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Cigna MGG,Cigna MGG,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Humana,Humana,381.54,,,,,,,per diem,381.54,381.54,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Humana MGG,Humana MGG,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Optum VA,Optum VA,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,UHC,UHC,381.54,,,,,,,per diem,381.54,381.54,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,UHC MGG,UHC MGG,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,VA,VA,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Wellcare MGG,Wellcare MGG,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Bright Health - commercial,Bright Health - commercial,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,381.54,381.54,Bright Health MGG,Bright Health MGG,381.54,,,,,,,case rate,381.54,381.54,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Aetna,Aetna,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Aetna MGG,Aetna MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,BCBS,BCBS,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,BCBS MGG,BCBS MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Cigna,Cigna,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Cigna MGG,Cigna MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Humana,Humana,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Humana MGG,Humana MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Optum VA,Optum VA,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,UHC,UHC,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,UHC MGG,UHC MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,VA,VA,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Wellcare MGG,Wellcare MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Bright Health - commercial,Bright Health - commercial,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,Bright Health MGG,Bright Health MGG,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Aetna,Aetna,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Aetna MGG,Aetna MGG,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,BCBS,BCBS,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,BCBS MGG,BCBS MGG,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Cigna,Cigna,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Cigna MGG,Cigna MGG,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Humana,Humana,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Humana MGG,Humana MGG,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Optum VA,Optum VA,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,UHC,UHC,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,UHC MGG,UHC MGG,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,VA,VA,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Wellcare MGG,Wellcare MGG,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Bright Health - commercial,Bright Health - commercial,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
IMMUNOELEC FLUIDS             ,38201571,CDM,302,RC,86325,CPT,,,,Inpatient,,,309.75,309.75,Bright Health MGG,Bright Health MGG,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Aetna,Aetna,44.45,,,,,,,per diem,44.45,44.45,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Aetna MGG,Aetna MGG,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,BCBS,BCBS,44.45,,,,,,,per diem,44.45,44.45,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,BCBS MGG,BCBS MGG,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Cigna,Cigna,44.45,,,,,,,per diem,44.45,44.45,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Cigna MGG,Cigna MGG,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Humana,Humana,44.45,,,,,,,per diem,44.45,44.45,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Humana MGG,Humana MGG,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Optum VA,Optum VA,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,UHC,UHC,44.45,,,,,,,per diem,44.45,44.45,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,UHC MGG,UHC MGG,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,VA,VA,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Wellcare MGG,Wellcare MGG,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Bright Health - commercial,Bright Health - commercial,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,44.45,44.45,Bright Health MGG,Bright Health MGG,44.45,,,,,,,case rate,44.45,44.45,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Aetna,Aetna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Aetna MGG,Aetna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,BCBS,BCBS,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,BCBS MGG,BCBS MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Cigna,Cigna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Cigna MGG,Cigna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Humana,Humana,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Humana MGG,Humana MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Optum VA,Optum VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,UHC,UHC,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,UHC MGG,UHC MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,VA,VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Wellcare MGG,Wellcare MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Bright Health - commercial,Bright Health - commercial,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,Bright Health MGG,Bright Health MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Aetna,Aetna,83.32,,,,,,,per diem,83.32,83.32,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Aetna MGG,Aetna MGG,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,BCBS,BCBS,83.32,,,,,,,per diem,83.32,83.32,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,BCBS MGG,BCBS MGG,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Cigna,Cigna,83.32,,,,,,,per diem,83.32,83.32,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Cigna MGG,Cigna MGG,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Humana,Humana,83.32,,,,,,,per diem,83.32,83.32,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Humana MGG,Humana MGG,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Optum VA,Optum VA,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,UHC,UHC,83.32,,,,,,,per diem,83.32,83.32,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,UHC MGG,UHC MGG,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,VA,VA,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Wellcare MGG,Wellcare MGG,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Bright Health - commercial,Bright Health - commercial,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,83.32,83.32,Bright Health MGG,Bright Health MGG,83.32,,,,,,,case rate,83.32,83.32,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Aetna,Aetna,116.06,,,,,,,per diem,116.06,116.06,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Aetna MGG,Aetna MGG,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,BCBS,BCBS,116.06,,,,,,,per diem,116.06,116.06,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,BCBS MGG,BCBS MGG,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Cigna,Cigna,116.06,,,,,,,per diem,116.06,116.06,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Cigna MGG,Cigna MGG,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Humana,Humana,116.06,,,,,,,per diem,116.06,116.06,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Humana MGG,Humana MGG,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Optum VA,Optum VA,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,UHC,UHC,116.06,,,,,,,per diem,116.06,116.06,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,UHC MGG,UHC MGG,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,VA,VA,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Wellcare MGG,Wellcare MGG,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Bright Health - commercial,Bright Health - commercial,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,116.06,116.06,Bright Health MGG,Bright Health MGG,116.06,,,,,,,case rate,116.06,116.06,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Aetna,Aetna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Aetna MGG,Aetna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,BCBS,BCBS,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,BCBS MGG,BCBS MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Cigna,Cigna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Cigna MGG,Cigna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Humana,Humana,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Humana MGG,Humana MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Optum VA,Optum VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,UHC,UHC,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,UHC MGG,UHC MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,VA,VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Wellcare MGG,Wellcare MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Bright Health - commercial,Bright Health - commercial,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,Bright Health MGG,Bright Health MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Aetna,Aetna,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Aetna MGG,Aetna MGG,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,BCBS,BCBS,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,BCBS MGG,BCBS MGG,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Cigna,Cigna,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Cigna MGG,Cigna MGG,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Humana,Humana,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Humana MGG,Humana MGG,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Optum VA,Optum VA,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,UHC,UHC,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,UHC MGG,UHC MGG,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,VA,VA,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Wellcare MGG,Wellcare MGG,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Bright Health - commercial,Bright Health - commercial,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,Bright Health MGG,Bright Health MGG,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Aetna,Aetna,47.79,,,,,,,per diem,47.79,47.79,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Aetna MGG,Aetna MGG,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,BCBS,BCBS,47.79,,,,,,,per diem,47.79,47.79,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,BCBS MGG,BCBS MGG,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Cigna,Cigna,47.79,,,,,,,per diem,47.79,47.79,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Cigna MGG,Cigna MGG,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Humana,Humana,47.79,,,,,,,per diem,47.79,47.79,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Humana MGG,Humana MGG,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Optum VA,Optum VA,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,UHC,UHC,47.79,,,,,,,per diem,47.79,47.79,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,UHC MGG,UHC MGG,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,VA,VA,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Wellcare MGG,Wellcare MGG,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Bright Health - commercial,Bright Health - commercial,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,47.79,47.79,Bright Health MGG,Bright Health MGG,47.79,,,,,,,case rate,47.79,47.79,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Aetna,Aetna,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Aetna MGG,Aetna MGG,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,BCBS,BCBS,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,BCBS MGG,BCBS MGG,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Cigna,Cigna,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Cigna MGG,Cigna MGG,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Humana,Humana,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Humana MGG,Humana MGG,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Optum VA,Optum VA,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,UHC,UHC,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,UHC MGG,UHC MGG,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,VA,VA,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Wellcare MGG,Wellcare MGG,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Bright Health - commercial,Bright Health - commercial,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,Bright Health MGG,Bright Health MGG,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Aetna,Aetna,188.81,,,,,,,per diem,188.81,188.81,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Aetna MGG,Aetna MGG,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,BCBS,BCBS,188.81,,,,,,,per diem,188.81,188.81,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,BCBS MGG,BCBS MGG,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Cigna,Cigna,188.81,,,,,,,per diem,188.81,188.81,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Cigna MGG,Cigna MGG,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Humana,Humana,188.81,,,,,,,per diem,188.81,188.81,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Humana MGG,Humana MGG,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Optum VA,Optum VA,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,UHC,UHC,188.81,,,,,,,per diem,188.81,188.81,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,UHC MGG,UHC MGG,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,VA,VA,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Wellcare MGG,Wellcare MGG,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Bright Health - commercial,Bright Health - commercial,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,188.81,188.81,Bright Health MGG,Bright Health MGG,188.81,,,,,,,case rate,188.81,188.81,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Aetna,Aetna,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Aetna MGG,Aetna MGG,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,BCBS,BCBS,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,BCBS MGG,BCBS MGG,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Cigna,Cigna,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Cigna MGG,Cigna MGG,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Humana,Humana,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Humana MGG,Humana MGG,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Optum VA,Optum VA,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,UHC,UHC,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,UHC MGG,UHC MGG,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,VA,VA,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Wellcare MGG,Wellcare MGG,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Bright Health - commercial,Bright Health - commercial,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,Bright Health MGG,Bright Health MGG,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Aetna,Aetna,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Aetna MGG,Aetna MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,BCBS,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS MGG,BCBS MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Cigna,Cigna,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Cigna MGG,Cigna MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Humana,Humana,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Humana MGG,Humana MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Optum VA,Optum VA,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,UHC,UHC,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,UHC MGG,UHC MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,VA,VA,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Wellcare MGG,Wellcare MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Bright Health - commercial,Bright Health - commercial,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Bright Health MGG,Bright Health MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Aetna,Aetna,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Aetna MGG,Aetna MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,BCBS,BCBS,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,BCBS MGG,BCBS MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Cigna,Cigna,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Cigna MGG,Cigna MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Humana,Humana,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Humana MGG,Humana MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Optum VA,Optum VA,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,UHC,UHC,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,UHC MGG,UHC MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,VA,VA,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Wellcare MGG,Wellcare MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Bright Health - commercial,Bright Health - commercial,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,Bright Health MGG,Bright Health MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Aetna,Aetna,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Aetna MGG,Aetna MGG,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,BCBS,BCBS,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,BCBS MGG,BCBS MGG,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Cigna,Cigna,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Cigna MGG,Cigna MGG,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Humana,Humana,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Humana MGG,Humana MGG,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Optum VA,Optum VA,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,UHC,UHC,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,UHC MGG,UHC MGG,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,VA,VA,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Wellcare MGG,Wellcare MGG,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Bright Health - commercial,Bright Health - commercial,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,Bright Health MGG,Bright Health MGG,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Aetna,Aetna,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Aetna MGG,Aetna MGG,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,BCBS,BCBS,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,BCBS MGG,BCBS MGG,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Cigna,Cigna,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Cigna MGG,Cigna MGG,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Humana,Humana,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Humana MGG,Humana MGG,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Optum VA,Optum VA,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,UHC,UHC,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,UHC MGG,UHC MGG,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,VA,VA,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Wellcare MGG,Wellcare MGG,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Bright Health - commercial,Bright Health - commercial,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,Bright Health MGG,Bright Health MGG,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Aetna,Aetna,374.73,,,,,,,per diem,374.73,374.73,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Aetna MGG,Aetna MGG,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,BCBS,BCBS,374.73,,,,,,,per diem,374.73,374.73,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,BCBS MGG,BCBS MGG,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Cigna,Cigna,374.73,,,,,,,per diem,374.73,374.73,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Cigna MGG,Cigna MGG,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Humana,Humana,374.73,,,,,,,per diem,374.73,374.73,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Humana MGG,Humana MGG,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Optum VA,Optum VA,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,UHC,UHC,374.73,,,,,,,per diem,374.73,374.73,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,UHC MGG,UHC MGG,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,VA,VA,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Wellcare MGG,Wellcare MGG,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Bright Health - commercial,Bright Health - commercial,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,374.73,374.73,Bright Health MGG,Bright Health MGG,374.73,,,,,,,case rate,374.73,374.73,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Aetna,Aetna,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Aetna MGG,Aetna MGG,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,BCBS,BCBS,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,BCBS MGG,BCBS MGG,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Cigna,Cigna,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Cigna MGG,Cigna MGG,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Humana,Humana,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Humana MGG,Humana MGG,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Optum VA,Optum VA,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,UHC,UHC,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,UHC MGG,UHC MGG,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,VA,VA,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Wellcare MGG,Wellcare MGG,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Bright Health - commercial,Bright Health - commercial,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,Bright Health MGG,Bright Health MGG,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Aetna,Aetna,124.52,,,,,,,per diem,124.52,124.52,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Aetna MGG,Aetna MGG,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,BCBS,BCBS,124.52,,,,,,,per diem,124.52,124.52,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,BCBS MGG,BCBS MGG,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Cigna,Cigna,124.52,,,,,,,per diem,124.52,124.52,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Cigna MGG,Cigna MGG,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Humana,Humana,124.52,,,,,,,per diem,124.52,124.52,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Humana MGG,Humana MGG,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Optum VA,Optum VA,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,UHC,UHC,124.52,,,,,,,per diem,124.52,124.52,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,UHC MGG,UHC MGG,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,VA,VA,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Wellcare MGG,Wellcare MGG,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Bright Health - commercial,Bright Health - commercial,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,124.52,124.52,Bright Health MGG,Bright Health MGG,124.52,,,,,,,case rate,124.52,124.52,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Aetna,Aetna,206.62,,,,,,,per diem,206.62,206.62,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Aetna MGG,Aetna MGG,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,BCBS,BCBS,206.62,,,,,,,per diem,206.62,206.62,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,BCBS MGG,BCBS MGG,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Cigna,Cigna,206.62,,,,,,,per diem,206.62,206.62,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Cigna MGG,Cigna MGG,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Humana,Humana,206.62,,,,,,,per diem,206.62,206.62,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Humana MGG,Humana MGG,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Optum VA,Optum VA,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,UHC,UHC,206.62,,,,,,,per diem,206.62,206.62,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,UHC MGG,UHC MGG,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,VA,VA,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Wellcare MGG,Wellcare MGG,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Bright Health - commercial,Bright Health - commercial,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,206.62,206.62,Bright Health MGG,Bright Health MGG,206.62,,,,,,,case rate,206.62,206.62,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Aetna,Aetna,171.7,,,,,,,per diem,171.7,171.7,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Aetna MGG,Aetna MGG,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,BCBS,BCBS,171.7,,,,,,,per diem,171.7,171.7,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,BCBS MGG,BCBS MGG,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Cigna,Cigna,171.7,,,,,,,per diem,171.7,171.7,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Cigna MGG,Cigna MGG,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Humana,Humana,171.7,,,,,,,per diem,171.7,171.7,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Humana MGG,Humana MGG,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Optum VA,Optum VA,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,UHC,UHC,171.7,,,,,,,per diem,171.7,171.7,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,UHC MGG,UHC MGG,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,VA,VA,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Wellcare MGG,Wellcare MGG,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Bright Health - commercial,Bright Health - commercial,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,171.7,171.7,Bright Health MGG,Bright Health MGG,171.7,,,,,,,case rate,171.7,171.7,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Aetna,Aetna,156.96,,,,,,,per diem,156.96,156.96,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Aetna MGG,Aetna MGG,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,BCBS,BCBS,156.96,,,,,,,per diem,156.96,156.96,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,BCBS MGG,BCBS MGG,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Cigna,Cigna,156.96,,,,,,,per diem,156.96,156.96,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Cigna MGG,Cigna MGG,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Humana,Humana,156.96,,,,,,,per diem,156.96,156.96,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Humana MGG,Humana MGG,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Optum VA,Optum VA,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,UHC,UHC,156.96,,,,,,,per diem,156.96,156.96,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,UHC MGG,UHC MGG,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,VA,VA,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Wellcare MGG,Wellcare MGG,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Bright Health - commercial,Bright Health - commercial,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,156.96,156.96,Bright Health MGG,Bright Health MGG,156.96,,,,,,,case rate,156.96,156.96,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Aetna,Aetna,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Aetna MGG,Aetna MGG,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,BCBS,BCBS,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,BCBS MGG,BCBS MGG,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Cigna,Cigna,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Cigna MGG,Cigna MGG,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Humana,Humana,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Humana MGG,Humana MGG,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Optum VA,Optum VA,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,UHC,UHC,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,UHC MGG,UHC MGG,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,VA,VA,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Wellcare MGG,Wellcare MGG,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Bright Health - commercial,Bright Health - commercial,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,Bright Health MGG,Bright Health MGG,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Aetna,Aetna,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Aetna MGG,Aetna MGG,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,BCBS,BCBS,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,BCBS MGG,BCBS MGG,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Cigna,Cigna,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Cigna MGG,Cigna MGG,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Humana,Humana,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Humana MGG,Humana MGG,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Optum VA,Optum VA,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,UHC,UHC,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,UHC MGG,UHC MGG,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,VA,VA,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Wellcare MGG,Wellcare MGG,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Bright Health - commercial,Bright Health - commercial,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,78.55,78.55,Bright Health MGG,Bright Health MGG,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Aetna,Aetna,172.34,,,,,,,per diem,172.34,172.34,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Aetna MGG,Aetna MGG,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,BCBS,BCBS,172.34,,,,,,,per diem,172.34,172.34,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,BCBS MGG,BCBS MGG,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Cigna,Cigna,172.34,,,,,,,per diem,172.34,172.34,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Cigna MGG,Cigna MGG,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Humana,Humana,172.34,,,,,,,per diem,172.34,172.34,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Humana MGG,Humana MGG,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Optum VA,Optum VA,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,UHC,UHC,172.34,,,,,,,per diem,172.34,172.34,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,UHC MGG,UHC MGG,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,VA,VA,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Wellcare MGG,Wellcare MGG,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Bright Health - commercial,Bright Health - commercial,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,172.34,172.34,Bright Health MGG,Bright Health MGG,172.34,,,,,,,case rate,172.34,172.34,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Aetna,Aetna,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Aetna MGG,Aetna MGG,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,BCBS,BCBS,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,BCBS MGG,BCBS MGG,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Cigna,Cigna,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Cigna MGG,Cigna MGG,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Humana,Humana,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Humana MGG,Humana MGG,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Optum VA,Optum VA,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,UHC,UHC,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,UHC MGG,UHC MGG,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,VA,VA,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Wellcare MGG,Wellcare MGG,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Bright Health - commercial,Bright Health - commercial,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,Bright Health MGG,Bright Health MGG,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Aetna,Aetna,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Aetna MGG,Aetna MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,BCBS,BCBS,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,BCBS MGG,BCBS MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Cigna,Cigna,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Cigna MGG,Cigna MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Humana,Humana,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Humana MGG,Humana MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Optum VA,Optum VA,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,UHC,UHC,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,UHC MGG,UHC MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,VA,VA,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Wellcare MGG,Wellcare MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Bright Health - commercial,Bright Health - commercial,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,Bright Health MGG,Bright Health MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Aetna,Aetna,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Aetna MGG,Aetna MGG,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,BCBS,BCBS,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,BCBS MGG,BCBS MGG,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Cigna,Cigna,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Cigna MGG,Cigna MGG,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Humana,Humana,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Humana MGG,Humana MGG,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Optum VA,Optum VA,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,UHC,UHC,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,UHC MGG,UHC MGG,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,VA,VA,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Wellcare MGG,Wellcare MGG,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Bright Health - commercial,Bright Health - commercial,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,68.99,68.99,Bright Health MGG,Bright Health MGG,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Aetna,Aetna,125.73,,,,,,,per diem,125.73,125.73,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Aetna MGG,Aetna MGG,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,BCBS,BCBS,125.73,,,,,,,per diem,125.73,125.73,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,BCBS MGG,BCBS MGG,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Cigna,Cigna,125.73,,,,,,,per diem,125.73,125.73,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Cigna MGG,Cigna MGG,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Humana,Humana,125.73,,,,,,,per diem,125.73,125.73,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Humana MGG,Humana MGG,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Optum VA,Optum VA,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,UHC,UHC,125.73,,,,,,,per diem,125.73,125.73,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,UHC MGG,UHC MGG,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,VA,VA,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Wellcare MGG,Wellcare MGG,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Bright Health - commercial,Bright Health - commercial,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,125.73,125.73,Bright Health MGG,Bright Health MGG,125.73,,,,,,,case rate,125.73,125.73,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Aetna,Aetna,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Aetna MGG,Aetna MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,BCBS,BCBS,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,BCBS MGG,BCBS MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Cigna,Cigna,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Cigna MGG,Cigna MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Humana,Humana,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Humana MGG,Humana MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Optum VA,Optum VA,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,UHC,UHC,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,UHC MGG,UHC MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,VA,VA,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Wellcare MGG,Wellcare MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Bright Health - commercial,Bright Health - commercial,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,175.35,175.35,Bright Health MGG,Bright Health MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Aetna,Aetna,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Aetna MGG,Aetna MGG,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,BCBS,BCBS,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,BCBS MGG,BCBS MGG,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Cigna,Cigna,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Cigna MGG,Cigna MGG,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Humana,Humana,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Humana MGG,Humana MGG,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Optum VA,Optum VA,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,UHC,UHC,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,UHC MGG,UHC MGG,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,VA,VA,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Wellcare MGG,Wellcare MGG,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Bright Health - commercial,Bright Health - commercial,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,Bright Health MGG,Bright Health MGG,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Aetna,Aetna,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Aetna MGG,Aetna MGG,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,BCBS,BCBS,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,BCBS MGG,BCBS MGG,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Cigna,Cigna,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Cigna MGG,Cigna MGG,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Humana,Humana,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Humana MGG,Humana MGG,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Optum VA,Optum VA,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,UHC,UHC,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,UHC MGG,UHC MGG,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,VA,VA,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Wellcare MGG,Wellcare MGG,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Bright Health - commercial,Bright Health - commercial,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,155.23,155.23,Bright Health MGG,Bright Health MGG,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Aetna,Aetna,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Aetna MGG,Aetna MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,BCBS,BCBS,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,BCBS MGG,BCBS MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Cigna,Cigna,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Cigna MGG,Cigna MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Humana,Humana,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Humana MGG,Humana MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Optum VA,Optum VA,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,UHC,UHC,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,UHC MGG,UHC MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,VA,VA,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Wellcare MGG,Wellcare MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Bright Health - commercial,Bright Health - commercial,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,19.56,19.56,Bright Health MGG,Bright Health MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Aetna,Aetna,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Aetna MGG,Aetna MGG,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,BCBS,BCBS,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,BCBS MGG,BCBS MGG,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Cigna,Cigna,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Cigna MGG,Cigna MGG,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Humana,Humana,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Humana MGG,Humana MGG,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Optum VA,Optum VA,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,UHC,UHC,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,UHC MGG,UHC MGG,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,VA,VA,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Wellcare MGG,Wellcare MGG,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Bright Health - commercial,Bright Health - commercial,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,Bright Health MGG,Bright Health MGG,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Aetna,Aetna,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Aetna MGG,Aetna MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,BCBS,BCBS,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,BCBS MGG,BCBS MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Cigna,Cigna,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Cigna MGG,Cigna MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Humana,Humana,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Humana MGG,Humana MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Optum VA,Optum VA,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,UHC,UHC,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,UHC MGG,UHC MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,VA,VA,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Wellcare MGG,Wellcare MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Bright Health - commercial,Bright Health - commercial,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,62.22,62.22,Bright Health MGG,Bright Health MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Aetna,Aetna,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Aetna MGG,Aetna MGG,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,BCBS,BCBS,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,BCBS MGG,BCBS MGG,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Cigna,Cigna,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Cigna MGG,Cigna MGG,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Humana,Humana,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Humana MGG,Humana MGG,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Optum VA,Optum VA,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,UHC,UHC,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,UHC MGG,UHC MGG,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,VA,VA,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Wellcare MGG,Wellcare MGG,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Bright Health - commercial,Bright Health - commercial,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,Bright Health MGG,Bright Health MGG,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Aetna,Aetna,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Aetna MGG,Aetna MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,BCBS,BCBS,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,BCBS MGG,BCBS MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Cigna,Cigna,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Cigna MGG,Cigna MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Humana,Humana,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Humana MGG,Humana MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Optum VA,Optum VA,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,UHC,UHC,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,UHC MGG,UHC MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,VA,VA,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Wellcare MGG,Wellcare MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Bright Health - commercial,Bright Health - commercial,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,14.99,14.99,Bright Health MGG,Bright Health MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Aetna,Aetna,16.76,,,,,,,per diem,16.76,16.76,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Aetna MGG,Aetna MGG,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,BCBS,BCBS,16.76,,,,,,,per diem,16.76,16.76,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,BCBS MGG,BCBS MGG,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Cigna,Cigna,16.76,,,,,,,per diem,16.76,16.76,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Cigna MGG,Cigna MGG,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Humana,Humana,16.76,,,,,,,per diem,16.76,16.76,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Humana MGG,Humana MGG,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Optum VA,Optum VA,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,UHC,UHC,16.76,,,,,,,per diem,16.76,16.76,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,UHC MGG,UHC MGG,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,VA,VA,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Wellcare MGG,Wellcare MGG,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Bright Health - commercial,Bright Health - commercial,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,16.76,16.76,Bright Health MGG,Bright Health MGG,16.76,,,,,,,case rate,16.76,16.76,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Aetna,Aetna,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Aetna MGG,Aetna MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,BCBS,BCBS,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,BCBS MGG,BCBS MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Cigna,Cigna,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Cigna MGG,Cigna MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Humana,Humana,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Humana MGG,Humana MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Optum VA,Optum VA,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,UHC,UHC,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,UHC MGG,UHC MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,VA,VA,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Wellcare MGG,Wellcare MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Bright Health - commercial,Bright Health - commercial,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,Bright Health MGG,Bright Health MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Aetna,Aetna,94.4,,,,,,,per diem,94.4,94.4,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Aetna MGG,Aetna MGG,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,BCBS,BCBS,94.4,,,,,,,per diem,94.4,94.4,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,BCBS MGG,BCBS MGG,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Cigna,Cigna,94.4,,,,,,,per diem,94.4,94.4,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Cigna MGG,Cigna MGG,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Humana,Humana,94.4,,,,,,,per diem,94.4,94.4,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Humana MGG,Humana MGG,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Optum VA,Optum VA,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,UHC,UHC,94.4,,,,,,,per diem,94.4,94.4,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,UHC MGG,UHC MGG,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,VA,VA,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Wellcare MGG,Wellcare MGG,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Bright Health - commercial,Bright Health - commercial,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,94.4,94.4,Bright Health MGG,Bright Health MGG,94.4,,,,,,,case rate,94.4,94.4,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Aetna,Aetna,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Aetna MGG,Aetna MGG,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,BCBS,BCBS,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,BCBS MGG,BCBS MGG,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Cigna,Cigna,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Cigna MGG,Cigna MGG,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Humana,Humana,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Humana MGG,Humana MGG,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Optum VA,Optum VA,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,UHC,UHC,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,UHC MGG,UHC MGG,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,VA,VA,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Wellcare MGG,Wellcare MGG,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Bright Health - commercial,Bright Health - commercial,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,Bright Health MGG,Bright Health MGG,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Aetna,Aetna,254.28,,,,,,,per diem,254.28,254.28,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Aetna MGG,Aetna MGG,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,BCBS,BCBS,254.28,,,,,,,per diem,254.28,254.28,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,BCBS MGG,BCBS MGG,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Cigna,Cigna,254.28,,,,,,,per diem,254.28,254.28,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Cigna MGG,Cigna MGG,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Humana,Humana,254.28,,,,,,,per diem,254.28,254.28,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Humana MGG,Humana MGG,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Optum VA,Optum VA,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,UHC,UHC,254.28,,,,,,,per diem,254.28,254.28,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,UHC MGG,UHC MGG,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,VA,VA,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Wellcare MGG,Wellcare MGG,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Bright Health - commercial,Bright Health - commercial,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,254.28,254.28,Bright Health MGG,Bright Health MGG,254.28,,,,,,,case rate,254.28,254.28,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Aetna,Aetna,145.28,,,,,,,per diem,145.28,145.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Aetna MGG,Aetna MGG,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,BCBS,BCBS,145.28,,,,,,,per diem,145.28,145.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,BCBS MGG,BCBS MGG,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Cigna,Cigna,145.28,,,,,,,per diem,145.28,145.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Cigna MGG,Cigna MGG,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Humana,Humana,145.28,,,,,,,per diem,145.28,145.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Humana MGG,Humana MGG,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Optum VA,Optum VA,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,UHC,UHC,145.28,,,,,,,per diem,145.28,145.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,UHC MGG,UHC MGG,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,VA,VA,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Wellcare MGG,Wellcare MGG,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Bright Health - commercial,Bright Health - commercial,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,145.28,145.28,Bright Health MGG,Bright Health MGG,145.28,,,,,,,case rate,145.28,145.28,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Aetna,Aetna,65.32,,,,,,,per diem,65.32,65.32,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Aetna MGG,Aetna MGG,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,BCBS,BCBS,65.32,,,,,,,per diem,65.32,65.32,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,BCBS MGG,BCBS MGG,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Cigna,Cigna,65.32,,,,,,,per diem,65.32,65.32,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Cigna MGG,Cigna MGG,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Humana,Humana,65.32,,,,,,,per diem,65.32,65.32,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Humana MGG,Humana MGG,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Optum VA,Optum VA,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,UHC,UHC,65.32,,,,,,,per diem,65.32,65.32,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,UHC MGG,UHC MGG,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,VA,VA,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Wellcare MGG,Wellcare MGG,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Bright Health - commercial,Bright Health - commercial,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,65.32,65.32,Bright Health MGG,Bright Health MGG,65.32,,,,,,,case rate,65.32,65.32,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Aetna,Aetna,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Aetna MGG,Aetna MGG,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,BCBS,BCBS,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,BCBS MGG,BCBS MGG,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Cigna,Cigna,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Cigna MGG,Cigna MGG,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Humana,Humana,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Humana MGG,Humana MGG,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Optum VA,Optum VA,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,UHC,UHC,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,UHC MGG,UHC MGG,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,VA,VA,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Wellcare MGG,Wellcare MGG,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Bright Health - commercial,Bright Health - commercial,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,Bright Health MGG,Bright Health MGG,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Aetna,Aetna,146.1,,,,,,,per diem,146.1,146.1,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Aetna MGG,Aetna MGG,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,BCBS,BCBS,146.1,,,,,,,per diem,146.1,146.1,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,BCBS MGG,BCBS MGG,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Cigna,Cigna,146.1,,,,,,,per diem,146.1,146.1,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Cigna MGG,Cigna MGG,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Humana,Humana,146.1,,,,,,,per diem,146.1,146.1,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Humana MGG,Humana MGG,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Optum VA,Optum VA,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,UHC,UHC,146.1,,,,,,,per diem,146.1,146.1,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,UHC MGG,UHC MGG,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,VA,VA,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Wellcare MGG,Wellcare MGG,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Bright Health - commercial,Bright Health - commercial,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,146.1,146.1,Bright Health MGG,Bright Health MGG,146.1,,,,,,,case rate,146.1,146.1,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Aetna,Aetna,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Aetna MGG,Aetna MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,BCBS,BCBS,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,BCBS MGG,BCBS MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Cigna,Cigna,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Cigna MGG,Cigna MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Humana,Humana,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Humana MGG,Humana MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Optum VA,Optum VA,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,UHC,UHC,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,UHC MGG,UHC MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,VA,VA,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Wellcare MGG,Wellcare MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Bright Health - commercial,Bright Health - commercial,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL URINE           ,38202030,CDM,301,RC,84155,CPT,,,,Inpatient,,,15.75,15.75,Bright Health MGG,Bright Health MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Aetna,Aetna,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Aetna MGG,Aetna MGG,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,BCBS,BCBS,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,BCBS MGG,BCBS MGG,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Cigna,Cigna,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Cigna MGG,Cigna MGG,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Humana,Humana,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Humana MGG,Humana MGG,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Optum VA,Optum VA,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,UHC,UHC,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,UHC MGG,UHC MGG,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,VA,VA,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Wellcare MGG,Wellcare MGG,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Bright Health - commercial,Bright Health - commercial,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,41.42,41.42,Bright Health MGG,Bright Health MGG,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Aetna,Aetna,313.45,,,,,,,per diem,313.45,313.45,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Aetna MGG,Aetna MGG,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,BCBS,BCBS,313.45,,,,,,,per diem,313.45,313.45,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,BCBS MGG,BCBS MGG,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Cigna,Cigna,313.45,,,,,,,per diem,313.45,313.45,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Cigna MGG,Cigna MGG,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Humana,Humana,313.45,,,,,,,per diem,313.45,313.45,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Humana MGG,Humana MGG,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Optum VA,Optum VA,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,UHC,UHC,313.45,,,,,,,per diem,313.45,313.45,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,UHC MGG,UHC MGG,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,VA,VA,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Wellcare MGG,Wellcare MGG,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Bright Health - commercial,Bright Health - commercial,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,313.45,313.45,Bright Health MGG,Bright Health MGG,313.45,,,,,,,case rate,313.45,313.45,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Aetna,Aetna,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Aetna MGG,Aetna MGG,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,BCBS,BCBS,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,BCBS MGG,BCBS MGG,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Cigna,Cigna,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Cigna MGG,Cigna MGG,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Humana,Humana,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Humana MGG,Humana MGG,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Optum VA,Optum VA,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,UHC,UHC,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,UHC MGG,UHC MGG,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,VA,VA,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Wellcare MGG,Wellcare MGG,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Bright Health - commercial,Bright Health - commercial,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,Bright Health MGG,Bright Health MGG,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Aetna,Aetna,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Aetna MGG,Aetna MGG,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,BCBS,BCBS,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,BCBS MGG,BCBS MGG,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Cigna,Cigna,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Cigna MGG,Cigna MGG,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Humana,Humana,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Humana MGG,Humana MGG,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Optum VA,Optum VA,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,UHC,UHC,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,UHC MGG,UHC MGG,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,VA,VA,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Wellcare MGG,Wellcare MGG,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Bright Health - commercial,Bright Health - commercial,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,Bright Health MGG,Bright Health MGG,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Aetna,Aetna,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Aetna MGG,Aetna MGG,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,BCBS,BCBS,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,BCBS MGG,BCBS MGG,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Cigna,Cigna,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Cigna MGG,Cigna MGG,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Humana,Humana,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Humana MGG,Humana MGG,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Optum VA,Optum VA,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,UHC,UHC,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,UHC MGG,UHC MGG,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,VA,VA,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Wellcare MGG,Wellcare MGG,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Bright Health - commercial,Bright Health - commercial,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,24.15,24.15,Bright Health MGG,Bright Health MGG,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Aetna,Aetna,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Aetna MGG,Aetna MGG,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,BCBS,BCBS,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,BCBS MGG,BCBS MGG,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Cigna,Cigna,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Cigna MGG,Cigna MGG,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Humana,Humana,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Humana MGG,Humana MGG,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Optum VA,Optum VA,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,UHC,UHC,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,UHC MGG,UHC MGG,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,VA,VA,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Wellcare MGG,Wellcare MGG,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Bright Health - commercial,Bright Health - commercial,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,Bright Health MGG,Bright Health MGG,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Aetna,Aetna,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Aetna MGG,Aetna MGG,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,BCBS,BCBS,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,BCBS MGG,BCBS MGG,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Cigna,Cigna,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Cigna MGG,Cigna MGG,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Humana,Humana,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Humana MGG,Humana MGG,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Optum VA,Optum VA,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,UHC,UHC,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,UHC MGG,UHC MGG,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,VA,VA,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Wellcare MGG,Wellcare MGG,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Bright Health - commercial,Bright Health - commercial,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,Bright Health MGG,Bright Health MGG,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Aetna,Aetna,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Aetna MGG,Aetna MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,BCBS,BCBS,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,BCBS MGG,BCBS MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Cigna,Cigna,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Cigna MGG,Cigna MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Humana,Humana,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Humana MGG,Humana MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Optum VA,Optum VA,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,UHC,UHC,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,UHC MGG,UHC MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,VA,VA,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Wellcare MGG,Wellcare MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Bright Health - commercial,Bright Health - commercial,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,Bright Health MGG,Bright Health MGG,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Aetna,Aetna,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Aetna MGG,Aetna MGG,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,BCBS,BCBS,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,BCBS MGG,BCBS MGG,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Cigna,Cigna,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Cigna MGG,Cigna MGG,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Humana,Humana,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Humana MGG,Humana MGG,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Optum VA,Optum VA,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,UHC,UHC,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,UHC MGG,UHC MGG,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,VA,VA,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Wellcare MGG,Wellcare MGG,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Bright Health - commercial,Bright Health - commercial,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,Bright Health MGG,Bright Health MGG,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Aetna,Aetna,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Aetna MGG,Aetna MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,BCBS,BCBS,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,BCBS MGG,BCBS MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Cigna,Cigna,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Cigna MGG,Cigna MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Humana,Humana,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Humana MGG,Humana MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Optum VA,Optum VA,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,UHC,UHC,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,UHC MGG,UHC MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,VA,VA,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Wellcare MGG,Wellcare MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Bright Health - commercial,Bright Health - commercial,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,Bright Health MGG,Bright Health MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Aetna,Aetna,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Aetna MGG,Aetna MGG,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,BCBS,BCBS,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,BCBS MGG,BCBS MGG,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Cigna,Cigna,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Cigna MGG,Cigna MGG,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Humana,Humana,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Humana MGG,Humana MGG,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Optum VA,Optum VA,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,UHC,UHC,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,UHC MGG,UHC MGG,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,VA,VA,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Wellcare MGG,Wellcare MGG,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Bright Health - commercial,Bright Health - commercial,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,Bright Health MGG,Bright Health MGG,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Aetna,Aetna,259.42,,,,,,,per diem,259.42,259.42,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Aetna MGG,Aetna MGG,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,BCBS,BCBS,259.42,,,,,,,per diem,259.42,259.42,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,BCBS MGG,BCBS MGG,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Cigna,Cigna,259.42,,,,,,,per diem,259.42,259.42,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Cigna MGG,Cigna MGG,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Humana,Humana,259.42,,,,,,,per diem,259.42,259.42,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Humana MGG,Humana MGG,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Optum VA,Optum VA,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,UHC,UHC,259.42,,,,,,,per diem,259.42,259.42,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,UHC MGG,UHC MGG,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,VA,VA,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Wellcare MGG,Wellcare MGG,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Bright Health - commercial,Bright Health - commercial,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,259.42,259.42,Bright Health MGG,Bright Health MGG,259.42,,,,,,,case rate,259.42,259.42,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Aetna,Aetna,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Aetna MGG,Aetna MGG,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,BCBS,BCBS,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,BCBS MGG,BCBS MGG,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Cigna,Cigna,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Cigna MGG,Cigna MGG,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Humana,Humana,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Humana MGG,Humana MGG,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Optum VA,Optum VA,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,UHC,UHC,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,UHC MGG,UHC MGG,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,VA,VA,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Wellcare MGG,Wellcare MGG,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Bright Health - commercial,Bright Health - commercial,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,Bright Health MGG,Bright Health MGG,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Aetna,Aetna,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Aetna MGG,Aetna MGG,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,BCBS,BCBS,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,BCBS MGG,BCBS MGG,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Cigna,Cigna,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Cigna MGG,Cigna MGG,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Humana,Humana,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Humana MGG,Humana MGG,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Optum VA,Optum VA,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,UHC,UHC,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,UHC MGG,UHC MGG,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,VA,VA,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Wellcare MGG,Wellcare MGG,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Bright Health - commercial,Bright Health - commercial,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,Bright Health MGG,Bright Health MGG,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Aetna,Aetna,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Aetna MGG,Aetna MGG,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,BCBS,BCBS,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,BCBS MGG,BCBS MGG,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Cigna,Cigna,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Cigna MGG,Cigna MGG,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Humana,Humana,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Humana MGG,Humana MGG,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Optum VA,Optum VA,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,UHC,UHC,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,UHC MGG,UHC MGG,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,VA,VA,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Wellcare MGG,Wellcare MGG,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Bright Health - commercial,Bright Health - commercial,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,Bright Health MGG,Bright Health MGG,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Aetna,Aetna,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Aetna MGG,Aetna MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,BCBS,BCBS,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,BCBS MGG,BCBS MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Cigna,Cigna,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Cigna MGG,Cigna MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Humana,Humana,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Humana MGG,Humana MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Optum VA,Optum VA,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,UHC,UHC,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,UHC MGG,UHC MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,VA,VA,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Wellcare MGG,Wellcare MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Bright Health - commercial,Bright Health - commercial,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,81.55,81.55,Bright Health MGG,Bright Health MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Aetna,Aetna,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Aetna MGG,Aetna MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,BCBS,BCBS,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,BCBS MGG,BCBS MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Cigna,Cigna,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Cigna MGG,Cigna MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Humana,Humana,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Humana MGG,Humana MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Optum VA,Optum VA,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,UHC,UHC,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,UHC MGG,UHC MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,VA,VA,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Wellcare MGG,Wellcare MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Bright Health - commercial,Bright Health - commercial,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,Bright Health MGG,Bright Health MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Aetna,Aetna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Aetna MGG,Aetna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,BCBS,BCBS,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,BCBS MGG,BCBS MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Cigna,Cigna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Cigna MGG,Cigna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Humana,Humana,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Humana MGG,Humana MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Optum VA,Optum VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,UHC,UHC,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,UHC MGG,UHC MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,VA,VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Wellcare MGG,Wellcare MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Bright Health - commercial,Bright Health - commercial,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,Bright Health MGG,Bright Health MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Aetna,Aetna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Aetna MGG,Aetna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,BCBS,BCBS,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,BCBS MGG,BCBS MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Cigna,Cigna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Cigna MGG,Cigna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Humana,Humana,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Humana MGG,Humana MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Optum VA,Optum VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,UHC,UHC,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,UHC MGG,UHC MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,VA,VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Wellcare MGG,Wellcare MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Bright Health - commercial,Bright Health - commercial,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,94.5,94.5,Bright Health MGG,Bright Health MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Aetna,Aetna,80.22,,,,,,,per diem,80.22,80.22,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Aetna MGG,Aetna MGG,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,BCBS,BCBS,80.22,,,,,,,per diem,80.22,80.22,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,BCBS MGG,BCBS MGG,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Cigna,Cigna,80.22,,,,,,,per diem,80.22,80.22,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Cigna MGG,Cigna MGG,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Humana,Humana,80.22,,,,,,,per diem,80.22,80.22,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Humana MGG,Humana MGG,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Optum VA,Optum VA,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,UHC,UHC,80.22,,,,,,,per diem,80.22,80.22,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,UHC MGG,UHC MGG,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,VA,VA,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Wellcare MGG,Wellcare MGG,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Bright Health - commercial,Bright Health - commercial,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,80.22,80.22,Bright Health MGG,Bright Health MGG,80.22,,,,,,,case rate,80.22,80.22,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Aetna,Aetna,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Aetna MGG,Aetna MGG,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,BCBS,BCBS,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,BCBS MGG,BCBS MGG,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Cigna,Cigna,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Cigna MGG,Cigna MGG,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Humana,Humana,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Humana MGG,Humana MGG,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Optum VA,Optum VA,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,UHC,UHC,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,UHC MGG,UHC MGG,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,VA,VA,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Wellcare MGG,Wellcare MGG,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Bright Health - commercial,Bright Health - commercial,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,Bright Health MGG,Bright Health MGG,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Aetna,Aetna,120.87,,,,,,,per diem,120.87,120.87,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Aetna MGG,Aetna MGG,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,BCBS,BCBS,120.87,,,,,,,per diem,120.87,120.87,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,BCBS MGG,BCBS MGG,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Cigna,Cigna,120.87,,,,,,,per diem,120.87,120.87,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Cigna MGG,Cigna MGG,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Humana,Humana,120.87,,,,,,,per diem,120.87,120.87,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Humana MGG,Humana MGG,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Optum VA,Optum VA,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,UHC,UHC,120.87,,,,,,,per diem,120.87,120.87,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,UHC MGG,UHC MGG,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,VA,VA,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Wellcare MGG,Wellcare MGG,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Bright Health - commercial,Bright Health - commercial,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,120.87,120.87,Bright Health MGG,Bright Health MGG,120.87,,,,,,,case rate,120.87,120.87,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Aetna,Aetna,131.83,,,,,,,per diem,131.83,131.83,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Aetna MGG,Aetna MGG,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,BCBS,BCBS,131.83,,,,,,,per diem,131.83,131.83,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,BCBS MGG,BCBS MGG,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Cigna,Cigna,131.83,,,,,,,per diem,131.83,131.83,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Cigna MGG,Cigna MGG,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Humana,Humana,131.83,,,,,,,per diem,131.83,131.83,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Humana MGG,Humana MGG,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Optum VA,Optum VA,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,UHC,UHC,131.83,,,,,,,per diem,131.83,131.83,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,UHC MGG,UHC MGG,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,VA,VA,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Wellcare MGG,Wellcare MGG,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Bright Health - commercial,Bright Health - commercial,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,131.83,131.83,Bright Health MGG,Bright Health MGG,131.83,,,,,,,case rate,131.83,131.83,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Aetna,Aetna,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Aetna MGG,Aetna MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,BCBS,BCBS,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,BCBS MGG,BCBS MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Cigna,Cigna,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Cigna MGG,Cigna MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Humana,Humana,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Humana MGG,Humana MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Optum VA,Optum VA,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,UHC,UHC,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,UHC MGG,UHC MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,VA,VA,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Wellcare MGG,Wellcare MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Bright Health - commercial,Bright Health - commercial,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,Bright Health MGG,Bright Health MGG,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Aetna,Aetna,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Aetna MGG,Aetna MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,BCBS,BCBS,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,BCBS MGG,BCBS MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Cigna,Cigna,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Cigna MGG,Cigna MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Humana,Humana,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Humana MGG,Humana MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Optum VA,Optum VA,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,UHC,UHC,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,UHC MGG,UHC MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,VA,VA,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Wellcare MGG,Wellcare MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Bright Health - commercial,Bright Health - commercial,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,18.71,18.71,Bright Health MGG,Bright Health MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Aetna,Aetna,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Aetna MGG,Aetna MGG,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,BCBS,BCBS,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,BCBS MGG,BCBS MGG,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Cigna,Cigna,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Cigna MGG,Cigna MGG,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Humana,Humana,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Humana MGG,Humana MGG,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Optum VA,Optum VA,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,UHC,UHC,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,UHC MGG,UHC MGG,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,VA,VA,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Wellcare MGG,Wellcare MGG,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Bright Health - commercial,Bright Health - commercial,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,Bright Health MGG,Bright Health MGG,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Aetna,Aetna,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Aetna MGG,Aetna MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,BCBS,BCBS,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,BCBS MGG,BCBS MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Cigna,Cigna,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Cigna MGG,Cigna MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Humana,Humana,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Humana MGG,Humana MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Optum VA,Optum VA,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,UHC,UHC,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,UHC MGG,UHC MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,VA,VA,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Wellcare MGG,Wellcare MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Bright Health - commercial,Bright Health - commercial,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,Bright Health MGG,Bright Health MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Aetna,Aetna,71.25,,,,,,,per diem,71.25,71.25,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Aetna MGG,Aetna MGG,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,BCBS,BCBS,71.25,,,,,,,per diem,71.25,71.25,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,BCBS MGG,BCBS MGG,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Cigna,Cigna,71.25,,,,,,,per diem,71.25,71.25,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Cigna MGG,Cigna MGG,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Humana,Humana,71.25,,,,,,,per diem,71.25,71.25,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Humana MGG,Humana MGG,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Optum VA,Optum VA,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,UHC,UHC,71.25,,,,,,,per diem,71.25,71.25,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,UHC MGG,UHC MGG,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,VA,VA,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Wellcare MGG,Wellcare MGG,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Bright Health - commercial,Bright Health - commercial,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,71.25,71.25,Bright Health MGG,Bright Health MGG,71.25,,,,,,,case rate,71.25,71.25,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Aetna,Aetna,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Aetna MGG,Aetna MGG,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,BCBS,BCBS,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,BCBS MGG,BCBS MGG,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Cigna,Cigna,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Cigna MGG,Cigna MGG,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Humana,Humana,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Humana MGG,Humana MGG,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Optum VA,Optum VA,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,UHC,UHC,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,UHC MGG,UHC MGG,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,VA,VA,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Wellcare MGG,Wellcare MGG,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Bright Health - commercial,Bright Health - commercial,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,Bright Health MGG,Bright Health MGG,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Aetna,Aetna,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Aetna MGG,Aetna MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,BCBS,BCBS,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,BCBS MGG,BCBS MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Cigna,Cigna,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Cigna MGG,Cigna MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Humana,Humana,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Humana MGG,Humana MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Optum VA,Optum VA,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,UHC,UHC,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,UHC MGG,UHC MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,VA,VA,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Wellcare MGG,Wellcare MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Bright Health - commercial,Bright Health - commercial,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,Bright Health MGG,Bright Health MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Aetna,Aetna,57.82,,,,,,,per diem,57.82,57.82,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Aetna MGG,Aetna MGG,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,BCBS,BCBS,57.82,,,,,,,per diem,57.82,57.82,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,BCBS MGG,BCBS MGG,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Cigna,Cigna,57.82,,,,,,,per diem,57.82,57.82,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Cigna MGG,Cigna MGG,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Humana,Humana,57.82,,,,,,,per diem,57.82,57.82,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Humana MGG,Humana MGG,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Optum VA,Optum VA,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,UHC,UHC,57.82,,,,,,,per diem,57.82,57.82,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,UHC MGG,UHC MGG,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,VA,VA,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Wellcare MGG,Wellcare MGG,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Bright Health - commercial,Bright Health - commercial,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,57.82,57.82,Bright Health MGG,Bright Health MGG,57.82,,,,,,,case rate,57.82,57.82,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Aetna,Aetna,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Aetna MGG,Aetna MGG,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,BCBS,BCBS,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,BCBS MGG,BCBS MGG,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Cigna,Cigna,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Cigna MGG,Cigna MGG,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Humana,Humana,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Humana MGG,Humana MGG,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Optum VA,Optum VA,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,UHC,UHC,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,UHC MGG,UHC MGG,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,VA,VA,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Wellcare MGG,Wellcare MGG,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Bright Health - commercial,Bright Health - commercial,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,Bright Health MGG,Bright Health MGG,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Aetna,Aetna,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Aetna MGG,Aetna MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,BCBS,BCBS,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,BCBS MGG,BCBS MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Cigna,Cigna,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Cigna MGG,Cigna MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Humana,Humana,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Humana MGG,Humana MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Optum VA,Optum VA,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,UHC,UHC,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,UHC MGG,UHC MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,VA,VA,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Wellcare MGG,Wellcare MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Bright Health - commercial,Bright Health - commercial,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,Bright Health MGG,Bright Health MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Aetna,Aetna,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Aetna MGG,Aetna MGG,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,BCBS,BCBS,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,BCBS MGG,BCBS MGG,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Cigna,Cigna,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Cigna MGG,Cigna MGG,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Humana,Humana,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Humana MGG,Humana MGG,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Optum VA,Optum VA,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,UHC,UHC,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,UHC MGG,UHC MGG,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,VA,VA,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Wellcare MGG,Wellcare MGG,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Bright Health - commercial,Bright Health - commercial,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,Bright Health MGG,Bright Health MGG,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Aetna,Aetna,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Aetna MGG,Aetna MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,BCBS,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS MGG,BCBS MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Cigna,Cigna,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Cigna MGG,Cigna MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Humana,Humana,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Humana MGG,Humana MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Optum VA,Optum VA,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,UHC,UHC,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,UHC MGG,UHC MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,VA,VA,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Wellcare MGG,Wellcare MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Bright Health - commercial,Bright Health - commercial,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,Bright Health MGG,Bright Health MGG,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Aetna,Aetna,24.5,,,,,,,per diem,24.5,24.5,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Aetna MGG,Aetna MGG,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,BCBS,BCBS,24.5,,,,,,,per diem,24.5,24.5,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,BCBS MGG,BCBS MGG,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Cigna,Cigna,24.5,,,,,,,per diem,24.5,24.5,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Cigna MGG,Cigna MGG,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Humana,Humana,24.5,,,,,,,per diem,24.5,24.5,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Humana MGG,Humana MGG,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Optum VA,Optum VA,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,UHC,UHC,24.5,,,,,,,per diem,24.5,24.5,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,UHC MGG,UHC MGG,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,VA,VA,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Wellcare MGG,Wellcare MGG,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Bright Health - commercial,Bright Health - commercial,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,24.5,24.5,Bright Health MGG,Bright Health MGG,24.5,,,,,,,case rate,24.5,24.5,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Aetna,Aetna,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Aetna MGG,Aetna MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,BCBS,BCBS,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,BCBS MGG,BCBS MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Cigna,Cigna,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Cigna MGG,Cigna MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Humana,Humana,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Humana MGG,Humana MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Optum VA,Optum VA,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,UHC,UHC,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,UHC MGG,UHC MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,VA,VA,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Wellcare MGG,Wellcare MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Bright Health - commercial,Bright Health - commercial,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,Bright Health MGG,Bright Health MGG,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Aetna,Aetna,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Aetna MGG,Aetna MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,BCBS,BCBS,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,BCBS MGG,BCBS MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Cigna,Cigna,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Cigna MGG,Cigna MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Humana,Humana,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Humana MGG,Humana MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Optum VA,Optum VA,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,UHC,UHC,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,UHC MGG,UHC MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,VA,VA,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Wellcare MGG,Wellcare MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Bright Health - commercial,Bright Health - commercial,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,Bright Health MGG,Bright Health MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Aetna,Aetna,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Aetna MGG,Aetna MGG,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,BCBS,BCBS,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,BCBS MGG,BCBS MGG,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Cigna,Cigna,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Cigna MGG,Cigna MGG,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Humana,Humana,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Humana MGG,Humana MGG,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Optum VA,Optum VA,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,UHC,UHC,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,UHC MGG,UHC MGG,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,VA,VA,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Wellcare MGG,Wellcare MGG,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Bright Health - commercial,Bright Health - commercial,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,Bright Health MGG,Bright Health MGG,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Aetna,Aetna,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Aetna MGG,Aetna MGG,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,BCBS,BCBS,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,BCBS MGG,BCBS MGG,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Cigna,Cigna,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Cigna MGG,Cigna MGG,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Humana,Humana,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Humana MGG,Humana MGG,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Optum VA,Optum VA,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,UHC,UHC,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,UHC MGG,UHC MGG,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,VA,VA,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Wellcare MGG,Wellcare MGG,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Bright Health - commercial,Bright Health - commercial,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,268.8,268.8,Bright Health MGG,Bright Health MGG,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Aetna,Aetna,253.42,,,,,,,per diem,253.42,253.42,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Aetna MGG,Aetna MGG,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,BCBS,BCBS,253.42,,,,,,,per diem,253.42,253.42,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,BCBS MGG,BCBS MGG,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Cigna,Cigna,253.42,,,,,,,per diem,253.42,253.42,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Cigna MGG,Cigna MGG,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Humana,Humana,253.42,,,,,,,per diem,253.42,253.42,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Humana MGG,Humana MGG,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Optum VA,Optum VA,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,UHC,UHC,253.42,,,,,,,per diem,253.42,253.42,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,UHC MGG,UHC MGG,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,VA,VA,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Wellcare MGG,Wellcare MGG,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Bright Health - commercial,Bright Health - commercial,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,253.42,253.42,Bright Health MGG,Bright Health MGG,253.42,,,,,,,case rate,253.42,253.42,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Aetna,Aetna,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Aetna MGG,Aetna MGG,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,BCBS,BCBS,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,BCBS MGG,BCBS MGG,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Cigna,Cigna,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Cigna MGG,Cigna MGG,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Humana,Humana,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Humana MGG,Humana MGG,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Optum VA,Optum VA,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,UHC,UHC,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,UHC MGG,UHC MGG,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,VA,VA,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Wellcare MGG,Wellcare MGG,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Bright Health - commercial,Bright Health - commercial,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,Bright Health MGG,Bright Health MGG,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Aetna,Aetna,248.09,,,,,,,per diem,248.09,248.09,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Aetna MGG,Aetna MGG,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,BCBS,BCBS,248.09,,,,,,,per diem,248.09,248.09,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,BCBS MGG,BCBS MGG,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Cigna,Cigna,248.09,,,,,,,per diem,248.09,248.09,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Cigna MGG,Cigna MGG,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Humana,Humana,248.09,,,,,,,per diem,248.09,248.09,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Humana MGG,Humana MGG,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Optum VA,Optum VA,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,UHC,UHC,248.09,,,,,,,per diem,248.09,248.09,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,UHC MGG,UHC MGG,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,VA,VA,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Wellcare MGG,Wellcare MGG,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Bright Health - commercial,Bright Health - commercial,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,248.09,248.09,Bright Health MGG,Bright Health MGG,248.09,,,,,,,case rate,248.09,248.09,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Aetna,Aetna,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Aetna MGG,Aetna MGG,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,BCBS,BCBS,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,BCBS MGG,BCBS MGG,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Cigna,Cigna,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Cigna MGG,Cigna MGG,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Humana,Humana,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Humana MGG,Humana MGG,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Optum VA,Optum VA,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,UHC,UHC,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,UHC MGG,UHC MGG,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,VA,VA,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Wellcare MGG,Wellcare MGG,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Bright Health - commercial,Bright Health - commercial,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,Bright Health MGG,Bright Health MGG,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Aetna,Aetna,197.76,,,,,,,per diem,197.76,197.76,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Aetna MGG,Aetna MGG,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,BCBS,BCBS,197.76,,,,,,,per diem,197.76,197.76,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,BCBS MGG,BCBS MGG,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Cigna,Cigna,197.76,,,,,,,per diem,197.76,197.76,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Cigna MGG,Cigna MGG,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Humana,Humana,197.76,,,,,,,per diem,197.76,197.76,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Humana MGG,Humana MGG,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Optum VA,Optum VA,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,UHC,UHC,197.76,,,,,,,per diem,197.76,197.76,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,UHC MGG,UHC MGG,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,VA,VA,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Wellcare MGG,Wellcare MGG,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Bright Health - commercial,Bright Health - commercial,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,197.76,197.76,Bright Health MGG,Bright Health MGG,197.76,,,,,,,case rate,197.76,197.76,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Aetna,Aetna,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Aetna MGG,Aetna MGG,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,BCBS,BCBS,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,BCBS MGG,BCBS MGG,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Cigna,Cigna,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Cigna MGG,Cigna MGG,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Humana,Humana,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Humana MGG,Humana MGG,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Optum VA,Optum VA,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,UHC,UHC,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,UHC MGG,UHC MGG,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,VA,VA,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Wellcare MGG,Wellcare MGG,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Bright Health - commercial,Bright Health - commercial,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,Bright Health MGG,Bright Health MGG,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Aetna,Aetna,148.58,,,,,,,per diem,148.58,148.58,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Aetna MGG,Aetna MGG,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,BCBS,BCBS,148.58,,,,,,,per diem,148.58,148.58,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,BCBS MGG,BCBS MGG,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Cigna,Cigna,148.58,,,,,,,per diem,148.58,148.58,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Cigna MGG,Cigna MGG,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Humana,Humana,148.58,,,,,,,per diem,148.58,148.58,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Humana MGG,Humana MGG,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Optum VA,Optum VA,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,UHC,UHC,148.58,,,,,,,per diem,148.58,148.58,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,UHC MGG,UHC MGG,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,VA,VA,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Wellcare MGG,Wellcare MGG,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Bright Health - commercial,Bright Health - commercial,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,148.58,148.58,Bright Health MGG,Bright Health MGG,148.58,,,,,,,case rate,148.58,148.58,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Aetna,Aetna,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Aetna MGG,Aetna MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,BCBS,BCBS,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,BCBS MGG,BCBS MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Cigna,Cigna,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Cigna MGG,Cigna MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Humana,Humana,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Humana MGG,Humana MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Optum VA,Optum VA,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,UHC,UHC,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,UHC MGG,UHC MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,VA,VA,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Wellcare MGG,Wellcare MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Bright Health - commercial,Bright Health - commercial,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,37.96,37.96,Bright Health MGG,Bright Health MGG,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Aetna,Aetna,159.95,,,,,,,per diem,159.95,159.95,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Aetna MGG,Aetna MGG,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,BCBS,BCBS,159.95,,,,,,,per diem,159.95,159.95,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,BCBS MGG,BCBS MGG,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Cigna,Cigna,159.95,,,,,,,per diem,159.95,159.95,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Cigna MGG,Cigna MGG,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Humana,Humana,159.95,,,,,,,per diem,159.95,159.95,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Humana MGG,Humana MGG,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Optum VA,Optum VA,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,UHC,UHC,159.95,,,,,,,per diem,159.95,159.95,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,UHC MGG,UHC MGG,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,VA,VA,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Wellcare MGG,Wellcare MGG,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Bright Health - commercial,Bright Health - commercial,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,159.95,159.95,Bright Health MGG,Bright Health MGG,159.95,,,,,,,case rate,159.95,159.95,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Aetna,Aetna,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Aetna MGG,Aetna MGG,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,BCBS,BCBS,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,BCBS MGG,BCBS MGG,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Cigna,Cigna,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Cigna MGG,Cigna MGG,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Humana,Humana,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Humana MGG,Humana MGG,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Optum VA,Optum VA,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,UHC,UHC,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,UHC MGG,UHC MGG,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,VA,VA,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Wellcare MGG,Wellcare MGG,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Bright Health - commercial,Bright Health - commercial,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,Bright Health MGG,Bright Health MGG,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Aetna,Aetna,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Aetna MGG,Aetna MGG,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,BCBS,BCBS,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,BCBS MGG,BCBS MGG,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Cigna,Cigna,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Cigna MGG,Cigna MGG,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Humana,Humana,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Humana MGG,Humana MGG,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Optum VA,Optum VA,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,UHC,UHC,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,UHC MGG,UHC MGG,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,VA,VA,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Wellcare MGG,Wellcare MGG,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Bright Health - commercial,Bright Health - commercial,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,Bright Health MGG,Bright Health MGG,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Aetna,Aetna,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Aetna MGG,Aetna MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,BCBS,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS MGG,BCBS MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Cigna,Cigna,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Cigna MGG,Cigna MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Humana,Humana,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Humana MGG,Humana MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Optum VA,Optum VA,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,UHC,UHC,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,UHC MGG,UHC MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,VA,VA,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Wellcare MGG,Wellcare MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Bright Health - commercial,Bright Health - commercial,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Bright Health MGG,Bright Health MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Aetna,Aetna,79.43,,,,,,,per diem,79.43,79.43,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Aetna MGG,Aetna MGG,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,BCBS,BCBS,79.43,,,,,,,per diem,79.43,79.43,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,BCBS MGG,BCBS MGG,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Cigna,Cigna,79.43,,,,,,,per diem,79.43,79.43,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Cigna MGG,Cigna MGG,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Humana,Humana,79.43,,,,,,,per diem,79.43,79.43,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Humana MGG,Humana MGG,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Optum VA,Optum VA,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,UHC,UHC,79.43,,,,,,,per diem,79.43,79.43,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,UHC MGG,UHC MGG,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,VA,VA,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Wellcare MGG,Wellcare MGG,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Bright Health - commercial,Bright Health - commercial,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,79.43,79.43,Bright Health MGG,Bright Health MGG,79.43,,,,,,,case rate,79.43,79.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Aetna,Aetna,273.99,,,,,,,per diem,273.99,273.99,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Aetna MGG,Aetna MGG,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,BCBS,BCBS,273.99,,,,,,,per diem,273.99,273.99,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,BCBS MGG,BCBS MGG,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Cigna,Cigna,273.99,,,,,,,per diem,273.99,273.99,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Cigna MGG,Cigna MGG,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Humana,Humana,273.99,,,,,,,per diem,273.99,273.99,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Humana MGG,Humana MGG,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Optum VA,Optum VA,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,UHC,UHC,273.99,,,,,,,per diem,273.99,273.99,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,UHC MGG,UHC MGG,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,VA,VA,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Wellcare MGG,Wellcare MGG,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Bright Health - commercial,Bright Health - commercial,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,273.99,273.99,Bright Health MGG,Bright Health MGG,273.99,,,,,,,case rate,273.99,273.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Aetna,Aetna,35.27,,,,,,,per diem,35.27,35.27,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Aetna MGG,Aetna MGG,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,BCBS,BCBS,35.27,,,,,,,per diem,35.27,35.27,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,BCBS MGG,BCBS MGG,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Cigna,Cigna,35.27,,,,,,,per diem,35.27,35.27,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Cigna MGG,Cigna MGG,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Humana,Humana,35.27,,,,,,,per diem,35.27,35.27,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Humana MGG,Humana MGG,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Optum VA,Optum VA,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,UHC,UHC,35.27,,,,,,,per diem,35.27,35.27,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,UHC MGG,UHC MGG,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,VA,VA,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Wellcare MGG,Wellcare MGG,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Bright Health - commercial,Bright Health - commercial,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,35.27,35.27,Bright Health MGG,Bright Health MGG,35.27,,,,,,,case rate,35.27,35.27,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Aetna,Aetna,47.81,,,,,,,per diem,47.81,47.81,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Aetna MGG,Aetna MGG,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,BCBS,BCBS,47.81,,,,,,,per diem,47.81,47.81,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,BCBS MGG,BCBS MGG,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Cigna,Cigna,47.81,,,,,,,per diem,47.81,47.81,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Cigna MGG,Cigna MGG,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Humana,Humana,47.81,,,,,,,per diem,47.81,47.81,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Humana MGG,Humana MGG,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Optum VA,Optum VA,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,UHC,UHC,47.81,,,,,,,per diem,47.81,47.81,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,UHC MGG,UHC MGG,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,VA,VA,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Wellcare MGG,Wellcare MGG,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Bright Health - commercial,Bright Health - commercial,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,47.81,47.81,Bright Health MGG,Bright Health MGG,47.81,,,,,,,case rate,47.81,47.81,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Aetna,Aetna,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Aetna MGG,Aetna MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,BCBS,BCBS,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,BCBS MGG,BCBS MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Cigna,Cigna,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Cigna MGG,Cigna MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Humana,Humana,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Humana MGG,Humana MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Optum VA,Optum VA,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,UHC,UHC,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,UHC MGG,UHC MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,VA,VA,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Wellcare MGG,Wellcare MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Bright Health - commercial,Bright Health - commercial,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,20.13,20.13,Bright Health MGG,Bright Health MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Aetna,Aetna,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Aetna MGG,Aetna MGG,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,BCBS,BCBS,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,BCBS MGG,BCBS MGG,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Cigna,Cigna,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Cigna MGG,Cigna MGG,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Humana,Humana,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Humana MGG,Humana MGG,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Optum VA,Optum VA,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,UHC,UHC,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,UHC MGG,UHC MGG,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,VA,VA,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Wellcare MGG,Wellcare MGG,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Bright Health - commercial,Bright Health - commercial,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,Bright Health MGG,Bright Health MGG,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Aetna,Aetna,164.58,,,,,,,per diem,164.58,164.58,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Aetna MGG,Aetna MGG,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,BCBS,BCBS,164.58,,,,,,,per diem,164.58,164.58,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,BCBS MGG,BCBS MGG,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Cigna,Cigna,164.58,,,,,,,per diem,164.58,164.58,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Cigna MGG,Cigna MGG,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Humana,Humana,164.58,,,,,,,per diem,164.58,164.58,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Humana MGG,Humana MGG,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Optum VA,Optum VA,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,UHC,UHC,164.58,,,,,,,per diem,164.58,164.58,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,UHC MGG,UHC MGG,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,VA,VA,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Wellcare MGG,Wellcare MGG,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Bright Health - commercial,Bright Health - commercial,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,164.58,164.58,Bright Health MGG,Bright Health MGG,164.58,,,,,,,case rate,164.58,164.58,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Aetna,Aetna,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Aetna MGG,Aetna MGG,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,BCBS,BCBS,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,BCBS MGG,BCBS MGG,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Cigna,Cigna,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Cigna MGG,Cigna MGG,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Humana,Humana,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Humana MGG,Humana MGG,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Optum VA,Optum VA,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,UHC,UHC,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,UHC MGG,UHC MGG,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,VA,VA,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Wellcare MGG,Wellcare MGG,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Bright Health - commercial,Bright Health - commercial,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,Bright Health MGG,Bright Health MGG,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Aetna,Aetna,167.71,,,,,,,per diem,167.71,167.71,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Aetna MGG,Aetna MGG,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,BCBS,BCBS,167.71,,,,,,,per diem,167.71,167.71,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,BCBS MGG,BCBS MGG,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Cigna,Cigna,167.71,,,,,,,per diem,167.71,167.71,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Cigna MGG,Cigna MGG,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Humana,Humana,167.71,,,,,,,per diem,167.71,167.71,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Humana MGG,Humana MGG,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Optum VA,Optum VA,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,UHC,UHC,167.71,,,,,,,per diem,167.71,167.71,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,UHC MGG,UHC MGG,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,VA,VA,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Wellcare MGG,Wellcare MGG,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Bright Health - commercial,Bright Health - commercial,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,167.71,167.71,Bright Health MGG,Bright Health MGG,167.71,,,,,,,case rate,167.71,167.71,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Aetna,Aetna,184.93,,,,,,,per diem,184.93,184.93,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Aetna MGG,Aetna MGG,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,BCBS,BCBS,184.93,,,,,,,per diem,184.93,184.93,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,BCBS MGG,BCBS MGG,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Cigna,Cigna,184.93,,,,,,,per diem,184.93,184.93,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Cigna MGG,Cigna MGG,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Humana,Humana,184.93,,,,,,,per diem,184.93,184.93,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Humana MGG,Humana MGG,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Optum VA,Optum VA,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,UHC,UHC,184.93,,,,,,,per diem,184.93,184.93,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,UHC MGG,UHC MGG,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,VA,VA,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Wellcare MGG,Wellcare MGG,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Bright Health - commercial,Bright Health - commercial,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,184.93,184.93,Bright Health MGG,Bright Health MGG,184.93,,,,,,,case rate,184.93,184.93,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Aetna,Aetna,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Aetna MGG,Aetna MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,BCBS,BCBS,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,BCBS MGG,BCBS MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Cigna,Cigna,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Cigna MGG,Cigna MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Humana,Humana,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Humana MGG,Humana MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Optum VA,Optum VA,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,UHC,UHC,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,UHC MGG,UHC MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,VA,VA,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Wellcare MGG,Wellcare MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Bright Health - commercial,Bright Health - commercial,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,Bright Health MGG,Bright Health MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Aetna,Aetna,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Aetna MGG,Aetna MGG,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,BCBS,BCBS,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,BCBS MGG,BCBS MGG,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Cigna,Cigna,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Cigna MGG,Cigna MGG,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Humana,Humana,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Humana MGG,Humana MGG,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Optum VA,Optum VA,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,UHC,UHC,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,UHC MGG,UHC MGG,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,VA,VA,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Wellcare MGG,Wellcare MGG,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Bright Health - commercial,Bright Health - commercial,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,Bright Health MGG,Bright Health MGG,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Aetna,Aetna,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Aetna MGG,Aetna MGG,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,BCBS,BCBS,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,BCBS MGG,BCBS MGG,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Cigna,Cigna,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Cigna MGG,Cigna MGG,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Humana,Humana,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Humana MGG,Humana MGG,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Optum VA,Optum VA,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,UHC,UHC,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,UHC MGG,UHC MGG,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,VA,VA,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Wellcare MGG,Wellcare MGG,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Bright Health - commercial,Bright Health - commercial,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,Bright Health MGG,Bright Health MGG,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Aetna,Aetna,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Aetna MGG,Aetna MGG,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,BCBS,BCBS,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,BCBS MGG,BCBS MGG,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Cigna,Cigna,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Cigna MGG,Cigna MGG,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Humana,Humana,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Humana MGG,Humana MGG,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Optum VA,Optum VA,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,UHC,UHC,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,UHC MGG,UHC MGG,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,VA,VA,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Wellcare MGG,Wellcare MGG,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Bright Health - commercial,Bright Health - commercial,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,Bright Health MGG,Bright Health MGG,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Aetna,Aetna,98.82,,,,,,,per diem,98.82,98.82,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Aetna MGG,Aetna MGG,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,BCBS,BCBS,98.82,,,,,,,per diem,98.82,98.82,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,BCBS MGG,BCBS MGG,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Cigna,Cigna,98.82,,,,,,,per diem,98.82,98.82,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Cigna MGG,Cigna MGG,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Humana,Humana,98.82,,,,,,,per diem,98.82,98.82,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Humana MGG,Humana MGG,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Optum VA,Optum VA,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,UHC,UHC,98.82,,,,,,,per diem,98.82,98.82,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,UHC MGG,UHC MGG,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,VA,VA,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Wellcare MGG,Wellcare MGG,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Bright Health - commercial,Bright Health - commercial,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,98.82,98.82,Bright Health MGG,Bright Health MGG,98.82,,,,,,,case rate,98.82,98.82,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Aetna,Aetna,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Aetna MGG,Aetna MGG,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,BCBS,BCBS,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,BCBS MGG,BCBS MGG,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Cigna,Cigna,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Cigna MGG,Cigna MGG,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Humana,Humana,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Humana MGG,Humana MGG,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Optum VA,Optum VA,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,UHC,UHC,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,UHC MGG,UHC MGG,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,VA,VA,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Wellcare MGG,Wellcare MGG,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Bright Health - commercial,Bright Health - commercial,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,Bright Health MGG,Bright Health MGG,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Aetna,Aetna,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Aetna MGG,Aetna MGG,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,BCBS,BCBS,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,BCBS MGG,BCBS MGG,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Cigna,Cigna,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Cigna MGG,Cigna MGG,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Humana,Humana,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Humana MGG,Humana MGG,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Optum VA,Optum VA,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,UHC,UHC,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,UHC MGG,UHC MGG,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,VA,VA,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Wellcare MGG,Wellcare MGG,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Bright Health - commercial,Bright Health - commercial,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,10.21,10.21,Bright Health MGG,Bright Health MGG,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Aetna,Aetna,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Aetna MGG,Aetna MGG,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,BCBS,BCBS,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,BCBS MGG,BCBS MGG,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Cigna,Cigna,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Cigna MGG,Cigna MGG,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Humana,Humana,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Humana MGG,Humana MGG,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Optum VA,Optum VA,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,UHC,UHC,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,UHC MGG,UHC MGG,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,VA,VA,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Wellcare MGG,Wellcare MGG,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Bright Health - commercial,Bright Health - commercial,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,Bright Health MGG,Bright Health MGG,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Aetna,Aetna,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Aetna MGG,Aetna MGG,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,BCBS,BCBS,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,BCBS MGG,BCBS MGG,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Cigna,Cigna,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Cigna MGG,Cigna MGG,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Humana,Humana,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Humana MGG,Humana MGG,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Optum VA,Optum VA,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,UHC,UHC,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,UHC MGG,UHC MGG,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,VA,VA,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Wellcare MGG,Wellcare MGG,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Bright Health - commercial,Bright Health - commercial,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,Bright Health MGG,Bright Health MGG,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Aetna,Aetna,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Aetna MGG,Aetna MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS,BCBS,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS MGG,BCBS MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Cigna,Cigna,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Cigna MGG,Cigna MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Humana,Humana,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Humana MGG,Humana MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Optum VA,Optum VA,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,UHC,UHC,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,UHC MGG,UHC MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,VA,VA,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Wellcare MGG,Wellcare MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Bright Health - commercial,Bright Health - commercial,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Bright Health MGG,Bright Health MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Aetna,Aetna,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Aetna MGG,Aetna MGG,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,BCBS,BCBS,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,BCBS MGG,BCBS MGG,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Cigna,Cigna,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Cigna MGG,Cigna MGG,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Humana,Humana,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Humana MGG,Humana MGG,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Optum VA,Optum VA,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,UHC,UHC,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,UHC MGG,UHC MGG,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,VA,VA,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Wellcare MGG,Wellcare MGG,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Bright Health - commercial,Bright Health - commercial,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,Bright Health MGG,Bright Health MGG,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Aetna,Aetna,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Aetna MGG,Aetna MGG,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,BCBS,BCBS,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,BCBS MGG,BCBS MGG,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Cigna,Cigna,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Cigna MGG,Cigna MGG,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Humana,Humana,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Humana MGG,Humana MGG,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Optum VA,Optum VA,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,UHC,UHC,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,UHC MGG,UHC MGG,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,VA,VA,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Wellcare MGG,Wellcare MGG,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Bright Health - commercial,Bright Health - commercial,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,Bright Health MGG,Bright Health MGG,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Aetna,Aetna,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Aetna MGG,Aetna MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,BCBS,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS MGG,BCBS MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Cigna,Cigna,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Cigna MGG,Cigna MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Humana,Humana,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Humana MGG,Humana MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Optum VA,Optum VA,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UHC,UHC,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UHC MGG,UHC MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,VA,VA,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Wellcare MGG,Wellcare MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Bright Health - commercial,Bright Health - commercial,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Bright Health MGG,Bright Health MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Aetna,Aetna,124.27,,,,,,,per diem,124.27,124.27,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Aetna MGG,Aetna MGG,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,BCBS,BCBS,124.27,,,,,,,per diem,124.27,124.27,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,BCBS MGG,BCBS MGG,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Cigna,Cigna,124.27,,,,,,,per diem,124.27,124.27,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Cigna MGG,Cigna MGG,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Humana,Humana,124.27,,,,,,,per diem,124.27,124.27,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Humana MGG,Humana MGG,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Optum VA,Optum VA,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,UHC,UHC,124.27,,,,,,,per diem,124.27,124.27,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,UHC MGG,UHC MGG,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,VA,VA,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Wellcare MGG,Wellcare MGG,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Bright Health - commercial,Bright Health - commercial,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,124.27,124.27,Bright Health MGG,Bright Health MGG,124.27,,,,,,,case rate,124.27,124.27,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Aetna,Aetna,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Aetna MGG,Aetna MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS,BCBS,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS MGG,BCBS MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Cigna,Cigna,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Cigna MGG,Cigna MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Humana,Humana,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Humana MGG,Humana MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Optum VA,Optum VA,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,UHC,UHC,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,UHC MGG,UHC MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,VA,VA,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Wellcare MGG,Wellcare MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Bright Health - commercial,Bright Health - commercial,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Bright Health MGG,Bright Health MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Aetna,Aetna,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Aetna MGG,Aetna MGG,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,BCBS,BCBS,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,BCBS MGG,BCBS MGG,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Cigna,Cigna,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Cigna MGG,Cigna MGG,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Humana,Humana,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Humana MGG,Humana MGG,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Optum VA,Optum VA,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,UHC,UHC,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,UHC MGG,UHC MGG,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,VA,VA,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Wellcare MGG,Wellcare MGG,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Bright Health - commercial,Bright Health - commercial,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,Bright Health MGG,Bright Health MGG,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Aetna,Aetna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Aetna MGG,Aetna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,BCBS,BCBS,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,BCBS MGG,BCBS MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Cigna,Cigna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Cigna MGG,Cigna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Humana,Humana,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Humana MGG,Humana MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Optum VA,Optum VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,UHC,UHC,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,UHC MGG,UHC MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,VA,VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Wellcare MGG,Wellcare MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Bright Health - commercial,Bright Health - commercial,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,Bright Health MGG,Bright Health MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Aetna,Aetna,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Aetna MGG,Aetna MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,BCBS,BCBS,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,BCBS MGG,BCBS MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Cigna,Cigna,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Cigna MGG,Cigna MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Humana,Humana,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Humana MGG,Humana MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Optum VA,Optum VA,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,UHC,UHC,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,UHC MGG,UHC MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,VA,VA,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Wellcare MGG,Wellcare MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Bright Health - commercial,Bright Health - commercial,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,Bright Health MGG,Bright Health MGG,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Aetna,Aetna,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Aetna MGG,Aetna MGG,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,BCBS,BCBS,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,BCBS MGG,BCBS MGG,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Cigna,Cigna,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Cigna MGG,Cigna MGG,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Humana,Humana,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Humana MGG,Humana MGG,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Optum VA,Optum VA,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,UHC,UHC,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,UHC MGG,UHC MGG,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,VA,VA,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Wellcare MGG,Wellcare MGG,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Bright Health - commercial,Bright Health - commercial,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,Bright Health MGG,Bright Health MGG,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Aetna,Aetna,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Aetna MGG,Aetna MGG,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,BCBS,BCBS,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,BCBS MGG,BCBS MGG,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Cigna,Cigna,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Cigna MGG,Cigna MGG,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Humana,Humana,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Humana MGG,Humana MGG,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Optum VA,Optum VA,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,UHC,UHC,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,UHC MGG,UHC MGG,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,VA,VA,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Wellcare MGG,Wellcare MGG,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Bright Health - commercial,Bright Health - commercial,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,Bright Health MGG,Bright Health MGG,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Aetna,Aetna,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Aetna MGG,Aetna MGG,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,BCBS,BCBS,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,BCBS MGG,BCBS MGG,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Cigna,Cigna,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Cigna MGG,Cigna MGG,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Humana,Humana,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Humana MGG,Humana MGG,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Optum VA,Optum VA,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,UHC,UHC,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,UHC MGG,UHC MGG,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,VA,VA,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Wellcare MGG,Wellcare MGG,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Bright Health - commercial,Bright Health - commercial,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,Bright Health MGG,Bright Health MGG,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Aetna,Aetna,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Aetna MGG,Aetna MGG,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,BCBS,BCBS,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,BCBS MGG,BCBS MGG,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Cigna,Cigna,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Cigna MGG,Cigna MGG,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Humana,Humana,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Humana MGG,Humana MGG,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Optum VA,Optum VA,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,UHC,UHC,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,UHC MGG,UHC MGG,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,VA,VA,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Wellcare MGG,Wellcare MGG,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Bright Health - commercial,Bright Health - commercial,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,Bright Health MGG,Bright Health MGG,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Aetna,Aetna,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Aetna MGG,Aetna MGG,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,BCBS,BCBS,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,BCBS MGG,BCBS MGG,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Cigna,Cigna,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Cigna MGG,Cigna MGG,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Humana,Humana,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Humana MGG,Humana MGG,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Optum VA,Optum VA,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,UHC,UHC,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,UHC MGG,UHC MGG,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,VA,VA,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Wellcare MGG,Wellcare MGG,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Bright Health - commercial,Bright Health - commercial,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,Bright Health MGG,Bright Health MGG,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Aetna,Aetna,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Aetna MGG,Aetna MGG,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,BCBS,BCBS,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,BCBS MGG,BCBS MGG,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Cigna,Cigna,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Cigna MGG,Cigna MGG,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Humana,Humana,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Humana MGG,Humana MGG,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Optum VA,Optum VA,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,UHC,UHC,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,UHC MGG,UHC MGG,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,VA,VA,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Wellcare MGG,Wellcare MGG,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Bright Health - commercial,Bright Health - commercial,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,Bright Health MGG,Bright Health MGG,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Aetna,Aetna,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Aetna MGG,Aetna MGG,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,BCBS,BCBS,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,BCBS MGG,BCBS MGG,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Cigna,Cigna,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Cigna MGG,Cigna MGG,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Humana,Humana,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Humana MGG,Humana MGG,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Optum VA,Optum VA,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,UHC,UHC,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,UHC MGG,UHC MGG,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,VA,VA,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Wellcare MGG,Wellcare MGG,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Bright Health - commercial,Bright Health - commercial,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,Bright Health MGG,Bright Health MGG,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Aetna,Aetna,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Aetna MGG,Aetna MGG,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,BCBS,BCBS,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,BCBS MGG,BCBS MGG,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Cigna,Cigna,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Cigna MGG,Cigna MGG,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Humana,Humana,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Humana MGG,Humana MGG,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Optum VA,Optum VA,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,UHC,UHC,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,UHC MGG,UHC MGG,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,VA,VA,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Wellcare MGG,Wellcare MGG,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Bright Health - commercial,Bright Health - commercial,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,Bright Health MGG,Bright Health MGG,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Aetna,Aetna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Aetna MGG,Aetna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,BCBS,BCBS,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,BCBS MGG,BCBS MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Cigna,Cigna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Cigna MGG,Cigna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Humana,Humana,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Humana MGG,Humana MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Optum VA,Optum VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,UHC,UHC,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,UHC MGG,UHC MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,VA,VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Wellcare MGG,Wellcare MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Bright Health - commercial,Bright Health - commercial,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,Bright Health MGG,Bright Health MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Aetna,Aetna,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Aetna MGG,Aetna MGG,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,BCBS,BCBS,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,BCBS MGG,BCBS MGG,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Cigna,Cigna,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Cigna MGG,Cigna MGG,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Humana,Humana,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Humana MGG,Humana MGG,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Optum VA,Optum VA,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,UHC,UHC,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,UHC MGG,UHC MGG,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,VA,VA,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Wellcare MGG,Wellcare MGG,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Bright Health - commercial,Bright Health - commercial,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,Bright Health MGG,Bright Health MGG,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Aetna,Aetna,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Aetna MGG,Aetna MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS,BCBS,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS MGG,BCBS MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Cigna,Cigna,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Cigna MGG,Cigna MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Humana,Humana,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Humana MGG,Humana MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Optum VA,Optum VA,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,UHC,UHC,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,UHC MGG,UHC MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,VA,VA,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Wellcare MGG,Wellcare MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Bright Health - commercial,Bright Health - commercial,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Bright Health MGG,Bright Health MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Aetna,Aetna,430.61,,,,,,,per diem,430.61,430.61,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Aetna MGG,Aetna MGG,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,BCBS,BCBS,430.61,,,,,,,per diem,430.61,430.61,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,BCBS MGG,BCBS MGG,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Cigna,Cigna,430.61,,,,,,,per diem,430.61,430.61,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Cigna MGG,Cigna MGG,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Humana,Humana,430.61,,,,,,,per diem,430.61,430.61,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Humana MGG,Humana MGG,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Optum VA,Optum VA,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,UHC,UHC,430.61,,,,,,,per diem,430.61,430.61,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,UHC MGG,UHC MGG,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,VA,VA,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Wellcare MGG,Wellcare MGG,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Bright Health - commercial,Bright Health - commercial,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,430.61,430.61,Bright Health MGG,Bright Health MGG,430.61,,,,,,,case rate,430.61,430.61,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Aetna,Aetna,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Aetna MGG,Aetna MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,BCBS,BCBS,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,BCBS MGG,BCBS MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Cigna,Cigna,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Cigna MGG,Cigna MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Humana,Humana,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Humana MGG,Humana MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Optum VA,Optum VA,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,UHC,UHC,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,UHC MGG,UHC MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,VA,VA,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Wellcare MGG,Wellcare MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Bright Health - commercial,Bright Health - commercial,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,Bright Health MGG,Bright Health MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Aetna,Aetna,128.38,,,,,,,per diem,128.38,128.38,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Aetna MGG,Aetna MGG,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,BCBS,BCBS,128.38,,,,,,,per diem,128.38,128.38,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,BCBS MGG,BCBS MGG,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Cigna,Cigna,128.38,,,,,,,per diem,128.38,128.38,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Cigna MGG,Cigna MGG,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Humana,Humana,128.38,,,,,,,per diem,128.38,128.38,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Humana MGG,Humana MGG,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Optum VA,Optum VA,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,UHC,UHC,128.38,,,,,,,per diem,128.38,128.38,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,UHC MGG,UHC MGG,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,VA,VA,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Wellcare MGG,Wellcare MGG,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Bright Health - commercial,Bright Health - commercial,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,128.38,128.38,Bright Health MGG,Bright Health MGG,128.38,,,,,,,case rate,128.38,128.38,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Aetna,Aetna,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Aetna MGG,Aetna MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,BCBS,BCBS,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,BCBS MGG,BCBS MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Cigna,Cigna,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Cigna MGG,Cigna MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Humana,Humana,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Humana MGG,Humana MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Optum VA,Optum VA,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,UHC,UHC,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,UHC MGG,UHC MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,VA,VA,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Wellcare MGG,Wellcare MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Bright Health - commercial,Bright Health - commercial,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,46.71,46.71,Bright Health MGG,Bright Health MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Aetna,Aetna,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Aetna MGG,Aetna MGG,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,BCBS,BCBS,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,BCBS MGG,BCBS MGG,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Cigna,Cigna,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Cigna MGG,Cigna MGG,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Humana,Humana,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Humana MGG,Humana MGG,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Optum VA,Optum VA,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,UHC,UHC,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,UHC MGG,UHC MGG,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,VA,VA,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Wellcare MGG,Wellcare MGG,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Bright Health - commercial,Bright Health - commercial,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,Bright Health MGG,Bright Health MGG,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Aetna,Aetna,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Aetna MGG,Aetna MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,BCBS,BCBS,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,BCBS MGG,BCBS MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Cigna,Cigna,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Cigna MGG,Cigna MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Humana,Humana,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Humana MGG,Humana MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Optum VA,Optum VA,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,UHC,UHC,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,UHC MGG,UHC MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,VA,VA,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Wellcare MGG,Wellcare MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Bright Health - commercial,Bright Health - commercial,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,Bright Health MGG,Bright Health MGG,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Aetna,Aetna,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Aetna MGG,Aetna MGG,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,BCBS,BCBS,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,BCBS MGG,BCBS MGG,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Cigna,Cigna,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Cigna MGG,Cigna MGG,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Humana,Humana,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Humana MGG,Humana MGG,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Optum VA,Optum VA,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,UHC,UHC,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,UHC MGG,UHC MGG,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,VA,VA,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Wellcare MGG,Wellcare MGG,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Bright Health - commercial,Bright Health - commercial,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,Bright Health MGG,Bright Health MGG,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Aetna,Aetna,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Aetna MGG,Aetna MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,BCBS,BCBS,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,BCBS MGG,BCBS MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Cigna,Cigna,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Cigna MGG,Cigna MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Humana,Humana,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Humana MGG,Humana MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Optum VA,Optum VA,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,UHC,UHC,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,UHC MGG,UHC MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,VA,VA,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Wellcare MGG,Wellcare MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Bright Health - commercial,Bright Health - commercial,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,Bright Health MGG,Bright Health MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Aetna,Aetna,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Aetna MGG,Aetna MGG,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,BCBS,BCBS,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,BCBS MGG,BCBS MGG,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Cigna,Cigna,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Cigna MGG,Cigna MGG,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Humana,Humana,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Humana MGG,Humana MGG,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Optum VA,Optum VA,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,UHC,UHC,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,UHC MGG,UHC MGG,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,VA,VA,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Wellcare MGG,Wellcare MGG,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Bright Health - commercial,Bright Health - commercial,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,Bright Health MGG,Bright Health MGG,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Aetna,Aetna,66.01,,,,,,,per diem,66.01,66.01,"Per diem rate, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Aetna MGG,Aetna MGG,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,BCBS,BCBS,66.01,,,,,,,per diem,66.01,66.01,"Per diem rate, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,BCBS MGG,BCBS MGG,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Cigna,Cigna,66.01,,,,,,,per diem,66.01,66.01,"Per diem rate, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Cigna MGG,Cigna MGG,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Humana,Humana,66.01,,,,,,,per diem,66.01,66.01,"Per diem rate, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Humana MGG,Humana MGG,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Optum VA,Optum VA,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,UHC,UHC,66.01,,,,,,,per diem,66.01,66.01,"Per diem rate, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,UHC MGG,UHC MGG,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,VA,VA,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Wellcare MGG,Wellcare MGG,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Bright Health - commercial,Bright Health - commercial,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
ESTROGEN                      ,38202960,CDM,301,RC,82672,CPT,,,,Inpatient,,,66.01,66.01,Bright Health MGG,Bright Health MGG,66.01,,,,,,,case rate,66.01,66.01,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Aetna,Aetna,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Aetna MGG,Aetna MGG,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,BCBS,BCBS,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,BCBS MGG,BCBS MGG,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Cigna,Cigna,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Cigna MGG,Cigna MGG,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Humana,Humana,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Humana MGG,Humana MGG,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Optum VA,Optum VA,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,UHC,UHC,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,UHC MGG,UHC MGG,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,VA,VA,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Wellcare MGG,Wellcare MGG,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Bright Health - commercial,Bright Health - commercial,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,Bright Health MGG,Bright Health MGG,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Aetna,Aetna,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Aetna MGG,Aetna MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,BCBS,BCBS,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,BCBS MGG,BCBS MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Cigna,Cigna,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Cigna MGG,Cigna MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Humana,Humana,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Humana MGG,Humana MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Optum VA,Optum VA,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,UHC,UHC,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,UHC MGG,UHC MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,VA,VA,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Wellcare MGG,Wellcare MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Bright Health - commercial,Bright Health - commercial,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,142.2,142.2,Bright Health MGG,Bright Health MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Aetna,Aetna,76.7,,,,,,,per diem,76.7,76.7,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Aetna MGG,Aetna MGG,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,BCBS,BCBS,76.7,,,,,,,per diem,76.7,76.7,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,BCBS MGG,BCBS MGG,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Cigna,Cigna,76.7,,,,,,,per diem,76.7,76.7,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Cigna MGG,Cigna MGG,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Humana,Humana,76.7,,,,,,,per diem,76.7,76.7,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Humana MGG,Humana MGG,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Optum VA,Optum VA,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,UHC,UHC,76.7,,,,,,,per diem,76.7,76.7,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,UHC MGG,UHC MGG,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,VA,VA,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Wellcare MGG,Wellcare MGG,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Bright Health - commercial,Bright Health - commercial,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,76.7,76.7,Bright Health MGG,Bright Health MGG,76.7,,,,,,,case rate,76.7,76.7,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Aetna,Aetna,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Aetna MGG,Aetna MGG,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,BCBS,BCBS,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,BCBS MGG,BCBS MGG,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Cigna,Cigna,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Cigna MGG,Cigna MGG,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Humana,Humana,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Humana MGG,Humana MGG,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Optum VA,Optum VA,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,UHC,UHC,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,UHC MGG,UHC MGG,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,VA,VA,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Wellcare MGG,Wellcare MGG,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Bright Health - commercial,Bright Health - commercial,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,Bright Health MGG,Bright Health MGG,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Aetna,Aetna,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Aetna MGG,Aetna MGG,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,BCBS,BCBS,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,BCBS MGG,BCBS MGG,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Cigna,Cigna,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Cigna MGG,Cigna MGG,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Humana,Humana,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Humana MGG,Humana MGG,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Optum VA,Optum VA,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,UHC,UHC,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,UHC MGG,UHC MGG,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,VA,VA,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Wellcare MGG,Wellcare MGG,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Bright Health - commercial,Bright Health - commercial,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,Bright Health MGG,Bright Health MGG,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Aetna,Aetna,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Aetna MGG,Aetna MGG,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,BCBS,BCBS,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,BCBS MGG,BCBS MGG,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Cigna,Cigna,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Cigna MGG,Cigna MGG,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Humana,Humana,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Humana MGG,Humana MGG,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Optum VA,Optum VA,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,UHC,UHC,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,UHC MGG,UHC MGG,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,VA,VA,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Wellcare MGG,Wellcare MGG,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Bright Health - commercial,Bright Health - commercial,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,Bright Health MGG,Bright Health MGG,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Aetna,Aetna,59.29,,,,,,,per diem,59.29,59.29,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Aetna MGG,Aetna MGG,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,BCBS,BCBS,59.29,,,,,,,per diem,59.29,59.29,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,BCBS MGG,BCBS MGG,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Cigna,Cigna,59.29,,,,,,,per diem,59.29,59.29,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Cigna MGG,Cigna MGG,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Humana,Humana,59.29,,,,,,,per diem,59.29,59.29,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Humana MGG,Humana MGG,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Optum VA,Optum VA,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,UHC,UHC,59.29,,,,,,,per diem,59.29,59.29,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,UHC MGG,UHC MGG,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,VA,VA,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Wellcare MGG,Wellcare MGG,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Bright Health - commercial,Bright Health - commercial,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,59.29,59.29,Bright Health MGG,Bright Health MGG,59.29,,,,,,,case rate,59.29,59.29,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Aetna,Aetna,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Aetna MGG,Aetna MGG,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,BCBS,BCBS,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,BCBS MGG,BCBS MGG,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Cigna,Cigna,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Cigna MGG,Cigna MGG,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Humana,Humana,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Humana MGG,Humana MGG,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Optum VA,Optum VA,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,UHC,UHC,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,UHC MGG,UHC MGG,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,VA,VA,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Wellcare MGG,Wellcare MGG,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Bright Health - commercial,Bright Health - commercial,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,Bright Health MGG,Bright Health MGG,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Aetna,Aetna,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Aetna MGG,Aetna MGG,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,BCBS,BCBS,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,BCBS MGG,BCBS MGG,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Cigna,Cigna,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Cigna MGG,Cigna MGG,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Humana,Humana,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Humana MGG,Humana MGG,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Optum VA,Optum VA,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,UHC,UHC,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,UHC MGG,UHC MGG,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,VA,VA,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Wellcare MGG,Wellcare MGG,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Bright Health - commercial,Bright Health - commercial,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,Bright Health MGG,Bright Health MGG,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Aetna,Aetna,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Aetna MGG,Aetna MGG,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,BCBS,BCBS,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,BCBS MGG,BCBS MGG,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Cigna,Cigna,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Cigna MGG,Cigna MGG,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Humana,Humana,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Humana MGG,Humana MGG,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Optum VA,Optum VA,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,UHC,UHC,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,UHC MGG,UHC MGG,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,VA,VA,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Wellcare MGG,Wellcare MGG,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Bright Health - commercial,Bright Health - commercial,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,Bright Health MGG,Bright Health MGG,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Aetna,Aetna,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Aetna MGG,Aetna MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,BCBS,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS MGG,BCBS MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Cigna,Cigna,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Cigna MGG,Cigna MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Humana,Humana,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Humana MGG,Humana MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Optum VA,Optum VA,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,UHC,UHC,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,UHC MGG,UHC MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,VA,VA,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Wellcare MGG,Wellcare MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Bright Health - commercial,Bright Health - commercial,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Bright Health MGG,Bright Health MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Aetna,Aetna,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Aetna MGG,Aetna MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,BCBS,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS MGG,BCBS MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Cigna,Cigna,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Cigna MGG,Cigna MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Humana,Humana,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Humana MGG,Humana MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Optum VA,Optum VA,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,UHC,UHC,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,UHC MGG,UHC MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,VA,VA,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Wellcare MGG,Wellcare MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Bright Health - commercial,Bright Health - commercial,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,Bright Health MGG,Bright Health MGG,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Aetna,Aetna,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Aetna MGG,Aetna MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,BCBS,BCBS,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,BCBS MGG,BCBS MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Cigna,Cigna,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Cigna MGG,Cigna MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Humana,Humana,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Humana MGG,Humana MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Optum VA,Optum VA,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,UHC,UHC,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,UHC MGG,UHC MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,VA,VA,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Wellcare MGG,Wellcare MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Bright Health - commercial,Bright Health - commercial,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,29.07,29.07,Bright Health MGG,Bright Health MGG,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Aetna,Aetna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Aetna MGG,Aetna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,BCBS,BCBS,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,BCBS MGG,BCBS MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Cigna,Cigna,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Cigna MGG,Cigna MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Humana,Humana,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Humana MGG,Humana MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Optum VA,Optum VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,UHC,UHC,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,UHC MGG,UHC MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,VA,VA,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Wellcare MGG,Wellcare MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Bright Health - commercial,Bright Health - commercial,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,Bright Health MGG,Bright Health MGG,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Aetna,Aetna,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Aetna MGG,Aetna MGG,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,BCBS,BCBS,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,BCBS MGG,BCBS MGG,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Cigna,Cigna,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Cigna MGG,Cigna MGG,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Humana,Humana,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Humana MGG,Humana MGG,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Optum VA,Optum VA,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,UHC,UHC,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,UHC MGG,UHC MGG,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,VA,VA,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Wellcare MGG,Wellcare MGG,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Bright Health - commercial,Bright Health - commercial,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,Bright Health MGG,Bright Health MGG,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Aetna,Aetna,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Aetna MGG,Aetna MGG,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,BCBS,BCBS,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,BCBS MGG,BCBS MGG,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Cigna,Cigna,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Cigna MGG,Cigna MGG,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Humana,Humana,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Humana MGG,Humana MGG,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Optum VA,Optum VA,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,UHC,UHC,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,UHC MGG,UHC MGG,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,VA,VA,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Wellcare MGG,Wellcare MGG,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Bright Health - commercial,Bright Health - commercial,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,Bright Health MGG,Bright Health MGG,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Aetna,Aetna,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Aetna MGG,Aetna MGG,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,BCBS,BCBS,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,BCBS MGG,BCBS MGG,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Cigna,Cigna,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Cigna MGG,Cigna MGG,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Humana,Humana,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Humana MGG,Humana MGG,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Optum VA,Optum VA,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,UHC,UHC,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,UHC MGG,UHC MGG,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,VA,VA,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Wellcare MGG,Wellcare MGG,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Bright Health - commercial,Bright Health - commercial,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,Bright Health MGG,Bright Health MGG,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Aetna,Aetna,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Aetna MGG,Aetna MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,BCBS,BCBS,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,BCBS MGG,BCBS MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Cigna,Cigna,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Cigna MGG,Cigna MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Humana,Humana,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Humana MGG,Humana MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Optum VA,Optum VA,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,UHC,UHC,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,UHC MGG,UHC MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,VA,VA,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Wellcare MGG,Wellcare MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Bright Health - commercial,Bright Health - commercial,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,Bright Health MGG,Bright Health MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Aetna,Aetna,103.07,,,,,,,per diem,103.07,103.07,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Aetna MGG,Aetna MGG,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,BCBS,BCBS,103.07,,,,,,,per diem,103.07,103.07,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,BCBS MGG,BCBS MGG,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Cigna,Cigna,103.07,,,,,,,per diem,103.07,103.07,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Cigna MGG,Cigna MGG,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Humana,Humana,103.07,,,,,,,per diem,103.07,103.07,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Humana MGG,Humana MGG,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Optum VA,Optum VA,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,UHC,UHC,103.07,,,,,,,per diem,103.07,103.07,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,UHC MGG,UHC MGG,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,VA,VA,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Wellcare MGG,Wellcare MGG,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Bright Health - commercial,Bright Health - commercial,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,103.07,103.07,Bright Health MGG,Bright Health MGG,103.07,,,,,,,case rate,103.07,103.07,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Aetna,Aetna,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Aetna MGG,Aetna MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS,BCBS,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS MGG,BCBS MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Cigna,Cigna,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Cigna MGG,Cigna MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Humana,Humana,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Humana MGG,Humana MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Optum VA,Optum VA,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,UHC,UHC,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,UHC MGG,UHC MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,VA,VA,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Wellcare MGG,Wellcare MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Bright Health - commercial,Bright Health - commercial,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Bright Health MGG,Bright Health MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Aetna,Aetna,214.31,,,,,,,per diem,214.31,214.31,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Aetna MGG,Aetna MGG,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,BCBS,BCBS,214.31,,,,,,,per diem,214.31,214.31,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,BCBS MGG,BCBS MGG,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Cigna,Cigna,214.31,,,,,,,per diem,214.31,214.31,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Cigna MGG,Cigna MGG,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Humana,Humana,214.31,,,,,,,per diem,214.31,214.31,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Humana MGG,Humana MGG,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Optum VA,Optum VA,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,UHC,UHC,214.31,,,,,,,per diem,214.31,214.31,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,UHC MGG,UHC MGG,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,VA,VA,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Wellcare MGG,Wellcare MGG,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Bright Health - commercial,Bright Health - commercial,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,214.31,214.31,Bright Health MGG,Bright Health MGG,214.31,,,,,,,case rate,214.31,214.31,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Aetna,Aetna,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Aetna MGG,Aetna MGG,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,BCBS,BCBS,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,BCBS MGG,BCBS MGG,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Cigna,Cigna,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Cigna MGG,Cigna MGG,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Humana,Humana,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Humana MGG,Humana MGG,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Optum VA,Optum VA,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,UHC,UHC,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,UHC MGG,UHC MGG,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,VA,VA,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Wellcare MGG,Wellcare MGG,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Bright Health - commercial,Bright Health - commercial,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,Bright Health MGG,Bright Health MGG,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Aetna,Aetna,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Aetna MGG,Aetna MGG,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,BCBS,BCBS,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,BCBS MGG,BCBS MGG,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Cigna,Cigna,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Cigna MGG,Cigna MGG,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Humana,Humana,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Humana MGG,Humana MGG,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Optum VA,Optum VA,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,UHC,UHC,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,UHC MGG,UHC MGG,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,VA,VA,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Wellcare MGG,Wellcare MGG,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Bright Health - commercial,Bright Health - commercial,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,Bright Health MGG,Bright Health MGG,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Aetna,Aetna,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Aetna MGG,Aetna MGG,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,BCBS,BCBS,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,BCBS MGG,BCBS MGG,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Cigna,Cigna,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Cigna MGG,Cigna MGG,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Humana,Humana,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Humana MGG,Humana MGG,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Optum VA,Optum VA,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,UHC,UHC,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,UHC MGG,UHC MGG,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,VA,VA,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Wellcare MGG,Wellcare MGG,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Bright Health - commercial,Bright Health - commercial,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,Bright Health MGG,Bright Health MGG,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Aetna,Aetna,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Aetna MGG,Aetna MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,BCBS,BCBS,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,BCBS MGG,BCBS MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Cigna,Cigna,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Cigna MGG,Cigna MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Humana,Humana,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Humana MGG,Humana MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Optum VA,Optum VA,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,UHC,UHC,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,UHC MGG,UHC MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,VA,VA,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Wellcare MGG,Wellcare MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Bright Health - commercial,Bright Health - commercial,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,55.65,55.65,Bright Health MGG,Bright Health MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Aetna,Aetna,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Aetna MGG,Aetna MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS,BCBS,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS MGG,BCBS MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Cigna,Cigna,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Cigna MGG,Cigna MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Humana,Humana,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Humana MGG,Humana MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Optum VA,Optum VA,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,UHC,UHC,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,UHC MGG,UHC MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,VA,VA,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Wellcare MGG,Wellcare MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Bright Health - commercial,Bright Health - commercial,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Bright Health MGG,Bright Health MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Aetna,Aetna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Aetna MGG,Aetna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,BCBS,BCBS,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,BCBS MGG,BCBS MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Cigna,Cigna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Cigna MGG,Cigna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Humana,Humana,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Humana MGG,Humana MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Optum VA,Optum VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,UHC,UHC,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,UHC MGG,UHC MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,VA,VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Wellcare MGG,Wellcare MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Bright Health - commercial,Bright Health - commercial,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,Bright Health MGG,Bright Health MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Aetna,Aetna,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Aetna MGG,Aetna MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,BCBS,BCBS,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,BCBS MGG,BCBS MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Cigna,Cigna,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Cigna MGG,Cigna MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Humana,Humana,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Humana MGG,Humana MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Optum VA,Optum VA,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,UHC,UHC,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,UHC MGG,UHC MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,VA,VA,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Wellcare MGG,Wellcare MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Bright Health - commercial,Bright Health - commercial,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,Bright Health MGG,Bright Health MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Aetna,Aetna,18.43,,,,,,,per diem,18.43,18.43,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Aetna MGG,Aetna MGG,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,BCBS,BCBS,18.43,,,,,,,per diem,18.43,18.43,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,BCBS MGG,BCBS MGG,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Cigna,Cigna,18.43,,,,,,,per diem,18.43,18.43,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Cigna MGG,Cigna MGG,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Humana,Humana,18.43,,,,,,,per diem,18.43,18.43,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Humana MGG,Humana MGG,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Optum VA,Optum VA,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,UHC,UHC,18.43,,,,,,,per diem,18.43,18.43,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,UHC MGG,UHC MGG,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,VA,VA,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Wellcare MGG,Wellcare MGG,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Bright Health - commercial,Bright Health - commercial,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,18.43,18.43,Bright Health MGG,Bright Health MGG,18.43,,,,,,,case rate,18.43,18.43,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Aetna,Aetna,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Aetna MGG,Aetna MGG,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,BCBS,BCBS,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,BCBS MGG,BCBS MGG,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Cigna,Cigna,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Cigna MGG,Cigna MGG,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Humana,Humana,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Humana MGG,Humana MGG,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Optum VA,Optum VA,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,UHC,UHC,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,UHC MGG,UHC MGG,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,VA,VA,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Wellcare MGG,Wellcare MGG,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Bright Health - commercial,Bright Health - commercial,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,Bright Health MGG,Bright Health MGG,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Aetna,Aetna,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Aetna MGG,Aetna MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,BCBS,BCBS,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,BCBS MGG,BCBS MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Cigna,Cigna,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Cigna MGG,Cigna MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Humana,Humana,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Humana MGG,Humana MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Optum VA,Optum VA,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,UHC,UHC,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,UHC MGG,UHC MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,VA,VA,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Wellcare MGG,Wellcare MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Bright Health - commercial,Bright Health - commercial,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,Bright Health MGG,Bright Health MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Aetna,Aetna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Aetna MGG,Aetna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,BCBS,BCBS,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,BCBS MGG,BCBS MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Cigna,Cigna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Cigna MGG,Cigna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Humana,Humana,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Humana MGG,Humana MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Optum VA,Optum VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,UHC,UHC,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,UHC MGG,UHC MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,VA,VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Wellcare MGG,Wellcare MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Bright Health - commercial,Bright Health - commercial,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,Bright Health MGG,Bright Health MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Aetna,Aetna,231.97,,,,,,,per diem,231.97,231.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Aetna MGG,Aetna MGG,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,BCBS,BCBS,231.97,,,,,,,per diem,231.97,231.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,BCBS MGG,BCBS MGG,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Cigna,Cigna,231.97,,,,,,,per diem,231.97,231.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Cigna MGG,Cigna MGG,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Humana,Humana,231.97,,,,,,,per diem,231.97,231.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Humana MGG,Humana MGG,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Optum VA,Optum VA,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,UHC,UHC,231.97,,,,,,,per diem,231.97,231.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,UHC MGG,UHC MGG,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,VA,VA,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Wellcare MGG,Wellcare MGG,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Bright Health - commercial,Bright Health - commercial,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,231.97,231.97,Bright Health MGG,Bright Health MGG,231.97,,,,,,,case rate,231.97,231.97,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Aetna,Aetna,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Aetna MGG,Aetna MGG,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,BCBS,BCBS,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,BCBS MGG,BCBS MGG,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Cigna,Cigna,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Cigna MGG,Cigna MGG,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Humana,Humana,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Humana MGG,Humana MGG,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Optum VA,Optum VA,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,UHC,UHC,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,UHC MGG,UHC MGG,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,VA,VA,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Wellcare MGG,Wellcare MGG,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Bright Health - commercial,Bright Health - commercial,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,Bright Health MGG,Bright Health MGG,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Aetna,Aetna,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Aetna MGG,Aetna MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,BCBS,BCBS,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,BCBS MGG,BCBS MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Cigna,Cigna,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Cigna MGG,Cigna MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Humana,Humana,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Humana MGG,Humana MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Optum VA,Optum VA,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,UHC,UHC,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,UHC MGG,UHC MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,VA,VA,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Wellcare MGG,Wellcare MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Bright Health - commercial,Bright Health - commercial,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,Bright Health MGG,Bright Health MGG,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Aetna,Aetna,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Aetna MGG,Aetna MGG,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,BCBS,BCBS,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,BCBS MGG,BCBS MGG,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Cigna,Cigna,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Cigna MGG,Cigna MGG,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Humana,Humana,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Humana MGG,Humana MGG,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Optum VA,Optum VA,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,UHC,UHC,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,UHC MGG,UHC MGG,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,VA,VA,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Wellcare MGG,Wellcare MGG,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Bright Health - commercial,Bright Health - commercial,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,Bright Health MGG,Bright Health MGG,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Aetna,Aetna,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Aetna MGG,Aetna MGG,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,BCBS,BCBS,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,BCBS MGG,BCBS MGG,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Cigna,Cigna,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Cigna MGG,Cigna MGG,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Humana,Humana,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Humana MGG,Humana MGG,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Optum VA,Optum VA,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,UHC,UHC,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,UHC MGG,UHC MGG,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,VA,VA,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Wellcare MGG,Wellcare MGG,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Bright Health - commercial,Bright Health - commercial,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,Bright Health MGG,Bright Health MGG,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Aetna,Aetna,132.43,,,,,,,per diem,132.43,132.43,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Aetna MGG,Aetna MGG,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,BCBS,BCBS,132.43,,,,,,,per diem,132.43,132.43,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,BCBS MGG,BCBS MGG,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Cigna,Cigna,132.43,,,,,,,per diem,132.43,132.43,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Cigna MGG,Cigna MGG,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Humana,Humana,132.43,,,,,,,per diem,132.43,132.43,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Humana MGG,Humana MGG,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Optum VA,Optum VA,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,UHC,UHC,132.43,,,,,,,per diem,132.43,132.43,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,UHC MGG,UHC MGG,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,VA,VA,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Wellcare MGG,Wellcare MGG,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Bright Health - commercial,Bright Health - commercial,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,132.43,132.43,Bright Health MGG,Bright Health MGG,132.43,,,,,,,case rate,132.43,132.43,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Aetna,Aetna,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Aetna MGG,Aetna MGG,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,BCBS,BCBS,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,BCBS MGG,BCBS MGG,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Cigna,Cigna,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Cigna MGG,Cigna MGG,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Humana,Humana,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Humana MGG,Humana MGG,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Optum VA,Optum VA,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,UHC,UHC,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,UHC MGG,UHC MGG,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,VA,VA,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Wellcare MGG,Wellcare MGG,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Bright Health - commercial,Bright Health - commercial,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,Bright Health MGG,Bright Health MGG,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Aetna,Aetna,250.32,,,,,,,per diem,250.32,250.32,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Aetna MGG,Aetna MGG,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,BCBS,BCBS,250.32,,,,,,,per diem,250.32,250.32,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,BCBS MGG,BCBS MGG,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Cigna,Cigna,250.32,,,,,,,per diem,250.32,250.32,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Cigna MGG,Cigna MGG,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Humana,Humana,250.32,,,,,,,per diem,250.32,250.32,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Humana MGG,Humana MGG,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Optum VA,Optum VA,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,UHC,UHC,250.32,,,,,,,per diem,250.32,250.32,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,UHC MGG,UHC MGG,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,VA,VA,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Wellcare MGG,Wellcare MGG,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Bright Health - commercial,Bright Health - commercial,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,250.32,250.32,Bright Health MGG,Bright Health MGG,250.32,,,,,,,case rate,250.32,250.32,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Aetna,Aetna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Aetna MGG,Aetna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,BCBS,BCBS,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,BCBS MGG,BCBS MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Cigna,Cigna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Cigna MGG,Cigna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Humana,Humana,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Humana MGG,Humana MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Optum VA,Optum VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,UHC,UHC,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,UHC MGG,UHC MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,VA,VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Wellcare MGG,Wellcare MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Bright Health - commercial,Bright Health - commercial,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,Bright Health MGG,Bright Health MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Aetna,Aetna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Aetna MGG,Aetna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,BCBS,BCBS,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,BCBS MGG,BCBS MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Cigna,Cigna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Cigna MGG,Cigna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Humana,Humana,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Humana MGG,Humana MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Optum VA,Optum VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,UHC,UHC,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,UHC MGG,UHC MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,VA,VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Wellcare MGG,Wellcare MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Bright Health - commercial,Bright Health - commercial,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,Bright Health MGG,Bright Health MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Aetna,Aetna,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Aetna MGG,Aetna MGG,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,BCBS,BCBS,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,BCBS MGG,BCBS MGG,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Cigna,Cigna,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Cigna MGG,Cigna MGG,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Humana,Humana,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Humana MGG,Humana MGG,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Optum VA,Optum VA,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,UHC,UHC,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,UHC MGG,UHC MGG,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,VA,VA,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Wellcare MGG,Wellcare MGG,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Bright Health - commercial,Bright Health - commercial,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,13.23,13.23,Bright Health MGG,Bright Health MGG,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Aetna,Aetna,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Aetna MGG,Aetna MGG,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,BCBS,BCBS,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,BCBS MGG,BCBS MGG,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Cigna,Cigna,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Cigna MGG,Cigna MGG,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Humana,Humana,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Humana MGG,Humana MGG,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Optum VA,Optum VA,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,UHC,UHC,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,UHC MGG,UHC MGG,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,VA,VA,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Wellcare MGG,Wellcare MGG,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Bright Health - commercial,Bright Health - commercial,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,Bright Health MGG,Bright Health MGG,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Aetna,Aetna,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Aetna MGG,Aetna MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,BCBS,BCBS,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,BCBS MGG,BCBS MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Cigna,Cigna,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Cigna MGG,Cigna MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Humana,Humana,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Humana MGG,Humana MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Optum VA,Optum VA,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,UHC,UHC,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,UHC MGG,UHC MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,VA,VA,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Wellcare MGG,Wellcare MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Bright Health - commercial,Bright Health - commercial,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,Bright Health MGG,Bright Health MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Aetna,Aetna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Aetna MGG,Aetna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,BCBS,BCBS,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,BCBS MGG,BCBS MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Cigna,Cigna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Cigna MGG,Cigna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Humana,Humana,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Humana MGG,Humana MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Optum VA,Optum VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,UHC,UHC,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,UHC MGG,UHC MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,VA,VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Wellcare MGG,Wellcare MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Bright Health - commercial,Bright Health - commercial,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,137.09,137.09,Bright Health MGG,Bright Health MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Aetna,Aetna,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Aetna MGG,Aetna MGG,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,BCBS,BCBS,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,BCBS MGG,BCBS MGG,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Cigna,Cigna,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Cigna MGG,Cigna MGG,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Humana,Humana,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Humana MGG,Humana MGG,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Optum VA,Optum VA,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,UHC,UHC,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,UHC MGG,UHC MGG,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,VA,VA,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Wellcare MGG,Wellcare MGG,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Bright Health - commercial,Bright Health - commercial,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,Bright Health MGG,Bright Health MGG,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Aetna,Aetna,20.64,,,,,,,per diem,20.64,20.64,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Aetna MGG,Aetna MGG,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,BCBS,BCBS,20.64,,,,,,,per diem,20.64,20.64,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,BCBS MGG,BCBS MGG,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Cigna,Cigna,20.64,,,,,,,per diem,20.64,20.64,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Cigna MGG,Cigna MGG,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Humana,Humana,20.64,,,,,,,per diem,20.64,20.64,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Humana MGG,Humana MGG,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Optum VA,Optum VA,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,UHC,UHC,20.64,,,,,,,per diem,20.64,20.64,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,UHC MGG,UHC MGG,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,VA,VA,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Wellcare MGG,Wellcare MGG,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Bright Health - commercial,Bright Health - commercial,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,20.64,20.64,Bright Health MGG,Bright Health MGG,20.64,,,,,,,case rate,20.64,20.64,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Aetna,Aetna,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Aetna MGG,Aetna MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,BCBS,BCBS,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,BCBS MGG,BCBS MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Cigna,Cigna,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Cigna MGG,Cigna MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Humana,Humana,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Humana MGG,Humana MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Optum VA,Optum VA,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,UHC,UHC,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,UHC MGG,UHC MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,VA,VA,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Wellcare MGG,Wellcare MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Bright Health - commercial,Bright Health - commercial,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,Bright Health MGG,Bright Health MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Aetna,Aetna,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Aetna MGG,Aetna MGG,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,BCBS,BCBS,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,BCBS MGG,BCBS MGG,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Cigna,Cigna,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Cigna MGG,Cigna MGG,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Humana,Humana,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Humana MGG,Humana MGG,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Optum VA,Optum VA,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,UHC,UHC,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,UHC MGG,UHC MGG,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,VA,VA,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Wellcare MGG,Wellcare MGG,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Bright Health - commercial,Bright Health - commercial,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,Bright Health MGG,Bright Health MGG,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Aetna,Aetna,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Aetna MGG,Aetna MGG,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,BCBS,BCBS,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,BCBS MGG,BCBS MGG,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Cigna,Cigna,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Cigna MGG,Cigna MGG,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Humana,Humana,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Humana MGG,Humana MGG,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Optum VA,Optum VA,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,UHC,UHC,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,UHC MGG,UHC MGG,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,VA,VA,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Wellcare MGG,Wellcare MGG,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Bright Health - commercial,Bright Health - commercial,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,Bright Health MGG,Bright Health MGG,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Aetna,Aetna,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Aetna MGG,Aetna MGG,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,BCBS,BCBS,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,BCBS MGG,BCBS MGG,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Cigna,Cigna,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Cigna MGG,Cigna MGG,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Humana,Humana,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Humana MGG,Humana MGG,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Optum VA,Optum VA,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,UHC,UHC,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,UHC MGG,UHC MGG,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,VA,VA,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Wellcare MGG,Wellcare MGG,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Bright Health - commercial,Bright Health - commercial,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,Bright Health MGG,Bright Health MGG,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Aetna,Aetna,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Aetna MGG,Aetna MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,BCBS,BCBS,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,BCBS MGG,BCBS MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Cigna,Cigna,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Cigna MGG,Cigna MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Humana,Humana,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Humana MGG,Humana MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Optum VA,Optum VA,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,UHC,UHC,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,UHC MGG,UHC MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,VA,VA,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Wellcare MGG,Wellcare MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Bright Health - commercial,Bright Health - commercial,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,17.04,17.04,Bright Health MGG,Bright Health MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Aetna,Aetna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Aetna MGG,Aetna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,BCBS,BCBS,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,BCBS MGG,BCBS MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Cigna,Cigna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Cigna MGG,Cigna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Humana,Humana,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Humana MGG,Humana MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Optum VA,Optum VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,UHC,UHC,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,UHC MGG,UHC MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,VA,VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Wellcare MGG,Wellcare MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Bright Health - commercial,Bright Health - commercial,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,7.47,7.47,Bright Health MGG,Bright Health MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Aetna,Aetna,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Aetna MGG,Aetna MGG,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,BCBS,BCBS,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,BCBS MGG,BCBS MGG,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Cigna,Cigna,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Cigna MGG,Cigna MGG,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Humana,Humana,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Humana MGG,Humana MGG,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Optum VA,Optum VA,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,UHC,UHC,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,UHC MGG,UHC MGG,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,VA,VA,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Wellcare MGG,Wellcare MGG,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Bright Health - commercial,Bright Health - commercial,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,Bright Health MGG,Bright Health MGG,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Aetna,Aetna,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Aetna MGG,Aetna MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,BCBS,BCBS,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,BCBS MGG,BCBS MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Cigna,Cigna,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Cigna MGG,Cigna MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Humana,Humana,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Humana MGG,Humana MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Optum VA,Optum VA,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,UHC,UHC,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,UHC MGG,UHC MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,VA,VA,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Wellcare MGG,Wellcare MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Bright Health - commercial,Bright Health - commercial,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,44.13,44.13,Bright Health MGG,Bright Health MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Aetna,Aetna,69.66,,,,,,,per diem,69.66,69.66,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Aetna MGG,Aetna MGG,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,BCBS,BCBS,69.66,,,,,,,per diem,69.66,69.66,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,BCBS MGG,BCBS MGG,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Cigna,Cigna,69.66,,,,,,,per diem,69.66,69.66,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Cigna MGG,Cigna MGG,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Humana,Humana,69.66,,,,,,,per diem,69.66,69.66,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Humana MGG,Humana MGG,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Optum VA,Optum VA,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,UHC,UHC,69.66,,,,,,,per diem,69.66,69.66,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,UHC MGG,UHC MGG,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,VA,VA,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Wellcare MGG,Wellcare MGG,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Bright Health - commercial,Bright Health - commercial,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,69.66,69.66,Bright Health MGG,Bright Health MGG,69.66,,,,,,,case rate,69.66,69.66,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Aetna,Aetna,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Aetna MGG,Aetna MGG,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,BCBS,BCBS,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,BCBS MGG,BCBS MGG,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Cigna,Cigna,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Cigna MGG,Cigna MGG,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Humana,Humana,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Humana MGG,Humana MGG,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Optum VA,Optum VA,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,UHC,UHC,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,UHC MGG,UHC MGG,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,VA,VA,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Wellcare MGG,Wellcare MGG,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Bright Health - commercial,Bright Health - commercial,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,Bright Health MGG,Bright Health MGG,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Aetna,Aetna,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Aetna MGG,Aetna MGG,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,BCBS,BCBS,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,BCBS MGG,BCBS MGG,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Cigna,Cigna,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Cigna MGG,Cigna MGG,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Humana,Humana,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Humana MGG,Humana MGG,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Optum VA,Optum VA,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,UHC,UHC,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,UHC MGG,UHC MGG,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,VA,VA,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Wellcare MGG,Wellcare MGG,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Bright Health - commercial,Bright Health - commercial,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,Bright Health MGG,Bright Health MGG,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Aetna,Aetna,127.58,,,,,,,per diem,127.58,127.58,"Per diem rate, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Aetna MGG,Aetna MGG,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,BCBS,BCBS,127.58,,,,,,,per diem,127.58,127.58,"Per diem rate, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,BCBS MGG,BCBS MGG,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Cigna,Cigna,127.58,,,,,,,per diem,127.58,127.58,"Per diem rate, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Cigna MGG,Cigna MGG,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Humana,Humana,127.58,,,,,,,per diem,127.58,127.58,"Per diem rate, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Humana MGG,Humana MGG,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Optum VA,Optum VA,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,UHC,UHC,127.58,,,,,,,per diem,127.58,127.58,"Per diem rate, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,UHC MGG,UHC MGG,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,VA,VA,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Wellcare MGG,Wellcare MGG,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Bright Health - commercial,Bright Health - commercial,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
TRICHROME STAIN               ,38203730,CDM,310,RC,88313,CPT,,,,Inpatient,,,127.58,127.58,Bright Health MGG,Bright Health MGG,127.58,,,,,,,case rate,127.58,127.58,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Aetna,Aetna,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Aetna MGG,Aetna MGG,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,BCBS,BCBS,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,BCBS MGG,BCBS MGG,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Cigna,Cigna,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Cigna MGG,Cigna MGG,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Humana,Humana,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Humana MGG,Humana MGG,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Optum VA,Optum VA,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,UHC,UHC,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,UHC MGG,UHC MGG,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,VA,VA,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Wellcare MGG,Wellcare MGG,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Bright Health - commercial,Bright Health - commercial,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,Bright Health MGG,Bright Health MGG,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Aetna,Aetna,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Aetna MGG,Aetna MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,BCBS,BCBS,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,BCBS MGG,BCBS MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Cigna,Cigna,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Cigna MGG,Cigna MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Humana,Humana,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Humana MGG,Humana MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Optum VA,Optum VA,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,UHC,UHC,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,UHC MGG,UHC MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,VA,VA,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Wellcare MGG,Wellcare MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Bright Health - commercial,Bright Health - commercial,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,9.51,9.51,Bright Health MGG,Bright Health MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Aetna,Aetna,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Aetna MGG,Aetna MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,BCBS,BCBS,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,BCBS MGG,BCBS MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Cigna,Cigna,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Cigna MGG,Cigna MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Humana,Humana,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Humana MGG,Humana MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Optum VA,Optum VA,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,UHC,UHC,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,UHC MGG,UHC MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,VA,VA,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Wellcare MGG,Wellcare MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Bright Health - commercial,Bright Health - commercial,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,175.35,175.35,Bright Health MGG,Bright Health MGG,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Aetna,Aetna,75.72,,,,,,,per diem,75.72,75.72,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Aetna MGG,Aetna MGG,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,BCBS,BCBS,75.72,,,,,,,per diem,75.72,75.72,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,BCBS MGG,BCBS MGG,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Cigna,Cigna,75.72,,,,,,,per diem,75.72,75.72,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Cigna MGG,Cigna MGG,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Humana,Humana,75.72,,,,,,,per diem,75.72,75.72,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Humana MGG,Humana MGG,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Optum VA,Optum VA,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,UHC,UHC,75.72,,,,,,,per diem,75.72,75.72,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,UHC MGG,UHC MGG,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,VA,VA,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Wellcare MGG,Wellcare MGG,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Bright Health - commercial,Bright Health - commercial,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,75.72,75.72,Bright Health MGG,Bright Health MGG,75.72,,,,,,,case rate,75.72,75.72,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Aetna,Aetna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Aetna MGG,Aetna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,BCBS,BCBS,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,BCBS MGG,BCBS MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Cigna,Cigna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Cigna MGG,Cigna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Humana,Humana,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Humana MGG,Humana MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Optum VA,Optum VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,UHC,UHC,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,UHC MGG,UHC MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,VA,VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Wellcare MGG,Wellcare MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Bright Health - commercial,Bright Health - commercial,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,Bright Health MGG,Bright Health MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Aetna,Aetna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Aetna MGG,Aetna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,BCBS,BCBS,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,BCBS MGG,BCBS MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Cigna,Cigna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Cigna MGG,Cigna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Humana,Humana,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Humana MGG,Humana MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Optum VA,Optum VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,UHC,UHC,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,UHC MGG,UHC MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,VA,VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Wellcare MGG,Wellcare MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Bright Health - commercial,Bright Health - commercial,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,Bright Health MGG,Bright Health MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Aetna,Aetna,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Aetna MGG,Aetna MGG,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,BCBS,BCBS,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,BCBS MGG,BCBS MGG,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Cigna,Cigna,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Cigna MGG,Cigna MGG,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Humana,Humana,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Humana MGG,Humana MGG,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Optum VA,Optum VA,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,UHC,UHC,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,UHC MGG,UHC MGG,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,VA,VA,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Wellcare MGG,Wellcare MGG,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Bright Health - commercial,Bright Health - commercial,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,Bright Health MGG,Bright Health MGG,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Aetna,Aetna,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Aetna MGG,Aetna MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,BCBS,BCBS,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,BCBS MGG,BCBS MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Cigna,Cigna,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Cigna MGG,Cigna MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Humana,Humana,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Humana MGG,Humana MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Optum VA,Optum VA,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,UHC,UHC,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,UHC MGG,UHC MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,VA,VA,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Wellcare MGG,Wellcare MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Bright Health - commercial,Bright Health - commercial,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,Bright Health MGG,Bright Health MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Aetna,Aetna,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Aetna MGG,Aetna MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,BCBS,BCBS,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,BCBS MGG,BCBS MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Cigna,Cigna,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Cigna MGG,Cigna MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Humana,Humana,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Humana MGG,Humana MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Optum VA,Optum VA,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,UHC,UHC,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,UHC MGG,UHC MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,VA,VA,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Wellcare MGG,Wellcare MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Bright Health - commercial,Bright Health - commercial,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,Bright Health MGG,Bright Health MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Aetna,Aetna,170.01,,,,,,,per diem,170.01,170.01,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Aetna MGG,Aetna MGG,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,BCBS,BCBS,170.01,,,,,,,per diem,170.01,170.01,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,BCBS MGG,BCBS MGG,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Cigna,Cigna,170.01,,,,,,,per diem,170.01,170.01,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Cigna MGG,Cigna MGG,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Humana,Humana,170.01,,,,,,,per diem,170.01,170.01,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Humana MGG,Humana MGG,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Optum VA,Optum VA,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,UHC,UHC,170.01,,,,,,,per diem,170.01,170.01,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,UHC MGG,UHC MGG,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,VA,VA,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Wellcare MGG,Wellcare MGG,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Bright Health - commercial,Bright Health - commercial,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,170.01,170.01,Bright Health MGG,Bright Health MGG,170.01,,,,,,,case rate,170.01,170.01,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Aetna,Aetna,260.26,,,,,,,per diem,260.26,260.26,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Aetna MGG,Aetna MGG,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,BCBS,BCBS,260.26,,,,,,,per diem,260.26,260.26,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,BCBS MGG,BCBS MGG,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Cigna,Cigna,260.26,,,,,,,per diem,260.26,260.26,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Cigna MGG,Cigna MGG,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Humana,Humana,260.26,,,,,,,per diem,260.26,260.26,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Humana MGG,Humana MGG,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Optum VA,Optum VA,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,UHC,UHC,260.26,,,,,,,per diem,260.26,260.26,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,UHC MGG,UHC MGG,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,VA,VA,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Wellcare MGG,Wellcare MGG,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Bright Health - commercial,Bright Health - commercial,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,260.26,260.26,Bright Health MGG,Bright Health MGG,260.26,,,,,,,case rate,260.26,260.26,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Aetna,Aetna,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Aetna MGG,Aetna MGG,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,BCBS,BCBS,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,BCBS MGG,BCBS MGG,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Cigna,Cigna,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Cigna MGG,Cigna MGG,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Humana,Humana,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Humana MGG,Humana MGG,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Optum VA,Optum VA,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,UHC,UHC,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,UHC MGG,UHC MGG,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,VA,VA,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Wellcare MGG,Wellcare MGG,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Bright Health - commercial,Bright Health - commercial,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,Bright Health MGG,Bright Health MGG,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Aetna,Aetna,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Aetna MGG,Aetna MGG,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,BCBS,BCBS,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,BCBS MGG,BCBS MGG,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Cigna,Cigna,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Cigna MGG,Cigna MGG,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Humana,Humana,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Humana MGG,Humana MGG,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Optum VA,Optum VA,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,UHC,UHC,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,UHC MGG,UHC MGG,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,VA,VA,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Wellcare MGG,Wellcare MGG,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Bright Health - commercial,Bright Health - commercial,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,Bright Health MGG,Bright Health MGG,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Aetna,Aetna,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Aetna MGG,Aetna MGG,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,BCBS,BCBS,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,BCBS MGG,BCBS MGG,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Cigna,Cigna,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Cigna MGG,Cigna MGG,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Humana,Humana,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Humana MGG,Humana MGG,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Optum VA,Optum VA,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,UHC,UHC,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,UHC MGG,UHC MGG,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,VA,VA,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Wellcare MGG,Wellcare MGG,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Bright Health - commercial,Bright Health - commercial,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,Bright Health MGG,Bright Health MGG,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Aetna,Aetna,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Aetna MGG,Aetna MGG,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,BCBS,BCBS,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,BCBS MGG,BCBS MGG,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Cigna,Cigna,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Cigna MGG,Cigna MGG,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Humana,Humana,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Humana MGG,Humana MGG,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Optum VA,Optum VA,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,UHC,UHC,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,UHC MGG,UHC MGG,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,VA,VA,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Wellcare MGG,Wellcare MGG,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Bright Health - commercial,Bright Health - commercial,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,Bright Health MGG,Bright Health MGG,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Aetna,Aetna,16.78,,,,,,,per diem,16.78,16.78,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Aetna MGG,Aetna MGG,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,BCBS,BCBS,16.78,,,,,,,per diem,16.78,16.78,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,BCBS MGG,BCBS MGG,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Cigna,Cigna,16.78,,,,,,,per diem,16.78,16.78,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Cigna MGG,Cigna MGG,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Humana,Humana,16.78,,,,,,,per diem,16.78,16.78,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Humana MGG,Humana MGG,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Optum VA,Optum VA,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,UHC,UHC,16.78,,,,,,,per diem,16.78,16.78,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,UHC MGG,UHC MGG,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,VA,VA,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Wellcare MGG,Wellcare MGG,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Bright Health - commercial,Bright Health - commercial,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,16.78,16.78,Bright Health MGG,Bright Health MGG,16.78,,,,,,,case rate,16.78,16.78,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Aetna,Aetna,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Aetna MGG,Aetna MGG,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,BCBS,BCBS,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,BCBS MGG,BCBS MGG,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Cigna,Cigna,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Cigna MGG,Cigna MGG,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Humana,Humana,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Humana MGG,Humana MGG,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Optum VA,Optum VA,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,UHC,UHC,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,UHC MGG,UHC MGG,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,VA,VA,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Wellcare MGG,Wellcare MGG,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Bright Health - commercial,Bright Health - commercial,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,Bright Health MGG,Bright Health MGG,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Aetna,Aetna,163.87,,,,,,,per diem,163.87,163.87,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Aetna MGG,Aetna MGG,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,BCBS,BCBS,163.87,,,,,,,per diem,163.87,163.87,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,BCBS MGG,BCBS MGG,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Cigna,Cigna,163.87,,,,,,,per diem,163.87,163.87,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Cigna MGG,Cigna MGG,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Humana,Humana,163.87,,,,,,,per diem,163.87,163.87,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Humana MGG,Humana MGG,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Optum VA,Optum VA,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,UHC,UHC,163.87,,,,,,,per diem,163.87,163.87,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,UHC MGG,UHC MGG,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,VA,VA,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Wellcare MGG,Wellcare MGG,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Bright Health - commercial,Bright Health - commercial,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,163.87,163.87,Bright Health MGG,Bright Health MGG,163.87,,,,,,,case rate,163.87,163.87,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Aetna,Aetna,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Aetna MGG,Aetna MGG,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,BCBS,BCBS,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,BCBS MGG,BCBS MGG,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Cigna,Cigna,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Cigna MGG,Cigna MGG,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Humana,Humana,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Humana MGG,Humana MGG,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Optum VA,Optum VA,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,UHC,UHC,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,UHC MGG,UHC MGG,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,VA,VA,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Wellcare MGG,Wellcare MGG,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Bright Health - commercial,Bright Health - commercial,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,Bright Health MGG,Bright Health MGG,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna,Aetna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna MGG,Aetna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,BCBS,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS MGG,BCBS MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna,Cigna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna MGG,Cigna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana,Humana,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana MGG,Humana MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Optum VA,Optum VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC,UHC,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC MGG,UHC MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Wellcare MGG,Wellcare MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health - commercial,Bright Health - commercial,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health MGG,Bright Health MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Aetna,Aetna,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Aetna MGG,Aetna MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,BCBS,BCBS,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,BCBS MGG,BCBS MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Cigna,Cigna,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Cigna MGG,Cigna MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Humana,Humana,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Humana MGG,Humana MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Optum VA,Optum VA,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,UHC,UHC,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,UHC MGG,UHC MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,VA,VA,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Wellcare MGG,Wellcare MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Bright Health - commercial,Bright Health - commercial,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,13.98,13.98,Bright Health MGG,Bright Health MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Aetna,Aetna,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Aetna MGG,Aetna MGG,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,BCBS,BCBS,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,BCBS MGG,BCBS MGG,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Cigna,Cigna,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Cigna MGG,Cigna MGG,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Humana,Humana,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Humana MGG,Humana MGG,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Optum VA,Optum VA,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,UHC,UHC,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,UHC MGG,UHC MGG,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,VA,VA,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Wellcare MGG,Wellcare MGG,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Bright Health - commercial,Bright Health - commercial,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,Bright Health MGG,Bright Health MGG,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Aetna,Aetna,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Aetna MGG,Aetna MGG,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,BCBS,BCBS,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,BCBS MGG,BCBS MGG,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Cigna,Cigna,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Cigna MGG,Cigna MGG,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Humana,Humana,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Humana MGG,Humana MGG,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Optum VA,Optum VA,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,UHC,UHC,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,UHC MGG,UHC MGG,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,VA,VA,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Wellcare MGG,Wellcare MGG,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Bright Health - commercial,Bright Health - commercial,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,Bright Health MGG,Bright Health MGG,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Aetna,Aetna,310.66,,,,,,,per diem,310.66,310.66,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Aetna MGG,Aetna MGG,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,BCBS,BCBS,310.66,,,,,,,per diem,310.66,310.66,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,BCBS MGG,BCBS MGG,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Cigna,Cigna,310.66,,,,,,,per diem,310.66,310.66,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Cigna MGG,Cigna MGG,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Humana,Humana,310.66,,,,,,,per diem,310.66,310.66,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Humana MGG,Humana MGG,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Optum VA,Optum VA,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,UHC,UHC,310.66,,,,,,,per diem,310.66,310.66,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,UHC MGG,UHC MGG,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,VA,VA,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Wellcare MGG,Wellcare MGG,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Bright Health - commercial,Bright Health - commercial,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,310.66,310.66,Bright Health MGG,Bright Health MGG,310.66,,,,,,,case rate,310.66,310.66,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Aetna,Aetna,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Aetna MGG,Aetna MGG,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,BCBS,BCBS,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,BCBS MGG,BCBS MGG,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Cigna,Cigna,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Cigna MGG,Cigna MGG,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Humana,Humana,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Humana MGG,Humana MGG,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Optum VA,Optum VA,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,UHC,UHC,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,UHC MGG,UHC MGG,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,VA,VA,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Wellcare MGG,Wellcare MGG,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Bright Health - commercial,Bright Health - commercial,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,Bright Health MGG,Bright Health MGG,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Aetna,Aetna,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Aetna MGG,Aetna MGG,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,BCBS,BCBS,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,BCBS MGG,BCBS MGG,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Cigna,Cigna,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Cigna MGG,Cigna MGG,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Humana,Humana,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Humana MGG,Humana MGG,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Optum VA,Optum VA,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,UHC,UHC,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,UHC MGG,UHC MGG,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,VA,VA,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Wellcare MGG,Wellcare MGG,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Bright Health - commercial,Bright Health - commercial,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,Bright Health MGG,Bright Health MGG,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Aetna,Aetna,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Aetna MGG,Aetna MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,BCBS,BCBS,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,BCBS MGG,BCBS MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Cigna,Cigna,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Cigna MGG,Cigna MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Humana,Humana,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Humana MGG,Humana MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Optum VA,Optum VA,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,UHC,UHC,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,UHC MGG,UHC MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,VA,VA,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Wellcare MGG,Wellcare MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Bright Health - commercial,Bright Health - commercial,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,290.5,290.5,Bright Health MGG,Bright Health MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Aetna,Aetna,68.59,,,,,,,per diem,68.59,68.59,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Aetna MGG,Aetna MGG,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,BCBS,BCBS,68.59,,,,,,,per diem,68.59,68.59,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,BCBS MGG,BCBS MGG,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Cigna,Cigna,68.59,,,,,,,per diem,68.59,68.59,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Cigna MGG,Cigna MGG,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Humana,Humana,68.59,,,,,,,per diem,68.59,68.59,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Humana MGG,Humana MGG,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Optum VA,Optum VA,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,UHC,UHC,68.59,,,,,,,per diem,68.59,68.59,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,UHC MGG,UHC MGG,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,VA,VA,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Wellcare MGG,Wellcare MGG,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Bright Health - commercial,Bright Health - commercial,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,68.59,68.59,Bright Health MGG,Bright Health MGG,68.59,,,,,,,case rate,68.59,68.59,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Aetna,Aetna,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Aetna MGG,Aetna MGG,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,BCBS,BCBS,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,BCBS MGG,BCBS MGG,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Cigna,Cigna,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Cigna MGG,Cigna MGG,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Humana,Humana,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Humana MGG,Humana MGG,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Optum VA,Optum VA,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,UHC,UHC,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,UHC MGG,UHC MGG,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,VA,VA,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Wellcare MGG,Wellcare MGG,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Bright Health - commercial,Bright Health - commercial,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,Bright Health MGG,Bright Health MGG,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Aetna,Aetna,405.14,,,,,,,per diem,405.14,405.14,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Aetna MGG,Aetna MGG,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,BCBS,BCBS,405.14,,,,,,,per diem,405.14,405.14,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,BCBS MGG,BCBS MGG,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Cigna,Cigna,405.14,,,,,,,per diem,405.14,405.14,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Cigna MGG,Cigna MGG,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Humana,Humana,405.14,,,,,,,per diem,405.14,405.14,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Humana MGG,Humana MGG,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Optum VA,Optum VA,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,UHC,UHC,405.14,,,,,,,per diem,405.14,405.14,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,UHC MGG,UHC MGG,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,VA,VA,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Wellcare MGG,Wellcare MGG,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Bright Health - commercial,Bright Health - commercial,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,405.14,405.14,Bright Health MGG,Bright Health MGG,405.14,,,,,,,case rate,405.14,405.14,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Aetna,Aetna,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Aetna MGG,Aetna MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,BCBS,BCBS,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,BCBS MGG,BCBS MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Cigna,Cigna,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Cigna MGG,Cigna MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Humana,Humana,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Humana MGG,Humana MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Optum VA,Optum VA,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,UHC,UHC,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,UHC MGG,UHC MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,VA,VA,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Wellcare MGG,Wellcare MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Bright Health - commercial,Bright Health - commercial,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,Bright Health MGG,Bright Health MGG,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Aetna,Aetna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Aetna MGG,Aetna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,BCBS,BCBS,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,BCBS MGG,BCBS MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Cigna,Cigna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Cigna MGG,Cigna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Humana,Humana,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Humana MGG,Humana MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Optum VA,Optum VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,UHC,UHC,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,UHC MGG,UHC MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,VA,VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Wellcare MGG,Wellcare MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Bright Health - commercial,Bright Health - commercial,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,Bright Health MGG,Bright Health MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Aetna,Aetna,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Aetna MGG,Aetna MGG,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,BCBS,BCBS,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,BCBS MGG,BCBS MGG,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Cigna,Cigna,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Cigna MGG,Cigna MGG,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Humana,Humana,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Humana MGG,Humana MGG,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Optum VA,Optum VA,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,UHC,UHC,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,UHC MGG,UHC MGG,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,VA,VA,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Wellcare MGG,Wellcare MGG,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Bright Health - commercial,Bright Health - commercial,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,Bright Health MGG,Bright Health MGG,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Aetna,Aetna,524.42,,,,,,,per diem,524.42,524.42,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Aetna MGG,Aetna MGG,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,BCBS,BCBS,524.42,,,,,,,per diem,524.42,524.42,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,BCBS MGG,BCBS MGG,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Cigna,Cigna,524.42,,,,,,,per diem,524.42,524.42,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Cigna MGG,Cigna MGG,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Humana,Humana,524.42,,,,,,,per diem,524.42,524.42,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Humana MGG,Humana MGG,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Optum VA,Optum VA,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,UHC,UHC,524.42,,,,,,,per diem,524.42,524.42,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,UHC MGG,UHC MGG,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,VA,VA,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Wellcare MGG,Wellcare MGG,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Bright Health - commercial,Bright Health - commercial,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,524.42,524.42,Bright Health MGG,Bright Health MGG,524.42,,,,,,,case rate,524.42,524.42,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Aetna,Aetna,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Aetna MGG,Aetna MGG,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,BCBS,BCBS,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,BCBS MGG,BCBS MGG,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Cigna,Cigna,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Cigna MGG,Cigna MGG,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Humana,Humana,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Humana MGG,Humana MGG,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Optum VA,Optum VA,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,UHC,UHC,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,UHC MGG,UHC MGG,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,VA,VA,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Wellcare MGG,Wellcare MGG,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Bright Health - commercial,Bright Health - commercial,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,Bright Health MGG,Bright Health MGG,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Aetna,Aetna,198.05,,,,,,,per diem,198.05,198.05,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Aetna MGG,Aetna MGG,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,BCBS,BCBS,198.05,,,,,,,per diem,198.05,198.05,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,BCBS MGG,BCBS MGG,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Cigna,Cigna,198.05,,,,,,,per diem,198.05,198.05,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Cigna MGG,Cigna MGG,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Humana,Humana,198.05,,,,,,,per diem,198.05,198.05,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Humana MGG,Humana MGG,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Optum VA,Optum VA,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,UHC,UHC,198.05,,,,,,,per diem,198.05,198.05,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,UHC MGG,UHC MGG,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,VA,VA,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Wellcare MGG,Wellcare MGG,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Bright Health - commercial,Bright Health - commercial,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,198.05,198.05,Bright Health MGG,Bright Health MGG,198.05,,,,,,,case rate,198.05,198.05,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Aetna,Aetna,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Aetna MGG,Aetna MGG,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,BCBS,BCBS,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,BCBS MGG,BCBS MGG,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Cigna,Cigna,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Cigna MGG,Cigna MGG,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Humana,Humana,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Humana MGG,Humana MGG,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Optum VA,Optum VA,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,UHC,UHC,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,UHC MGG,UHC MGG,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,VA,VA,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Wellcare MGG,Wellcare MGG,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Bright Health - commercial,Bright Health - commercial,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,Bright Health MGG,Bright Health MGG,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Aetna,Aetna,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Aetna MGG,Aetna MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,BCBS,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS MGG,BCBS MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Cigna,Cigna,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Cigna MGG,Cigna MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Humana,Humana,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Humana MGG,Humana MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Optum VA,Optum VA,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,UHC,UHC,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,UHC MGG,UHC MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,VA,VA,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Wellcare MGG,Wellcare MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Bright Health - commercial,Bright Health - commercial,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Bright Health MGG,Bright Health MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Aetna,Aetna,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Aetna MGG,Aetna MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,BCBS,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS MGG,BCBS MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Cigna,Cigna,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Cigna MGG,Cigna MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Humana,Humana,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Humana MGG,Humana MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Optum VA,Optum VA,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,UHC,UHC,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,UHC MGG,UHC MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,VA,VA,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Wellcare MGG,Wellcare MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Bright Health - commercial,Bright Health - commercial,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,Bright Health MGG,Bright Health MGG,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Aetna,Aetna,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Aetna MGG,Aetna MGG,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,BCBS,BCBS,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,BCBS MGG,BCBS MGG,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Cigna,Cigna,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Cigna MGG,Cigna MGG,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Humana,Humana,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Humana MGG,Humana MGG,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Optum VA,Optum VA,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,UHC,UHC,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,UHC MGG,UHC MGG,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,VA,VA,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Wellcare MGG,Wellcare MGG,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Bright Health - commercial,Bright Health - commercial,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,Bright Health MGG,Bright Health MGG,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Aetna,Aetna,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Aetna MGG,Aetna MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,BCBS,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS MGG,BCBS MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Cigna,Cigna,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Cigna MGG,Cigna MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Humana,Humana,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Humana MGG,Humana MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Optum VA,Optum VA,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,UHC,UHC,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,UHC MGG,UHC MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,VA,VA,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Wellcare MGG,Wellcare MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Bright Health - commercial,Bright Health - commercial,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,Bright Health MGG,Bright Health MGG,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Aetna,Aetna,293.37,,,,,,,per diem,293.37,293.37,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Aetna MGG,Aetna MGG,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,BCBS,BCBS,293.37,,,,,,,per diem,293.37,293.37,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,BCBS MGG,BCBS MGG,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Cigna,Cigna,293.37,,,,,,,per diem,293.37,293.37,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Cigna MGG,Cigna MGG,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Humana,Humana,293.37,,,,,,,per diem,293.37,293.37,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Humana MGG,Humana MGG,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Optum VA,Optum VA,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,UHC,UHC,293.37,,,,,,,per diem,293.37,293.37,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,UHC MGG,UHC MGG,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,VA,VA,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Wellcare MGG,Wellcare MGG,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Bright Health - commercial,Bright Health - commercial,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,293.37,293.37,Bright Health MGG,Bright Health MGG,293.37,,,,,,,case rate,293.37,293.37,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Aetna,Aetna,115.57,,,,,,,per diem,115.57,115.57,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Aetna MGG,Aetna MGG,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,BCBS,BCBS,115.57,,,,,,,per diem,115.57,115.57,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,BCBS MGG,BCBS MGG,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Cigna,Cigna,115.57,,,,,,,per diem,115.57,115.57,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Cigna MGG,Cigna MGG,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Humana,Humana,115.57,,,,,,,per diem,115.57,115.57,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Humana MGG,Humana MGG,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Optum VA,Optum VA,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,UHC,UHC,115.57,,,,,,,per diem,115.57,115.57,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,UHC MGG,UHC MGG,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,VA,VA,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Wellcare MGG,Wellcare MGG,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Bright Health - commercial,Bright Health - commercial,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,115.57,115.57,Bright Health MGG,Bright Health MGG,115.57,,,,,,,case rate,115.57,115.57,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Aetna,Aetna,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Aetna MGG,Aetna MGG,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,BCBS,BCBS,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,BCBS MGG,BCBS MGG,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Cigna,Cigna,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Cigna MGG,Cigna MGG,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Humana,Humana,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Humana MGG,Humana MGG,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Optum VA,Optum VA,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,UHC,UHC,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,UHC MGG,UHC MGG,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,VA,VA,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Wellcare MGG,Wellcare MGG,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Bright Health - commercial,Bright Health - commercial,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,Bright Health MGG,Bright Health MGG,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Aetna,Aetna,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Aetna MGG,Aetna MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,BCBS,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS MGG,BCBS MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Cigna,Cigna,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Cigna MGG,Cigna MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Humana,Humana,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Humana MGG,Humana MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Optum VA,Optum VA,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UHC,UHC,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UHC MGG,UHC MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,VA,VA,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Wellcare MGG,Wellcare MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Bright Health - commercial,Bright Health - commercial,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,Bright Health MGG,Bright Health MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Aetna,Aetna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Aetna MGG,Aetna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,BCBS,BCBS,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,BCBS MGG,BCBS MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Cigna,Cigna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Cigna MGG,Cigna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Humana,Humana,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Humana MGG,Humana MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Optum VA,Optum VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,UHC,UHC,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,UHC MGG,UHC MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,VA,VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Wellcare MGG,Wellcare MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Bright Health - commercial,Bright Health - commercial,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,Bright Health MGG,Bright Health MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Aetna,Aetna,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Aetna MGG,Aetna MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,BCBS,BCBS,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,BCBS MGG,BCBS MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Cigna,Cigna,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Cigna MGG,Cigna MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Humana,Humana,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Humana MGG,Humana MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Optum VA,Optum VA,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,UHC,UHC,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,UHC MGG,UHC MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,VA,VA,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Wellcare MGG,Wellcare MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Bright Health - commercial,Bright Health - commercial,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,Bright Health MGG,Bright Health MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Aetna,Aetna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Aetna MGG,Aetna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS,BCBS,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS MGG,BCBS MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Cigna,Cigna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Cigna MGG,Cigna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Humana,Humana,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Humana MGG,Humana MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Optum VA,Optum VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,UHC,UHC,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,UHC MGG,UHC MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,VA,VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Wellcare MGG,Wellcare MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Bright Health - commercial,Bright Health - commercial,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Bright Health MGG,Bright Health MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Aetna,Aetna,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Aetna MGG,Aetna MGG,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,BCBS,BCBS,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,BCBS MGG,BCBS MGG,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Cigna,Cigna,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Cigna MGG,Cigna MGG,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Humana,Humana,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Humana MGG,Humana MGG,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Optum VA,Optum VA,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,UHC,UHC,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,UHC MGG,UHC MGG,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,VA,VA,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Wellcare MGG,Wellcare MGG,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Bright Health - commercial,Bright Health - commercial,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MEPERIDINE                    ,38205500,CDM,301,RC,80100,CPT,,,,Inpatient,,,9.45,9.45,Bright Health MGG,Bright Health MGG,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Aetna,Aetna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Aetna MGG,Aetna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,BCBS,BCBS,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,BCBS MGG,BCBS MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Cigna,Cigna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Cigna MGG,Cigna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Humana,Humana,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Humana MGG,Humana MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Optum VA,Optum VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,UHC,UHC,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,UHC MGG,UHC MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,VA,VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Wellcare MGG,Wellcare MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Bright Health - commercial,Bright Health - commercial,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,Bright Health MGG,Bright Health MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Aetna,Aetna,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Aetna MGG,Aetna MGG,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,BCBS,BCBS,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,BCBS MGG,BCBS MGG,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Cigna,Cigna,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Cigna MGG,Cigna MGG,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Humana,Humana,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Humana MGG,Humana MGG,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Optum VA,Optum VA,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,UHC,UHC,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,UHC MGG,UHC MGG,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,VA,VA,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Wellcare MGG,Wellcare MGG,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Bright Health - commercial,Bright Health - commercial,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,Bright Health MGG,Bright Health MGG,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Aetna,Aetna,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Aetna MGG,Aetna MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,BCBS,BCBS,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,BCBS MGG,BCBS MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Cigna,Cigna,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Cigna MGG,Cigna MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Humana,Humana,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Humana MGG,Humana MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Optum VA,Optum VA,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,UHC,UHC,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,UHC MGG,UHC MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,VA,VA,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Wellcare MGG,Wellcare MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Bright Health - commercial,Bright Health - commercial,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,Bright Health MGG,Bright Health MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Aetna,Aetna,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Aetna MGG,Aetna MGG,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,BCBS,BCBS,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,BCBS MGG,BCBS MGG,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Cigna,Cigna,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Cigna MGG,Cigna MGG,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Humana,Humana,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Humana MGG,Humana MGG,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Optum VA,Optum VA,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,UHC,UHC,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,UHC MGG,UHC MGG,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,VA,VA,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Wellcare MGG,Wellcare MGG,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Bright Health - commercial,Bright Health - commercial,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,Bright Health MGG,Bright Health MGG,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Aetna,Aetna,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Aetna MGG,Aetna MGG,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,BCBS,BCBS,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,BCBS MGG,BCBS MGG,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Cigna,Cigna,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Cigna MGG,Cigna MGG,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Humana,Humana,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Humana MGG,Humana MGG,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Optum VA,Optum VA,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,UHC,UHC,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,UHC MGG,UHC MGG,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,VA,VA,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Wellcare MGG,Wellcare MGG,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Bright Health - commercial,Bright Health - commercial,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,Bright Health MGG,Bright Health MGG,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Aetna,Aetna,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Aetna MGG,Aetna MGG,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,BCBS,BCBS,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,BCBS MGG,BCBS MGG,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Cigna,Cigna,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Cigna MGG,Cigna MGG,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Humana,Humana,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Humana MGG,Humana MGG,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Optum VA,Optum VA,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,UHC,UHC,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,UHC MGG,UHC MGG,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,VA,VA,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Wellcare MGG,Wellcare MGG,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Bright Health - commercial,Bright Health - commercial,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,Bright Health MGG,Bright Health MGG,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Aetna,Aetna,34.19,,,,,,,per diem,34.19,34.19,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Aetna MGG,Aetna MGG,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,BCBS,BCBS,34.19,,,,,,,per diem,34.19,34.19,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,BCBS MGG,BCBS MGG,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Cigna,Cigna,34.19,,,,,,,per diem,34.19,34.19,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Cigna MGG,Cigna MGG,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Humana,Humana,34.19,,,,,,,per diem,34.19,34.19,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Humana MGG,Humana MGG,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Optum VA,Optum VA,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,UHC,UHC,34.19,,,,,,,per diem,34.19,34.19,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,UHC MGG,UHC MGG,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,VA,VA,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Wellcare MGG,Wellcare MGG,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Bright Health - commercial,Bright Health - commercial,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,34.19,34.19,Bright Health MGG,Bright Health MGG,34.19,,,,,,,case rate,34.19,34.19,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Aetna,Aetna,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Aetna MGG,Aetna MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,BCBS,BCBS,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,BCBS MGG,BCBS MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Cigna,Cigna,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Cigna MGG,Cigna MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Humana,Humana,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Humana MGG,Humana MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Optum VA,Optum VA,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,UHC,UHC,90.3,,,,,,,per diem,90.3,90.3,"Per diem rate, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,UHC MGG,UHC MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,VA,VA,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Wellcare MGG,Wellcare MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Bright Health - commercial,Bright Health - commercial,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
IRON PROFILE                  ,38205541,CDM,301,RC,83540,CPT,,,,Inpatient,,,90.3,90.3,Bright Health MGG,Bright Health MGG,90.3,,,,,,,case rate,90.3,90.3,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Aetna,Aetna,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Aetna MGG,Aetna MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,BCBS,BCBS,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,BCBS MGG,BCBS MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Cigna,Cigna,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Cigna MGG,Cigna MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Humana,Humana,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Humana MGG,Humana MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Optum VA,Optum VA,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,UHC,UHC,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,UHC MGG,UHC MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,VA,VA,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Wellcare MGG,Wellcare MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Bright Health - commercial,Bright Health - commercial,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,Bright Health MGG,Bright Health MGG,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Aetna,Aetna,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Aetna MGG,Aetna MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,BCBS,BCBS,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,BCBS MGG,BCBS MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Cigna,Cigna,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Cigna MGG,Cigna MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Humana,Humana,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Humana MGG,Humana MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Optum VA,Optum VA,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,UHC,UHC,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,UHC MGG,UHC MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,VA,VA,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Wellcare MGG,Wellcare MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Bright Health - commercial,Bright Health - commercial,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,Bright Health MGG,Bright Health MGG,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Aetna,Aetna,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Aetna MGG,Aetna MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,BCBS,BCBS,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,BCBS MGG,BCBS MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Cigna,Cigna,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Cigna MGG,Cigna MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Humana,Humana,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Humana MGG,Humana MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Optum VA,Optum VA,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,UHC,UHC,85.37,,,,,,,per diem,85.37,85.37,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,UHC MGG,UHC MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,VA,VA,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Wellcare MGG,Wellcare MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Bright Health - commercial,Bright Health - commercial,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,85.37,85.37,Bright Health MGG,Bright Health MGG,85.37,,,,,,,case rate,85.37,85.37,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Aetna,Aetna,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Aetna MGG,Aetna MGG,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,BCBS,BCBS,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,BCBS MGG,BCBS MGG,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Cigna,Cigna,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Cigna MGG,Cigna MGG,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Humana,Humana,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Humana MGG,Humana MGG,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Optum VA,Optum VA,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,UHC,UHC,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,UHC MGG,UHC MGG,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,VA,VA,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Wellcare MGG,Wellcare MGG,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Bright Health - commercial,Bright Health - commercial,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,Bright Health MGG,Bright Health MGG,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Aetna,Aetna,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Aetna MGG,Aetna MGG,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,BCBS,BCBS,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,BCBS MGG,BCBS MGG,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Cigna,Cigna,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Cigna MGG,Cigna MGG,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Humana,Humana,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Humana MGG,Humana MGG,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Optum VA,Optum VA,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,UHC,UHC,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,UHC MGG,UHC MGG,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,VA,VA,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Wellcare MGG,Wellcare MGG,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Bright Health - commercial,Bright Health - commercial,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,5.72,5.72,Bright Health MGG,Bright Health MGG,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Aetna,Aetna,555.66,,,,,,,per diem,555.66,555.66,"Per diem rate, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Aetna MGG,Aetna MGG,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,BCBS,BCBS,555.66,,,,,,,per diem,555.66,555.66,"Per diem rate, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,BCBS MGG,BCBS MGG,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Cigna,Cigna,555.66,,,,,,,per diem,555.66,555.66,"Per diem rate, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Cigna MGG,Cigna MGG,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Humana,Humana,555.66,,,,,,,per diem,555.66,555.66,"Per diem rate, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Humana MGG,Humana MGG,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Optum VA,Optum VA,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,UHC,UHC,555.66,,,,,,,per diem,555.66,555.66,"Per diem rate, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,UHC MGG,UHC MGG,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,VA,VA,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Wellcare MGG,Wellcare MGG,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Bright Health - commercial,Bright Health - commercial,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
THROMBOPHILIA PANEL           ,38205567,CDM,305,RC,85303,CPT,,,,Inpatient,,,555.66,555.66,Bright Health MGG,Bright Health MGG,555.66,,,,,,,case rate,555.66,555.66,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Aetna,Aetna,210.88,,,,,,,per diem,210.88,210.88,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Aetna MGG,Aetna MGG,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,BCBS,BCBS,210.88,,,,,,,per diem,210.88,210.88,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,BCBS MGG,BCBS MGG,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Cigna,Cigna,210.88,,,,,,,per diem,210.88,210.88,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Cigna MGG,Cigna MGG,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Humana,Humana,210.88,,,,,,,per diem,210.88,210.88,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Humana MGG,Humana MGG,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Optum VA,Optum VA,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,UHC,UHC,210.88,,,,,,,per diem,210.88,210.88,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,UHC MGG,UHC MGG,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,VA,VA,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Wellcare MGG,Wellcare MGG,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Bright Health - commercial,Bright Health - commercial,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,210.88,210.88,Bright Health MGG,Bright Health MGG,210.88,,,,,,,case rate,210.88,210.88,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Aetna,Aetna,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Aetna MGG,Aetna MGG,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,BCBS,BCBS,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,BCBS MGG,BCBS MGG,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Cigna,Cigna,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Cigna MGG,Cigna MGG,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Humana,Humana,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Humana MGG,Humana MGG,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Optum VA,Optum VA,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,UHC,UHC,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,UHC MGG,UHC MGG,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,VA,VA,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Wellcare MGG,Wellcare MGG,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Bright Health - commercial,Bright Health - commercial,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,Bright Health MGG,Bright Health MGG,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Aetna,Aetna,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Aetna MGG,Aetna MGG,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,BCBS,BCBS,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,BCBS MGG,BCBS MGG,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Cigna,Cigna,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Cigna MGG,Cigna MGG,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Humana,Humana,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Humana MGG,Humana MGG,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Optum VA,Optum VA,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,UHC,UHC,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,UHC MGG,UHC MGG,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,VA,VA,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Wellcare MGG,Wellcare MGG,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Bright Health - commercial,Bright Health - commercial,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,Bright Health MGG,Bright Health MGG,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Aetna,Aetna,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Aetna MGG,Aetna MGG,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,BCBS,BCBS,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,BCBS MGG,BCBS MGG,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Cigna,Cigna,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Cigna MGG,Cigna MGG,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Humana,Humana,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Humana MGG,Humana MGG,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Optum VA,Optum VA,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,UHC,UHC,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,UHC MGG,UHC MGG,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,VA,VA,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Wellcare MGG,Wellcare MGG,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Bright Health - commercial,Bright Health - commercial,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,Bright Health MGG,Bright Health MGG,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Aetna,Aetna,326.55,,,,,,,per diem,326.55,326.55,"Per diem rate, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Aetna MGG,Aetna MGG,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,BCBS,BCBS,326.55,,,,,,,per diem,326.55,326.55,"Per diem rate, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,BCBS MGG,BCBS MGG,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Cigna,Cigna,326.55,,,,,,,per diem,326.55,326.55,"Per diem rate, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Cigna MGG,Cigna MGG,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Humana,Humana,326.55,,,,,,,per diem,326.55,326.55,"Per diem rate, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Humana MGG,Humana MGG,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Optum VA,Optum VA,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,UHC,UHC,326.55,,,,,,,per diem,326.55,326.55,"Per diem rate, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,UHC MGG,UHC MGG,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,VA,VA,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Wellcare MGG,Wellcare MGG,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Bright Health - commercial,Bright Health - commercial,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
LUPUS ANTICOAGULANT           ,38205572,CDM,305,RC,85613,CPT,,,,Inpatient,,,326.55,326.55,Bright Health MGG,Bright Health MGG,326.55,,,,,,,case rate,326.55,326.55,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Aetna,Aetna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Aetna MGG,Aetna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,BCBS,BCBS,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,BCBS MGG,BCBS MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Cigna,Cigna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Cigna MGG,Cigna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Humana,Humana,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Humana MGG,Humana MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Optum VA,Optum VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,UHC,UHC,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,UHC MGG,UHC MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,VA,VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Wellcare MGG,Wellcare MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Bright Health - commercial,Bright Health - commercial,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
INHALANT PANEL                ,38205582,CDM,302,RC,86003,CPT,,,,Inpatient,,,78.75,78.75,Bright Health MGG,Bright Health MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Aetna,Aetna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Aetna MGG,Aetna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,BCBS,BCBS,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,BCBS MGG,BCBS MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Cigna,Cigna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Cigna MGG,Cigna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Humana,Humana,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Humana MGG,Humana MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Optum VA,Optum VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,UHC,UHC,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,UHC MGG,UHC MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,VA,VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Wellcare MGG,Wellcare MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Bright Health - commercial,Bright Health - commercial,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,Bright Health MGG,Bright Health MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Aetna,Aetna,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Aetna MGG,Aetna MGG,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,BCBS,BCBS,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,BCBS MGG,BCBS MGG,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Cigna,Cigna,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Cigna MGG,Cigna MGG,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Humana,Humana,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Humana MGG,Humana MGG,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Optum VA,Optum VA,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,UHC,UHC,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,UHC MGG,UHC MGG,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,VA,VA,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Wellcare MGG,Wellcare MGG,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Bright Health - commercial,Bright Health - commercial,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,Bright Health MGG,Bright Health MGG,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Aetna,Aetna,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Aetna MGG,Aetna MGG,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,BCBS,BCBS,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,BCBS MGG,BCBS MGG,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Cigna,Cigna,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Cigna MGG,Cigna MGG,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Humana,Humana,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Humana MGG,Humana MGG,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Optum VA,Optum VA,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,UHC,UHC,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,UHC MGG,UHC MGG,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,VA,VA,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Wellcare MGG,Wellcare MGG,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Bright Health - commercial,Bright Health - commercial,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,Bright Health MGG,Bright Health MGG,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Aetna,Aetna,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Aetna MGG,Aetna MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,BCBS,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS MGG,BCBS MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Cigna,Cigna,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Cigna MGG,Cigna MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Humana,Humana,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Humana MGG,Humana MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Optum VA,Optum VA,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,UHC,UHC,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,UHC MGG,UHC MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,VA,VA,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Wellcare MGG,Wellcare MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Bright Health - commercial,Bright Health - commercial,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,Bright Health MGG,Bright Health MGG,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Aetna,Aetna,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Aetna MGG,Aetna MGG,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,BCBS,BCBS,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,BCBS MGG,BCBS MGG,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Cigna,Cigna,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Cigna MGG,Cigna MGG,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Humana,Humana,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Humana MGG,Humana MGG,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Optum VA,Optum VA,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,UHC,UHC,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,UHC MGG,UHC MGG,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,VA,VA,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Wellcare MGG,Wellcare MGG,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Bright Health - commercial,Bright Health - commercial,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,Bright Health MGG,Bright Health MGG,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Aetna,Aetna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Aetna MGG,Aetna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,BCBS,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS MGG,BCBS MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Cigna,Cigna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Cigna MGG,Cigna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Humana,Humana,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Humana MGG,Humana MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Optum VA,Optum VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,UHC,UHC,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,UHC MGG,UHC MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,VA,VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Wellcare MGG,Wellcare MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Bright Health - commercial,Bright Health - commercial,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Bright Health MGG,Bright Health MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Aetna,Aetna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Aetna MGG,Aetna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,BCBS,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS MGG,BCBS MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Cigna,Cigna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Cigna MGG,Cigna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Humana,Humana,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Humana MGG,Humana MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Optum VA,Optum VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,UHC,UHC,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,UHC MGG,UHC MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,VA,VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Wellcare MGG,Wellcare MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Bright Health - commercial,Bright Health - commercial,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,Bright Health MGG,Bright Health MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Aetna,Aetna,122.9,,,,,,,per diem,122.9,122.9,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Aetna MGG,Aetna MGG,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,BCBS,BCBS,122.9,,,,,,,per diem,122.9,122.9,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,BCBS MGG,BCBS MGG,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Cigna,Cigna,122.9,,,,,,,per diem,122.9,122.9,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Cigna MGG,Cigna MGG,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Humana,Humana,122.9,,,,,,,per diem,122.9,122.9,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Humana MGG,Humana MGG,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Optum VA,Optum VA,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,UHC,UHC,122.9,,,,,,,per diem,122.9,122.9,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,UHC MGG,UHC MGG,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,VA,VA,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Wellcare MGG,Wellcare MGG,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Bright Health - commercial,Bright Health - commercial,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,122.9,122.9,Bright Health MGG,Bright Health MGG,122.9,,,,,,,case rate,122.9,122.9,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Aetna,Aetna,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Aetna MGG,Aetna MGG,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,BCBS,BCBS,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,BCBS MGG,BCBS MGG,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Cigna,Cigna,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Cigna MGG,Cigna MGG,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Humana,Humana,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Humana MGG,Humana MGG,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Optum VA,Optum VA,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,UHC,UHC,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,UHC MGG,UHC MGG,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,VA,VA,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Wellcare MGG,Wellcare MGG,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Bright Health - commercial,Bright Health - commercial,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,Bright Health MGG,Bright Health MGG,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Aetna,Aetna,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Aetna MGG,Aetna MGG,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,BCBS,BCBS,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,BCBS MGG,BCBS MGG,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Cigna,Cigna,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Cigna MGG,Cigna MGG,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Humana,Humana,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Humana MGG,Humana MGG,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Optum VA,Optum VA,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,UHC,UHC,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,UHC MGG,UHC MGG,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,VA,VA,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Wellcare MGG,Wellcare MGG,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Bright Health - commercial,Bright Health - commercial,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,89.38,89.38,Bright Health MGG,Bright Health MGG,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Aetna,Aetna,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Aetna MGG,Aetna MGG,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,BCBS,BCBS,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,BCBS MGG,BCBS MGG,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Cigna,Cigna,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Cigna MGG,Cigna MGG,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Humana,Humana,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Humana MGG,Humana MGG,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Optum VA,Optum VA,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,UHC,UHC,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,UHC MGG,UHC MGG,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,VA,VA,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Wellcare MGG,Wellcare MGG,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Bright Health - commercial,Bright Health - commercial,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,Bright Health MGG,Bright Health MGG,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Aetna,Aetna,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Aetna MGG,Aetna MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,BCBS,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS MGG,BCBS MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Cigna,Cigna,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Cigna MGG,Cigna MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Humana,Humana,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Humana MGG,Humana MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Optum VA,Optum VA,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,UHC,UHC,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,UHC MGG,UHC MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,VA,VA,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Wellcare MGG,Wellcare MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Bright Health - commercial,Bright Health - commercial,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Bright Health MGG,Bright Health MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Aetna,Aetna,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Aetna MGG,Aetna MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,BCBS,BCBS,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,BCBS MGG,BCBS MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Cigna,Cigna,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Cigna MGG,Cigna MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Humana,Humana,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Humana MGG,Humana MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Optum VA,Optum VA,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,UHC,UHC,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,UHC MGG,UHC MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,VA,VA,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Wellcare MGG,Wellcare MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Bright Health - commercial,Bright Health - commercial,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,Bright Health MGG,Bright Health MGG,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna,Aetna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Aetna MGG,Aetna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,BCBS,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS MGG,BCBS MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna,Cigna,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Cigna MGG,Cigna MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana,Humana,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Humana MGG,Humana MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Optum VA,Optum VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC,UHC,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UHC MGG,UHC MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,VA,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Wellcare MGG,Wellcare MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health - commercial,Bright Health - commercial,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,Bright Health MGG,Bright Health MGG,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Aetna,Aetna,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Aetna MGG,Aetna MGG,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,BCBS,BCBS,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,BCBS MGG,BCBS MGG,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Cigna,Cigna,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Cigna MGG,Cigna MGG,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Humana,Humana,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Humana MGG,Humana MGG,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Optum VA,Optum VA,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,UHC,UHC,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,UHC MGG,UHC MGG,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,VA,VA,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Wellcare MGG,Wellcare MGG,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Bright Health - commercial,Bright Health - commercial,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,Bright Health MGG,Bright Health MGG,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Aetna,Aetna,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Aetna MGG,Aetna MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,BCBS,BCBS,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,BCBS MGG,BCBS MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Cigna,Cigna,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Cigna MGG,Cigna MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Humana,Humana,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Humana MGG,Humana MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Optum VA,Optum VA,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,UHC,UHC,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,UHC MGG,UHC MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,VA,VA,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Wellcare MGG,Wellcare MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Bright Health - commercial,Bright Health - commercial,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,Bright Health MGG,Bright Health MGG,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Aetna,Aetna,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Aetna MGG,Aetna MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,BCBS,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS MGG,BCBS MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Cigna,Cigna,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Cigna MGG,Cigna MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Humana,Humana,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Humana MGG,Humana MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Optum VA,Optum VA,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UHC,UHC,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UHC MGG,UHC MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA,VA,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Wellcare MGG,Wellcare MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Bright Health - commercial,Bright Health - commercial,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Bright Health MGG,Bright Health MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Aetna,Aetna,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Aetna MGG,Aetna MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,BCBS,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS MGG,BCBS MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Cigna,Cigna,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Cigna MGG,Cigna MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Humana,Humana,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Humana MGG,Humana MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Optum VA,Optum VA,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UHC,UHC,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UHC MGG,UHC MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA,VA,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Wellcare MGG,Wellcare MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Bright Health - commercial,Bright Health - commercial,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Bright Health MGG,Bright Health MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Aetna,Aetna,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Aetna MGG,Aetna MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,BCBS,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS MGG,BCBS MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Cigna,Cigna,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Cigna MGG,Cigna MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Humana,Humana,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Humana MGG,Humana MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Optum VA,Optum VA,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UHC,UHC,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UHC MGG,UHC MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA,VA,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Wellcare MGG,Wellcare MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Bright Health - commercial,Bright Health - commercial,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Bright Health MGG,Bright Health MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Aetna,Aetna,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Aetna MGG,Aetna MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,BCBS,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS MGG,BCBS MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Cigna,Cigna,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Cigna MGG,Cigna MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Humana,Humana,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Humana MGG,Humana MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Optum VA,Optum VA,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UHC,UHC,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UHC MGG,UHC MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA,VA,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Wellcare MGG,Wellcare MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Bright Health - commercial,Bright Health - commercial,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,Bright Health MGG,Bright Health MGG,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Aetna,Aetna,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Aetna MGG,Aetna MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,BCBS,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS MGG,BCBS MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Cigna,Cigna,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Cigna MGG,Cigna MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Humana,Humana,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Humana MGG,Humana MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Optum VA,Optum VA,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,UHC,UHC,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,UHC MGG,UHC MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,VA,VA,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Wellcare MGG,Wellcare MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Bright Health - commercial,Bright Health - commercial,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Bright Health MGG,Bright Health MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Aetna,Aetna,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Aetna MGG,Aetna MGG,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,BCBS,BCBS,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,BCBS MGG,BCBS MGG,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Cigna,Cigna,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Cigna MGG,Cigna MGG,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Humana,Humana,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Humana MGG,Humana MGG,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Optum VA,Optum VA,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,UHC,UHC,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,UHC MGG,UHC MGG,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,VA,VA,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Wellcare MGG,Wellcare MGG,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Bright Health - commercial,Bright Health - commercial,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,Bright Health MGG,Bright Health MGG,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Aetna,Aetna,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Aetna MGG,Aetna MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,BCBS,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS MGG,BCBS MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Cigna,Cigna,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Cigna MGG,Cigna MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Humana,Humana,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Humana MGG,Humana MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Optum VA,Optum VA,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,UHC,UHC,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,UHC MGG,UHC MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,VA,VA,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Wellcare MGG,Wellcare MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Bright Health - commercial,Bright Health - commercial,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,Bright Health MGG,Bright Health MGG,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Aetna,Aetna,56.85,,,,,,,per diem,56.85,56.85,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Aetna MGG,Aetna MGG,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,BCBS,BCBS,56.85,,,,,,,per diem,56.85,56.85,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,BCBS MGG,BCBS MGG,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Cigna,Cigna,56.85,,,,,,,per diem,56.85,56.85,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Cigna MGG,Cigna MGG,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Humana,Humana,56.85,,,,,,,per diem,56.85,56.85,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Humana MGG,Humana MGG,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Optum VA,Optum VA,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,UHC,UHC,56.85,,,,,,,per diem,56.85,56.85,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,UHC MGG,UHC MGG,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,VA,VA,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Wellcare MGG,Wellcare MGG,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Bright Health - commercial,Bright Health - commercial,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,56.85,56.85,Bright Health MGG,Bright Health MGG,56.85,,,,,,,case rate,56.85,56.85,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Aetna,Aetna,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Aetna MGG,Aetna MGG,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,BCBS,BCBS,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,BCBS MGG,BCBS MGG,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Cigna,Cigna,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Cigna MGG,Cigna MGG,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Humana,Humana,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Humana MGG,Humana MGG,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Optum VA,Optum VA,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,UHC,UHC,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,UHC MGG,UHC MGG,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,VA,VA,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Wellcare MGG,Wellcare MGG,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Bright Health - commercial,Bright Health - commercial,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,Bright Health MGG,Bright Health MGG,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Aetna,Aetna,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Aetna MGG,Aetna MGG,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,BCBS,BCBS,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,BCBS MGG,BCBS MGG,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Cigna,Cigna,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Cigna MGG,Cigna MGG,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Humana,Humana,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Humana MGG,Humana MGG,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Optum VA,Optum VA,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,UHC,UHC,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,UHC MGG,UHC MGG,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,VA,VA,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Wellcare MGG,Wellcare MGG,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Bright Health - commercial,Bright Health - commercial,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,Bright Health MGG,Bright Health MGG,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Aetna,Aetna,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Aetna MGG,Aetna MGG,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,BCBS,BCBS,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,BCBS MGG,BCBS MGG,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Cigna,Cigna,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Cigna MGG,Cigna MGG,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Humana,Humana,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Humana MGG,Humana MGG,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Optum VA,Optum VA,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,UHC,UHC,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,UHC MGG,UHC MGG,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,VA,VA,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Wellcare MGG,Wellcare MGG,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Bright Health - commercial,Bright Health - commercial,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,Bright Health MGG,Bright Health MGG,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Aetna,Aetna,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Aetna MGG,Aetna MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,BCBS,BCBS,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,BCBS MGG,BCBS MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Cigna,Cigna,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Cigna MGG,Cigna MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Humana,Humana,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Humana MGG,Humana MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Optum VA,Optum VA,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,UHC,UHC,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,UHC MGG,UHC MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,VA,VA,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Wellcare MGG,Wellcare MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Bright Health - commercial,Bright Health - commercial,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,Bright Health MGG,Bright Health MGG,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Aetna,Aetna,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Aetna MGG,Aetna MGG,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,BCBS,BCBS,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,BCBS MGG,BCBS MGG,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Cigna,Cigna,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Cigna MGG,Cigna MGG,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Humana,Humana,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Humana MGG,Humana MGG,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Optum VA,Optum VA,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,UHC,UHC,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,UHC MGG,UHC MGG,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,VA,VA,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Wellcare MGG,Wellcare MGG,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Bright Health - commercial,Bright Health - commercial,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,Bright Health MGG,Bright Health MGG,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Aetna,Aetna,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Aetna MGG,Aetna MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,BCBS,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS MGG,BCBS MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Cigna,Cigna,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Cigna MGG,Cigna MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Humana,Humana,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Humana MGG,Humana MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Optum VA,Optum VA,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,UHC,UHC,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,UHC MGG,UHC MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,VA,VA,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Wellcare MGG,Wellcare MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Bright Health - commercial,Bright Health - commercial,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,Bright Health MGG,Bright Health MGG,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Aetna,Aetna,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Aetna MGG,Aetna MGG,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,BCBS,BCBS,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,BCBS MGG,BCBS MGG,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Cigna,Cigna,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Cigna MGG,Cigna MGG,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Humana,Humana,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Humana MGG,Humana MGG,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Optum VA,Optum VA,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,UHC,UHC,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,UHC MGG,UHC MGG,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,VA,VA,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Wellcare MGG,Wellcare MGG,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Bright Health - commercial,Bright Health - commercial,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,Bright Health MGG,Bright Health MGG,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Aetna,Aetna,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Aetna MGG,Aetna MGG,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,BCBS,BCBS,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,BCBS MGG,BCBS MGG,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Cigna,Cigna,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Cigna MGG,Cigna MGG,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Humana,Humana,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Humana MGG,Humana MGG,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Optum VA,Optum VA,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,UHC,UHC,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,UHC MGG,UHC MGG,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,VA,VA,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Wellcare MGG,Wellcare MGG,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Bright Health - commercial,Bright Health - commercial,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,Bright Health MGG,Bright Health MGG,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Aetna,Aetna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Aetna MGG,Aetna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,BCBS,BCBS,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,BCBS MGG,BCBS MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Cigna,Cigna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Cigna MGG,Cigna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Humana,Humana,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Humana MGG,Humana MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Optum VA,Optum VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,UHC,UHC,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,UHC MGG,UHC MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,VA,VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Wellcare MGG,Wellcare MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Bright Health - commercial,Bright Health - commercial,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,6.87,6.87,Bright Health MGG,Bright Health MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Aetna,Aetna,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Aetna MGG,Aetna MGG,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,BCBS,BCBS,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,BCBS MGG,BCBS MGG,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Cigna,Cigna,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Cigna MGG,Cigna MGG,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Humana,Humana,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Humana MGG,Humana MGG,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Optum VA,Optum VA,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,UHC,UHC,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,UHC MGG,UHC MGG,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,VA,VA,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Wellcare MGG,Wellcare MGG,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Bright Health - commercial,Bright Health - commercial,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,Bright Health MGG,Bright Health MGG,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Aetna,Aetna,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Aetna MGG,Aetna MGG,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,BCBS,BCBS,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,BCBS MGG,BCBS MGG,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Cigna,Cigna,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Cigna MGG,Cigna MGG,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Humana,Humana,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Humana MGG,Humana MGG,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Optum VA,Optum VA,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,UHC,UHC,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,UHC MGG,UHC MGG,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,VA,VA,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Wellcare MGG,Wellcare MGG,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Bright Health - commercial,Bright Health - commercial,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,Bright Health MGG,Bright Health MGG,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Aetna,Aetna,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Aetna MGG,Aetna MGG,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,BCBS,BCBS,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,BCBS MGG,BCBS MGG,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Cigna,Cigna,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Cigna MGG,Cigna MGG,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Humana,Humana,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Humana MGG,Humana MGG,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Optum VA,Optum VA,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,UHC,UHC,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,UHC MGG,UHC MGG,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,VA,VA,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Wellcare MGG,Wellcare MGG,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Bright Health - commercial,Bright Health - commercial,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,Bright Health MGG,Bright Health MGG,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Aetna,Aetna,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Aetna MGG,Aetna MGG,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,BCBS,BCBS,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,BCBS MGG,BCBS MGG,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Cigna,Cigna,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Cigna MGG,Cigna MGG,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Humana,Humana,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Humana MGG,Humana MGG,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Optum VA,Optum VA,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,UHC,UHC,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,UHC MGG,UHC MGG,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,VA,VA,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Wellcare MGG,Wellcare MGG,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Bright Health - commercial,Bright Health - commercial,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,Bright Health MGG,Bright Health MGG,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Aetna,Aetna,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Aetna MGG,Aetna MGG,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,BCBS,BCBS,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,BCBS MGG,BCBS MGG,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Cigna,Cigna,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Cigna MGG,Cigna MGG,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Humana,Humana,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Humana MGG,Humana MGG,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Optum VA,Optum VA,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,UHC,UHC,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,UHC MGG,UHC MGG,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,VA,VA,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Wellcare MGG,Wellcare MGG,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Bright Health - commercial,Bright Health - commercial,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,Bright Health MGG,Bright Health MGG,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Aetna,Aetna,203.13,,,,,,,per diem,203.13,203.13,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Aetna MGG,Aetna MGG,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,BCBS,BCBS,203.13,,,,,,,per diem,203.13,203.13,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,BCBS MGG,BCBS MGG,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Cigna,Cigna,203.13,,,,,,,per diem,203.13,203.13,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Cigna MGG,Cigna MGG,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Humana,Humana,203.13,,,,,,,per diem,203.13,203.13,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Humana MGG,Humana MGG,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Optum VA,Optum VA,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,UHC,UHC,203.13,,,,,,,per diem,203.13,203.13,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,UHC MGG,UHC MGG,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,VA,VA,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Wellcare MGG,Wellcare MGG,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Bright Health - commercial,Bright Health - commercial,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,203.13,203.13,Bright Health MGG,Bright Health MGG,203.13,,,,,,,case rate,203.13,203.13,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Aetna,Aetna,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Aetna MGG,Aetna MGG,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,BCBS,BCBS,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,BCBS MGG,BCBS MGG,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Cigna,Cigna,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Cigna MGG,Cigna MGG,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Humana,Humana,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Humana MGG,Humana MGG,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Optum VA,Optum VA,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,UHC,UHC,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,UHC MGG,UHC MGG,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,VA,VA,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Wellcare MGG,Wellcare MGG,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Bright Health - commercial,Bright Health - commercial,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,131.41,131.41,Bright Health MGG,Bright Health MGG,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Aetna,Aetna,156.7,,,,,,,per diem,156.7,156.7,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Aetna MGG,Aetna MGG,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,BCBS,BCBS,156.7,,,,,,,per diem,156.7,156.7,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,BCBS MGG,BCBS MGG,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Cigna,Cigna,156.7,,,,,,,per diem,156.7,156.7,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Cigna MGG,Cigna MGG,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Humana,Humana,156.7,,,,,,,per diem,156.7,156.7,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Humana MGG,Humana MGG,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Optum VA,Optum VA,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,UHC,UHC,156.7,,,,,,,per diem,156.7,156.7,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,UHC MGG,UHC MGG,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,VA,VA,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Wellcare MGG,Wellcare MGG,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Bright Health - commercial,Bright Health - commercial,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,156.7,156.7,Bright Health MGG,Bright Health MGG,156.7,,,,,,,case rate,156.7,156.7,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Aetna,Aetna,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Aetna MGG,Aetna MGG,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,BCBS,BCBS,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,BCBS MGG,BCBS MGG,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Cigna,Cigna,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Cigna MGG,Cigna MGG,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Humana,Humana,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Humana MGG,Humana MGG,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Optum VA,Optum VA,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,UHC,UHC,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,UHC MGG,UHC MGG,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,VA,VA,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Wellcare MGG,Wellcare MGG,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Bright Health - commercial,Bright Health - commercial,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,Bright Health MGG,Bright Health MGG,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Aetna,Aetna,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Aetna MGG,Aetna MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,BCBS,BCBS,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,BCBS MGG,BCBS MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Cigna,Cigna,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Cigna MGG,Cigna MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Humana,Humana,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Humana MGG,Humana MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Optum VA,Optum VA,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,UHC,UHC,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,UHC MGG,UHC MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,VA,VA,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Wellcare MGG,Wellcare MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Bright Health - commercial,Bright Health - commercial,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,Bright Health MGG,Bright Health MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Aetna,Aetna,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Aetna MGG,Aetna MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,BCBS,BCBS,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,BCBS MGG,BCBS MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Cigna,Cigna,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Cigna MGG,Cigna MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Humana,Humana,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Humana MGG,Humana MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Optum VA,Optum VA,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,UHC,UHC,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,UHC MGG,UHC MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,VA,VA,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Wellcare MGG,Wellcare MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Bright Health - commercial,Bright Health - commercial,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,Bright Health MGG,Bright Health MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Aetna,Aetna,108.98,,,,,,,per diem,108.98,108.98,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Aetna MGG,Aetna MGG,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,BCBS,BCBS,108.98,,,,,,,per diem,108.98,108.98,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,BCBS MGG,BCBS MGG,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Cigna,Cigna,108.98,,,,,,,per diem,108.98,108.98,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Cigna MGG,Cigna MGG,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Humana,Humana,108.98,,,,,,,per diem,108.98,108.98,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Humana MGG,Humana MGG,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Optum VA,Optum VA,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,UHC,UHC,108.98,,,,,,,per diem,108.98,108.98,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,UHC MGG,UHC MGG,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,VA,VA,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Wellcare MGG,Wellcare MGG,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Bright Health - commercial,Bright Health - commercial,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,108.98,108.98,Bright Health MGG,Bright Health MGG,108.98,,,,,,,case rate,108.98,108.98,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Aetna,Aetna,262.5,,,,,,,per diem,262.5,262.5,"Per diem rate, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Aetna MGG,Aetna MGG,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,BCBS,BCBS,262.5,,,,,,,per diem,262.5,262.5,"Per diem rate, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,BCBS MGG,BCBS MGG,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Cigna,Cigna,262.5,,,,,,,per diem,262.5,262.5,"Per diem rate, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Cigna MGG,Cigna MGG,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Humana,Humana,262.5,,,,,,,per diem,262.5,262.5,"Per diem rate, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Humana MGG,Humana MGG,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Optum VA,Optum VA,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,UHC,UHC,262.5,,,,,,,per diem,262.5,262.5,"Per diem rate, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,UHC MGG,UHC MGG,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,VA,VA,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Wellcare MGG,Wellcare MGG,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Bright Health - commercial,Bright Health - commercial,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
SOLUBLE TRANSFERRIN RECEPTOR  ,38207005,CDM,300,RC,84238,CPT,,,,Inpatient,,,262.5,262.5,Bright Health MGG,Bright Health MGG,262.5,,,,,,,case rate,262.5,262.5,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Aetna,Aetna,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Aetna MGG,Aetna MGG,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,BCBS,BCBS,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,BCBS MGG,BCBS MGG,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Cigna,Cigna,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Cigna MGG,Cigna MGG,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Humana,Humana,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Humana MGG,Humana MGG,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Optum VA,Optum VA,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,UHC,UHC,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,UHC MGG,UHC MGG,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,VA,VA,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Wellcare MGG,Wellcare MGG,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Bright Health - commercial,Bright Health - commercial,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,Bright Health MGG,Bright Health MGG,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Aetna,Aetna,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Aetna MGG,Aetna MGG,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,BCBS,BCBS,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,BCBS MGG,BCBS MGG,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Cigna,Cigna,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Cigna MGG,Cigna MGG,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Humana,Humana,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Humana MGG,Humana MGG,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Optum VA,Optum VA,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,UHC,UHC,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,UHC MGG,UHC MGG,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,VA,VA,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Wellcare MGG,Wellcare MGG,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Bright Health - commercial,Bright Health - commercial,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,Bright Health MGG,Bright Health MGG,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Aetna,Aetna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Aetna MGG,Aetna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,BCBS,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS MGG,BCBS MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Cigna,Cigna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Cigna MGG,Cigna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Humana,Humana,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Humana MGG,Humana MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Optum VA,Optum VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UHC,UHC,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UHC MGG,UHC MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,VA,VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Wellcare MGG,Wellcare MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Bright Health - commercial,Bright Health - commercial,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Bright Health MGG,Bright Health MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Aetna,Aetna,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Aetna MGG,Aetna MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS,BCBS,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS MGG,BCBS MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Cigna,Cigna,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Cigna MGG,Cigna MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Humana,Humana,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Humana MGG,Humana MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Optum VA,Optum VA,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,UHC,UHC,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,UHC MGG,UHC MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,VA,VA,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Wellcare MGG,Wellcare MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Bright Health - commercial,Bright Health - commercial,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Bright Health MGG,Bright Health MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Aetna,Aetna,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Aetna MGG,Aetna MGG,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,BCBS,BCBS,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,BCBS MGG,BCBS MGG,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Cigna,Cigna,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Cigna MGG,Cigna MGG,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Humana,Humana,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Humana MGG,Humana MGG,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Optum VA,Optum VA,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,UHC,UHC,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,UHC MGG,UHC MGG,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,VA,VA,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Wellcare MGG,Wellcare MGG,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Bright Health - commercial,Bright Health - commercial,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,Bright Health MGG,Bright Health MGG,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Aetna,Aetna,181.01,,,,,,,per diem,181.01,181.01,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Aetna MGG,Aetna MGG,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,BCBS,BCBS,181.01,,,,,,,per diem,181.01,181.01,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,BCBS MGG,BCBS MGG,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Cigna,Cigna,181.01,,,,,,,per diem,181.01,181.01,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Cigna MGG,Cigna MGG,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Humana,Humana,181.01,,,,,,,per diem,181.01,181.01,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Humana MGG,Humana MGG,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Optum VA,Optum VA,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,UHC,UHC,181.01,,,,,,,per diem,181.01,181.01,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,UHC MGG,UHC MGG,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,VA,VA,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Wellcare MGG,Wellcare MGG,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Bright Health - commercial,Bright Health - commercial,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,181.01,181.01,Bright Health MGG,Bright Health MGG,181.01,,,,,,,case rate,181.01,181.01,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Aetna,Aetna,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Aetna MGG,Aetna MGG,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,BCBS,BCBS,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,BCBS MGG,BCBS MGG,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Cigna,Cigna,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Cigna MGG,Cigna MGG,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Humana,Humana,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Humana MGG,Humana MGG,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Optum VA,Optum VA,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,UHC,UHC,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,UHC MGG,UHC MGG,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,VA,VA,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Wellcare MGG,Wellcare MGG,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Bright Health - commercial,Bright Health - commercial,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,Bright Health MGG,Bright Health MGG,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Aetna,Aetna,352.42,,,,,,,per diem,352.42,352.42,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Aetna MGG,Aetna MGG,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,BCBS,BCBS,352.42,,,,,,,per diem,352.42,352.42,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,BCBS MGG,BCBS MGG,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Cigna,Cigna,352.42,,,,,,,per diem,352.42,352.42,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Cigna MGG,Cigna MGG,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Humana,Humana,352.42,,,,,,,per diem,352.42,352.42,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Humana MGG,Humana MGG,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Optum VA,Optum VA,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,UHC,UHC,352.42,,,,,,,per diem,352.42,352.42,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,UHC MGG,UHC MGG,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,VA,VA,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Wellcare MGG,Wellcare MGG,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Bright Health - commercial,Bright Health - commercial,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,352.42,352.42,Bright Health MGG,Bright Health MGG,352.42,,,,,,,case rate,352.42,352.42,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Aetna,Aetna,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Aetna MGG,Aetna MGG,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,BCBS,BCBS,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,BCBS MGG,BCBS MGG,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Cigna,Cigna,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Cigna MGG,Cigna MGG,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Humana,Humana,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Humana MGG,Humana MGG,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Optum VA,Optum VA,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,UHC,UHC,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,UHC MGG,UHC MGG,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,VA,VA,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Wellcare MGG,Wellcare MGG,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Bright Health - commercial,Bright Health - commercial,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,Bright Health MGG,Bright Health MGG,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Aetna,Aetna,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Aetna MGG,Aetna MGG,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,BCBS,BCBS,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,BCBS MGG,BCBS MGG,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Cigna,Cigna,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Cigna MGG,Cigna MGG,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Humana,Humana,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Humana MGG,Humana MGG,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Optum VA,Optum VA,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,UHC,UHC,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,UHC MGG,UHC MGG,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,VA,VA,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Wellcare MGG,Wellcare MGG,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Bright Health - commercial,Bright Health - commercial,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,Bright Health MGG,Bright Health MGG,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Aetna,Aetna,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Aetna MGG,Aetna MGG,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,BCBS,BCBS,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,BCBS MGG,BCBS MGG,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Cigna,Cigna,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Cigna MGG,Cigna MGG,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Humana,Humana,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Humana MGG,Humana MGG,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Optum VA,Optum VA,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,UHC,UHC,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,UHC MGG,UHC MGG,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,VA,VA,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Wellcare MGG,Wellcare MGG,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Bright Health - commercial,Bright Health - commercial,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
OSMOLALITY STOOL              ,38207021,CDM,301,RC,84999,CPT,,,,Inpatient,,,141.75,141.75,Bright Health MGG,Bright Health MGG,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Aetna,Aetna,145.59,,,,,,,per diem,145.59,145.59,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Aetna MGG,Aetna MGG,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,BCBS,BCBS,145.59,,,,,,,per diem,145.59,145.59,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,BCBS MGG,BCBS MGG,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Cigna,Cigna,145.59,,,,,,,per diem,145.59,145.59,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Cigna MGG,Cigna MGG,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Humana,Humana,145.59,,,,,,,per diem,145.59,145.59,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Humana MGG,Humana MGG,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Optum VA,Optum VA,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,UHC,UHC,145.59,,,,,,,per diem,145.59,145.59,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,UHC MGG,UHC MGG,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,VA,VA,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Wellcare MGG,Wellcare MGG,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Bright Health - commercial,Bright Health - commercial,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87154,CPT,,,,Inpatient,,,145.59,145.59,Bright Health MGG,Bright Health MGG,145.59,,,,,,,case rate,145.59,145.59,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Aetna,Aetna,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Aetna MGG,Aetna MGG,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,BCBS,BCBS,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,BCBS MGG,BCBS MGG,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Cigna,Cigna,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Cigna MGG,Cigna MGG,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Humana,Humana,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Humana MGG,Humana MGG,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Optum VA,Optum VA,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,UHC,UHC,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,UHC MGG,UHC MGG,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,VA,VA,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Wellcare MGG,Wellcare MGG,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Bright Health - commercial,Bright Health - commercial,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,Bright Health MGG,Bright Health MGG,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Aetna,Aetna,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Aetna MGG,Aetna MGG,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,BCBS,BCBS,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,BCBS MGG,BCBS MGG,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Cigna,Cigna,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Cigna MGG,Cigna MGG,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Humana,Humana,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Humana MGG,Humana MGG,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Optum VA,Optum VA,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,UHC,UHC,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,UHC MGG,UHC MGG,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,VA,VA,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Wellcare MGG,Wellcare MGG,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Bright Health - commercial,Bright Health - commercial,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,Bright Health MGG,Bright Health MGG,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Aetna,Aetna,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Aetna MGG,Aetna MGG,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,BCBS,BCBS,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,BCBS MGG,BCBS MGG,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Cigna,Cigna,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Cigna MGG,Cigna MGG,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Humana,Humana,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Humana MGG,Humana MGG,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Optum VA,Optum VA,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,UHC,UHC,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,UHC MGG,UHC MGG,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,VA,VA,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Wellcare MGG,Wellcare MGG,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Bright Health - commercial,Bright Health - commercial,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,Bright Health MGG,Bright Health MGG,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Aetna,Aetna,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Aetna MGG,Aetna MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,BCBS,BCBS,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,BCBS MGG,BCBS MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Cigna,Cigna,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Cigna MGG,Cigna MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Humana,Humana,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Humana MGG,Humana MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Optum VA,Optum VA,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,UHC,UHC,75.85,,,,,,,per diem,75.85,75.85,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,UHC MGG,UHC MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,VA,VA,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Wellcare MGG,Wellcare MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Bright Health - commercial,Bright Health - commercial,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,75.85,75.85,Bright Health MGG,Bright Health MGG,75.85,,,,,,,case rate,75.85,75.85,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Aetna,Aetna,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Aetna MGG,Aetna MGG,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,BCBS,BCBS,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,BCBS MGG,BCBS MGG,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Cigna,Cigna,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Cigna MGG,Cigna MGG,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Humana,Humana,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Humana MGG,Humana MGG,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Optum VA,Optum VA,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,UHC,UHC,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,UHC MGG,UHC MGG,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,VA,VA,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Wellcare MGG,Wellcare MGG,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Bright Health - commercial,Bright Health - commercial,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,Bright Health MGG,Bright Health MGG,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Aetna,Aetna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Aetna MGG,Aetna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,BCBS,BCBS,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,BCBS MGG,BCBS MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Cigna,Cigna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Cigna MGG,Cigna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Humana,Humana,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Humana MGG,Humana MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Optum VA,Optum VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,UHC,UHC,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,UHC MGG,UHC MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,VA,VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Wellcare MGG,Wellcare MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Bright Health - commercial,Bright Health - commercial,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,Bright Health MGG,Bright Health MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Aetna,Aetna,151.85,,,,,,,per diem,151.85,151.85,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Aetna MGG,Aetna MGG,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,BCBS,BCBS,151.85,,,,,,,per diem,151.85,151.85,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,BCBS MGG,BCBS MGG,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Cigna,Cigna,151.85,,,,,,,per diem,151.85,151.85,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Cigna MGG,Cigna MGG,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Humana,Humana,151.85,,,,,,,per diem,151.85,151.85,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Humana MGG,Humana MGG,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Optum VA,Optum VA,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,UHC,UHC,151.85,,,,,,,per diem,151.85,151.85,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,UHC MGG,UHC MGG,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,VA,VA,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Wellcare MGG,Wellcare MGG,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Bright Health - commercial,Bright Health - commercial,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,151.85,151.85,Bright Health MGG,Bright Health MGG,151.85,,,,,,,case rate,151.85,151.85,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Aetna,Aetna,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Aetna MGG,Aetna MGG,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,BCBS,BCBS,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,BCBS MGG,BCBS MGG,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Cigna,Cigna,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Cigna MGG,Cigna MGG,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Humana,Humana,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Humana MGG,Humana MGG,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Optum VA,Optum VA,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,UHC,UHC,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,UHC MGG,UHC MGG,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,VA,VA,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Wellcare MGG,Wellcare MGG,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Bright Health - commercial,Bright Health - commercial,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,Bright Health MGG,Bright Health MGG,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Aetna,Aetna,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Aetna MGG,Aetna MGG,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,BCBS,BCBS,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,BCBS MGG,BCBS MGG,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Cigna,Cigna,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Cigna MGG,Cigna MGG,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Humana,Humana,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Humana MGG,Humana MGG,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Optum VA,Optum VA,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,UHC,UHC,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,UHC MGG,UHC MGG,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,VA,VA,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Wellcare MGG,Wellcare MGG,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Bright Health - commercial,Bright Health - commercial,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,358.05,358.05,Bright Health MGG,Bright Health MGG,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Aetna,Aetna,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Aetna MGG,Aetna MGG,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,BCBS,BCBS,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,BCBS MGG,BCBS MGG,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Cigna,Cigna,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Cigna MGG,Cigna MGG,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Humana,Humana,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Humana MGG,Humana MGG,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Optum VA,Optum VA,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,UHC,UHC,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,UHC MGG,UHC MGG,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,VA,VA,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Wellcare MGG,Wellcare MGG,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Bright Health - commercial,Bright Health - commercial,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,Bright Health MGG,Bright Health MGG,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Aetna,Aetna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Aetna MGG,Aetna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,BCBS,BCBS,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,BCBS MGG,BCBS MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Cigna,Cigna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Cigna MGG,Cigna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Humana,Humana,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Humana MGG,Humana MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Optum VA,Optum VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,UHC,UHC,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,UHC MGG,UHC MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,VA,VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Wellcare MGG,Wellcare MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Bright Health - commercial,Bright Health - commercial,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,Bright Health MGG,Bright Health MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Aetna,Aetna,146.6,,,,,,,per diem,146.6,146.6,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Aetna MGG,Aetna MGG,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,BCBS,BCBS,146.6,,,,,,,per diem,146.6,146.6,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,BCBS MGG,BCBS MGG,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Cigna,Cigna,146.6,,,,,,,per diem,146.6,146.6,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Cigna MGG,Cigna MGG,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Humana,Humana,146.6,,,,,,,per diem,146.6,146.6,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Humana MGG,Humana MGG,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Optum VA,Optum VA,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,UHC,UHC,146.6,,,,,,,per diem,146.6,146.6,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,UHC MGG,UHC MGG,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,VA,VA,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Wellcare MGG,Wellcare MGG,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Bright Health - commercial,Bright Health - commercial,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,146.6,146.6,Bright Health MGG,Bright Health MGG,146.6,,,,,,,case rate,146.6,146.6,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Aetna,Aetna,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Aetna MGG,Aetna MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,BCBS,BCBS,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,BCBS MGG,BCBS MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Cigna,Cigna,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Cigna MGG,Cigna MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Humana,Humana,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Humana MGG,Humana MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Optum VA,Optum VA,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,UHC,UHC,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,UHC MGG,UHC MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,VA,VA,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Wellcare MGG,Wellcare MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Bright Health - commercial,Bright Health - commercial,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,Bright Health MGG,Bright Health MGG,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Aetna,Aetna,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Aetna MGG,Aetna MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,BCBS,BCBS,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,BCBS MGG,BCBS MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Cigna,Cigna,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Cigna MGG,Cigna MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Humana,Humana,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Humana MGG,Humana MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Optum VA,Optum VA,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,UHC,UHC,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,UHC MGG,UHC MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,VA,VA,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Wellcare MGG,Wellcare MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Bright Health - commercial,Bright Health - commercial,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,Bright Health MGG,Bright Health MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna,Aetna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Aetna MGG,Aetna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,BCBS,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS MGG,BCBS MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna,Cigna,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Cigna MGG,Cigna MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana,Humana,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Humana MGG,Humana MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Optum VA,Optum VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC,UHC,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UHC MGG,UHC MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,VA,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Wellcare MGG,Wellcare MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health - commercial,Bright Health - commercial,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,Bright Health MGG,Bright Health MGG,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Aetna,Aetna,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Aetna MGG,Aetna MGG,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,BCBS,BCBS,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,BCBS MGG,BCBS MGG,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Cigna,Cigna,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Cigna MGG,Cigna MGG,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Humana,Humana,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Humana MGG,Humana MGG,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Optum VA,Optum VA,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,UHC,UHC,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,UHC MGG,UHC MGG,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,VA,VA,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Wellcare MGG,Wellcare MGG,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Bright Health - commercial,Bright Health - commercial,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,Bright Health MGG,Bright Health MGG,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Aetna,Aetna,144.81,,,,,,,per diem,144.81,144.81,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Aetna MGG,Aetna MGG,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,BCBS,BCBS,144.81,,,,,,,per diem,144.81,144.81,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,BCBS MGG,BCBS MGG,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Cigna,Cigna,144.81,,,,,,,per diem,144.81,144.81,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Cigna MGG,Cigna MGG,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Humana,Humana,144.81,,,,,,,per diem,144.81,144.81,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Humana MGG,Humana MGG,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Optum VA,Optum VA,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,UHC,UHC,144.81,,,,,,,per diem,144.81,144.81,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,UHC MGG,UHC MGG,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,VA,VA,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Wellcare MGG,Wellcare MGG,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Bright Health - commercial,Bright Health - commercial,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,144.81,144.81,Bright Health MGG,Bright Health MGG,144.81,,,,,,,case rate,144.81,144.81,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Aetna,Aetna,363.65,,,,,,,per diem,363.65,363.65,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Aetna MGG,Aetna MGG,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,BCBS,BCBS,363.65,,,,,,,per diem,363.65,363.65,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,BCBS MGG,BCBS MGG,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Cigna,Cigna,363.65,,,,,,,per diem,363.65,363.65,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Cigna MGG,Cigna MGG,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Humana,Humana,363.65,,,,,,,per diem,363.65,363.65,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Humana MGG,Humana MGG,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Optum VA,Optum VA,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,UHC,UHC,363.65,,,,,,,per diem,363.65,363.65,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,UHC MGG,UHC MGG,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,VA,VA,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Wellcare MGG,Wellcare MGG,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Bright Health - commercial,Bright Health - commercial,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,363.65,363.65,Bright Health MGG,Bright Health MGG,363.65,,,,,,,case rate,363.65,363.65,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Aetna,Aetna,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Aetna MGG,Aetna MGG,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,BCBS,BCBS,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,BCBS MGG,BCBS MGG,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Cigna,Cigna,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Cigna MGG,Cigna MGG,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Humana,Humana,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Humana MGG,Humana MGG,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Optum VA,Optum VA,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,UHC,UHC,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,UHC MGG,UHC MGG,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,VA,VA,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Wellcare MGG,Wellcare MGG,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Bright Health - commercial,Bright Health - commercial,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,Bright Health MGG,Bright Health MGG,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Aetna,Aetna,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Aetna MGG,Aetna MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,BCBS,BCBS,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,BCBS MGG,BCBS MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Cigna,Cigna,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Cigna MGG,Cigna MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Humana,Humana,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Humana MGG,Humana MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Optum VA,Optum VA,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,UHC,UHC,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,UHC MGG,UHC MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,VA,VA,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Wellcare MGG,Wellcare MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Bright Health - commercial,Bright Health - commercial,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,Bright Health MGG,Bright Health MGG,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Aetna,Aetna,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Aetna MGG,Aetna MGG,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,BCBS,BCBS,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,BCBS MGG,BCBS MGG,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Cigna,Cigna,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Cigna MGG,Cigna MGG,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Humana,Humana,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Humana MGG,Humana MGG,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Optum VA,Optum VA,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,UHC,UHC,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,UHC MGG,UHC MGG,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,VA,VA,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Wellcare MGG,Wellcare MGG,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Bright Health - commercial,Bright Health - commercial,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,Bright Health MGG,Bright Health MGG,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Aetna,Aetna,328.41,,,,,,,per diem,328.41,328.41,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Aetna MGG,Aetna MGG,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,BCBS,BCBS,328.41,,,,,,,per diem,328.41,328.41,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,BCBS MGG,BCBS MGG,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Cigna,Cigna,328.41,,,,,,,per diem,328.41,328.41,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Cigna MGG,Cigna MGG,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Humana,Humana,328.41,,,,,,,per diem,328.41,328.41,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Humana MGG,Humana MGG,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Optum VA,Optum VA,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,UHC,UHC,328.41,,,,,,,per diem,328.41,328.41,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,UHC MGG,UHC MGG,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,VA,VA,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Wellcare MGG,Wellcare MGG,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Bright Health - commercial,Bright Health - commercial,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,328.41,328.41,Bright Health MGG,Bright Health MGG,328.41,,,,,,,case rate,328.41,328.41,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Aetna,Aetna,157.7,,,,,,,per diem,157.7,157.7,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Aetna MGG,Aetna MGG,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,BCBS,BCBS,157.7,,,,,,,per diem,157.7,157.7,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,BCBS MGG,BCBS MGG,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Cigna,Cigna,157.7,,,,,,,per diem,157.7,157.7,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Cigna MGG,Cigna MGG,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Humana,Humana,157.7,,,,,,,per diem,157.7,157.7,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Humana MGG,Humana MGG,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Optum VA,Optum VA,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,UHC,UHC,157.7,,,,,,,per diem,157.7,157.7,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,UHC MGG,UHC MGG,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,VA,VA,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Wellcare MGG,Wellcare MGG,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Bright Health - commercial,Bright Health - commercial,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,157.7,157.7,Bright Health MGG,Bright Health MGG,157.7,,,,,,,case rate,157.7,157.7,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Aetna,Aetna,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Aetna MGG,Aetna MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,BCBS,BCBS,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,BCBS MGG,BCBS MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Cigna,Cigna,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Cigna MGG,Cigna MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Humana,Humana,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Humana MGG,Humana MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Optum VA,Optum VA,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,UHC,UHC,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,UHC MGG,UHC MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,VA,VA,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Wellcare MGG,Wellcare MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Bright Health - commercial,Bright Health - commercial,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,88237,CPT,,,,Inpatient,,,1926.73,1926.73,Bright Health MGG,Bright Health MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Aetna,Aetna,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Aetna MGG,Aetna MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,BCBS,BCBS,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,BCBS MGG,BCBS MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Cigna,Cigna,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Cigna MGG,Cigna MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Humana,Humana,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Humana MGG,Humana MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Optum VA,Optum VA,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,UHC,UHC,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,UHC MGG,UHC MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,VA,VA,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Wellcare MGG,Wellcare MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Bright Health - commercial,Bright Health - commercial,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,88237,CPT,,,,Inpatient,,,914.63,914.63,Bright Health MGG,Bright Health MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Aetna,Aetna,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Aetna MGG,Aetna MGG,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,BCBS,BCBS,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,BCBS MGG,BCBS MGG,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Cigna,Cigna,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Cigna MGG,Cigna MGG,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Humana,Humana,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Humana MGG,Humana MGG,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Optum VA,Optum VA,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,UHC,UHC,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,UHC MGG,UHC MGG,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,VA,VA,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Wellcare MGG,Wellcare MGG,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Bright Health - commercial,Bright Health - commercial,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,88342,CPT,,,,Inpatient,,,427.33,427.33,Bright Health MGG,Bright Health MGG,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Aetna,Aetna,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Aetna MGG,Aetna MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,BCBS,BCBS,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,BCBS MGG,BCBS MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Cigna,Cigna,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Cigna MGG,Cigna MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Humana,Humana,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Humana MGG,Humana MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Optum VA,Optum VA,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,UHC,UHC,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,UHC MGG,UHC MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,VA,VA,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Wellcare MGG,Wellcare MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Bright Health - commercial,Bright Health - commercial,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,88271,CPT,,,,Inpatient,,,153.15,153.15,Bright Health MGG,Bright Health MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna,Aetna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna MGG,Aetna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS,BCBS,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS MGG,BCBS MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna,Cigna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna MGG,Cigna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana,Humana,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana MGG,Humana MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Optum VA,Optum VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC,UHC,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC MGG,UHC MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,VA,VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Wellcare MGG,Wellcare MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health - commercial,Bright Health - commercial,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health MGG,Bright Health MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna,Aetna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna MGG,Aetna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS,BCBS,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS MGG,BCBS MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna,Cigna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna MGG,Cigna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana,Humana,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana MGG,Humana MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Optum VA,Optum VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC,UHC,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC MGG,UHC MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,VA,VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Wellcare MGG,Wellcare MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health - commercial,Bright Health - commercial,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health MGG,Bright Health MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna,Aetna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna MGG,Aetna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS,BCBS,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS MGG,BCBS MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna,Cigna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna MGG,Cigna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana,Humana,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana MGG,Humana MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Optum VA,Optum VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC,UHC,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC MGG,UHC MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,VA,VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Wellcare MGG,Wellcare MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health - commercial,Bright Health - commercial,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health MGG,Bright Health MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna,Aetna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna MGG,Aetna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS,BCBS,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS MGG,BCBS MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna,Cigna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna MGG,Cigna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana,Humana,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana MGG,Humana MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Optum VA,Optum VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC,UHC,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC MGG,UHC MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,VA,VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Wellcare MGG,Wellcare MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health - commercial,Bright Health - commercial,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health MGG,Bright Health MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna,Aetna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Aetna MGG,Aetna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS,BCBS,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,BCBS MGG,BCBS MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna,Cigna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Cigna MGG,Cigna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana,Humana,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Humana MGG,Humana MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Optum VA,Optum VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC,UHC,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,UHC MGG,UHC MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,VA,VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Wellcare MGG,Wellcare MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health - commercial,Bright Health - commercial,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,88271,CPT,,,,Inpatient,,,145.66,145.66,Bright Health MGG,Bright Health MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Aetna,Aetna,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Aetna MGG,Aetna MGG,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,BCBS,BCBS,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,BCBS MGG,BCBS MGG,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Cigna,Cigna,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Cigna MGG,Cigna MGG,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Humana,Humana,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Humana MGG,Humana MGG,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Optum VA,Optum VA,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,UHC,UHC,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,UHC MGG,UHC MGG,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,VA,VA,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Wellcare MGG,Wellcare MGG,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Bright Health - commercial,Bright Health - commercial,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,88271,CPT,,,,Inpatient,,,152.08,152.08,Bright Health MGG,Bright Health MGG,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Aetna,Aetna,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Aetna MGG,Aetna MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,BCBS,BCBS,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,BCBS MGG,BCBS MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Cigna,Cigna,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Cigna MGG,Cigna MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Humana,Humana,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Humana MGG,Humana MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Optum VA,Optum VA,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,UHC,UHC,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,UHC MGG,UHC MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,VA,VA,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Wellcare MGG,Wellcare MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Bright Health - commercial,Bright Health - commercial,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,88271,CPT,,,,Inpatient,,,189.57,189.57,Bright Health MGG,Bright Health MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Aetna,Aetna,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Aetna MGG,Aetna MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,BCBS,BCBS,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,BCBS MGG,BCBS MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Cigna,Cigna,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Cigna MGG,Cigna MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Humana,Humana,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Humana MGG,Humana MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Optum VA,Optum VA,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,UHC,UHC,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,UHC MGG,UHC MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,VA,VA,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Wellcare MGG,Wellcare MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Bright Health - commercial,Bright Health - commercial,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,88271,CPT,,,,Inpatient,,,323.44,323.44,Bright Health MGG,Bright Health MGG,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Aetna,Aetna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Aetna MGG,Aetna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,BCBS,BCBS,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,BCBS MGG,BCBS MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Cigna,Cigna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Cigna MGG,Cigna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Humana,Humana,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Humana MGG,Humana MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Optum VA,Optum VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,UHC,UHC,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,UHC MGG,UHC MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,VA,VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Wellcare MGG,Wellcare MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Bright Health - commercial,Bright Health - commercial,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,88185,CPT,,,,Inpatient,,,137.09,137.09,Bright Health MGG,Bright Health MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Aetna,Aetna,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Aetna MGG,Aetna MGG,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,BCBS,BCBS,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,BCBS MGG,BCBS MGG,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Cigna,Cigna,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Cigna MGG,Cigna MGG,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Humana,Humana,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Humana MGG,Humana MGG,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Optum VA,Optum VA,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,UHC,UHC,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,UHC MGG,UHC MGG,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,VA,VA,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Wellcare MGG,Wellcare MGG,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Bright Health - commercial,Bright Health - commercial,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,82787,CPT,,,,Inpatient,,,979.97,979.97,Bright Health MGG,Bright Health MGG,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Aetna,Aetna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Aetna MGG,Aetna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,BCBS,BCBS,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,BCBS MGG,BCBS MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Cigna,Cigna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Cigna MGG,Cigna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Humana,Humana,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Humana MGG,Humana MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Optum VA,Optum VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,UHC,UHC,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,UHC MGG,UHC MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,VA,VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Wellcare MGG,Wellcare MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Bright Health - commercial,Bright Health - commercial,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Bright Health MGG,Bright Health MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Aetna,Aetna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Aetna MGG,Aetna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,BCBS,BCBS,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,BCBS MGG,BCBS MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Cigna,Cigna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Cigna MGG,Cigna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Humana,Humana,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Humana MGG,Humana MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Optum VA,Optum VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,UHC,UHC,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,UHC MGG,UHC MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,VA,VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Wellcare MGG,Wellcare MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Bright Health - commercial,Bright Health - commercial,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,82787,CPT,,,59,Inpatient,,,128.52,128.52,Bright Health MGG,Bright Health MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna,Aetna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Aetna MGG,Aetna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS,BCBS,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,BCBS MGG,BCBS MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna,Cigna,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Cigna MGG,Cigna MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana,Humana,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Humana MGG,Humana MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Optum VA,Optum VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC,UHC,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,UHC MGG,UHC MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,VA,VA,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Wellcare MGG,Wellcare MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health - commercial,Bright Health - commercial,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,86003,CPT,,,,Inpatient,,,69.62,69.62,Bright Health MGG,Bright Health MGG,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Aetna,Aetna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Aetna MGG,Aetna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,BCBS,BCBS,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,BCBS MGG,BCBS MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Cigna,Cigna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Cigna MGG,Cigna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Humana,Humana,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Humana MGG,Humana MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Optum VA,Optum VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,UHC,UHC,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,UHC MGG,UHC MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,VA,VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Wellcare MGG,Wellcare MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Bright Health - commercial,Bright Health - commercial,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Bright Health MGG,Bright Health MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Aetna,Aetna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Aetna MGG,Aetna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,BCBS,BCBS,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,BCBS MGG,BCBS MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Cigna,Cigna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Cigna MGG,Cigna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Humana,Humana,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Humana MGG,Humana MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Optum VA,Optum VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,UHC,UHC,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,UHC MGG,UHC MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,VA,VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Wellcare MGG,Wellcare MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Bright Health - commercial,Bright Health - commercial,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Bright Health MGG,Bright Health MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Aetna,Aetna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Aetna MGG,Aetna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,BCBS,BCBS,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,BCBS MGG,BCBS MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Cigna,Cigna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Cigna MGG,Cigna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Humana,Humana,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Humana MGG,Humana MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Optum VA,Optum VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,UHC,UHC,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,UHC MGG,UHC MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,VA,VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Wellcare MGG,Wellcare MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Bright Health - commercial,Bright Health - commercial,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Bright Health MGG,Bright Health MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Aetna,Aetna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Aetna MGG,Aetna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,BCBS,BCBS,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,BCBS MGG,BCBS MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Cigna,Cigna,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Cigna MGG,Cigna MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Humana,Humana,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Humana MGG,Humana MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Optum VA,Optum VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,UHC,UHC,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,UHC MGG,UHC MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,VA,VA,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Wellcare MGG,Wellcare MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Bright Health - commercial,Bright Health - commercial,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,86003,CPT,,,,Inpatient,,,48.2,48.2,Bright Health MGG,Bright Health MGG,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,86003,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Aetna,Aetna,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Aetna MGG,Aetna MGG,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,BCBS,BCBS,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,BCBS MGG,BCBS MGG,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Cigna,Cigna,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Cigna MGG,Cigna MGG,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Humana,Humana,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Humana MGG,Humana MGG,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Optum VA,Optum VA,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,UHC,UHC,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,UHC MGG,UHC MGG,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,VA,VA,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Wellcare MGG,Wellcare MGG,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Bright Health - commercial,Bright Health - commercial,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,86003,CPT,,,,Inpatient,,,252.38,252.38,Bright Health MGG,Bright Health MGG,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Aetna,Aetna,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Aetna MGG,Aetna MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,BCBS,BCBS,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,BCBS MGG,BCBS MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Cigna,Cigna,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Cigna MGG,Cigna MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Humana,Humana,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Humana MGG,Humana MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Optum VA,Optum VA,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,UHC,UHC,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,UHC MGG,UHC MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,VA,VA,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Wellcare MGG,Wellcare MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Bright Health - commercial,Bright Health - commercial,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,86003,CPT,,,,Inpatient,,,68.54,68.54,Bright Health MGG,Bright Health MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,86003,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,86003,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,86003,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Aetna,Aetna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Aetna MGG,Aetna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,BCBS,BCBS,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,BCBS MGG,BCBS MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Cigna,Cigna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Cigna MGG,Cigna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Humana,Humana,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Humana MGG,Humana MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Optum VA,Optum VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,UHC,UHC,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,UHC MGG,UHC MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,VA,VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Wellcare MGG,Wellcare MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Bright Health - commercial,Bright Health - commercial,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,86003,CPT,,,,Inpatient,,,66.4,66.4,Bright Health MGG,Bright Health MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,86003,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Aetna,Aetna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Aetna MGG,Aetna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,BCBS,BCBS,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,BCBS MGG,BCBS MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Cigna,Cigna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Cigna MGG,Cigna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Humana,Humana,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Humana MGG,Humana MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Optum VA,Optum VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,UHC,UHC,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,UHC MGG,UHC MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,VA,VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Wellcare MGG,Wellcare MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Bright Health - commercial,Bright Health - commercial,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Bright Health MGG,Bright Health MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Aetna,Aetna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Aetna MGG,Aetna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,BCBS,BCBS,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,BCBS MGG,BCBS MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Cigna,Cigna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Cigna MGG,Cigna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Humana,Humana,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Humana MGG,Humana MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Optum VA,Optum VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,UHC,UHC,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,UHC MGG,UHC MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,VA,VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Wellcare MGG,Wellcare MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Bright Health - commercial,Bright Health - commercial,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Bright Health MGG,Bright Health MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Aetna,Aetna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Aetna MGG,Aetna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,BCBS,BCBS,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,BCBS MGG,BCBS MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Cigna,Cigna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Cigna MGG,Cigna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Humana,Humana,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Humana MGG,Humana MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Optum VA,Optum VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,UHC,UHC,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,UHC MGG,UHC MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,VA,VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Wellcare MGG,Wellcare MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Bright Health - commercial,Bright Health - commercial,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Bright Health MGG,Bright Health MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Aetna,Aetna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Aetna MGG,Aetna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,BCBS,BCBS,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,BCBS MGG,BCBS MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Cigna,Cigna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Cigna MGG,Cigna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Humana,Humana,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Humana MGG,Humana MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Optum VA,Optum VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,UHC,UHC,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,UHC MGG,UHC MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,VA,VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Wellcare MGG,Wellcare MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Bright Health - commercial,Bright Health - commercial,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,86003,CPT,,,,Inpatient,,,62.12,62.12,Bright Health MGG,Bright Health MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Aetna,Aetna,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Aetna MGG,Aetna MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,BCBS,BCBS,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,BCBS MGG,BCBS MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Cigna,Cigna,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Cigna MGG,Cigna MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Humana,Humana,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Humana MGG,Humana MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Optum VA,Optum VA,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,UHC,UHC,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,UHC MGG,UHC MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,VA,VA,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Wellcare MGG,Wellcare MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Bright Health - commercial,Bright Health - commercial,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,86003,CPT,,,,Inpatient,,,190.64,190.64,Bright Health MGG,Bright Health MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Aetna,Aetna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Aetna MGG,Aetna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,BCBS,BCBS,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,BCBS MGG,BCBS MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Cigna,Cigna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Cigna MGG,Cigna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Humana,Humana,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Humana MGG,Humana MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Optum VA,Optum VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,UHC,UHC,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,UHC MGG,UHC MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,VA,VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Wellcare MGG,Wellcare MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Bright Health - commercial,Bright Health - commercial,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Bright Health MGG,Bright Health MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Aetna,Aetna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Aetna MGG,Aetna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,BCBS,BCBS,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,BCBS MGG,BCBS MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Cigna,Cigna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Cigna MGG,Cigna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Humana,Humana,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Humana MGG,Humana MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Optum VA,Optum VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,UHC,UHC,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,UHC MGG,UHC MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,VA,VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Wellcare MGG,Wellcare MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Bright Health - commercial,Bright Health - commercial,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,86003,CPT,,,,Inpatient,,,52.48,52.48,Bright Health MGG,Bright Health MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,86003,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,86003,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Aetna,Aetna,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Aetna MGG,Aetna MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,BCBS,BCBS,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,BCBS MGG,BCBS MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Cigna,Cigna,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Cigna MGG,Cigna MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Humana,Humana,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Humana MGG,Humana MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Optum VA,Optum VA,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,UHC,UHC,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,UHC MGG,UHC MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,VA,VA,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Wellcare MGG,Wellcare MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Bright Health - commercial,Bright Health - commercial,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Bright Health MGG,Bright Health MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Aetna,Aetna,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Aetna MGG,Aetna MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,BCBS,BCBS,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,BCBS MGG,BCBS MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Cigna,Cigna,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Cigna MGG,Cigna MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Humana,Humana,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Humana MGG,Humana MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Optum VA,Optum VA,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,UHC,UHC,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,UHC MGG,UHC MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,VA,VA,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Wellcare MGG,Wellcare MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Bright Health - commercial,Bright Health - commercial,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,86787,CPT,,,,Inpatient,,,329.87,329.87,Bright Health MGG,Bright Health MGG,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Aetna,Aetna,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Aetna MGG,Aetna MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,BCBS,BCBS,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,BCBS MGG,BCBS MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Cigna,Cigna,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Cigna MGG,Cigna MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Humana,Humana,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Humana MGG,Humana MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Optum VA,Optum VA,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,UHC,UHC,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,UHC MGG,UHC MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,VA,VA,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Wellcare MGG,Wellcare MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Bright Health - commercial,Bright Health - commercial,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Bright Health MGG,Bright Health MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Aetna,Aetna,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Aetna MGG,Aetna MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,BCBS,BCBS,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,BCBS MGG,BCBS MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Cigna,Cigna,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Cigna MGG,Cigna MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Humana,Humana,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Humana MGG,Humana MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Optum VA,Optum VA,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,UHC,UHC,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,UHC MGG,UHC MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,VA,VA,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Wellcare MGG,Wellcare MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Bright Health - commercial,Bright Health - commercial,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Bright Health MGG,Bright Health MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Aetna,Aetna,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Aetna MGG,Aetna MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,BCBS,BCBS,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,BCBS MGG,BCBS MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Cigna,Cigna,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Cigna MGG,Cigna MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Humana,Humana,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Humana MGG,Humana MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Optum VA,Optum VA,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,UHC,UHC,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,UHC MGG,UHC MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,VA,VA,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Wellcare MGG,Wellcare MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Bright Health - commercial,Bright Health - commercial,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Bright Health MGG,Bright Health MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Aetna,Aetna,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Aetna MGG,Aetna MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,BCBS,BCBS,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,BCBS MGG,BCBS MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Cigna,Cigna,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Cigna MGG,Cigna MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Humana,Humana,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Humana MGG,Humana MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Optum VA,Optum VA,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,UHC,UHC,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,UHC MGG,UHC MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,VA,VA,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Wellcare MGG,Wellcare MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Bright Health - commercial,Bright Health - commercial,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,82784,CPT,,,,Inpatient,,,206.7,206.7,Bright Health MGG,Bright Health MGG,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Aetna,Aetna,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Aetna MGG,Aetna MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,BCBS,BCBS,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,BCBS MGG,BCBS MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Cigna,Cigna,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Cigna MGG,Cigna MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Humana,Humana,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Humana MGG,Humana MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Optum VA,Optum VA,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,UHC,UHC,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,UHC MGG,UHC MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,VA,VA,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Wellcare MGG,Wellcare MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Bright Health - commercial,Bright Health - commercial,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,82784,CPT,,,,Inpatient,,,178.86,178.86,Bright Health MGG,Bright Health MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,82784,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Aetna,Aetna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Aetna MGG,Aetna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,BCBS,BCBS,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,BCBS MGG,BCBS MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Cigna,Cigna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Cigna MGG,Cigna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Humana,Humana,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Humana MGG,Humana MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Optum VA,Optum VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,UHC,UHC,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,UHC MGG,UHC MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,VA,VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Wellcare MGG,Wellcare MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Bright Health - commercial,Bright Health - commercial,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Bright Health MGG,Bright Health MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Aetna,Aetna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Aetna MGG,Aetna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,BCBS,BCBS,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,BCBS MGG,BCBS MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Cigna,Cigna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Cigna MGG,Cigna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Humana,Humana,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Humana MGG,Humana MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Optum VA,Optum VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,UHC,UHC,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,UHC MGG,UHC MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,VA,VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Wellcare MGG,Wellcare MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Bright Health - commercial,Bright Health - commercial,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Bright Health MGG,Bright Health MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Aetna,Aetna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Aetna MGG,Aetna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,BCBS,BCBS,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,BCBS MGG,BCBS MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Cigna,Cigna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Cigna MGG,Cigna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Humana,Humana,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Humana MGG,Humana MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Optum VA,Optum VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,UHC,UHC,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,UHC MGG,UHC MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,VA,VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Wellcare MGG,Wellcare MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Bright Health - commercial,Bright Health - commercial,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,82784,CPT,,,,Inpatient,,,224.91,224.91,Bright Health MGG,Bright Health MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Aetna,Aetna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Aetna MGG,Aetna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,BCBS,BCBS,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,BCBS MGG,BCBS MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Cigna,Cigna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Cigna MGG,Cigna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Humana,Humana,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Humana MGG,Humana MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Optum VA,Optum VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,UHC,UHC,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,UHC MGG,UHC MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,VA,VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Wellcare MGG,Wellcare MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Bright Health - commercial,Bright Health - commercial,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,82784,CPT,,,,Inpatient,,,27.85,27.85,Bright Health MGG,Bright Health MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Aetna,Aetna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Aetna MGG,Aetna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,BCBS,BCBS,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,BCBS MGG,BCBS MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Cigna,Cigna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Cigna MGG,Cigna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Humana,Humana,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Humana MGG,Humana MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Optum VA,Optum VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,UHC,UHC,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,UHC MGG,UHC MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,VA,VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Wellcare MGG,Wellcare MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Bright Health - commercial,Bright Health - commercial,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,82784,CPT,,,,Inpatient,,,25.7,25.7,Bright Health MGG,Bright Health MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Aetna,Aetna,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Aetna MGG,Aetna MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,BCBS,BCBS,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,BCBS MGG,BCBS MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Cigna,Cigna,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Cigna MGG,Cigna MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Humana,Humana,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Humana MGG,Humana MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Optum VA,Optum VA,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,UHC,UHC,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,UHC MGG,UHC MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,VA,VA,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Wellcare MGG,Wellcare MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Bright Health - commercial,Bright Health - commercial,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,86900,CPT,,,,Inpatient,,,156.37,156.37,Bright Health MGG,Bright Health MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Aetna,Aetna,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Aetna MGG,Aetna MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,BCBS,BCBS,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,BCBS MGG,BCBS MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Cigna,Cigna,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Cigna MGG,Cigna MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Humana,Humana,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Humana MGG,Humana MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Optum VA,Optum VA,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,UHC,UHC,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,UHC MGG,UHC MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,VA,VA,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Wellcare MGG,Wellcare MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Bright Health - commercial,Bright Health - commercial,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,86901,CPT,,,,Inpatient,,,311.66,311.66,Bright Health MGG,Bright Health MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Aetna,Aetna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Aetna MGG,Aetna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,BCBS,BCBS,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,BCBS MGG,BCBS MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Cigna,Cigna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Cigna MGG,Cigna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Humana,Humana,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Humana MGG,Humana MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Optum VA,Optum VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,UHC,UHC,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,UHC MGG,UHC MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,VA,VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Wellcare MGG,Wellcare MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Bright Health - commercial,Bright Health - commercial,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,86901,CPT,,,,Inpatient,,,35.34,35.34,Bright Health MGG,Bright Health MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Aetna,Aetna,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Aetna MGG,Aetna MGG,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,BCBS,BCBS,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,BCBS MGG,BCBS MGG,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Cigna,Cigna,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Cigna MGG,Cigna MGG,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Humana,Humana,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Humana MGG,Humana MGG,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Optum VA,Optum VA,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,UHC,UHC,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,UHC MGG,UHC MGG,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,VA,VA,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Wellcare MGG,Wellcare MGG,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Bright Health - commercial,Bright Health - commercial,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,86255,CPT,,,,Inpatient,,,164.93,164.93,Bright Health MGG,Bright Health MGG,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Aetna,Aetna,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Aetna MGG,Aetna MGG,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,BCBS,BCBS,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,BCBS MGG,BCBS MGG,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Cigna,Cigna,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Cigna MGG,Cigna MGG,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Humana,Humana,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Humana MGG,Humana MGG,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Optum VA,Optum VA,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,UHC,UHC,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,UHC MGG,UHC MGG,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,VA,VA,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Wellcare MGG,Wellcare MGG,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Bright Health - commercial,Bright Health - commercial,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,86255,CPT,,,,Inpatient,,,604.04,604.04,Bright Health MGG,Bright Health MGG,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Aetna,Aetna,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Aetna MGG,Aetna MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,BCBS,BCBS,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,BCBS MGG,BCBS MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Cigna,Cigna,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Cigna MGG,Cigna MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Humana,Humana,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Humana MGG,Humana MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Optum VA,Optum VA,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,UHC,UHC,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,UHC MGG,UHC MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,VA,VA,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Wellcare MGG,Wellcare MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Bright Health - commercial,Bright Health - commercial,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,86255,CPT,,,,Inpatient,,,81.4,81.4,Bright Health MGG,Bright Health MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Aetna,Aetna,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Aetna MGG,Aetna MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,BCBS,BCBS,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,BCBS MGG,BCBS MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Cigna,Cigna,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Cigna MGG,Cigna MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Humana,Humana,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Humana MGG,Humana MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Optum VA,Optum VA,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,UHC,UHC,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,UHC MGG,UHC MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,VA,VA,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Wellcare MGG,Wellcare MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Bright Health - commercial,Bright Health - commercial,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,86255,CPT,,,,Inpatient,,,28.92,28.92,Bright Health MGG,Bright Health MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Aetna,Aetna,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Aetna MGG,Aetna MGG,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,BCBS,BCBS,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,BCBS MGG,BCBS MGG,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Cigna,Cigna,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Cigna MGG,Cigna MGG,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Humana,Humana,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Humana MGG,Humana MGG,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Optum VA,Optum VA,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,UHC,UHC,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,UHC MGG,UHC MGG,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,VA,VA,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Wellcare MGG,Wellcare MGG,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Bright Health - commercial,Bright Health - commercial,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,86255,CPT,,,,Inpatient,,,812.89,812.89,Bright Health MGG,Bright Health MGG,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Aetna,Aetna,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Aetna MGG,Aetna MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,BCBS,BCBS,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,BCBS MGG,BCBS MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Cigna,Cigna,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Cigna MGG,Cigna MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Humana,Humana,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Humana MGG,Humana MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Optum VA,Optum VA,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,UHC,UHC,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,UHC MGG,UHC MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,VA,VA,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Wellcare MGG,Wellcare MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Bright Health - commercial,Bright Health - commercial,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Bright Health MGG,Bright Health MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Aetna,Aetna,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Aetna MGG,Aetna MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,BCBS,BCBS,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,BCBS MGG,BCBS MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Cigna,Cigna,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Cigna MGG,Cigna MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Humana,Humana,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Humana MGG,Humana MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Optum VA,Optum VA,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,UHC,UHC,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,UHC MGG,UHC MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,VA,VA,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Wellcare MGG,Wellcare MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Bright Health - commercial,Bright Health - commercial,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,86255,CPT,,,,Inpatient,,,86.75,86.75,Bright Health MGG,Bright Health MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Aetna,Aetna,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Aetna MGG,Aetna MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,BCBS,BCBS,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,BCBS MGG,BCBS MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Cigna,Cigna,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Cigna MGG,Cigna MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Humana,Humana,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Humana MGG,Humana MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Optum VA,Optum VA,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,UHC,UHC,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,UHC MGG,UHC MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,VA,VA,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Wellcare MGG,Wellcare MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Bright Health - commercial,Bright Health - commercial,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,86255,CPT,,,,Inpatient,,,924.27,924.27,Bright Health MGG,Bright Health MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Aetna,Aetna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Aetna MGG,Aetna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,BCBS,BCBS,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,BCBS MGG,BCBS MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Cigna,Cigna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Cigna MGG,Cigna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Humana,Humana,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Humana MGG,Humana MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Optum VA,Optum VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,UHC,UHC,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,UHC MGG,UHC MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,VA,VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Wellcare MGG,Wellcare MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Bright Health - commercial,Bright Health - commercial,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,86255,CPT,,,,Inpatient,,,52.48,52.48,Bright Health MGG,Bright Health MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Aetna,Aetna,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Aetna MGG,Aetna MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,BCBS,BCBS,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,BCBS MGG,BCBS MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Cigna,Cigna,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Cigna MGG,Cigna MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Humana,Humana,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Humana MGG,Humana MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Optum VA,Optum VA,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,UHC,UHC,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,UHC MGG,UHC MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,VA,VA,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Wellcare MGG,Wellcare MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Bright Health - commercial,Bright Health - commercial,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,86255,CPT,,,,Inpatient,,,565.49,565.49,Bright Health MGG,Bright Health MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Aetna,Aetna,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Aetna MGG,Aetna MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,BCBS,BCBS,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,BCBS MGG,BCBS MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Cigna,Cigna,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Cigna MGG,Cigna MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Humana,Humana,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Humana MGG,Humana MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Optum VA,Optum VA,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,UHC,UHC,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,UHC MGG,UHC MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,VA,VA,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Wellcare MGG,Wellcare MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Bright Health - commercial,Bright Health - commercial,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,86255,CPT,,,,Inpatient,,,1311.98,1311.98,Bright Health MGG,Bright Health MGG,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Aetna,Aetna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Aetna MGG,Aetna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,BCBS,BCBS,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,BCBS MGG,BCBS MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Cigna,Cigna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Cigna MGG,Cigna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Humana,Humana,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Humana MGG,Humana MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Optum VA,Optum VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,UHC,UHC,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,UHC MGG,UHC MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,VA,VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Wellcare MGG,Wellcare MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Bright Health - commercial,Bright Health - commercial,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,84702,CPT,,,,Inpatient,,,59.98,59.98,Bright Health MGG,Bright Health MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,84702,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,80061,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Aetna,Aetna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Aetna MGG,Aetna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,BCBS,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS MGG,BCBS MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Cigna,Cigna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Cigna MGG,Cigna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Humana,Humana,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Humana MGG,Humana MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Optum VA,Optum VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,UHC,UHC,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,UHC MGG,UHC MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,VA,VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Wellcare MGG,Wellcare MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Bright Health - commercial,Bright Health - commercial,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Bright Health MGG,Bright Health MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Aetna,Aetna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Aetna MGG,Aetna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,BCBS,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS MGG,BCBS MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Cigna,Cigna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Cigna MGG,Cigna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Humana,Humana,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Humana MGG,Humana MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Optum VA,Optum VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,UHC,UHC,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,UHC MGG,UHC MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,VA,VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Wellcare MGG,Wellcare MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Bright Health - commercial,Bright Health - commercial,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,Bright Health MGG,Bright Health MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Aetna,Aetna,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Aetna MGG,Aetna MGG,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,BCBS,BCBS,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,BCBS MGG,BCBS MGG,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Cigna,Cigna,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Cigna MGG,Cigna MGG,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Humana,Humana,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Humana MGG,Humana MGG,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Optum VA,Optum VA,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,UHC,UHC,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,UHC MGG,UHC MGG,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,VA,VA,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Wellcare MGG,Wellcare MGG,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Bright Health - commercial,Bright Health - commercial,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,84311,CPT,,,,Inpatient,,,32.13,32.13,Bright Health MGG,Bright Health MGG,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Aetna,Aetna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Aetna MGG,Aetna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,BCBS,BCBS,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,BCBS MGG,BCBS MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Cigna,Cigna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Cigna MGG,Cigna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Humana,Humana,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Humana MGG,Humana MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Optum VA,Optum VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,UHC,UHC,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,UHC MGG,UHC MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,VA,VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Wellcare MGG,Wellcare MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Bright Health - commercial,Bright Health - commercial,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,84311,CPT,,,,Inpatient,,,133.88,133.88,Bright Health MGG,Bright Health MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Aetna,Aetna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Aetna MGG,Aetna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,BCBS,BCBS,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,BCBS MGG,BCBS MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Cigna,Cigna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Cigna MGG,Cigna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Humana,Humana,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Humana MGG,Humana MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Optum VA,Optum VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,UHC,UHC,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,UHC MGG,UHC MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,VA,VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Wellcare MGG,Wellcare MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Bright Health - commercial,Bright Health - commercial,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,82507,CPT,,,,Inpatient,,,31.06,31.06,Bright Health MGG,Bright Health MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Aetna,Aetna,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Aetna MGG,Aetna MGG,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,BCBS,BCBS,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,BCBS MGG,BCBS MGG,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Cigna,Cigna,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Cigna MGG,Cigna MGG,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Humana,Humana,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Humana MGG,Humana MGG,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Optum VA,Optum VA,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,UHC,UHC,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,UHC MGG,UHC MGG,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,VA,VA,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Wellcare MGG,Wellcare MGG,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Bright Health - commercial,Bright Health - commercial,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,85307,CPT,,,,Inpatient,,,223.84,223.84,Bright Health MGG,Bright Health MGG,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Aetna,Aetna,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Aetna MGG,Aetna MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,BCBS,BCBS,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,BCBS MGG,BCBS MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Cigna,Cigna,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Cigna MGG,Cigna MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Humana,Humana,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Humana MGG,Humana MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Optum VA,Optum VA,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,UHC,UHC,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,UHC MGG,UHC MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,VA,VA,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Wellcare MGG,Wellcare MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Bright Health - commercial,Bright Health - commercial,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,83520,CPT,,,,Inpatient,,,282.74,282.74,Bright Health MGG,Bright Health MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Aetna,Aetna,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Aetna MGG,Aetna MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,BCBS,BCBS,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,BCBS MGG,BCBS MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Cigna,Cigna,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Cigna MGG,Cigna MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Humana,Humana,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Humana MGG,Humana MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Optum VA,Optum VA,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,UHC,UHC,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,UHC MGG,UHC MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,VA,VA,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Wellcare MGG,Wellcare MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Bright Health - commercial,Bright Health - commercial,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,83520,CPT,,,,Inpatient,,,236.69,236.69,Bright Health MGG,Bright Health MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,83520,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Aetna,Aetna,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Aetna MGG,Aetna MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,BCBS,BCBS,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,BCBS MGG,BCBS MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Cigna,Cigna,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Cigna MGG,Cigna MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Humana,Humana,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Humana MGG,Humana MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Optum VA,Optum VA,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,UHC,UHC,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,UHC MGG,UHC MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,VA,VA,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Wellcare MGG,Wellcare MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Bright Health - commercial,Bright Health - commercial,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,83520,CPT,,,,Inpatient,,,204.56,204.56,Bright Health MGG,Bright Health MGG,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Aetna,Aetna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Aetna MGG,Aetna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,BCBS,BCBS,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,BCBS MGG,BCBS MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Cigna,Cigna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Cigna MGG,Cigna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Humana,Humana,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Humana MGG,Humana MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Optum VA,Optum VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,UHC,UHC,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,UHC MGG,UHC MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,VA,VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Wellcare MGG,Wellcare MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Bright Health - commercial,Bright Health - commercial,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,83520,CPT,,,,Inpatient,,,54.62,54.62,Bright Health MGG,Bright Health MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Aetna,Aetna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Aetna MGG,Aetna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,BCBS,BCBS,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,BCBS MGG,BCBS MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Cigna,Cigna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Cigna MGG,Cigna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Humana,Humana,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Humana MGG,Humana MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Optum VA,Optum VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,UHC,UHC,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,UHC MGG,UHC MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,VA,VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Wellcare MGG,Wellcare MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Bright Health - commercial,Bright Health - commercial,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,83520,CPT,,,,Inpatient,,,70.69,70.69,Bright Health MGG,Bright Health MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Aetna,Aetna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Aetna MGG,Aetna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,BCBS,BCBS,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,BCBS MGG,BCBS MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Cigna,Cigna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Cigna MGG,Cigna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Humana,Humana,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Humana MGG,Humana MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Optum VA,Optum VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,UHC,UHC,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,UHC MGG,UHC MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,VA,VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Wellcare MGG,Wellcare MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Bright Health - commercial,Bright Health - commercial,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Bright Health MGG,Bright Health MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Aetna,Aetna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Aetna MGG,Aetna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,BCBS,BCBS,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,BCBS MGG,BCBS MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Cigna,Cigna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Cigna MGG,Cigna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Humana,Humana,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Humana MGG,Humana MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Optum VA,Optum VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,UHC,UHC,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,UHC MGG,UHC MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,VA,VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Wellcare MGG,Wellcare MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Bright Health - commercial,Bright Health - commercial,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Bright Health MGG,Bright Health MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Aetna,Aetna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Aetna MGG,Aetna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,BCBS,BCBS,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,BCBS MGG,BCBS MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Cigna,Cigna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Cigna MGG,Cigna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Humana,Humana,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Humana MGG,Humana MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Optum VA,Optum VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,UHC,UHC,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,UHC MGG,UHC MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,VA,VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Wellcare MGG,Wellcare MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Bright Health - commercial,Bright Health - commercial,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,83520,CPT,,,,Inpatient,,,64.26,64.26,Bright Health MGG,Bright Health MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Aetna,Aetna,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Aetna MGG,Aetna MGG,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,BCBS,BCBS,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,BCBS MGG,BCBS MGG,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Cigna,Cigna,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Cigna MGG,Cigna MGG,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Humana,Humana,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Humana MGG,Humana MGG,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Optum VA,Optum VA,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,UHC,UHC,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,UHC MGG,UHC MGG,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,VA,VA,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Wellcare MGG,Wellcare MGG,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Bright Health - commercial,Bright Health - commercial,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,83520,CPT,,,,Inpatient,,,741.13,741.13,Bright Health MGG,Bright Health MGG,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,83520,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Aetna,Aetna,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Aetna MGG,Aetna MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,BCBS,BCBS,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,BCBS MGG,BCBS MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Cigna,Cigna,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Cigna MGG,Cigna MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Humana,Humana,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Humana MGG,Humana MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Optum VA,Optum VA,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,UHC,UHC,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,UHC MGG,UHC MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,VA,VA,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Wellcare MGG,Wellcare MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Bright Health - commercial,Bright Health - commercial,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,83520,CPT,,,,Inpatient,,,382.35,382.35,Bright Health MGG,Bright Health MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Aetna,Aetna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Aetna MGG,Aetna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,BCBS,BCBS,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,BCBS MGG,BCBS MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Cigna,Cigna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Cigna MGG,Cigna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Humana,Humana,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Humana MGG,Humana MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Optum VA,Optum VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,UHC,UHC,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,UHC MGG,UHC MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,VA,VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Wellcare MGG,Wellcare MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Bright Health - commercial,Bright Health - commercial,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,83520,CPT,,,,Inpatient,,,53.55,53.55,Bright Health MGG,Bright Health MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Aetna,Aetna,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Aetna MGG,Aetna MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,BCBS,BCBS,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,BCBS MGG,BCBS MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Cigna,Cigna,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Cigna MGG,Cigna MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Humana,Humana,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Humana MGG,Humana MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Optum VA,Optum VA,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,UHC,UHC,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,UHC MGG,UHC MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,VA,VA,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Wellcare MGG,Wellcare MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Bright Health - commercial,Bright Health - commercial,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,83520,CPT,,,,Inpatient,,,1681.47,1681.47,Bright Health MGG,Bright Health MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Aetna,Aetna,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Aetna MGG,Aetna MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,BCBS,BCBS,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,BCBS MGG,BCBS MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Cigna,Cigna,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Cigna MGG,Cigna MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Humana,Humana,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Humana MGG,Humana MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Optum VA,Optum VA,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,UHC,UHC,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,UHC MGG,UHC MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,VA,VA,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Wellcare MGG,Wellcare MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Bright Health - commercial,Bright Health - commercial,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,83520,CPT,,,59,Inpatient,,,1681.47,1681.47,Bright Health MGG,Bright Health MGG,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Aetna,Aetna,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Aetna MGG,Aetna MGG,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,BCBS,BCBS,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,BCBS MGG,BCBS MGG,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Cigna,Cigna,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Cigna MGG,Cigna MGG,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Humana,Humana,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Humana MGG,Humana MGG,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Optum VA,Optum VA,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,UHC,UHC,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,UHC MGG,UHC MGG,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,VA,VA,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Wellcare MGG,Wellcare MGG,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Bright Health - commercial,Bright Health - commercial,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,84591,CPT,,,,Inpatient,,,384.49,384.49,Bright Health MGG,Bright Health MGG,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Aetna,Aetna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Aetna MGG,Aetna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,BCBS,BCBS,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,BCBS MGG,BCBS MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Cigna,Cigna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Cigna MGG,Cigna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Humana,Humana,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Humana MGG,Humana MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Optum VA,Optum VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,UHC,UHC,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,UHC MGG,UHC MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,VA,VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Wellcare MGG,Wellcare MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Bright Health - commercial,Bright Health - commercial,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Bright Health MGG,Bright Health MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Aetna,Aetna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Aetna MGG,Aetna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,BCBS,BCBS,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,BCBS MGG,BCBS MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Cigna,Cigna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Cigna MGG,Cigna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Humana,Humana,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Humana MGG,Humana MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Optum VA,Optum VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,UHC,UHC,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,UHC MGG,UHC MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,VA,VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Wellcare MGG,Wellcare MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Bright Health - commercial,Bright Health - commercial,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,82040,CPT,,,,Inpatient,,,224.91,224.91,Bright Health MGG,Bright Health MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Aetna,Aetna,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Aetna MGG,Aetna MGG,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,BCBS,BCBS,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,BCBS MGG,BCBS MGG,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Cigna,Cigna,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Cigna MGG,Cigna MGG,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Humana,Humana,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Humana MGG,Humana MGG,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Optum VA,Optum VA,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,UHC,UHC,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,UHC MGG,UHC MGG,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,VA,VA,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Wellcare MGG,Wellcare MGG,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Bright Health - commercial,Bright Health - commercial,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,82105,CPT,,,,Inpatient,,,556.92,556.92,Bright Health MGG,Bright Health MGG,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Aetna,Aetna,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Aetna MGG,Aetna MGG,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,BCBS,BCBS,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,BCBS MGG,BCBS MGG,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Cigna,Cigna,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Cigna MGG,Cigna MGG,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Humana,Humana,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Humana MGG,Humana MGG,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Optum VA,Optum VA,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,UHC,UHC,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,UHC MGG,UHC MGG,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,VA,VA,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Wellcare MGG,Wellcare MGG,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Bright Health - commercial,Bright Health - commercial,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,82088,CPT,,,,Inpatient,,,568.7,568.7,Bright Health MGG,Bright Health MGG,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Aetna,Aetna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Aetna MGG,Aetna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,BCBS,BCBS,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,BCBS MGG,BCBS MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Cigna,Cigna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Cigna MGG,Cigna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Humana,Humana,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Humana MGG,Humana MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Optum VA,Optum VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,UHC,UHC,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,UHC MGG,UHC MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,VA,VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Wellcare MGG,Wellcare MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Bright Health - commercial,Bright Health - commercial,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,84075,CPT,,,,Inpatient,,,25.7,25.7,Bright Health MGG,Bright Health MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Aetna,Aetna,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Aetna MGG,Aetna MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,BCBS,BCBS,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,BCBS MGG,BCBS MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Cigna,Cigna,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Cigna MGG,Cigna MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Humana,Humana,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Humana MGG,Humana MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Optum VA,Optum VA,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,UHC,UHC,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,UHC MGG,UHC MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,VA,VA,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Wellcare MGG,Wellcare MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Bright Health - commercial,Bright Health - commercial,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Bright Health MGG,Bright Health MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Aetna,Aetna,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Aetna MGG,Aetna MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,BCBS,BCBS,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,BCBS MGG,BCBS MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Cigna,Cigna,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Cigna MGG,Cigna MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Humana,Humana,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Humana MGG,Humana MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Optum VA,Optum VA,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,UHC,UHC,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,UHC MGG,UHC MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,VA,VA,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Wellcare MGG,Wellcare MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Bright Health - commercial,Bright Health - commercial,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,80150,CPT,,,,Inpatient,,,356.64,356.64,Bright Health MGG,Bright Health MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Aetna,Aetna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Aetna MGG,Aetna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,BCBS,BCBS,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,BCBS MGG,BCBS MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Cigna,Cigna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Cigna MGG,Cigna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Humana,Humana,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Humana MGG,Humana MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Optum VA,Optum VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,UHC,UHC,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,UHC MGG,UHC MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,VA,VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Wellcare MGG,Wellcare MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Bright Health - commercial,Bright Health - commercial,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,80299,CPT,,,,Inpatient,,,36.41,36.41,Bright Health MGG,Bright Health MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Aetna,Aetna,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Aetna MGG,Aetna MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,BCBS,BCBS,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,BCBS MGG,BCBS MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Cigna,Cigna,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Cigna MGG,Cigna MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Humana,Humana,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Humana MGG,Humana MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Optum VA,Optum VA,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,UHC,UHC,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,UHC MGG,UHC MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,VA,VA,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Wellcare MGG,Wellcare MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Bright Health - commercial,Bright Health - commercial,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,80299,CPT,,,,Inpatient,,,317.02,317.02,Bright Health MGG,Bright Health MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Aetna,Aetna,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Aetna MGG,Aetna MGG,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,BCBS,BCBS,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,BCBS MGG,BCBS MGG,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Cigna,Cigna,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Cigna MGG,Cigna MGG,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Humana,Humana,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Humana MGG,Humana MGG,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Optum VA,Optum VA,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,UHC,UHC,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,UHC MGG,UHC MGG,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,VA,VA,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Wellcare MGG,Wellcare MGG,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Bright Health - commercial,Bright Health - commercial,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,80299,CPT,,,,Inpatient,,,161.72,161.72,Bright Health MGG,Bright Health MGG,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Aetna,Aetna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Aetna MGG,Aetna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,BCBS,BCBS,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,BCBS MGG,BCBS MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Cigna,Cigna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Cigna MGG,Cigna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Humana,Humana,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Humana MGG,Humana MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Optum VA,Optum VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,UHC,UHC,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,UHC MGG,UHC MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,VA,VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Wellcare MGG,Wellcare MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Bright Health - commercial,Bright Health - commercial,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Bright Health MGG,Bright Health MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Aetna,Aetna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Aetna MGG,Aetna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,BCBS,BCBS,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,BCBS MGG,BCBS MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Cigna,Cigna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Cigna MGG,Cigna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Humana,Humana,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Humana MGG,Humana MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Optum VA,Optum VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,UHC,UHC,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,UHC MGG,UHC MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,VA,VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Wellcare MGG,Wellcare MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Bright Health - commercial,Bright Health - commercial,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,80299,CPT,,,,Inpatient,,,64.26,64.26,Bright Health MGG,Bright Health MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Aetna,Aetna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Aetna MGG,Aetna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,BCBS,BCBS,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,BCBS MGG,BCBS MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Cigna,Cigna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Cigna MGG,Cigna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Humana,Humana,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Humana MGG,Humana MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Optum VA,Optum VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,UHC,UHC,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,UHC MGG,UHC MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,VA,VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Wellcare MGG,Wellcare MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Bright Health - commercial,Bright Health - commercial,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,80299,CPT,,,,Inpatient,,,97.46,97.46,Bright Health MGG,Bright Health MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Aetna,Aetna,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Aetna MGG,Aetna MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,BCBS,BCBS,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,BCBS MGG,BCBS MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Cigna,Cigna,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Cigna MGG,Cigna MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Humana,Humana,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Humana MGG,Humana MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Optum VA,Optum VA,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,UHC,UHC,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,UHC MGG,UHC MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,VA,VA,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Wellcare MGG,Wellcare MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Bright Health - commercial,Bright Health - commercial,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,80299,CPT,,,,Inpatient,,,439.11,439.11,Bright Health MGG,Bright Health MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Aetna,Aetna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Aetna MGG,Aetna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,BCBS,BCBS,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,BCBS MGG,BCBS MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Cigna,Cigna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Cigna MGG,Cigna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Humana,Humana,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Humana MGG,Humana MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Optum VA,Optum VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,UHC,UHC,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,UHC MGG,UHC MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,VA,VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Wellcare MGG,Wellcare MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Bright Health - commercial,Bright Health - commercial,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,82010,CPT,,,,Inpatient,,,59.98,59.98,Bright Health MGG,Bright Health MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Aetna,Aetna,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Aetna MGG,Aetna MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,BCBS,BCBS,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,BCBS MGG,BCBS MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Cigna,Cigna,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Cigna MGG,Cigna MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Humana,Humana,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Humana MGG,Humana MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Optum VA,Optum VA,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,UHC,UHC,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,UHC MGG,UHC MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,VA,VA,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Wellcare MGG,Wellcare MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Bright Health - commercial,Bright Health - commercial,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,86300,CPT,,,,Inpatient,,,439.11,439.11,Bright Health MGG,Bright Health MGG,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Aetna,Aetna,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Aetna MGG,Aetna MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS,BCBS,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS MGG,BCBS MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Cigna,Cigna,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Cigna MGG,Cigna MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Humana,Humana,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Humana MGG,Humana MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Optum VA,Optum VA,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,UHC,UHC,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,UHC MGG,UHC MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,VA,VA,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Wellcare MGG,Wellcare MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Bright Health - commercial,Bright Health - commercial,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,Bright Health MGG,Bright Health MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Aetna,Aetna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Aetna MGG,Aetna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS,BCBS,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS MGG,BCBS MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Cigna,Cigna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Cigna MGG,Cigna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Humana,Humana,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Humana MGG,Humana MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Optum VA,Optum VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,UHC,UHC,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,UHC MGG,UHC MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,VA,VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Wellcare MGG,Wellcare MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Bright Health - commercial,Bright Health - commercial,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,Bright Health MGG,Bright Health MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Aetna,Aetna,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Aetna MGG,Aetna MGG,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,BCBS,BCBS,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,BCBS MGG,BCBS MGG,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Cigna,Cigna,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Cigna MGG,Cigna MGG,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Humana,Humana,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Humana MGG,Humana MGG,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Optum VA,Optum VA,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,UHC,UHC,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,UHC MGG,UHC MGG,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,VA,VA,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Wellcare MGG,Wellcare MGG,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Bright Health - commercial,Bright Health - commercial,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,82150,CPT,,,,Inpatient,,,546.21,546.21,Bright Health MGG,Bright Health MGG,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,82150,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Aetna,Aetna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Aetna MGG,Aetna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,BCBS,BCBS,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,BCBS MGG,BCBS MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Cigna,Cigna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Cigna MGG,Cigna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Humana,Humana,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Humana MGG,Humana MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Optum VA,Optum VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,UHC,UHC,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,UHC MGG,UHC MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,VA,VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Wellcare MGG,Wellcare MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Bright Health - commercial,Bright Health - commercial,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Bright Health MGG,Bright Health MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Aetna,Aetna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Aetna MGG,Aetna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,BCBS,BCBS,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,BCBS MGG,BCBS MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Cigna,Cigna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Cigna MGG,Cigna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Humana,Humana,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Humana MGG,Humana MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Optum VA,Optum VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,UHC,UHC,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,UHC MGG,UHC MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,VA,VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Wellcare MGG,Wellcare MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Bright Health - commercial,Bright Health - commercial,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,82150,CPT,,,,Inpatient,,,133.88,133.88,Bright Health MGG,Bright Health MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Aetna,Aetna,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Aetna MGG,Aetna MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,BCBS,BCBS,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,BCBS MGG,BCBS MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Cigna,Cigna,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Cigna MGG,Cigna MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Humana,Humana,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Humana MGG,Humana MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Optum VA,Optum VA,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,UHC,UHC,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,UHC MGG,UHC MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,VA,VA,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Wellcare MGG,Wellcare MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Bright Health - commercial,Bright Health - commercial,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,86038,CPT,,,,Inpatient,,,326.66,326.66,Bright Health MGG,Bright Health MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,86038,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Aetna,Aetna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Aetna MGG,Aetna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,BCBS,BCBS,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,BCBS MGG,BCBS MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Cigna,Cigna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Cigna MGG,Cigna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Humana,Humana,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Humana MGG,Humana MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Optum VA,Optum VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,UHC,UHC,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,UHC MGG,UHC MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,VA,VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Wellcare MGG,Wellcare MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Bright Health - commercial,Bright Health - commercial,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,86038,CPT,,,,Inpatient,,,49.27,49.27,Bright Health MGG,Bright Health MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Aetna,Aetna,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Aetna MGG,Aetna MGG,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,BCBS,BCBS,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,BCBS MGG,BCBS MGG,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Cigna,Cigna,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Cigna MGG,Cigna MGG,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Humana,Humana,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Humana MGG,Humana MGG,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Optum VA,Optum VA,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,UHC,UHC,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,UHC MGG,UHC MGG,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,VA,VA,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Wellcare MGG,Wellcare MGG,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Bright Health - commercial,Bright Health - commercial,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,82164,CPT,,,,Inpatient,,,227.05,227.05,Bright Health MGG,Bright Health MGG,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Aetna,Aetna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Aetna MGG,Aetna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS,BCBS,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS MGG,BCBS MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Cigna,Cigna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Cigna MGG,Cigna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Humana,Humana,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Humana MGG,Humana MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Optum VA,Optum VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,UHC,UHC,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,UHC MGG,UHC MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,VA,VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Wellcare MGG,Wellcare MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Bright Health - commercial,Bright Health - commercial,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,Bright Health MGG,Bright Health MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Aetna,Aetna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Aetna MGG,Aetna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,BCBS,BCBS,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,BCBS MGG,BCBS MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Cigna,Cigna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Cigna MGG,Cigna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Humana,Humana,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Humana MGG,Humana MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Optum VA,Optum VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,UHC,UHC,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,UHC MGG,UHC MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,VA,VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Wellcare MGG,Wellcare MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Bright Health - commercial,Bright Health - commercial,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,86682,CPT,,,,Inpatient,,,145.66,145.66,Bright Health MGG,Bright Health MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Aetna,Aetna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Aetna MGG,Aetna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,BCBS,BCBS,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,BCBS MGG,BCBS MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Cigna,Cigna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Cigna MGG,Cigna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Humana,Humana,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Humana MGG,Humana MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Optum VA,Optum VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,UHC,UHC,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,UHC MGG,UHC MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,VA,VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Wellcare MGG,Wellcare MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Bright Health - commercial,Bright Health - commercial,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,86682,CPT,,,,Inpatient,,,96.39,96.39,Bright Health MGG,Bright Health MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Aetna,Aetna,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Aetna MGG,Aetna MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,BCBS,BCBS,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,BCBS MGG,BCBS MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Cigna,Cigna,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Cigna MGG,Cigna MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Humana,Humana,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Humana MGG,Humana MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Optum VA,Optum VA,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,UHC,UHC,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,UHC MGG,UHC MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,VA,VA,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Wellcare MGG,Wellcare MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Bright Health - commercial,Bright Health - commercial,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,86682,CPT,,,,Inpatient,,,136.02,136.02,Bright Health MGG,Bright Health MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Aetna,Aetna,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Aetna MGG,Aetna MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,BCBS,BCBS,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,BCBS MGG,BCBS MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Cigna,Cigna,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Cigna MGG,Cigna MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Humana,Humana,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Humana MGG,Humana MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Optum VA,Optum VA,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,UHC,UHC,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,UHC MGG,UHC MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,VA,VA,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Wellcare MGG,Wellcare MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Bright Health - commercial,Bright Health - commercial,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,86682,CPT,,,,Inpatient,,,539.78,539.78,Bright Health MGG,Bright Health MGG,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Aetna,Aetna,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Aetna MGG,Aetna MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,BCBS,BCBS,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,BCBS MGG,BCBS MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Cigna,Cigna,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Cigna MGG,Cigna MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Humana,Humana,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Humana MGG,Humana MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Optum VA,Optum VA,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,UHC,UHC,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,UHC MGG,UHC MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,VA,VA,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Wellcare MGG,Wellcare MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Bright Health - commercial,Bright Health - commercial,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,86870,CPT,,,,Inpatient,,,447.68,447.68,Bright Health MGG,Bright Health MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Aetna,Aetna,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Aetna MGG,Aetna MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,BCBS,BCBS,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,BCBS MGG,BCBS MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Cigna,Cigna,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Cigna MGG,Cigna MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Humana,Humana,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Humana MGG,Humana MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Optum VA,Optum VA,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,UHC,UHC,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,UHC MGG,UHC MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,VA,VA,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Wellcare MGG,Wellcare MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Bright Health - commercial,Bright Health - commercial,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,86870,CPT,,,,Inpatient,,,198.14,198.14,Bright Health MGG,Bright Health MGG,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Aetna,Aetna,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Aetna MGG,Aetna MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,BCBS,BCBS,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,BCBS MGG,BCBS MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Cigna,Cigna,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Cigna MGG,Cigna MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Humana,Humana,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Humana MGG,Humana MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Optum VA,Optum VA,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,UHC,UHC,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,UHC MGG,UHC MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,VA,VA,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Wellcare MGG,Wellcare MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Bright Health - commercial,Bright Health - commercial,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,86870,CPT,,,,Inpatient,,,104.96,104.96,Bright Health MGG,Bright Health MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Aetna,Aetna,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Aetna MGG,Aetna MGG,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,BCBS,BCBS,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,BCBS MGG,BCBS MGG,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Cigna,Cigna,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Cigna MGG,Cigna MGG,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Humana,Humana,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Humana MGG,Humana MGG,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Optum VA,Optum VA,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,UHC,UHC,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,UHC MGG,UHC MGG,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,VA,VA,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Wellcare MGG,Wellcare MGG,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Bright Health - commercial,Bright Health - commercial,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,86870,CPT,,,,Inpatient,,,216.34,216.34,Bright Health MGG,Bright Health MGG,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Aetna,Aetna,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Aetna MGG,Aetna MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,BCBS,BCBS,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,BCBS MGG,BCBS MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Cigna,Cigna,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Cigna MGG,Cigna MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Humana,Humana,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Humana MGG,Humana MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Optum VA,Optum VA,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,UHC,UHC,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,UHC MGG,UHC MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,VA,VA,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Wellcare MGG,Wellcare MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Bright Health - commercial,Bright Health - commercial,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,86850,CPT,,,,Inpatient,,,104.96,104.96,Bright Health MGG,Bright Health MGG,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Aetna,Aetna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Aetna MGG,Aetna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,BCBS,BCBS,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,BCBS MGG,BCBS MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Cigna,Cigna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Cigna MGG,Cigna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Humana,Humana,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Humana MGG,Humana MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Optum VA,Optum VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,UHC,UHC,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,UHC MGG,UHC MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,VA,VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Wellcare MGG,Wellcare MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Bright Health - commercial,Bright Health - commercial,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,86850,CPT,,,,Inpatient,,,145.66,145.66,Bright Health MGG,Bright Health MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Aetna,Aetna,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Aetna MGG,Aetna MGG,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,BCBS,BCBS,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,BCBS MGG,BCBS MGG,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Cigna,Cigna,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Cigna MGG,Cigna MGG,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Humana,Humana,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Humana MGG,Humana MGG,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Optum VA,Optum VA,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,UHC,UHC,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,UHC MGG,UHC MGG,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,VA,VA,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Wellcare MGG,Wellcare MGG,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Bright Health - commercial,Bright Health - commercial,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,86225,CPT,,,,Inpatient,,,379.13,379.13,Bright Health MGG,Bright Health MGG,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,86225,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Aetna,Aetna,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Aetna MGG,Aetna MGG,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,BCBS,BCBS,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,BCBS MGG,BCBS MGG,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Cigna,Cigna,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Cigna MGG,Cigna MGG,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Humana,Humana,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Humana MGG,Humana MGG,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Optum VA,Optum VA,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,UHC,UHC,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,UHC MGG,UHC MGG,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,VA,VA,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Wellcare MGG,Wellcare MGG,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Bright Health - commercial,Bright Health - commercial,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,86022,CPT,,,,Inpatient,,,1489.76,1489.76,Bright Health MGG,Bright Health MGG,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Aetna,Aetna,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Aetna MGG,Aetna MGG,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,BCBS,BCBS,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,BCBS MGG,BCBS MGG,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Cigna,Cigna,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Cigna MGG,Cigna MGG,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Humana,Humana,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Humana MGG,Humana MGG,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Optum VA,Optum VA,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,UHC,UHC,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,UHC MGG,UHC MGG,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,VA,VA,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Wellcare MGG,Wellcare MGG,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Bright Health - commercial,Bright Health - commercial,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,86022,CPT,,,,Inpatient,,,589.05,589.05,Bright Health MGG,Bright Health MGG,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Aetna,Aetna,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Aetna MGG,Aetna MGG,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,BCBS,BCBS,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,BCBS MGG,BCBS MGG,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Cigna,Cigna,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Cigna MGG,Cigna MGG,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Humana,Humana,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Humana MGG,Humana MGG,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Optum VA,Optum VA,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,UHC,UHC,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,UHC MGG,UHC MGG,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,VA,VA,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Wellcare MGG,Wellcare MGG,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Bright Health - commercial,Bright Health - commercial,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,86022,CPT,,,,Inpatient,,,538.38,538.38,Bright Health MGG,Bright Health MGG,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Aetna,Aetna,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Aetna MGG,Aetna MGG,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,BCBS,BCBS,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,BCBS MGG,BCBS MGG,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Cigna,Cigna,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Cigna MGG,Cigna MGG,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Humana,Humana,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Humana MGG,Humana MGG,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Optum VA,Optum VA,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,UHC,UHC,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,UHC MGG,UHC MGG,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,VA,VA,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Wellcare MGG,Wellcare MGG,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Bright Health - commercial,Bright Health - commercial,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,86022,CPT,,,,Inpatient,,,73.9,73.9,Bright Health MGG,Bright Health MGG,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Aetna,Aetna,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Aetna MGG,Aetna MGG,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,BCBS,BCBS,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,BCBS MGG,BCBS MGG,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Cigna,Cigna,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Cigna MGG,Cigna MGG,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Humana,Humana,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Humana MGG,Humana MGG,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Optum VA,Optum VA,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,UHC,UHC,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,UHC MGG,UHC MGG,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,VA,VA,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Wellcare MGG,Wellcare MGG,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Bright Health - commercial,Bright Health - commercial,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,86022,CPT,,,,Inpatient,,,177.79,177.79,Bright Health MGG,Bright Health MGG,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Aetna,Aetna,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Aetna MGG,Aetna MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,BCBS,BCBS,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,BCBS MGG,BCBS MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Cigna,Cigna,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Cigna MGG,Cigna MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Humana,Humana,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Humana MGG,Humana MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Optum VA,Optum VA,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,UHC,UHC,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,UHC MGG,UHC MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,VA,VA,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Wellcare MGG,Wellcare MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Bright Health - commercial,Bright Health - commercial,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,86022,CPT,,,,Inpatient,,,443.39,443.39,Bright Health MGG,Bright Health MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Aetna,Aetna,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Aetna MGG,Aetna MGG,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,BCBS,BCBS,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,BCBS MGG,BCBS MGG,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Cigna,Cigna,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Cigna MGG,Cigna MGG,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Humana,Humana,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Humana MGG,Humana MGG,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Optum VA,Optum VA,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,UHC,UHC,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,UHC MGG,UHC MGG,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,VA,VA,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Wellcare MGG,Wellcare MGG,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Bright Health - commercial,Bright Health - commercial,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,85300,CPT,,,,Inpatient,,,524.79,524.79,Bright Health MGG,Bright Health MGG,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Aetna,Aetna,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Aetna MGG,Aetna MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,BCBS,BCBS,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,BCBS MGG,BCBS MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Cigna,Cigna,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Cigna MGG,Cigna MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Humana,Humana,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Humana MGG,Humana MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Optum VA,Optum VA,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,UHC,UHC,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,UHC MGG,UHC MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,VA,VA,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Wellcare MGG,Wellcare MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Bright Health - commercial,Bright Health - commercial,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,85415,CPT,,,,Inpatient,,,79.25,79.25,Bright Health MGG,Bright Health MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Aetna,Aetna,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Aetna MGG,Aetna MGG,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,BCBS,BCBS,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,BCBS MGG,BCBS MGG,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Cigna,Cigna,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Cigna MGG,Cigna MGG,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Humana,Humana,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Humana MGG,Humana MGG,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Optum VA,Optum VA,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,UHC,UHC,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,UHC MGG,UHC MGG,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,VA,VA,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Wellcare MGG,Wellcare MGG,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Bright Health - commercial,Bright Health - commercial,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,85303,CPT,,,,Inpatient,,,218.48,218.48,Bright Health MGG,Bright Health MGG,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Aetna,Aetna,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Aetna MGG,Aetna MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,BCBS,BCBS,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,BCBS MGG,BCBS MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Cigna,Cigna,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Cigna MGG,Cigna MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Humana,Humana,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Humana MGG,Humana MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Optum VA,Optum VA,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,UHC,UHC,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,UHC MGG,UHC MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,VA,VA,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Wellcare MGG,Wellcare MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Bright Health - commercial,Bright Health - commercial,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Bright Health MGG,Bright Health MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Aetna,Aetna,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Aetna MGG,Aetna MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,BCBS,BCBS,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,BCBS MGG,BCBS MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Cigna,Cigna,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Cigna MGG,Cigna MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Humana,Humana,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Humana MGG,Humana MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Optum VA,Optum VA,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,UHC,UHC,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,UHC MGG,UHC MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,VA,VA,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Wellcare MGG,Wellcare MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Bright Health - commercial,Bright Health - commercial,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,87449,CPT,,,,Inpatient,,,501.23,501.23,Bright Health MGG,Bright Health MGG,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Aetna,Aetna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Aetna MGG,Aetna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,BCBS,BCBS,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,BCBS MGG,BCBS MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Cigna,Cigna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Cigna MGG,Cigna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Humana,Humana,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Humana MGG,Humana MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Optum VA,Optum VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,UHC,UHC,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,UHC MGG,UHC MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,VA,VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Wellcare MGG,Wellcare MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Bright Health - commercial,Bright Health - commercial,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Bright Health MGG,Bright Health MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Aetna,Aetna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Aetna MGG,Aetna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,BCBS,BCBS,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,BCBS MGG,BCBS MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Cigna,Cigna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Cigna MGG,Cigna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Humana,Humana,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Humana MGG,Humana MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Optum VA,Optum VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,UHC,UHC,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,UHC MGG,UHC MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,VA,VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Wellcare MGG,Wellcare MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Bright Health - commercial,Bright Health - commercial,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Bright Health MGG,Bright Health MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Aetna,Aetna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Aetna MGG,Aetna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,BCBS,BCBS,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,BCBS MGG,BCBS MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Cigna,Cigna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Cigna MGG,Cigna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Humana,Humana,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Humana MGG,Humana MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Optum VA,Optum VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,UHC,UHC,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,UHC MGG,UHC MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,VA,VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Wellcare MGG,Wellcare MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Bright Health - commercial,Bright Health - commercial,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,86710,CPT,,,,Inpatient,,,343.79,343.79,Bright Health MGG,Bright Health MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Aetna,Aetna,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Aetna MGG,Aetna MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,BCBS,BCBS,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,BCBS MGG,BCBS MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Cigna,Cigna,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Cigna MGG,Cigna MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Humana,Humana,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Humana MGG,Humana MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Optum VA,Optum VA,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,UHC,UHC,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,UHC MGG,UHC MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,VA,VA,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Wellcare MGG,Wellcare MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Bright Health - commercial,Bright Health - commercial,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,83880,CPT,,,,Inpatient,,,142.44,142.44,Bright Health MGG,Bright Health MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna,Aetna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Aetna MGG,Aetna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,BCBS,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS MGG,BCBS MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna,Cigna,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Cigna MGG,Cigna MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana,Humana,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Humana MGG,Humana MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Optum VA,Optum VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC,UHC,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UHC MGG,UHC MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,VA,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Wellcare MGG,Wellcare MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health - commercial,Bright Health - commercial,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,Bright Health MGG,Bright Health MGG,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Aetna,Aetna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Aetna MGG,Aetna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,BCBS,BCBS,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,BCBS MGG,BCBS MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Cigna,Cigna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Cigna MGG,Cigna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Humana,Humana,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Humana MGG,Humana MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Optum VA,Optum VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,UHC,UHC,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,UHC MGG,UHC MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,VA,VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Wellcare MGG,Wellcare MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Bright Health - commercial,Bright Health - commercial,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,84520,CPT,,,,Inpatient,,,23.56,23.56,Bright Health MGG,Bright Health MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Aetna,Aetna,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Aetna MGG,Aetna MGG,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,BCBS,BCBS,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,BCBS MGG,BCBS MGG,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Cigna,Cigna,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Cigna MGG,Cigna MGG,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Humana,Humana,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Humana MGG,Humana MGG,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Optum VA,Optum VA,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,UHC,UHC,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,UHC MGG,UHC MGG,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,VA,VA,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Wellcare MGG,Wellcare MGG,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Bright Health - commercial,Bright Health - commercial,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,83883,CPT,,,,Inpatient,,,232.41,232.41,Bright Health MGG,Bright Health MGG,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Aetna,Aetna,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Aetna MGG,Aetna MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,BCBS,BCBS,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,BCBS MGG,BCBS MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Cigna,Cigna,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Cigna MGG,Cigna MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Humana,Humana,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Humana MGG,Humana MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Optum VA,Optum VA,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,UHC,UHC,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,UHC MGG,UHC MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,VA,VA,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Wellcare MGG,Wellcare MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Bright Health - commercial,Bright Health - commercial,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,86141,CPT,,,,Inpatient,,,270.96,270.96,Bright Health MGG,Bright Health MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,82330,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,82378,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Aetna,Aetna,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Aetna MGG,Aetna MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,BCBS,BCBS,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,BCBS MGG,BCBS MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Cigna,Cigna,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Cigna MGG,Cigna MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Humana,Humana,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Humana MGG,Humana MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Optum VA,Optum VA,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,UHC,UHC,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,UHC MGG,UHC MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,VA,VA,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Wellcare MGG,Wellcare MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Bright Health - commercial,Bright Health - commercial,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,82378,CPT,,,,Inpatient,,,76.04,76.04,Bright Health MGG,Bright Health MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Aetna,Aetna,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Aetna MGG,Aetna MGG,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,BCBS,BCBS,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,BCBS MGG,BCBS MGG,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Cigna,Cigna,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Cigna MGG,Cigna MGG,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Humana,Humana,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Humana MGG,Humana MGG,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Optum VA,Optum VA,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,UHC,UHC,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,UHC MGG,UHC MGG,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,VA,VA,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Wellcare MGG,Wellcare MGG,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Bright Health - commercial,Bright Health - commercial,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,82384,CPT,,,,Inpatient,,,545.14,545.14,Bright Health MGG,Bright Health MGG,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Aetna,Aetna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Aetna MGG,Aetna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,BCBS,BCBS,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,BCBS MGG,BCBS MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Cigna,Cigna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Cigna MGG,Cigna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Humana,Humana,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Humana MGG,Humana MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Optum VA,Optum VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,UHC,UHC,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,UHC MGG,UHC MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,VA,VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Wellcare MGG,Wellcare MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Bright Health - commercial,Bright Health - commercial,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,86146,CPT,,,,Inpatient,,,111.38,111.38,Bright Health MGG,Bright Health MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,86146,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,83519,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Aetna,Aetna,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Aetna MGG,Aetna MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,BCBS,BCBS,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,BCBS MGG,BCBS MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Cigna,Cigna,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Cigna MGG,Cigna MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Humana,Humana,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Humana MGG,Humana MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Optum VA,Optum VA,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,UHC,UHC,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,UHC MGG,UHC MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,VA,VA,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Wellcare MGG,Wellcare MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Bright Health - commercial,Bright Health - commercial,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Bright Health MGG,Bright Health MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Aetna,Aetna,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Aetna MGG,Aetna MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,BCBS,BCBS,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,BCBS MGG,BCBS MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Cigna,Cigna,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Cigna MGG,Cigna MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Humana,Humana,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Humana MGG,Humana MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Optum VA,Optum VA,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,UHC,UHC,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,UHC MGG,UHC MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,VA,VA,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Wellcare MGG,Wellcare MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Bright Health - commercial,Bright Health - commercial,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Bright Health MGG,Bright Health MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Aetna,Aetna,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Aetna MGG,Aetna MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,BCBS,BCBS,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,BCBS MGG,BCBS MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Cigna,Cigna,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Cigna MGG,Cigna MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Humana,Humana,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Humana MGG,Humana MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Optum VA,Optum VA,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,UHC,UHC,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,UHC MGG,UHC MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,VA,VA,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Wellcare MGG,Wellcare MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Bright Health - commercial,Bright Health - commercial,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,83519,CPT,,,,Inpatient,,,924.27,924.27,Bright Health MGG,Bright Health MGG,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Aetna,Aetna,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Aetna MGG,Aetna MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,BCBS,BCBS,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,BCBS MGG,BCBS MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Cigna,Cigna,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Cigna MGG,Cigna MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Humana,Humana,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Humana MGG,Humana MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Optum VA,Optum VA,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,UHC,UHC,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,UHC MGG,UHC MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,VA,VA,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Wellcare MGG,Wellcare MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Bright Health - commercial,Bright Health - commercial,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,83519,CPT,,,,Inpatient,,,431.61,431.61,Bright Health MGG,Bright Health MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,89051,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Aetna,Aetna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Aetna MGG,Aetna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS,BCBS,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS MGG,BCBS MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Cigna,Cigna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Cigna MGG,Cigna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Humana,Humana,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Humana MGG,Humana MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Optum VA,Optum VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,UHC,UHC,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,UHC MGG,UHC MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,VA,VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Wellcare MGG,Wellcare MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Bright Health - commercial,Bright Health - commercial,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,Bright Health MGG,Bright Health MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Aetna,Aetna,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Aetna MGG,Aetna MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,BCBS,BCBS,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,BCBS MGG,BCBS MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Cigna,Cigna,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Cigna MGG,Cigna MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Humana,Humana,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Humana MGG,Humana MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Optum VA,Optum VA,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,UHC,UHC,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,UHC MGG,UHC MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,VA,VA,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Wellcare MGG,Wellcare MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Bright Health - commercial,Bright Health - commercial,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,87556,CPT,,,,Inpatient,,,166.01,166.01,Bright Health MGG,Bright Health MGG,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Aetna,Aetna,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Aetna MGG,Aetna MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,BCBS,BCBS,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,BCBS MGG,BCBS MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Cigna,Cigna,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Cigna MGG,Cigna MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Humana,Humana,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Humana MGG,Humana MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Optum VA,Optum VA,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,UHC,UHC,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,UHC MGG,UHC MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,VA,VA,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Wellcare MGG,Wellcare MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Bright Health - commercial,Bright Health - commercial,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,86644,CPT,,,,Inpatient,,,565.49,565.49,Bright Health MGG,Bright Health MGG,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Aetna,Aetna,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Aetna MGG,Aetna MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,BCBS,BCBS,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,BCBS MGG,BCBS MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Cigna,Cigna,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Cigna MGG,Cigna MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Humana,Humana,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Humana MGG,Humana MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Optum VA,Optum VA,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,UHC,UHC,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,UHC MGG,UHC MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,VA,VA,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Wellcare MGG,Wellcare MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Bright Health - commercial,Bright Health - commercial,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Bright Health MGG,Bright Health MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Aetna,Aetna,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Aetna MGG,Aetna MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,BCBS,BCBS,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,BCBS MGG,BCBS MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Cigna,Cigna,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Cigna MGG,Cigna MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Humana,Humana,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Humana MGG,Humana MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Optum VA,Optum VA,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,UHC,UHC,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,UHC MGG,UHC MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,VA,VA,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Wellcare MGG,Wellcare MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Bright Health - commercial,Bright Health - commercial,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,85240,CPT,,,,Inpatient,,,549.42,549.42,Bright Health MGG,Bright Health MGG,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Aetna,Aetna,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Aetna MGG,Aetna MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,BCBS,BCBS,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,BCBS MGG,BCBS MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Cigna,Cigna,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Cigna MGG,Cigna MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Humana,Humana,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Humana MGG,Humana MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Optum VA,Optum VA,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,UHC,UHC,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,UHC MGG,UHC MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,VA,VA,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Wellcare MGG,Wellcare MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Bright Health - commercial,Bright Health - commercial,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,85240,CPT,,,,Inpatient,,,76.04,76.04,Bright Health MGG,Bright Health MGG,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Aetna,Aetna,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Aetna MGG,Aetna MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,BCBS,BCBS,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,BCBS MGG,BCBS MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Cigna,Cigna,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Cigna MGG,Cigna MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Humana,Humana,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Humana MGG,Humana MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Optum VA,Optum VA,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,UHC,UHC,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,UHC MGG,UHC MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,VA,VA,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Wellcare MGG,Wellcare MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Bright Health - commercial,Bright Health - commercial,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,86160,CPT,,,,Inpatient,,,428.4,428.4,Bright Health MGG,Bright Health MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Aetna,Aetna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Aetna MGG,Aetna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,BCBS,BCBS,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,BCBS MGG,BCBS MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Cigna,Cigna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Cigna MGG,Cigna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Humana,Humana,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Humana MGG,Humana MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Optum VA,Optum VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,UHC,UHC,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,UHC MGG,UHC MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,VA,VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Wellcare MGG,Wellcare MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Bright Health - commercial,Bright Health - commercial,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,86160,CPT,,,,Inpatient,,,59.98,59.98,Bright Health MGG,Bright Health MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Aetna,Aetna,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Aetna MGG,Aetna MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,BCBS,BCBS,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,BCBS MGG,BCBS MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Cigna,Cigna,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Cigna MGG,Cigna MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Humana,Humana,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Humana MGG,Humana MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Optum VA,Optum VA,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,UHC,UHC,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,UHC MGG,UHC MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,VA,VA,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Wellcare MGG,Wellcare MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Bright Health - commercial,Bright Health - commercial,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,86160,CPT,,,,Inpatient,,,499.09,499.09,Bright Health MGG,Bright Health MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Aetna,Aetna,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Aetna MGG,Aetna MGG,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,BCBS,BCBS,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,BCBS MGG,BCBS MGG,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Cigna,Cigna,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Cigna MGG,Cigna MGG,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Humana,Humana,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Humana MGG,Humana MGG,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Optum VA,Optum VA,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,UHC,UHC,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,UHC MGG,UHC MGG,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,VA,VA,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Wellcare MGG,Wellcare MGG,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Bright Health - commercial,Bright Health - commercial,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,86160,CPT,,,,Inpatient,,,555.85,555.85,Bright Health MGG,Bright Health MGG,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Aetna,Aetna,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Aetna MGG,Aetna MGG,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,BCBS,BCBS,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,BCBS MGG,BCBS MGG,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Cigna,Cigna,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Cigna MGG,Cigna MGG,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Humana,Humana,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Humana MGG,Humana MGG,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Optum VA,Optum VA,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,UHC,UHC,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,UHC MGG,UHC MGG,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,VA,VA,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Wellcare MGG,Wellcare MGG,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Bright Health - commercial,Bright Health - commercial,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,82525,CPT,,,,Inpatient,,,209.92,209.92,Bright Health MGG,Bright Health MGG,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Aetna,Aetna,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Aetna MGG,Aetna MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,BCBS,BCBS,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,BCBS MGG,BCBS MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Cigna,Cigna,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Cigna MGG,Cigna MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Humana,Humana,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Humana MGG,Humana MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Optum VA,Optum VA,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,UHC,UHC,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,UHC MGG,UHC MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,VA,VA,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Wellcare MGG,Wellcare MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Bright Health - commercial,Bright Health - commercial,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,82525,CPT,,,,Inpatient,,,397.34,397.34,Bright Health MGG,Bright Health MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Aetna,Aetna,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Aetna MGG,Aetna MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,BCBS,BCBS,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,BCBS MGG,BCBS MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Cigna,Cigna,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Cigna MGG,Cigna MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Humana,Humana,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Humana MGG,Humana MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Optum VA,Optum VA,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,UHC,UHC,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,UHC MGG,UHC MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,VA,VA,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Wellcare MGG,Wellcare MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Bright Health - commercial,Bright Health - commercial,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,82533,CPT,,,,Inpatient,,,270.96,270.96,Bright Health MGG,Bright Health MGG,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Aetna,Aetna,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Aetna MGG,Aetna MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,BCBS,BCBS,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,BCBS MGG,BCBS MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Cigna,Cigna,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Cigna MGG,Cigna MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Humana,Humana,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Humana MGG,Humana MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Optum VA,Optum VA,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,UHC,UHC,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,UHC MGG,UHC MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,VA,VA,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Wellcare MGG,Wellcare MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Bright Health - commercial,Bright Health - commercial,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,82533,CPT,,,,Inpatient,,,308.45,308.45,Bright Health MGG,Bright Health MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Aetna,Aetna,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Aetna MGG,Aetna MGG,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,BCBS,BCBS,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,BCBS MGG,BCBS MGG,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Cigna,Cigna,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Cigna MGG,Cigna MGG,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Humana,Humana,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Humana MGG,Humana MGG,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Optum VA,Optum VA,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,UHC,UHC,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,UHC MGG,UHC MGG,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,VA,VA,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Wellcare MGG,Wellcare MGG,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Bright Health - commercial,Bright Health - commercial,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,86360,CPT,,,,Inpatient,,,283.82,283.82,Bright Health MGG,Bright Health MGG,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Aetna,Aetna,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Aetna MGG,Aetna MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,BCBS,BCBS,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,BCBS MGG,BCBS MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Cigna,Cigna,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Cigna MGG,Cigna MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Humana,Humana,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Humana MGG,Humana MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Optum VA,Optum VA,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,UHC,UHC,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,UHC MGG,UHC MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,VA,VA,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Wellcare MGG,Wellcare MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Bright Health - commercial,Bright Health - commercial,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,86360,CPT,,,,Inpatient,,,132.8,132.8,Bright Health MGG,Bright Health MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Aetna,Aetna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Aetna MGG,Aetna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,BCBS,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS MGG,BCBS MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Cigna,Cigna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Cigna MGG,Cigna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Humana,Humana,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Humana MGG,Humana MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Optum VA,Optum VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,UHC,UHC,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,UHC MGG,UHC MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,VA,VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Wellcare MGG,Wellcare MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Bright Health - commercial,Bright Health - commercial,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Bright Health MGG,Bright Health MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Aetna,Aetna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Aetna MGG,Aetna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,BCBS,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS MGG,BCBS MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Cigna,Cigna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Cigna MGG,Cigna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Humana,Humana,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Humana MGG,Humana MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Optum VA,Optum VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,UHC,UHC,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,UHC MGG,UHC MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,VA,VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Wellcare MGG,Wellcare MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Bright Health - commercial,Bright Health - commercial,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,Bright Health MGG,Bright Health MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Aetna,Aetna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Aetna MGG,Aetna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,BCBS,BCBS,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,BCBS MGG,BCBS MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Cigna,Cigna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Cigna MGG,Cigna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Humana,Humana,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Humana MGG,Humana MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Optum VA,Optum VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,UHC,UHC,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,UHC MGG,UHC MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,VA,VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Wellcare MGG,Wellcare MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Bright Health - commercial,Bright Health - commercial,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,86671,CPT,,,59,Inpatient,,,51.41,51.41,Bright Health MGG,Bright Health MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,86615,CPT,,,59,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Aetna,Aetna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Aetna MGG,Aetna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,BCBS,BCBS,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,BCBS MGG,BCBS MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Cigna,Cigna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Cigna MGG,Cigna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Humana,Humana,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Humana MGG,Humana MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Optum VA,Optum VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,UHC,UHC,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,UHC MGG,UHC MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,VA,VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Wellcare MGG,Wellcare MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Bright Health - commercial,Bright Health - commercial,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Bright Health MGG,Bright Health MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Aetna,Aetna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Aetna MGG,Aetna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,BCBS,BCBS,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,BCBS MGG,BCBS MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Cigna,Cigna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Cigna MGG,Cigna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Humana,Humana,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Humana MGG,Humana MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Optum VA,Optum VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,UHC,UHC,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,UHC MGG,UHC MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,VA,VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Wellcare MGG,Wellcare MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Bright Health - commercial,Bright Health - commercial,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,83516,CPT,,,,Inpatient,,,97.46,97.46,Bright Health MGG,Bright Health MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Aetna,Aetna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Aetna MGG,Aetna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,BCBS,BCBS,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,BCBS MGG,BCBS MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Cigna,Cigna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Cigna MGG,Cigna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Humana,Humana,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Humana MGG,Humana MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Optum VA,Optum VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,UHC,UHC,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,UHC MGG,UHC MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,VA,VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Wellcare MGG,Wellcare MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Bright Health - commercial,Bright Health - commercial,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,83516,CPT,,,,Inpatient,,,212.06,212.06,Bright Health MGG,Bright Health MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Aetna,Aetna,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Aetna MGG,Aetna MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,BCBS,BCBS,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,BCBS MGG,BCBS MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Cigna,Cigna,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Cigna MGG,Cigna MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Humana,Humana,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Humana MGG,Humana MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Optum VA,Optum VA,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,UHC,UHC,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,UHC MGG,UHC MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,VA,VA,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Wellcare MGG,Wellcare MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Bright Health - commercial,Bright Health - commercial,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,83516,CPT,,,,Inpatient,,,202.42,202.42,Bright Health MGG,Bright Health MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,83516,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Aetna,Aetna,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Aetna MGG,Aetna MGG,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,BCBS,BCBS,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,BCBS MGG,BCBS MGG,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Cigna,Cigna,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Cigna MGG,Cigna MGG,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Humana,Humana,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Humana MGG,Humana MGG,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Optum VA,Optum VA,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,UHC,UHC,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,UHC MGG,UHC MGG,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,VA,VA,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Wellcare MGG,Wellcare MGG,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Bright Health - commercial,Bright Health - commercial,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,83516,CPT,,,,Inpatient,,,147.67,147.67,Bright Health MGG,Bright Health MGG,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Aetna,Aetna,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Aetna MGG,Aetna MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,BCBS,BCBS,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,BCBS MGG,BCBS MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Cigna,Cigna,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Cigna MGG,Cigna MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Humana,Humana,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Humana MGG,Humana MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Optum VA,Optum VA,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,UHC,UHC,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,UHC MGG,UHC MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,VA,VA,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Wellcare MGG,Wellcare MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Bright Health - commercial,Bright Health - commercial,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.82,87.82,Bright Health MGG,Bright Health MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Aetna,Aetna,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Aetna MGG,Aetna MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,BCBS,BCBS,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,BCBS MGG,BCBS MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Cigna,Cigna,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Cigna MGG,Cigna MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Humana,Humana,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Humana MGG,Humana MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Optum VA,Optum VA,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,UHC,UHC,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,UHC MGG,UHC MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,VA,VA,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Wellcare MGG,Wellcare MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Bright Health - commercial,Bright Health - commercial,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,83516,CPT,,,,Inpatient,,,149.94,149.94,Bright Health MGG,Bright Health MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Aetna,Aetna,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Aetna MGG,Aetna MGG,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,BCBS,BCBS,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,BCBS MGG,BCBS MGG,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Cigna,Cigna,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Cigna MGG,Cigna MGG,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Humana,Humana,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Humana MGG,Humana MGG,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Optum VA,Optum VA,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,UHC,UHC,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,UHC MGG,UHC MGG,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,VA,VA,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Wellcare MGG,Wellcare MGG,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Bright Health - commercial,Bright Health - commercial,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,83516,CPT,,,,Inpatient,,,182.07,182.07,Bright Health MGG,Bright Health MGG,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Aetna,Aetna,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Aetna MGG,Aetna MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,BCBS,BCBS,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,BCBS MGG,BCBS MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Cigna,Cigna,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Cigna MGG,Cigna MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Humana,Humana,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Humana MGG,Humana MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Optum VA,Optum VA,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,UHC,UHC,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,UHC MGG,UHC MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,VA,VA,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Wellcare MGG,Wellcare MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Bright Health - commercial,Bright Health - commercial,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,83516,CPT,,,,Inpatient,,,188.5,188.5,Bright Health MGG,Bright Health MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Aetna,Aetna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Aetna MGG,Aetna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,BCBS,BCBS,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,BCBS MGG,BCBS MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Cigna,Cigna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Cigna MGG,Cigna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Humana,Humana,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Humana MGG,Humana MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Optum VA,Optum VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,UHC,UHC,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,UHC MGG,UHC MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,VA,VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Wellcare MGG,Wellcare MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Bright Health - commercial,Bright Health - commercial,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,83516,CPT,,,,Inpatient,,,394.13,394.13,Bright Health MGG,Bright Health MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Aetna,Aetna,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Aetna MGG,Aetna MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,BCBS,BCBS,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,BCBS MGG,BCBS MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Cigna,Cigna,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Cigna MGG,Cigna MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Humana,Humana,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Humana MGG,Humana MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Optum VA,Optum VA,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,UHC,UHC,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,UHC MGG,UHC MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,VA,VA,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Wellcare MGG,Wellcare MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Bright Health - commercial,Bright Health - commercial,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,83516,CPT,,,,Inpatient,,,285.96,285.96,Bright Health MGG,Bright Health MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Aetna,Aetna,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Aetna MGG,Aetna MGG,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,BCBS,BCBS,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,BCBS MGG,BCBS MGG,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Cigna,Cigna,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Cigna MGG,Cigna MGG,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Humana,Humana,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Humana MGG,Humana MGG,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Optum VA,Optum VA,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,UHC,UHC,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,UHC MGG,UHC MGG,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,VA,VA,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Wellcare MGG,Wellcare MGG,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Bright Health - commercial,Bright Health - commercial,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,83516,CPT,,,,Inpatient,,,403.77,403.77,Bright Health MGG,Bright Health MGG,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Aetna,Aetna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Aetna MGG,Aetna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,BCBS,BCBS,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,BCBS MGG,BCBS MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Cigna,Cigna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Cigna MGG,Cigna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Humana,Humana,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Humana MGG,Humana MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Optum VA,Optum VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,UHC,UHC,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,UHC MGG,UHC MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,VA,VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Wellcare MGG,Wellcare MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Bright Health - commercial,Bright Health - commercial,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Bright Health MGG,Bright Health MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Aetna,Aetna,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Aetna MGG,Aetna MGG,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,BCBS,BCBS,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,BCBS MGG,BCBS MGG,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Cigna,Cigna,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Cigna MGG,Cigna MGG,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Humana,Humana,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Humana MGG,Humana MGG,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Optum VA,Optum VA,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,UHC,UHC,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,UHC MGG,UHC MGG,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,VA,VA,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Wellcare MGG,Wellcare MGG,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Bright Health - commercial,Bright Health - commercial,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,83516,CPT,,,,Inpatient,,,159.55,159.55,Bright Health MGG,Bright Health MGG,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Aetna,Aetna,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Aetna MGG,Aetna MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,BCBS,BCBS,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,BCBS MGG,BCBS MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Cigna,Cigna,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Cigna MGG,Cigna MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Humana,Humana,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Humana MGG,Humana MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Optum VA,Optum VA,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,UHC,UHC,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,UHC MGG,UHC MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,VA,VA,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Wellcare MGG,Wellcare MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Bright Health - commercial,Bright Health - commercial,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Bright Health MGG,Bright Health MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Aetna,Aetna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Aetna MGG,Aetna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,BCBS,BCBS,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,BCBS MGG,BCBS MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Cigna,Cigna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Cigna MGG,Cigna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Humana,Humana,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Humana MGG,Humana MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Optum VA,Optum VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,UHC,UHC,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,UHC MGG,UHC MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,VA,VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Wellcare MGG,Wellcare MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Bright Health - commercial,Bright Health - commercial,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,83516,CPT,,,,Inpatient,,,49.27,49.27,Bright Health MGG,Bright Health MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,83516,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,83516,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Aetna,Aetna,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Aetna MGG,Aetna MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,BCBS,BCBS,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,BCBS MGG,BCBS MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Cigna,Cigna,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Cigna MGG,Cigna MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Humana,Humana,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Humana MGG,Humana MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Optum VA,Optum VA,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,UHC,UHC,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,UHC MGG,UHC MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,VA,VA,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Wellcare MGG,Wellcare MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Bright Health - commercial,Bright Health - commercial,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Bright Health MGG,Bright Health MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Aetna,Aetna,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Aetna MGG,Aetna MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,BCBS,BCBS,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,BCBS MGG,BCBS MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Cigna,Cigna,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Cigna MGG,Cigna MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Humana,Humana,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Humana MGG,Humana MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Optum VA,Optum VA,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,UHC,UHC,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,UHC MGG,UHC MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,VA,VA,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Wellcare MGG,Wellcare MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Bright Health - commercial,Bright Health - commercial,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,83516,CPT,,,,Inpatient,,,442.32,442.32,Bright Health MGG,Bright Health MGG,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,83516,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Aetna,Aetna,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Aetna MGG,Aetna MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,BCBS,BCBS,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,BCBS MGG,BCBS MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Cigna,Cigna,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Cigna MGG,Cigna MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Humana,Humana,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Humana MGG,Humana MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Optum VA,Optum VA,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,UHC,UHC,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,UHC MGG,UHC MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,VA,VA,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Wellcare MGG,Wellcare MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Bright Health - commercial,Bright Health - commercial,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Bright Health MGG,Bright Health MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Aetna,Aetna,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Aetna MGG,Aetna MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,BCBS,BCBS,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,BCBS MGG,BCBS MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Cigna,Cigna,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Cigna MGG,Cigna MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Humana,Humana,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Humana MGG,Humana MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Optum VA,Optum VA,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,UHC,UHC,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,UHC MGG,UHC MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,VA,VA,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Wellcare MGG,Wellcare MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Bright Health - commercial,Bright Health - commercial,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,83516,CPT,,,,Inpatient,,,441.25,441.25,Bright Health MGG,Bright Health MGG,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Aetna,Aetna,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Aetna MGG,Aetna MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,BCBS,BCBS,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,BCBS MGG,BCBS MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Cigna,Cigna,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Cigna MGG,Cigna MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Humana,Humana,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Humana MGG,Humana MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Optum VA,Optum VA,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,UHC,UHC,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,UHC MGG,UHC MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,VA,VA,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Wellcare MGG,Wellcare MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Bright Health - commercial,Bright Health - commercial,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,83516,CPT,,,,Inpatient,,,43.91,43.91,Bright Health MGG,Bright Health MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Aetna,Aetna,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Aetna MGG,Aetna MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,BCBS,BCBS,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,BCBS MGG,BCBS MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Cigna,Cigna,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Cigna MGG,Cigna MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Humana,Humana,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Humana MGG,Humana MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Optum VA,Optum VA,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,UHC,UHC,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,UHC MGG,UHC MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,VA,VA,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Wellcare MGG,Wellcare MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Bright Health - commercial,Bright Health - commercial,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Bright Health MGG,Bright Health MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Aetna,Aetna,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Aetna MGG,Aetna MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,BCBS,BCBS,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,BCBS MGG,BCBS MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Cigna,Cigna,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Cigna MGG,Cigna MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Humana,Humana,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Humana MGG,Humana MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Optum VA,Optum VA,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,UHC,UHC,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,UHC MGG,UHC MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,VA,VA,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Wellcare MGG,Wellcare MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Bright Health - commercial,Bright Health - commercial,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,83516,CPT,,,,Inpatient,,,430.54,430.54,Bright Health MGG,Bright Health MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,83516,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,83516,CPT,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Aetna,Aetna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Aetna MGG,Aetna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS,BCBS,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS MGG,BCBS MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Cigna,Cigna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Cigna MGG,Cigna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Humana,Humana,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Humana MGG,Humana MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Optum VA,Optum VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,UHC,UHC,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,UHC MGG,UHC MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,VA,VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Wellcare MGG,Wellcare MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Bright Health - commercial,Bright Health - commercial,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,Bright Health MGG,Bright Health MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Aetna,Aetna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Aetna MGG,Aetna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,BCBS,BCBS,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,BCBS MGG,BCBS MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Cigna,Cigna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Cigna MGG,Cigna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Humana,Humana,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Humana MGG,Humana MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Optum VA,Optum VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,UHC,UHC,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,UHC MGG,UHC MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,VA,VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Wellcare MGG,Wellcare MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Bright Health - commercial,Bright Health - commercial,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Bright Health MGG,Bright Health MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Aetna,Aetna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Aetna MGG,Aetna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,BCBS,BCBS,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,BCBS MGG,BCBS MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Cigna,Cigna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Cigna MGG,Cigna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Humana,Humana,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Humana MGG,Humana MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Optum VA,Optum VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,UHC,UHC,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,UHC MGG,UHC MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,VA,VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Wellcare MGG,Wellcare MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Bright Health - commercial,Bright Health - commercial,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,82570,CPT,,,,Inpatient,,,159.58,159.58,Bright Health MGG,Bright Health MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Aetna,Aetna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Aetna MGG,Aetna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,BCBS,BCBS,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,BCBS MGG,BCBS MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Cigna,Cigna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Cigna MGG,Cigna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Humana,Humana,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Humana MGG,Humana MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Optum VA,Optum VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,UHC,UHC,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,UHC MGG,UHC MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,VA,VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Wellcare MGG,Wellcare MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Bright Health - commercial,Bright Health - commercial,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,82570,CPT,,,,Inpatient,,,33.2,33.2,Bright Health MGG,Bright Health MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Aetna,Aetna,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Aetna MGG,Aetna MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,BCBS,BCBS,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,BCBS MGG,BCBS MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Cigna,Cigna,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Cigna MGG,Cigna MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Humana,Humana,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Humana MGG,Humana MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Optum VA,Optum VA,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,UHC,UHC,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,UHC MGG,UHC MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,VA,VA,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Wellcare MGG,Wellcare MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Bright Health - commercial,Bright Health - commercial,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,82550,CPT,,,,Inpatient,,,86.75,86.75,Bright Health MGG,Bright Health MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,86140,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Aetna,Aetna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Aetna MGG,Aetna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS,BCBS,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS MGG,BCBS MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Cigna,Cigna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Cigna MGG,Cigna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Humana,Humana,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Humana MGG,Humana MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Optum VA,Optum VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,UHC,UHC,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,UHC MGG,UHC MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,VA,VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Wellcare MGG,Wellcare MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Bright Health - commercial,Bright Health - commercial,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,Bright Health MGG,Bright Health MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Aetna,Aetna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Aetna MGG,Aetna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS,BCBS,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS MGG,BCBS MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Cigna,Cigna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Cigna MGG,Cigna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Humana,Humana,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Humana MGG,Humana MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Optum VA,Optum VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,UHC,UHC,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,UHC MGG,UHC MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,VA,VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Wellcare MGG,Wellcare MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Bright Health - commercial,Bright Health - commercial,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,Bright Health MGG,Bright Health MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Aetna,Aetna,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Aetna MGG,Aetna MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,BCBS,BCBS,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,BCBS MGG,BCBS MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Cigna,Cigna,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Cigna MGG,Cigna MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Humana,Humana,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Humana MGG,Humana MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Optum VA,Optum VA,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,UHC,UHC,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,UHC MGG,UHC MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,VA,VA,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Wellcare MGG,Wellcare MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Bright Health - commercial,Bright Health - commercial,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,86631,CPT,,,,Inpatient,,,87.82,87.82,Bright Health MGG,Bright Health MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,86631,CPT,,,59,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna,Aetna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Aetna MGG,Aetna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS,BCBS,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,BCBS MGG,BCBS MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna,Cigna,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Cigna MGG,Cigna MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana,Humana,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Humana MGG,Humana MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Optum VA,Optum VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC,UHC,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,UHC MGG,UHC MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,VA,VA,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Wellcare MGG,Wellcare MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health - commercial,Bright Health - commercial,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,86631,CPT,,,,Inpatient,,,113.53,113.53,Bright Health MGG,Bright Health MGG,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Aetna,Aetna,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Aetna MGG,Aetna MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,BCBS,BCBS,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,BCBS MGG,BCBS MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Cigna,Cigna,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Cigna MGG,Cigna MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Humana,Humana,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Humana MGG,Humana MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Optum VA,Optum VA,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,UHC,UHC,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,UHC MGG,UHC MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,VA,VA,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Wellcare MGG,Wellcare MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Bright Health - commercial,Bright Health - commercial,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,86632,CPT,,,,Inpatient,,,87.82,87.82,Bright Health MGG,Bright Health MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,86632,CPT,,,59,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Aetna,Aetna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Aetna MGG,Aetna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,BCBS,BCBS,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,BCBS MGG,BCBS MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Cigna,Cigna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Cigna MGG,Cigna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Humana,Humana,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Humana MGG,Humana MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Optum VA,Optum VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,UHC,UHC,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,UHC MGG,UHC MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,VA,VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Wellcare MGG,Wellcare MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Bright Health - commercial,Bright Health - commercial,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Bright Health MGG,Bright Health MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Aetna,Aetna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Aetna MGG,Aetna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,BCBS,BCBS,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,BCBS MGG,BCBS MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Cigna,Cigna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Cigna MGG,Cigna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Humana,Humana,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Humana MGG,Humana MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Optum VA,Optum VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,UHC,UHC,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,UHC MGG,UHC MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,VA,VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Wellcare MGG,Wellcare MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Bright Health - commercial,Bright Health - commercial,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Bright Health MGG,Bright Health MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Aetna,Aetna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Aetna MGG,Aetna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,BCBS,BCBS,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,BCBS MGG,BCBS MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Cigna,Cigna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Cigna MGG,Cigna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Humana,Humana,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Humana MGG,Humana MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Optum VA,Optum VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,UHC,UHC,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,UHC MGG,UHC MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,VA,VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Wellcare MGG,Wellcare MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Bright Health - commercial,Bright Health - commercial,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Bright Health MGG,Bright Health MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Aetna,Aetna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Aetna MGG,Aetna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,BCBS,BCBS,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,BCBS MGG,BCBS MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Cigna,Cigna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Cigna MGG,Cigna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Humana,Humana,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Humana MGG,Humana MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Optum VA,Optum VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,UHC,UHC,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,UHC MGG,UHC MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,VA,VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Wellcare MGG,Wellcare MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Bright Health - commercial,Bright Health - commercial,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,86632,CPT,,,,Inpatient,,,121.02,121.02,Bright Health MGG,Bright Health MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Aetna,Aetna,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Aetna MGG,Aetna MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,BCBS,BCBS,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,BCBS MGG,BCBS MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Cigna,Cigna,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Cigna MGG,Cigna MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Humana,Humana,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Humana MGG,Humana MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Optum VA,Optum VA,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,UHC,UHC,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,UHC MGG,UHC MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,VA,VA,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Wellcare MGG,Wellcare MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Bright Health - commercial,Bright Health - commercial,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,80185,CPT,,,,Inpatient,,,94.25,94.25,Bright Health MGG,Bright Health MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,80301,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,80301,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Aetna,Aetna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Aetna MGG,Aetna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,BCBS,BCBS,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,BCBS MGG,BCBS MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Cigna,Cigna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Cigna MGG,Cigna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Humana,Humana,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Humana MGG,Humana MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Optum VA,Optum VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,UHC,UHC,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,UHC MGG,UHC MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,VA,VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Wellcare MGG,Wellcare MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Bright Health - commercial,Bright Health - commercial,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,80301,CPT,,,,Inpatient,,,59.98,59.98,Bright Health MGG,Bright Health MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Aetna,Aetna,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Aetna MGG,Aetna MGG,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,BCBS,BCBS,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,BCBS MGG,BCBS MGG,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Cigna,Cigna,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Cigna MGG,Cigna MGG,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Humana,Humana,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Humana MGG,Humana MGG,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Optum VA,Optum VA,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,UHC,UHC,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,UHC MGG,UHC MGG,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,VA,VA,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Wellcare MGG,Wellcare MGG,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Bright Health - commercial,Bright Health - commercial,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,80301,CPT,,,,Inpatient,,,399.48,399.48,Bright Health MGG,Bright Health MGG,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Aetna,Aetna,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Aetna MGG,Aetna MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,BCBS,BCBS,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,BCBS MGG,BCBS MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Cigna,Cigna,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Cigna MGG,Cigna MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Humana,Humana,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Humana MGG,Humana MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Optum VA,Optum VA,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,UHC,UHC,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,UHC MGG,UHC MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,VA,VA,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Wellcare MGG,Wellcare MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Bright Health - commercial,Bright Health - commercial,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,80301,CPT,,,,Inpatient,,,112.46,112.46,Bright Health MGG,Bright Health MGG,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Aetna,Aetna,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Aetna MGG,Aetna MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,BCBS,BCBS,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,BCBS MGG,BCBS MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Cigna,Cigna,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Cigna MGG,Cigna MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Humana,Humana,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Humana MGG,Humana MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Optum VA,Optum VA,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,UHC,UHC,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,UHC MGG,UHC MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,VA,VA,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Wellcare MGG,Wellcare MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Bright Health - commercial,Bright Health - commercial,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,80301,CPT,,,,Inpatient,,,149.94,149.94,Bright Health MGG,Bright Health MGG,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Aetna,Aetna,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Aetna MGG,Aetna MGG,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,BCBS,BCBS,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,BCBS MGG,BCBS MGG,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Cigna,Cigna,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Cigna MGG,Cigna MGG,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Humana,Humana,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Humana MGG,Humana MGG,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Optum VA,Optum VA,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,UHC,UHC,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,UHC MGG,UHC MGG,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,VA,VA,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Wellcare MGG,Wellcare MGG,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Bright Health - commercial,Bright Health - commercial,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,80302,CPT,,,,Inpatient,,,808.61,808.61,Bright Health MGG,Bright Health MGG,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Aetna,Aetna,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Aetna MGG,Aetna MGG,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,BCBS,BCBS,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,BCBS MGG,BCBS MGG,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Cigna,Cigna,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Cigna MGG,Cigna MGG,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Humana,Humana,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Humana MGG,Humana MGG,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Optum VA,Optum VA,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,UHC,UHC,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,UHC MGG,UHC MGG,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,VA,VA,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Wellcare MGG,Wellcare MGG,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Bright Health - commercial,Bright Health - commercial,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,80302,CPT,,,,Inpatient,,,433.76,433.76,Bright Health MGG,Bright Health MGG,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Aetna,Aetna,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Aetna MGG,Aetna MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,BCBS,BCBS,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,BCBS MGG,BCBS MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Cigna,Cigna,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Cigna MGG,Cigna MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Humana,Humana,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Humana MGG,Humana MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Optum VA,Optum VA,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,UHC,UHC,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,UHC MGG,UHC MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,VA,VA,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Wellcare MGG,Wellcare MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Bright Health - commercial,Bright Health - commercial,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,80304,CPT,,,,Inpatient,,,776.48,776.48,Bright Health MGG,Bright Health MGG,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Aetna,Aetna,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Aetna MGG,Aetna MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,BCBS,BCBS,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,BCBS MGG,BCBS MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Cigna,Cigna,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Cigna MGG,Cigna MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Humana,Humana,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Humana MGG,Humana MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Optum VA,Optum VA,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,UHC,UHC,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,UHC MGG,UHC MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,VA,VA,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Wellcare MGG,Wellcare MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Bright Health - commercial,Bright Health - commercial,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,80320,CPT,,,,Inpatient,,,144.59,144.59,Bright Health MGG,Bright Health MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Aetna,Aetna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Aetna MGG,Aetna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,BCBS,BCBS,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,BCBS MGG,BCBS MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Cigna,Cigna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Cigna MGG,Cigna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Humana,Humana,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Humana MGG,Humana MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Optum VA,Optum VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,UHC,UHC,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,UHC MGG,UHC MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,VA,VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Wellcare MGG,Wellcare MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Bright Health - commercial,Bright Health - commercial,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,80320,CPT,,,,Inpatient,,,111.38,111.38,Bright Health MGG,Bright Health MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Aetna,Aetna,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Aetna MGG,Aetna MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,BCBS,BCBS,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,BCBS MGG,BCBS MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Cigna,Cigna,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Cigna MGG,Cigna MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Humana,Humana,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Humana MGG,Humana MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Optum VA,Optum VA,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,UHC,UHC,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,UHC MGG,UHC MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,VA,VA,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Wellcare MGG,Wellcare MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Bright Health - commercial,Bright Health - commercial,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,80320,CPT,,,,Inpatient,,,148.87,148.87,Bright Health MGG,Bright Health MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Aetna,Aetna,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Aetna MGG,Aetna MGG,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,BCBS,BCBS,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,BCBS MGG,BCBS MGG,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Cigna,Cigna,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Cigna MGG,Cigna MGG,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Humana,Humana,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Humana MGG,Humana MGG,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Optum VA,Optum VA,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,UHC,UHC,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,UHC MGG,UHC MGG,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,VA,VA,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Wellcare MGG,Wellcare MGG,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Bright Health - commercial,Bright Health - commercial,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,82670,CPT,,,,Inpatient,,,1157.75,1157.75,Bright Health MGG,Bright Health MGG,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Aetna,Aetna,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Aetna MGG,Aetna MGG,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,BCBS,BCBS,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,BCBS MGG,BCBS MGG,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Cigna,Cigna,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Cigna MGG,Cigna MGG,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Humana,Humana,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Humana MGG,Humana MGG,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Optum VA,Optum VA,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,UHC,UHC,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,UHC MGG,UHC MGG,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,VA,VA,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Wellcare MGG,Wellcare MGG,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Bright Health - commercial,Bright Health - commercial,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,82677,CPT,,,,Inpatient,,,517.29,517.29,Bright Health MGG,Bright Health MGG,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Aetna,Aetna,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Aetna MGG,Aetna MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,BCBS,BCBS,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,BCBS MGG,BCBS MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Cigna,Cigna,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Cigna MGG,Cigna MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Humana,Humana,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Humana MGG,Humana MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Optum VA,Optum VA,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,UHC,UHC,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,UHC MGG,UHC MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,VA,VA,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Wellcare MGG,Wellcare MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Bright Health - commercial,Bright Health - commercial,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Bright Health MGG,Bright Health MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Aetna,Aetna,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Aetna MGG,Aetna MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,BCBS,BCBS,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,BCBS MGG,BCBS MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Cigna,Cigna,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Cigna MGG,Cigna MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Humana,Humana,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Humana MGG,Humana MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Optum VA,Optum VA,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,UHC,UHC,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,UHC MGG,UHC MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,VA,VA,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Wellcare MGG,Wellcare MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Bright Health - commercial,Bright Health - commercial,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,85384,CPT,,,,Inpatient,,,288.1,288.1,Bright Health MGG,Bright Health MGG,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Aetna,Aetna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Aetna MGG,Aetna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,BCBS,BCBS,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,BCBS MGG,BCBS MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Cigna,Cigna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Cigna MGG,Cigna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Humana,Humana,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Humana MGG,Humana MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Optum VA,Optum VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,UHC,UHC,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,UHC MGG,UHC MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,VA,VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Wellcare MGG,Wellcare MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Bright Health - commercial,Bright Health - commercial,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,86780,CPT,,,,Inpatient,,,159.58,159.58,Bright Health MGG,Bright Health MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,86780,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Aetna,Aetna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Aetna MGG,Aetna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,BCBS,BCBS,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,BCBS MGG,BCBS MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Cigna,Cigna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Cigna MGG,Cigna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Humana,Humana,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Humana MGG,Humana MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Optum VA,Optum VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,UHC,UHC,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,UHC MGG,UHC MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,VA,VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Wellcare MGG,Wellcare MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Bright Health - commercial,Bright Health - commercial,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,86677,CPT,,,,Inpatient,,,61.05,61.05,Bright Health MGG,Bright Health MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Aetna,Aetna,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Aetna MGG,Aetna MGG,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,BCBS,BCBS,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,BCBS MGG,BCBS MGG,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Cigna,Cigna,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Cigna MGG,Cigna MGG,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Humana,Humana,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Humana MGG,Humana MGG,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Optum VA,Optum VA,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,UHC,UHC,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,UHC MGG,UHC MGG,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,VA,VA,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Wellcare MGG,Wellcare MGG,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Bright Health - commercial,Bright Health - commercial,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,86677,CPT,,,,Inpatient,,,445.54,445.54,Bright Health MGG,Bright Health MGG,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Aetna,Aetna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Aetna MGG,Aetna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,BCBS,BCBS,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,BCBS MGG,BCBS MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Cigna,Cigna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Cigna MGG,Cigna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Humana,Humana,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Humana MGG,Humana MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Optum VA,Optum VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,UHC,UHC,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,UHC MGG,UHC MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,VA,VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Wellcare MGG,Wellcare MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Bright Health - commercial,Bright Health - commercial,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,86708,CPT,,,,Inpatient,,,51.41,51.41,Bright Health MGG,Bright Health MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Aetna,Aetna,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Aetna MGG,Aetna MGG,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,BCBS,BCBS,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,BCBS MGG,BCBS MGG,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Cigna,Cigna,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Cigna MGG,Cigna MGG,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Humana,Humana,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Humana MGG,Humana MGG,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Optum VA,Optum VA,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,UHC,UHC,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,UHC MGG,UHC MGG,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,VA,VA,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Wellcare MGG,Wellcare MGG,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Bright Health - commercial,Bright Health - commercial,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,Bright Health MGG,Bright Health MGG,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Aetna,Aetna,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Aetna MGG,Aetna MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,BCBS,BCBS,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,BCBS MGG,BCBS MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Cigna,Cigna,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Cigna MGG,Cigna MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Humana,Humana,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Humana MGG,Humana MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Optum VA,Optum VA,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,UHC,UHC,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,UHC MGG,UHC MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,VA,VA,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Wellcare MGG,Wellcare MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Bright Health - commercial,Bright Health - commercial,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Bright Health MGG,Bright Health MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Aetna,Aetna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Aetna MGG,Aetna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,BCBS,BCBS,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,BCBS MGG,BCBS MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Cigna,Cigna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Cigna MGG,Cigna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Humana,Humana,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Humana MGG,Humana MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Optum VA,Optum VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,UHC,UHC,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,UHC MGG,UHC MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,VA,VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Wellcare MGG,Wellcare MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Bright Health - commercial,Bright Health - commercial,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Bright Health MGG,Bright Health MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Aetna,Aetna,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Aetna MGG,Aetna MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,BCBS,BCBS,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,BCBS MGG,BCBS MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Cigna,Cigna,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Cigna MGG,Cigna MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Humana,Humana,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Humana MGG,Humana MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Optum VA,Optum VA,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,UHC,UHC,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,UHC MGG,UHC MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,VA,VA,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Wellcare MGG,Wellcare MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Bright Health - commercial,Bright Health - commercial,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,85613,CPT,,,,Inpatient,,,219.56,219.56,Bright Health MGG,Bright Health MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Aetna,Aetna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Aetna MGG,Aetna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,BCBS,BCBS,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,BCBS MGG,BCBS MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Cigna,Cigna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Cigna MGG,Cigna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Humana,Humana,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Humana MGG,Humana MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Optum VA,Optum VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,UHC,UHC,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,UHC MGG,UHC MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,VA,VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Wellcare MGG,Wellcare MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Bright Health - commercial,Bright Health - commercial,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,85613,CPT,,,,Inpatient,,,53.55,53.55,Bright Health MGG,Bright Health MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,86701,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Aetna,Aetna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Aetna MGG,Aetna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,BCBS,BCBS,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,BCBS MGG,BCBS MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Cigna,Cigna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Cigna MGG,Cigna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Humana,Humana,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Humana MGG,Humana MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Optum VA,Optum VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,UHC,UHC,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,UHC MGG,UHC MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,VA,VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Wellcare MGG,Wellcare MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Bright Health - commercial,Bright Health - commercial,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,86696,CPT,,,,Inpatient,,,85.68,85.68,Bright Health MGG,Bright Health MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Aetna,Aetna,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Aetna MGG,Aetna MGG,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,BCBS,BCBS,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,BCBS MGG,BCBS MGG,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Cigna,Cigna,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Cigna MGG,Cigna MGG,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Humana,Humana,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Humana MGG,Humana MGG,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Optum VA,Optum VA,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,UHC,UHC,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,UHC MGG,UHC MGG,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,VA,VA,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Wellcare MGG,Wellcare MGG,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Bright Health - commercial,Bright Health - commercial,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,86753,CPT,,,,Inpatient,,,373.78,373.78,Bright Health MGG,Bright Health MGG,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Aetna,Aetna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Aetna MGG,Aetna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,BCBS,BCBS,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,BCBS MGG,BCBS MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Cigna,Cigna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Cigna MGG,Cigna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Humana,Humana,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Humana MGG,Humana MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Optum VA,Optum VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,UHC,UHC,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,UHC MGG,UHC MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,VA,VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Wellcare MGG,Wellcare MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Bright Health - commercial,Bright Health - commercial,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Bright Health MGG,Bright Health MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Aetna,Aetna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Aetna MGG,Aetna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,BCBS,BCBS,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,BCBS MGG,BCBS MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Cigna,Cigna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Cigna MGG,Cigna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Humana,Humana,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Humana MGG,Humana MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Optum VA,Optum VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,UHC,UHC,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,UHC MGG,UHC MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,VA,VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Wellcare MGG,Wellcare MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Bright Health - commercial,Bright Health - commercial,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,86753,CPT,,,,Inpatient,,,62.12,62.12,Bright Health MGG,Bright Health MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Aetna,Aetna,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Aetna MGG,Aetna MGG,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,BCBS,BCBS,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,BCBS MGG,BCBS MGG,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Cigna,Cigna,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Cigna MGG,Cigna MGG,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Humana,Humana,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Humana MGG,Humana MGG,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Optum VA,Optum VA,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,UHC,UHC,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,UHC MGG,UHC MGG,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,VA,VA,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Wellcare MGG,Wellcare MGG,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Bright Health - commercial,Bright Health - commercial,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,83525,CPT,,,,Inpatient,,,571.91,571.91,Bright Health MGG,Bright Health MGG,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Aetna,Aetna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Aetna MGG,Aetna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,BCBS,BCBS,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,BCBS MGG,BCBS MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Cigna,Cigna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Cigna MGG,Cigna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Humana,Humana,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Humana MGG,Humana MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Optum VA,Optum VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,UHC,UHC,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,UHC MGG,UHC MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,VA,VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Wellcare MGG,Wellcare MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Bright Health - commercial,Bright Health - commercial,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,83605,CPT,,,,Inpatient,,,53.55,53.55,Bright Health MGG,Bright Health MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Aetna,Aetna,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Aetna MGG,Aetna MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,BCBS,BCBS,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,BCBS MGG,BCBS MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Cigna,Cigna,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Cigna MGG,Cigna MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Humana,Humana,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Humana MGG,Humana MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Optum VA,Optum VA,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,UHC,UHC,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,UHC MGG,UHC MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,VA,VA,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Wellcare MGG,Wellcare MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Bright Health - commercial,Bright Health - commercial,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Bright Health MGG,Bright Health MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Aetna,Aetna,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Aetna MGG,Aetna MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,BCBS,BCBS,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,BCBS MGG,BCBS MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Cigna,Cigna,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Cigna MGG,Cigna MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Humana,Humana,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Humana MGG,Humana MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Optum VA,Optum VA,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,UHC,UHC,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,UHC MGG,UHC MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,VA,VA,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Wellcare MGG,Wellcare MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Bright Health - commercial,Bright Health - commercial,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.21,18.21,Bright Health MGG,Bright Health MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Aetna,Aetna,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Aetna MGG,Aetna MGG,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,BCBS,BCBS,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,BCBS MGG,BCBS MGG,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Cigna,Cigna,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Cigna MGG,Cigna MGG,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Humana,Humana,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Humana MGG,Humana MGG,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Optum VA,Optum VA,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,UHC,UHC,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,UHC MGG,UHC MGG,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,VA,VA,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Wellcare MGG,Wellcare MGG,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Bright Health - commercial,Bright Health - commercial,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,86713,CPT,,,,Inpatient,,,491.59,491.59,Bright Health MGG,Bright Health MGG,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,85540,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Aetna,Aetna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Aetna MGG,Aetna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,BCBS,BCBS,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,BCBS MGG,BCBS MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Cigna,Cigna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Cigna MGG,Cigna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Humana,Humana,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Humana MGG,Humana MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Optum VA,Optum VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,UHC,UHC,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,UHC MGG,UHC MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,VA,VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Wellcare MGG,Wellcare MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Bright Health - commercial,Bright Health - commercial,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Bright Health MGG,Bright Health MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Aetna,Aetna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Aetna MGG,Aetna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,BCBS,BCBS,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,BCBS MGG,BCBS MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Cigna,Cigna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Cigna MGG,Cigna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Humana,Humana,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Humana MGG,Humana MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Optum VA,Optum VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,UHC,UHC,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,UHC MGG,UHC MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,VA,VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Wellcare MGG,Wellcare MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Bright Health - commercial,Bright Health - commercial,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,83690,CPT,,,,Inpatient,,,133.88,133.88,Bright Health MGG,Bright Health MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Aetna,Aetna,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Aetna MGG,Aetna MGG,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,BCBS,BCBS,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,BCBS MGG,BCBS MGG,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Cigna,Cigna,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Cigna MGG,Cigna MGG,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Humana,Humana,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Humana MGG,Humana MGG,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Optum VA,Optum VA,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,UHC,UHC,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,UHC MGG,UHC MGG,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,VA,VA,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Wellcare MGG,Wellcare MGG,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Bright Health - commercial,Bright Health - commercial,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,86618,CPT,,,,Inpatient,,,650.1,650.1,Bright Health MGG,Bright Health MGG,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Aetna,Aetna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Aetna MGG,Aetna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,BCBS,BCBS,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,BCBS MGG,BCBS MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Cigna,Cigna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Cigna MGG,Cigna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Humana,Humana,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Humana MGG,Humana MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Optum VA,Optum VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,UHC,UHC,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,UHC MGG,UHC MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,VA,VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Wellcare MGG,Wellcare MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Bright Health - commercial,Bright Health - commercial,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,83735,CPT,,,,Inpatient,,,66.4,66.4,Bright Health MGG,Bright Health MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Aetna,Aetna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Aetna MGG,Aetna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,BCBS,BCBS,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,BCBS MGG,BCBS MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Cigna,Cigna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Cigna MGG,Cigna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Humana,Humana,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Humana MGG,Humana MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Optum VA,Optum VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,UHC,UHC,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,UHC MGG,UHC MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,VA,VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Wellcare MGG,Wellcare MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Bright Health - commercial,Bright Health - commercial,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,83735,CPT,,,,Inpatient,,,31.06,31.06,Bright Health MGG,Bright Health MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Aetna,Aetna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Aetna MGG,Aetna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,BCBS,BCBS,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,BCBS MGG,BCBS MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Cigna,Cigna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Cigna MGG,Cigna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Humana,Humana,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Humana MGG,Humana MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Optum VA,Optum VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,UHC,UHC,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,UHC MGG,UHC MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,VA,VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Wellcare MGG,Wellcare MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Bright Health - commercial,Bright Health - commercial,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,83735,CPT,,,,Inpatient,,,33.2,33.2,Bright Health MGG,Bright Health MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Aetna,Aetna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Aetna MGG,Aetna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,BCBS,BCBS,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,BCBS MGG,BCBS MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Cigna,Cigna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Cigna MGG,Cigna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Humana,Humana,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Humana MGG,Humana MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Optum VA,Optum VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,UHC,UHC,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,UHC MGG,UHC MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,VA,VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Wellcare MGG,Wellcare MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Bright Health - commercial,Bright Health - commercial,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,86308,CPT,,,,Inpatient,,,25.7,25.7,Bright Health MGG,Bright Health MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,86331,CPT,,,59,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Aetna,Aetna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Aetna MGG,Aetna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,BCBS,BCBS,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,BCBS MGG,BCBS MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Cigna,Cigna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Cigna MGG,Cigna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Humana,Humana,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Humana MGG,Humana MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Optum VA,Optum VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,UHC,UHC,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,UHC MGG,UHC MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,VA,VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Wellcare MGG,Wellcare MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Bright Health - commercial,Bright Health - commercial,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,87177,CPT,,,,Inpatient,,,64.26,64.26,Bright Health MGG,Bright Health MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,80184,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,80184,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Aetna,Aetna,15.94,,,,,,,per diem,15.94,15.94,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Aetna MGG,Aetna MGG,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,BCBS,BCBS,15.94,,,,,,,per diem,15.94,15.94,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,BCBS MGG,BCBS MGG,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Cigna,Cigna,15.94,,,,,,,per diem,15.94,15.94,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Cigna MGG,Cigna MGG,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Humana,Humana,15.94,,,,,,,per diem,15.94,15.94,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Humana MGG,Humana MGG,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Optum VA,Optum VA,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,UHC,UHC,15.94,,,,,,,per diem,15.94,15.94,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,UHC MGG,UHC MGG,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,VA,VA,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Wellcare MGG,Wellcare MGG,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Bright Health - commercial,Bright Health - commercial,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,84300,CPT,,,,Inpatient,,,15.94,15.94,Bright Health MGG,Bright Health MGG,15.94,,,,,,,case rate,15.94,15.94,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Aetna,Aetna,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Aetna MGG,Aetna MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,BCBS,BCBS,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,BCBS MGG,BCBS MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Cigna,Cigna,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Cigna MGG,Cigna MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Humana,Humana,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Humana MGG,Humana MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Optum VA,Optum VA,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,UHC,UHC,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,UHC MGG,UHC MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,VA,VA,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Wellcare MGG,Wellcare MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Bright Health - commercial,Bright Health - commercial,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,82436,CPT,,,,Inpatient,,,27.5,27.5,Bright Health MGG,Bright Health MGG,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Aetna,Aetna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Aetna MGG,Aetna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,BCBS,BCBS,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,BCBS MGG,BCBS MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Cigna,Cigna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Cigna MGG,Cigna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Humana,Humana,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Humana MGG,Humana MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Optum VA,Optum VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,UHC,UHC,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,UHC MGG,UHC MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,VA,VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Wellcare MGG,Wellcare MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Bright Health - commercial,Bright Health - commercial,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,83986,CPT,,,,Inpatient,,,33.2,33.2,Bright Health MGG,Bright Health MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Aetna,Aetna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Aetna MGG,Aetna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,BCBS,BCBS,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,BCBS MGG,BCBS MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Cigna,Cigna,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Cigna MGG,Cigna MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Humana,Humana,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Humana MGG,Humana MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Optum VA,Optum VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,UHC,UHC,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,UHC MGG,UHC MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,VA,VA,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Wellcare MGG,Wellcare MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Bright Health - commercial,Bright Health - commercial,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,84133,CPT,,,,Inpatient,,,33.2,33.2,Bright Health MGG,Bright Health MGG,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Aetna,Aetna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Aetna MGG,Aetna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,BCBS,BCBS,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,BCBS MGG,BCBS MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Cigna,Cigna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Cigna MGG,Cigna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Humana,Humana,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Humana MGG,Humana MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Optum VA,Optum VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,UHC,UHC,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,UHC MGG,UHC MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,VA,VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Wellcare MGG,Wellcare MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Bright Health - commercial,Bright Health - commercial,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,84146,CPT,,,,Inpatient,,,84.61,84.61,Bright Health MGG,Bright Health MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Aetna,Aetna,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Aetna MGG,Aetna MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,BCBS,BCBS,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,BCBS MGG,BCBS MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Cigna,Cigna,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Cigna MGG,Cigna MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Humana,Humana,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Humana MGG,Humana MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Optum VA,Optum VA,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,UHC,UHC,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,UHC MGG,UHC MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,VA,VA,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Wellcare MGG,Wellcare MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Bright Health - commercial,Bright Health - commercial,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,84146,CPT,,,,Inpatient,,,835.38,835.38,Bright Health MGG,Bright Health MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Aetna,Aetna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Aetna MGG,Aetna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,BCBS,BCBS,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,BCBS MGG,BCBS MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Cigna,Cigna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Cigna MGG,Cigna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Humana,Humana,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Humana MGG,Humana MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Optum VA,Optum VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,UHC,UHC,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,UHC MGG,UHC MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,VA,VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Wellcare MGG,Wellcare MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Bright Health - commercial,Bright Health - commercial,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,84153,CPT,,,,Inpatient,,,78.18,78.18,Bright Health MGG,Bright Health MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Aetna,Aetna,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Aetna MGG,Aetna MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,BCBS,BCBS,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,BCBS MGG,BCBS MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Cigna,Cigna,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Cigna MGG,Cigna MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Humana,Humana,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Humana MGG,Humana MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Optum VA,Optum VA,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,UHC,UHC,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,UHC MGG,UHC MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,VA,VA,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Wellcare MGG,Wellcare MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Bright Health - commercial,Bright Health - commercial,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,84153,CPT,,,,Inpatient,,,138.16,138.16,Bright Health MGG,Bright Health MGG,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Aetna,Aetna,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Aetna MGG,Aetna MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,BCBS,BCBS,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,BCBS MGG,BCBS MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Cigna,Cigna,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Cigna MGG,Cigna MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Humana,Humana,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Humana MGG,Humana MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Optum VA,Optum VA,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,UHC,UHC,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,UHC MGG,UHC MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,VA,VA,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Wellcare MGG,Wellcare MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Bright Health - commercial,Bright Health - commercial,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,84155,CPT,,,,Inpatient,,,28.92,28.92,Bright Health MGG,Bright Health MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,84157,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Aetna,Aetna,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Aetna MGG,Aetna MGG,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,BCBS,BCBS,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,BCBS MGG,BCBS MGG,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Cigna,Cigna,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Cigna MGG,Cigna MGG,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Humana,Humana,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Humana MGG,Humana MGG,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Optum VA,Optum VA,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,UHC,UHC,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,UHC MGG,UHC MGG,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,VA,VA,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Wellcare MGG,Wellcare MGG,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Bright Health - commercial,Bright Health - commercial,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,84165,CPT,,,,Inpatient,,,195.99,195.99,Bright Health MGG,Bright Health MGG,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,85610,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Aetna,Aetna,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Aetna MGG,Aetna MGG,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,BCBS,BCBS,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,BCBS MGG,BCBS MGG,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Cigna,Cigna,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Cigna MGG,Cigna MGG,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Humana,Humana,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Humana MGG,Humana MGG,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Optum VA,Optum VA,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,UHC,UHC,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,UHC MGG,UHC MGG,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,VA,VA,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Wellcare MGG,Wellcare MGG,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Bright Health - commercial,Bright Health - commercial,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,83970,CPT,,,,Inpatient,,,421.97,421.97,Bright Health MGG,Bright Health MGG,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Aetna,Aetna,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Aetna MGG,Aetna MGG,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,BCBS,BCBS,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,BCBS MGG,BCBS MGG,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Cigna,Cigna,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Cigna MGG,Cigna MGG,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Humana,Humana,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Humana MGG,Humana MGG,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Optum VA,Optum VA,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,UHC,UHC,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,UHC MGG,UHC MGG,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,VA,VA,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Wellcare MGG,Wellcare MGG,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Bright Health - commercial,Bright Health - commercial,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,83970,CPT,,,,Inpatient,,,302.02,302.02,Bright Health MGG,Bright Health MGG,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Aetna,Aetna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Aetna MGG,Aetna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,BCBS,BCBS,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,BCBS MGG,BCBS MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Cigna,Cigna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Cigna MGG,Cigna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Humana,Humana,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Humana MGG,Humana MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Optum VA,Optum VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,UHC,UHC,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,UHC MGG,UHC MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,VA,VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Wellcare MGG,Wellcare MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Bright Health - commercial,Bright Health - commercial,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Bright Health MGG,Bright Health MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Aetna,Aetna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Aetna MGG,Aetna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,BCBS,BCBS,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,BCBS MGG,BCBS MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Cigna,Cigna,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Cigna MGG,Cigna MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Humana,Humana,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Humana MGG,Humana MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Optum VA,Optum VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,UHC,UHC,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,UHC MGG,UHC MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,VA,VA,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Wellcare MGG,Wellcare MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Bright Health - commercial,Bright Health - commercial,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,85730,CPT,,,,Inpatient,,,25.7,25.7,Bright Health MGG,Bright Health MGG,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,85730,CPT,,,,Inpatient,,,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Aetna,Aetna,47.22,,,,,,,per diem,47.22,47.22,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Aetna MGG,Aetna MGG,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,BCBS,BCBS,47.22,,,,,,,per diem,47.22,47.22,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,BCBS MGG,BCBS MGG,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Cigna,Cigna,47.22,,,,,,,per diem,47.22,47.22,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Cigna MGG,Cigna MGG,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Humana,Humana,47.22,,,,,,,per diem,47.22,47.22,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Humana MGG,Humana MGG,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Optum VA,Optum VA,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,UHC,UHC,47.22,,,,,,,per diem,47.22,47.22,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,UHC MGG,UHC MGG,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,VA,VA,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Wellcare MGG,Wellcare MGG,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Bright Health - commercial,Bright Health - commercial,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,86317,CPT,,,,Inpatient,,,47.22,47.22,Bright Health MGG,Bright Health MGG,47.22,,,,,,,case rate,47.22,47.22,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Aetna,Aetna,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Aetna MGG,Aetna MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,BCBS,BCBS,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,BCBS MGG,BCBS MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Cigna,Cigna,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Cigna MGG,Cigna MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Humana,Humana,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Humana MGG,Humana MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Optum VA,Optum VA,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,UHC,UHC,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,UHC MGG,UHC MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,VA,VA,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Wellcare MGG,Wellcare MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Bright Health - commercial,Bright Health - commercial,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,86317,CPT,,,,Inpatient,,,28.92,28.92,Bright Health MGG,Bright Health MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Aetna,Aetna,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Aetna MGG,Aetna MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,BCBS,BCBS,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,BCBS MGG,BCBS MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Cigna,Cigna,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Cigna MGG,Cigna MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Humana,Humana,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Humana MGG,Humana MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Optum VA,Optum VA,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,UHC,UHC,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,UHC MGG,UHC MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,VA,VA,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Wellcare MGG,Wellcare MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Bright Health - commercial,Bright Health - commercial,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,86317,CPT,,,,Inpatient,,,65.33,65.33,Bright Health MGG,Bright Health MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,86317,CPT,,,59,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,86317,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,86762,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Aetna,Aetna,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Aetna MGG,Aetna MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,BCBS,BCBS,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,BCBS MGG,BCBS MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Cigna,Cigna,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Cigna MGG,Cigna MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Humana,Humana,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Humana MGG,Humana MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Optum VA,Optum VA,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,UHC,UHC,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,UHC MGG,UHC MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,VA,VA,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Wellcare MGG,Wellcare MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Bright Health - commercial,Bright Health - commercial,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,86762,CPT,,,,Inpatient,,,252.76,252.76,Bright Health MGG,Bright Health MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Aetna,Aetna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Aetna MGG,Aetna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,BCBS,BCBS,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,BCBS MGG,BCBS MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Cigna,Cigna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Cigna MGG,Cigna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Humana,Humana,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Humana MGG,Humana MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Optum VA,Optum VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,UHC,UHC,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,UHC MGG,UHC MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,VA,VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Wellcare MGG,Wellcare MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Bright Health - commercial,Bright Health - commercial,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,86762,CPT,,,,Inpatient,,,85.68,85.68,Bright Health MGG,Bright Health MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Aetna,Aetna,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Aetna MGG,Aetna MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,BCBS,BCBS,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,BCBS MGG,BCBS MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Cigna,Cigna,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Cigna MGG,Cigna MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Humana,Humana,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Humana MGG,Humana MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Optum VA,Optum VA,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,UHC,UHC,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,UHC MGG,UHC MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,VA,VA,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Wellcare MGG,Wellcare MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Bright Health - commercial,Bright Health - commercial,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Bright Health MGG,Bright Health MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Aetna,Aetna,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Aetna MGG,Aetna MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,BCBS,BCBS,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,BCBS MGG,BCBS MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Cigna,Cigna,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Cigna MGG,Cigna MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Humana,Humana,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Humana MGG,Humana MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Optum VA,Optum VA,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,UHC,UHC,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,UHC MGG,UHC MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,VA,VA,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Wellcare MGG,Wellcare MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Bright Health - commercial,Bright Health - commercial,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,86765,CPT,,,,Inpatient,,,326.66,326.66,Bright Health MGG,Bright Health MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Aetna,Aetna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Aetna MGG,Aetna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,BCBS,BCBS,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,BCBS MGG,BCBS MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Cigna,Cigna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Cigna MGG,Cigna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Humana,Humana,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Humana MGG,Humana MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Optum VA,Optum VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,UHC,UHC,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,UHC MGG,UHC MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,VA,VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Wellcare MGG,Wellcare MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Bright Health - commercial,Bright Health - commercial,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,84302,CPT,,,,Inpatient,,,23.56,23.56,Bright Health MGG,Bright Health MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Aetna,Aetna,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Aetna MGG,Aetna MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,BCBS,BCBS,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,BCBS MGG,BCBS MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Cigna,Cigna,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Cigna MGG,Cigna MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Humana,Humana,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Humana MGG,Humana MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Optum VA,Optum VA,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,UHC,UHC,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,UHC MGG,UHC MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,VA,VA,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Wellcare MGG,Wellcare MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Bright Health - commercial,Bright Health - commercial,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,84403,CPT,,,,Inpatient,,,130.66,130.66,Bright Health MGG,Bright Health MGG,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,84403,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,80198,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Aetna,Aetna,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Aetna MGG,Aetna MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,BCBS,BCBS,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,BCBS MGG,BCBS MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Cigna,Cigna,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Cigna MGG,Cigna MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Humana,Humana,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Humana MGG,Humana MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Optum VA,Optum VA,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,UHC,UHC,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,UHC MGG,UHC MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,VA,VA,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Wellcare MGG,Wellcare MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Bright Health - commercial,Bright Health - commercial,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,85670,CPT,,,,Inpatient,,,72.83,72.83,Bright Health MGG,Bright Health MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Aetna,Aetna,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Aetna MGG,Aetna MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,BCBS,BCBS,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,BCBS MGG,BCBS MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Cigna,Cigna,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Cigna MGG,Cigna MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Humana,Humana,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Humana MGG,Humana MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Optum VA,Optum VA,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,UHC,UHC,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,UHC MGG,UHC MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,VA,VA,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Wellcare MGG,Wellcare MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Bright Health - commercial,Bright Health - commercial,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Bright Health MGG,Bright Health MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Aetna,Aetna,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Aetna MGG,Aetna MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,BCBS,BCBS,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,BCBS MGG,BCBS MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Cigna,Cigna,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Cigna MGG,Cigna MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Humana,Humana,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Humana MGG,Humana MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Optum VA,Optum VA,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,UHC,UHC,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,UHC MGG,UHC MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,VA,VA,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Wellcare MGG,Wellcare MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Bright Health - commercial,Bright Health - commercial,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,85670,CPT,,,,Inpatient,,,389.84,389.84,Bright Health MGG,Bright Health MGG,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Aetna,Aetna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Aetna MGG,Aetna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,BCBS,BCBS,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,BCBS MGG,BCBS MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Cigna,Cigna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Cigna MGG,Cigna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Humana,Humana,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Humana MGG,Humana MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Optum VA,Optum VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,UHC,UHC,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,UHC MGG,UHC MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,VA,VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Wellcare MGG,Wellcare MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Bright Health - commercial,Bright Health - commercial,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,84478,CPT,,,,Inpatient,,,26.78,26.78,Bright Health MGG,Bright Health MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Aetna,Aetna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Aetna MGG,Aetna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,BCBS,BCBS,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,BCBS MGG,BCBS MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Cigna,Cigna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Cigna MGG,Cigna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Humana,Humana,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Humana MGG,Humana MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Optum VA,Optum VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,UHC,UHC,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,UHC MGG,UHC MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,VA,VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Wellcare MGG,Wellcare MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Bright Health - commercial,Bright Health - commercial,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,81003,CPT,,,,Inpatient,,,49.27,49.27,Bright Health MGG,Bright Health MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Aetna,Aetna,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Aetna MGG,Aetna MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,BCBS,BCBS,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,BCBS MGG,BCBS MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Cigna,Cigna,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Cigna MGG,Cigna MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Humana,Humana,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Humana MGG,Humana MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Optum VA,Optum VA,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,UHC,UHC,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,UHC MGG,UHC MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,VA,VA,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Wellcare MGG,Wellcare MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Bright Health - commercial,Bright Health - commercial,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,87385,CPT,,,,Inpatient,,,269.89,269.89,Bright Health MGG,Bright Health MGG,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Aetna,Aetna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Aetna MGG,Aetna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,BCBS,BCBS,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,BCBS MGG,BCBS MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Cigna,Cigna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Cigna MGG,Cigna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Humana,Humana,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Humana MGG,Humana MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Optum VA,Optum VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,UHC,UHC,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,UHC MGG,UHC MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,VA,VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Wellcare MGG,Wellcare MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Bright Health - commercial,Bright Health - commercial,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,86790,CPT,,,,Inpatient,,,85.68,85.68,Bright Health MGG,Bright Health MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Aetna,Aetna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Aetna MGG,Aetna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,BCBS,BCBS,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,BCBS MGG,BCBS MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Cigna,Cigna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Cigna MGG,Cigna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Humana,Humana,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Humana MGG,Humana MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Optum VA,Optum VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,UHC,UHC,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,UHC MGG,UHC MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,VA,VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Wellcare MGG,Wellcare MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Bright Health - commercial,Bright Health - commercial,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Bright Health MGG,Bright Health MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Aetna,Aetna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Aetna MGG,Aetna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,BCBS,BCBS,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,BCBS MGG,BCBS MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Cigna,Cigna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Cigna MGG,Cigna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Humana,Humana,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Humana MGG,Humana MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Optum VA,Optum VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,UHC,UHC,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,UHC MGG,UHC MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,VA,VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Wellcare MGG,Wellcare MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Bright Health - commercial,Bright Health - commercial,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,86790,CPT,,,,Inpatient,,,159.58,159.58,Bright Health MGG,Bright Health MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Aetna,Aetna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Aetna MGG,Aetna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,BCBS,BCBS,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,BCBS MGG,BCBS MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Cigna,Cigna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Cigna MGG,Cigna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Humana,Humana,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Humana MGG,Humana MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Optum VA,Optum VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,UHC,UHC,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,UHC MGG,UHC MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,VA,VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Wellcare MGG,Wellcare MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Bright Health - commercial,Bright Health - commercial,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,86790,CPT,,,,Inpatient,,,137.09,137.09,Bright Health MGG,Bright Health MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,86790,CPT,,,59,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,86790,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Aetna,Aetna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Aetna MGG,Aetna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,BCBS,BCBS,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,BCBS MGG,BCBS MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Cigna,Cigna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Cigna MGG,Cigna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Humana,Humana,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Humana MGG,Humana MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Optum VA,Optum VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,UHC,UHC,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,UHC MGG,UHC MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,VA,VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Wellcare MGG,Wellcare MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Bright Health - commercial,Bright Health - commercial,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,86790,CPT,,,,Inpatient,,,53.55,53.55,Bright Health MGG,Bright Health MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Aetna,Aetna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Aetna MGG,Aetna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,BCBS,BCBS,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,BCBS MGG,BCBS MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Cigna,Cigna,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Cigna MGG,Cigna MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Humana,Humana,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Humana MGG,Humana MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Optum VA,Optum VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,UHC,UHC,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,UHC MGG,UHC MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,VA,VA,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Wellcare MGG,Wellcare MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Bright Health - commercial,Bright Health - commercial,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,86790,CPT,,,59,Inpatient,,,53.55,53.55,Bright Health MGG,Bright Health MGG,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Aetna,Aetna,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Aetna MGG,Aetna MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS,BCBS,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS MGG,BCBS MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Cigna,Cigna,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Cigna MGG,Cigna MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Humana,Humana,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Humana MGG,Humana MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Optum VA,Optum VA,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,UHC,UHC,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,UHC MGG,UHC MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,VA,VA,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Wellcare MGG,Wellcare MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Bright Health - commercial,Bright Health - commercial,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,Bright Health MGG,Bright Health MGG,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Aetna,Aetna,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Aetna MGG,Aetna MGG,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,BCBS,BCBS,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,BCBS MGG,BCBS MGG,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Cigna,Cigna,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Cigna MGG,Cigna MGG,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Humana,Humana,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Humana MGG,Humana MGG,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Optum VA,Optum VA,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,UHC,UHC,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,UHC MGG,UHC MGG,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,VA,VA,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Wellcare MGG,Wellcare MGG,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Bright Health - commercial,Bright Health - commercial,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,84080,CPT,,,,Inpatient,,,451.96,451.96,Bright Health MGG,Bright Health MGG,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Aetna,Aetna,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Aetna MGG,Aetna MGG,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,BCBS,BCBS,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,BCBS MGG,BCBS MGG,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Cigna,Cigna,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Cigna MGG,Cigna MGG,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Humana,Humana,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Humana MGG,Humana MGG,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Optum VA,Optum VA,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,UHC,UHC,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,UHC MGG,UHC MGG,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,VA,VA,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Wellcare MGG,Wellcare MGG,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Bright Health - commercial,Bright Health - commercial,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,82175,CPT,,,,Inpatient,,,418.76,418.76,Bright Health MGG,Bright Health MGG,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Aetna,Aetna,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Aetna MGG,Aetna MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,BCBS,BCBS,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,BCBS MGG,BCBS MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Cigna,Cigna,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Cigna MGG,Cigna MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Humana,Humana,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Humana MGG,Humana MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Optum VA,Optum VA,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,UHC,UHC,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,UHC MGG,UHC MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,VA,VA,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Wellcare MGG,Wellcare MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Bright Health - commercial,Bright Health - commercial,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,82175,CPT,,,,Inpatient,,,423.05,423.05,Bright Health MGG,Bright Health MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Aetna,Aetna,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Aetna MGG,Aetna MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS,BCBS,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS MGG,BCBS MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Cigna,Cigna,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Cigna MGG,Cigna MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Humana,Humana,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Humana MGG,Humana MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Optum VA,Optum VA,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,UHC,UHC,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,UHC MGG,UHC MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,VA,VA,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Wellcare MGG,Wellcare MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Bright Health - commercial,Bright Health - commercial,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,Bright Health MGG,Bright Health MGG,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Aetna,Aetna,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Aetna MGG,Aetna MGG,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,BCBS,BCBS,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,BCBS MGG,BCBS MGG,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Cigna,Cigna,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Cigna MGG,Cigna MGG,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Humana,Humana,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Humana MGG,Humana MGG,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Optum VA,Optum VA,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,UHC,UHC,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,UHC MGG,UHC MGG,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,VA,VA,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Wellcare MGG,Wellcare MGG,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Bright Health - commercial,Bright Health - commercial,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,83825,CPT,,,,Inpatient,,,306.31,306.31,Bright Health MGG,Bright Health MGG,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Aetna,Aetna,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Aetna MGG,Aetna MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,BCBS,BCBS,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,BCBS MGG,BCBS MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Cigna,Cigna,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Cigna MGG,Cigna MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Humana,Humana,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Humana MGG,Humana MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Optum VA,Optum VA,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,UHC,UHC,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,UHC MGG,UHC MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,VA,VA,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Wellcare MGG,Wellcare MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Bright Health - commercial,Bright Health - commercial,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,83825,CPT,,,,Inpatient,,,308.45,308.45,Bright Health MGG,Bright Health MGG,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Aetna,Aetna,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Aetna MGG,Aetna MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,BCBS,BCBS,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,BCBS MGG,BCBS MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Cigna,Cigna,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Cigna MGG,Cigna MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Humana,Humana,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Humana MGG,Humana MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Optum VA,Optum VA,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,UHC,UHC,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,UHC MGG,UHC MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,VA,VA,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Wellcare MGG,Wellcare MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Bright Health - commercial,Bright Health - commercial,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,80345,CPT,,,,Inpatient,,,202.42,202.42,Bright Health MGG,Bright Health MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Aetna,Aetna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Aetna MGG,Aetna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,BCBS,BCBS,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,BCBS MGG,BCBS MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Cigna,Cigna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Cigna MGG,Cigna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Humana,Humana,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Humana MGG,Humana MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Optum VA,Optum VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,UHC,UHC,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,UHC MGG,UHC MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,VA,VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Wellcare MGG,Wellcare MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Bright Health - commercial,Bright Health - commercial,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,82340,CPT,,,,Inpatient,,,31.06,31.06,Bright Health MGG,Bright Health MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Aetna,Aetna,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Aetna MGG,Aetna MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,BCBS,BCBS,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,BCBS MGG,BCBS MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Cigna,Cigna,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Cigna MGG,Cigna MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Humana,Humana,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Humana MGG,Humana MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Optum VA,Optum VA,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,UHC,UHC,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,UHC MGG,UHC MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,VA,VA,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Wellcare MGG,Wellcare MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Bright Health - commercial,Bright Health - commercial,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,80349,CPT,,,,Inpatient,,,220.63,220.63,Bright Health MGG,Bright Health MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Aetna,Aetna,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Aetna MGG,Aetna MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS,BCBS,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS MGG,BCBS MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Cigna,Cigna,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Cigna MGG,Cigna MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Humana,Humana,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Humana MGG,Humana MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Optum VA,Optum VA,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,UHC,UHC,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,UHC MGG,UHC MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,VA,VA,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Wellcare MGG,Wellcare MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Bright Health - commercial,Bright Health - commercial,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,88262,CPT,,,,Inpatient,,,1118.12,1118.12,Bright Health MGG,Bright Health MGG,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Aetna,Aetna,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Aetna MGG,Aetna MGG,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,BCBS,BCBS,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,BCBS MGG,BCBS MGG,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Cigna,Cigna,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Cigna MGG,Cigna MGG,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Humana,Humana,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Humana MGG,Humana MGG,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Optum VA,Optum VA,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,UHC,UHC,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,UHC MGG,UHC MGG,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,VA,VA,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Wellcare MGG,Wellcare MGG,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Bright Health - commercial,Bright Health - commercial,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,88262,CPT,,,,Inpatient,,,1349.46,1349.46,Bright Health MGG,Bright Health MGG,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Aetna,Aetna,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Aetna MGG,Aetna MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,BCBS,BCBS,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,BCBS MGG,BCBS MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Cigna,Cigna,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Cigna MGG,Cigna MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Humana,Humana,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Humana MGG,Humana MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Optum VA,Optum VA,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,UHC,UHC,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,UHC MGG,UHC MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,VA,VA,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Wellcare MGG,Wellcare MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Bright Health - commercial,Bright Health - commercial,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,88262,CPT,,,,Inpatient,,,1926.73,1926.73,Bright Health MGG,Bright Health MGG,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Aetna,Aetna,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Aetna MGG,Aetna MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,BCBS,BCBS,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,BCBS MGG,BCBS MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Cigna,Cigna,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Cigna MGG,Cigna MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Humana,Humana,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Humana MGG,Humana MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Optum VA,Optum VA,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,UHC,UHC,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,UHC MGG,UHC MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,VA,VA,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Wellcare MGG,Wellcare MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Bright Health - commercial,Bright Health - commercial,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Bright Health MGG,Bright Health MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Aetna,Aetna,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Aetna MGG,Aetna MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,BCBS,BCBS,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,BCBS MGG,BCBS MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Cigna,Cigna,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Cigna MGG,Cigna MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Humana,Humana,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Humana MGG,Humana MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Optum VA,Optum VA,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,UHC,UHC,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,UHC MGG,UHC MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,VA,VA,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Wellcare MGG,Wellcare MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Bright Health - commercial,Bright Health - commercial,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,88262,CPT,,,,Inpatient,,,1098.85,1098.85,Bright Health MGG,Bright Health MGG,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Aetna,Aetna,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Aetna MGG,Aetna MGG,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,BCBS,BCBS,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,BCBS MGG,BCBS MGG,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Cigna,Cigna,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Cigna MGG,Cigna MGG,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Humana,Humana,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Humana MGG,Humana MGG,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Optum VA,Optum VA,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,UHC,UHC,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,UHC MGG,UHC MGG,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,VA,VA,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Wellcare MGG,Wellcare MGG,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Bright Health - commercial,Bright Health - commercial,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,88262,CPT,,,,Inpatient,,,183.14,183.14,Bright Health MGG,Bright Health MGG,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Aetna,Aetna,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Aetna MGG,Aetna MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,BCBS,BCBS,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,BCBS MGG,BCBS MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Cigna,Cigna,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Cigna MGG,Cigna MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Humana,Humana,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Humana MGG,Humana MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Optum VA,Optum VA,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,UHC,UHC,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,UHC MGG,UHC MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,VA,VA,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Wellcare MGG,Wellcare MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Bright Health - commercial,Bright Health - commercial,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,88262,CPT,,,,Inpatient,,,914.63,914.63,Bright Health MGG,Bright Health MGG,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Aetna,Aetna,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Aetna MGG,Aetna MGG,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,BCBS,BCBS,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,BCBS MGG,BCBS MGG,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Cigna,Cigna,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Cigna MGG,Cigna MGG,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Humana,Humana,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Humana MGG,Humana MGG,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Optum VA,Optum VA,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,UHC,UHC,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,UHC MGG,UHC MGG,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,VA,VA,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Wellcare MGG,Wellcare MGG,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Bright Health - commercial,Bright Health - commercial,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,88262,CPT,,,,Inpatient,,,726.14,726.14,Bright Health MGG,Bright Health MGG,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Aetna,Aetna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Aetna MGG,Aetna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,BCBS,BCBS,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,BCBS MGG,BCBS MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Cigna,Cigna,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Cigna MGG,Cigna MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Humana,Humana,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Humana MGG,Humana MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Optum VA,Optum VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,UHC,UHC,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,UHC MGG,UHC MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,VA,VA,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Wellcare MGG,Wellcare MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Bright Health - commercial,Bright Health - commercial,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,82397,CPT,,,,Inpatient,,,67.47,67.47,Bright Health MGG,Bright Health MGG,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Aetna,Aetna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Aetna MGG,Aetna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,BCBS,BCBS,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,BCBS MGG,BCBS MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Cigna,Cigna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Cigna MGG,Cigna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Humana,Humana,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Humana MGG,Humana MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Optum VA,Optum VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,UHC,UHC,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,UHC MGG,UHC MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,VA,VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Wellcare MGG,Wellcare MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Bright Health - commercial,Bright Health - commercial,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,82438,CPT,,,,Inpatient,,,23.56,23.56,Bright Health MGG,Bright Health MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Aetna,Aetna,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Aetna MGG,Aetna MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS,BCBS,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS MGG,BCBS MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Cigna,Cigna,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Cigna MGG,Cigna MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Humana,Humana,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Humana MGG,Humana MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Optum VA,Optum VA,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,UHC,UHC,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,UHC MGG,UHC MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,VA,VA,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Wellcare MGG,Wellcare MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Bright Health - commercial,Bright Health - commercial,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,Bright Health MGG,Bright Health MGG,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Aetna,Aetna,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Aetna MGG,Aetna MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,BCBS,BCBS,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,BCBS MGG,BCBS MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Cigna,Cigna,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Cigna MGG,Cigna MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Humana,Humana,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Humana MGG,Humana MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Optum VA,Optum VA,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,UHC,UHC,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,UHC MGG,UHC MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,VA,VA,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Wellcare MGG,Wellcare MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Bright Health - commercial,Bright Health - commercial,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,82530,CPT,,,,Inpatient,,,71.76,71.76,Bright Health MGG,Bright Health MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Aetna,Aetna,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Aetna MGG,Aetna MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,BCBS,BCBS,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,BCBS MGG,BCBS MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Cigna,Cigna,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Cigna MGG,Cigna MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Humana,Humana,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Humana MGG,Humana MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Optum VA,Optum VA,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,UHC,UHC,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,UHC MGG,UHC MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,VA,VA,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Wellcare MGG,Wellcare MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Bright Health - commercial,Bright Health - commercial,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,86658,CPT,,,,Inpatient,,,356.64,356.64,Bright Health MGG,Bright Health MGG,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Aetna,Aetna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Aetna MGG,Aetna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,BCBS,BCBS,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,BCBS MGG,BCBS MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Cigna,Cigna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Cigna MGG,Cigna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Humana,Humana,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Humana MGG,Humana MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Optum VA,Optum VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,UHC,UHC,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,UHC MGG,UHC MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,VA,VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Wellcare MGG,Wellcare MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Bright Health - commercial,Bright Health - commercial,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,86658,CPT,,,,Inpatient,,,63.19,63.19,Bright Health MGG,Bright Health MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Aetna,Aetna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Aetna MGG,Aetna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,BCBS,BCBS,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,BCBS MGG,BCBS MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Cigna,Cigna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Cigna MGG,Cigna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Humana,Humana,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Humana MGG,Humana MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Optum VA,Optum VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,UHC,UHC,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,UHC MGG,UHC MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,VA,VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Wellcare MGG,Wellcare MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Bright Health - commercial,Bright Health - commercial,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Bright Health MGG,Bright Health MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Aetna,Aetna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Aetna MGG,Aetna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,BCBS,BCBS,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,BCBS MGG,BCBS MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Cigna,Cigna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Cigna MGG,Cigna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Humana,Humana,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Humana MGG,Humana MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Optum VA,Optum VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,UHC,UHC,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,UHC MGG,UHC MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,VA,VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Wellcare MGG,Wellcare MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Bright Health - commercial,Bright Health - commercial,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Bright Health MGG,Bright Health MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Aetna,Aetna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Aetna MGG,Aetna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,BCBS,BCBS,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,BCBS MGG,BCBS MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Cigna,Cigna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Cigna MGG,Cigna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Humana,Humana,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Humana MGG,Humana MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Optum VA,Optum VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,UHC,UHC,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,UHC MGG,UHC MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,VA,VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Wellcare MGG,Wellcare MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Bright Health - commercial,Bright Health - commercial,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,86658,CPT,,,59,Inpatient,,,63.19,63.19,Bright Health MGG,Bright Health MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Aetna,Aetna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Aetna MGG,Aetna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,BCBS,BCBS,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,BCBS MGG,BCBS MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Cigna,Cigna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Cigna MGG,Cigna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Humana,Humana,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Humana MGG,Humana MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Optum VA,Optum VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,UHC,UHC,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,UHC MGG,UHC MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,VA,VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Wellcare MGG,Wellcare MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Bright Health - commercial,Bright Health - commercial,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,86658,CPT,,,,Inpatient,,,61.05,61.05,Bright Health MGG,Bright Health MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Aetna,Aetna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Aetna MGG,Aetna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,BCBS,BCBS,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,BCBS MGG,BCBS MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Cigna,Cigna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Cigna MGG,Cigna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Humana,Humana,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Humana MGG,Humana MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Optum VA,Optum VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,UHC,UHC,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,UHC MGG,UHC MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,VA,VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Wellcare MGG,Wellcare MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Bright Health - commercial,Bright Health - commercial,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Bright Health MGG,Bright Health MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Aetna,Aetna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Aetna MGG,Aetna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,BCBS,BCBS,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,BCBS MGG,BCBS MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Cigna,Cigna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Cigna MGG,Cigna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Humana,Humana,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Humana MGG,Humana MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Optum VA,Optum VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,UHC,UHC,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,UHC MGG,UHC MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,VA,VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Wellcare MGG,Wellcare MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Bright Health - commercial,Bright Health - commercial,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Bright Health MGG,Bright Health MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Aetna,Aetna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Aetna MGG,Aetna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,BCBS,BCBS,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,BCBS MGG,BCBS MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Cigna,Cigna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Cigna MGG,Cigna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Humana,Humana,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Humana MGG,Humana MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Optum VA,Optum VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,UHC,UHC,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,UHC MGG,UHC MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,VA,VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Wellcare MGG,Wellcare MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Bright Health - commercial,Bright Health - commercial,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Bright Health MGG,Bright Health MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Aetna,Aetna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Aetna MGG,Aetna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,BCBS,BCBS,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,BCBS MGG,BCBS MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Cigna,Cigna,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Cigna MGG,Cigna MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Humana,Humana,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Humana MGG,Humana MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Optum VA,Optum VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,UHC,UHC,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,UHC MGG,UHC MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,VA,VA,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Wellcare MGG,Wellcare MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Bright Health - commercial,Bright Health - commercial,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,86658,CPT,,,59,Inpatient,,,61.05,61.05,Bright Health MGG,Bright Health MGG,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Aetna,Aetna,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Aetna MGG,Aetna MGG,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,BCBS,BCBS,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,BCBS MGG,BCBS MGG,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Cigna,Cigna,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Cigna MGG,Cigna MGG,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Humana,Humana,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Humana MGG,Humana MGG,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Optum VA,Optum VA,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,UHC,UHC,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,UHC MGG,UHC MGG,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,VA,VA,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Wellcare MGG,Wellcare MGG,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Bright Health - commercial,Bright Health - commercial,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,86658,CPT,,,59,Inpatient,,,435.9,435.9,Bright Health MGG,Bright Health MGG,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Aetna,Aetna,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Aetna MGG,Aetna MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,BCBS,BCBS,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,BCBS MGG,BCBS MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Cigna,Cigna,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Cigna MGG,Cigna MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Humana,Humana,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Humana MGG,Humana MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Optum VA,Optum VA,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,UHC,UHC,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,UHC MGG,UHC MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,VA,VA,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Wellcare MGG,Wellcare MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Bright Health - commercial,Bright Health - commercial,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Bright Health MGG,Bright Health MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Aetna,Aetna,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Aetna MGG,Aetna MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,BCBS,BCBS,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,BCBS MGG,BCBS MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Cigna,Cigna,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Cigna MGG,Cigna MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Humana,Humana,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Humana MGG,Humana MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Optum VA,Optum VA,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,UHC,UHC,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,UHC MGG,UHC MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,VA,VA,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Wellcare MGG,Wellcare MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Bright Health - commercial,Bright Health - commercial,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,82710,CPT,,,,Inpatient,,,607.26,607.26,Bright Health MGG,Bright Health MGG,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Aetna,Aetna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Aetna MGG,Aetna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,BCBS,BCBS,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,BCBS MGG,BCBS MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Cigna,Cigna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Cigna MGG,Cigna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Humana,Humana,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Humana MGG,Humana MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Optum VA,Optum VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,UHC,UHC,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,UHC MGG,UHC MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,VA,VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Wellcare MGG,Wellcare MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Bright Health - commercial,Bright Health - commercial,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,86695,CPT,,,,Inpatient,,,78.18,78.18,Bright Health MGG,Bright Health MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,86334,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Aetna,Aetna,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Aetna MGG,Aetna MGG,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,BCBS,BCBS,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,BCBS MGG,BCBS MGG,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Cigna,Cigna,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Cigna MGG,Cigna MGG,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Humana,Humana,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Humana MGG,Humana MGG,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Optum VA,Optum VA,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,UHC,UHC,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,UHC MGG,UHC MGG,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,VA,VA,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Wellcare MGG,Wellcare MGG,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Bright Health - commercial,Bright Health - commercial,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,86334,CPT,,,,Inpatient,,,44.98,44.98,Bright Health MGG,Bright Health MGG,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Aetna,Aetna,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Aetna MGG,Aetna MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,BCBS,BCBS,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,BCBS MGG,BCBS MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Cigna,Cigna,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Cigna MGG,Cigna MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Humana,Humana,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Humana MGG,Humana MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Optum VA,Optum VA,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,UHC,UHC,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,UHC MGG,UHC MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,VA,VA,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Wellcare MGG,Wellcare MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Bright Health - commercial,Bright Health - commercial,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Bright Health MGG,Bright Health MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Aetna,Aetna,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Aetna MGG,Aetna MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,BCBS,BCBS,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,BCBS MGG,BCBS MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Cigna,Cigna,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Cigna MGG,Cigna MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Humana,Humana,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Humana MGG,Humana MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Optum VA,Optum VA,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,UHC,UHC,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,UHC MGG,UHC MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,VA,VA,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Wellcare MGG,Wellcare MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Bright Health - commercial,Bright Health - commercial,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Bright Health MGG,Bright Health MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Aetna,Aetna,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Aetna MGG,Aetna MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,BCBS,BCBS,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,BCBS MGG,BCBS MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Cigna,Cigna,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Cigna MGG,Cigna MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Humana,Humana,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Humana MGG,Humana MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Optum VA,Optum VA,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,UHC,UHC,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,UHC MGG,UHC MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,VA,VA,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Wellcare MGG,Wellcare MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Bright Health - commercial,Bright Health - commercial,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Bright Health MGG,Bright Health MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Aetna,Aetna,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Aetna MGG,Aetna MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,BCBS,BCBS,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,BCBS MGG,BCBS MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Cigna,Cigna,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Cigna MGG,Cigna MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Humana,Humana,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Humana MGG,Humana MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Optum VA,Optum VA,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,UHC,UHC,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,UHC MGG,UHC MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,VA,VA,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Wellcare MGG,Wellcare MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Bright Health - commercial,Bright Health - commercial,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,83655,CPT,,,,Inpatient,,,635.1,635.1,Bright Health MGG,Bright Health MGG,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Aetna,Aetna,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Aetna MGG,Aetna MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,BCBS,BCBS,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,BCBS MGG,BCBS MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Cigna,Cigna,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Cigna MGG,Cigna MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Humana,Humana,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Humana MGG,Humana MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Optum VA,Optum VA,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,UHC,UHC,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,UHC MGG,UHC MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,VA,VA,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Wellcare MGG,Wellcare MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Bright Health - commercial,Bright Health - commercial,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,86720,CPT,,,,Inpatient,,,91.04,91.04,Bright Health MGG,Bright Health MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Aetna,Aetna,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Aetna MGG,Aetna MGG,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,BCBS,BCBS,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,BCBS MGG,BCBS MGG,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Cigna,Cigna,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Cigna MGG,Cigna MGG,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Humana,Humana,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Humana MGG,Humana MGG,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Optum VA,Optum VA,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,UHC,UHC,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,UHC MGG,UHC MGG,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,VA,VA,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Wellcare MGG,Wellcare MGG,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Bright Health - commercial,Bright Health - commercial,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,83835,CPT,,,,Inpatient,,,797.9,797.9,Bright Health MGG,Bright Health MGG,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Aetna,Aetna,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Aetna MGG,Aetna MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,BCBS,BCBS,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,BCBS MGG,BCBS MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Cigna,Cigna,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Cigna MGG,Cigna MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Humana,Humana,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Humana MGG,Humana MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Optum VA,Optum VA,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,UHC,UHC,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,UHC MGG,UHC MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,VA,VA,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Wellcare MGG,Wellcare MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Bright Health - commercial,Bright Health - commercial,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Bright Health MGG,Bright Health MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Aetna,Aetna,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Aetna MGG,Aetna MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,BCBS,BCBS,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,BCBS MGG,BCBS MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Cigna,Cigna,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Cigna MGG,Cigna MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Humana,Humana,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Humana MGG,Humana MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Optum VA,Optum VA,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,UHC,UHC,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,UHC MGG,UHC MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,VA,VA,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Wellcare MGG,Wellcare MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Bright Health - commercial,Bright Health - commercial,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,86735,CPT,,,,Inpatient,,,190.64,190.64,Bright Health MGG,Bright Health MGG,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,86738,CPT,,,,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Aetna,Aetna,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Aetna MGG,Aetna MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS,BCBS,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS MGG,BCBS MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Cigna,Cigna,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Cigna MGG,Cigna MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Humana,Humana,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Humana MGG,Humana MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Optum VA,Optum VA,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,UHC,UHC,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,UHC MGG,UHC MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,VA,VA,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Wellcare MGG,Wellcare MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Bright Health - commercial,Bright Health - commercial,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,Bright Health MGG,Bright Health MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,87798,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Aetna,Aetna,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Aetna MGG,Aetna MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,BCBS,BCBS,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,BCBS MGG,BCBS MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Cigna,Cigna,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Cigna MGG,Cigna MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Humana,Humana,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Humana MGG,Humana MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Optum VA,Optum VA,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,UHC,UHC,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,UHC MGG,UHC MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,VA,VA,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Wellcare MGG,Wellcare MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Bright Health - commercial,Bright Health - commercial,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Bright Health MGG,Bright Health MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Aetna,Aetna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Aetna MGG,Aetna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,BCBS,BCBS,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,BCBS MGG,BCBS MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Cigna,Cigna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Cigna MGG,Cigna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Humana,Humana,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Humana MGG,Humana MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Optum VA,Optum VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,UHC,UHC,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,UHC MGG,UHC MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,VA,VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Wellcare MGG,Wellcare MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Bright Health - commercial,Bright Health - commercial,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Bright Health MGG,Bright Health MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Aetna,Aetna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Aetna MGG,Aetna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,BCBS,BCBS,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,BCBS MGG,BCBS MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Cigna,Cigna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Cigna MGG,Cigna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Humana,Humana,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Humana MGG,Humana MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Optum VA,Optum VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,UHC,UHC,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,UHC MGG,UHC MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,VA,VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Wellcare MGG,Wellcare MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Bright Health - commercial,Bright Health - commercial,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,87798,CPT,,,,Inpatient,,,212.06,212.06,Bright Health MGG,Bright Health MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Aetna,Aetna,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Aetna MGG,Aetna MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,BCBS,BCBS,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,BCBS MGG,BCBS MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Cigna,Cigna,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Cigna MGG,Cigna MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Humana,Humana,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Humana MGG,Humana MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Optum VA,Optum VA,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,UHC,UHC,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,UHC MGG,UHC MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,VA,VA,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Wellcare MGG,Wellcare MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Bright Health - commercial,Bright Health - commercial,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,87798,CPT,,,,Inpatient,,,148.87,148.87,Bright Health MGG,Bright Health MGG,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Aetna,Aetna,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Aetna MGG,Aetna MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,BCBS,BCBS,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,BCBS MGG,BCBS MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Cigna,Cigna,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Cigna MGG,Cigna MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Humana,Humana,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Humana MGG,Humana MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Optum VA,Optum VA,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,UHC,UHC,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,UHC MGG,UHC MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,VA,VA,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Wellcare MGG,Wellcare MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Bright Health - commercial,Bright Health - commercial,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,87798,CPT,,,,Inpatient,,,508.73,508.73,Bright Health MGG,Bright Health MGG,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Aetna,Aetna,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Aetna MGG,Aetna MGG,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,BCBS,BCBS,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,BCBS MGG,BCBS MGG,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Cigna,Cigna,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Cigna MGG,Cigna MGG,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Humana,Humana,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Humana MGG,Humana MGG,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Optum VA,Optum VA,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,UHC,UHC,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,UHC MGG,UHC MGG,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,VA,VA,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Wellcare MGG,Wellcare MGG,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Bright Health - commercial,Bright Health - commercial,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,87798,CPT,,,,Inpatient,,,941.41,941.41,Bright Health MGG,Bright Health MGG,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Aetna,Aetna,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Aetna MGG,Aetna MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,BCBS,BCBS,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,BCBS MGG,BCBS MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Cigna,Cigna,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Cigna MGG,Cigna MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Humana,Humana,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Humana MGG,Humana MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Optum VA,Optum VA,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,UHC,UHC,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,UHC MGG,UHC MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,VA,VA,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Wellcare MGG,Wellcare MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Bright Health - commercial,Bright Health - commercial,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,87798,CPT,,,,Inpatient,,,259.18,259.18,Bright Health MGG,Bright Health MGG,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Aetna,Aetna,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Aetna MGG,Aetna MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,BCBS,BCBS,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,BCBS MGG,BCBS MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Cigna,Cigna,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Cigna MGG,Cigna MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Humana,Humana,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Humana MGG,Humana MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Optum VA,Optum VA,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,UHC,UHC,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,UHC MGG,UHC MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,VA,VA,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Wellcare MGG,Wellcare MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Bright Health - commercial,Bright Health - commercial,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,87798,CPT,,,,Inpatient,,,239.9,239.9,Bright Health MGG,Bright Health MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Aetna,Aetna,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Aetna MGG,Aetna MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,BCBS,BCBS,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,BCBS MGG,BCBS MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Cigna,Cigna,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Cigna MGG,Cigna MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Humana,Humana,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Humana MGG,Humana MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Optum VA,Optum VA,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,UHC,UHC,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,UHC MGG,UHC MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,VA,VA,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Wellcare MGG,Wellcare MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Bright Health - commercial,Bright Health - commercial,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Bright Health MGG,Bright Health MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Aetna,Aetna,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Aetna MGG,Aetna MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,BCBS,BCBS,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,BCBS MGG,BCBS MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Cigna,Cigna,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Cigna MGG,Cigna MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Humana,Humana,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Humana MGG,Humana MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Optum VA,Optum VA,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,UHC,UHC,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,UHC MGG,UHC MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,VA,VA,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Wellcare MGG,Wellcare MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Bright Health - commercial,Bright Health - commercial,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,87798,CPT,,,59,Inpatient,,,239.9,239.9,Bright Health MGG,Bright Health MGG,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Aetna,Aetna,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Aetna MGG,Aetna MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,BCBS,BCBS,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,BCBS MGG,BCBS MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Cigna,Cigna,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Cigna MGG,Cigna MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Humana,Humana,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Humana MGG,Humana MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Optum VA,Optum VA,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,UHC,UHC,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,UHC MGG,UHC MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,VA,VA,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Wellcare MGG,Wellcare MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Bright Health - commercial,Bright Health - commercial,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,87798,CPT,,,,Inpatient,,,178.86,178.86,Bright Health MGG,Bright Health MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Aetna,Aetna,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Aetna MGG,Aetna MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,BCBS,BCBS,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,BCBS MGG,BCBS MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Cigna,Cigna,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Cigna MGG,Cigna MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Humana,Humana,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Humana MGG,Humana MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Optum VA,Optum VA,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,UHC,UHC,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,UHC MGG,UHC MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,VA,VA,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Wellcare MGG,Wellcare MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Bright Health - commercial,Bright Health - commercial,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,87798,CPT,,,,Inpatient,,,156.37,156.37,Bright Health MGG,Bright Health MGG,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Aetna,Aetna,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Aetna MGG,Aetna MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,BCBS,BCBS,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,BCBS MGG,BCBS MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Cigna,Cigna,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Cigna MGG,Cigna MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Humana,Humana,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Humana MGG,Humana MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Optum VA,Optum VA,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,UHC,UHC,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,UHC MGG,UHC MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,VA,VA,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Wellcare MGG,Wellcare MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Bright Health - commercial,Bright Health - commercial,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,87798,CPT,,,,Inpatient,,,144.59,144.59,Bright Health MGG,Bright Health MGG,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Aetna,Aetna,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Aetna MGG,Aetna MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,BCBS,BCBS,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,BCBS MGG,BCBS MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Cigna,Cigna,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Cigna MGG,Cigna MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Humana,Humana,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Humana MGG,Humana MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Optum VA,Optum VA,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,UHC,UHC,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,UHC MGG,UHC MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,VA,VA,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Wellcare MGG,Wellcare MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Bright Health - commercial,Bright Health - commercial,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,83874,CPT,,,,Inpatient,,,326.66,326.66,Bright Health MGG,Bright Health MGG,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Aetna,Aetna,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Aetna MGG,Aetna MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS,BCBS,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS MGG,BCBS MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Cigna,Cigna,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Cigna MGG,Cigna MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Humana,Humana,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Humana MGG,Humana MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Optum VA,Optum VA,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,UHC,UHC,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,UHC MGG,UHC MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,VA,VA,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Wellcare MGG,Wellcare MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Bright Health - commercial,Bright Health - commercial,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,Bright Health MGG,Bright Health MGG,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Aetna,Aetna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Aetna MGG,Aetna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,BCBS,BCBS,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,BCBS MGG,BCBS MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Cigna,Cigna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Cigna MGG,Cigna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Humana,Humana,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Humana MGG,Humana MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Optum VA,Optum VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,UHC,UHC,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,UHC MGG,UHC MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,VA,VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Wellcare MGG,Wellcare MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Bright Health - commercial,Bright Health - commercial,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,83945,CPT,,,,Inpatient,,,31.06,31.06,Bright Health MGG,Bright Health MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,86757,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Aetna,Aetna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Aetna MGG,Aetna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,BCBS,BCBS,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,BCBS MGG,BCBS MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Cigna,Cigna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Cigna MGG,Cigna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Humana,Humana,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Humana MGG,Humana MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Optum VA,Optum VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,UHC,UHC,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,UHC MGG,UHC MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,VA,VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Wellcare MGG,Wellcare MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Bright Health - commercial,Bright Health - commercial,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,86757,CPT,,,,Inpatient,,,96.39,96.39,Bright Health MGG,Bright Health MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Aetna,Aetna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Aetna MGG,Aetna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,BCBS,BCBS,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,BCBS MGG,BCBS MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Cigna,Cigna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Cigna MGG,Cigna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Humana,Humana,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Humana MGG,Humana MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Optum VA,Optum VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,UHC,UHC,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,UHC MGG,UHC MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,VA,VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Wellcare MGG,Wellcare MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Bright Health - commercial,Bright Health - commercial,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,86757,CPT,,,59,Inpatient,,,96.39,96.39,Bright Health MGG,Bright Health MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Aetna,Aetna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Aetna MGG,Aetna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,BCBS,BCBS,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,BCBS MGG,BCBS MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Cigna,Cigna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Cigna MGG,Cigna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Humana,Humana,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Humana MGG,Humana MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Optum VA,Optum VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,UHC,UHC,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,UHC MGG,UHC MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,VA,VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Wellcare MGG,Wellcare MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Bright Health - commercial,Bright Health - commercial,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,84402,CPT,,,,Inpatient,,,52.48,52.48,Bright Health MGG,Bright Health MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,84402,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Aetna,Aetna,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Aetna MGG,Aetna MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,BCBS,BCBS,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,BCBS MGG,BCBS MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Cigna,Cigna,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Cigna MGG,Cigna MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Humana,Humana,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Humana MGG,Humana MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Optum VA,Optum VA,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,UHC,UHC,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,UHC MGG,UHC MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,VA,VA,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Wellcare MGG,Wellcare MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Bright Health - commercial,Bright Health - commercial,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,86376,CPT,,,,Inpatient,,,202.42,202.42,Bright Health MGG,Bright Health MGG,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Aetna,Aetna,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Aetna MGG,Aetna MGG,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,BCBS,BCBS,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,BCBS MGG,BCBS MGG,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Cigna,Cigna,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Cigna MGG,Cigna MGG,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Humana,Humana,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Humana MGG,Humana MGG,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Optum VA,Optum VA,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,UHC,UHC,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,UHC MGG,UHC MGG,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,VA,VA,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Wellcare MGG,Wellcare MGG,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Bright Health - commercial,Bright Health - commercial,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,86376,CPT,,,,Inpatient,,,40.7,40.7,Bright Health MGG,Bright Health MGG,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Aetna,Aetna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Aetna MGG,Aetna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,BCBS,BCBS,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,BCBS MGG,BCBS MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Cigna,Cigna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Cigna MGG,Cigna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Humana,Humana,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Humana MGG,Humana MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Optum VA,Optum VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,UHC,UHC,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,UHC MGG,UHC MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,VA,VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Wellcare MGG,Wellcare MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Bright Health - commercial,Bright Health - commercial,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,86777,CPT,,,,Inpatient,,,85.68,85.68,Bright Health MGG,Bright Health MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Aetna,Aetna,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Aetna MGG,Aetna MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,BCBS,BCBS,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,BCBS MGG,BCBS MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Cigna,Cigna,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Cigna MGG,Cigna MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Humana,Humana,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Humana MGG,Humana MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Optum VA,Optum VA,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,UHC,UHC,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,UHC MGG,UHC MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,VA,VA,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Wellcare MGG,Wellcare MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Bright Health - commercial,Bright Health - commercial,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,86777,CPT,,,,Inpatient,,,252.76,252.76,Bright Health MGG,Bright Health MGG,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Aetna,Aetna,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Aetna MGG,Aetna MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,BCBS,BCBS,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,BCBS MGG,BCBS MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Cigna,Cigna,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Cigna MGG,Cigna MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Humana,Humana,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Humana MGG,Humana MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Optum VA,Optum VA,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,UHC,UHC,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,UHC MGG,UHC MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,VA,VA,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Wellcare MGG,Wellcare MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Bright Health - commercial,Bright Health - commercial,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,82947,CPT,,,,Inpatient,,,28.92,28.92,Bright Health MGG,Bright Health MGG,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Aetna,Aetna,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Aetna MGG,Aetna MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,BCBS,BCBS,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,BCBS MGG,BCBS MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Cigna,Cigna,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Cigna MGG,Cigna MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Humana,Humana,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Humana MGG,Humana MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Optum VA,Optum VA,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,UHC,UHC,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,UHC MGG,UHC MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,VA,VA,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Wellcare MGG,Wellcare MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Bright Health - commercial,Bright Health - commercial,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,82785,CPT,,,,Inpatient,,,77.11,77.11,Bright Health MGG,Bright Health MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Aetna,Aetna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Aetna MGG,Aetna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,BCBS,BCBS,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,BCBS MGG,BCBS MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Cigna,Cigna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Cigna MGG,Cigna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Humana,Humana,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Humana MGG,Humana MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Optum VA,Optum VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,UHC,UHC,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,UHC MGG,UHC MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,VA,VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Wellcare MGG,Wellcare MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Bright Health - commercial,Bright Health - commercial,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,82785,CPT,,,,Inpatient,,,96.39,96.39,Bright Health MGG,Bright Health MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Aetna,Aetna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Aetna MGG,Aetna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,BCBS,BCBS,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,BCBS MGG,BCBS MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Cigna,Cigna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Cigna MGG,Cigna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Humana,Humana,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Humana MGG,Humana MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Optum VA,Optum VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,UHC,UHC,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,UHC MGG,UHC MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,VA,VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Wellcare MGG,Wellcare MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Bright Health - commercial,Bright Health - commercial,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,87209,CPT,,,,Inpatient,,,64.26,64.26,Bright Health MGG,Bright Health MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,84999,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Aetna,Aetna,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Aetna MGG,Aetna MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,BCBS,BCBS,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,BCBS MGG,BCBS MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Cigna,Cigna,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Cigna MGG,Cigna MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Humana,Humana,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Humana MGG,Humana MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Optum VA,Optum VA,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,UHC,UHC,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,UHC MGG,UHC MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,VA,VA,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Wellcare MGG,Wellcare MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Bright Health - commercial,Bright Health - commercial,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,84999,CPT,,,,Inpatient,,,236.69,236.69,Bright Health MGG,Bright Health MGG,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Aetna,Aetna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Aetna MGG,Aetna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,BCBS,BCBS,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,BCBS MGG,BCBS MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Cigna,Cigna,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Cigna MGG,Cigna MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Humana,Humana,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Humana MGG,Humana MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Optum VA,Optum VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,UHC,UHC,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,UHC MGG,UHC MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,VA,VA,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Wellcare MGG,Wellcare MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Bright Health - commercial,Bright Health - commercial,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,84999,CPT,,,,Inpatient,,,23.56,23.56,Bright Health MGG,Bright Health MGG,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,85250,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Aetna,Aetna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Aetna MGG,Aetna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,BCBS,BCBS,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,BCBS MGG,BCBS MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Cigna,Cigna,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Cigna MGG,Cigna MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Humana,Humana,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Humana MGG,Humana MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Optum VA,Optum VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,UHC,UHC,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,UHC MGG,UHC MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,VA,VA,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Wellcare MGG,Wellcare MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Bright Health - commercial,Bright Health - commercial,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,82042,CPT,,,,Inpatient,,,224.91,224.91,Bright Health MGG,Bright Health MGG,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Aetna,Aetna,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Aetna MGG,Aetna MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,BCBS,BCBS,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,BCBS MGG,BCBS MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Cigna,Cigna,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Cigna MGG,Cigna MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Humana,Humana,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Humana MGG,Humana MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Optum VA,Optum VA,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,UHC,UHC,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,UHC MGG,UHC MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,VA,VA,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Wellcare MGG,Wellcare MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Bright Health - commercial,Bright Health - commercial,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,82042,CPT,,,,Inpatient,,,10.71,10.71,Bright Health MGG,Bright Health MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Aetna,Aetna,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Aetna MGG,Aetna MGG,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,BCBS,BCBS,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,BCBS MGG,BCBS MGG,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Cigna,Cigna,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Cigna MGG,Cigna MGG,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Humana,Humana,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Humana MGG,Humana MGG,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Optum VA,Optum VA,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,UHC,UHC,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,UHC MGG,UHC MGG,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,VA,VA,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Wellcare MGG,Wellcare MGG,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Bright Health - commercial,Bright Health - commercial,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,86689,CPT,,,,Inpatient,,,460.53,460.53,Bright Health MGG,Bright Health MGG,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Aetna,Aetna,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Aetna MGG,Aetna MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,BCBS,BCBS,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,BCBS MGG,BCBS MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Cigna,Cigna,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Cigna MGG,Cigna MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Humana,Humana,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Humana MGG,Humana MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Optum VA,Optum VA,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,UHC,UHC,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,UHC MGG,UHC MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,VA,VA,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Wellcare MGG,Wellcare MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Bright Health - commercial,Bright Health - commercial,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,86689,CPT,,,,Inpatient,,,139.23,139.23,Bright Health MGG,Bright Health MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Aetna,Aetna,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Aetna MGG,Aetna MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,BCBS,BCBS,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,BCBS MGG,BCBS MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Cigna,Cigna,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Cigna MGG,Cigna MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Humana,Humana,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Humana MGG,Humana MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Optum VA,Optum VA,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,UHC,UHC,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,UHC MGG,UHC MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,VA,VA,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Wellcare MGG,Wellcare MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Bright Health - commercial,Bright Health - commercial,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Bright Health MGG,Bright Health MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Aetna,Aetna,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Aetna MGG,Aetna MGG,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,BCBS,BCBS,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,BCBS MGG,BCBS MGG,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Cigna,Cigna,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Cigna MGG,Cigna MGG,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Humana,Humana,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Humana MGG,Humana MGG,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Optum VA,Optum VA,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,UHC,UHC,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,UHC MGG,UHC MGG,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,VA,VA,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Wellcare MGG,Wellcare MGG,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Bright Health - commercial,Bright Health - commercial,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,86235,CPT,,,,Inpatient,,,95.32,95.32,Bright Health MGG,Bright Health MGG,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,86235,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Aetna,Aetna,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Aetna MGG,Aetna MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,BCBS,BCBS,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,BCBS MGG,BCBS MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Cigna,Cigna,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Cigna MGG,Cigna MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Humana,Humana,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Humana MGG,Humana MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Optum VA,Optum VA,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,UHC,UHC,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,UHC MGG,UHC MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,VA,VA,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Wellcare MGG,Wellcare MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Bright Health - commercial,Bright Health - commercial,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,86235,CPT,,,,Inpatient,,,77.11,77.11,Bright Health MGG,Bright Health MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Aetna,Aetna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Aetna MGG,Aetna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,BCBS,BCBS,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,BCBS MGG,BCBS MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Cigna,Cigna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Cigna MGG,Cigna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Humana,Humana,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Humana MGG,Humana MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Optum VA,Optum VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,UHC,UHC,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,UHC MGG,UHC MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,VA,VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Wellcare MGG,Wellcare MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Bright Health - commercial,Bright Health - commercial,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,86235,CPT,,,,Inpatient,,,29.99,29.99,Bright Health MGG,Bright Health MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Aetna,Aetna,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Aetna MGG,Aetna MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,BCBS,BCBS,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,BCBS MGG,BCBS MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Cigna,Cigna,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Cigna MGG,Cigna MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Humana,Humana,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Humana MGG,Humana MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Optum VA,Optum VA,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,UHC,UHC,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,UHC MGG,UHC MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,VA,VA,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Wellcare MGG,Wellcare MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Bright Health - commercial,Bright Health - commercial,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,86235,CPT,,,,Inpatient,,,307.38,307.38,Bright Health MGG,Bright Health MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,86235,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Aetna,Aetna,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Aetna MGG,Aetna MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,BCBS,BCBS,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,BCBS MGG,BCBS MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Cigna,Cigna,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Cigna MGG,Cigna MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Humana,Humana,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Humana MGG,Humana MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Optum VA,Optum VA,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,UHC,UHC,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,UHC MGG,UHC MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,VA,VA,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Wellcare MGG,Wellcare MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Bright Health - commercial,Bright Health - commercial,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,86235,CPT,,,,Inpatient,,,430.54,430.54,Bright Health MGG,Bright Health MGG,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna,Aetna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Aetna MGG,Aetna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS,BCBS,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,BCBS MGG,BCBS MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna,Cigna,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Cigna MGG,Cigna MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana,Humana,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Humana MGG,Humana MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Optum VA,Optum VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC,UHC,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,UHC MGG,UHC MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,VA,VA,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Wellcare MGG,Wellcare MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health - commercial,Bright Health - commercial,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,86235,CPT,,,,Inpatient,,,58.91,58.91,Bright Health MGG,Bright Health MGG,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Aetna,Aetna,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Aetna MGG,Aetna MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,BCBS,BCBS,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,BCBS MGG,BCBS MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Cigna,Cigna,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Cigna MGG,Cigna MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Humana,Humana,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Humana MGG,Humana MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Optum VA,Optum VA,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,UHC,UHC,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,UHC MGG,UHC MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,VA,VA,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Wellcare MGG,Wellcare MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Bright Health - commercial,Bright Health - commercial,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Bright Health MGG,Bright Health MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Aetna,Aetna,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Aetna MGG,Aetna MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,BCBS,BCBS,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,BCBS MGG,BCBS MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Cigna,Cigna,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Cigna MGG,Cigna MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Humana,Humana,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Humana MGG,Humana MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Optum VA,Optum VA,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,UHC,UHC,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,UHC MGG,UHC MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,VA,VA,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Wellcare MGG,Wellcare MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Bright Health - commercial,Bright Health - commercial,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,84166,CPT,,,,Inpatient,,,65.33,65.33,Bright Health MGG,Bright Health MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Aetna,Aetna,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Aetna MGG,Aetna MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,BCBS,BCBS,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,BCBS MGG,BCBS MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Cigna,Cigna,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Cigna MGG,Cigna MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Humana,Humana,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Humana MGG,Humana MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Optum VA,Optum VA,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,UHC,UHC,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,UHC MGG,UHC MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,VA,VA,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Wellcare MGG,Wellcare MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Bright Health - commercial,Bright Health - commercial,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,86335,CPT,,,,Inpatient,,,293.45,293.45,Bright Health MGG,Bright Health MGG,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Aetna,Aetna,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Aetna MGG,Aetna MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,BCBS,BCBS,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,BCBS MGG,BCBS MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Cigna,Cigna,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Cigna MGG,Cigna MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Humana,Humana,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Humana MGG,Humana MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Optum VA,Optum VA,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,UHC,UHC,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,UHC MGG,UHC MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,VA,VA,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Wellcare MGG,Wellcare MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Bright Health - commercial,Bright Health - commercial,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,86335,CPT,,,,Inpatient,,,141.37,141.37,Bright Health MGG,Bright Health MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Aetna,Aetna,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Aetna MGG,Aetna MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,BCBS,BCBS,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,BCBS MGG,BCBS MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Cigna,Cigna,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Cigna MGG,Cigna MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Humana,Humana,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Humana MGG,Humana MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Optum VA,Optum VA,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,UHC,UHC,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,UHC MGG,UHC MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,VA,VA,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Wellcare MGG,Wellcare MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Bright Health - commercial,Bright Health - commercial,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,86335,CPT,,,,Inpatient,,,131.73,131.73,Bright Health MGG,Bright Health MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Aetna,Aetna,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Aetna MGG,Aetna MGG,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,BCBS,BCBS,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,BCBS MGG,BCBS MGG,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Cigna,Cigna,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Cigna MGG,Cigna MGG,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Humana,Humana,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Humana MGG,Humana MGG,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Optum VA,Optum VA,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,UHC,UHC,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,UHC MGG,UHC MGG,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,VA,VA,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Wellcare MGG,Wellcare MGG,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Bright Health - commercial,Bright Health - commercial,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,82542,CPT,,,,Inpatient,,,380.21,380.21,Bright Health MGG,Bright Health MGG,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Aetna,Aetna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Aetna MGG,Aetna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,BCBS,BCBS,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,BCBS MGG,BCBS MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Cigna,Cigna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Cigna MGG,Cigna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Humana,Humana,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Humana MGG,Humana MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Optum VA,Optum VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,UHC,UHC,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,UHC MGG,UHC MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,VA,VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Wellcare MGG,Wellcare MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Bright Health - commercial,Bright Health - commercial,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,82542,CPT,,,,Inpatient,,,66.4,66.4,Bright Health MGG,Bright Health MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,86665,CPT,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Aetna,Aetna,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Aetna MGG,Aetna MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,BCBS,BCBS,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,BCBS MGG,BCBS MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Cigna,Cigna,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Cigna MGG,Cigna MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Humana,Humana,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Humana MGG,Humana MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Optum VA,Optum VA,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,UHC,UHC,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,UHC MGG,UHC MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,VA,VA,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Wellcare MGG,Wellcare MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Bright Health - commercial,Bright Health - commercial,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,80346,CPT,,,,Inpatient,,,354.5,354.5,Bright Health MGG,Bright Health MGG,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Aetna,Aetna,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Aetna MGG,Aetna MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,BCBS,BCBS,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,BCBS MGG,BCBS MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Cigna,Cigna,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Cigna MGG,Cigna MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Humana,Humana,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Humana MGG,Humana MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Optum VA,Optum VA,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,UHC,UHC,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,UHC MGG,UHC MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,VA,VA,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Wellcare MGG,Wellcare MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Bright Health - commercial,Bright Health - commercial,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,80346,CPT,,,,Inpatient,,,91.04,91.04,Bright Health MGG,Bright Health MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Aetna,Aetna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Aetna MGG,Aetna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS,BCBS,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS MGG,BCBS MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Cigna,Cigna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Cigna MGG,Cigna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Humana,Humana,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Humana MGG,Humana MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Optum VA,Optum VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,UHC,UHC,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,UHC MGG,UHC MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,VA,VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Wellcare MGG,Wellcare MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Bright Health - commercial,Bright Health - commercial,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,Bright Health MGG,Bright Health MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Aetna,Aetna,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Aetna MGG,Aetna MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,BCBS,BCBS,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,BCBS MGG,BCBS MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Cigna,Cigna,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Cigna MGG,Cigna MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Humana,Humana,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Humana MGG,Humana MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Optum VA,Optum VA,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,UHC,UHC,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,UHC MGG,UHC MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,VA,VA,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Wellcare MGG,Wellcare MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Bright Health - commercial,Bright Health - commercial,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Bright Health MGG,Bright Health MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Aetna,Aetna,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Aetna MGG,Aetna MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,BCBS,BCBS,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,BCBS MGG,BCBS MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Cigna,Cigna,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Cigna MGG,Cigna MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Humana,Humana,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Humana MGG,Humana MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Optum VA,Optum VA,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,UHC,UHC,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,UHC MGG,UHC MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,VA,VA,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Wellcare MGG,Wellcare MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Bright Health - commercial,Bright Health - commercial,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,84156,CPT,,,,Inpatient,,,19.28,19.28,Bright Health MGG,Bright Health MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Aetna,Aetna,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Aetna MGG,Aetna MGG,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,BCBS,BCBS,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,BCBS MGG,BCBS MGG,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Cigna,Cigna,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Cigna MGG,Cigna MGG,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Humana,Humana,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Humana MGG,Humana MGG,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Optum VA,Optum VA,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,UHC,UHC,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,UHC MGG,UHC MGG,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,VA,VA,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Wellcare MGG,Wellcare MGG,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Bright Health - commercial,Bright Health - commercial,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,85520,CPT,,,,Inpatient,,,716.5,716.5,Bright Health MGG,Bright Health MGG,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Aetna,Aetna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Aetna MGG,Aetna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,BCBS,BCBS,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,BCBS MGG,BCBS MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Cigna,Cigna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Cigna MGG,Cigna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Humana,Humana,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Humana MGG,Humana MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Optum VA,Optum VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,UHC,UHC,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,UHC MGG,UHC MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,VA,VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Wellcare MGG,Wellcare MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Bright Health - commercial,Bright Health - commercial,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,85520,CPT,,,,Inpatient,,,96.39,96.39,Bright Health MGG,Bright Health MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Aetna,Aetna,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Aetna MGG,Aetna MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,BCBS,BCBS,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,BCBS MGG,BCBS MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Cigna,Cigna,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Cigna MGG,Cigna MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Humana,Humana,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Humana MGG,Humana MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Optum VA,Optum VA,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,UHC,UHC,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,UHC MGG,UHC MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,VA,VA,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Wellcare MGG,Wellcare MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Bright Health - commercial,Bright Health - commercial,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,86256,CPT,,,,Inpatient,,,188.5,188.5,Bright Health MGG,Bright Health MGG,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Aetna,Aetna,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Aetna MGG,Aetna MGG,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,BCBS,BCBS,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,BCBS MGG,BCBS MGG,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Cigna,Cigna,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Cigna MGG,Cigna MGG,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Humana,Humana,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Humana MGG,Humana MGG,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Optum VA,Optum VA,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,UHC,UHC,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,UHC MGG,UHC MGG,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,VA,VA,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Wellcare MGG,Wellcare MGG,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Bright Health - commercial,Bright Health - commercial,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,86256,CPT,,,,Inpatient,,,194.92,194.92,Bright Health MGG,Bright Health MGG,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,86256,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Aetna,Aetna,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Aetna MGG,Aetna MGG,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,BCBS,BCBS,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,BCBS MGG,BCBS MGG,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Cigna,Cigna,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Cigna MGG,Cigna MGG,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Humana,Humana,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Humana MGG,Humana MGG,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Optum VA,Optum VA,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,UHC,UHC,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,UHC MGG,UHC MGG,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,VA,VA,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Wellcare MGG,Wellcare MGG,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Bright Health - commercial,Bright Health - commercial,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,86256,CPT,,,,Inpatient,,,116.74,116.74,Bright Health MGG,Bright Health MGG,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Aetna,Aetna,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Aetna MGG,Aetna MGG,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,BCBS,BCBS,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,BCBS MGG,BCBS MGG,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Cigna,Cigna,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Cigna MGG,Cigna MGG,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Humana,Humana,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Humana MGG,Humana MGG,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Optum VA,Optum VA,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,UHC,UHC,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,UHC MGG,UHC MGG,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,VA,VA,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Wellcare MGG,Wellcare MGG,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Bright Health - commercial,Bright Health - commercial,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,86256,CPT,,,,Inpatient,,,520.51,520.51,Bright Health MGG,Bright Health MGG,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Aetna,Aetna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Aetna MGG,Aetna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,BCBS,BCBS,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,BCBS MGG,BCBS MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Cigna,Cigna,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Cigna MGG,Cigna MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Humana,Humana,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Humana MGG,Humana MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Optum VA,Optum VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,UHC,UHC,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,UHC MGG,UHC MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,VA,VA,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Wellcare MGG,Wellcare MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Bright Health - commercial,Bright Health - commercial,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,86256,CPT,,,,Inpatient,,,117.81,117.81,Bright Health MGG,Bright Health MGG,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Aetna,Aetna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Aetna MGG,Aetna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,BCBS,BCBS,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,BCBS MGG,BCBS MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Cigna,Cigna,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Cigna MGG,Cigna MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Humana,Humana,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Humana MGG,Humana MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Optum VA,Optum VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,UHC,UHC,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,UHC MGG,UHC MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,VA,VA,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Wellcare MGG,Wellcare MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Bright Health - commercial,Bright Health - commercial,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,86256,CPT,,,,Inpatient,,,133.88,133.88,Bright Health MGG,Bright Health MGG,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Aetna,Aetna,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Aetna MGG,Aetna MGG,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,BCBS,BCBS,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,BCBS MGG,BCBS MGG,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Cigna,Cigna,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Cigna MGG,Cigna MGG,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Humana,Humana,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Humana MGG,Humana MGG,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Optum VA,Optum VA,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,UHC,UHC,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,UHC MGG,UHC MGG,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,VA,VA,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Wellcare MGG,Wellcare MGG,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Bright Health - commercial,Bright Health - commercial,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,86256,CPT,,,,Inpatient,,,759.34,759.34,Bright Health MGG,Bright Health MGG,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Aetna,Aetna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Aetna MGG,Aetna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,BCBS,BCBS,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,BCBS MGG,BCBS MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Cigna,Cigna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Cigna MGG,Cigna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Humana,Humana,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Humana MGG,Humana MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Optum VA,Optum VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,UHC,UHC,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,UHC MGG,UHC MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,VA,VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Wellcare MGG,Wellcare MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Bright Health - commercial,Bright Health - commercial,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Bright Health MGG,Bright Health MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Aetna,Aetna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Aetna MGG,Aetna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,BCBS,BCBS,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,BCBS MGG,BCBS MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Cigna,Cigna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Cigna MGG,Cigna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Humana,Humana,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Humana MGG,Humana MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Optum VA,Optum VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,UHC,UHC,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,UHC MGG,UHC MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,VA,VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Wellcare MGG,Wellcare MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Bright Health - commercial,Bright Health - commercial,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,86256,CPT,,,,Inpatient,,,52.48,52.48,Bright Health MGG,Bright Health MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Aetna,Aetna,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Aetna MGG,Aetna MGG,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,BCBS,BCBS,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,BCBS MGG,BCBS MGG,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Cigna,Cigna,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Cigna MGG,Cigna MGG,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Humana,Humana,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Humana MGG,Humana MGG,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Optum VA,Optum VA,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,UHC,UHC,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,UHC MGG,UHC MGG,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,VA,VA,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Wellcare MGG,Wellcare MGG,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Bright Health - commercial,Bright Health - commercial,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,86256,CPT,,,,Inpatient,,,390.92,390.92,Bright Health MGG,Bright Health MGG,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Aetna,Aetna,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Aetna MGG,Aetna MGG,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,BCBS,BCBS,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,BCBS MGG,BCBS MGG,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Cigna,Cigna,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Cigna MGG,Cigna MGG,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Humana,Humana,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Humana MGG,Humana MGG,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Optum VA,Optum VA,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,UHC,UHC,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,UHC MGG,UHC MGG,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,VA,VA,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Wellcare MGG,Wellcare MGG,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Bright Health - commercial,Bright Health - commercial,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,86256,CPT,,,,Inpatient,,,637.25,637.25,Bright Health MGG,Bright Health MGG,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Aetna,Aetna,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Aetna MGG,Aetna MGG,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,BCBS,BCBS,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,BCBS MGG,BCBS MGG,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Cigna,Cigna,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Cigna MGG,Cigna MGG,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Humana,Humana,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Humana MGG,Humana MGG,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Optum VA,Optum VA,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,UHC,UHC,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,UHC MGG,UHC MGG,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,VA,VA,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Wellcare MGG,Wellcare MGG,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Bright Health - commercial,Bright Health - commercial,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,87015,CPT,,,,Inpatient,,,679.01,679.01,Bright Health MGG,Bright Health MGG,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Aetna,Aetna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Aetna MGG,Aetna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,BCBS,BCBS,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,BCBS MGG,BCBS MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Cigna,Cigna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Cigna MGG,Cigna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Humana,Humana,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Humana MGG,Humana MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Optum VA,Optum VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,UHC,UHC,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,UHC MGG,UHC MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,VA,VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Wellcare MGG,Wellcare MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Bright Health - commercial,Bright Health - commercial,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,85291,CPT,,,,Inpatient,,,36.41,36.41,Bright Health MGG,Bright Health MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Aetna,Aetna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Aetna MGG,Aetna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,BCBS,BCBS,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,BCBS MGG,BCBS MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Cigna,Cigna,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Cigna MGG,Cigna MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Humana,Humana,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Humana MGG,Humana MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Optum VA,Optum VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,UHC,UHC,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,UHC MGG,UHC MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,VA,VA,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Wellcare MGG,Wellcare MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Bright Health - commercial,Bright Health - commercial,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,85220,CPT,,,,Inpatient,,,74.97,74.97,Bright Health MGG,Bright Health MGG,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Aetna,Aetna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Aetna MGG,Aetna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,BCBS,BCBS,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,BCBS MGG,BCBS MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Cigna,Cigna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Cigna MGG,Cigna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Humana,Humana,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Humana MGG,Humana MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Optum VA,Optum VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,UHC,UHC,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,UHC MGG,UHC MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,VA,VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Wellcare MGG,Wellcare MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Bright Health - commercial,Bright Health - commercial,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,85611,CPT,,,,Inpatient,,,36.41,36.41,Bright Health MGG,Bright Health MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Aetna,Aetna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Aetna MGG,Aetna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,BCBS,BCBS,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,BCBS MGG,BCBS MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Cigna,Cigna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Cigna MGG,Cigna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Humana,Humana,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Humana MGG,Humana MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Optum VA,Optum VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,UHC,UHC,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,UHC MGG,UHC MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,VA,VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Wellcare MGG,Wellcare MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Bright Health - commercial,Bright Health - commercial,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,85611,CPT,,,,Inpatient,,,27.85,27.85,Bright Health MGG,Bright Health MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Aetna,Aetna,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Aetna MGG,Aetna MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,BCBS,BCBS,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,BCBS MGG,BCBS MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Cigna,Cigna,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Cigna MGG,Cigna MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Humana,Humana,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Humana MGG,Humana MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Optum VA,Optum VA,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,UHC,UHC,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,UHC MGG,UHC MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,VA,VA,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Wellcare MGG,Wellcare MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Bright Health - commercial,Bright Health - commercial,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,85732,CPT,,,,Inpatient,,,136.02,136.02,Bright Health MGG,Bright Health MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Aetna,Aetna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Aetna MGG,Aetna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,BCBS,BCBS,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,BCBS MGG,BCBS MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Cigna,Cigna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Cigna MGG,Cigna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Humana,Humana,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Humana MGG,Humana MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Optum VA,Optum VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,UHC,UHC,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,UHC MGG,UHC MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,VA,VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Wellcare MGG,Wellcare MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Bright Health - commercial,Bright Health - commercial,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Bright Health MGG,Bright Health MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Aetna,Aetna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Aetna MGG,Aetna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,BCBS,BCBS,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,BCBS MGG,BCBS MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Cigna,Cigna,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Cigna MGG,Cigna MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Humana,Humana,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Humana MGG,Humana MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Optum VA,Optum VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,UHC,UHC,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,UHC MGG,UHC MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,VA,VA,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Wellcare MGG,Wellcare MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Bright Health - commercial,Bright Health - commercial,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,85732,CPT,,,,Inpatient,,,36.41,36.41,Bright Health MGG,Bright Health MGG,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Aetna,Aetna,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Aetna MGG,Aetna MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,BCBS,BCBS,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,BCBS MGG,BCBS MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Cigna,Cigna,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Cigna MGG,Cigna MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Humana,Humana,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Humana MGG,Humana MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Optum VA,Optum VA,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,UHC,UHC,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,UHC MGG,UHC MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,VA,VA,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Wellcare MGG,Wellcare MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Bright Health - commercial,Bright Health - commercial,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,85732,CPT,,,,Inpatient,,,141.37,141.37,Bright Health MGG,Bright Health MGG,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Aetna,Aetna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Aetna MGG,Aetna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,BCBS,BCBS,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,BCBS MGG,BCBS MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Cigna,Cigna,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Cigna MGG,Cigna MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Humana,Humana,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Humana MGG,Humana MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Optum VA,Optum VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,UHC,UHC,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,UHC MGG,UHC MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,VA,VA,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Wellcare MGG,Wellcare MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Bright Health - commercial,Bright Health - commercial,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,85732,CPT,,,,Inpatient,,,27.85,27.85,Bright Health MGG,Bright Health MGG,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,85732,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Aetna,Aetna,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Aetna MGG,Aetna MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,BCBS,BCBS,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,BCBS MGG,BCBS MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Cigna,Cigna,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Cigna MGG,Cigna MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Humana,Humana,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Humana MGG,Humana MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Optum VA,Optum VA,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,UHC,UHC,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,UHC MGG,UHC MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,VA,VA,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Wellcare MGG,Wellcare MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Bright Health - commercial,Bright Health - commercial,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Bright Health MGG,Bright Health MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Aetna,Aetna,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Aetna MGG,Aetna MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,BCBS,BCBS,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,BCBS MGG,BCBS MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Cigna,Cigna,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Cigna MGG,Cigna MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Humana,Humana,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Humana MGG,Humana MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Optum VA,Optum VA,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,UHC,UHC,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,UHC MGG,UHC MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,VA,VA,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Wellcare MGG,Wellcare MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Bright Health - commercial,Bright Health - commercial,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,86147,CPT,,,,Inpatient,,,305.24,305.24,Bright Health MGG,Bright Health MGG,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Aetna,Aetna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Aetna MGG,Aetna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,BCBS,BCBS,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,BCBS MGG,BCBS MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Cigna,Cigna,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Cigna MGG,Cigna MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Humana,Humana,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Humana MGG,Humana MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Optum VA,Optum VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,UHC,UHC,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,UHC MGG,UHC MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,VA,VA,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Wellcare MGG,Wellcare MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Bright Health - commercial,Bright Health - commercial,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,86147,CPT,,,,Inpatient,,,108.17,108.17,Bright Health MGG,Bright Health MGG,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Aetna,Aetna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Aetna MGG,Aetna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,BCBS,BCBS,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,BCBS MGG,BCBS MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Cigna,Cigna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Cigna MGG,Cigna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Humana,Humana,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Humana MGG,Humana MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Optum VA,Optum VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,UHC,UHC,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,UHC MGG,UHC MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,VA,VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Wellcare MGG,Wellcare MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Bright Health - commercial,Bright Health - commercial,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,86606,CPT,,,,Inpatient,,,78.18,78.18,Bright Health MGG,Bright Health MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Aetna,Aetna,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Aetna MGG,Aetna MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,BCBS,BCBS,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,BCBS MGG,BCBS MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Cigna,Cigna,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Cigna MGG,Cigna MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Humana,Humana,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Humana MGG,Humana MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Optum VA,Optum VA,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,UHC,UHC,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,UHC MGG,UHC MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,VA,VA,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Wellcare MGG,Wellcare MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Bright Health - commercial,Bright Health - commercial,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,86606,CPT,,,,Inpatient,,,87.82,87.82,Bright Health MGG,Bright Health MGG,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,86606,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Aetna,Aetna,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Aetna MGG,Aetna MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,BCBS,BCBS,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,BCBS MGG,BCBS MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Cigna,Cigna,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Cigna MGG,Cigna MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Humana,Humana,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Humana MGG,Humana MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Optum VA,Optum VA,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,UHC,UHC,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,UHC MGG,UHC MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,VA,VA,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Wellcare MGG,Wellcare MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Bright Health - commercial,Bright Health - commercial,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,83090,CPT,,,,Inpatient,,,178.86,178.86,Bright Health MGG,Bright Health MGG,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Aetna,Aetna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Aetna MGG,Aetna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,BCBS,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS MGG,BCBS MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Cigna,Cigna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Cigna MGG,Cigna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Humana,Humana,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Humana MGG,Humana MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Optum VA,Optum VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UHC,UHC,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UHC MGG,UHC MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,VA,VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Wellcare MGG,Wellcare MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Bright Health - commercial,Bright Health - commercial,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Bright Health MGG,Bright Health MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Aetna,Aetna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Aetna MGG,Aetna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,BCBS,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS MGG,BCBS MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Cigna,Cigna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Cigna MGG,Cigna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Humana,Humana,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Humana MGG,Humana MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Optum VA,Optum VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UHC,UHC,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UHC MGG,UHC MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,VA,VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Wellcare MGG,Wellcare MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Bright Health - commercial,Bright Health - commercial,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Bright Health MGG,Bright Health MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Aetna,Aetna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Aetna MGG,Aetna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,BCBS,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS MGG,BCBS MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Cigna,Cigna,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Cigna MGG,Cigna MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Humana,Humana,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Humana MGG,Humana MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Optum VA,Optum VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UHC,UHC,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UHC MGG,UHC MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,VA,VA,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Wellcare MGG,Wellcare MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Bright Health - commercial,Bright Health - commercial,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,Bright Health MGG,Bright Health MGG,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Aetna,Aetna,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Aetna MGG,Aetna MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,BCBS,BCBS,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,BCBS MGG,BCBS MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Cigna,Cigna,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Cigna MGG,Cigna MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Humana,Humana,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Humana MGG,Humana MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Optum VA,Optum VA,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,UHC,UHC,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,UHC MGG,UHC MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,VA,VA,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Wellcare MGG,Wellcare MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Bright Health - commercial,Bright Health - commercial,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Bright Health MGG,Bright Health MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Aetna,Aetna,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Aetna MGG,Aetna MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,BCBS,BCBS,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,BCBS MGG,BCBS MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Cigna,Cigna,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Cigna MGG,Cigna MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Humana,Humana,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Humana MGG,Humana MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Optum VA,Optum VA,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,UHC,UHC,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,UHC MGG,UHC MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,VA,VA,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Wellcare MGG,Wellcare MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Bright Health - commercial,Bright Health - commercial,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,86653,CPT,,,,Inpatient,,,93.18,93.18,Bright Health MGG,Bright Health MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Aetna,Aetna,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Aetna MGG,Aetna MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS,BCBS,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS MGG,BCBS MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Cigna,Cigna,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Cigna MGG,Cigna MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Humana,Humana,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Humana MGG,Humana MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Optum VA,Optum VA,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,UHC,UHC,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,UHC MGG,UHC MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,VA,VA,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Wellcare MGG,Wellcare MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Bright Health - commercial,Bright Health - commercial,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,Bright Health MGG,Bright Health MGG,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,86611,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,86611,CPT,,,59,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Aetna,Aetna,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Aetna MGG,Aetna MGG,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,BCBS,BCBS,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,BCBS MGG,BCBS MGG,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Cigna,Cigna,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Cigna MGG,Cigna MGG,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Humana,Humana,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Humana MGG,Humana MGG,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Optum VA,Optum VA,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,UHC,UHC,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,UHC MGG,UHC MGG,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,VA,VA,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Wellcare MGG,Wellcare MGG,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Bright Health - commercial,Bright Health - commercial,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,85306,CPT,,,,Inpatient,,,358.79,358.79,Bright Health MGG,Bright Health MGG,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Aetna,Aetna,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Aetna MGG,Aetna MGG,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,BCBS,BCBS,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,BCBS MGG,BCBS MGG,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Cigna,Cigna,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Cigna MGG,Cigna MGG,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Humana,Humana,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Humana MGG,Humana MGG,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Optum VA,Optum VA,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,UHC,UHC,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,UHC MGG,UHC MGG,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,VA,VA,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Wellcare MGG,Wellcare MGG,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Bright Health - commercial,Bright Health - commercial,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,85306,CPT,,,,Inpatient,,,328.8,328.8,Bright Health MGG,Bright Health MGG,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Aetna,Aetna,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Aetna MGG,Aetna MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,BCBS,BCBS,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,BCBS MGG,BCBS MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Cigna,Cigna,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Cigna MGG,Cigna MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Humana,Humana,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Humana MGG,Humana MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Optum VA,Optum VA,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,UHC,UHC,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,UHC MGG,UHC MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,VA,VA,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Wellcare MGG,Wellcare MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Bright Health - commercial,Bright Health - commercial,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,85306,CPT,,,,Inpatient,,,65.33,65.33,Bright Health MGG,Bright Health MGG,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Aetna,Aetna,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Aetna MGG,Aetna MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,BCBS,BCBS,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,BCBS MGG,BCBS MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Cigna,Cigna,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Cigna MGG,Cigna MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Humana,Humana,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Humana MGG,Humana MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Optum VA,Optum VA,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,UHC,UHC,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,UHC MGG,UHC MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,VA,VA,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Wellcare MGG,Wellcare MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Bright Health - commercial,Bright Health - commercial,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,87149,CPT,,,,Inpatient,,,86.75,86.75,Bright Health MGG,Bright Health MGG,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Aetna,Aetna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Aetna MGG,Aetna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,BCBS,BCBS,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,BCBS MGG,BCBS MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Cigna,Cigna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Cigna MGG,Cigna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Humana,Humana,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Humana MGG,Humana MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Optum VA,Optum VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,UHC,UHC,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,UHC MGG,UHC MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,VA,VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Wellcare MGG,Wellcare MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Bright Health - commercial,Bright Health - commercial,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,84105,CPT,,,,Inpatient,,,31.06,31.06,Bright Health MGG,Bright Health MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Aetna,Aetna,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Aetna MGG,Aetna MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,BCBS,BCBS,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,BCBS MGG,BCBS MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Cigna,Cigna,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Cigna MGG,Cigna MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Humana,Humana,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Humana MGG,Humana MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Optum VA,Optum VA,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,UHC,UHC,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,UHC MGG,UHC MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,VA,VA,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Wellcare MGG,Wellcare MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Bright Health - commercial,Bright Health - commercial,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,84105,CPT,,,,Inpatient,,,19.28,19.28,Bright Health MGG,Bright Health MGG,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Aetna,Aetna,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Aetna MGG,Aetna MGG,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,BCBS,BCBS,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,BCBS MGG,BCBS MGG,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Cigna,Cigna,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Cigna MGG,Cigna MGG,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Humana,Humana,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Humana MGG,Humana MGG,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Optum VA,Optum VA,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,UHC,UHC,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,UHC MGG,UHC MGG,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,VA,VA,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Wellcare MGG,Wellcare MGG,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Bright Health - commercial,Bright Health - commercial,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,84560,CPT,,,,Inpatient,,,146.73,146.73,Bright Health MGG,Bright Health MGG,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Aetna,Aetna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Aetna MGG,Aetna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,BCBS,BCBS,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,BCBS MGG,BCBS MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Cigna,Cigna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Cigna MGG,Cigna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Humana,Humana,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Humana MGG,Humana MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Optum VA,Optum VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,UHC,UHC,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,UHC MGG,UHC MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,VA,VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Wellcare MGG,Wellcare MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Bright Health - commercial,Bright Health - commercial,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,84560,CPT,,,,Inpatient,,,31.06,31.06,Bright Health MGG,Bright Health MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Aetna,Aetna,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Aetna MGG,Aetna MGG,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,BCBS,BCBS,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,BCBS MGG,BCBS MGG,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Cigna,Cigna,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Cigna MGG,Cigna MGG,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Humana,Humana,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Humana MGG,Humana MGG,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Optum VA,Optum VA,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,UHC,UHC,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,UHC MGG,UHC MGG,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,VA,VA,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Wellcare MGG,Wellcare MGG,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Bright Health - commercial,Bright Health - commercial,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,84560,CPT,,,,Inpatient,,,20.35,20.35,Bright Health MGG,Bright Health MGG,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Aetna,Aetna,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Aetna MGG,Aetna MGG,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,BCBS,BCBS,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,BCBS MGG,BCBS MGG,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Cigna,Cigna,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Cigna MGG,Cigna MGG,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Humana,Humana,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Humana MGG,Humana MGG,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Optum VA,Optum VA,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,UHC,UHC,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,UHC MGG,UHC MGG,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,VA,VA,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Wellcare MGG,Wellcare MGG,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Bright Health - commercial,Bright Health - commercial,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,85260,CPT,,,,Inpatient,,,368.42,368.42,Bright Health MGG,Bright Health MGG,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Aetna,Aetna,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Aetna MGG,Aetna MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,BCBS,BCBS,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,BCBS MGG,BCBS MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Cigna,Cigna,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Cigna MGG,Cigna MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Humana,Humana,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Humana MGG,Humana MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Optum VA,Optum VA,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,UHC,UHC,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,UHC MGG,UHC MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,VA,VA,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Wellcare MGG,Wellcare MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Bright Health - commercial,Bright Health - commercial,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,86747,CPT,,,,Inpatient,,,101.75,101.75,Bright Health MGG,Bright Health MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Aetna,Aetna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Aetna MGG,Aetna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,BCBS,BCBS,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,BCBS MGG,BCBS MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Cigna,Cigna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Cigna MGG,Cigna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Humana,Humana,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Humana MGG,Humana MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Optum VA,Optum VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,UHC,UHC,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,UHC MGG,UHC MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,VA,VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Wellcare MGG,Wellcare MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Bright Health - commercial,Bright Health - commercial,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,85230,CPT,,,,Inpatient,,,78.18,78.18,Bright Health MGG,Bright Health MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Aetna,Aetna,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Aetna MGG,Aetna MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,BCBS,BCBS,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,BCBS MGG,BCBS MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Cigna,Cigna,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Cigna MGG,Cigna MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Humana,Humana,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Humana MGG,Humana MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Optum VA,Optum VA,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,UHC,UHC,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,UHC MGG,UHC MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,VA,VA,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Wellcare MGG,Wellcare MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Bright Health - commercial,Bright Health - commercial,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,86612,CPT,,,,Inpatient,,,257.04,257.04,Bright Health MGG,Bright Health MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Aetna,Aetna,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Aetna MGG,Aetna MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,BCBS,BCBS,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,BCBS MGG,BCBS MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Cigna,Cigna,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Cigna MGG,Cigna MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Humana,Humana,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Humana MGG,Humana MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Optum VA,Optum VA,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,UHC,UHC,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,UHC MGG,UHC MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,VA,VA,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Wellcare MGG,Wellcare MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Bright Health - commercial,Bright Health - commercial,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,86612,CPT,,,,Inpatient,,,101.75,101.75,Bright Health MGG,Bright Health MGG,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Aetna,Aetna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Aetna MGG,Aetna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,BCBS,BCBS,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,BCBS MGG,BCBS MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Cigna,Cigna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Cigna MGG,Cigna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Humana,Humana,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Humana MGG,Humana MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Optum VA,Optum VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,UHC,UHC,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,UHC MGG,UHC MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,VA,VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Wellcare MGG,Wellcare MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Bright Health - commercial,Bright Health - commercial,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,86698,CPT,,,,Inpatient,,,299.88,299.88,Bright Health MGG,Bright Health MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Aetna,Aetna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Aetna MGG,Aetna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,BCBS,BCBS,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,BCBS MGG,BCBS MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Cigna,Cigna,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Cigna MGG,Cigna MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Humana,Humana,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Humana MGG,Humana MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Optum VA,Optum VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,UHC,UHC,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,UHC MGG,UHC MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,VA,VA,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Wellcare MGG,Wellcare MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Bright Health - commercial,Bright Health - commercial,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,86698,CPT,,,59,Inpatient,,,299.88,299.88,Bright Health MGG,Bright Health MGG,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Aetna,Aetna,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Aetna MGG,Aetna MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,BCBS,BCBS,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,BCBS MGG,BCBS MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Cigna,Cigna,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Cigna MGG,Cigna MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Humana,Humana,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Humana MGG,Humana MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Optum VA,Optum VA,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,UHC,UHC,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,UHC MGG,UHC MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,VA,VA,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Wellcare MGG,Wellcare MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Bright Health - commercial,Bright Health - commercial,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Bright Health MGG,Bright Health MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Aetna,Aetna,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Aetna MGG,Aetna MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,BCBS,BCBS,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,BCBS MGG,BCBS MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Cigna,Cigna,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Cigna MGG,Cigna MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Humana,Humana,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Humana MGG,Humana MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Optum VA,Optum VA,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,UHC,UHC,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,UHC MGG,UHC MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,VA,VA,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Wellcare MGG,Wellcare MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Bright Health - commercial,Bright Health - commercial,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,80375,CPT,,,,Inpatient,,,511.94,511.94,Bright Health MGG,Bright Health MGG,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Aetna,Aetna,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Aetna MGG,Aetna MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,BCBS,BCBS,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,BCBS MGG,BCBS MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Cigna,Cigna,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Cigna MGG,Cigna MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Humana,Humana,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Humana MGG,Humana MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Optum VA,Optum VA,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,UHC,UHC,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,UHC MGG,UHC MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,VA,VA,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Wellcare MGG,Wellcare MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Bright Health - commercial,Bright Health - commercial,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,80377,CPT,,,,Inpatient,,,531.22,531.22,Bright Health MGG,Bright Health MGG,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Aetna,Aetna,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Aetna MGG,Aetna MGG,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,BCBS,BCBS,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,BCBS MGG,BCBS MGG,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Cigna,Cigna,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Cigna MGG,Cigna MGG,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Humana,Humana,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Humana MGG,Humana MGG,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Optum VA,Optum VA,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,UHC,UHC,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,UHC MGG,UHC MGG,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,VA,VA,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Wellcare MGG,Wellcare MGG,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Bright Health - commercial,Bright Health - commercial,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,85576,CPT,,,,Inpatient,,,1190.95,1190.95,Bright Health MGG,Bright Health MGG,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,85576,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Aetna,Aetna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Aetna MGG,Aetna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,BCBS,BCBS,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,BCBS MGG,BCBS MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Cigna,Cigna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Cigna MGG,Cigna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Humana,Humana,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Humana MGG,Humana MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Optum VA,Optum VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,UHC,UHC,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,UHC MGG,UHC MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,VA,VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Wellcare MGG,Wellcare MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Bright Health - commercial,Bright Health - commercial,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,81005,CPT,,,,Inpatient,,,159.58,159.58,Bright Health MGG,Bright Health MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Aetna,Aetna,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Aetna MGG,Aetna MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,BCBS,BCBS,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,BCBS MGG,BCBS MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Cigna,Cigna,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Cigna MGG,Cigna MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Humana,Humana,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Humana MGG,Humana MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Optum VA,Optum VA,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,UHC,UHC,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,UHC MGG,UHC MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,VA,VA,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Wellcare MGG,Wellcare MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Bright Health - commercial,Bright Health - commercial,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,86316,CPT,,,,Inpatient,,,91.04,91.04,Bright Health MGG,Bright Health MGG,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Aetna,Aetna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Aetna MGG,Aetna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,BCBS,BCBS,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,BCBS MGG,BCBS MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Cigna,Cigna,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Cigna MGG,Cigna MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Humana,Humana,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Humana MGG,Humana MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Optum VA,Optum VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,UHC,UHC,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,UHC MGG,UHC MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,VA,VA,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Wellcare MGG,Wellcare MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Bright Health - commercial,Bright Health - commercial,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,86316,CPT,,,,Inpatient,,,97.46,97.46,Bright Health MGG,Bright Health MGG,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Aetna,Aetna,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Aetna MGG,Aetna MGG,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,BCBS,BCBS,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,BCBS MGG,BCBS MGG,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Cigna,Cigna,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Cigna MGG,Cigna MGG,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Humana,Humana,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Humana MGG,Humana MGG,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Optum VA,Optum VA,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,UHC,UHC,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,UHC MGG,UHC MGG,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,VA,VA,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Wellcare MGG,Wellcare MGG,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Bright Health - commercial,Bright Health - commercial,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,86694,CPT,,,,Inpatient,,,119.95,119.95,Bright Health MGG,Bright Health MGG,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Aetna,Aetna,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Aetna MGG,Aetna MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,BCBS,BCBS,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,BCBS MGG,BCBS MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Cigna,Cigna,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Cigna MGG,Cigna MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Humana,Humana,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Humana MGG,Humana MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Optum VA,Optum VA,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,UHC,UHC,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,UHC MGG,UHC MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,VA,VA,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Wellcare MGG,Wellcare MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Bright Health - commercial,Bright Health - commercial,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Bright Health MGG,Bright Health MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Aetna,Aetna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Aetna MGG,Aetna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,BCBS,BCBS,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,BCBS MGG,BCBS MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Cigna,Cigna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Cigna MGG,Cigna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Humana,Humana,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Humana MGG,Humana MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Optum VA,Optum VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,UHC,UHC,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,UHC MGG,UHC MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,VA,VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Wellcare MGG,Wellcare MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Bright Health - commercial,Bright Health - commercial,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Bright Health MGG,Bright Health MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Aetna,Aetna,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Aetna MGG,Aetna MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,BCBS,BCBS,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,BCBS MGG,BCBS MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Cigna,Cigna,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Cigna MGG,Cigna MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Humana,Humana,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Humana MGG,Humana MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Optum VA,Optum VA,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,UHC,UHC,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,UHC MGG,UHC MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,VA,VA,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Wellcare MGG,Wellcare MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Bright Health - commercial,Bright Health - commercial,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,86694,CPT,,,,Inpatient,,,124.24,124.24,Bright Health MGG,Bright Health MGG,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Aetna,Aetna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Aetna MGG,Aetna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,BCBS,BCBS,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,BCBS MGG,BCBS MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Cigna,Cigna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Cigna MGG,Cigna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Humana,Humana,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Humana MGG,Humana MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Optum VA,Optum VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,UHC,UHC,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,UHC MGG,UHC MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,VA,VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Wellcare MGG,Wellcare MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Bright Health - commercial,Bright Health - commercial,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Bright Health MGG,Bright Health MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Aetna,Aetna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Aetna MGG,Aetna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,BCBS,BCBS,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,BCBS MGG,BCBS MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Cigna,Cigna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Cigna MGG,Cigna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Humana,Humana,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Humana MGG,Humana MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Optum VA,Optum VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,UHC,UHC,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,UHC MGG,UHC MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,VA,VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Wellcare MGG,Wellcare MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Bright Health - commercial,Bright Health - commercial,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,86694,CPT,,,,Inpatient,,,343.79,343.79,Bright Health MGG,Bright Health MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Aetna,Aetna,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Aetna MGG,Aetna MGG,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,BCBS,BCBS,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,BCBS MGG,BCBS MGG,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Cigna,Cigna,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Cigna MGG,Cigna MGG,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Humana,Humana,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Humana MGG,Humana MGG,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Optum VA,Optum VA,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,UHC,UHC,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,UHC MGG,UHC MGG,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,VA,VA,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Wellcare MGG,Wellcare MGG,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Bright Health - commercial,Bright Health - commercial,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,86977,CPT,,,,Inpatient,,,193.85,193.85,Bright Health MGG,Bright Health MGG,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,86355,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Aetna,Aetna,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Aetna MGG,Aetna MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,BCBS,BCBS,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,BCBS MGG,BCBS MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Cigna,Cigna,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Cigna MGG,Cigna MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Humana,Humana,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Humana MGG,Humana MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Optum VA,Optum VA,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,UHC,UHC,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,UHC MGG,UHC MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,VA,VA,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Wellcare MGG,Wellcare MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Bright Health - commercial,Bright Health - commercial,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,86355,CPT,,,,Inpatient,,,132.8,132.8,Bright Health MGG,Bright Health MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Aetna,Aetna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Aetna MGG,Aetna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,BCBS,BCBS,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,BCBS MGG,BCBS MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Cigna,Cigna,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Cigna MGG,Cigna MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Humana,Humana,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Humana MGG,Humana MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Optum VA,Optum VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,UHC,UHC,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,UHC MGG,UHC MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,VA,VA,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Wellcare MGG,Wellcare MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Bright Health - commercial,Bright Health - commercial,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,86970,CPT,,,,Inpatient,,,145.66,145.66,Bright Health MGG,Bright Health MGG,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Aetna,Aetna,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Aetna MGG,Aetna MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,BCBS,BCBS,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,BCBS MGG,BCBS MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Cigna,Cigna,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Cigna MGG,Cigna MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Humana,Humana,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Humana MGG,Humana MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Optum VA,Optum VA,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,UHC,UHC,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,UHC MGG,UHC MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,VA,VA,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Wellcare MGG,Wellcare MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Bright Health - commercial,Bright Health - commercial,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,86359,CPT,,,,Inpatient,,,285.96,285.96,Bright Health MGG,Bright Health MGG,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Aetna,Aetna,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Aetna MGG,Aetna MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,BCBS,BCBS,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,BCBS MGG,BCBS MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Cigna,Cigna,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Cigna MGG,Cigna MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Humana,Humana,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Humana MGG,Humana MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Optum VA,Optum VA,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,UHC,UHC,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,UHC MGG,UHC MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,VA,VA,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Wellcare MGG,Wellcare MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Bright Health - commercial,Bright Health - commercial,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,86359,CPT,,,,Inpatient,,,132.8,132.8,Bright Health MGG,Bright Health MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Aetna,Aetna,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Aetna MGG,Aetna MGG,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,BCBS,BCBS,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,BCBS MGG,BCBS MGG,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Cigna,Cigna,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Cigna MGG,Cigna MGG,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Humana,Humana,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Humana MGG,Humana MGG,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Optum VA,Optum VA,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,UHC,UHC,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,UHC MGG,UHC MGG,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,VA,VA,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Wellcare MGG,Wellcare MGG,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Bright Health - commercial,Bright Health - commercial,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,Bright Health MGG,Bright Health MGG,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Aetna,Aetna,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Aetna MGG,Aetna MGG,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,BCBS,BCBS,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,BCBS MGG,BCBS MGG,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Cigna,Cigna,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Cigna MGG,Cigna MGG,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Humana,Humana,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Humana MGG,Humana MGG,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Optum VA,Optum VA,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,UHC,UHC,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,UHC MGG,UHC MGG,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,VA,VA,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Wellcare MGG,Wellcare MGG,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Bright Health - commercial,Bright Health - commercial,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,87529,CPT,,,,Inpatient,,,709,709,Bright Health MGG,Bright Health MGG,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Aetna,Aetna,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Aetna MGG,Aetna MGG,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,BCBS,BCBS,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,BCBS MGG,BCBS MGG,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Cigna,Cigna,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Cigna MGG,Cigna MGG,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Humana,Humana,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Humana MGG,Humana MGG,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Optum VA,Optum VA,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,UHC,UHC,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,UHC MGG,UHC MGG,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,VA,VA,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Wellcare MGG,Wellcare MGG,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Bright Health - commercial,Bright Health - commercial,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,87529,CPT,,,,Inpatient,,,857.87,857.87,Bright Health MGG,Bright Health MGG,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Aetna,Aetna,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Aetna MGG,Aetna MGG,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,BCBS,BCBS,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,BCBS MGG,BCBS MGG,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Cigna,Cigna,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Cigna MGG,Cigna MGG,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Humana,Humana,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Humana MGG,Humana MGG,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Optum VA,Optum VA,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,UHC,UHC,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,UHC MGG,UHC MGG,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,VA,VA,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Wellcare MGG,Wellcare MGG,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Bright Health - commercial,Bright Health - commercial,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,87529,CPT,,,,Inpatient,,,738.99,738.99,Bright Health MGG,Bright Health MGG,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Aetna,Aetna,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Aetna MGG,Aetna MGG,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,BCBS,BCBS,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,BCBS MGG,BCBS MGG,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Cigna,Cigna,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Cigna MGG,Cigna MGG,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Humana,Humana,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Humana MGG,Humana MGG,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Optum VA,Optum VA,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,UHC,UHC,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,UHC MGG,UHC MGG,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,VA,VA,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Wellcare MGG,Wellcare MGG,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Bright Health - commercial,Bright Health - commercial,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,87529,CPT,,,,Inpatient,,,737.92,737.92,Bright Health MGG,Bright Health MGG,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Aetna,Aetna,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Aetna MGG,Aetna MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS,BCBS,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS MGG,BCBS MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Cigna,Cigna,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Cigna MGG,Cigna MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Humana,Humana,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Humana MGG,Humana MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Optum VA,Optum VA,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,UHC,UHC,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,UHC MGG,UHC MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,VA,VA,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Wellcare MGG,Wellcare MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Bright Health - commercial,Bright Health - commercial,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Bright Health MGG,Bright Health MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Aetna,Aetna,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Aetna MGG,Aetna MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS,BCBS,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS MGG,BCBS MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Cigna,Cigna,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Cigna MGG,Cigna MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Humana,Humana,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Humana MGG,Humana MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Optum VA,Optum VA,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,UHC,UHC,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,UHC MGG,UHC MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,VA,VA,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Wellcare MGG,Wellcare MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Bright Health - commercial,Bright Health - commercial,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,Bright Health MGG,Bright Health MGG,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,86148,CPT,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Aetna,Aetna,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Aetna MGG,Aetna MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,BCBS,BCBS,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,BCBS MGG,BCBS MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Cigna,Cigna,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Cigna MGG,Cigna MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Humana,Humana,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Humana MGG,Humana MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Optum VA,Optum VA,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,UHC,UHC,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,UHC MGG,UHC MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,VA,VA,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Wellcare MGG,Wellcare MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Bright Health - commercial,Bright Health - commercial,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Bright Health MGG,Bright Health MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Aetna,Aetna,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Aetna MGG,Aetna MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,BCBS,BCBS,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,BCBS MGG,BCBS MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Cigna,Cigna,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Cigna MGG,Cigna MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Humana,Humana,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Humana MGG,Humana MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Optum VA,Optum VA,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,UHC,UHC,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,UHC MGG,UHC MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,VA,VA,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Wellcare MGG,Wellcare MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Bright Health - commercial,Bright Health - commercial,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,86638,CPT,,,,Inpatient,,,192.78,192.78,Bright Health MGG,Bright Health MGG,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Aetna,Aetna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Aetna MGG,Aetna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,BCBS,BCBS,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,BCBS MGG,BCBS MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Cigna,Cigna,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Cigna MGG,Cigna MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Humana,Humana,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Humana MGG,Humana MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Optum VA,Optum VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,UHC,UHC,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,UHC MGG,UHC MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,VA,VA,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Wellcare MGG,Wellcare MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Bright Health - commercial,Bright Health - commercial,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,Bright Health MGG,Bright Health MGG,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Aetna,Aetna,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Aetna MGG,Aetna MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,BCBS,BCBS,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,BCBS MGG,BCBS MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Cigna,Cigna,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Cigna MGG,Cigna MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Humana,Humana,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Humana MGG,Humana MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Optum VA,Optum VA,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,UHC,UHC,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,UHC MGG,UHC MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,VA,VA,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Wellcare MGG,Wellcare MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Bright Health - commercial,Bright Health - commercial,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,86789,CPT,,,,Inpatient,,,264.54,264.54,Bright Health MGG,Bright Health MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Aetna,Aetna,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Aetna MGG,Aetna MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,BCBS,BCBS,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,BCBS MGG,BCBS MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Cigna,Cigna,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Cigna MGG,Cigna MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Humana,Humana,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Humana MGG,Humana MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Optum VA,Optum VA,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,UHC,UHC,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,UHC MGG,UHC MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,VA,VA,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Wellcare MGG,Wellcare MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Bright Health - commercial,Bright Health - commercial,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,Bright Health MGG,Bright Health MGG,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Aetna,Aetna,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Aetna MGG,Aetna MGG,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,BCBS,BCBS,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,BCBS MGG,BCBS MGG,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Cigna,Cigna,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Cigna MGG,Cigna MGG,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Humana,Humana,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Humana MGG,Humana MGG,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Optum VA,Optum VA,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,UHC,UHC,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,UHC MGG,UHC MGG,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,VA,VA,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Wellcare MGG,Wellcare MGG,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Bright Health - commercial,Bright Health - commercial,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,86880,CPT,,,,Inpatient,,,175.64,175.64,Bright Health MGG,Bright Health MGG,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Aetna,Aetna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Aetna MGG,Aetna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,BCBS,BCBS,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,BCBS MGG,BCBS MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Cigna,Cigna,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Cigna MGG,Cigna MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Humana,Humana,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Humana MGG,Humana MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Optum VA,Optum VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,UHC,UHC,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,UHC MGG,UHC MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,VA,VA,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Wellcare MGG,Wellcare MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Bright Health - commercial,Bright Health - commercial,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,86880,CPT,,,,Inpatient,,,70.69,70.69,Bright Health MGG,Bright Health MGG,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Aetna,Aetna,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Aetna MGG,Aetna MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,BCBS,BCBS,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,BCBS MGG,BCBS MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Cigna,Cigna,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Cigna MGG,Cigna MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Humana,Humana,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Humana MGG,Humana MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Optum VA,Optum VA,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,UHC,UHC,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,UHC MGG,UHC MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,VA,VA,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Wellcare MGG,Wellcare MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Bright Health - commercial,Bright Health - commercial,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,86880,CPT,,,,Inpatient,,,153.15,153.15,Bright Health MGG,Bright Health MGG,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Aetna,Aetna,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Aetna MGG,Aetna MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,BCBS,BCBS,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,BCBS MGG,BCBS MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Cigna,Cigna,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Cigna MGG,Cigna MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Humana,Humana,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Humana MGG,Humana MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Optum VA,Optum VA,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,UHC,UHC,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,UHC MGG,UHC MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,VA,VA,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Wellcare MGG,Wellcare MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Bright Health - commercial,Bright Health - commercial,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,86880,CPT,,,,Inpatient,,,147.8,147.8,Bright Health MGG,Bright Health MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,86905,CPT,,,,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Aetna,Aetna,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Aetna MGG,Aetna MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,BCBS,BCBS,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,BCBS MGG,BCBS MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Cigna,Cigna,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Cigna MGG,Cigna MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Humana,Humana,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Humana MGG,Humana MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Optum VA,Optum VA,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,UHC,UHC,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,UHC MGG,UHC MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,VA,VA,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Wellcare MGG,Wellcare MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Bright Health - commercial,Bright Health - commercial,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,86905,CPT,,,,Inpatient,,,77.11,77.11,Bright Health MGG,Bright Health MGG,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Aetna,Aetna,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Aetna MGG,Aetna MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,BCBS,BCBS,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,BCBS MGG,BCBS MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Cigna,Cigna,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Cigna MGG,Cigna MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Humana,Humana,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Humana MGG,Humana MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Optum VA,Optum VA,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,UHC,UHC,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,UHC MGG,UHC MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,VA,VA,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Wellcare MGG,Wellcare MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Bright Health - commercial,Bright Health - commercial,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,86905,CPT,,,,Inpatient,,,132.8,132.8,Bright Health MGG,Bright Health MGG,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Aetna,Aetna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Aetna MGG,Aetna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,BCBS,BCBS,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,BCBS MGG,BCBS MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Cigna,Cigna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Cigna MGG,Cigna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Humana,Humana,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Humana MGG,Humana MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Optum VA,Optum VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,UHC,UHC,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,UHC MGG,UHC MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,VA,VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Wellcare MGG,Wellcare MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Bright Health - commercial,Bright Health - commercial,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,86905,CPT,,,,Inpatient,,,31.06,31.06,Bright Health MGG,Bright Health MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Aetna,Aetna,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Aetna MGG,Aetna MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,BCBS,BCBS,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,BCBS MGG,BCBS MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Cigna,Cigna,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Cigna MGG,Cigna MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Humana,Humana,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Humana MGG,Humana MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Optum VA,Optum VA,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,UHC,UHC,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,UHC MGG,UHC MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,VA,VA,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Wellcare MGG,Wellcare MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Bright Health - commercial,Bright Health - commercial,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,86860,CPT,,,,Inpatient,,,147.8,147.8,Bright Health MGG,Bright Health MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Aetna,Aetna,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Aetna MGG,Aetna MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,BCBS,BCBS,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,BCBS MGG,BCBS MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Cigna,Cigna,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Cigna MGG,Cigna MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Humana,Humana,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Humana MGG,Humana MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Optum VA,Optum VA,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,UHC,UHC,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,UHC MGG,UHC MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,VA,VA,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Wellcare MGG,Wellcare MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Bright Health - commercial,Bright Health - commercial,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,86978,CPT,,,,Inpatient,,,443.39,443.39,Bright Health MGG,Bright Health MGG,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Aetna,Aetna,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Aetna MGG,Aetna MGG,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,BCBS,BCBS,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,BCBS MGG,BCBS MGG,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Cigna,Cigna,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Cigna MGG,Cigna MGG,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Humana,Humana,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Humana MGG,Humana MGG,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Optum VA,Optum VA,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,UHC,UHC,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,UHC MGG,UHC MGG,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,VA,VA,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Wellcare MGG,Wellcare MGG,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Bright Health - commercial,Bright Health - commercial,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,86902,CPT,,,,Inpatient,,,221.7,221.7,Bright Health MGG,Bright Health MGG,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Aetna,Aetna,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Aetna MGG,Aetna MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,BCBS,BCBS,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,BCBS MGG,BCBS MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Cigna,Cigna,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Cigna MGG,Cigna MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Humana,Humana,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Humana MGG,Humana MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Optum VA,Optum VA,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,UHC,UHC,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,UHC MGG,UHC MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,VA,VA,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Wellcare MGG,Wellcare MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Bright Health - commercial,Bright Health - commercial,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Bright Health MGG,Bright Health MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Aetna,Aetna,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Aetna MGG,Aetna MGG,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,BCBS,BCBS,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,BCBS MGG,BCBS MGG,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Cigna,Cigna,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Cigna MGG,Cigna MGG,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Humana,Humana,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Humana MGG,Humana MGG,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Optum VA,Optum VA,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,UHC,UHC,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,UHC MGG,UHC MGG,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,VA,VA,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Wellcare MGG,Wellcare MGG,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Bright Health - commercial,Bright Health - commercial,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,J2790,CPT,,,,Inpatient,1,EA,365.21,365.21,Bright Health MGG,Bright Health MGG,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Aetna,Aetna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Aetna MGG,Aetna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,BCBS,BCBS,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,BCBS MGG,BCBS MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Cigna,Cigna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Cigna MGG,Cigna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Humana,Humana,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Humana MGG,Humana MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Optum VA,Optum VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,UHC,UHC,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,UHC MGG,UHC MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,VA,VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Wellcare MGG,Wellcare MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Bright Health - commercial,Bright Health - commercial,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,P9012,CPT,,,,Inpatient,,,121.02,121.02,Bright Health MGG,Bright Health MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Aetna,Aetna,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Aetna MGG,Aetna MGG,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,BCBS,BCBS,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,BCBS MGG,BCBS MGG,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Cigna,Cigna,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Cigna MGG,Cigna MGG,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Humana,Humana,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Humana MGG,Humana MGG,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Optum VA,Optum VA,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,UHC,UHC,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,UHC MGG,UHC MGG,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,VA,VA,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Wellcare MGG,Wellcare MGG,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Bright Health - commercial,Bright Health - commercial,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,82731,CPT,,,,Inpatient,,,674.73,674.73,Bright Health MGG,Bright Health MGG,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Aetna,Aetna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Aetna MGG,Aetna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,BCBS,BCBS,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,BCBS MGG,BCBS MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Cigna,Cigna,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Cigna MGG,Cigna MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Humana,Humana,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Humana MGG,Humana MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Optum VA,Optum VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,UHC,UHC,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,UHC MGG,UHC MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,VA,VA,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Wellcare MGG,Wellcare MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Bright Health - commercial,Bright Health - commercial,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,P9017,CPT,,,,Inpatient,,,168.15,168.15,Bright Health MGG,Bright Health MGG,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Aetna,Aetna,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Aetna MGG,Aetna MGG,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,BCBS,BCBS,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,BCBS MGG,BCBS MGG,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Cigna,Cigna,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Cigna MGG,Cigna MGG,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Humana,Humana,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Humana MGG,Humana MGG,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Optum VA,Optum VA,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,UHC,UHC,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,UHC MGG,UHC MGG,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,VA,VA,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Wellcare MGG,Wellcare MGG,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Bright Health - commercial,Bright Health - commercial,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,P9059,CPT,,,,Inpatient,,,309.7,309.7,Bright Health MGG,Bright Health MGG,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Aetna,Aetna,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Aetna MGG,Aetna MGG,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,BCBS,BCBS,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,BCBS MGG,BCBS MGG,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Cigna,Cigna,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Cigna MGG,Cigna MGG,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Humana,Humana,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Humana MGG,Humana MGG,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Optum VA,Optum VA,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,UHC,UHC,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,UHC MGG,UHC MGG,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,VA,VA,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Wellcare MGG,Wellcare MGG,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Bright Health - commercial,Bright Health - commercial,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,85390,CPT,,,,Inpatient,,,76.61,76.61,Bright Health MGG,Bright Health MGG,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,82962,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Aetna,Aetna,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Aetna MGG,Aetna MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,BCBS,BCBS,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,BCBS MGG,BCBS MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Cigna,Cigna,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Cigna MGG,Cigna MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Humana,Humana,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Humana MGG,Humana MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Optum VA,Optum VA,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,UHC,UHC,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,UHC MGG,UHC MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,VA,VA,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Wellcare MGG,Wellcare MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Bright Health - commercial,Bright Health - commercial,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,85460,CPT,,,,Inpatient,,,287.03,287.03,Bright Health MGG,Bright Health MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Aetna,Aetna,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Aetna MGG,Aetna MGG,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,BCBS,BCBS,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,BCBS MGG,BCBS MGG,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Cigna,Cigna,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Cigna MGG,Cigna MGG,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Humana,Humana,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Humana MGG,Humana MGG,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Optum VA,Optum VA,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,UHC,UHC,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,UHC MGG,UHC MGG,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,VA,VA,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Wellcare MGG,Wellcare MGG,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Bright Health - commercial,Bright Health - commercial,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,87389,CPT,,,,Inpatient,,,250.67,250.67,Bright Health MGG,Bright Health MGG,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Aetna,Aetna,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Aetna MGG,Aetna MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,BCBS,BCBS,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,BCBS MGG,BCBS MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Cigna,Cigna,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Cigna MGG,Cigna MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Humana,Humana,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Humana MGG,Humana MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Optum VA,Optum VA,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,UHC,UHC,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,UHC MGG,UHC MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,VA,VA,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Wellcare MGG,Wellcare MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Bright Health - commercial,Bright Health - commercial,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,84112,CPT,,,,Inpatient,,,189.57,189.57,Bright Health MGG,Bright Health MGG,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Aetna,Aetna,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Aetna MGG,Aetna MGG,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,BCBS,BCBS,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,BCBS MGG,BCBS MGG,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Cigna,Cigna,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Cigna MGG,Cigna MGG,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Humana,Humana,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Humana MGG,Humana MGG,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Optum VA,Optum VA,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,UHC,UHC,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,UHC MGG,UHC MGG,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,VA,VA,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Wellcare MGG,Wellcare MGG,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Bright Health - commercial,Bright Health - commercial,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,P9034,CPT,,,,Inpatient,,,960.69,960.69,Bright Health MGG,Bright Health MGG,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Aetna,Aetna,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Aetna MGG,Aetna MGG,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,BCBS,BCBS,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,BCBS MGG,BCBS MGG,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Cigna,Cigna,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Cigna MGG,Cigna MGG,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Humana,Humana,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Humana MGG,Humana MGG,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Optum VA,Optum VA,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,UHC,UHC,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,UHC MGG,UHC MGG,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,VA,VA,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Wellcare MGG,Wellcare MGG,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Bright Health - commercial,Bright Health - commercial,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,P9037,CPT,,,,Inpatient,,,2320.86,2320.86,Bright Health MGG,Bright Health MGG,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Aetna,Aetna,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Aetna MGG,Aetna MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,BCBS,BCBS,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,BCBS MGG,BCBS MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Cigna,Cigna,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Cigna MGG,Cigna MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Humana,Humana,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Humana MGG,Humana MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Optum VA,Optum VA,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,UHC,UHC,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,UHC MGG,UHC MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,VA,VA,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Wellcare MGG,Wellcare MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Bright Health - commercial,Bright Health - commercial,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,81025,CPT,,,,Inpatient,,,251.69,251.69,Bright Health MGG,Bright Health MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Aetna,Aetna,381.14,,,,,,,per diem,381.14,381.14,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Aetna MGG,Aetna MGG,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,BCBS,BCBS,381.14,,,,,,,per diem,381.14,381.14,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,BCBS MGG,BCBS MGG,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Cigna,Cigna,381.14,,,,,,,per diem,381.14,381.14,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Cigna MGG,Cigna MGG,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Humana,Humana,381.14,,,,,,,per diem,381.14,381.14,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Humana MGG,Humana MGG,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Optum VA,Optum VA,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,UHC,UHC,381.14,,,,,,,per diem,381.14,381.14,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,UHC MGG,UHC MGG,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,VA,VA,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Wellcare MGG,Wellcare MGG,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Bright Health - commercial,Bright Health - commercial,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,P9016,CPT,,,,Inpatient,,,381.14,381.14,Bright Health MGG,Bright Health MGG,381.14,,,,,,,case rate,381.14,381.14,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Aetna,Aetna,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Aetna MGG,Aetna MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,BCBS,BCBS,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,BCBS MGG,BCBS MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Cigna,Cigna,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Cigna MGG,Cigna MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Humana,Humana,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Humana MGG,Humana MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Optum VA,Optum VA,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,UHC,UHC,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,UHC MGG,UHC MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,VA,VA,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Wellcare MGG,Wellcare MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Bright Health - commercial,Bright Health - commercial,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,P9021,CPT,,,,Inpatient,,,423.05,423.05,Bright Health MGG,Bright Health MGG,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Aetna,Aetna,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Aetna MGG,Aetna MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,BCBS,BCBS,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,BCBS MGG,BCBS MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Cigna,Cigna,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Cigna MGG,Cigna MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Humana,Humana,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Humana MGG,Humana MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Optum VA,Optum VA,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,UHC,UHC,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,UHC MGG,UHC MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,VA,VA,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Wellcare MGG,Wellcare MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Bright Health - commercial,Bright Health - commercial,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,P9021,CPT,,,,Inpatient,,,311.66,311.66,Bright Health MGG,Bright Health MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Aetna,Aetna,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Aetna MGG,Aetna MGG,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,BCBS,BCBS,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,BCBS MGG,BCBS MGG,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Cigna,Cigna,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Cigna MGG,Cigna MGG,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Humana,Humana,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Humana MGG,Humana MGG,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Optum VA,Optum VA,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,UHC,UHC,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,UHC MGG,UHC MGG,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,VA,VA,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Wellcare MGG,Wellcare MGG,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Bright Health - commercial,Bright Health - commercial,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,P9022,CPT,,,,Inpatient,,,353.43,353.43,Bright Health MGG,Bright Health MGG,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Aetna,Aetna,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Aetna MGG,Aetna MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,BCBS,BCBS,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,BCBS MGG,BCBS MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Cigna,Cigna,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Cigna MGG,Cigna MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Humana,Humana,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Humana MGG,Humana MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Optum VA,Optum VA,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,UHC,UHC,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,UHC MGG,UHC MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,VA,VA,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Wellcare MGG,Wellcare MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Bright Health - commercial,Bright Health - commercial,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,P9010,CPT,,,,Inpatient,,,397.34,397.34,Bright Health MGG,Bright Health MGG,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Aetna,Aetna,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Aetna MGG,Aetna MGG,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,BCBS,BCBS,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,BCBS MGG,BCBS MGG,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Cigna,Cigna,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Cigna MGG,Cigna MGG,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Humana,Humana,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Humana MGG,Humana MGG,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Optum VA,Optum VA,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,UHC,UHC,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,UHC MGG,UHC MGG,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,VA,VA,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Wellcare MGG,Wellcare MGG,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Bright Health - commercial,Bright Health - commercial,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,P9056,CPT,,,,Inpatient,,,583.7,583.7,Bright Health MGG,Bright Health MGG,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Aetna,Aetna,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Aetna MGG,Aetna MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,BCBS,BCBS,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,BCBS MGG,BCBS MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Cigna,Cigna,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Cigna MGG,Cigna MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Humana,Humana,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Humana MGG,Humana MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Optum VA,Optum VA,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,UHC,UHC,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,UHC MGG,UHC MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,VA,VA,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Wellcare MGG,Wellcare MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Bright Health - commercial,Bright Health - commercial,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,85347,CPT,,,,Inpatient,,,81.4,81.4,Bright Health MGG,Bright Health MGG,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Aetna,Aetna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Aetna MGG,Aetna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,BCBS,BCBS,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,BCBS MGG,BCBS MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Cigna,Cigna,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Cigna MGG,Cigna MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Humana,Humana,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Humana MGG,Humana MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Optum VA,Optum VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,UHC,UHC,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,UHC MGG,UHC MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,VA,VA,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Wellcare MGG,Wellcare MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Bright Health - commercial,Bright Health - commercial,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,83695,CPT,,,,Inpatient,,,96.39,96.39,Bright Health MGG,Bright Health MGG,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,86663,CPT,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Aetna,Aetna,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Aetna MGG,Aetna MGG,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,BCBS,BCBS,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,BCBS MGG,BCBS MGG,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Cigna,Cigna,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Cigna MGG,Cigna MGG,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Humana,Humana,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Humana MGG,Humana MGG,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Optum VA,Optum VA,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,UHC,UHC,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,UHC MGG,UHC MGG,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,VA,VA,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Wellcare MGG,Wellcare MGG,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Bright Health - commercial,Bright Health - commercial,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,81220,CPT,,,,Inpatient,,,3754.93,3754.93,Bright Health MGG,Bright Health MGG,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Aetna,Aetna,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Aetna MGG,Aetna MGG,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,BCBS,BCBS,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,BCBS MGG,BCBS MGG,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Cigna,Cigna,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Cigna MGG,Cigna MGG,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Humana,Humana,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Humana MGG,Humana MGG,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Optum VA,Optum VA,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,UHC,UHC,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,UHC MGG,UHC MGG,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,VA,VA,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Wellcare MGG,Wellcare MGG,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Bright Health - commercial,Bright Health - commercial,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,80323,CPT,,,,Inpatient,,,170.29,170.29,Bright Health MGG,Bright Health MGG,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Aetna,Aetna,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Aetna MGG,Aetna MGG,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,BCBS,BCBS,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,BCBS MGG,BCBS MGG,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Cigna,Cigna,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Cigna MGG,Cigna MGG,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Humana,Humana,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Humana MGG,Humana MGG,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Optum VA,Optum VA,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,UHC,UHC,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,UHC MGG,UHC MGG,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,VA,VA,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Wellcare MGG,Wellcare MGG,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Bright Health - commercial,Bright Health - commercial,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,87498,CPT,,,,Inpatient,,,402.7,402.7,Bright Health MGG,Bright Health MGG,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Aetna,Aetna,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Aetna MGG,Aetna MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,BCBS,BCBS,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,BCBS MGG,BCBS MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Cigna,Cigna,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Cigna MGG,Cigna MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Humana,Humana,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Humana MGG,Humana MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Optum VA,Optum VA,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,UHC,UHC,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,UHC MGG,UHC MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,VA,VA,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Wellcare MGG,Wellcare MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Bright Health - commercial,Bright Health - commercial,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,86788,CPT,,,,Inpatient,,,287.03,287.03,Bright Health MGG,Bright Health MGG,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Aetna,Aetna,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Aetna MGG,Aetna MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,BCBS,BCBS,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,BCBS MGG,BCBS MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Cigna,Cigna,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Cigna MGG,Cigna MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Humana,Humana,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Humana MGG,Humana MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Optum VA,Optum VA,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,UHC,UHC,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,UHC MGG,UHC MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,VA,VA,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Wellcare MGG,Wellcare MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Bright Health - commercial,Bright Health - commercial,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,86788,CPT,,,,Inpatient,,,282.74,282.74,Bright Health MGG,Bright Health MGG,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,86337,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Aetna,Aetna,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Aetna MGG,Aetna MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,BCBS,BCBS,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,BCBS MGG,BCBS MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Cigna,Cigna,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Cigna MGG,Cigna MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Humana,Humana,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Humana MGG,Humana MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Optum VA,Optum VA,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,UHC,UHC,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,UHC MGG,UHC MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,VA,VA,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Wellcare MGG,Wellcare MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Bright Health - commercial,Bright Health - commercial,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,82017,CPT,,,,Inpatient,,,307.38,307.38,Bright Health MGG,Bright Health MGG,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Aetna,Aetna,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Aetna MGG,Aetna MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,BCBS,BCBS,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,BCBS MGG,BCBS MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Cigna,Cigna,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Cigna MGG,Cigna MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Humana,Humana,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Humana MGG,Humana MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Optum VA,Optum VA,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,UHC,UHC,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,UHC MGG,UHC MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,VA,VA,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Wellcare MGG,Wellcare MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Bright Health - commercial,Bright Health - commercial,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,83789,CPT,,,,Inpatient,,,79.25,79.25,Bright Health MGG,Bright Health MGG,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Aetna,Aetna,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Aetna MGG,Aetna MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,BCBS,BCBS,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,BCBS MGG,BCBS MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Cigna,Cigna,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Cigna MGG,Cigna MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Humana,Humana,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Humana MGG,Humana MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Optum VA,Optum VA,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,UHC,UHC,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,UHC MGG,UHC MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,VA,VA,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Wellcare MGG,Wellcare MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Bright Health - commercial,Bright Health - commercial,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,80180,CPT,,,,Inpatient,,,142.44,142.44,Bright Health MGG,Bright Health MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Aetna,Aetna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Aetna MGG,Aetna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,BCBS,BCBS,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,BCBS MGG,BCBS MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Cigna,Cigna,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Cigna MGG,Cigna MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Humana,Humana,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Humana MGG,Humana MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Optum VA,Optum VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,UHC,UHC,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,UHC MGG,UHC MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,VA,VA,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Wellcare MGG,Wellcare MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Bright Health - commercial,Bright Health - commercial,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,80367,CPT,,,,Inpatient,,,111.38,111.38,Bright Health MGG,Bright Health MGG,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,84255,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Aetna,Aetna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Aetna MGG,Aetna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,BCBS,BCBS,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,BCBS MGG,BCBS MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Cigna,Cigna,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Cigna MGG,Cigna MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Humana,Humana,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Humana MGG,Humana MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Optum VA,Optum VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,UHC,UHC,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,UHC MGG,UHC MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,VA,VA,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Wellcare MGG,Wellcare MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Bright Health - commercial,Bright Health - commercial,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,86005,CPT,,,,Inpatient,,,51.41,51.41,Bright Health MGG,Bright Health MGG,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Aetna,Aetna,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Aetna MGG,Aetna MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,BCBS,BCBS,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,BCBS MGG,BCBS MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Cigna,Cigna,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Cigna MGG,Cigna MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Humana,Humana,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Humana MGG,Humana MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Optum VA,Optum VA,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,UHC,UHC,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,UHC MGG,UHC MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,VA,VA,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Wellcare MGG,Wellcare MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Bright Health - commercial,Bright Health - commercial,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,86609,CPT,,,,Inpatient,,,139.23,139.23,Bright Health MGG,Bright Health MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Aetna,Aetna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Aetna MGG,Aetna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,BCBS,BCBS,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,BCBS MGG,BCBS MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Cigna,Cigna,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Cigna MGG,Cigna MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Humana,Humana,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Humana MGG,Humana MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Optum VA,Optum VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,UHC,UHC,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,UHC MGG,UHC MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,VA,VA,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Wellcare MGG,Wellcare MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Bright Health - commercial,Bright Health - commercial,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,86001,CPT,,,,Inpatient,,,109.24,109.24,Bright Health MGG,Bright Health MGG,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Aetna,Aetna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Aetna MGG,Aetna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,BCBS,BCBS,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,BCBS MGG,BCBS MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Cigna,Cigna,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Cigna MGG,Cigna MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Humana,Humana,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Humana MGG,Humana MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Optum VA,Optum VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,UHC,UHC,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,UHC MGG,UHC MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,VA,VA,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Wellcare MGG,Wellcare MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Bright Health - commercial,Bright Health - commercial,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,86161,CPT,,,,Inpatient,,,121.02,121.02,Bright Health MGG,Bright Health MGG,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Aetna,Aetna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Aetna MGG,Aetna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,BCBS,BCBS,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,BCBS MGG,BCBS MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Cigna,Cigna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Cigna MGG,Cigna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Humana,Humana,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Humana MGG,Humana MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Optum VA,Optum VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,UHC,UHC,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,UHC MGG,UHC MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,VA,VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Wellcare MGG,Wellcare MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Bright Health - commercial,Bright Health - commercial,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,80155,CPT,,,,Inpatient,,,54.62,54.62,Bright Health MGG,Bright Health MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Aetna,Aetna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Aetna MGG,Aetna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,BCBS,BCBS,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,BCBS MGG,BCBS MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Cigna,Cigna,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Cigna MGG,Cigna MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Humana,Humana,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Humana MGG,Humana MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Optum VA,Optum VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,UHC,UHC,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,UHC MGG,UHC MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,VA,VA,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Wellcare MGG,Wellcare MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Bright Health - commercial,Bright Health - commercial,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,86215,CPT,,,,Inpatient,,,24.63,24.63,Bright Health MGG,Bright Health MGG,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Aetna,Aetna,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Aetna MGG,Aetna MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,BCBS,BCBS,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,BCBS MGG,BCBS MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Cigna,Cigna,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Cigna MGG,Cigna MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Humana,Humana,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Humana MGG,Humana MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Optum VA,Optum VA,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,UHC,UHC,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,UHC MGG,UHC MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,VA,VA,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Wellcare MGG,Wellcare MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Bright Health - commercial,Bright Health - commercial,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,87380,CPT,,,,Inpatient,,,131.73,131.73,Bright Health MGG,Bright Health MGG,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Aetna,Aetna,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Aetna MGG,Aetna MGG,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,BCBS,BCBS,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,BCBS MGG,BCBS MGG,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Cigna,Cigna,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Cigna MGG,Cigna MGG,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Humana,Humana,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Humana MGG,Humana MGG,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Optum VA,Optum VA,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,UHC,UHC,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,UHC MGG,UHC MGG,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,VA,VA,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Wellcare MGG,Wellcare MGG,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Bright Health - commercial,Bright Health - commercial,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,85301,CPT,,,,Inpatient,,,50.34,50.34,Bright Health MGG,Bright Health MGG,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Aetna,Aetna,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Aetna MGG,Aetna MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,BCBS,BCBS,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,BCBS MGG,BCBS MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Cigna,Cigna,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Cigna MGG,Cigna MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Humana,Humana,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Humana MGG,Humana MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Optum VA,Optum VA,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,UHC,UHC,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,UHC MGG,UHC MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,VA,VA,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Wellcare MGG,Wellcare MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Bright Health - commercial,Bright Health - commercial,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Bright Health MGG,Bright Health MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Aetna,Aetna,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Aetna MGG,Aetna MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,BCBS,BCBS,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,BCBS MGG,BCBS MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Cigna,Cigna,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Cigna MGG,Cigna MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Humana,Humana,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Humana MGG,Humana MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Optum VA,Optum VA,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,UHC,UHC,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,UHC MGG,UHC MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,VA,VA,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Wellcare MGG,Wellcare MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Bright Health - commercial,Bright Health - commercial,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,87799,CPT,,,,Inpatient,,,598.69,598.69,Bright Health MGG,Bright Health MGG,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Aetna,Aetna,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Aetna MGG,Aetna MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,BCBS,BCBS,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,BCBS MGG,BCBS MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Cigna,Cigna,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Cigna MGG,Cigna MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Humana,Humana,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Humana MGG,Humana MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Optum VA,Optum VA,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,UHC,UHC,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,UHC MGG,UHC MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,VA,VA,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Wellcare MGG,Wellcare MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Bright Health - commercial,Bright Health - commercial,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,82239,CPT,,,,Inpatient,,,72.83,72.83,Bright Health MGG,Bright Health MGG,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Aetna,Aetna,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Aetna MGG,Aetna MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,BCBS,BCBS,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,BCBS MGG,BCBS MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Cigna,Cigna,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Cigna MGG,Cigna MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Humana,Humana,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Humana MGG,Humana MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Optum VA,Optum VA,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,UHC,UHC,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,UHC MGG,UHC MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,VA,VA,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Wellcare MGG,Wellcare MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Bright Health - commercial,Bright Health - commercial,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,85598,CPT,,,,Inpatient,,,158.51,158.51,Bright Health MGG,Bright Health MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Aetna,Aetna,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Aetna MGG,Aetna MGG,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,BCBS,BCBS,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,BCBS MGG,BCBS MGG,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Cigna,Cigna,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Cigna MGG,Cigna MGG,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Humana,Humana,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Humana MGG,Humana MGG,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Optum VA,Optum VA,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,UHC,UHC,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,UHC MGG,UHC MGG,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,VA,VA,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Wellcare MGG,Wellcare MGG,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Bright Health - commercial,Bright Health - commercial,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,87581,CPT,,,,Inpatient,,,176.72,176.72,Bright Health MGG,Bright Health MGG,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Aetna,Aetna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Aetna MGG,Aetna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,BCBS,BCBS,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,BCBS MGG,BCBS MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Cigna,Cigna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Cigna MGG,Cigna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Humana,Humana,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Humana MGG,Humana MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Optum VA,Optum VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,UHC,UHC,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,UHC MGG,UHC MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,VA,VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Wellcare MGG,Wellcare MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Bright Health - commercial,Bright Health - commercial,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,86336,CPT,,,,Inpatient,,,66.4,66.4,Bright Health MGG,Bright Health MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,83150,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Aetna,Aetna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Aetna MGG,Aetna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,BCBS,BCBS,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,BCBS MGG,BCBS MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Cigna,Cigna,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Cigna MGG,Cigna MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Humana,Humana,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Humana MGG,Humana MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Optum VA,Optum VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,UHC,UHC,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,UHC MGG,UHC MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,VA,VA,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Wellcare MGG,Wellcare MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Bright Health - commercial,Bright Health - commercial,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,82671,CPT,,,,Inpatient,,,137.09,137.09,Bright Health MGG,Bright Health MGG,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Aetna,Aetna,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Aetna MGG,Aetna MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,BCBS,BCBS,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,BCBS MGG,BCBS MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Cigna,Cigna,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Cigna MGG,Cigna MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Humana,Humana,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Humana MGG,Humana MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Optum VA,Optum VA,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,UHC,UHC,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,UHC MGG,UHC MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,VA,VA,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Wellcare MGG,Wellcare MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Bright Health - commercial,Bright Health - commercial,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,85397,CPT,,,,Inpatient,,,158.51,158.51,Bright Health MGG,Bright Health MGG,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Aetna,Aetna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Aetna MGG,Aetna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,BCBS,BCBS,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,BCBS MGG,BCBS MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Cigna,Cigna,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Cigna MGG,Cigna MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Humana,Humana,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Humana MGG,Humana MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Optum VA,Optum VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,UHC,UHC,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,UHC MGG,UHC MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,VA,VA,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Wellcare MGG,Wellcare MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Bright Health - commercial,Bright Health - commercial,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,83018,CPT,,,,Inpatient,,,46.05,46.05,Bright Health MGG,Bright Health MGG,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Aetna,Aetna,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Aetna MGG,Aetna MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,BCBS,BCBS,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,BCBS MGG,BCBS MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Cigna,Cigna,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Cigna MGG,Cigna MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Humana,Humana,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Humana MGG,Humana MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Optum VA,Optum VA,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,UHC,UHC,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,UHC MGG,UHC MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,VA,VA,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Wellcare MGG,Wellcare MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Bright Health - commercial,Bright Health - commercial,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,83018,CPT,,,,Inpatient,,,71.76,71.76,Bright Health MGG,Bright Health MGG,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Aetna,Aetna,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Aetna MGG,Aetna MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,BCBS,BCBS,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,BCBS MGG,BCBS MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Cigna,Cigna,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Cigna MGG,Cigna MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Humana,Humana,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Humana MGG,Humana MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Optum VA,Optum VA,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,UHC,UHC,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,UHC MGG,UHC MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,VA,VA,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Wellcare MGG,Wellcare MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Bright Health - commercial,Bright Health - commercial,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,86001,CPT,,,,Inpatient,,,47.12,47.12,Bright Health MGG,Bright Health MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Aetna,Aetna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Aetna MGG,Aetna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,BCBS,BCBS,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,BCBS MGG,BCBS MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Cigna,Cigna,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Cigna MGG,Cigna MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Humana,Humana,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Humana MGG,Humana MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Optum VA,Optum VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,UHC,UHC,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,UHC MGG,UHC MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,VA,VA,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Wellcare MGG,Wellcare MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Bright Health - commercial,Bright Health - commercial,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,84275,CPT,,,,Inpatient,,,26.78,26.78,Bright Health MGG,Bright Health MGG,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,87533,CPT,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Aetna,Aetna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Aetna MGG,Aetna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,BCBS,BCBS,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,BCBS MGG,BCBS MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Cigna,Cigna,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Cigna MGG,Cigna MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Humana,Humana,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Humana MGG,Humana MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Optum VA,Optum VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,UHC,UHC,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,UHC MGG,UHC MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,VA,VA,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Wellcare MGG,Wellcare MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Bright Health - commercial,Bright Health - commercial,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,86001,CPT,,,,Inpatient,,,55.69,55.69,Bright Health MGG,Bright Health MGG,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,80203,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Aetna,Aetna,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Aetna MGG,Aetna MGG,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,BCBS,BCBS,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,BCBS MGG,BCBS MGG,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Cigna,Cigna,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Cigna MGG,Cigna MGG,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Humana,Humana,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Humana MGG,Humana MGG,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Optum VA,Optum VA,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,UHC,UHC,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,UHC MGG,UHC MGG,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,VA,VA,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Wellcare MGG,Wellcare MGG,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Bright Health - commercial,Bright Health - commercial,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,87486,CPT,,,,Inpatient,,,366.28,366.28,Bright Health MGG,Bright Health MGG,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Aetna,Aetna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Aetna MGG,Aetna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,BCBS,BCBS,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,BCBS MGG,BCBS MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Cigna,Cigna,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Cigna MGG,Cigna MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Humana,Humana,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Humana MGG,Humana MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Optum VA,Optum VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,UHC,UHC,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,UHC MGG,UHC MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,VA,VA,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Wellcare MGG,Wellcare MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Bright Health - commercial,Bright Health - commercial,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,86617,CPT,,,,Inpatient,,,66.4,66.4,Bright Health MGG,Bright Health MGG,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Aetna,Aetna,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Aetna MGG,Aetna MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,BCBS,BCBS,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,BCBS MGG,BCBS MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Cigna,Cigna,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Cigna MGG,Cigna MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Humana,Humana,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Humana MGG,Humana MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Optum VA,Optum VA,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,UHC,UHC,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,UHC MGG,UHC MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,VA,VA,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Wellcare MGG,Wellcare MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Bright Health - commercial,Bright Health - commercial,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Bright Health MGG,Bright Health MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Aetna,Aetna,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Aetna MGG,Aetna MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,BCBS,BCBS,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,BCBS MGG,BCBS MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Cigna,Cigna,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Cigna MGG,Cigna MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Humana,Humana,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Humana MGG,Humana MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Optum VA,Optum VA,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,UHC,UHC,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,UHC MGG,UHC MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,VA,VA,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Wellcare MGG,Wellcare MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Bright Health - commercial,Bright Health - commercial,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,86617,CPT,,,,Inpatient,,,68.54,68.54,Bright Health MGG,Bright Health MGG,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Aetna,Aetna,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Aetna MGG,Aetna MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,BCBS,BCBS,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,BCBS MGG,BCBS MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Cigna,Cigna,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Cigna MGG,Cigna MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Humana,Humana,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Humana MGG,Humana MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Optum VA,Optum VA,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,UHC,UHC,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,UHC MGG,UHC MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,VA,VA,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Wellcare MGG,Wellcare MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Bright Health - commercial,Bright Health - commercial,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,87476,CPT,,,,Inpatient,,,155.3,155.3,Bright Health MGG,Bright Health MGG,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Aetna,Aetna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Aetna MGG,Aetna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,BCBS,BCBS,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,BCBS MGG,BCBS MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Cigna,Cigna,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Cigna MGG,Cigna MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Humana,Humana,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Humana MGG,Humana MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Optum VA,Optum VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,UHC,UHC,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,UHC MGG,UHC MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,VA,VA,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Wellcare MGG,Wellcare MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Bright Health - commercial,Bright Health - commercial,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,87341,CPT,,,,Inpatient,,,57.83,57.83,Bright Health MGG,Bright Health MGG,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Aetna,Aetna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Aetna MGG,Aetna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,BCBS,BCBS,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,BCBS MGG,BCBS MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Cigna,Cigna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Cigna MGG,Cigna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Humana,Humana,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Humana MGG,Humana MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Optum VA,Optum VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,UHC,UHC,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,UHC MGG,UHC MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,VA,VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Wellcare MGG,Wellcare MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Bright Health - commercial,Bright Health - commercial,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,84252,CPT,,,,Inpatient,,,84.61,84.61,Bright Health MGG,Bright Health MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Aetna,Aetna,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Aetna MGG,Aetna MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,BCBS,BCBS,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,BCBS MGG,BCBS MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Cigna,Cigna,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Cigna MGG,Cigna MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Humana,Humana,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Humana MGG,Humana MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Optum VA,Optum VA,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,UHC,UHC,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,UHC MGG,UHC MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,VA,VA,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Wellcare MGG,Wellcare MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Bright Health - commercial,Bright Health - commercial,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,84378,CPT,,,,Inpatient,,,47.12,47.12,Bright Health MGG,Bright Health MGG,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,80362,CPT,,,,Inpatient,,,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Aetna,Aetna,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Aetna MGG,Aetna MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,BCBS,BCBS,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,BCBS MGG,BCBS MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Cigna,Cigna,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Cigna MGG,Cigna MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Humana,Humana,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Humana MGG,Humana MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Optum VA,Optum VA,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,UHC,UHC,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,UHC MGG,UHC MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,VA,VA,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Wellcare MGG,Wellcare MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Bright Health - commercial,Bright Health - commercial,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Bright Health MGG,Bright Health MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Aetna,Aetna,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Aetna MGG,Aetna MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,BCBS,BCBS,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,BCBS MGG,BCBS MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Cigna,Cigna,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Cigna MGG,Cigna MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Humana,Humana,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Humana MGG,Humana MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Optum VA,Optum VA,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,UHC,UHC,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,UHC MGG,UHC MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,VA,VA,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Wellcare MGG,Wellcare MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Bright Health - commercial,Bright Health - commercial,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,87799,CPT,,,,Inpatient,,,186.35,186.35,Bright Health MGG,Bright Health MGG,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Aetna,Aetna,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Aetna MGG,Aetna MGG,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,BCBS,BCBS,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,BCBS MGG,BCBS MGG,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Cigna,Cigna,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Cigna MGG,Cigna MGG,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Humana,Humana,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Humana MGG,Humana MGG,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Optum VA,Optum VA,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,UHC,UHC,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,UHC MGG,UHC MGG,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,VA,VA,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Wellcare MGG,Wellcare MGG,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Bright Health - commercial,Bright Health - commercial,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,80356,CPT,,,,Inpatient,,,972.47,972.47,Bright Health MGG,Bright Health MGG,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Aetna,Aetna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Aetna MGG,Aetna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,BCBS,BCBS,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,BCBS MGG,BCBS MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Cigna,Cigna,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Cigna MGG,Cigna MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Humana,Humana,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Humana MGG,Humana MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Optum VA,Optum VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,UHC,UHC,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,UHC MGG,UHC MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,VA,VA,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Wellcare MGG,Wellcare MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Bright Health - commercial,Bright Health - commercial,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,85335,CPT,,,,Inpatient,,,54.62,54.62,Bright Health MGG,Bright Health MGG,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Aetna,Aetna,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Aetna MGG,Aetna MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,BCBS,BCBS,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,BCBS MGG,BCBS MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Cigna,Cigna,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Cigna MGG,Cigna MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Humana,Humana,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Humana MGG,Humana MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Optum VA,Optum VA,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,UHC,UHC,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,UHC MGG,UHC MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,VA,VA,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Wellcare MGG,Wellcare MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Bright Health - commercial,Bright Health - commercial,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,83698,CPT,,,,Inpatient,,,139.23,139.23,Bright Health MGG,Bright Health MGG,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Aetna,Aetna,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Aetna MGG,Aetna MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,BCBS,BCBS,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,BCBS MGG,BCBS MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Cigna,Cigna,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Cigna MGG,Cigna MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Humana,Humana,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Humana MGG,Humana MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Optum VA,Optum VA,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,UHC,UHC,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,UHC MGG,UHC MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,VA,VA,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Wellcare MGG,Wellcare MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Bright Health - commercial,Bright Health - commercial,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,87400,CPT,,,,Inpatient,,,362,362,Bright Health MGG,Bright Health MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Aetna,Aetna,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Aetna MGG,Aetna MGG,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,BCBS,BCBS,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,BCBS MGG,BCBS MGG,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Cigna,Cigna,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Cigna MGG,Cigna MGG,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Humana,Humana,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Humana MGG,Humana MGG,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Optum VA,Optum VA,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,UHC,UHC,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,UHC MGG,UHC MGG,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,VA,VA,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Wellcare MGG,Wellcare MGG,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Bright Health - commercial,Bright Health - commercial,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,87880,CPT,,,,Inpatient,,,966.04,966.04,Bright Health MGG,Bright Health MGG,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Aetna,Aetna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Aetna MGG,Aetna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,BCBS,BCBS,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,BCBS MGG,BCBS MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Cigna,Cigna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Cigna MGG,Cigna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Humana,Humana,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Humana MGG,Humana MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Optum VA,Optum VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,UHC,UHC,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,UHC MGG,UHC MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,VA,VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Wellcare MGG,Wellcare MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Bright Health - commercial,Bright Health - commercial,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,83021,CPT,,,,Inpatient,,,35.34,35.34,Bright Health MGG,Bright Health MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Aetna,Aetna,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Aetna MGG,Aetna MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,BCBS,BCBS,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,BCBS MGG,BCBS MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Cigna,Cigna,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Cigna MGG,Cigna MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Humana,Humana,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Humana MGG,Humana MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Optum VA,Optum VA,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,UHC,UHC,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,UHC MGG,UHC MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,VA,VA,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Wellcare MGG,Wellcare MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Bright Health - commercial,Bright Health - commercial,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,81243,CPT,,,,Inpatient,,,382.35,382.35,Bright Health MGG,Bright Health MGG,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Aetna,Aetna,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Aetna MGG,Aetna MGG,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,BCBS,BCBS,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,BCBS MGG,BCBS MGG,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Cigna,Cigna,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Cigna MGG,Cigna MGG,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Humana,Humana,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Humana MGG,Humana MGG,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Optum VA,Optum VA,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,UHC,UHC,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,UHC MGG,UHC MGG,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,VA,VA,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Wellcare MGG,Wellcare MGG,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Bright Health - commercial,Bright Health - commercial,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,81401,CPT,,,,Inpatient,,,208.85,208.85,Bright Health MGG,Bright Health MGG,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Aetna,Aetna,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Aetna MGG,Aetna MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,BCBS,BCBS,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,BCBS MGG,BCBS MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Cigna,Cigna,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Cigna MGG,Cigna MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Humana,Humana,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Humana MGG,Humana MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Optum VA,Optum VA,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,UHC,UHC,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,UHC MGG,UHC MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,VA,VA,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Wellcare MGG,Wellcare MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Bright Health - commercial,Bright Health - commercial,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,81479,CPT,,,,Inpatient,,,93.18,93.18,Bright Health MGG,Bright Health MGG,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,81400,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Aetna,Aetna,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Aetna MGG,Aetna MGG,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,BCBS,BCBS,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,BCBS MGG,BCBS MGG,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Cigna,Cigna,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Cigna MGG,Cigna MGG,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Humana,Humana,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Humana MGG,Humana MGG,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Optum VA,Optum VA,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,UHC,UHC,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,UHC MGG,UHC MGG,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,VA,VA,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Wellcare MGG,Wellcare MGG,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Bright Health - commercial,Bright Health - commercial,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,81401,CPT,,,,Inpatient,,,296.67,296.67,Bright Health MGG,Bright Health MGG,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Aetna,Aetna,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Aetna MGG,Aetna MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,BCBS,BCBS,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,BCBS MGG,BCBS MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Cigna,Cigna,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Cigna MGG,Cigna MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Humana,Humana,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Humana MGG,Humana MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Optum VA,Optum VA,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,UHC,UHC,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,UHC MGG,UHC MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,VA,VA,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Wellcare MGG,Wellcare MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Bright Health - commercial,Bright Health - commercial,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,81256,CPT,,,,Inpatient,,,338.44,338.44,Bright Health MGG,Bright Health MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Aetna,Aetna,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Aetna MGG,Aetna MGG,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,BCBS,BCBS,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,BCBS MGG,BCBS MGG,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Cigna,Cigna,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Cigna MGG,Cigna MGG,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Humana,Humana,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Humana MGG,Humana MGG,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Optum VA,Optum VA,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,UHC,UHC,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,UHC MGG,UHC MGG,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,VA,VA,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Wellcare MGG,Wellcare MGG,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Bright Health - commercial,Bright Health - commercial,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,81240,CPT,,,,Inpatient,,,254.9,254.9,Bright Health MGG,Bright Health MGG,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Aetna,Aetna,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Aetna MGG,Aetna MGG,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,BCBS,BCBS,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,BCBS MGG,BCBS MGG,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Cigna,Cigna,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Cigna MGG,Cigna MGG,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Humana,Humana,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Humana MGG,Humana MGG,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Optum VA,Optum VA,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,UHC,UHC,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,UHC MGG,UHC MGG,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,VA,VA,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Wellcare MGG,Wellcare MGG,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Bright Health - commercial,Bright Health - commercial,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,81229,CPT,,,,Inpatient,,,8173.87,8173.87,Bright Health MGG,Bright Health MGG,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Aetna,Aetna,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Aetna MGG,Aetna MGG,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,BCBS,BCBS,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,BCBS MGG,BCBS MGG,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Cigna,Cigna,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Cigna MGG,Cigna MGG,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Humana,Humana,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Humana MGG,Humana MGG,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Optum VA,Optum VA,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,UHC,UHC,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,UHC MGG,UHC MGG,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,VA,VA,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Wellcare MGG,Wellcare MGG,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Bright Health - commercial,Bright Health - commercial,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,81315,CPT,,,,Inpatient,,,1074.21,1074.21,Bright Health MGG,Bright Health MGG,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Aetna,Aetna,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Aetna MGG,Aetna MGG,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,BCBS,BCBS,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,BCBS MGG,BCBS MGG,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Cigna,Cigna,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Cigna MGG,Cigna MGG,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Humana,Humana,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Humana MGG,Humana MGG,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Optum VA,Optum VA,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,UHC,UHC,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,UHC MGG,UHC MGG,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,VA,VA,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Wellcare MGG,Wellcare MGG,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Bright Health - commercial,Bright Health - commercial,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,81229,CPT,,,,Inpatient,,,6686.25,6686.25,Bright Health MGG,Bright Health MGG,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Aetna,Aetna,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Aetna MGG,Aetna MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,BCBS,BCBS,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,BCBS MGG,BCBS MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Cigna,Cigna,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Cigna MGG,Cigna MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Humana,Humana,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Humana MGG,Humana MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Optum VA,Optum VA,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,UHC,UHC,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,UHC MGG,UHC MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,VA,VA,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Wellcare MGG,Wellcare MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Bright Health - commercial,Bright Health - commercial,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,81207,CPT,,,,Inpatient,,,318.09,318.09,Bright Health MGG,Bright Health MGG,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Aetna,Aetna,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Aetna MGG,Aetna MGG,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,BCBS,BCBS,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,BCBS MGG,BCBS MGG,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Cigna,Cigna,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Cigna MGG,Cigna MGG,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Humana,Humana,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Humana MGG,Humana MGG,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Optum VA,Optum VA,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,UHC,UHC,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,UHC MGG,UHC MGG,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,VA,VA,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Wellcare MGG,Wellcare MGG,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Bright Health - commercial,Bright Health - commercial,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,81206,CPT,,,,Inpatient,,,849.3,849.3,Bright Health MGG,Bright Health MGG,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Aetna,Aetna,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Aetna MGG,Aetna MGG,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,BCBS,BCBS,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,BCBS MGG,BCBS MGG,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Cigna,Cigna,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Cigna MGG,Cigna MGG,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Humana,Humana,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Humana MGG,Humana MGG,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Optum VA,Optum VA,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,UHC,UHC,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,UHC MGG,UHC MGG,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,VA,VA,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Wellcare MGG,Wellcare MGG,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Bright Health - commercial,Bright Health - commercial,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,81331,CPT,,,,Inpatient,,,114.6,114.6,Bright Health MGG,Bright Health MGG,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Aetna,Aetna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Aetna MGG,Aetna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,BCBS,BCBS,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,BCBS MGG,BCBS MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Cigna,Cigna,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Cigna MGG,Cigna MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Humana,Humana,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Humana MGG,Humana MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Optum VA,Optum VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,UHC,UHC,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,UHC MGG,UHC MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,VA,VA,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Wellcare MGG,Wellcare MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Bright Health - commercial,Bright Health - commercial,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,81310,CPT,,,,Inpatient,,,212.06,212.06,Bright Health MGG,Bright Health MGG,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Aetna,Aetna,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Aetna MGG,Aetna MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,BCBS,BCBS,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,BCBS MGG,BCBS MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Cigna,Cigna,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Cigna MGG,Cigna MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Humana,Humana,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Humana MGG,Humana MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Optum VA,Optum VA,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,UHC,UHC,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,UHC MGG,UHC MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,VA,VA,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Wellcare MGG,Wellcare MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Bright Health - commercial,Bright Health - commercial,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,86674,CPT,,,,Inpatient,,,338.44,338.44,Bright Health MGG,Bright Health MGG,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Aetna,Aetna,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Aetna MGG,Aetna MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,BCBS,BCBS,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,BCBS MGG,BCBS MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Cigna,Cigna,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Cigna MGG,Cigna MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Humana,Humana,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Humana MGG,Humana MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Optum VA,Optum VA,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,UHC,UHC,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,UHC MGG,UHC MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,VA,VA,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Wellcare MGG,Wellcare MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Bright Health - commercial,Bright Health - commercial,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,81241,CPT,,,,Inpatient,,,317.02,317.02,Bright Health MGG,Bright Health MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Aetna,Aetna,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Aetna MGG,Aetna MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,BCBS,BCBS,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,BCBS MGG,BCBS MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Cigna,Cigna,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Cigna MGG,Cigna MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Humana,Humana,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Humana MGG,Humana MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Optum VA,Optum VA,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,UHC,UHC,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,UHC MGG,UHC MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,VA,VA,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Wellcare MGG,Wellcare MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Bright Health - commercial,Bright Health - commercial,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,84210,CPT,,,,Inpatient,,,264.54,264.54,Bright Health MGG,Bright Health MGG,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Aetna,Aetna,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Aetna MGG,Aetna MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,BCBS,BCBS,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,BCBS MGG,BCBS MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Cigna,Cigna,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Cigna MGG,Cigna MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Humana,Humana,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Humana MGG,Humana MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Optum VA,Optum VA,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,UHC,UHC,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,UHC MGG,UHC MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,VA,VA,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Wellcare MGG,Wellcare MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Bright Health - commercial,Bright Health - commercial,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,85555,CPT,,,,Inpatient,,,219.56,219.56,Bright Health MGG,Bright Health MGG,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Aetna,Aetna,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Aetna MGG,Aetna MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,BCBS,BCBS,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,BCBS MGG,BCBS MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Cigna,Cigna,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Cigna MGG,Cigna MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Humana,Humana,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Humana MGG,Humana MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Optum VA,Optum VA,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,UHC,UHC,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,UHC MGG,UHC MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,VA,VA,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Wellcare MGG,Wellcare MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Bright Health - commercial,Bright Health - commercial,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,84220,CPT,,,,Inpatient,,,447.68,447.68,Bright Health MGG,Bright Health MGG,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Aetna,Aetna,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Aetna MGG,Aetna MGG,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,BCBS,BCBS,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,BCBS MGG,BCBS MGG,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Cigna,Cigna,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Cigna MGG,Cigna MGG,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Humana,Humana,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Humana MGG,Humana MGG,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Optum VA,Optum VA,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,UHC,UHC,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,UHC MGG,UHC MGG,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,VA,VA,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Wellcare MGG,Wellcare MGG,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Bright Health - commercial,Bright Health - commercial,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,83918,CPT,,,,Inpatient,,,463.74,463.74,Bright Health MGG,Bright Health MGG,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Aetna,Aetna,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Aetna MGG,Aetna MGG,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,BCBS,BCBS,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,BCBS MGG,BCBS MGG,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Cigna,Cigna,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Cigna MGG,Cigna MGG,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Humana,Humana,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Humana MGG,Humana MGG,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Optum VA,Optum VA,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,UHC,UHC,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,UHC MGG,UHC MGG,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,VA,VA,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Wellcare MGG,Wellcare MGG,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Bright Health - commercial,Bright Health - commercial,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,82139,CPT,,,,Inpatient,,,1027.09,1027.09,Bright Health MGG,Bright Health MGG,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Aetna,Aetna,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Aetna MGG,Aetna MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,BCBS,BCBS,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,BCBS MGG,BCBS MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Cigna,Cigna,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Cigna MGG,Cigna MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Humana,Humana,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Humana MGG,Humana MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Optum VA,Optum VA,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,UHC,UHC,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,UHC MGG,UHC MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,VA,VA,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Wellcare MGG,Wellcare MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Bright Health - commercial,Bright Health - commercial,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,82585,CPT,,,,Inpatient,,,142.44,142.44,Bright Health MGG,Bright Health MGG,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Aetna,Aetna,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Aetna MGG,Aetna MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,BCBS,BCBS,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,BCBS MGG,BCBS MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Cigna,Cigna,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Cigna MGG,Cigna MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Humana,Humana,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Humana MGG,Humana MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Optum VA,Optum VA,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,UHC,UHC,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,UHC MGG,UHC MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,VA,VA,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Wellcare MGG,Wellcare MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Bright Health - commercial,Bright Health - commercial,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,86157,CPT,,,,Inpatient,,,317.02,317.02,Bright Health MGG,Bright Health MGG,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Aetna,Aetna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Aetna MGG,Aetna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,BCBS,BCBS,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,BCBS MGG,BCBS MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Cigna,Cigna,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Cigna MGG,Cigna MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Humana,Humana,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Humana MGG,Humana MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Optum VA,Optum VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,UHC,UHC,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,UHC MGG,UHC MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,VA,VA,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Wellcare MGG,Wellcare MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Bright Health - commercial,Bright Health - commercial,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,86309,CPT,,,,Inpatient,,,29.99,29.99,Bright Health MGG,Bright Health MGG,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,86717,CPT,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Aetna,Aetna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Aetna MGG,Aetna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,BCBS,BCBS,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,BCBS MGG,BCBS MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Cigna,Cigna,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Cigna MGG,Cigna MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Humana,Humana,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Humana MGG,Humana MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Optum VA,Optum VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,UHC,UHC,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,UHC MGG,UHC MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,VA,VA,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Wellcare MGG,Wellcare MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Bright Health - commercial,Bright Health - commercial,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,86609,CPT,,,,Inpatient,,,343.79,343.79,Bright Health MGG,Bright Health MGG,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Aetna,Aetna,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Aetna MGG,Aetna MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,BCBS,BCBS,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,BCBS MGG,BCBS MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Cigna,Cigna,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Cigna MGG,Cigna MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Humana,Humana,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Humana MGG,Humana MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Optum VA,Optum VA,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,UHC,UHC,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,UHC MGG,UHC MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,VA,VA,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Wellcare MGG,Wellcare MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Bright Health - commercial,Bright Health - commercial,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,82726,CPT,,,,Inpatient,,,83.54,83.54,Bright Health MGG,Bright Health MGG,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Aetna,Aetna,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Aetna MGG,Aetna MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,BCBS,BCBS,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,BCBS MGG,BCBS MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Cigna,Cigna,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Cigna MGG,Cigna MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Humana,Humana,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Humana MGG,Humana MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Optum VA,Optum VA,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,UHC,UHC,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,UHC MGG,UHC MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,VA,VA,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Wellcare MGG,Wellcare MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Bright Health - commercial,Bright Health - commercial,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,83018,CPT,,,,Inpatient,,,94.25,94.25,Bright Health MGG,Bright Health MGG,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Aetna,Aetna,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Aetna MGG,Aetna MGG,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,BCBS,BCBS,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,BCBS MGG,BCBS MGG,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Cigna,Cigna,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Cigna MGG,Cigna MGG,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Humana,Humana,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Humana MGG,Humana MGG,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Optum VA,Optum VA,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,UHC,UHC,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,UHC MGG,UHC MGG,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,VA,VA,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Wellcare MGG,Wellcare MGG,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Bright Health - commercial,Bright Health - commercial,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,82978,CPT,,,,Inpatient,,,284.89,284.89,Bright Health MGG,Bright Health MGG,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Aetna,Aetna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Aetna MGG,Aetna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,BCBS,BCBS,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,BCBS MGG,BCBS MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Cigna,Cigna,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Cigna MGG,Cigna MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Humana,Humana,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Humana MGG,Humana MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Optum VA,Optum VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,UHC,UHC,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,UHC MGG,UHC MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,VA,VA,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Wellcare MGG,Wellcare MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Bright Health - commercial,Bright Health - commercial,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,82725,CPT,,,,Inpatient,,,62.12,62.12,Bright Health MGG,Bright Health MGG,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Aetna,Aetna,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Aetna MGG,Aetna MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,BCBS,BCBS,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,BCBS MGG,BCBS MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Cigna,Cigna,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Cigna MGG,Cigna MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Humana,Humana,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Humana MGG,Humana MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Optum VA,Optum VA,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,UHC,UHC,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,UHC MGG,UHC MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,VA,VA,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Wellcare MGG,Wellcare MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Bright Health - commercial,Bright Health - commercial,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,83993,CPT,,,,Inpatient,,,92.11,92.11,Bright Health MGG,Bright Health MGG,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Aetna,Aetna,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Aetna MGG,Aetna MGG,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,BCBS,BCBS,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,BCBS MGG,BCBS MGG,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Cigna,Cigna,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Cigna MGG,Cigna MGG,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Humana,Humana,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Humana MGG,Humana MGG,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Optum VA,Optum VA,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,UHC,UHC,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,UHC MGG,UHC MGG,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,VA,VA,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Wellcare MGG,Wellcare MGG,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Bright Health - commercial,Bright Health - commercial,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,81405,CPT,,,,Inpatient,,,793.61,793.61,Bright Health MGG,Bright Health MGG,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Aetna,Aetna,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Aetna MGG,Aetna MGG,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,BCBS,BCBS,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,BCBS MGG,BCBS MGG,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Cigna,Cigna,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Cigna MGG,Cigna MGG,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Humana,Humana,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Humana MGG,Humana MGG,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Optum VA,Optum VA,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,UHC,UHC,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,UHC MGG,UHC MGG,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,VA,VA,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Wellcare MGG,Wellcare MGG,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Bright Health - commercial,Bright Health - commercial,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,81257,CPT,,,,Inpatient,,,834.31,834.31,Bright Health MGG,Bright Health MGG,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Aetna,Aetna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Aetna MGG,Aetna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,BCBS,BCBS,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,BCBS MGG,BCBS MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Cigna,Cigna,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Cigna MGG,Cigna MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Humana,Humana,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Humana MGG,Humana MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Optum VA,Optum VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,UHC,UHC,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,UHC MGG,UHC MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,VA,VA,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Wellcare MGG,Wellcare MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Bright Health - commercial,Bright Health - commercial,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,81401,CPT,,,,Inpatient,,,163.86,163.86,Bright Health MGG,Bright Health MGG,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Aetna,Aetna,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Aetna MGG,Aetna MGG,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,BCBS,BCBS,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,BCBS MGG,BCBS MGG,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Cigna,Cigna,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Cigna MGG,Cigna MGG,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Humana,Humana,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Humana MGG,Humana MGG,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Optum VA,Optum VA,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,UHC,UHC,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,UHC MGG,UHC MGG,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,VA,VA,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Wellcare MGG,Wellcare MGG,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Bright Health - commercial,Bright Health - commercial,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,81401,CPT,,,,Inpatient,,,1918.16,1918.16,Bright Health MGG,Bright Health MGG,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Aetna,Aetna,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Aetna MGG,Aetna MGG,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,BCBS,BCBS,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,BCBS MGG,BCBS MGG,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Cigna,Cigna,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Cigna MGG,Cigna MGG,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Humana,Humana,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Humana MGG,Humana MGG,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Optum VA,Optum VA,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,UHC,UHC,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,UHC MGG,UHC MGG,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,VA,VA,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Wellcare MGG,Wellcare MGG,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Bright Health - commercial,Bright Health - commercial,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,81342,CPT,,,,Inpatient,,,717.57,717.57,Bright Health MGG,Bright Health MGG,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Aetna,Aetna,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Aetna MGG,Aetna MGG,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,BCBS,BCBS,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,BCBS MGG,BCBS MGG,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Cigna,Cigna,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Cigna MGG,Cigna MGG,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Humana,Humana,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Humana MGG,Humana MGG,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Optum VA,Optum VA,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,UHC,UHC,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,UHC MGG,UHC MGG,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,VA,VA,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Wellcare MGG,Wellcare MGG,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Bright Health - commercial,Bright Health - commercial,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,87910,CPT,,,,Inpatient,,,911.42,911.42,Bright Health MGG,Bright Health MGG,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Aetna,Aetna,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Aetna MGG,Aetna MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,BCBS,BCBS,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,BCBS MGG,BCBS MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Cigna,Cigna,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Cigna MGG,Cigna MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Humana,Humana,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Humana MGG,Humana MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Optum VA,Optum VA,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,UHC,UHC,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,UHC MGG,UHC MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,VA,VA,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Wellcare MGG,Wellcare MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Bright Health - commercial,Bright Health - commercial,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,82634,CPT,,,,Inpatient,,,136.02,136.02,Bright Health MGG,Bright Health MGG,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Aetna,Aetna,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Aetna MGG,Aetna MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,BCBS,BCBS,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,BCBS MGG,BCBS MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Cigna,Cigna,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Cigna MGG,Cigna MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Humana,Humana,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Humana MGG,Humana MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Optum VA,Optum VA,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,UHC,UHC,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,UHC MGG,UHC MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,VA,VA,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Wellcare MGG,Wellcare MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Bright Health - commercial,Bright Health - commercial,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,82163,CPT,,,,Inpatient,,,499.09,499.09,Bright Health MGG,Bright Health MGG,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Aetna,Aetna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Aetna MGG,Aetna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,BCBS,BCBS,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,BCBS MGG,BCBS MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Cigna,Cigna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Cigna MGG,Cigna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Humana,Humana,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Humana MGG,Humana MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Optum VA,Optum VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,UHC,UHC,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,UHC MGG,UHC MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,VA,VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Wellcare MGG,Wellcare MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Bright Health - commercial,Bright Health - commercial,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Bright Health MGG,Bright Health MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Aetna,Aetna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Aetna MGG,Aetna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,BCBS,BCBS,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,BCBS MGG,BCBS MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Cigna,Cigna,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Cigna MGG,Cigna MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Humana,Humana,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Humana MGG,Humana MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Optum VA,Optum VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,UHC,UHC,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,UHC MGG,UHC MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,VA,VA,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Wellcare MGG,Wellcare MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Bright Health - commercial,Bright Health - commercial,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,86001,CPT,,,,Inpatient,,,84.61,84.61,Bright Health MGG,Bright Health MGG,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Aetna,Aetna,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Aetna MGG,Aetna MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,BCBS,BCBS,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,BCBS MGG,BCBS MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Cigna,Cigna,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Cigna MGG,Cigna MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Humana,Humana,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Humana MGG,Humana MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Optum VA,Optum VA,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,UHC,UHC,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,UHC MGG,UHC MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,VA,VA,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Wellcare MGG,Wellcare MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Bright Health - commercial,Bright Health - commercial,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,81273,CPT,,,,Inpatient,,,311.66,311.66,Bright Health MGG,Bright Health MGG,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Aetna,Aetna,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Aetna MGG,Aetna MGG,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,BCBS,BCBS,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,BCBS MGG,BCBS MGG,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Cigna,Cigna,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Cigna MGG,Cigna MGG,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Humana,Humana,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Humana MGG,Humana MGG,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Optum VA,Optum VA,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,UHC,UHC,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,UHC MGG,UHC MGG,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,VA,VA,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Wellcare MGG,Wellcare MGG,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Bright Health - commercial,Bright Health - commercial,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,81225,CPT,,,,Inpatient,,,2613.52,2613.52,Bright Health MGG,Bright Health MGG,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Aetna,Aetna,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Aetna MGG,Aetna MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,BCBS,BCBS,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,BCBS MGG,BCBS MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Cigna,Cigna,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Cigna MGG,Cigna MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Humana,Humana,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Humana MGG,Humana MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Optum VA,Optum VA,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,UHC,UHC,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,UHC MGG,UHC MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,VA,VA,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Wellcare MGG,Wellcare MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Bright Health - commercial,Bright Health - commercial,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,81401,CPT,,,,Inpatient,,,362,362,Bright Health MGG,Bright Health MGG,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Aetna,Aetna,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Aetna MGG,Aetna MGG,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,BCBS,BCBS,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,BCBS MGG,BCBS MGG,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Cigna,Cigna,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Cigna MGG,Cigna MGG,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Humana,Humana,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Humana MGG,Humana MGG,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Optum VA,Optum VA,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,UHC,UHC,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,UHC MGG,UHC MGG,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,VA,VA,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Wellcare MGG,Wellcare MGG,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Bright Health - commercial,Bright Health - commercial,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,81479,CPT,,,,Inpatient,,,821.46,821.46,Bright Health MGG,Bright Health MGG,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Aetna,Aetna,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Aetna MGG,Aetna MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,BCBS,BCBS,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,BCBS MGG,BCBS MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Cigna,Cigna,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Cigna MGG,Cigna MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Humana,Humana,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Humana MGG,Humana MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Optum VA,Optum VA,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,UHC,UHC,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,UHC MGG,UHC MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,VA,VA,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Wellcare MGG,Wellcare MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Bright Health - commercial,Bright Health - commercial,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,81403,CPT,,,,Inpatient,,,248.47,248.47,Bright Health MGG,Bright Health MGG,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Aetna,Aetna,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Aetna MGG,Aetna MGG,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,BCBS,BCBS,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,BCBS MGG,BCBS MGG,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Cigna,Cigna,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Cigna MGG,Cigna MGG,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Humana,Humana,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Humana MGG,Humana MGG,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Optum VA,Optum VA,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,UHC,UHC,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,UHC MGG,UHC MGG,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,VA,VA,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Wellcare MGG,Wellcare MGG,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Bright Health - commercial,Bright Health - commercial,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,81272,CPT,,,,Inpatient,,,414.48,414.48,Bright Health MGG,Bright Health MGG,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Aetna,Aetna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Aetna MGG,Aetna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,BCBS,BCBS,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,BCBS MGG,BCBS MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Cigna,Cigna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Cigna MGG,Cigna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Humana,Humana,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Humana MGG,Humana MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Optum VA,Optum VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,UHC,UHC,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,UHC MGG,UHC MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,VA,VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Wellcare MGG,Wellcare MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Bright Health - commercial,Bright Health - commercial,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Bright Health MGG,Bright Health MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Aetna,Aetna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Aetna MGG,Aetna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,BCBS,BCBS,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,BCBS MGG,BCBS MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Cigna,Cigna,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Cigna MGG,Cigna MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Humana,Humana,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Humana MGG,Humana MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Optum VA,Optum VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,UHC,UHC,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,UHC MGG,UHC MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,VA,VA,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Wellcare MGG,Wellcare MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Bright Health - commercial,Bright Health - commercial,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,86666,CPT,,,,Inpatient,,,49.27,49.27,Bright Health MGG,Bright Health MGG,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna,Aetna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna MGG,Aetna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS,BCBS,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS MGG,BCBS MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna,Cigna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna MGG,Cigna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana,Humana,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana MGG,Humana MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Optum VA,Optum VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC,UHC,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC MGG,UHC MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,VA,VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Wellcare MGG,Wellcare MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health - commercial,Bright Health - commercial,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health MGG,Bright Health MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna,Aetna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna MGG,Aetna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS,BCBS,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS MGG,BCBS MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna,Cigna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna MGG,Cigna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana,Humana,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana MGG,Humana MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Optum VA,Optum VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC,UHC,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC MGG,UHC MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,VA,VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Wellcare MGG,Wellcare MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health - commercial,Bright Health - commercial,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health MGG,Bright Health MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna,Aetna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna MGG,Aetna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS,BCBS,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS MGG,BCBS MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna,Cigna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna MGG,Cigna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana,Humana,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana MGG,Humana MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Optum VA,Optum VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC,UHC,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC MGG,UHC MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,VA,VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Wellcare MGG,Wellcare MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health - commercial,Bright Health - commercial,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health MGG,Bright Health MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna,Aetna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna MGG,Aetna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS,BCBS,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS MGG,BCBS MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna,Cigna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna MGG,Cigna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana,Humana,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana MGG,Humana MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Optum VA,Optum VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC,UHC,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC MGG,UHC MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,VA,VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Wellcare MGG,Wellcare MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health - commercial,Bright Health - commercial,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health MGG,Bright Health MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna,Aetna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Aetna MGG,Aetna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS,BCBS,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,BCBS MGG,BCBS MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna,Cigna,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Cigna MGG,Cigna MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana,Humana,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Humana MGG,Humana MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Optum VA,Optum VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC,UHC,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,UHC MGG,UHC MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,VA,VA,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Wellcare MGG,Wellcare MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health - commercial,Bright Health - commercial,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,86768,CPT,,,,Inpatient,,,63.19,63.19,Bright Health MGG,Bright Health MGG,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Aetna,Aetna,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Aetna MGG,Aetna MGG,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,BCBS,BCBS,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,BCBS MGG,BCBS MGG,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Cigna,Cigna,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Cigna MGG,Cigna MGG,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Humana,Humana,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Humana MGG,Humana MGG,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Optum VA,Optum VA,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,UHC,UHC,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,UHC MGG,UHC MGG,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,VA,VA,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Wellcare MGG,Wellcare MGG,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Bright Health - commercial,Bright Health - commercial,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,81245,CPT,,,,Inpatient,,,1383.73,1383.73,Bright Health MGG,Bright Health MGG,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,81479,CPT,,,,Inpatient,,,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Aetna,Aetna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Aetna MGG,Aetna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,BCBS,BCBS,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,BCBS MGG,BCBS MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Cigna,Cigna,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Cigna MGG,Cigna MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Humana,Humana,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Humana MGG,Humana MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Optum VA,Optum VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,UHC,UHC,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,UHC MGG,UHC MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,VA,VA,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Wellcare MGG,Wellcare MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Bright Health - commercial,Bright Health - commercial,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,86357,CPT,,,,Inpatient,,,37.49,37.49,Bright Health MGG,Bright Health MGG,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Aetna,Aetna,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Aetna MGG,Aetna MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,BCBS,BCBS,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,BCBS MGG,BCBS MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Cigna,Cigna,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Cigna MGG,Cigna MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Humana,Humana,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Humana MGG,Humana MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Optum VA,Optum VA,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,UHC,UHC,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,UHC MGG,UHC MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,VA,VA,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Wellcare MGG,Wellcare MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Bright Health - commercial,Bright Health - commercial,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,88275,CPT,,,,Inpatient,,,160.65,160.65,Bright Health MGG,Bright Health MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Aetna,Aetna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Aetna MGG,Aetna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,BCBS,BCBS,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,BCBS MGG,BCBS MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Cigna,Cigna,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Cigna MGG,Cigna MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Humana,Humana,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Humana MGG,Humana MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Optum VA,Optum VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,UHC,UHC,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,UHC MGG,UHC MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,VA,VA,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Wellcare MGG,Wellcare MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Bright Health - commercial,Bright Health - commercial,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,88291,CPT,,,,Inpatient,,,172.43,172.43,Bright Health MGG,Bright Health MGG,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Aetna,Aetna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Aetna MGG,Aetna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,BCBS,BCBS,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,BCBS MGG,BCBS MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Cigna,Cigna,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Cigna MGG,Cigna MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Humana,Humana,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Humana MGG,Humana MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Optum VA,Optum VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,UHC,UHC,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,UHC MGG,UHC MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,VA,VA,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Wellcare MGG,Wellcare MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Bright Health - commercial,Bright Health - commercial,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,82300,CPT,,,,Inpatient,,,59.98,59.98,Bright Health MGG,Bright Health MGG,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Aetna,Aetna,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Aetna MGG,Aetna MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,BCBS,BCBS,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,BCBS MGG,BCBS MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Cigna,Cigna,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Cigna MGG,Cigna MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Humana,Humana,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Humana MGG,Humana MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Optum VA,Optum VA,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,UHC,UHC,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,UHC MGG,UHC MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,VA,VA,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Wellcare MGG,Wellcare MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Bright Health - commercial,Bright Health - commercial,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,88275,CPT,,,,Inpatient,,,147.8,147.8,Bright Health MGG,Bright Health MGG,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Aetna,Aetna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Aetna MGG,Aetna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,BCBS,BCBS,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,BCBS MGG,BCBS MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Cigna,Cigna,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Cigna MGG,Cigna MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Humana,Humana,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Humana MGG,Humana MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Optum VA,Optum VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,UHC,UHC,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,UHC MGG,UHC MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,VA,VA,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Wellcare MGG,Wellcare MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Bright Health - commercial,Bright Health - commercial,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,88291,CPT,,,,Inpatient,,,159.58,159.58,Bright Health MGG,Bright Health MGG,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Aetna,Aetna,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Aetna MGG,Aetna MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,BCBS,BCBS,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,BCBS MGG,BCBS MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Cigna,Cigna,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Cigna MGG,Cigna MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Humana,Humana,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Humana MGG,Humana MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Optum VA,Optum VA,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,UHC,UHC,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,UHC MGG,UHC MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,VA,VA,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Wellcare MGG,Wellcare MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Bright Health - commercial,Bright Health - commercial,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Bright Health MGG,Bright Health MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Aetna,Aetna,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Aetna MGG,Aetna MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,BCBS,BCBS,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,BCBS MGG,BCBS MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Cigna,Cigna,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Cigna MGG,Cigna MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Humana,Humana,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Humana MGG,Humana MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Optum VA,Optum VA,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,UHC,UHC,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,UHC MGG,UHC MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,VA,VA,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Wellcare MGG,Wellcare MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Bright Health - commercial,Bright Health - commercial,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,86356,CPT,,,,Inpatient,,,251.69,251.69,Bright Health MGG,Bright Health MGG,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna,Aetna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Aetna MGG,Aetna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS,BCBS,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,BCBS MGG,BCBS MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna,Cigna,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Cigna MGG,Cigna MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana,Humana,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Humana MGG,Humana MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Optum VA,Optum VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC,UHC,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,UHC MGG,UHC MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,VA,VA,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Wellcare MGG,Wellcare MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health - commercial,Bright Health - commercial,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,86356,CPT,,,,Inpatient,,,89.96,89.96,Bright Health MGG,Bright Health MGG,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Aetna,Aetna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Aetna MGG,Aetna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,BCBS,BCBS,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,BCBS MGG,BCBS MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Cigna,Cigna,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Cigna MGG,Cigna MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Humana,Humana,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Humana MGG,Humana MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Optum VA,Optum VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,UHC,UHC,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,UHC MGG,UHC MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,VA,VA,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Wellcare MGG,Wellcare MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Bright Health - commercial,Bright Health - commercial,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,84392,CPT,,,,Inpatient,,,31.06,31.06,Bright Health MGG,Bright Health MGG,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,86666,CPT,,,,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Aetna,Aetna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Aetna MGG,Aetna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,BCBS,BCBS,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,BCBS MGG,BCBS MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Cigna,Cigna,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Cigna MGG,Cigna MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Humana,Humana,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Humana MGG,Humana MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Optum VA,Optum VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,UHC,UHC,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,UHC MGG,UHC MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,VA,VA,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Wellcare MGG,Wellcare MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Bright Health - commercial,Bright Health - commercial,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,86666,CPT,,,59,Inpatient,,,88.89,88.89,Bright Health MGG,Bright Health MGG,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna,Aetna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna MGG,Aetna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS,BCBS,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS MGG,BCBS MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna,Cigna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna MGG,Cigna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana,Humana,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana MGG,Humana MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Optum VA,Optum VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC,UHC,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC MGG,UHC MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,VA,VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Wellcare MGG,Wellcare MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health - commercial,Bright Health - commercial,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health MGG,Bright Health MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna,Aetna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna MGG,Aetna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS,BCBS,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS MGG,BCBS MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna,Cigna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna MGG,Cigna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana,Humana,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana MGG,Humana MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Optum VA,Optum VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC,UHC,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC MGG,UHC MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,VA,VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Wellcare MGG,Wellcare MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health - commercial,Bright Health - commercial,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health MGG,Bright Health MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna,Aetna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna MGG,Aetna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS,BCBS,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS MGG,BCBS MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna,Cigna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna MGG,Cigna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana,Humana,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana MGG,Humana MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Optum VA,Optum VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC,UHC,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC MGG,UHC MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,VA,VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Wellcare MGG,Wellcare MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health - commercial,Bright Health - commercial,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health MGG,Bright Health MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna,Aetna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna MGG,Aetna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS,BCBS,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS MGG,BCBS MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna,Cigna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna MGG,Cigna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana,Humana,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana MGG,Humana MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Optum VA,Optum VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC,UHC,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC MGG,UHC MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,VA,VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Wellcare MGG,Wellcare MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health - commercial,Bright Health - commercial,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health MGG,Bright Health MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna,Aetna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Aetna MGG,Aetna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS,BCBS,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,BCBS MGG,BCBS MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna,Cigna,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Cigna MGG,Cigna MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana,Humana,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Humana MGG,Humana MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Optum VA,Optum VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC,UHC,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,UHC MGG,UHC MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,VA,VA,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Wellcare MGG,Wellcare MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health - commercial,Bright Health - commercial,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,86353,CPT,,,,Inpatient,,,199.21,199.21,Bright Health MGG,Bright Health MGG,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Aetna,Aetna,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Aetna MGG,Aetna MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,BCBS,BCBS,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,BCBS MGG,BCBS MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Cigna,Cigna,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Cigna MGG,Cigna MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Humana,Humana,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Humana MGG,Humana MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Optum VA,Optum VA,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,UHC,UHC,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,UHC MGG,UHC MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,VA,VA,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Wellcare MGG,Wellcare MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Bright Health - commercial,Bright Health - commercial,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,87900,CPT,,,,Inpatient,,,327.73,327.73,Bright Health MGG,Bright Health MGG,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Aetna,Aetna,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Aetna MGG,Aetna MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,BCBS,BCBS,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,BCBS MGG,BCBS MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Cigna,Cigna,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Cigna MGG,Cigna MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Humana,Humana,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Humana MGG,Humana MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Optum VA,Optum VA,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,UHC,UHC,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,UHC MGG,UHC MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,VA,VA,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Wellcare MGG,Wellcare MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Bright Health - commercial,Bright Health - commercial,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,81227,CPT,,,,Inpatient,,,162.79,162.79,Bright Health MGG,Bright Health MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Aetna,Aetna,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Aetna MGG,Aetna MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,BCBS,BCBS,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,BCBS MGG,BCBS MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Cigna,Cigna,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Cigna MGG,Cigna MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Humana,Humana,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Humana MGG,Humana MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Optum VA,Optum VA,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,UHC,UHC,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,UHC MGG,UHC MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,VA,VA,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Wellcare MGG,Wellcare MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Bright Health - commercial,Bright Health - commercial,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,81355,CPT,,,,Inpatient,,,162.79,162.79,Bright Health MGG,Bright Health MGG,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Aetna,Aetna,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Aetna MGG,Aetna MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,BCBS,BCBS,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,BCBS MGG,BCBS MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Cigna,Cigna,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Cigna MGG,Cigna MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Humana,Humana,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Humana MGG,Humana MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Optum VA,Optum VA,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,UHC,UHC,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,UHC MGG,UHC MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,VA,VA,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Wellcare MGG,Wellcare MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Bright Health - commercial,Bright Health - commercial,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251101,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Bright Health MGG,Bright Health MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Aetna,Aetna,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Aetna MGG,Aetna MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,BCBS,BCBS,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,BCBS MGG,BCBS MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Cigna,Cigna,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Cigna MGG,Cigna MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Humana,Humana,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Humana MGG,Humana MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Optum VA,Optum VA,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,UHC,UHC,46054,,,,,,,per diem,46054,46054,"Per diem rate, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,UHC MGG,UHC MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,VA,VA,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Wellcare MGG,Wellcare MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Bright Health - commercial,Bright Health - commercial,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O BCR-ABL T9,38251102,CDM,86600000000,RC,#####,CPT,,,###,Inpatient,,,46054,46054,Bright Health MGG,Bright Health MGG,46054,,,,,,,case rate,46054,46054,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Aetna,Aetna,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Aetna MGG,Aetna MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,BCBS,BCBS,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,BCBS MGG,BCBS MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Cigna,Cigna,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Cigna MGG,Cigna MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Humana,Humana,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Humana MGG,Humana MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Optum VA,Optum VA,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,UHC,UHC,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,UHC MGG,UHC MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,VA,VA,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Wellcare MGG,Wellcare MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Bright Health - commercial,Bright Health - commercial,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,83527,CPT,,,,Inpatient,,,49.98,49.98,Bright Health MGG,Bright Health MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Aetna,Aetna,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Aetna MGG,Aetna MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,BCBS,BCBS,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,BCBS MGG,BCBS MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Cigna,Cigna,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Cigna MGG,Cigna MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Humana,Humana,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Humana MGG,Humana MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Optum VA,Optum VA,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,UHC,UHC,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,UHC MGG,UHC MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,VA,VA,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Wellcare MGG,Wellcare MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Bright Health - commercial,Bright Health - commercial,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Bright Health MGG,Bright Health MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Aetna,Aetna,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Aetna MGG,Aetna MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,BCBS,BCBS,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,BCBS MGG,BCBS MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Cigna,Cigna,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Cigna MGG,Cigna MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Humana,Humana,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Humana MGG,Humana MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Optum VA,Optum VA,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,UHC,UHC,411.06,,,,,,,per diem,411.06,411.06,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,UHC MGG,UHC MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,VA,VA,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Wellcare MGG,Wellcare MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Bright Health - commercial,Bright Health - commercial,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,88368,CPT,,,,Inpatient,,,411.06,411.06,Bright Health MGG,Bright Health MGG,411.06,,,,,,,case rate,411.06,411.06,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Aetna,Aetna,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Aetna MGG,Aetna MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,BCBS,BCBS,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,BCBS MGG,BCBS MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Cigna,Cigna,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Cigna MGG,Cigna MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Humana,Humana,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Humana MGG,Humana MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Optum VA,Optum VA,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,UHC,UHC,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,UHC MGG,UHC MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,VA,VA,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Wellcare MGG,Wellcare MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Bright Health - commercial,Bright Health - commercial,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Bright Health MGG,Bright Health MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Aetna,Aetna,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Aetna MGG,Aetna MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,BCBS,BCBS,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,BCBS MGG,BCBS MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Cigna,Cigna,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Cigna MGG,Cigna MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Humana,Humana,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Humana MGG,Humana MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Optum VA,Optum VA,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,UHC,UHC,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,UHC MGG,UHC MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,VA,VA,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Wellcare MGG,Wellcare MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Bright Health - commercial,Bright Health - commercial,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Bright Health MGG,Bright Health MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Aetna,Aetna,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Aetna MGG,Aetna MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,BCBS,BCBS,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,BCBS MGG,BCBS MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Cigna,Cigna,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Cigna MGG,Cigna MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Humana,Humana,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Humana MGG,Humana MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Optum VA,Optum VA,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,UHC,UHC,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,UHC MGG,UHC MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,VA,VA,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Wellcare MGG,Wellcare MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Bright Health - commercial,Bright Health - commercial,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,88341,CPT,,,,Inpatient,,,321.3,321.3,Bright Health MGG,Bright Health MGG,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Aetna,Aetna,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Aetna MGG,Aetna MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,BCBS,BCBS,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,BCBS MGG,BCBS MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Cigna,Cigna,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Cigna MGG,Cigna MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Humana,Humana,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Humana MGG,Humana MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Optum VA,Optum VA,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,UHC,UHC,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,UHC MGG,UHC MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,VA,VA,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Wellcare MGG,Wellcare MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Bright Health - commercial,Bright Health - commercial,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,24.48,24.48,Bright Health MGG,Bright Health MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Aetna,Aetna,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Aetna MGG,Aetna MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,BCBS,BCBS,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,BCBS MGG,BCBS MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Cigna,Cigna,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Cigna MGG,Cigna MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Humana,Humana,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Humana MGG,Humana MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Optum VA,Optum VA,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,UHC,UHC,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,UHC MGG,UHC MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,VA,VA,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Wellcare MGG,Wellcare MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Bright Health - commercial,Bright Health - commercial,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,85445,CPT,,,,Inpatient,,,24.48,24.48,Bright Health MGG,Bright Health MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Aetna,Aetna,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Aetna MGG,Aetna MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,BCBS,BCBS,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,BCBS MGG,BCBS MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Cigna,Cigna,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Cigna MGG,Cigna MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Humana,Humana,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Humana MGG,Humana MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Optum VA,Optum VA,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,UHC,UHC,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,UHC MGG,UHC MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,VA,VA,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Wellcare MGG,Wellcare MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Bright Health - commercial,Bright Health - commercial,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,87290,CPT,,,,Inpatient,,,35.7,35.7,Bright Health MGG,Bright Health MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Aetna,Aetna,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Aetna MGG,Aetna MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,BCBS,BCBS,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,BCBS MGG,BCBS MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Cigna,Cigna,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Cigna MGG,Cigna MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Humana,Humana,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Humana MGG,Humana MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Optum VA,Optum VA,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,UHC,UHC,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,UHC MGG,UHC MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,VA,VA,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Wellcare MGG,Wellcare MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Bright Health - commercial,Bright Health - commercial,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Bright Health MGG,Bright Health MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Aetna,Aetna,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Aetna MGG,Aetna MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,BCBS,BCBS,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,BCBS MGG,BCBS MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Cigna,Cigna,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Cigna MGG,Cigna MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Humana,Humana,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Humana MGG,Humana MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Optum VA,Optum VA,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,UHC,UHC,239.7,,,,,,,per diem,239.7,239.7,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,UHC MGG,UHC MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,VA,VA,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Wellcare MGG,Wellcare MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Bright Health - commercial,Bright Health - commercial,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,86356,CPT,,,,Inpatient,,,239.7,239.7,Bright Health MGG,Bright Health MGG,239.7,,,,,,,case rate,239.7,239.7,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Aetna,Aetna,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Aetna MGG,Aetna MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,BCBS,BCBS,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,BCBS MGG,BCBS MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Cigna,Cigna,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Cigna MGG,Cigna MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Humana,Humana,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Humana MGG,Humana MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Optum VA,Optum VA,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,UHC,UHC,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,UHC MGG,UHC MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,VA,VA,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Wellcare MGG,Wellcare MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Bright Health - commercial,Bright Health - commercial,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Bright Health MGG,Bright Health MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Aetna,Aetna,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Aetna MGG,Aetna MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,BCBS,BCBS,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,BCBS MGG,BCBS MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Cigna,Cigna,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Cigna MGG,Cigna MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Humana,Humana,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Humana MGG,Humana MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Optum VA,Optum VA,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,UHC,UHC,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,UHC MGG,UHC MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,VA,VA,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Wellcare MGG,Wellcare MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Bright Health - commercial,Bright Health - commercial,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Bright Health MGG,Bright Health MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Aetna,Aetna,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Aetna MGG,Aetna MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,BCBS,BCBS,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,BCBS MGG,BCBS MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Cigna,Cigna,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Cigna MGG,Cigna MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Humana,Humana,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Humana MGG,Humana MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Optum VA,Optum VA,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,UHC,UHC,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,UHC MGG,UHC MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,VA,VA,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Wellcare MGG,Wellcare MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Bright Health - commercial,Bright Health - commercial,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,86336,CPT,,,,Inpatient,,,63.24,63.24,Bright Health MGG,Bright Health MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Aetna,Aetna,1018.98,,,,,,,per diem,1018.98,1018.98,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Aetna MGG,Aetna MGG,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,BCBS,BCBS,1018.98,,,,,,,per diem,1018.98,1018.98,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,BCBS MGG,BCBS MGG,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Cigna,Cigna,1018.98,,,,,,,per diem,1018.98,1018.98,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Cigna MGG,Cigna MGG,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Humana,Humana,1018.98,,,,,,,per diem,1018.98,1018.98,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Humana MGG,Humana MGG,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Optum VA,Optum VA,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,UHC,UHC,1018.98,,,,,,,per diem,1018.98,1018.98,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,UHC MGG,UHC MGG,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,VA,VA,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Wellcare MGG,Wellcare MGG,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Bright Health - commercial,Bright Health - commercial,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,81275,CPT,,,,Inpatient,,,1018.98,1018.98,Bright Health MGG,Bright Health MGG,1018.98,,,,,,,case rate,1018.98,1018.98,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Aetna,Aetna,265.2,,,,,,,per diem,265.2,265.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Aetna MGG,Aetna MGG,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,BCBS,BCBS,265.2,,,,,,,per diem,265.2,265.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,BCBS MGG,BCBS MGG,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Cigna,Cigna,265.2,,,,,,,per diem,265.2,265.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Cigna MGG,Cigna MGG,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Humana,Humana,265.2,,,,,,,per diem,265.2,265.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Humana MGG,Humana MGG,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Optum VA,Optum VA,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,UHC,UHC,265.2,,,,,,,per diem,265.2,265.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,UHC MGG,UHC MGG,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,VA,VA,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Wellcare MGG,Wellcare MGG,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Bright Health - commercial,Bright Health - commercial,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,88381,CPT,,,,Inpatient,,,265.2,265.2,Bright Health MGG,Bright Health MGG,265.2,,,,,,,case rate,265.2,265.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,81276,CPT,,,,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Aetna,Aetna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Aetna MGG,Aetna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,BCBS,BCBS,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,BCBS MGG,BCBS MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Cigna,Cigna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Cigna MGG,Cigna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Humana,Humana,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Humana MGG,Humana MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Optum VA,Optum VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,UHC,UHC,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,UHC MGG,UHC MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,VA,VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Wellcare MGG,Wellcare MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Bright Health - commercial,Bright Health - commercial,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,81301,CPT,,,,Inpatient,,,669.12,669.12,Bright Health MGG,Bright Health MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Aetna,Aetna,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Aetna MGG,Aetna MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,BCBS,BCBS,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,BCBS MGG,BCBS MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Cigna,Cigna,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Cigna MGG,Cigna MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Humana,Humana,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Humana MGG,Humana MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Optum VA,Optum VA,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,UHC,UHC,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,UHC MGG,UHC MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,VA,VA,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Wellcare MGG,Wellcare MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Bright Health - commercial,Bright Health - commercial,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Bright Health MGG,Bright Health MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Aetna,Aetna,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Aetna MGG,Aetna MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,BCBS,BCBS,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,BCBS MGG,BCBS MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Cigna,Cigna,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Cigna MGG,Cigna MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Humana,Humana,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Humana MGG,Humana MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Optum VA,Optum VA,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,UHC,UHC,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,UHC MGG,UHC MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,VA,VA,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Wellcare MGG,Wellcare MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Bright Health - commercial,Bright Health - commercial,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Bright Health MGG,Bright Health MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Aetna,Aetna,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Aetna MGG,Aetna MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,BCBS,BCBS,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,BCBS MGG,BCBS MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Cigna,Cigna,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Cigna MGG,Cigna MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Humana,Humana,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Humana MGG,Humana MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Optum VA,Optum VA,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,UHC,UHC,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,UHC MGG,UHC MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,VA,VA,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Wellcare MGG,Wellcare MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Bright Health - commercial,Bright Health - commercial,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Bright Health MGG,Bright Health MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Aetna,Aetna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Aetna MGG,Aetna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,BCBS,BCBS,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,BCBS MGG,BCBS MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Cigna,Cigna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Cigna MGG,Cigna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Humana,Humana,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Humana MGG,Humana MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Optum VA,Optum VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,UHC,UHC,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,UHC MGG,UHC MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,VA,VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Wellcare MGG,Wellcare MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Bright Health - commercial,Bright Health - commercial,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,81288,CPT,,,,Inpatient,,,200.94,200.94,Bright Health MGG,Bright Health MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Aetna,Aetna,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Aetna MGG,Aetna MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,BCBS,BCBS,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,BCBS MGG,BCBS MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Cigna,Cigna,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Cigna MGG,Cigna MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Humana,Humana,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Humana MGG,Humana MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Optum VA,Optum VA,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,UHC,UHC,849.66,,,,,,,per diem,849.66,849.66,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,UHC MGG,UHC MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,VA,VA,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Wellcare MGG,Wellcare MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Bright Health - commercial,Bright Health - commercial,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,81210,CPT,,,,Inpatient,,,849.66,849.66,Bright Health MGG,Bright Health MGG,849.66,,,,,,,case rate,849.66,849.66,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Aetna,Aetna,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Aetna MGG,Aetna MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,BCBS,BCBS,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,BCBS MGG,BCBS MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Cigna,Cigna,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Cigna MGG,Cigna MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Humana,Humana,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Humana MGG,Humana MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Optum VA,Optum VA,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,UHC,UHC,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,UHC MGG,UHC MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,VA,VA,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Wellcare MGG,Wellcare MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Bright Health - commercial,Bright Health - commercial,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,88381,CPT,,,,Inpatient,,,160.14,160.14,Bright Health MGG,Bright Health MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Aetna,Aetna,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Aetna MGG,Aetna MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,BCBS,BCBS,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,BCBS MGG,BCBS MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Cigna,Cigna,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Cigna MGG,Cigna MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Humana,Humana,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Humana MGG,Humana MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Optum VA,Optum VA,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,UHC,UHC,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,UHC MGG,UHC MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,VA,VA,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Wellcare MGG,Wellcare MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Bright Health - commercial,Bright Health - commercial,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,81206,CPT,,,,Inpatient,,,808.86,808.86,Bright Health MGG,Bright Health MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Aetna,Aetna,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Aetna MGG,Aetna MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,BCBS,BCBS,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,BCBS MGG,BCBS MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Cigna,Cigna,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Cigna MGG,Cigna MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Humana,Humana,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Humana MGG,Humana MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Optum VA,Optum VA,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,UHC,UHC,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,UHC MGG,UHC MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,VA,VA,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Wellcare MGG,Wellcare MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Bright Health - commercial,Bright Health - commercial,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,81207,CPT,,,,Inpatient,,,715.02,715.02,Bright Health MGG,Bright Health MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Aetna,Aetna,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Aetna MGG,Aetna MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,BCBS,BCBS,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,BCBS MGG,BCBS MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Cigna,Cigna,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Cigna MGG,Cigna MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Humana,Humana,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Humana MGG,Humana MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Optum VA,Optum VA,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,UHC,UHC,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,UHC MGG,UHC MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,VA,VA,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Wellcare MGG,Wellcare MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Bright Health - commercial,Bright Health - commercial,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,81206,CPT,,,,Inpatient,,,302.94,302.94,Bright Health MGG,Bright Health MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Aetna,Aetna,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Aetna MGG,Aetna MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,BCBS,BCBS,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,BCBS MGG,BCBS MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Cigna,Cigna,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Cigna MGG,Cigna MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Humana,Humana,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Humana MGG,Humana MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Optum VA,Optum VA,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,UHC,UHC,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,UHC MGG,UHC MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,VA,VA,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Wellcare MGG,Wellcare MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Bright Health - commercial,Bright Health - commercial,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,81207,CPT,,,,Inpatient,,,302.94,302.94,Bright Health MGG,Bright Health MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna,Aetna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna MGG,Aetna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS,BCBS,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS MGG,BCBS MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna,Cigna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna MGG,Cigna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana,Humana,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana MGG,Humana MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Optum VA,Optum VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC,UHC,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC MGG,UHC MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,VA,VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Wellcare MGG,Wellcare MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health - commercial,Bright Health - commercial,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health MGG,Bright Health MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna,Aetna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna MGG,Aetna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS,BCBS,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS MGG,BCBS MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna,Cigna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna MGG,Cigna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana,Humana,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana MGG,Humana MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Optum VA,Optum VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC,UHC,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC MGG,UHC MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,VA,VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Wellcare MGG,Wellcare MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health - commercial,Bright Health - commercial,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health MGG,Bright Health MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna,Aetna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna MGG,Aetna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS,BCBS,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS MGG,BCBS MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna,Cigna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna MGG,Cigna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana,Humana,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana MGG,Humana MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Optum VA,Optum VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC,UHC,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC MGG,UHC MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,VA,VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Wellcare MGG,Wellcare MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health - commercial,Bright Health - commercial,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health MGG,Bright Health MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna,Aetna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna MGG,Aetna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS,BCBS,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS MGG,BCBS MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna,Cigna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna MGG,Cigna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana,Humana,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana MGG,Humana MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Optum VA,Optum VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC,UHC,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC MGG,UHC MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,VA,VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Wellcare MGG,Wellcare MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health - commercial,Bright Health - commercial,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health MGG,Bright Health MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna,Aetna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Aetna MGG,Aetna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS,BCBS,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,BCBS MGG,BCBS MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna,Cigna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Cigna MGG,Cigna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana,Humana,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Humana MGG,Humana MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Optum VA,Optum VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC,UHC,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,UHC MGG,UHC MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,VA,VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Wellcare MGG,Wellcare MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health - commercial,Bright Health - commercial,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,88275,CPT,,,,Inpatient,,,133.62,133.62,Bright Health MGG,Bright Health MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Aetna,Aetna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Aetna MGG,Aetna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,BCBS,BCBS,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,BCBS MGG,BCBS MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Cigna,Cigna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Cigna MGG,Cigna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Humana,Humana,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Humana MGG,Humana MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Optum VA,Optum VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,UHC,UHC,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,UHC MGG,UHC MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,VA,VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Wellcare MGG,Wellcare MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Bright Health - commercial,Bright Health - commercial,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,88291,CPT,,,,Inpatient,,,143.82,143.82,Bright Health MGG,Bright Health MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Aetna,Aetna,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Aetna MGG,Aetna MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,BCBS,BCBS,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,BCBS MGG,BCBS MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Cigna,Cigna,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Cigna MGG,Cigna MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Humana,Humana,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Humana MGG,Humana MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Optum VA,Optum VA,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,UHC,UHC,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,UHC MGG,UHC MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,VA,VA,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Wellcare MGG,Wellcare MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Bright Health - commercial,Bright Health - commercial,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,81261,CPT,,,,Inpatient,,,471.24,471.24,Bright Health MGG,Bright Health MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Aetna,Aetna,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Aetna MGG,Aetna MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,BCBS,BCBS,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,BCBS MGG,BCBS MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Cigna,Cigna,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Cigna MGG,Cigna MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Humana,Humana,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Humana MGG,Humana MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Optum VA,Optum VA,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,UHC,UHC,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,UHC MGG,UHC MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,VA,VA,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Wellcare MGG,Wellcare MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Bright Health - commercial,Bright Health - commercial,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,81264,CPT,,,,Inpatient,,,471.24,471.24,Bright Health MGG,Bright Health MGG,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Aetna,Aetna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Aetna MGG,Aetna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,BCBS,BCBS,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,BCBS MGG,BCBS MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Cigna,Cigna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Cigna MGG,Cigna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Humana,Humana,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Humana MGG,Humana MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Optum VA,Optum VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,UHC,UHC,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,UHC MGG,UHC MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,VA,VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Wellcare MGG,Wellcare MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Bright Health - commercial,Bright Health - commercial,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,81405,CPT,,,,Inpatient,,,433.5,433.5,Bright Health MGG,Bright Health MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Aetna,Aetna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Aetna MGG,Aetna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,BCBS,BCBS,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,BCBS MGG,BCBS MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Cigna,Cigna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Cigna MGG,Cigna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Humana,Humana,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Humana MGG,Humana MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Optum VA,Optum VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,UHC,UHC,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,UHC MGG,UHC MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,VA,VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Wellcare MGG,Wellcare MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Bright Health - commercial,Bright Health - commercial,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,81406,CPT,,,,Inpatient,,,433.5,433.5,Bright Health MGG,Bright Health MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Aetna,Aetna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Aetna MGG,Aetna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,BCBS,BCBS,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,BCBS MGG,BCBS MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Cigna,Cigna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Cigna MGG,Cigna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Humana,Humana,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Humana MGG,Humana MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Optum VA,Optum VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,UHC,UHC,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,UHC MGG,UHC MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,VA,VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Wellcare MGG,Wellcare MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Bright Health - commercial,Bright Health - commercial,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,81403,CPT,,,,Inpatient,,,433.5,433.5,Bright Health MGG,Bright Health MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Aetna,Aetna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Aetna MGG,Aetna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,BCBS,BCBS,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,BCBS MGG,BCBS MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Cigna,Cigna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Cigna MGG,Cigna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Humana,Humana,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Humana MGG,Humana MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Optum VA,Optum VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,UHC,UHC,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,UHC MGG,UHC MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,VA,VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Wellcare MGG,Wellcare MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Bright Health - commercial,Bright Health - commercial,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,81407,CPT,,,,Inpatient,,,433.5,433.5,Bright Health MGG,Bright Health MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Aetna,Aetna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Aetna MGG,Aetna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,BCBS,BCBS,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,BCBS MGG,BCBS MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Cigna,Cigna,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Cigna MGG,Cigna MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Humana,Humana,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Humana MGG,Humana MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Optum VA,Optum VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,UHC,UHC,433.5,,,,,,,per diem,433.5,433.5,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,UHC MGG,UHC MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,VA,VA,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Wellcare MGG,Wellcare MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Bright Health - commercial,Bright Health - commercial,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,81404,CPT,,,,Inpatient,,,433.5,433.5,Bright Health MGG,Bright Health MGG,433.5,,,,,,,case rate,433.5,433.5,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Aetna,Aetna,402.9,,,,,,,per diem,402.9,402.9,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Aetna MGG,Aetna MGG,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,BCBS,BCBS,402.9,,,,,,,per diem,402.9,402.9,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,BCBS MGG,BCBS MGG,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Cigna,Cigna,402.9,,,,,,,per diem,402.9,402.9,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Cigna MGG,Cigna MGG,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Humana,Humana,402.9,,,,,,,per diem,402.9,402.9,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Humana MGG,Humana MGG,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Optum VA,Optum VA,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,UHC,UHC,402.9,,,,,,,per diem,402.9,402.9,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,UHC MGG,UHC MGG,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,VA,VA,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Wellcare MGG,Wellcare MGG,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Bright Health - commercial,Bright Health - commercial,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,81479,CPT,,,,Inpatient,,,402.9,402.9,Bright Health MGG,Bright Health MGG,402.9,,,,,,,case rate,402.9,402.9,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Aetna,Aetna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Aetna MGG,Aetna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,BCBS,BCBS,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,BCBS MGG,BCBS MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Cigna,Cigna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Cigna MGG,Cigna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Humana,Humana,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Humana MGG,Humana MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Optum VA,Optum VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,UHC,UHC,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,UHC MGG,UHC MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,VA,VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Wellcare MGG,Wellcare MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Bright Health - commercial,Bright Health - commercial,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,83789,CPT,,,,Inpatient,,,598.74,598.74,Bright Health MGG,Bright Health MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Aetna,Aetna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Aetna MGG,Aetna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,BCBS,BCBS,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,BCBS MGG,BCBS MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Cigna,Cigna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Cigna MGG,Cigna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Humana,Humana,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Humana MGG,Humana MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Optum VA,Optum VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,UHC,UHC,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,UHC MGG,UHC MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,VA,VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Wellcare MGG,Wellcare MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Bright Health - commercial,Bright Health - commercial,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,88230,CPT,,,,Inpatient,,,143.82,143.82,Bright Health MGG,Bright Health MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Aetna,Aetna,911.88,,,,,,,per diem,911.88,911.88,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Aetna MGG,Aetna MGG,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,BCBS,BCBS,911.88,,,,,,,per diem,911.88,911.88,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,BCBS MGG,BCBS MGG,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Cigna,Cigna,911.88,,,,,,,per diem,911.88,911.88,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Cigna MGG,Cigna MGG,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Humana,Humana,911.88,,,,,,,per diem,911.88,911.88,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Humana MGG,Humana MGG,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Optum VA,Optum VA,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,UHC,UHC,911.88,,,,,,,per diem,911.88,911.88,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,UHC MGG,UHC MGG,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,VA,VA,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Wellcare MGG,Wellcare MGG,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Bright Health - commercial,Bright Health - commercial,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,88291,CPT,,,,Inpatient,,,911.88,911.88,Bright Health MGG,Bright Health MGG,911.88,,,,,,,case rate,911.88,911.88,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Aetna,Aetna,6366.84,,,,,,,per diem,6366.84,6366.84,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Aetna MGG,Aetna MGG,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,BCBS,BCBS,6366.84,,,,,,,per diem,6366.84,6366.84,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,BCBS MGG,BCBS MGG,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Cigna,Cigna,6366.84,,,,,,,per diem,6366.84,6366.84,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Cigna MGG,Cigna MGG,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Humana,Humana,6366.84,,,,,,,per diem,6366.84,6366.84,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Humana MGG,Humana MGG,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Optum VA,Optum VA,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,UHC,UHC,6366.84,,,,,,,per diem,6366.84,6366.84,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,UHC MGG,UHC MGG,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,VA,VA,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Wellcare MGG,Wellcare MGG,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Bright Health - commercial,Bright Health - commercial,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,81229,CPT,,,,Inpatient,,,6366.84,6366.84,Bright Health MGG,Bright Health MGG,6366.84,,,,,,,case rate,6366.84,6366.84,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna,Aetna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna MGG,Aetna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS,BCBS,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS MGG,BCBS MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna,Cigna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna MGG,Cigna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana,Humana,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana MGG,Humana MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Optum VA,Optum VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC,UHC,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC MGG,UHC MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,VA,VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Wellcare MGG,Wellcare MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health - commercial,Bright Health - commercial,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health MGG,Bright Health MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna,Aetna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna MGG,Aetna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS,BCBS,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS MGG,BCBS MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna,Cigna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna MGG,Cigna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana,Humana,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana MGG,Humana MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Optum VA,Optum VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC,UHC,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC MGG,UHC MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,VA,VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Wellcare MGG,Wellcare MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health - commercial,Bright Health - commercial,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health MGG,Bright Health MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna,Aetna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna MGG,Aetna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS,BCBS,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS MGG,BCBS MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna,Cigna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna MGG,Cigna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana,Humana,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana MGG,Humana MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Optum VA,Optum VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC,UHC,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC MGG,UHC MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,VA,VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Wellcare MGG,Wellcare MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health - commercial,Bright Health - commercial,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health MGG,Bright Health MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna,Aetna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna MGG,Aetna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS,BCBS,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS MGG,BCBS MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna,Cigna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna MGG,Cigna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana,Humana,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana MGG,Humana MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Optum VA,Optum VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC,UHC,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC MGG,UHC MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,VA,VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Wellcare MGG,Wellcare MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health - commercial,Bright Health - commercial,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health MGG,Bright Health MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna,Aetna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Aetna MGG,Aetna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS,BCBS,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,BCBS MGG,BCBS MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna,Cigna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Cigna MGG,Cigna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana,Humana,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Humana MGG,Humana MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Optum VA,Optum VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC,UHC,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,UHC MGG,UHC MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,VA,VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Wellcare MGG,Wellcare MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health - commercial,Bright Health - commercial,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,P9012,CPT,,,,Inpatient,,,343.74,343.74,Bright Health MGG,Bright Health MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Aetna,Aetna,242.76,,,,,,,per diem,242.76,242.76,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Aetna MGG,Aetna MGG,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,BCBS,BCBS,242.76,,,,,,,per diem,242.76,242.76,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,BCBS MGG,BCBS MGG,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Cigna,Cigna,242.76,,,,,,,per diem,242.76,242.76,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Cigna MGG,Cigna MGG,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Humana,Humana,242.76,,,,,,,per diem,242.76,242.76,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Humana MGG,Humana MGG,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Optum VA,Optum VA,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,UHC,UHC,242.76,,,,,,,per diem,242.76,242.76,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,UHC MGG,UHC MGG,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,VA,VA,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Wellcare MGG,Wellcare MGG,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Bright Health - commercial,Bright Health - commercial,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,81240,CPT,,,,Inpatient,,,242.76,242.76,Bright Health MGG,Bright Health MGG,242.76,,,,,,,case rate,242.76,242.76,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Aetna,Aetna,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Aetna MGG,Aetna MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,BCBS,BCBS,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,BCBS MGG,BCBS MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Cigna,Cigna,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Cigna MGG,Cigna MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Humana,Humana,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Humana MGG,Humana MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Optum VA,Optum VA,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,UHC,UHC,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,UHC MGG,UHC MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,VA,VA,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Wellcare MGG,Wellcare MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Bright Health - commercial,Bright Health - commercial,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,81241,CPT,,,,Inpatient,,,301.92,301.92,Bright Health MGG,Bright Health MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Aetna,Aetna,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Aetna MGG,Aetna MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,BCBS,BCBS,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,BCBS MGG,BCBS MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Cigna,Cigna,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Cigna MGG,Cigna MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Humana,Humana,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Humana MGG,Humana MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Optum VA,Optum VA,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,UHC,UHC,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,UHC MGG,UHC MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,VA,VA,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Wellcare MGG,Wellcare MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Bright Health - commercial,Bright Health - commercial,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,85525,CPT,,,,Inpatient,,,52.02,52.02,Bright Health MGG,Bright Health MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,85597,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Aetna,Aetna,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Aetna MGG,Aetna MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,BCBS,BCBS,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,BCBS MGG,BCBS MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Cigna,Cigna,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Cigna MGG,Cigna MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Humana,Humana,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Humana MGG,Humana MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Optum VA,Optum VA,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,UHC,UHC,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,UHC MGG,UHC MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,VA,VA,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Wellcare MGG,Wellcare MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Bright Health - commercial,Bright Health - commercial,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,85598,CPT,,,,Inpatient,,,150.96,150.96,Bright Health MGG,Bright Health MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Aetna,Aetna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Aetna MGG,Aetna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,BCBS,BCBS,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,BCBS MGG,BCBS MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Cigna,Cigna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Cigna MGG,Cigna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Humana,Humana,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Humana MGG,Humana MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Optum VA,Optum VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,UHC,UHC,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,UHC MGG,UHC MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,VA,VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Wellcare MGG,Wellcare MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Bright Health - commercial,Bright Health - commercial,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,S3620,CPT,,,,Inpatient,,,141.78,141.78,Bright Health MGG,Bright Health MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Aetna,Aetna,202.98,,,,,,,per diem,202.98,202.98,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Aetna MGG,Aetna MGG,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,BCBS,BCBS,202.98,,,,,,,per diem,202.98,202.98,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,BCBS MGG,BCBS MGG,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Cigna,Cigna,202.98,,,,,,,per diem,202.98,202.98,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Cigna MGG,Cigna MGG,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Humana,Humana,202.98,,,,,,,per diem,202.98,202.98,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Humana MGG,Humana MGG,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Optum VA,Optum VA,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,UHC,UHC,202.98,,,,,,,per diem,202.98,202.98,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,UHC MGG,UHC MGG,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,VA,VA,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Wellcare MGG,Wellcare MGG,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Bright Health - commercial,Bright Health - commercial,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,83033,CPT,,,,Inpatient,,,202.98,202.98,Bright Health MGG,Bright Health MGG,202.98,,,,,,,case rate,202.98,202.98,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Aetna,Aetna,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Aetna MGG,Aetna MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,BCBS,BCBS,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,BCBS MGG,BCBS MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Cigna,Cigna,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Cigna MGG,Cigna MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Humana,Humana,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Humana MGG,Humana MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Optum VA,Optum VA,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,UHC,UHC,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,UHC MGG,UHC MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,VA,VA,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Wellcare MGG,Wellcare MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Bright Health - commercial,Bright Health - commercial,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,81379,CPT,,,,Inpatient,,,2695.86,2695.86,Bright Health MGG,Bright Health MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Aetna,Aetna,886.38,,,,,,,per diem,886.38,886.38,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Aetna MGG,Aetna MGG,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,BCBS,BCBS,886.38,,,,,,,per diem,886.38,886.38,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,BCBS MGG,BCBS MGG,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Cigna,Cigna,886.38,,,,,,,per diem,886.38,886.38,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Cigna MGG,Cigna MGG,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Humana,Humana,886.38,,,,,,,per diem,886.38,886.38,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Humana MGG,Humana MGG,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Optum VA,Optum VA,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,UHC,UHC,886.38,,,,,,,per diem,886.38,886.38,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,UHC MGG,UHC MGG,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,VA,VA,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Wellcare MGG,Wellcare MGG,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Bright Health - commercial,Bright Health - commercial,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,81382,CPT,,,,Inpatient,,,886.38,886.38,Bright Health MGG,Bright Health MGG,886.38,,,,,,,case rate,886.38,886.38,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Aetna,Aetna,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Aetna MGG,Aetna MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,BCBS,BCBS,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,BCBS MGG,BCBS MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Cigna,Cigna,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Cigna MGG,Cigna MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Humana,Humana,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Humana MGG,Humana MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Optum VA,Optum VA,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,UHC,UHC,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,UHC MGG,UHC MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,VA,VA,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Wellcare MGG,Wellcare MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Bright Health - commercial,Bright Health - commercial,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,83664,CPT,,,,Inpatient,,,194.82,194.82,Bright Health MGG,Bright Health MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Aetna,Aetna,584.46,,,,,,,per diem,584.46,584.46,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Aetna MGG,Aetna MGG,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,BCBS,BCBS,584.46,,,,,,,per diem,584.46,584.46,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,BCBS MGG,BCBS MGG,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Cigna,Cigna,584.46,,,,,,,per diem,584.46,584.46,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Cigna MGG,Cigna MGG,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Humana,Humana,584.46,,,,,,,per diem,584.46,584.46,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Humana MGG,Humana MGG,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Optum VA,Optum VA,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,UHC,UHC,584.46,,,,,,,per diem,584.46,584.46,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,UHC MGG,UHC MGG,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,VA,VA,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Wellcare MGG,Wellcare MGG,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Bright Health - commercial,Bright Health - commercial,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,86828,CPT,,,,Inpatient,,,584.46,584.46,Bright Health MGG,Bright Health MGG,584.46,,,,,,,case rate,584.46,584.46,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Aetna,Aetna,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Aetna MGG,Aetna MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,BCBS,BCBS,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,BCBS MGG,BCBS MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Cigna,Cigna,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Cigna MGG,Cigna MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Humana,Humana,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Humana MGG,Humana MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Optum VA,Optum VA,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,UHC,UHC,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,UHC MGG,UHC MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,VA,VA,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Wellcare MGG,Wellcare MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Bright Health - commercial,Bright Health - commercial,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,S3620,CPT,,,,Inpatient,,,110.16,110.16,Bright Health MGG,Bright Health MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Aetna,Aetna,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Aetna MGG,Aetna MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,BCBS,BCBS,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,BCBS MGG,BCBS MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Cigna,Cigna,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Cigna MGG,Cigna MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Humana,Humana,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Humana MGG,Humana MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Optum VA,Optum VA,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,UHC,UHC,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,UHC MGG,UHC MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,VA,VA,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Wellcare MGG,Wellcare MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Bright Health - commercial,Bright Health - commercial,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,S3620,CPT,,,,Inpatient,,,122.4,122.4,Bright Health MGG,Bright Health MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Aetna,Aetna,1285.2,,,,,,,per diem,1285.2,1285.2,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Aetna MGG,Aetna MGG,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,BCBS,BCBS,1285.2,,,,,,,per diem,1285.2,1285.2,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,BCBS MGG,BCBS MGG,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Cigna,Cigna,1285.2,,,,,,,per diem,1285.2,1285.2,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Cigna MGG,Cigna MGG,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Humana,Humana,1285.2,,,,,,,per diem,1285.2,1285.2,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Humana MGG,Humana MGG,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Optum VA,Optum VA,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,UHC,UHC,1285.2,,,,,,,per diem,1285.2,1285.2,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,UHC MGG,UHC MGG,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,VA,VA,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Wellcare MGG,Wellcare MGG,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Bright Health - commercial,Bright Health - commercial,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,88230,CPT,,,,Inpatient,,,1285.2,1285.2,Bright Health MGG,Bright Health MGG,1285.2,,,,,,,case rate,1285.2,1285.2,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Aetna,Aetna,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Aetna MGG,Aetna MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,BCBS,BCBS,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,BCBS MGG,BCBS MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Cigna,Cigna,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Cigna MGG,Cigna MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Humana,Humana,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Humana MGG,Humana MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Optum VA,Optum VA,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,UHC,UHC,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,UHC MGG,UHC MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,VA,VA,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Wellcare MGG,Wellcare MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Bright Health - commercial,Bright Health - commercial,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,88267,CPT,,,,Inpatient,,,1193.4,1193.4,Bright Health MGG,Bright Health MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Aetna,Aetna,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Aetna MGG,Aetna MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,BCBS,BCBS,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,BCBS MGG,BCBS MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Cigna,Cigna,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Cigna MGG,Cigna MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Humana,Humana,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Humana MGG,Humana MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Optum VA,Optum VA,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,UHC,UHC,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,UHC MGG,UHC MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,VA,VA,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Wellcare MGG,Wellcare MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Bright Health - commercial,Bright Health - commercial,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,88235,CPT,,,,Inpatient,,,1193.4,1193.4,Bright Health MGG,Bright Health MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Aetna,Aetna,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Aetna MGG,Aetna MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,BCBS,BCBS,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,BCBS MGG,BCBS MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Cigna,Cigna,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Cigna MGG,Cigna MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Humana,Humana,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Humana MGG,Humana MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Optum VA,Optum VA,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,UHC,UHC,1193.4,,,,,,,per diem,1193.4,1193.4,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,UHC MGG,UHC MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,VA,VA,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Wellcare MGG,Wellcare MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Bright Health - commercial,Bright Health - commercial,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,88280,CPT,,,,Inpatient,,,1193.4,1193.4,Bright Health MGG,Bright Health MGG,1193.4,,,,,,,case rate,1193.4,1193.4,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Aetna,Aetna,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Aetna MGG,Aetna MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,BCBS,BCBS,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,BCBS MGG,BCBS MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Cigna,Cigna,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Cigna MGG,Cigna MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Humana,Humana,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Humana MGG,Humana MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Optum VA,Optum VA,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,UHC,UHC,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,UHC MGG,UHC MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,VA,VA,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Wellcare MGG,Wellcare MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Bright Health - commercial,Bright Health - commercial,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,88239,CPT,,,,Inpatient,,,972.06,972.06,Bright Health MGG,Bright Health MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Aetna,Aetna,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Aetna MGG,Aetna MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,BCBS,BCBS,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,BCBS MGG,BCBS MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Cigna,Cigna,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Cigna MGG,Cigna MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Humana,Humana,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Humana MGG,Humana MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Optum VA,Optum VA,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,UHC,UHC,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,UHC MGG,UHC MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,VA,VA,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Wellcare MGG,Wellcare MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Bright Health - commercial,Bright Health - commercial,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Bright Health MGG,Bright Health MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Aetna,Aetna,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Aetna MGG,Aetna MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,BCBS,BCBS,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,BCBS MGG,BCBS MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Cigna,Cigna,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Cigna MGG,Cigna MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Humana,Humana,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Humana MGG,Humana MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Optum VA,Optum VA,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,UHC,UHC,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,UHC MGG,UHC MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,VA,VA,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Wellcare MGG,Wellcare MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Bright Health - commercial,Bright Health - commercial,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,88230,CPT,,,,Inpatient,,,163.2,163.2,Bright Health MGG,Bright Health MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Aetna,Aetna,144.84,,,,,,,per diem,144.84,144.84,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Aetna MGG,Aetna MGG,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,BCBS,BCBS,144.84,,,,,,,per diem,144.84,144.84,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,BCBS MGG,BCBS MGG,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Cigna,Cigna,144.84,,,,,,,per diem,144.84,144.84,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Cigna MGG,Cigna MGG,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Humana,Humana,144.84,,,,,,,per diem,144.84,144.84,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Humana MGG,Humana MGG,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Optum VA,Optum VA,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,UHC,UHC,144.84,,,,,,,per diem,144.84,144.84,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,UHC MGG,UHC MGG,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,VA,VA,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Wellcare MGG,Wellcare MGG,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Bright Health - commercial,Bright Health - commercial,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,88273,CPT,,,,Inpatient,,,144.84,144.84,Bright Health MGG,Bright Health MGG,144.84,,,,,,,case rate,144.84,144.84,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Aetna,Aetna,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Aetna MGG,Aetna MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,BCBS,BCBS,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,BCBS MGG,BCBS MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Cigna,Cigna,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Cigna MGG,Cigna MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Humana,Humana,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Humana MGG,Humana MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Optum VA,Optum VA,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,UHC,UHC,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,UHC MGG,UHC MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,VA,VA,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Wellcare MGG,Wellcare MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Bright Health - commercial,Bright Health - commercial,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Bright Health MGG,Bright Health MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Aetna,Aetna,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Aetna MGG,Aetna MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,BCBS,BCBS,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,BCBS MGG,BCBS MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Cigna,Cigna,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Cigna MGG,Cigna MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Humana,Humana,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Humana MGG,Humana MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Optum VA,Optum VA,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,UHC,UHC,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,UHC MGG,UHC MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,VA,VA,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Wellcare MGG,Wellcare MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Bright Health - commercial,Bright Health - commercial,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,84485,CPT,,,,Inpatient,,,118.32,118.32,Bright Health MGG,Bright Health MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Aetna,Aetna,159.12,,,,,,,per diem,159.12,159.12,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Aetna MGG,Aetna MGG,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,BCBS,BCBS,159.12,,,,,,,per diem,159.12,159.12,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,BCBS MGG,BCBS MGG,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Cigna,Cigna,159.12,,,,,,,per diem,159.12,159.12,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Cigna MGG,Cigna MGG,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Humana,Humana,159.12,,,,,,,per diem,159.12,159.12,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Humana MGG,Humana MGG,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Optum VA,Optum VA,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,UHC,UHC,159.12,,,,,,,per diem,159.12,159.12,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,UHC MGG,UHC MGG,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,VA,VA,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Wellcare MGG,Wellcare MGG,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Bright Health - commercial,Bright Health - commercial,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,88273,CPT,,,,Inpatient,,,159.12,159.12,Bright Health MGG,Bright Health MGG,159.12,,,,,,,case rate,159.12,159.12,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Aetna,Aetna,645.66,,,,,,,per diem,645.66,645.66,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Aetna MGG,Aetna MGG,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,BCBS,BCBS,645.66,,,,,,,per diem,645.66,645.66,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,BCBS MGG,BCBS MGG,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Cigna,Cigna,645.66,,,,,,,per diem,645.66,645.66,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Cigna MGG,Cigna MGG,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Humana,Humana,645.66,,,,,,,per diem,645.66,645.66,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Humana MGG,Humana MGG,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Optum VA,Optum VA,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,UHC,UHC,645.66,,,,,,,per diem,645.66,645.66,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,UHC MGG,UHC MGG,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,VA,VA,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Wellcare MGG,Wellcare MGG,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Bright Health - commercial,Bright Health - commercial,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,88230,CPT,,,,Inpatient,,,645.66,645.66,Bright Health MGG,Bright Health MGG,645.66,,,,,,,case rate,645.66,645.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Aetna,Aetna,3076.32,,,,,,,per diem,3076.32,3076.32,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Aetna MGG,Aetna MGG,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,BCBS,BCBS,3076.32,,,,,,,per diem,3076.32,3076.32,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,BCBS MGG,BCBS MGG,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Cigna,Cigna,3076.32,,,,,,,per diem,3076.32,3076.32,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Cigna MGG,Cigna MGG,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Humana,Humana,3076.32,,,,,,,per diem,3076.32,3076.32,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Humana MGG,Humana MGG,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Optum VA,Optum VA,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,UHC,UHC,3076.32,,,,,,,per diem,3076.32,3076.32,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,UHC MGG,UHC MGG,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,VA,VA,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Wellcare MGG,Wellcare MGG,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Bright Health - commercial,Bright Health - commercial,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,88230,CPT,,,,Inpatient,,,3076.32,3076.32,Bright Health MGG,Bright Health MGG,3076.32,,,,,,,case rate,3076.32,3076.32,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Aetna,Aetna,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Aetna MGG,Aetna MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,BCBS,BCBS,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,BCBS MGG,BCBS MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Cigna,Cigna,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Cigna MGG,Cigna MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Humana,Humana,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Humana MGG,Humana MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Optum VA,Optum VA,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,UHC,UHC,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,UHC MGG,UHC MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,VA,VA,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Wellcare MGG,Wellcare MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Bright Health - commercial,Bright Health - commercial,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,88289,CPT,,,,Inpatient,,,76.5,76.5,Bright Health MGG,Bright Health MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Aetna,Aetna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Aetna MGG,Aetna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,BCBS,BCBS,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,BCBS MGG,BCBS MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Cigna,Cigna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Cigna MGG,Cigna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Humana,Humana,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Humana MGG,Humana MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Optum VA,Optum VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,UHC,UHC,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,UHC MGG,UHC MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,VA,VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Wellcare MGG,Wellcare MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Bright Health - commercial,Bright Health - commercial,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Bright Health MGG,Bright Health MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Aetna,Aetna,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Aetna MGG,Aetna MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,BCBS,BCBS,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,BCBS MGG,BCBS MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Cigna,Cigna,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Cigna MGG,Cigna MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Humana,Humana,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Humana MGG,Humana MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Optum VA,Optum VA,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,UHC,UHC,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,UHC MGG,UHC MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,VA,VA,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Wellcare MGG,Wellcare MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Bright Health - commercial,Bright Health - commercial,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,85347,CPT,,,,Inpatient,,,77.52,77.52,Bright Health MGG,Bright Health MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Aetna,Aetna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Aetna MGG,Aetna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,BCBS,BCBS,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,BCBS MGG,BCBS MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Cigna,Cigna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Cigna MGG,Cigna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Humana,Humana,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Humana MGG,Humana MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Optum VA,Optum VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,UHC,UHC,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,UHC MGG,UHC MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,VA,VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Wellcare MGG,Wellcare MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Bright Health - commercial,Bright Health - commercial,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,85390,CPT,,,,Inpatient,,,73.44,73.44,Bright Health MGG,Bright Health MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Aetna,Aetna,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Aetna MGG,Aetna MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,BCBS,BCBS,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,BCBS MGG,BCBS MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Cigna,Cigna,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Cigna MGG,Cigna MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Humana,Humana,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Humana MGG,Humana MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Optum VA,Optum VA,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,UHC,UHC,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,UHC MGG,UHC MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,VA,VA,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Wellcare MGG,Wellcare MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Bright Health - commercial,Bright Health - commercial,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,81244,CPT,,,,Inpatient,,,325.38,325.38,Bright Health MGG,Bright Health MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Aetna,Aetna,475.15,,,,,,,per diem,475.15,475.15,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Aetna MGG,Aetna MGG,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,BCBS,BCBS,475.15,,,,,,,per diem,475.15,475.15,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,BCBS MGG,BCBS MGG,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Cigna,Cigna,475.15,,,,,,,per diem,475.15,475.15,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Cigna MGG,Cigna MGG,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Humana,Humana,475.15,,,,,,,per diem,475.15,475.15,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Humana MGG,Humana MGG,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Optum VA,Optum VA,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,UHC,UHC,475.15,,,,,,,per diem,475.15,475.15,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,UHC MGG,UHC MGG,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,VA,VA,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Wellcare MGG,Wellcare MGG,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Bright Health - commercial,Bright Health - commercial,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,P9040,CPT,,,,Inpatient,,,475.15,475.15,Bright Health MGG,Bright Health MGG,475.15,,,,,,,case rate,475.15,475.15,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Aetna,Aetna,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Aetna MGG,Aetna MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,BCBS,BCBS,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,BCBS MGG,BCBS MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Cigna,Cigna,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Cigna MGG,Cigna MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Humana,Humana,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Humana MGG,Humana MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Optum VA,Optum VA,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,UHC,UHC,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,UHC MGG,UHC MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,VA,VA,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Wellcare MGG,Wellcare MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Bright Health - commercial,Bright Health - commercial,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,87341,CPT,,,,Inpatient,,,46.92,46.92,Bright Health MGG,Bright Health MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Aetna,Aetna,43.86,,,,,,,per diem,43.86,43.86,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Aetna MGG,Aetna MGG,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,BCBS,BCBS,43.86,,,,,,,per diem,43.86,43.86,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,BCBS MGG,BCBS MGG,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Cigna,Cigna,43.86,,,,,,,per diem,43.86,43.86,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Cigna MGG,Cigna MGG,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Humana,Humana,43.86,,,,,,,per diem,43.86,43.86,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Humana MGG,Humana MGG,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Optum VA,Optum VA,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,UHC,UHC,43.86,,,,,,,per diem,43.86,43.86,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,UHC MGG,UHC MGG,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,VA,VA,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Wellcare MGG,Wellcare MGG,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Bright Health - commercial,Bright Health - commercial,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,85301,CPT,,,,Inpatient,,,43.86,43.86,Bright Health MGG,Bright Health MGG,43.86,,,,,,,case rate,43.86,43.86,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Aetna,Aetna,1556.61,,,,,,,per diem,1556.61,1556.61,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Aetna MGG,Aetna MGG,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,BCBS,BCBS,1556.61,,,,,,,per diem,1556.61,1556.61,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,BCBS MGG,BCBS MGG,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Cigna,Cigna,1556.61,,,,,,,per diem,1556.61,1556.61,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Cigna MGG,Cigna MGG,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Humana,Humana,1556.61,,,,,,,per diem,1556.61,1556.61,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Humana MGG,Humana MGG,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Optum VA,Optum VA,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,UHC,UHC,1556.61,,,,,,,per diem,1556.61,1556.61,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,UHC MGG,UHC MGG,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,VA,VA,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Wellcare MGG,Wellcare MGG,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Bright Health - commercial,Bright Health - commercial,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,P9035,CPT,,,,Inpatient,,,1556.61,1556.61,Bright Health MGG,Bright Health MGG,1556.61,,,,,,,case rate,1556.61,1556.61,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Aetna,Aetna,322.66,,,,,,,per diem,322.66,322.66,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Aetna MGG,Aetna MGG,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,BCBS,BCBS,322.66,,,,,,,per diem,322.66,322.66,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,BCBS MGG,BCBS MGG,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Cigna,Cigna,322.66,,,,,,,per diem,322.66,322.66,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Cigna MGG,Cigna MGG,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Humana,Humana,322.66,,,,,,,per diem,322.66,322.66,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Humana MGG,Humana MGG,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Optum VA,Optum VA,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,UHC,UHC,322.66,,,,,,,per diem,322.66,322.66,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,UHC MGG,UHC MGG,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,VA,VA,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Wellcare MGG,Wellcare MGG,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Bright Health - commercial,Bright Health - commercial,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,P9016,CPT,,,,Inpatient,,,322.66,322.66,Bright Health MGG,Bright Health MGG,322.66,,,,,,,case rate,322.66,322.66,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Aetna,Aetna,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Aetna MGG,Aetna MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,BCBS,BCBS,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,BCBS MGG,BCBS MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Cigna,Cigna,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Cigna MGG,Cigna MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Humana,Humana,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Humana MGG,Humana MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Optum VA,Optum VA,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,UHC,UHC,122.4,,,,,,,per diem,122.4,122.4,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,UHC MGG,UHC MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,VA,VA,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Wellcare MGG,Wellcare MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Bright Health - commercial,Bright Health - commercial,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,82633,CPT,,,,Inpatient,,,122.4,122.4,Bright Health MGG,Bright Health MGG,122.4,,,,,,,case rate,122.4,122.4,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Aetna,Aetna,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Aetna MGG,Aetna MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,BCBS,BCBS,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,BCBS MGG,BCBS MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Cigna,Cigna,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Cigna MGG,Cigna MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Humana,Humana,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Humana MGG,Humana MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Optum VA,Optum VA,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,UHC,UHC,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,UHC MGG,UHC MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,VA,VA,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Wellcare MGG,Wellcare MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Bright Health - commercial,Bright Health - commercial,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,83876,CPT,,,,Inpatient,,,47.94,47.94,Bright Health MGG,Bright Health MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Aetna,Aetna,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Aetna MGG,Aetna MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,BCBS,BCBS,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,BCBS MGG,BCBS MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Cigna,Cigna,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Cigna MGG,Cigna MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Humana,Humana,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Humana MGG,Humana MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Optum VA,Optum VA,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,UHC,UHC,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,UHC MGG,UHC MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,VA,VA,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Wellcare MGG,Wellcare MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Bright Health - commercial,Bright Health - commercial,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,83664,CPT,,,,Inpatient,,,76.5,76.5,Bright Health MGG,Bright Health MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Aetna,Aetna,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Aetna MGG,Aetna MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,BCBS,BCBS,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,BCBS MGG,BCBS MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Cigna,Cigna,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Cigna MGG,Cigna MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Humana,Humana,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Humana MGG,Humana MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Optum VA,Optum VA,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,UHC,UHC,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,UHC MGG,UHC MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,VA,VA,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Wellcare MGG,Wellcare MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Bright Health - commercial,Bright Health - commercial,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,81403,CPT,,,,Inpatient,,,1055.7,1055.7,Bright Health MGG,Bright Health MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Aetna,Aetna,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Aetna MGG,Aetna MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,BCBS,BCBS,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,BCBS MGG,BCBS MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Cigna,Cigna,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Cigna MGG,Cigna MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Humana,Humana,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Humana MGG,Humana MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Optum VA,Optum VA,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,UHC,UHC,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,UHC MGG,UHC MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,VA,VA,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Wellcare MGG,Wellcare MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Bright Health - commercial,Bright Health - commercial,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Bright Health MGG,Bright Health MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Aetna,Aetna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Aetna MGG,Aetna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,BCBS,BCBS,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,BCBS MGG,BCBS MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Cigna,Cigna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Cigna MGG,Cigna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Humana,Humana,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Humana MGG,Humana MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Optum VA,Optum VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,UHC,UHC,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,UHC MGG,UHC MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,VA,VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Wellcare MGG,Wellcare MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Bright Health - commercial,Bright Health - commercial,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,86975,CPT,,,,Inpatient,,,133.62,133.62,Bright Health MGG,Bright Health MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Aetna,Aetna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Aetna MGG,Aetna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,BCBS,BCBS,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,BCBS MGG,BCBS MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Cigna,Cigna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Cigna MGG,Cigna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Humana,Humana,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Humana MGG,Humana MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Optum VA,Optum VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,UHC,UHC,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,UHC MGG,UHC MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,VA,VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Wellcare MGG,Wellcare MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Bright Health - commercial,Bright Health - commercial,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,86976,CPT,,,,Inpatient,,,133.62,133.62,Bright Health MGG,Bright Health MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Aetna,Aetna,1020,,,,,,,per diem,1020,1020,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Aetna MGG,Aetna MGG,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,BCBS,BCBS,1020,,,,,,,per diem,1020,1020,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,BCBS MGG,BCBS MGG,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Cigna,Cigna,1020,,,,,,,per diem,1020,1020,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Cigna MGG,Cigna MGG,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Humana,Humana,1020,,,,,,,per diem,1020,1020,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Humana MGG,Humana MGG,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Optum VA,Optum VA,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,UHC,UHC,1020,,,,,,,per diem,1020,1020,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,UHC MGG,UHC MGG,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,VA,VA,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Wellcare MGG,Wellcare MGG,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Bright Health - commercial,Bright Health - commercial,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,81479,CPT,,,,Inpatient,,,1020,1020,Bright Health MGG,Bright Health MGG,1020,,,,,,,case rate,1020,1020,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Aetna,Aetna,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Aetna MGG,Aetna MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,BCBS,BCBS,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,BCBS MGG,BCBS MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Cigna,Cigna,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Cigna MGG,Cigna MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Humana,Humana,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Humana MGG,Humana MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Optum VA,Optum VA,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,UHC,UHC,163.2,,,,,,,per diem,163.2,163.2,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,UHC MGG,UHC MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,VA,VA,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Wellcare MGG,Wellcare MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Bright Health - commercial,Bright Health - commercial,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,86999,CPT,,,,Inpatient,,,163.2,163.2,Bright Health MGG,Bright Health MGG,163.2,,,,,,,case rate,163.2,163.2,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Aetna,Aetna,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Aetna MGG,Aetna MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,BCBS,BCBS,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,BCBS MGG,BCBS MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Cigna,Cigna,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Cigna MGG,Cigna MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Humana,Humana,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Humana MGG,Humana MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Optum VA,Optum VA,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,UHC,UHC,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,UHC MGG,UHC MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,VA,VA,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Wellcare MGG,Wellcare MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Bright Health - commercial,Bright Health - commercial,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Bright Health MGG,Bright Health MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Aetna,Aetna,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Aetna MGG,Aetna MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,BCBS,BCBS,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,BCBS MGG,BCBS MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Cigna,Cigna,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Cigna MGG,Cigna MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Humana,Humana,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Humana MGG,Humana MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Optum VA,Optum VA,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,UHC,UHC,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,UHC MGG,UHC MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,VA,VA,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Wellcare MGG,Wellcare MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Bright Health - commercial,Bright Health - commercial,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,81373,CPT,,,,Inpatient,,,166.26,166.26,Bright Health MGG,Bright Health MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Aetna,Aetna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Aetna MGG,Aetna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,BCBS,BCBS,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,BCBS MGG,BCBS MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Cigna,Cigna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Cigna MGG,Cigna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Humana,Humana,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Humana MGG,Humana MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Optum VA,Optum VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,UHC,UHC,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,UHC MGG,UHC MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,VA,VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Wellcare MGG,Wellcare MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Bright Health - commercial,Bright Health - commercial,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,86960,CPT,,,,Inpatient,,,128.52,128.52,Bright Health MGG,Bright Health MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Aetna,Aetna,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Aetna MGG,Aetna MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,BCBS,BCBS,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,BCBS MGG,BCBS MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Cigna,Cigna,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Cigna MGG,Cigna MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Humana,Humana,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Humana MGG,Humana MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Optum VA,Optum VA,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,UHC,UHC,177.48,,,,,,,per diem,177.48,177.48,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,UHC MGG,UHC MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,VA,VA,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Wellcare MGG,Wellcare MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Bright Health - commercial,Bright Health - commercial,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,87799,CPT,,,,Inpatient,,,177.48,177.48,Bright Health MGG,Bright Health MGG,177.48,,,,,,,case rate,177.48,177.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Aetna,Aetna,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Aetna MGG,Aetna MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,BCBS,BCBS,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,BCBS MGG,BCBS MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Cigna,Cigna,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Cigna MGG,Cigna MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Humana,Humana,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Humana MGG,Humana MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Optum VA,Optum VA,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,UHC,UHC,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,UHC MGG,UHC MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,VA,VA,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Wellcare MGG,Wellcare MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Bright Health - commercial,Bright Health - commercial,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,86357,CPT,,,,Inpatient,,,126.48,126.48,Bright Health MGG,Bright Health MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Aetna,Aetna,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Aetna MGG,Aetna MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,BCBS,BCBS,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,BCBS MGG,BCBS MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Cigna,Cigna,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Cigna MGG,Cigna MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Humana,Humana,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Humana MGG,Humana MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Optum VA,Optum VA,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,UHC,UHC,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,UHC MGG,UHC MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,VA,VA,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Wellcare MGG,Wellcare MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Bright Health - commercial,Bright Health - commercial,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,86356,CPT,,,,Inpatient,,,126.48,126.48,Bright Health MGG,Bright Health MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Aetna,Aetna,84.66,,,,,,,per diem,84.66,84.66,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Aetna MGG,Aetna MGG,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,BCBS,BCBS,84.66,,,,,,,per diem,84.66,84.66,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,BCBS MGG,BCBS MGG,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Cigna,Cigna,84.66,,,,,,,per diem,84.66,84.66,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Cigna MGG,Cigna MGG,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Humana,Humana,84.66,,,,,,,per diem,84.66,84.66,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Humana MGG,Humana MGG,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Optum VA,Optum VA,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,UHC,UHC,84.66,,,,,,,per diem,84.66,84.66,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,UHC MGG,UHC MGG,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,VA,VA,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Wellcare MGG,Wellcare MGG,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Bright Health - commercial,Bright Health - commercial,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,86849,CPT,,,,Inpatient,,,84.66,84.66,Bright Health MGG,Bright Health MGG,84.66,,,,,,,case rate,84.66,84.66,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Aetna,Aetna,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Aetna MGG,Aetna MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,BCBS,BCBS,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,BCBS MGG,BCBS MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Cigna,Cigna,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Cigna MGG,Cigna MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Humana,Humana,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Humana MGG,Humana MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Optum VA,Optum VA,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,UHC,UHC,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,UHC MGG,UHC MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,VA,VA,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Wellcare MGG,Wellcare MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Bright Health - commercial,Bright Health - commercial,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,86702,CPT,,,,Inpatient,,,66.3,66.3,Bright Health MGG,Bright Health MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Aetna,Aetna,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Aetna MGG,Aetna MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,BCBS,BCBS,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,BCBS MGG,BCBS MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Cigna,Cigna,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Cigna MGG,Cigna MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Humana,Humana,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Humana MGG,Humana MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Optum VA,Optum VA,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,UHC,UHC,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,UHC MGG,UHC MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,VA,VA,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Wellcare MGG,Wellcare MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Bright Health - commercial,Bright Health - commercial,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,88233,CPT,,,,Inpatient,,,972.06,972.06,Bright Health MGG,Bright Health MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Aetna,Aetna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Aetna MGG,Aetna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,BCBS,BCBS,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,BCBS MGG,BCBS MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Cigna,Cigna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Cigna MGG,Cigna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Humana,Humana,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Humana MGG,Humana MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Optum VA,Optum VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,UHC,UHC,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,UHC MGG,UHC MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,VA,VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Wellcare MGG,Wellcare MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Bright Health - commercial,Bright Health - commercial,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,87188,CPT,,,,Inpatient,,,26.52,26.52,Bright Health MGG,Bright Health MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Aetna,Aetna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Aetna MGG,Aetna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,BCBS,BCBS,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,BCBS MGG,BCBS MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Cigna,Cigna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Cigna MGG,Cigna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Humana,Humana,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Humana MGG,Humana MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Optum VA,Optum VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,UHC,UHC,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,UHC MGG,UHC MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,VA,VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Wellcare MGG,Wellcare MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Bright Health - commercial,Bright Health - commercial,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,87188,CPT,,,59,Inpatient,,,26.52,26.52,Bright Health MGG,Bright Health MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Aetna,Aetna,467.16,,,,,,,per diem,467.16,467.16,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Aetna MGG,Aetna MGG,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,BCBS,BCBS,467.16,,,,,,,per diem,467.16,467.16,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,BCBS MGG,BCBS MGG,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Cigna,Cigna,467.16,,,,,,,per diem,467.16,467.16,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Cigna MGG,Cigna MGG,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Humana,Humana,467.16,,,,,,,per diem,467.16,467.16,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Humana MGG,Humana MGG,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Optum VA,Optum VA,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,UHC,UHC,467.16,,,,,,,per diem,467.16,467.16,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,UHC MGG,UHC MGG,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,VA,VA,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Wellcare MGG,Wellcare MGG,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Bright Health - commercial,Bright Health - commercial,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,87153,CPT,,,,Inpatient,,,467.16,467.16,Bright Health MGG,Bright Health MGG,467.16,,,,,,,case rate,467.16,467.16,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Aetna,Aetna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Aetna MGG,Aetna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,BCBS,BCBS,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,BCBS MGG,BCBS MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Cigna,Cigna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Cigna MGG,Cigna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Humana,Humana,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Humana MGG,Humana MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Optum VA,Optum VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,UHC,UHC,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,UHC MGG,UHC MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,VA,VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Wellcare MGG,Wellcare MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Bright Health - commercial,Bright Health - commercial,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,87150,CPT,,,,Inpatient,,,143.82,143.82,Bright Health MGG,Bright Health MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Aetna,Aetna,22.44,,,,,,,per diem,22.44,22.44,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Aetna MGG,Aetna MGG,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,BCBS,BCBS,22.44,,,,,,,per diem,22.44,22.44,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,BCBS MGG,BCBS MGG,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Cigna,Cigna,22.44,,,,,,,per diem,22.44,22.44,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Cigna MGG,Cigna MGG,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Humana,Humana,22.44,,,,,,,per diem,22.44,22.44,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Humana MGG,Humana MGG,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Optum VA,Optum VA,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,UHC,UHC,22.44,,,,,,,per diem,22.44,22.44,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,UHC MGG,UHC MGG,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,VA,VA,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Wellcare MGG,Wellcare MGG,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Bright Health - commercial,Bright Health - commercial,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,87158,CPT,,,,Inpatient,,,22.44,22.44,Bright Health MGG,Bright Health MGG,22.44,,,,,,,case rate,22.44,22.44,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Aetna,Aetna,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Aetna MGG,Aetna MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,BCBS,BCBS,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,BCBS MGG,BCBS MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Cigna,Cigna,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Cigna MGG,Cigna MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Humana,Humana,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Humana MGG,Humana MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Optum VA,Optum VA,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,UHC,UHC,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,UHC MGG,UHC MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,VA,VA,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Wellcare MGG,Wellcare MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Bright Health - commercial,Bright Health - commercial,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,88366,CPT,,,,Inpatient,,,628.32,628.32,Bright Health MGG,Bright Health MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Aetna,Aetna,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Aetna MGG,Aetna MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,BCBS,BCBS,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,BCBS MGG,BCBS MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Cigna,Cigna,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Cigna MGG,Cigna MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Humana,Humana,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Humana MGG,Humana MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Optum VA,Optum VA,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,UHC,UHC,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,UHC MGG,UHC MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,VA,VA,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Wellcare MGG,Wellcare MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Bright Health - commercial,Bright Health - commercial,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,88275,CPT,,,,Inpatient,,,308.04,308.04,Bright Health MGG,Bright Health MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Aetna,Aetna,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Aetna MGG,Aetna MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,BCBS,BCBS,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,BCBS MGG,BCBS MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Cigna,Cigna,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Cigna MGG,Cigna MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Humana,Humana,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Humana MGG,Humana MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Optum VA,Optum VA,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,UHC,UHC,308.04,,,,,,,per diem,308.04,308.04,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,UHC MGG,UHC MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,VA,VA,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Wellcare MGG,Wellcare MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Bright Health - commercial,Bright Health - commercial,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,88291,CPT,,,,Inpatient,,,308.04,308.04,Bright Health MGG,Bright Health MGG,308.04,,,,,,,case rate,308.04,308.04,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Aetna,Aetna,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Aetna MGG,Aetna MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,BCBS,BCBS,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,BCBS MGG,BCBS MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Cigna,Cigna,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Cigna MGG,Cigna MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Humana,Humana,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Humana MGG,Humana MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Optum VA,Optum VA,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,UHC,UHC,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,UHC MGG,UHC MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,VA,VA,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Wellcare MGG,Wellcare MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Bright Health - commercial,Bright Health - commercial,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,88381,CPT,,,,Inpatient,,,501.84,501.84,Bright Health MGG,Bright Health MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Aetna,Aetna,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Aetna MGG,Aetna MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,BCBS,BCBS,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,BCBS MGG,BCBS MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Cigna,Cigna,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Cigna MGG,Cigna MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Humana,Humana,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Humana MGG,Humana MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Optum VA,Optum VA,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,UHC,UHC,501.84,,,,,,,per diem,501.84,501.84,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,UHC MGG,UHC MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,VA,VA,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Wellcare MGG,Wellcare MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Bright Health - commercial,Bright Health - commercial,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,81311,CPT,,,,Inpatient,,,501.84,501.84,Bright Health MGG,Bright Health MGG,501.84,,,,,,,case rate,501.84,501.84,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Aetna,Aetna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Aetna MGG,Aetna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,BCBS,BCBS,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,BCBS MGG,BCBS MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Cigna,Cigna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Cigna MGG,Cigna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Humana,Humana,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Humana MGG,Humana MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Optum VA,Optum VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,UHC,UHC,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,UHC MGG,UHC MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,VA,VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Wellcare MGG,Wellcare MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Bright Health - commercial,Bright Health - commercial,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,81210,CPT,,,,Inpatient,,,927.18,927.18,Bright Health MGG,Bright Health MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Aetna,Aetna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Aetna MGG,Aetna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,BCBS,BCBS,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,BCBS MGG,BCBS MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Cigna,Cigna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Cigna MGG,Cigna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Humana,Humana,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Humana MGG,Humana MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Optum VA,Optum VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,UHC,UHC,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,UHC MGG,UHC MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,VA,VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Wellcare MGG,Wellcare MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Bright Health - commercial,Bright Health - commercial,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,81275,CPT,,,,Inpatient,,,927.18,927.18,Bright Health MGG,Bright Health MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Aetna,Aetna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Aetna MGG,Aetna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,BCBS,BCBS,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,BCBS MGG,BCBS MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Cigna,Cigna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Cigna MGG,Cigna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Humana,Humana,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Humana MGG,Humana MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Optum VA,Optum VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,UHC,UHC,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,UHC MGG,UHC MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,VA,VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Wellcare MGG,Wellcare MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Bright Health - commercial,Bright Health - commercial,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,81276,CPT,,,,Inpatient,,,927.18,927.18,Bright Health MGG,Bright Health MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Aetna,Aetna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Aetna MGG,Aetna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,BCBS,BCBS,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,BCBS MGG,BCBS MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Cigna,Cigna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Cigna MGG,Cigna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Humana,Humana,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Humana MGG,Humana MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Optum VA,Optum VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,UHC,UHC,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,UHC MGG,UHC MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,VA,VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Wellcare MGG,Wellcare MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Bright Health - commercial,Bright Health - commercial,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,81311,CPT,,,,Inpatient,,,927.18,927.18,Bright Health MGG,Bright Health MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Aetna,Aetna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Aetna MGG,Aetna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,BCBS,BCBS,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,BCBS MGG,BCBS MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Cigna,Cigna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Cigna MGG,Cigna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Humana,Humana,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Humana MGG,Humana MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Optum VA,Optum VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,UHC,UHC,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,UHC MGG,UHC MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,VA,VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Wellcare MGG,Wellcare MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Bright Health - commercial,Bright Health - commercial,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,81403,CPT,,,,Inpatient,,,927.18,927.18,Bright Health MGG,Bright Health MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Aetna,Aetna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Aetna MGG,Aetna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,BCBS,BCBS,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,BCBS MGG,BCBS MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Cigna,Cigna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Cigna MGG,Cigna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Humana,Humana,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Humana MGG,Humana MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Optum VA,Optum VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,UHC,UHC,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,UHC MGG,UHC MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,VA,VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Wellcare MGG,Wellcare MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Bright Health - commercial,Bright Health - commercial,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,81401,CPT,,,,Inpatient,,,927.18,927.18,Bright Health MGG,Bright Health MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Aetna,Aetna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Aetna MGG,Aetna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,BCBS,BCBS,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,BCBS MGG,BCBS MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Cigna,Cigna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Cigna MGG,Cigna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Humana,Humana,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Humana MGG,Humana MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Optum VA,Optum VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,UHC,UHC,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,UHC MGG,UHC MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,VA,VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Wellcare MGG,Wellcare MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Bright Health - commercial,Bright Health - commercial,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,81479,CPT,,,,Inpatient,,,927.18,927.18,Bright Health MGG,Bright Health MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Aetna,Aetna,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Aetna MGG,Aetna MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,BCBS,BCBS,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,BCBS MGG,BCBS MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Cigna,Cigna,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Cigna MGG,Cigna MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Humana,Humana,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Humana MGG,Humana MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Optum VA,Optum VA,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,UHC,UHC,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,UHC MGG,UHC MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,VA,VA,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Wellcare MGG,Wellcare MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Bright Health - commercial,Bright Health - commercial,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,88381,CPT,,,,Inpatient,,,701.76,701.76,Bright Health MGG,Bright Health MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Aetna,Aetna,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Aetna MGG,Aetna MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,BCBS,BCBS,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,BCBS MGG,BCBS MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Cigna,Cigna,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Cigna MGG,Cigna MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Humana,Humana,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Humana MGG,Humana MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Optum VA,Optum VA,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,UHC,UHC,701.76,,,,,,,per diem,701.76,701.76,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,UHC MGG,UHC MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,VA,VA,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Wellcare MGG,Wellcare MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Bright Health - commercial,Bright Health - commercial,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,81403,CPT,,,,Inpatient,,,701.76,701.76,Bright Health MGG,Bright Health MGG,701.76,,,,,,,case rate,701.76,701.76,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Aetna,Aetna,665.04,,,,,,,per diem,665.04,665.04,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Aetna MGG,Aetna MGG,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,BCBS,BCBS,665.04,,,,,,,per diem,665.04,665.04,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,BCBS MGG,BCBS MGG,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Cigna,Cigna,665.04,,,,,,,per diem,665.04,665.04,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Cigna MGG,Cigna MGG,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Humana,Humana,665.04,,,,,,,per diem,665.04,665.04,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Humana MGG,Humana MGG,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Optum VA,Optum VA,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,UHC,UHC,665.04,,,,,,,per diem,665.04,665.04,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,UHC MGG,UHC MGG,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,VA,VA,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Wellcare MGG,Wellcare MGG,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Bright Health - commercial,Bright Health - commercial,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,81220,CPT,,,,Inpatient,,,665.04,665.04,Bright Health MGG,Bright Health MGG,665.04,,,,,,,case rate,665.04,665.04,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Aetna,Aetna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Aetna MGG,Aetna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,BCBS,BCBS,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,BCBS MGG,BCBS MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Cigna,Cigna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Cigna MGG,Cigna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Humana,Humana,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Humana MGG,Humana MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Optum VA,Optum VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,UHC,UHC,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,UHC MGG,UHC MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,VA,VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Wellcare MGG,Wellcare MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Bright Health - commercial,Bright Health - commercial,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,88381,CPT,,,,Inpatient,,,406.98,406.98,Bright Health MGG,Bright Health MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Aetna,Aetna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Aetna MGG,Aetna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,BCBS,BCBS,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,BCBS MGG,BCBS MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Cigna,Cigna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Cigna MGG,Cigna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Humana,Humana,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Humana MGG,Humana MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Optum VA,Optum VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,UHC,UHC,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,UHC MGG,UHC MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,VA,VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Wellcare MGG,Wellcare MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Bright Health - commercial,Bright Health - commercial,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,81235,CPT,,,,Inpatient,,,406.98,406.98,Bright Health MGG,Bright Health MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Aetna,Aetna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Aetna MGG,Aetna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,BCBS,BCBS,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,BCBS MGG,BCBS MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Cigna,Cigna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Cigna MGG,Cigna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Humana,Humana,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Humana MGG,Humana MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Optum VA,Optum VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,UHC,UHC,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,UHC MGG,UHC MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,VA,VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Wellcare MGG,Wellcare MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Bright Health - commercial,Bright Health - commercial,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,88341,CPT,,,,Inpatient,,,406.98,406.98,Bright Health MGG,Bright Health MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Aetna,Aetna,7301.16,,,,,,,per diem,7301.16,7301.16,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Aetna MGG,Aetna MGG,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,BCBS,BCBS,7301.16,,,,,,,per diem,7301.16,7301.16,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,BCBS MGG,BCBS MGG,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Cigna,Cigna,7301.16,,,,,,,per diem,7301.16,7301.16,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Cigna MGG,Cigna MGG,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Humana,Humana,7301.16,,,,,,,per diem,7301.16,7301.16,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Humana MGG,Humana MGG,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Optum VA,Optum VA,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,UHC,UHC,7301.16,,,,,,,per diem,7301.16,7301.16,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,UHC MGG,UHC MGG,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,VA,VA,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Wellcare MGG,Wellcare MGG,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Bright Health - commercial,Bright Health - commercial,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,81162,CPT,,,,Inpatient,,,7301.16,7301.16,Bright Health MGG,Bright Health MGG,7301.16,,,,,,,case rate,7301.16,7301.16,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Aetna,Aetna,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Aetna MGG,Aetna MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,BCBS,BCBS,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,BCBS MGG,BCBS MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Cigna,Cigna,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Cigna MGG,Cigna MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Humana,Humana,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Humana MGG,Humana MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Optum VA,Optum VA,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,UHC,UHC,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,UHC MGG,UHC MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,VA,VA,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Wellcare MGG,Wellcare MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Bright Health - commercial,Bright Health - commercial,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,80169,CPT,,,,Inpatient,,,67.32,67.32,Bright Health MGG,Bright Health MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Aetna,Aetna,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Aetna MGG,Aetna MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,BCBS,BCBS,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,BCBS MGG,BCBS MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Cigna,Cigna,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Cigna MGG,Cigna MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Humana,Humana,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Humana MGG,Humana MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Optum VA,Optum VA,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,UHC,UHC,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,UHC MGG,UHC MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,VA,VA,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Wellcare MGG,Wellcare MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Bright Health - commercial,Bright Health - commercial,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Bright Health MGG,Bright Health MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Aetna,Aetna,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Aetna MGG,Aetna MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,BCBS,BCBS,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,BCBS MGG,BCBS MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Cigna,Cigna,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Cigna MGG,Cigna MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Humana,Humana,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Humana MGG,Humana MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Optum VA,Optum VA,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,UHC,UHC,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,UHC MGG,UHC MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,VA,VA,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Wellcare MGG,Wellcare MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Bright Health - commercial,Bright Health - commercial,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Bright Health MGG,Bright Health MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Aetna,Aetna,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Aetna MGG,Aetna MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,BCBS,BCBS,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,BCBS MGG,BCBS MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Cigna,Cigna,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Cigna MGG,Cigna MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Humana,Humana,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Humana MGG,Humana MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Optum VA,Optum VA,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,UHC,UHC,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,UHC MGG,UHC MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,VA,VA,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Wellcare MGG,Wellcare MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Bright Health - commercial,Bright Health - commercial,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Bright Health MGG,Bright Health MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Aetna,Aetna,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Aetna MGG,Aetna MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,BCBS,BCBS,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,BCBS MGG,BCBS MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Cigna,Cigna,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Cigna MGG,Cigna MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Humana,Humana,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Humana MGG,Humana MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Optum VA,Optum VA,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,UHC,UHC,235.62,,,,,,,per diem,235.62,235.62,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,UHC MGG,UHC MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,VA,VA,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Wellcare MGG,Wellcare MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Bright Health - commercial,Bright Health - commercial,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,87081,CPT,,,,Inpatient,,,235.62,235.62,Bright Health MGG,Bright Health MGG,235.62,,,,,,,case rate,235.62,235.62,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Aetna,Aetna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Aetna MGG,Aetna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,BCBS,BCBS,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,BCBS MGG,BCBS MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Cigna,Cigna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Cigna MGG,Cigna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Humana,Humana,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Humana MGG,Humana MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Optum VA,Optum VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,UHC,UHC,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,UHC MGG,UHC MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,VA,VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Wellcare MGG,Wellcare MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Bright Health - commercial,Bright Health - commercial,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,87081,CPT,,,,Inpatient,,,26.52,26.52,Bright Health MGG,Bright Health MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Aetna,Aetna,627.3,,,,,,,per diem,627.3,627.3,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Aetna MGG,Aetna MGG,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,BCBS,BCBS,627.3,,,,,,,per diem,627.3,627.3,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,BCBS MGG,BCBS MGG,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Cigna,Cigna,627.3,,,,,,,per diem,627.3,627.3,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Cigna MGG,Cigna MGG,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Humana,Humana,627.3,,,,,,,per diem,627.3,627.3,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Humana MGG,Humana MGG,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Optum VA,Optum VA,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,UHC,UHC,627.3,,,,,,,per diem,627.3,627.3,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,UHC MGG,UHC MGG,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,VA,VA,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Wellcare MGG,Wellcare MGG,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Bright Health - commercial,Bright Health - commercial,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,87081,CPT,,,,Inpatient,,,627.3,627.3,Bright Health MGG,Bright Health MGG,627.3,,,,,,,case rate,627.3,627.3,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Aetna,Aetna,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Aetna MGG,Aetna MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,BCBS,BCBS,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,BCBS MGG,BCBS MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Cigna,Cigna,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Cigna MGG,Cigna MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Humana,Humana,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Humana MGG,Humana MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Optum VA,Optum VA,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,UHC,UHC,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,UHC MGG,UHC MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,VA,VA,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Wellcare MGG,Wellcare MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Bright Health - commercial,Bright Health - commercial,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,87081,CPT,,,,Inpatient,,,210.12,210.12,Bright Health MGG,Bright Health MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Aetna,Aetna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Aetna MGG,Aetna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,BCBS,BCBS,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,BCBS MGG,BCBS MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Cigna,Cigna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Cigna MGG,Cigna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Humana,Humana,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Humana MGG,Humana MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Optum VA,Optum VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,UHC,UHC,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,UHC MGG,UHC MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,VA,VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Wellcare MGG,Wellcare MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Bright Health - commercial,Bright Health - commercial,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Bright Health MGG,Bright Health MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Aetna,Aetna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Aetna MGG,Aetna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,BCBS,BCBS,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,BCBS MGG,BCBS MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Cigna,Cigna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Cigna MGG,Cigna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Humana,Humana,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Humana MGG,Humana MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Optum VA,Optum VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,UHC,UHC,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,UHC MGG,UHC MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,VA,VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Wellcare MGG,Wellcare MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Bright Health - commercial,Bright Health - commercial,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,87081,CPT,,,,Inpatient,,,25.5,25.5,Bright Health MGG,Bright Health MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Aetna,Aetna,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Aetna MGG,Aetna MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,BCBS,BCBS,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,BCBS MGG,BCBS MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Cigna,Cigna,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Cigna MGG,Cigna MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Humana,Humana,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Humana MGG,Humana MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Optum VA,Optum VA,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,UHC,UHC,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,UHC MGG,UHC MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,VA,VA,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Wellcare MGG,Wellcare MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Bright Health - commercial,Bright Health - commercial,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,87081,CPT,,,,Inpatient,,,164.22,164.22,Bright Health MGG,Bright Health MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna,Aetna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna MGG,Aetna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS,BCBS,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS MGG,BCBS MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna,Cigna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna MGG,Cigna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana,Humana,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana MGG,Humana MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Optum VA,Optum VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC,UHC,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC MGG,UHC MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,VA,VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Wellcare MGG,Wellcare MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health - commercial,Bright Health - commercial,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health MGG,Bright Health MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna,Aetna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna MGG,Aetna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS,BCBS,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS MGG,BCBS MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna,Cigna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna MGG,Cigna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana,Humana,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana MGG,Humana MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Optum VA,Optum VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC,UHC,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC MGG,UHC MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,VA,VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Wellcare MGG,Wellcare MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health - commercial,Bright Health - commercial,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health MGG,Bright Health MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna,Aetna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna MGG,Aetna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS,BCBS,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS MGG,BCBS MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna,Cigna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna MGG,Cigna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana,Humana,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana MGG,Humana MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Optum VA,Optum VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC,UHC,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC MGG,UHC MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,VA,VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Wellcare MGG,Wellcare MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health - commercial,Bright Health - commercial,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health MGG,Bright Health MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna,Aetna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna MGG,Aetna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS,BCBS,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS MGG,BCBS MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna,Cigna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna MGG,Cigna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana,Humana,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana MGG,Humana MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Optum VA,Optum VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC,UHC,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC MGG,UHC MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,VA,VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Wellcare MGG,Wellcare MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health - commercial,Bright Health - commercial,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health MGG,Bright Health MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna,Aetna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna MGG,Aetna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS,BCBS,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS MGG,BCBS MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna,Cigna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna MGG,Cigna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana,Humana,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana MGG,Humana MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Optum VA,Optum VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC,UHC,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC MGG,UHC MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,VA,VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Wellcare MGG,Wellcare MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health - commercial,Bright Health - commercial,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health MGG,Bright Health MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna,Aetna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna MGG,Aetna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS,BCBS,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS MGG,BCBS MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna,Cigna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna MGG,Cigna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana,Humana,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana MGG,Humana MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Optum VA,Optum VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC,UHC,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC MGG,UHC MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,VA,VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Wellcare MGG,Wellcare MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health - commercial,Bright Health - commercial,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health MGG,Bright Health MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna,Aetna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Aetna MGG,Aetna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS,BCBS,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,BCBS MGG,BCBS MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna,Cigna,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Cigna MGG,Cigna MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana,Humana,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Humana MGG,Humana MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Optum VA,Optum VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC,UHC,243.78,,,,,,,per diem,243.78,243.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,UHC MGG,UHC MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,VA,VA,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Wellcare MGG,Wellcare MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health - commercial,Bright Health - commercial,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,87081,CPT,,,,Inpatient,,,243.78,243.78,Bright Health MGG,Bright Health MGG,243.78,,,,,,,case rate,243.78,243.78,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Aetna,Aetna,227.46,,,,,,,per diem,227.46,227.46,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Aetna MGG,Aetna MGG,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,BCBS,BCBS,227.46,,,,,,,per diem,227.46,227.46,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,BCBS MGG,BCBS MGG,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Cigna,Cigna,227.46,,,,,,,per diem,227.46,227.46,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Cigna MGG,Cigna MGG,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Humana,Humana,227.46,,,,,,,per diem,227.46,227.46,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Humana MGG,Humana MGG,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Optum VA,Optum VA,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,UHC,UHC,227.46,,,,,,,per diem,227.46,227.46,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,UHC MGG,UHC MGG,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,VA,VA,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Wellcare MGG,Wellcare MGG,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Bright Health - commercial,Bright Health - commercial,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,87071,CPT,,,,Inpatient,,,227.46,227.46,Bright Health MGG,Bright Health MGG,227.46,,,,,,,case rate,227.46,227.46,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Aetna,Aetna,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Aetna MGG,Aetna MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,BCBS,BCBS,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,BCBS MGG,BCBS MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Cigna,Cigna,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Cigna MGG,Cigna MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Humana,Humana,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Humana MGG,Humana MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Optum VA,Optum VA,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,UHC,UHC,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,UHC MGG,UHC MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,VA,VA,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Wellcare MGG,Wellcare MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Bright Health - commercial,Bright Health - commercial,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,87206,CPT,,,,Inpatient,,,187.68,187.68,Bright Health MGG,Bright Health MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Aetna,Aetna,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Aetna MGG,Aetna MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,BCBS,BCBS,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,BCBS MGG,BCBS MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Cigna,Cigna,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Cigna MGG,Cigna MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Humana,Humana,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Humana MGG,Humana MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Optum VA,Optum VA,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,UHC,UHC,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,UHC MGG,UHC MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,VA,VA,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Wellcare MGG,Wellcare MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Bright Health - commercial,Bright Health - commercial,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,87206,CPT,,,,Inpatient,,,205.02,205.02,Bright Health MGG,Bright Health MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Aetna,Aetna,184.62,,,,,,,per diem,184.62,184.62,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Aetna MGG,Aetna MGG,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,BCBS,BCBS,184.62,,,,,,,per diem,184.62,184.62,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,BCBS MGG,BCBS MGG,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Cigna,Cigna,184.62,,,,,,,per diem,184.62,184.62,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Cigna MGG,Cigna MGG,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Humana,Humana,184.62,,,,,,,per diem,184.62,184.62,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Humana MGG,Humana MGG,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Optum VA,Optum VA,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,UHC,UHC,184.62,,,,,,,per diem,184.62,184.62,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,UHC MGG,UHC MGG,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,VA,VA,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Wellcare MGG,Wellcare MGG,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Bright Health - commercial,Bright Health - commercial,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,87206,CPT,,,,Inpatient,,,184.62,184.62,Bright Health MGG,Bright Health MGG,184.62,,,,,,,case rate,184.62,184.62,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Aetna,Aetna,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Aetna MGG,Aetna MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,BCBS,BCBS,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,BCBS MGG,BCBS MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Cigna,Cigna,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Cigna MGG,Cigna MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Humana,Humana,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Humana MGG,Humana MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Optum VA,Optum VA,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,UHC,UHC,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,UHC MGG,UHC MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,VA,VA,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Wellcare MGG,Wellcare MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Bright Health - commercial,Bright Health - commercial,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Bright Health MGG,Bright Health MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Aetna,Aetna,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Aetna MGG,Aetna MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,BCBS,BCBS,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,BCBS MGG,BCBS MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Cigna,Cigna,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Cigna MGG,Cigna MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Humana,Humana,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Humana MGG,Humana MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Optum VA,Optum VA,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,UHC,UHC,74.46,,,,,,,per diem,74.46,74.46,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,UHC MGG,UHC MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,VA,VA,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Wellcare MGG,Wellcare MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Bright Health - commercial,Bright Health - commercial,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,87899,CPT,,,,Inpatient,,,74.46,74.46,Bright Health MGG,Bright Health MGG,74.46,,,,,,,case rate,74.46,74.46,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Aetna,Aetna,63.1,,,,,,,per diem,63.1,63.1,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Aetna MGG,Aetna MGG,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,BCBS,BCBS,63.1,,,,,,,per diem,63.1,63.1,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,BCBS MGG,BCBS MGG,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Cigna,Cigna,63.1,,,,,,,per diem,63.1,63.1,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Cigna MGG,Cigna MGG,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Humana,Humana,63.1,,,,,,,per diem,63.1,63.1,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Humana MGG,Humana MGG,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Optum VA,Optum VA,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,UHC,UHC,63.1,,,,,,,per diem,63.1,63.1,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,UHC MGG,UHC MGG,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,VA,VA,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Wellcare MGG,Wellcare MGG,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Bright Health - commercial,Bright Health - commercial,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,87449,CPT,,,,Inpatient,,,63.1,63.1,Bright Health MGG,Bright Health MGG,63.1,,,,,,,case rate,63.1,63.1,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Aetna,Aetna,269.28,,,,,,,per diem,269.28,269.28,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Aetna MGG,Aetna MGG,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,BCBS,BCBS,269.28,,,,,,,per diem,269.28,269.28,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,BCBS MGG,BCBS MGG,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Cigna,Cigna,269.28,,,,,,,per diem,269.28,269.28,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Cigna MGG,Cigna MGG,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Humana,Humana,269.28,,,,,,,per diem,269.28,269.28,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Humana MGG,Humana MGG,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Optum VA,Optum VA,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,UHC,UHC,269.28,,,,,,,per diem,269.28,269.28,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,UHC MGG,UHC MGG,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,VA,VA,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Wellcare MGG,Wellcare MGG,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Bright Health - commercial,Bright Health - commercial,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,87186,CPT,,,,Inpatient,,,269.28,269.28,Bright Health MGG,Bright Health MGG,269.28,,,,,,,case rate,269.28,269.28,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Aetna,Aetna,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Aetna MGG,Aetna MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,BCBS,BCBS,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,BCBS MGG,BCBS MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Cigna,Cigna,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Cigna MGG,Cigna MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Humana,Humana,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Humana MGG,Humana MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Optum VA,Optum VA,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,UHC,UHC,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,UHC MGG,UHC MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,VA,VA,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Wellcare MGG,Wellcare MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Bright Health - commercial,Bright Health - commercial,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Bright Health MGG,Bright Health MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Aetna,Aetna,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Aetna MGG,Aetna MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,BCBS,BCBS,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,BCBS MGG,BCBS MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Cigna,Cigna,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Cigna MGG,Cigna MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Humana,Humana,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Humana MGG,Humana MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Optum VA,Optum VA,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,UHC,UHC,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,UHC MGG,UHC MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,VA,VA,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Wellcare MGG,Wellcare MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Bright Health - commercial,Bright Health - commercial,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Bright Health MGG,Bright Health MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Aetna,Aetna,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Aetna MGG,Aetna MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,BCBS,BCBS,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,BCBS MGG,BCBS MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Cigna,Cigna,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Cigna MGG,Cigna MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Humana,Humana,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Humana MGG,Humana MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Optum VA,Optum VA,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,UHC,UHC,37.74,,,,,,,per diem,37.74,37.74,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,UHC MGG,UHC MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,VA,VA,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Wellcare MGG,Wellcare MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Bright Health - commercial,Bright Health - commercial,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,87186,CPT,,,,Inpatient,,,37.74,37.74,Bright Health MGG,Bright Health MGG,37.74,,,,,,,case rate,37.74,37.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Aetna,Aetna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Aetna MGG,Aetna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,BCBS,BCBS,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,BCBS MGG,BCBS MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Cigna,Cigna,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Cigna MGG,Cigna MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Humana,Humana,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Humana MGG,Humana MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Optum VA,Optum VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,UHC,UHC,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,UHC MGG,UHC MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,VA,VA,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Wellcare MGG,Wellcare MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Bright Health - commercial,Bright Health - commercial,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,87186,CPT,,,,Inpatient,,,133.62,133.62,Bright Health MGG,Bright Health MGG,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Aetna,Aetna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Aetna MGG,Aetna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,BCBS,BCBS,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,BCBS MGG,BCBS MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Cigna,Cigna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Cigna MGG,Cigna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Humana,Humana,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Humana MGG,Humana MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Optum VA,Optum VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,UHC,UHC,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,UHC MGG,UHC MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,VA,VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Wellcare MGG,Wellcare MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Bright Health - commercial,Bright Health - commercial,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Bright Health MGG,Bright Health MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Aetna,Aetna,369.24,,,,,,,per diem,369.24,369.24,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Aetna MGG,Aetna MGG,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,BCBS,BCBS,369.24,,,,,,,per diem,369.24,369.24,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,BCBS MGG,BCBS MGG,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Cigna,Cigna,369.24,,,,,,,per diem,369.24,369.24,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Cigna MGG,Cigna MGG,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Humana,Humana,369.24,,,,,,,per diem,369.24,369.24,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Humana MGG,Humana MGG,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Optum VA,Optum VA,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,UHC,UHC,369.24,,,,,,,per diem,369.24,369.24,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,UHC MGG,UHC MGG,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,VA,VA,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Wellcare MGG,Wellcare MGG,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Bright Health - commercial,Bright Health - commercial,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,87186,CPT,,,,Inpatient,,,369.24,369.24,Bright Health MGG,Bright Health MGG,369.24,,,,,,,case rate,369.24,369.24,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Aetna,Aetna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Aetna MGG,Aetna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,BCBS,BCBS,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,BCBS MGG,BCBS MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Cigna,Cigna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Cigna MGG,Cigna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Humana,Humana,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Humana MGG,Humana MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Optum VA,Optum VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,UHC,UHC,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,UHC MGG,UHC MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,VA,VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Wellcare MGG,Wellcare MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Bright Health - commercial,Bright Health - commercial,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Bright Health MGG,Bright Health MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Aetna,Aetna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Aetna MGG,Aetna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,BCBS,BCBS,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,BCBS MGG,BCBS MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Cigna,Cigna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Cigna MGG,Cigna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Humana,Humana,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Humana MGG,Humana MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Optum VA,Optum VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,UHC,UHC,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,UHC MGG,UHC MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,VA,VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Wellcare MGG,Wellcare MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Bright Health - commercial,Bright Health - commercial,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,87186,CPT,,,59,Inpatient,,,465.12,465.12,Bright Health MGG,Bright Health MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Aetna,Aetna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Aetna MGG,Aetna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,BCBS,BCBS,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,BCBS MGG,BCBS MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Cigna,Cigna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Cigna MGG,Cigna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Humana,Humana,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Humana MGG,Humana MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Optum VA,Optum VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,UHC,UHC,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,UHC MGG,UHC MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,VA,VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Wellcare MGG,Wellcare MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Bright Health - commercial,Bright Health - commercial,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Bright Health MGG,Bright Health MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Aetna,Aetna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Aetna MGG,Aetna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,BCBS,BCBS,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,BCBS MGG,BCBS MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Cigna,Cigna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Cigna MGG,Cigna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Humana,Humana,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Humana MGG,Humana MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Optum VA,Optum VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,UHC,UHC,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,UHC MGG,UHC MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,VA,VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Wellcare MGG,Wellcare MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Bright Health - commercial,Bright Health - commercial,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,87186,CPT,,,91,Inpatient,,,465.12,465.12,Bright Health MGG,Bright Health MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Aetna,Aetna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Aetna MGG,Aetna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,BCBS,BCBS,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,BCBS MGG,BCBS MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Cigna,Cigna,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Cigna MGG,Cigna MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Humana,Humana,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Humana MGG,Humana MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Optum VA,Optum VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,UHC,UHC,465.12,,,,,,,per diem,465.12,465.12,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,UHC MGG,UHC MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,VA,VA,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Wellcare MGG,Wellcare MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Bright Health - commercial,Bright Health - commercial,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,87186,CPT,,,,Inpatient,,,465.12,465.12,Bright Health MGG,Bright Health MGG,465.12,,,,,,,case rate,465.12,465.12,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Aetna,Aetna,148.41,,,,,,,per diem,148.41,148.41,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Aetna MGG,Aetna MGG,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,BCBS,BCBS,148.41,,,,,,,per diem,148.41,148.41,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,BCBS MGG,BCBS MGG,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Cigna,Cigna,148.41,,,,,,,per diem,148.41,148.41,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Cigna MGG,Cigna MGG,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Humana,Humana,148.41,,,,,,,per diem,148.41,148.41,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Humana MGG,Humana MGG,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Optum VA,Optum VA,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,UHC,UHC,148.41,,,,,,,per diem,148.41,148.41,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,UHC MGG,UHC MGG,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,VA,VA,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Wellcare MGG,Wellcare MGG,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Bright Health - commercial,Bright Health - commercial,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,87186,CPT,,,,Inpatient,,,148.41,148.41,Bright Health MGG,Bright Health MGG,148.41,,,,,,,case rate,148.41,148.41,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Aetna,Aetna,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Aetna MGG,Aetna MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,BCBS,BCBS,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,BCBS MGG,BCBS MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Cigna,Cigna,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Cigna MGG,Cigna MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Humana,Humana,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Humana MGG,Humana MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Optum VA,Optum VA,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,UHC,UHC,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,UHC MGG,UHC MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,VA,VA,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Wellcare MGG,Wellcare MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Bright Health - commercial,Bright Health - commercial,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,87186,CPT,,,,Inpatient,,,466.14,466.14,Bright Health MGG,Bright Health MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Aetna,Aetna,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Aetna MGG,Aetna MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,BCBS,BCBS,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,BCBS MGG,BCBS MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Cigna,Cigna,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Cigna MGG,Cigna MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Humana,Humana,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Humana MGG,Humana MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Optum VA,Optum VA,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,UHC,UHC,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,UHC MGG,UHC MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,VA,VA,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Wellcare MGG,Wellcare MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Bright Health - commercial,Bright Health - commercial,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,87186,CPT,,,59,Inpatient,,,154.02,154.02,Bright Health MGG,Bright Health MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Aetna,Aetna,993.48,,,,,,,per diem,993.48,993.48,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Aetna MGG,Aetna MGG,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,BCBS,BCBS,993.48,,,,,,,per diem,993.48,993.48,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,BCBS MGG,BCBS MGG,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Cigna,Cigna,993.48,,,,,,,per diem,993.48,993.48,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Cigna MGG,Cigna MGG,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Humana,Humana,993.48,,,,,,,per diem,993.48,993.48,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Humana MGG,Humana MGG,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Optum VA,Optum VA,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,UHC,UHC,993.48,,,,,,,per diem,993.48,993.48,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,UHC MGG,UHC MGG,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,VA,VA,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Wellcare MGG,Wellcare MGG,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Bright Health - commercial,Bright Health - commercial,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,87186,CPT,,,,Inpatient,,,993.48,993.48,Bright Health MGG,Bright Health MGG,993.48,,,,,,,case rate,993.48,993.48,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Aetna,Aetna,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Aetna MGG,Aetna MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,BCBS,BCBS,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,BCBS MGG,BCBS MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Cigna,Cigna,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Cigna MGG,Cigna MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Humana,Humana,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Humana MGG,Humana MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Optum VA,Optum VA,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,UHC,UHC,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,UHC MGG,UHC MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,VA,VA,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Wellcare MGG,Wellcare MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Bright Health - commercial,Bright Health - commercial,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,87186,CPT,,,,Inpatient,,,1391.28,1391.28,Bright Health MGG,Bright Health MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Aetna,Aetna,339.66,,,,,,,per diem,339.66,339.66,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Aetna MGG,Aetna MGG,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,BCBS,BCBS,339.66,,,,,,,per diem,339.66,339.66,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,BCBS MGG,BCBS MGG,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Cigna,Cigna,339.66,,,,,,,per diem,339.66,339.66,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Cigna MGG,Cigna MGG,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Humana,Humana,339.66,,,,,,,per diem,339.66,339.66,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Humana MGG,Humana MGG,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Optum VA,Optum VA,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,UHC,UHC,339.66,,,,,,,per diem,339.66,339.66,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,UHC MGG,UHC MGG,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,VA,VA,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Wellcare MGG,Wellcare MGG,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Bright Health - commercial,Bright Health - commercial,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,87186,CPT,,,,Inpatient,,,339.66,339.66,Bright Health MGG,Bright Health MGG,339.66,,,,,,,case rate,339.66,339.66,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Aetna,Aetna,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Aetna MGG,Aetna MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,BCBS,BCBS,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,BCBS MGG,BCBS MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Cigna,Cigna,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Cigna MGG,Cigna MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Humana,Humana,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Humana MGG,Humana MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Optum VA,Optum VA,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,UHC,UHC,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,UHC MGG,UHC MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,VA,VA,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Wellcare MGG,Wellcare MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Bright Health - commercial,Bright Health - commercial,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,87186,CPT,,,,Inpatient,,,428.4,428.4,Bright Health MGG,Bright Health MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Aetna,Aetna,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Aetna MGG,Aetna MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,BCBS,BCBS,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,BCBS MGG,BCBS MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Cigna,Cigna,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Cigna MGG,Cigna MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Humana,Humana,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Humana MGG,Humana MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Optum VA,Optum VA,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,UHC,UHC,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,UHC MGG,UHC MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,VA,VA,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Wellcare MGG,Wellcare MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Bright Health - commercial,Bright Health - commercial,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,87186,CPT,,,59,Inpatient,,,428.4,428.4,Bright Health MGG,Bright Health MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Aetna,Aetna,694.62,,,,,,,per diem,694.62,694.62,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Aetna MGG,Aetna MGG,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,BCBS,BCBS,694.62,,,,,,,per diem,694.62,694.62,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,BCBS MGG,BCBS MGG,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Cigna,Cigna,694.62,,,,,,,per diem,694.62,694.62,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Cigna MGG,Cigna MGG,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Humana,Humana,694.62,,,,,,,per diem,694.62,694.62,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Humana MGG,Humana MGG,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Optum VA,Optum VA,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,UHC,UHC,694.62,,,,,,,per diem,694.62,694.62,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,UHC MGG,UHC MGG,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,VA,VA,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Wellcare MGG,Wellcare MGG,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Bright Health - commercial,Bright Health - commercial,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,87556,CPT,,,,Inpatient,,,694.62,694.62,Bright Health MGG,Bright Health MGG,694.62,,,,,,,case rate,694.62,694.62,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Aetna,Aetna,363.12,,,,,,,per diem,363.12,363.12,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Aetna MGG,Aetna MGG,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,BCBS,BCBS,363.12,,,,,,,per diem,363.12,363.12,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,BCBS MGG,BCBS MGG,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Cigna,Cigna,363.12,,,,,,,per diem,363.12,363.12,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Cigna MGG,Cigna MGG,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Humana,Humana,363.12,,,,,,,per diem,363.12,363.12,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Humana MGG,Humana MGG,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Optum VA,Optum VA,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,UHC,UHC,363.12,,,,,,,per diem,363.12,363.12,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,UHC MGG,UHC MGG,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,VA,VA,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Wellcare MGG,Wellcare MGG,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Bright Health - commercial,Bright Health - commercial,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,87556,CPT,,,,Inpatient,,,363.12,363.12,Bright Health MGG,Bright Health MGG,363.12,,,,,,,case rate,363.12,363.12,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Aetna,Aetna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Aetna MGG,Aetna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,BCBS,BCBS,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,BCBS MGG,BCBS MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Cigna,Cigna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Cigna MGG,Cigna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Humana,Humana,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Humana MGG,Humana MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Optum VA,Optum VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,UHC,UHC,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,UHC MGG,UHC MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,VA,VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Wellcare MGG,Wellcare MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Bright Health - commercial,Bright Health - commercial,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Bright Health MGG,Bright Health MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Aetna,Aetna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Aetna MGG,Aetna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,BCBS,BCBS,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,BCBS MGG,BCBS MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Cigna,Cigna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Cigna MGG,Cigna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Humana,Humana,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Humana MGG,Humana MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Optum VA,Optum VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,UHC,UHC,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,UHC MGG,UHC MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,VA,VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Wellcare MGG,Wellcare MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Bright Health - commercial,Bright Health - commercial,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,87491,CPT,,,,Inpatient,,,143.82,143.82,Bright Health MGG,Bright Health MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Aetna,Aetna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Aetna MGG,Aetna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,BCBS,BCBS,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,BCBS MGG,BCBS MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Cigna,Cigna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Cigna MGG,Cigna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Humana,Humana,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Humana MGG,Humana MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Optum VA,Optum VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,UHC,UHC,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,UHC MGG,UHC MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,VA,VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Wellcare MGG,Wellcare MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Bright Health - commercial,Bright Health - commercial,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,87491,CPT,,,,Inpatient,,,141.78,141.78,Bright Health MGG,Bright Health MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Aetna,Aetna,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Aetna MGG,Aetna MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,BCBS,BCBS,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,BCBS MGG,BCBS MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Cigna,Cigna,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Cigna MGG,Cigna MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Humana,Humana,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Humana MGG,Humana MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Optum VA,Optum VA,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,UHC,UHC,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,UHC MGG,UHC MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,VA,VA,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Wellcare MGG,Wellcare MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Bright Health - commercial,Bright Health - commercial,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,87176,CPT,,,,Inpatient,,,98.94,98.94,Bright Health MGG,Bright Health MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Aetna,Aetna,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Aetna MGG,Aetna MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,BCBS,BCBS,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,BCBS MGG,BCBS MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Cigna,Cigna,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Cigna MGG,Cigna MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Humana,Humana,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Humana MGG,Humana MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Optum VA,Optum VA,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,UHC,UHC,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,UHC MGG,UHC MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,VA,VA,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Wellcare MGG,Wellcare MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Bright Health - commercial,Bright Health - commercial,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,87327,CPT,,,,Inpatient,,,1102.62,1102.62,Bright Health MGG,Bright Health MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Aetna,Aetna,315.18,,,,,,,per diem,315.18,315.18,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Aetna MGG,Aetna MGG,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,BCBS,BCBS,315.18,,,,,,,per diem,315.18,315.18,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,BCBS MGG,BCBS MGG,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Cigna,Cigna,315.18,,,,,,,per diem,315.18,315.18,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Cigna MGG,Cigna MGG,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Humana,Humana,315.18,,,,,,,per diem,315.18,315.18,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Humana MGG,Humana MGG,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Optum VA,Optum VA,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,UHC,UHC,315.18,,,,,,,per diem,315.18,315.18,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,UHC MGG,UHC MGG,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,VA,VA,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Wellcare MGG,Wellcare MGG,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Bright Health - commercial,Bright Health - commercial,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,87102,CPT,,,,Inpatient,,,315.18,315.18,Bright Health MGG,Bright Health MGG,315.18,,,,,,,case rate,315.18,315.18,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Aetna,Aetna,516.8,,,,,,,per diem,516.8,516.8,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Aetna MGG,Aetna MGG,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,BCBS,BCBS,516.8,,,,,,,per diem,516.8,516.8,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,BCBS MGG,BCBS MGG,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Cigna,Cigna,516.8,,,,,,,per diem,516.8,516.8,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Cigna MGG,Cigna MGG,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Humana,Humana,516.8,,,,,,,per diem,516.8,516.8,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Humana MGG,Humana MGG,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Optum VA,Optum VA,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,UHC,UHC,516.8,,,,,,,per diem,516.8,516.8,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,UHC MGG,UHC MGG,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,VA,VA,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Wellcare MGG,Wellcare MGG,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Bright Health - commercial,Bright Health - commercial,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,87070,CPT,,,,Inpatient,,,516.8,516.8,Bright Health MGG,Bright Health MGG,516.8,,,,,,,case rate,516.8,516.8,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Aetna,Aetna,366.03,,,,,,,per diem,366.03,366.03,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Aetna MGG,Aetna MGG,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,BCBS,BCBS,366.03,,,,,,,per diem,366.03,366.03,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,BCBS MGG,BCBS MGG,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Cigna,Cigna,366.03,,,,,,,per diem,366.03,366.03,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Cigna MGG,Cigna MGG,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Humana,Humana,366.03,,,,,,,per diem,366.03,366.03,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Humana MGG,Humana MGG,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Optum VA,Optum VA,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,UHC,UHC,366.03,,,,,,,per diem,366.03,366.03,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,UHC MGG,UHC MGG,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,VA,VA,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Wellcare MGG,Wellcare MGG,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Bright Health - commercial,Bright Health - commercial,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,87070,CPT,,,,Inpatient,,,366.03,366.03,Bright Health MGG,Bright Health MGG,366.03,,,,,,,case rate,366.03,366.03,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna,Aetna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Aetna MGG,Aetna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS,BCBS,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,BCBS MGG,BCBS MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna,Cigna,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Cigna MGG,Cigna MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana,Humana,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Humana MGG,Humana MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Optum VA,Optum VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC,UHC,520.2,,,,,,,per diem,520.2,520.2,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,UHC MGG,UHC MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,VA,VA,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Wellcare MGG,Wellcare MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health - commercial,Bright Health - commercial,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,87070,CPT,,,,Inpatient,,,520.2,520.2,Bright Health MGG,Bright Health MGG,520.2,,,,,,,case rate,520.2,520.2,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Aetna,Aetna,389.64,,,,,,,per diem,389.64,389.64,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Aetna MGG,Aetna MGG,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,BCBS,BCBS,389.64,,,,,,,per diem,389.64,389.64,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,BCBS MGG,BCBS MGG,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Cigna,Cigna,389.64,,,,,,,per diem,389.64,389.64,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Cigna MGG,Cigna MGG,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Humana,Humana,389.64,,,,,,,per diem,389.64,389.64,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Humana MGG,Humana MGG,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Optum VA,Optum VA,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,UHC,UHC,389.64,,,,,,,per diem,389.64,389.64,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,UHC MGG,UHC MGG,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,VA,VA,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Wellcare MGG,Wellcare MGG,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Bright Health - commercial,Bright Health - commercial,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,87070,CPT,,,,Inpatient,,,389.64,389.64,Bright Health MGG,Bright Health MGG,389.64,,,,,,,case rate,389.64,389.64,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna,Aetna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna MGG,Aetna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS,BCBS,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS MGG,BCBS MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna,Cigna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna MGG,Cigna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana,Humana,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana MGG,Humana MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Optum VA,Optum VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC,UHC,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC MGG,UHC MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,VA,VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Wellcare MGG,Wellcare MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health - commercial,Bright Health - commercial,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health MGG,Bright Health MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna,Aetna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna MGG,Aetna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS,BCBS,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS MGG,BCBS MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna,Cigna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna MGG,Cigna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana,Humana,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana MGG,Humana MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Optum VA,Optum VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC,UHC,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC MGG,UHC MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,VA,VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Wellcare MGG,Wellcare MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health - commercial,Bright Health - commercial,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health MGG,Bright Health MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna,Aetna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna MGG,Aetna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS,BCBS,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS MGG,BCBS MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna,Cigna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna MGG,Cigna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana,Humana,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana MGG,Humana MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Optum VA,Optum VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC,UHC,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC MGG,UHC MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,VA,VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Wellcare MGG,Wellcare MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health - commercial,Bright Health - commercial,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health MGG,Bright Health MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna,Aetna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna MGG,Aetna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS,BCBS,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS MGG,BCBS MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna,Cigna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna MGG,Cigna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana,Humana,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana MGG,Humana MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Optum VA,Optum VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC,UHC,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC MGG,UHC MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,VA,VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Wellcare MGG,Wellcare MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health - commercial,Bright Health - commercial,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health MGG,Bright Health MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Aetna,Aetna,282.29,,,,,,,per diem,282.29,282.29,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Aetna MGG,Aetna MGG,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,BCBS,BCBS,282.29,,,,,,,per diem,282.29,282.29,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,BCBS MGG,BCBS MGG,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Cigna,Cigna,282.29,,,,,,,per diem,282.29,282.29,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Cigna MGG,Cigna MGG,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Humana,Humana,282.29,,,,,,,per diem,282.29,282.29,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Humana MGG,Humana MGG,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Optum VA,Optum VA,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,UHC,UHC,282.29,,,,,,,per diem,282.29,282.29,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,UHC MGG,UHC MGG,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,VA,VA,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Wellcare MGG,Wellcare MGG,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Bright Health - commercial,Bright Health - commercial,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,87070,CPT,,,,Inpatient,,,282.29,282.29,Bright Health MGG,Bright Health MGG,282.29,,,,,,,case rate,282.29,282.29,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna,Aetna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Aetna MGG,Aetna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS,BCBS,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,BCBS MGG,BCBS MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna,Cigna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Cigna MGG,Cigna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana,Humana,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Humana MGG,Humana MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Optum VA,Optum VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC,UHC,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,UHC MGG,UHC MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,VA,VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Wellcare MGG,Wellcare MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health - commercial,Bright Health - commercial,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,87070,CPT,,,,Inpatient,,,538.56,538.56,Bright Health MGG,Bright Health MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Aetna,Aetna,83.66,,,,,,,per diem,83.66,83.66,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Aetna MGG,Aetna MGG,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,BCBS,BCBS,83.66,,,,,,,per diem,83.66,83.66,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,BCBS MGG,BCBS MGG,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Cigna,Cigna,83.66,,,,,,,per diem,83.66,83.66,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Cigna MGG,Cigna MGG,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Humana,Humana,83.66,,,,,,,per diem,83.66,83.66,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Humana MGG,Humana MGG,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Optum VA,Optum VA,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,UHC,UHC,83.66,,,,,,,per diem,83.66,83.66,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,UHC MGG,UHC MGG,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,VA,VA,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Wellcare MGG,Wellcare MGG,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Bright Health - commercial,Bright Health - commercial,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,87077,CPT,,,,Inpatient,,,83.66,83.66,Bright Health MGG,Bright Health MGG,83.66,,,,,,,case rate,83.66,83.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Aetna,Aetna,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Aetna MGG,Aetna MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,BCBS,BCBS,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,BCBS MGG,BCBS MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Cigna,Cigna,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Cigna MGG,Cigna MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Humana,Humana,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Humana MGG,Humana MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Optum VA,Optum VA,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,UHC,UHC,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,UHC MGG,UHC MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,VA,VA,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Wellcare MGG,Wellcare MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Bright Health - commercial,Bright Health - commercial,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,87077,CPT,,,,Inpatient,,,35.7,35.7,Bright Health MGG,Bright Health MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Aetna,Aetna,140.76,,,,,,,per diem,140.76,140.76,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Aetna MGG,Aetna MGG,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,BCBS,BCBS,140.76,,,,,,,per diem,140.76,140.76,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,BCBS MGG,BCBS MGG,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Cigna,Cigna,140.76,,,,,,,per diem,140.76,140.76,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Cigna MGG,Cigna MGG,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Humana,Humana,140.76,,,,,,,per diem,140.76,140.76,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Humana MGG,Humana MGG,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Optum VA,Optum VA,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,UHC,UHC,140.76,,,,,,,per diem,140.76,140.76,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,UHC MGG,UHC MGG,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,VA,VA,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Wellcare MGG,Wellcare MGG,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Bright Health - commercial,Bright Health - commercial,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,87077,CPT,,,,Inpatient,,,140.76,140.76,Bright Health MGG,Bright Health MGG,140.76,,,,,,,case rate,140.76,140.76,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Aetna,Aetna,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Aetna MGG,Aetna MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,BCBS,BCBS,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,BCBS MGG,BCBS MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Cigna,Cigna,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Cigna MGG,Cigna MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Humana,Humana,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Humana MGG,Humana MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Optum VA,Optum VA,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,UHC,UHC,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,UHC MGG,UHC MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,VA,VA,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Wellcare MGG,Wellcare MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Bright Health - commercial,Bright Health - commercial,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Bright Health MGG,Bright Health MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Aetna,Aetna,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Aetna MGG,Aetna MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,BCBS,BCBS,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,BCBS MGG,BCBS MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Cigna,Cigna,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Cigna MGG,Cigna MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Humana,Humana,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Humana MGG,Humana MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Optum VA,Optum VA,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,UHC,UHC,426.36,,,,,,,per diem,426.36,426.36,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,UHC MGG,UHC MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,VA,VA,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Wellcare MGG,Wellcare MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Bright Health - commercial,Bright Health - commercial,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,87075,CPT,,,,Inpatient,,,426.36,426.36,Bright Health MGG,Bright Health MGG,426.36,,,,,,,case rate,426.36,426.36,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Aetna,Aetna,517.14,,,,,,,per diem,517.14,517.14,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Aetna MGG,Aetna MGG,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,BCBS,BCBS,517.14,,,,,,,per diem,517.14,517.14,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,BCBS MGG,BCBS MGG,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Cigna,Cigna,517.14,,,,,,,per diem,517.14,517.14,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Cigna MGG,Cigna MGG,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Humana,Humana,517.14,,,,,,,per diem,517.14,517.14,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Humana MGG,Humana MGG,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Optum VA,Optum VA,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,UHC,UHC,517.14,,,,,,,per diem,517.14,517.14,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,UHC MGG,UHC MGG,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,VA,VA,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Wellcare MGG,Wellcare MGG,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Bright Health - commercial,Bright Health - commercial,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,87040,CPT,,,,Inpatient,,,517.14,517.14,Bright Health MGG,Bright Health MGG,517.14,,,,,,,case rate,517.14,517.14,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Aetna,Aetna,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Aetna MGG,Aetna MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,BCBS,BCBS,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,BCBS MGG,BCBS MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Cigna,Cigna,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Cigna MGG,Cigna MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Humana,Humana,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Humana MGG,Humana MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Optum VA,Optum VA,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,UHC,UHC,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,UHC MGG,UHC MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,VA,VA,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Wellcare MGG,Wellcare MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Bright Health - commercial,Bright Health - commercial,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Bright Health MGG,Bright Health MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Aetna,Aetna,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Aetna MGG,Aetna MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,BCBS,BCBS,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,BCBS MGG,BCBS MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Cigna,Cigna,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Cigna MGG,Cigna MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Humana,Humana,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Humana MGG,Humana MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Optum VA,Optum VA,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,UHC,UHC,248.88,,,,,,,per diem,248.88,248.88,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,UHC MGG,UHC MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,VA,VA,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Wellcare MGG,Wellcare MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Bright Health - commercial,Bright Health - commercial,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,87046,CPT,,,,Inpatient,,,248.88,248.88,Bright Health MGG,Bright Health MGG,248.88,,,,,,,case rate,248.88,248.88,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Aetna,Aetna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Aetna MGG,Aetna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,BCBS,BCBS,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,BCBS MGG,BCBS MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Cigna,Cigna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Cigna MGG,Cigna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Humana,Humana,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Humana MGG,Humana MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Optum VA,Optum VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,UHC,UHC,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,UHC MGG,UHC MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,VA,VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Wellcare MGG,Wellcare MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Bright Health - commercial,Bright Health - commercial,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,87046,CPT,,,,Inpatient,,,9.18,9.18,Bright Health MGG,Bright Health MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Aetna,Aetna,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Aetna MGG,Aetna MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,BCBS,BCBS,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,BCBS MGG,BCBS MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Cigna,Cigna,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Cigna MGG,Cigna MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Humana,Humana,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Humana MGG,Humana MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Optum VA,Optum VA,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,UHC,UHC,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,UHC MGG,UHC MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,VA,VA,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Wellcare MGG,Wellcare MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Bright Health - commercial,Bright Health - commercial,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Bright Health MGG,Bright Health MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Aetna,Aetna,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Aetna MGG,Aetna MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,BCBS,BCBS,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,BCBS MGG,BCBS MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Cigna,Cigna,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Cigna MGG,Cigna MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Humana,Humana,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Humana MGG,Humana MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Optum VA,Optum VA,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,UHC,UHC,126.48,,,,,,,per diem,126.48,126.48,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,UHC MGG,UHC MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,VA,VA,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Wellcare MGG,Wellcare MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Bright Health - commercial,Bright Health - commercial,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,87046,CPT,,,,Inpatient,,,126.48,126.48,Bright Health MGG,Bright Health MGG,126.48,,,,,,,case rate,126.48,126.48,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Aetna,Aetna,258.06,,,,,,,per diem,258.06,258.06,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Aetna MGG,Aetna MGG,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,BCBS,BCBS,258.06,,,,,,,per diem,258.06,258.06,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,BCBS MGG,BCBS MGG,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Cigna,Cigna,258.06,,,,,,,per diem,258.06,258.06,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Cigna MGG,Cigna MGG,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Humana,Humana,258.06,,,,,,,per diem,258.06,258.06,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Humana MGG,Humana MGG,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Optum VA,Optum VA,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,UHC,UHC,258.06,,,,,,,per diem,258.06,258.06,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,UHC MGG,UHC MGG,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,VA,VA,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Wellcare MGG,Wellcare MGG,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Bright Health - commercial,Bright Health - commercial,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,87046,CPT,,,,Inpatient,,,258.06,258.06,Bright Health MGG,Bright Health MGG,258.06,,,,,,,case rate,258.06,258.06,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Aetna,Aetna,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Aetna MGG,Aetna MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,BCBS,BCBS,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,BCBS MGG,BCBS MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Cigna,Cigna,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Cigna MGG,Cigna MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Humana,Humana,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Humana MGG,Humana MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Optum VA,Optum VA,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,UHC,UHC,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,UHC MGG,UHC MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,VA,VA,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Wellcare MGG,Wellcare MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Bright Health - commercial,Bright Health - commercial,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,87110,CPT,,,,Inpatient,,,81.6,81.6,Bright Health MGG,Bright Health MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Aetna,Aetna,221.34,,,,,,,per diem,221.34,221.34,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Aetna MGG,Aetna MGG,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,BCBS,BCBS,221.34,,,,,,,per diem,221.34,221.34,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,BCBS MGG,BCBS MGG,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Cigna,Cigna,221.34,,,,,,,per diem,221.34,221.34,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Cigna MGG,Cigna MGG,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Humana,Humana,221.34,,,,,,,per diem,221.34,221.34,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Humana MGG,Humana MGG,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Optum VA,Optum VA,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,UHC,UHC,221.34,,,,,,,per diem,221.34,221.34,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,UHC MGG,UHC MGG,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,VA,VA,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Wellcare MGG,Wellcare MGG,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Bright Health - commercial,Bright Health - commercial,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,87110,CPT,,,,Inpatient,,,221.34,221.34,Bright Health MGG,Bright Health MGG,221.34,,,,,,,case rate,221.34,221.34,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Aetna,Aetna,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Aetna MGG,Aetna MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,BCBS,BCBS,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,BCBS MGG,BCBS MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Cigna,Cigna,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Cigna MGG,Cigna MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Humana,Humana,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Humana MGG,Humana MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Optum VA,Optum VA,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,UHC,UHC,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,UHC MGG,UHC MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,VA,VA,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Wellcare MGG,Wellcare MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Bright Health - commercial,Bright Health - commercial,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,87252,CPT,,,,Inpatient,,,136.68,136.68,Bright Health MGG,Bright Health MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,87252,CPT,,,,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Aetna,Aetna,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Aetna MGG,Aetna MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,BCBS,BCBS,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,BCBS MGG,BCBS MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Cigna,Cigna,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Cigna MGG,Cigna MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Humana,Humana,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Humana MGG,Humana MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Optum VA,Optum VA,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,UHC,UHC,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,UHC MGG,UHC MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,VA,VA,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Wellcare MGG,Wellcare MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Bright Health - commercial,Bright Health - commercial,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,87252,CPT,,,,Inpatient,,,53.04,53.04,Bright Health MGG,Bright Health MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Aetna,Aetna,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Aetna MGG,Aetna MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,BCBS,BCBS,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,BCBS MGG,BCBS MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Cigna,Cigna,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Cigna MGG,Cigna MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Humana,Humana,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Humana MGG,Humana MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Optum VA,Optum VA,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,UHC,UHC,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,UHC MGG,UHC MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,VA,VA,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Wellcare MGG,Wellcare MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Bright Health - commercial,Bright Health - commercial,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,87147,CPT,,,,Inpatient,,,32.64,32.64,Bright Health MGG,Bright Health MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Aetna,Aetna,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Aetna MGG,Aetna MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,BCBS,BCBS,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,BCBS MGG,BCBS MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Cigna,Cigna,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Cigna MGG,Cigna MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Humana,Humana,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Humana MGG,Humana MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Optum VA,Optum VA,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,UHC,UHC,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,UHC MGG,UHC MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,VA,VA,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Wellcare MGG,Wellcare MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Bright Health - commercial,Bright Health - commercial,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Bright Health MGG,Bright Health MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Aetna,Aetna,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Aetna MGG,Aetna MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,BCBS,BCBS,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,BCBS MGG,BCBS MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Cigna,Cigna,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Cigna MGG,Cigna MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Humana,Humana,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Humana MGG,Humana MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Optum VA,Optum VA,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,UHC,UHC,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,UHC MGG,UHC MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,VA,VA,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Wellcare MGG,Wellcare MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Bright Health - commercial,Bright Health - commercial,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,87147,CPT,,,,Inpatient,,,27.54,27.54,Bright Health MGG,Bright Health MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Aetna,Aetna,413.1,,,,,,,per diem,413.1,413.1,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Aetna MGG,Aetna MGG,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,BCBS,BCBS,413.1,,,,,,,per diem,413.1,413.1,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,BCBS MGG,BCBS MGG,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Cigna,Cigna,413.1,,,,,,,per diem,413.1,413.1,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Cigna MGG,Cigna MGG,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Humana,Humana,413.1,,,,,,,per diem,413.1,413.1,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Humana MGG,Humana MGG,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Optum VA,Optum VA,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,UHC,UHC,413.1,,,,,,,per diem,413.1,413.1,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,UHC MGG,UHC MGG,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,VA,VA,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Wellcare MGG,Wellcare MGG,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Bright Health - commercial,Bright Health - commercial,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,87045,CPT,,,,Inpatient,,,413.1,413.1,Bright Health MGG,Bright Health MGG,413.1,,,,,,,case rate,413.1,413.1,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Aetna,Aetna,631.38,,,,,,,per diem,631.38,631.38,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Aetna MGG,Aetna MGG,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,BCBS,BCBS,631.38,,,,,,,per diem,631.38,631.38,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,BCBS MGG,BCBS MGG,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Cigna,Cigna,631.38,,,,,,,per diem,631.38,631.38,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Cigna MGG,Cigna MGG,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Humana,Humana,631.38,,,,,,,per diem,631.38,631.38,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Humana MGG,Humana MGG,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Optum VA,Optum VA,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,UHC,UHC,631.38,,,,,,,per diem,631.38,631.38,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,UHC MGG,UHC MGG,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,VA,VA,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Wellcare MGG,Wellcare MGG,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Bright Health - commercial,Bright Health - commercial,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,87086,CPT,,,,Inpatient,,,631.38,631.38,Bright Health MGG,Bright Health MGG,631.38,,,,,,,case rate,631.38,631.38,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,80300,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Aetna,Aetna,292.74,,,,,,,per diem,292.74,292.74,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Aetna MGG,Aetna MGG,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,BCBS,BCBS,292.74,,,,,,,per diem,292.74,292.74,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,BCBS MGG,BCBS MGG,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Cigna,Cigna,292.74,,,,,,,per diem,292.74,292.74,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Cigna MGG,Cigna MGG,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Humana,Humana,292.74,,,,,,,per diem,292.74,292.74,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Humana MGG,Humana MGG,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Optum VA,Optum VA,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,UHC,UHC,292.74,,,,,,,per diem,292.74,292.74,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,UHC MGG,UHC MGG,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,VA,VA,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Wellcare MGG,Wellcare MGG,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Bright Health - commercial,Bright Health - commercial,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,87210,CPT,,,,Inpatient,,,292.74,292.74,Bright Health MGG,Bright Health MGG,292.74,,,,,,,case rate,292.74,292.74,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Aetna,Aetna,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Aetna MGG,Aetna MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,BCBS,BCBS,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,BCBS MGG,BCBS MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Cigna,Cigna,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Cigna MGG,Cigna MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Humana,Humana,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Humana MGG,Humana MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Optum VA,Optum VA,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,UHC,UHC,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,UHC MGG,UHC MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,VA,VA,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Wellcare MGG,Wellcare MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Bright Health - commercial,Bright Health - commercial,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Bright Health MGG,Bright Health MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Aetna,Aetna,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Aetna MGG,Aetna MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,BCBS,BCBS,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,BCBS MGG,BCBS MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Cigna,Cigna,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Cigna MGG,Cigna MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Humana,Humana,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Humana MGG,Humana MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Optum VA,Optum VA,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,UHC,UHC,302.94,,,,,,,per diem,302.94,302.94,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,UHC MGG,UHC MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,VA,VA,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Wellcare MGG,Wellcare MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Bright Health - commercial,Bright Health - commercial,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,87210,CPT,,,,Inpatient,,,302.94,302.94,Bright Health MGG,Bright Health MGG,302.94,,,,,,,case rate,302.94,302.94,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Aetna,Aetna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Aetna MGG,Aetna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,BCBS,BCBS,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,BCBS MGG,BCBS MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Cigna,Cigna,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Cigna MGG,Cigna MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Humana,Humana,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Humana MGG,Humana MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Optum VA,Optum VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,UHC,UHC,209.1,,,,,,,per diem,209.1,209.1,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,UHC MGG,UHC MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,VA,VA,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Wellcare MGG,Wellcare MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Bright Health - commercial,Bright Health - commercial,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,87205,CPT,,,,Inpatient,,,209.1,209.1,Bright Health MGG,Bright Health MGG,209.1,,,,,,,case rate,209.1,209.1,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Aetna,Aetna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Aetna MGG,Aetna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,BCBS,BCBS,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,BCBS MGG,BCBS MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Cigna,Cigna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Cigna MGG,Cigna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Humana,Humana,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Humana MGG,Humana MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Optum VA,Optum VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,UHC,UHC,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,UHC MGG,UHC MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,VA,VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Wellcare MGG,Wellcare MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Bright Health - commercial,Bright Health - commercial,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,87254,CPT,,,,Inpatient,,,368.22,368.22,Bright Health MGG,Bright Health MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna,Aetna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna MGG,Aetna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS,BCBS,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS MGG,BCBS MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna,Cigna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna MGG,Cigna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana,Humana,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana MGG,Humana MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Optum VA,Optum VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC,UHC,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC MGG,UHC MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,VA,VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Wellcare MGG,Wellcare MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health - commercial,Bright Health - commercial,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health MGG,Bright Health MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna,Aetna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna MGG,Aetna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS,BCBS,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS MGG,BCBS MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna,Cigna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna MGG,Cigna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana,Humana,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana MGG,Humana MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Optum VA,Optum VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC,UHC,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC MGG,UHC MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,VA,VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Wellcare MGG,Wellcare MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health - commercial,Bright Health - commercial,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health MGG,Bright Health MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna,Aetna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna MGG,Aetna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS,BCBS,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS MGG,BCBS MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna,Cigna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna MGG,Cigna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana,Humana,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana MGG,Humana MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Optum VA,Optum VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC,UHC,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC MGG,UHC MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,VA,VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Wellcare MGG,Wellcare MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health - commercial,Bright Health - commercial,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health MGG,Bright Health MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Aetna,Aetna,78.54,,,,,,,per diem,78.54,78.54,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Aetna MGG,Aetna MGG,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,BCBS,BCBS,78.54,,,,,,,per diem,78.54,78.54,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,BCBS MGG,BCBS MGG,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Cigna,Cigna,78.54,,,,,,,per diem,78.54,78.54,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Cigna MGG,Cigna MGG,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Humana,Humana,78.54,,,,,,,per diem,78.54,78.54,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Humana MGG,Humana MGG,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Optum VA,Optum VA,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,UHC,UHC,78.54,,,,,,,per diem,78.54,78.54,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,UHC MGG,UHC MGG,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,VA,VA,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Wellcare MGG,Wellcare MGG,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Bright Health - commercial,Bright Health - commercial,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,87254,CPT,,,59,Inpatient,,,78.54,78.54,Bright Health MGG,Bright Health MGG,78.54,,,,,,,case rate,78.54,78.54,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna,Aetna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna MGG,Aetna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS,BCBS,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS MGG,BCBS MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna,Cigna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna MGG,Cigna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana,Humana,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana MGG,Humana MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Optum VA,Optum VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC,UHC,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC MGG,UHC MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,VA,VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Wellcare MGG,Wellcare MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health - commercial,Bright Health - commercial,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health MGG,Bright Health MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Aetna,Aetna,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Aetna MGG,Aetna MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,BCBS,BCBS,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,BCBS MGG,BCBS MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Cigna,Cigna,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Cigna MGG,Cigna MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Humana,Humana,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Humana MGG,Humana MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Optum VA,Optum VA,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,UHC,UHC,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,UHC MGG,UHC MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,VA,VA,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Wellcare MGG,Wellcare MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Bright Health - commercial,Bright Health - commercial,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Bright Health MGG,Bright Health MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna,Aetna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Aetna MGG,Aetna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS,BCBS,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,BCBS MGG,BCBS MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna,Cigna,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Cigna MGG,Cigna MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana,Humana,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Humana MGG,Humana MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Optum VA,Optum VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC,UHC,113.22,,,,,,,per diem,113.22,113.22,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,UHC MGG,UHC MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,VA,VA,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Wellcare MGG,Wellcare MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health - commercial,Bright Health - commercial,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,87254,CPT,,,,Inpatient,,,113.22,113.22,Bright Health MGG,Bright Health MGG,113.22,,,,,,,case rate,113.22,113.22,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Aetna,Aetna,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Aetna MGG,Aetna MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,BCBS,BCBS,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,BCBS MGG,BCBS MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Cigna,Cigna,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Cigna MGG,Cigna MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Humana,Humana,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Humana MGG,Humana MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Optum VA,Optum VA,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,UHC,UHC,56.1,,,,,,,per diem,56.1,56.1,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,UHC MGG,UHC MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,VA,VA,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Wellcare MGG,Wellcare MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Bright Health - commercial,Bright Health - commercial,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,87254,CPT,,,59,Inpatient,,,56.1,56.1,Bright Health MGG,Bright Health MGG,56.1,,,,,,,case rate,56.1,56.1,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Aetna,Aetna,31.62,,,,,,,per diem,31.62,31.62,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Aetna MGG,Aetna MGG,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,BCBS,BCBS,31.62,,,,,,,per diem,31.62,31.62,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,BCBS MGG,BCBS MGG,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Cigna,Cigna,31.62,,,,,,,per diem,31.62,31.62,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Cigna MGG,Cigna MGG,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Humana,Humana,31.62,,,,,,,per diem,31.62,31.62,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Humana MGG,Humana MGG,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Optum VA,Optum VA,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,UHC,UHC,31.62,,,,,,,per diem,31.62,31.62,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,UHC MGG,UHC MGG,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,VA,VA,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Wellcare MGG,Wellcare MGG,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Bright Health - commercial,Bright Health - commercial,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,87254,CPT,,,,Inpatient,,,31.62,31.62,Bright Health MGG,Bright Health MGG,31.62,,,,,,,case rate,31.62,31.62,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Aetna,Aetna,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Aetna MGG,Aetna MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,BCBS,BCBS,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,BCBS MGG,BCBS MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Cigna,Cigna,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Cigna MGG,Cigna MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Humana,Humana,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Humana MGG,Humana MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Optum VA,Optum VA,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,UHC,UHC,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,UHC MGG,UHC MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,VA,VA,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Wellcare MGG,Wellcare MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Bright Health - commercial,Bright Health - commercial,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,87254,CPT,,,,Inpatient,,,53.04,53.04,Bright Health MGG,Bright Health MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Aetna,Aetna,253.98,,,,,,,per diem,253.98,253.98,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Aetna MGG,Aetna MGG,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,BCBS,BCBS,253.98,,,,,,,per diem,253.98,253.98,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,BCBS MGG,BCBS MGG,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Cigna,Cigna,253.98,,,,,,,per diem,253.98,253.98,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Cigna MGG,Cigna MGG,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Humana,Humana,253.98,,,,,,,per diem,253.98,253.98,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Humana MGG,Humana MGG,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Optum VA,Optum VA,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,UHC,UHC,253.98,,,,,,,per diem,253.98,253.98,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,UHC MGG,UHC MGG,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,VA,VA,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Wellcare MGG,Wellcare MGG,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Bright Health - commercial,Bright Health - commercial,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,87177,CPT,,,,Inpatient,,,253.98,253.98,Bright Health MGG,Bright Health MGG,253.98,,,,,,,case rate,253.98,253.98,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Aetna,Aetna,69.36,,,,,,,per diem,69.36,69.36,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Aetna MGG,Aetna MGG,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,BCBS,BCBS,69.36,,,,,,,per diem,69.36,69.36,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,BCBS MGG,BCBS MGG,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Cigna,Cigna,69.36,,,,,,,per diem,69.36,69.36,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Cigna MGG,Cigna MGG,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Humana,Humana,69.36,,,,,,,per diem,69.36,69.36,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Humana MGG,Humana MGG,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Optum VA,Optum VA,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,UHC,UHC,69.36,,,,,,,per diem,69.36,69.36,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,UHC MGG,UHC MGG,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,VA,VA,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Wellcare MGG,Wellcare MGG,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Bright Health - commercial,Bright Health - commercial,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,87177,CPT,,,,Inpatient,,,69.36,69.36,Bright Health MGG,Bright Health MGG,69.36,,,,,,,case rate,69.36,69.36,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Aetna,Aetna,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Aetna MGG,Aetna MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,BCBS,BCBS,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,BCBS MGG,BCBS MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Cigna,Cigna,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Cigna MGG,Cigna MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Humana,Humana,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Humana MGG,Humana MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Optum VA,Optum VA,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,UHC,UHC,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,UHC MGG,UHC MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,VA,VA,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Wellcare MGG,Wellcare MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Bright Health - commercial,Bright Health - commercial,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,87177,CPT,,,,Inpatient,,,63.24,63.24,Bright Health MGG,Bright Health MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Aetna,Aetna,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Aetna MGG,Aetna MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,BCBS,BCBS,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,BCBS MGG,BCBS MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Cigna,Cigna,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Cigna MGG,Cigna MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Humana,Humana,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Humana MGG,Humana MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Optum VA,Optum VA,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,UHC,UHC,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,UHC MGG,UHC MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,VA,VA,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Wellcare MGG,Wellcare MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Bright Health - commercial,Bright Health - commercial,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,86317,CPT,,,,Inpatient,,,205.02,205.02,Bright Health MGG,Bright Health MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Aetna,Aetna,146.88,,,,,,,per diem,146.88,146.88,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Aetna MGG,Aetna MGG,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,BCBS,BCBS,146.88,,,,,,,per diem,146.88,146.88,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,BCBS MGG,BCBS MGG,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Cigna,Cigna,146.88,,,,,,,per diem,146.88,146.88,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Cigna MGG,Cigna MGG,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Humana,Humana,146.88,,,,,,,per diem,146.88,146.88,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Humana MGG,Humana MGG,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Optum VA,Optum VA,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,UHC,UHC,146.88,,,,,,,per diem,146.88,146.88,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,UHC MGG,UHC MGG,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,VA,VA,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Wellcare MGG,Wellcare MGG,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Bright Health - commercial,Bright Health - commercial,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,86592,CPT,,,,Inpatient,,,146.88,146.88,Bright Health MGG,Bright Health MGG,146.88,,,,,,,case rate,146.88,146.88,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Aetna,Aetna,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Aetna MGG,Aetna MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,BCBS,BCBS,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,BCBS MGG,BCBS MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Cigna,Cigna,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Cigna MGG,Cigna MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Humana,Humana,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Humana MGG,Humana MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Optum VA,Optum VA,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,UHC,UHC,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,UHC MGG,UHC MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,VA,VA,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Wellcare MGG,Wellcare MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Bright Health - commercial,Bright Health - commercial,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,84302,CPT,,,,Inpatient,,,53.04,53.04,Bright Health MGG,Bright Health MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Aetna,Aetna,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Aetna MGG,Aetna MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,BCBS,BCBS,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,BCBS MGG,BCBS MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Cigna,Cigna,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Cigna MGG,Cigna MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Humana,Humana,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Humana MGG,Humana MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Optum VA,Optum VA,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,UHC,UHC,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,UHC MGG,UHC MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,VA,VA,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Wellcare MGG,Wellcare MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Bright Health - commercial,Bright Health - commercial,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,86593,CPT,,,,Inpatient,,,94.86,94.86,Bright Health MGG,Bright Health MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Aetna,Aetna,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Aetna MGG,Aetna MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,BCBS,BCBS,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,BCBS MGG,BCBS MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Cigna,Cigna,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Cigna MGG,Cigna MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Humana,Humana,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Humana MGG,Humana MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Optum VA,Optum VA,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,UHC,UHC,46.92,,,,,,,per diem,46.92,46.92,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,UHC MGG,UHC MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,VA,VA,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Wellcare MGG,Wellcare MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Bright Health - commercial,Bright Health - commercial,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,87116,CPT,,,,Inpatient,,,46.92,46.92,Bright Health MGG,Bright Health MGG,46.92,,,,,,,case rate,46.92,46.92,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Aetna,Aetna,399.84,,,,,,,per diem,399.84,399.84,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Aetna MGG,Aetna MGG,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,BCBS,BCBS,399.84,,,,,,,per diem,399.84,399.84,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,BCBS MGG,BCBS MGG,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Cigna,Cigna,399.84,,,,,,,per diem,399.84,399.84,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Cigna MGG,Cigna MGG,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Humana,Humana,399.84,,,,,,,per diem,399.84,399.84,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Humana MGG,Humana MGG,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Optum VA,Optum VA,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,UHC,UHC,399.84,,,,,,,per diem,399.84,399.84,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,UHC MGG,UHC MGG,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,VA,VA,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Wellcare MGG,Wellcare MGG,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Bright Health - commercial,Bright Health - commercial,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,87116,CPT,,,,Inpatient,,,399.84,399.84,Bright Health MGG,Bright Health MGG,399.84,,,,,,,case rate,399.84,399.84,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Aetna,Aetna,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Aetna MGG,Aetna MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,BCBS,BCBS,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,BCBS MGG,BCBS MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Cigna,Cigna,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Cigna MGG,Cigna MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Humana,Humana,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Humana MGG,Humana MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Optum VA,Optum VA,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,UHC,UHC,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,UHC MGG,UHC MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,VA,VA,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Wellcare MGG,Wellcare MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Bright Health - commercial,Bright Health - commercial,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,80324,CPT,,,,Inpatient,,,70.38,70.38,Bright Health MGG,Bright Health MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Aetna,Aetna,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Aetna MGG,Aetna MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,BCBS,BCBS,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,BCBS MGG,BCBS MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Cigna,Cigna,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Cigna MGG,Cigna MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Humana,Humana,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Humana MGG,Humana MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Optum VA,Optum VA,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,UHC,UHC,110.16,,,,,,,per diem,110.16,110.16,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,UHC MGG,UHC MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,VA,VA,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Wellcare MGG,Wellcare MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Bright Health - commercial,Bright Health - commercial,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,87076,CPT,,,,Inpatient,,,110.16,110.16,Bright Health MGG,Bright Health MGG,110.16,,,,,,,case rate,110.16,110.16,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Aetna,Aetna,114.24,,,,,,,per diem,114.24,114.24,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Aetna MGG,Aetna MGG,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,BCBS,BCBS,114.24,,,,,,,per diem,114.24,114.24,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,BCBS MGG,BCBS MGG,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Cigna,Cigna,114.24,,,,,,,per diem,114.24,114.24,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Cigna MGG,Cigna MGG,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Humana,Humana,114.24,,,,,,,per diem,114.24,114.24,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Humana MGG,Humana MGG,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Optum VA,Optum VA,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,UHC,UHC,114.24,,,,,,,per diem,114.24,114.24,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,UHC MGG,UHC MGG,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,VA,VA,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Wellcare MGG,Wellcare MGG,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Bright Health - commercial,Bright Health - commercial,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,87076,CPT,,,,Inpatient,,,114.24,114.24,Bright Health MGG,Bright Health MGG,114.24,,,,,,,case rate,114.24,114.24,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Aetna,Aetna,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Aetna MGG,Aetna MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,BCBS,BCBS,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,BCBS MGG,BCBS MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Cigna,Cigna,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Cigna MGG,Cigna MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Humana,Humana,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Humana MGG,Humana MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Optum VA,Optum VA,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,UHC,UHC,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,UHC MGG,UHC MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,VA,VA,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Wellcare MGG,Wellcare MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Bright Health - commercial,Bright Health - commercial,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,80345,CPT,,,,Inpatient,,,49.98,49.98,Bright Health MGG,Bright Health MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Aetna,Aetna,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Aetna MGG,Aetna MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,BCBS,BCBS,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,BCBS MGG,BCBS MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Cigna,Cigna,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Cigna MGG,Cigna MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Humana,Humana,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Humana MGG,Humana MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Optum VA,Optum VA,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,UHC,UHC,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,UHC MGG,UHC MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,VA,VA,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Wellcare MGG,Wellcare MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Bright Health - commercial,Bright Health - commercial,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,80349,CPT,,,,Inpatient,,,81.6,81.6,Bright Health MGG,Bright Health MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Aetna,Aetna,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Aetna MGG,Aetna MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,BCBS,BCBS,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,BCBS MGG,BCBS MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Cigna,Cigna,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Cigna MGG,Cigna MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Humana,Humana,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Humana MGG,Humana MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Optum VA,Optum VA,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,UHC,UHC,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,UHC MGG,UHC MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,VA,VA,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Wellcare MGG,Wellcare MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Bright Health - commercial,Bright Health - commercial,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,82438,CPT,,,,Inpatient,,,53.04,53.04,Bright Health MGG,Bright Health MGG,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Aetna,Aetna,65.28,,,,,,,per diem,65.28,65.28,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Aetna MGG,Aetna MGG,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,BCBS,BCBS,65.28,,,,,,,per diem,65.28,65.28,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,BCBS MGG,BCBS MGG,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Cigna,Cigna,65.28,,,,,,,per diem,65.28,65.28,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Cigna MGG,Cigna MGG,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Humana,Humana,65.28,,,,,,,per diem,65.28,65.28,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Humana MGG,Humana MGG,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Optum VA,Optum VA,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,UHC,UHC,65.28,,,,,,,per diem,65.28,65.28,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,UHC MGG,UHC MGG,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,VA,VA,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Wellcare MGG,Wellcare MGG,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Bright Health - commercial,Bright Health - commercial,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,80353,CPT,,,,Inpatient,,,65.28,65.28,Bright Health MGG,Bright Health MGG,65.28,,,,,,,case rate,65.28,65.28,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Aetna,Aetna,579.36,,,,,,,per diem,579.36,579.36,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Aetna MGG,Aetna MGG,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,BCBS,BCBS,579.36,,,,,,,per diem,579.36,579.36,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,BCBS MGG,BCBS MGG,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Cigna,Cigna,579.36,,,,,,,per diem,579.36,579.36,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Cigna MGG,Cigna MGG,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Humana,Humana,579.36,,,,,,,per diem,579.36,579.36,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Humana MGG,Humana MGG,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Optum VA,Optum VA,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,UHC,UHC,579.36,,,,,,,per diem,579.36,579.36,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,UHC MGG,UHC MGG,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,VA,VA,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Wellcare MGG,Wellcare MGG,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Bright Health - commercial,Bright Health - commercial,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,86635,CPT,,,,Inpatient,,,579.36,579.36,Bright Health MGG,Bright Health MGG,579.36,,,,,,,case rate,579.36,579.36,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Aetna,Aetna,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Aetna MGG,Aetna MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,BCBS,BCBS,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,BCBS MGG,BCBS MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Cigna,Cigna,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Cigna MGG,Cigna MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Humana,Humana,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Humana MGG,Humana MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Optum VA,Optum VA,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,UHC,UHC,81.6,,,,,,,per diem,81.6,81.6,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,UHC MGG,UHC MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,VA,VA,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Wellcare MGG,Wellcare MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Bright Health - commercial,Bright Health - commercial,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,86635,CPT,,,,Inpatient,,,81.6,81.6,Bright Health MGG,Bright Health MGG,81.6,,,,,,,case rate,81.6,81.6,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Aetna,Aetna,725.22,,,,,,,per diem,725.22,725.22,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Aetna MGG,Aetna MGG,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,BCBS,BCBS,725.22,,,,,,,per diem,725.22,725.22,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,BCBS MGG,BCBS MGG,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Cigna,Cigna,725.22,,,,,,,per diem,725.22,725.22,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Cigna MGG,Cigna MGG,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Humana,Humana,725.22,,,,,,,per diem,725.22,725.22,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Humana MGG,Humana MGG,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Optum VA,Optum VA,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,UHC,UHC,725.22,,,,,,,per diem,725.22,725.22,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,UHC MGG,UHC MGG,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,VA,VA,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Wellcare MGG,Wellcare MGG,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Bright Health - commercial,Bright Health - commercial,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,86635,CPT,,,,Inpatient,,,725.22,725.22,Bright Health MGG,Bright Health MGG,725.22,,,,,,,case rate,725.22,725.22,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Aetna,Aetna,68.34,,,,,,,per diem,68.34,68.34,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Aetna MGG,Aetna MGG,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,BCBS,BCBS,68.34,,,,,,,per diem,68.34,68.34,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,BCBS MGG,BCBS MGG,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Cigna,Cigna,68.34,,,,,,,per diem,68.34,68.34,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Cigna MGG,Cigna MGG,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Humana,Humana,68.34,,,,,,,per diem,68.34,68.34,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Humana MGG,Humana MGG,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Optum VA,Optum VA,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,UHC,UHC,68.34,,,,,,,per diem,68.34,68.34,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,UHC MGG,UHC MGG,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,VA,VA,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Wellcare MGG,Wellcare MGG,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Bright Health - commercial,Bright Health - commercial,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,87106,CPT,,,,Inpatient,,,68.34,68.34,Bright Health MGG,Bright Health MGG,68.34,,,,,,,case rate,68.34,68.34,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Aetna,Aetna,17.97,,,,,,,per diem,17.97,17.97,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Aetna MGG,Aetna MGG,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,BCBS,BCBS,17.97,,,,,,,per diem,17.97,17.97,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,BCBS MGG,BCBS MGG,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Cigna,Cigna,17.97,,,,,,,per diem,17.97,17.97,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Cigna MGG,Cigna MGG,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Humana,Humana,17.97,,,,,,,per diem,17.97,17.97,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Humana MGG,Humana MGG,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Optum VA,Optum VA,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,UHC,UHC,17.97,,,,,,,per diem,17.97,17.97,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,UHC MGG,UHC MGG,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,VA,VA,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Wellcare MGG,Wellcare MGG,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Bright Health - commercial,Bright Health - commercial,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,87207,CPT,,,,Inpatient,,,17.97,17.97,Bright Health MGG,Bright Health MGG,17.97,,,,,,,case rate,17.97,17.97,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Aetna,Aetna,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Aetna MGG,Aetna MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,BCBS,BCBS,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,BCBS MGG,BCBS MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Cigna,Cigna,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Cigna MGG,Cigna MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Humana,Humana,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Humana MGG,Humana MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Optum VA,Optum VA,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,UHC,UHC,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,UHC MGG,UHC MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,VA,VA,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Wellcare MGG,Wellcare MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Bright Health - commercial,Bright Health - commercial,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,87207,CPT,,,,Inpatient,,,29.58,29.58,Bright Health MGG,Bright Health MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Aetna,Aetna,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Aetna MGG,Aetna MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,BCBS,BCBS,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,BCBS MGG,BCBS MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Cigna,Cigna,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Cigna MGG,Cigna MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Humana,Humana,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Humana MGG,Humana MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Optum VA,Optum VA,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,UHC,UHC,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,UHC MGG,UHC MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,VA,VA,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Wellcare MGG,Wellcare MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Bright Health - commercial,Bright Health - commercial,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,87798,CPT,,,,Inpatient,,,129.99,129.99,Bright Health MGG,Bright Health MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Aetna,Aetna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Aetna MGG,Aetna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,BCBS,BCBS,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,BCBS MGG,BCBS MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Cigna,Cigna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Cigna MGG,Cigna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Humana,Humana,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Humana MGG,Humana MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Optum VA,Optum VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,UHC,UHC,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,UHC MGG,UHC MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,VA,VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Wellcare MGG,Wellcare MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Bright Health - commercial,Bright Health - commercial,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,87798,CPT,,,,Inpatient,,,141.78,141.78,Bright Health MGG,Bright Health MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Aetna,Aetna,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Aetna MGG,Aetna MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,BCBS,BCBS,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,BCBS MGG,BCBS MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Cigna,Cigna,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Cigna MGG,Cigna MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Humana,Humana,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Humana MGG,Humana MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Optum VA,Optum VA,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,UHC,UHC,157.08,,,,,,,per diem,157.08,157.08,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,UHC MGG,UHC MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,VA,VA,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Wellcare MGG,Wellcare MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Bright Health - commercial,Bright Health - commercial,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,87798,CPT,,,,Inpatient,,,157.08,157.08,Bright Health MGG,Bright Health MGG,157.08,,,,,,,case rate,157.08,157.08,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Aetna,Aetna,150.97,,,,,,,per diem,150.97,150.97,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Aetna MGG,Aetna MGG,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,BCBS,BCBS,150.97,,,,,,,per diem,150.97,150.97,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,BCBS MGG,BCBS MGG,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Cigna,Cigna,150.97,,,,,,,per diem,150.97,150.97,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Cigna MGG,Cigna MGG,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Humana,Humana,150.97,,,,,,,per diem,150.97,150.97,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Humana MGG,Humana MGG,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Optum VA,Optum VA,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,UHC,UHC,150.97,,,,,,,per diem,150.97,150.97,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,UHC MGG,UHC MGG,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,VA,VA,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Wellcare MGG,Wellcare MGG,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Bright Health - commercial,Bright Health - commercial,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,87798,CPT,,,,Inpatient,,,150.97,150.97,Bright Health MGG,Bright Health MGG,150.97,,,,,,,case rate,150.97,150.97,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Aetna,Aetna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Aetna MGG,Aetna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,BCBS,BCBS,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,BCBS MGG,BCBS MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Cigna,Cigna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Cigna MGG,Cigna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Humana,Humana,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Humana MGG,Humana MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Optum VA,Optum VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,UHC,UHC,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,UHC MGG,UHC MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,VA,VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Wellcare MGG,Wellcare MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Bright Health - commercial,Bright Health - commercial,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,87798,CPT,,,,Inpatient,,,138.72,138.72,Bright Health MGG,Bright Health MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Aetna,Aetna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Aetna MGG,Aetna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,BCBS,BCBS,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,BCBS MGG,BCBS MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Cigna,Cigna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Cigna MGG,Cigna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Humana,Humana,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Humana MGG,Humana MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Optum VA,Optum VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,UHC,UHC,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,UHC MGG,UHC MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,VA,VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Wellcare MGG,Wellcare MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Bright Health - commercial,Bright Health - commercial,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,87798,CPT,,,59,Inpatient,,,138.72,138.72,Bright Health MGG,Bright Health MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Aetna,Aetna,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Aetna MGG,Aetna MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,BCBS,BCBS,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,BCBS MGG,BCBS MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Cigna,Cigna,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Cigna MGG,Cigna MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Humana,Humana,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Humana MGG,Humana MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Optum VA,Optum VA,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,UHC,UHC,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,UHC MGG,UHC MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,VA,VA,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Wellcare MGG,Wellcare MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Bright Health - commercial,Bright Health - commercial,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,80361,CPT,,,,Inpatient,,,87.72,87.72,Bright Health MGG,Bright Health MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Aetna,Aetna,60.18,,,,,,,per diem,60.18,60.18,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Aetna MGG,Aetna MGG,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,BCBS,BCBS,60.18,,,,,,,per diem,60.18,60.18,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,BCBS MGG,BCBS MGG,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Cigna,Cigna,60.18,,,,,,,per diem,60.18,60.18,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Cigna MGG,Cigna MGG,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Humana,Humana,60.18,,,,,,,per diem,60.18,60.18,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Humana MGG,Humana MGG,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Optum VA,Optum VA,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,UHC,UHC,60.18,,,,,,,per diem,60.18,60.18,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,UHC MGG,UHC MGG,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,VA,VA,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Wellcare MGG,Wellcare MGG,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Bright Health - commercial,Bright Health - commercial,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,83992,CPT,,,,Inpatient,,,60.18,60.18,Bright Health MGG,Bright Health MGG,60.18,,,,,,,case rate,60.18,60.18,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Aetna,Aetna,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Aetna MGG,Aetna MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,BCBS,BCBS,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,BCBS MGG,BCBS MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Cigna,Cigna,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Cigna MGG,Cigna MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Humana,Humana,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Humana MGG,Humana MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Optum VA,Optum VA,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,UHC,UHC,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,UHC MGG,UHC MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,VA,VA,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Wellcare MGG,Wellcare MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Bright Health - commercial,Bright Health - commercial,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,87209,CPT,,,,Inpatient,,,137.7,137.7,Bright Health MGG,Bright Health MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Aetna,Aetna,72.42,,,,,,,per diem,72.42,72.42,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Aetna MGG,Aetna MGG,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,BCBS,BCBS,72.42,,,,,,,per diem,72.42,72.42,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,BCBS MGG,BCBS MGG,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Cigna,Cigna,72.42,,,,,,,per diem,72.42,72.42,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Cigna MGG,Cigna MGG,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Humana,Humana,72.42,,,,,,,per diem,72.42,72.42,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Humana MGG,Humana MGG,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Optum VA,Optum VA,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,UHC,UHC,72.42,,,,,,,per diem,72.42,72.42,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,UHC MGG,UHC MGG,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,VA,VA,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Wellcare MGG,Wellcare MGG,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Bright Health - commercial,Bright Health - commercial,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,87209,CPT,,,,Inpatient,,,72.42,72.42,Bright Health MGG,Bright Health MGG,72.42,,,,,,,case rate,72.42,72.42,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Aetna,Aetna,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Aetna MGG,Aetna MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,BCBS,BCBS,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,BCBS MGG,BCBS MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Cigna,Cigna,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Cigna MGG,Cigna MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Humana,Humana,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Humana MGG,Humana MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Optum VA,Optum VA,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,UHC,UHC,63.24,,,,,,,per diem,63.24,63.24,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,UHC MGG,UHC MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,VA,VA,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Wellcare MGG,Wellcare MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Bright Health - commercial,Bright Health - commercial,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,87209,CPT,,,,Inpatient,,,63.24,63.24,Bright Health MGG,Bright Health MGG,63.24,,,,,,,case rate,63.24,63.24,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Aetna,Aetna,271.32,,,,,,,per diem,271.32,271.32,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Aetna MGG,Aetna MGG,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,BCBS,BCBS,271.32,,,,,,,per diem,271.32,271.32,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,BCBS MGG,BCBS MGG,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Cigna,Cigna,271.32,,,,,,,per diem,271.32,271.32,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Cigna MGG,Cigna MGG,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Humana,Humana,271.32,,,,,,,per diem,271.32,271.32,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Humana MGG,Humana MGG,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Optum VA,Optum VA,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,UHC,UHC,271.32,,,,,,,per diem,271.32,271.32,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,UHC MGG,UHC MGG,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,VA,VA,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Wellcare MGG,Wellcare MGG,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Bright Health - commercial,Bright Health - commercial,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,87220,CPT,,,,Inpatient,,,271.32,271.32,Bright Health MGG,Bright Health MGG,271.32,,,,,,,case rate,271.32,271.32,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Aetna,Aetna,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Aetna MGG,Aetna MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,BCBS,BCBS,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,BCBS MGG,BCBS MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Cigna,Cigna,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Cigna MGG,Cigna MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Humana,Humana,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Humana MGG,Humana MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Optum VA,Optum VA,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,UHC,UHC,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,UHC MGG,UHC MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,VA,VA,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Wellcare MGG,Wellcare MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Bright Health - commercial,Bright Health - commercial,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,84999,CPT,,,,Inpatient,,,55.08,55.08,Bright Health MGG,Bright Health MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Aetna,Aetna,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Aetna MGG,Aetna MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,BCBS,BCBS,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,BCBS MGG,BCBS MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Cigna,Cigna,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Cigna MGG,Cigna MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Humana,Humana,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Humana MGG,Humana MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Optum VA,Optum VA,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,UHC,UHC,164.22,,,,,,,per diem,164.22,164.22,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,UHC MGG,UHC MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,VA,VA,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Wellcare MGG,Wellcare MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Bright Health - commercial,Bright Health - commercial,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,87497,CPT,,,,Inpatient,,,164.22,164.22,Bright Health MGG,Bright Health MGG,164.22,,,,,,,case rate,164.22,164.22,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Aetna,Aetna,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Aetna MGG,Aetna MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,BCBS,BCBS,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,BCBS MGG,BCBS MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Cigna,Cigna,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Cigna MGG,Cigna MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Humana,Humana,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Humana MGG,Humana MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Optum VA,Optum VA,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,UHC,UHC,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,UHC MGG,UHC MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,VA,VA,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Wellcare MGG,Wellcare MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Bright Health - commercial,Bright Health - commercial,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,80365,CPT,,,,Inpatient,,,285.6,285.6,Bright Health MGG,Bright Health MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Aetna,Aetna,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Aetna MGG,Aetna MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,BCBS,BCBS,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,BCBS MGG,BCBS MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Cigna,Cigna,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Cigna MGG,Cigna MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Humana,Humana,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Humana MGG,Humana MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Optum VA,Optum VA,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,UHC,UHC,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,UHC MGG,UHC MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,VA,VA,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Wellcare MGG,Wellcare MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Bright Health - commercial,Bright Health - commercial,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,80347,CPT,,,,Inpatient,,,83.64,83.64,Bright Health MGG,Bright Health MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Aetna,Aetna,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Aetna MGG,Aetna MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,BCBS,BCBS,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,BCBS MGG,BCBS MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Cigna,Cigna,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Cigna MGG,Cigna MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Humana,Humana,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Humana MGG,Humana MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Optum VA,Optum VA,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,UHC,UHC,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,UHC MGG,UHC MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,VA,VA,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Wellcare MGG,Wellcare MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Bright Health - commercial,Bright Health - commercial,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,87015,CPT,,,,Inpatient,,,35.7,35.7,Bright Health MGG,Bright Health MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Aetna,Aetna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Aetna MGG,Aetna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,BCBS,BCBS,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,BCBS MGG,BCBS MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Cigna,Cigna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Cigna MGG,Cigna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Humana,Humana,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Humana MGG,Humana MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Optum VA,Optum VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,UHC,UHC,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,UHC MGG,UHC MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,VA,VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Wellcare MGG,Wellcare MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Bright Health - commercial,Bright Health - commercial,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,87015,CPT,,,,Inpatient,,,25.5,25.5,Bright Health MGG,Bright Health MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Aetna,Aetna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Aetna MGG,Aetna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,BCBS,BCBS,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,BCBS MGG,BCBS MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Cigna,Cigna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Cigna MGG,Cigna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Humana,Humana,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Humana MGG,Humana MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Optum VA,Optum VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,UHC,UHC,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,UHC MGG,UHC MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,VA,VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Wellcare MGG,Wellcare MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Bright Health - commercial,Bright Health - commercial,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,87015,CPT,,,,Inpatient,,,26.52,26.52,Bright Health MGG,Bright Health MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Aetna,Aetna,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Aetna MGG,Aetna MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,BCBS,BCBS,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,BCBS MGG,BCBS MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Cigna,Cigna,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Cigna MGG,Cigna MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Humana,Humana,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Humana MGG,Humana MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Optum VA,Optum VA,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,UHC,UHC,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,UHC MGG,UHC MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,VA,VA,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Wellcare MGG,Wellcare MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Bright Health - commercial,Bright Health - commercial,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,87015,CPT,,,,Inpatient,,,80.58,80.58,Bright Health MGG,Bright Health MGG,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Aetna,Aetna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Aetna MGG,Aetna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,BCBS,BCBS,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,BCBS MGG,BCBS MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Cigna,Cigna,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Cigna MGG,Cigna MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Humana,Humana,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Humana MGG,Humana MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Optum VA,Optum VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,UHC,UHC,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,UHC MGG,UHC MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,VA,VA,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Wellcare MGG,Wellcare MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Bright Health - commercial,Bright Health - commercial,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,87185,CPT,,,,Inpatient,,,25.5,25.5,Bright Health MGG,Bright Health MGG,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Aetna,Aetna,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Aetna MGG,Aetna MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,BCBS,BCBS,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,BCBS MGG,BCBS MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Cigna,Cigna,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Cigna MGG,Cigna MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Humana,Humana,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Humana MGG,Humana MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Optum VA,Optum VA,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,UHC,UHC,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,UHC MGG,UHC MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,VA,VA,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Wellcare MGG,Wellcare MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Bright Health - commercial,Bright Health - commercial,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,87103,CPT,,,,Inpatient,,,336.6,336.6,Bright Health MGG,Bright Health MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Aetna,Aetna,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Aetna MGG,Aetna MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,BCBS,BCBS,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,BCBS MGG,BCBS MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Cigna,Cigna,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Cigna MGG,Cigna MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Humana,Humana,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Humana MGG,Humana MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Optum VA,Optum VA,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,UHC,UHC,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,UHC MGG,UHC MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,VA,VA,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Wellcare MGG,Wellcare MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Bright Health - commercial,Bright Health - commercial,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,87181,CPT,,,,Inpatient,,,449.82,449.82,Bright Health MGG,Bright Health MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Aetna,Aetna,40.8,,,,,,,per diem,40.8,40.8,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Aetna MGG,Aetna MGG,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,BCBS,BCBS,40.8,,,,,,,per diem,40.8,40.8,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,BCBS MGG,BCBS MGG,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Cigna,Cigna,40.8,,,,,,,per diem,40.8,40.8,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Cigna MGG,Cigna MGG,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Humana,Humana,40.8,,,,,,,per diem,40.8,40.8,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Humana MGG,Humana MGG,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Optum VA,Optum VA,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,UHC,UHC,40.8,,,,,,,per diem,40.8,40.8,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,UHC MGG,UHC MGG,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,VA,VA,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Wellcare MGG,Wellcare MGG,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Bright Health - commercial,Bright Health - commercial,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,87181,CPT,,,,Inpatient,,,40.8,40.8,Bright Health MGG,Bright Health MGG,40.8,,,,,,,case rate,40.8,40.8,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Aetna,Aetna,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Aetna MGG,Aetna MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,BCBS,BCBS,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,BCBS MGG,BCBS MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Cigna,Cigna,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Cigna MGG,Cigna MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Humana,Humana,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Humana MGG,Humana MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Optum VA,Optum VA,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,UHC,UHC,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,UHC MGG,UHC MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,VA,VA,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Wellcare MGG,Wellcare MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Bright Health - commercial,Bright Health - commercial,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,87181,CPT,,,,Inpatient,,,428.4,428.4,Bright Health MGG,Bright Health MGG,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Aetna,Aetna,148.92,,,,,,,per diem,148.92,148.92,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Aetna MGG,Aetna MGG,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,BCBS,BCBS,148.92,,,,,,,per diem,148.92,148.92,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,BCBS MGG,BCBS MGG,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Cigna,Cigna,148.92,,,,,,,per diem,148.92,148.92,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Cigna MGG,Cigna MGG,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Humana,Humana,148.92,,,,,,,per diem,148.92,148.92,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Humana MGG,Humana MGG,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Optum VA,Optum VA,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,UHC,UHC,148.92,,,,,,,per diem,148.92,148.92,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,UHC MGG,UHC MGG,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,VA,VA,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Wellcare MGG,Wellcare MGG,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Bright Health - commercial,Bright Health - commercial,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,87149,CPT,,,,Inpatient,,,148.92,148.92,Bright Health MGG,Bright Health MGG,148.92,,,,,,,case rate,148.92,148.92,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Aetna,Aetna,230.52,,,,,,,per diem,230.52,230.52,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Aetna MGG,Aetna MGG,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,BCBS,BCBS,230.52,,,,,,,per diem,230.52,230.52,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,BCBS MGG,BCBS MGG,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Cigna,Cigna,230.52,,,,,,,per diem,230.52,230.52,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Cigna MGG,Cigna MGG,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Humana,Humana,230.52,,,,,,,per diem,230.52,230.52,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Humana MGG,Humana MGG,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Optum VA,Optum VA,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,UHC,UHC,230.52,,,,,,,per diem,230.52,230.52,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,UHC MGG,UHC MGG,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,VA,VA,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Wellcare MGG,Wellcare MGG,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Bright Health - commercial,Bright Health - commercial,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,87149,CPT,,,,Inpatient,,,230.52,230.52,Bright Health MGG,Bright Health MGG,230.52,,,,,,,case rate,230.52,230.52,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Aetna,Aetna,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Aetna MGG,Aetna MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,BCBS,BCBS,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,BCBS MGG,BCBS MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Cigna,Cigna,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Cigna MGG,Cigna MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Humana,Humana,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Humana MGG,Humana MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Optum VA,Optum VA,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,UHC,UHC,205.02,,,,,,,per diem,205.02,205.02,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,UHC MGG,UHC MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,VA,VA,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Wellcare MGG,Wellcare MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Bright Health - commercial,Bright Health - commercial,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,87149,CPT,,,,Inpatient,,,205.02,205.02,Bright Health MGG,Bright Health MGG,205.02,,,,,,,case rate,205.02,205.02,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Aetna,Aetna,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Aetna MGG,Aetna MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,BCBS,BCBS,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,BCBS MGG,BCBS MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Cigna,Cigna,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Cigna MGG,Cigna MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Humana,Humana,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Humana MGG,Humana MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Optum VA,Optum VA,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,UHC,UHC,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,UHC MGG,UHC MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,VA,VA,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Wellcare MGG,Wellcare MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Bright Health - commercial,Bright Health - commercial,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Bright Health MGG,Bright Health MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Aetna,Aetna,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Aetna MGG,Aetna MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,BCBS,BCBS,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,BCBS MGG,BCBS MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Cigna,Cigna,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Cigna MGG,Cigna MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Humana,Humana,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Humana MGG,Humana MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Optum VA,Optum VA,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,UHC,UHC,158.1,,,,,,,per diem,158.1,158.1,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,UHC MGG,UHC MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,VA,VA,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Wellcare MGG,Wellcare MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Bright Health - commercial,Bright Health - commercial,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,87149,CPT,,,,Inpatient,,,158.1,158.1,Bright Health MGG,Bright Health MGG,158.1,,,,,,,case rate,158.1,158.1,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Aetna,Aetna,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Aetna MGG,Aetna MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,BCBS,BCBS,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,BCBS MGG,BCBS MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Cigna,Cigna,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Cigna MGG,Cigna MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Humana,Humana,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Humana MGG,Humana MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Optum VA,Optum VA,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,UHC,UHC,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,UHC MGG,UHC MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,VA,VA,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Wellcare MGG,Wellcare MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Bright Health - commercial,Bright Health - commercial,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Bright Health MGG,Bright Health MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Aetna,Aetna,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Aetna MGG,Aetna MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,BCBS,BCBS,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,BCBS MGG,BCBS MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Cigna,Cigna,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Cigna MGG,Cigna MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Humana,Humana,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Humana MGG,Humana MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Optum VA,Optum VA,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,UHC,UHC,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,UHC MGG,UHC MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,VA,VA,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Wellcare MGG,Wellcare MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Bright Health - commercial,Bright Health - commercial,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,87149,CPT,,,,Inpatient,,,154.02,154.02,Bright Health MGG,Bright Health MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Aetna,Aetna,66.86,,,,,,,per diem,66.86,66.86,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Aetna MGG,Aetna MGG,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,BCBS,BCBS,66.86,,,,,,,per diem,66.86,66.86,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,BCBS MGG,BCBS MGG,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Cigna,Cigna,66.86,,,,,,,per diem,66.86,66.86,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Cigna MGG,Cigna MGG,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Humana,Humana,66.86,,,,,,,per diem,66.86,66.86,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Humana MGG,Humana MGG,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Optum VA,Optum VA,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,UHC,UHC,66.86,,,,,,,per diem,66.86,66.86,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,UHC MGG,UHC MGG,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,VA,VA,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Wellcare MGG,Wellcare MGG,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Bright Health - commercial,Bright Health - commercial,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,87149,CPT,,,,Inpatient,,,66.86,66.86,Bright Health MGG,Bright Health MGG,66.86,,,,,,,case rate,66.86,66.86,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Aetna,Aetna,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Aetna MGG,Aetna MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,BCBS,BCBS,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,BCBS MGG,BCBS MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Cigna,Cigna,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Cigna MGG,Cigna MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Humana,Humana,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Humana MGG,Humana MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Optum VA,Optum VA,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,UHC,UHC,69.44,,,,,,,per diem,69.44,69.44,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,UHC MGG,UHC MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,VA,VA,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Wellcare MGG,Wellcare MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Bright Health - commercial,Bright Health - commercial,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,87149,CPT,,,59,Inpatient,,,69.44,69.44,Bright Health MGG,Bright Health MGG,69.44,,,,,,,case rate,69.44,69.44,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Aetna,Aetna,28.56,,,,,,,per diem,28.56,28.56,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Aetna MGG,Aetna MGG,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,BCBS,BCBS,28.56,,,,,,,per diem,28.56,28.56,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,BCBS MGG,BCBS MGG,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Cigna,Cigna,28.56,,,,,,,per diem,28.56,28.56,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Cigna MGG,Cigna MGG,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Humana,Humana,28.56,,,,,,,per diem,28.56,28.56,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Humana MGG,Humana MGG,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Optum VA,Optum VA,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,UHC,UHC,28.56,,,,,,,per diem,28.56,28.56,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,UHC MGG,UHC MGG,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,VA,VA,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Wellcare MGG,Wellcare MGG,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Bright Health - commercial,Bright Health - commercial,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,87140,CPT,,,,Inpatient,,,28.56,28.56,Bright Health MGG,Bright Health MGG,28.56,,,,,,,case rate,28.56,28.56,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Aetna,Aetna,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Aetna MGG,Aetna MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,BCBS,BCBS,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,BCBS MGG,BCBS MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Cigna,Cigna,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Cigna MGG,Cigna MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Humana,Humana,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Humana MGG,Humana MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Optum VA,Optum VA,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,UHC,UHC,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,UHC MGG,UHC MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,VA,VA,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Wellcare MGG,Wellcare MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Bright Health - commercial,Bright Health - commercial,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,87140,CPT,,,,Inpatient,,,97.92,97.92,Bright Health MGG,Bright Health MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Aetna,Aetna,23.46,,,,,,,per diem,23.46,23.46,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Aetna MGG,Aetna MGG,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,BCBS,BCBS,23.46,,,,,,,per diem,23.46,23.46,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,BCBS MGG,BCBS MGG,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Cigna,Cigna,23.46,,,,,,,per diem,23.46,23.46,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Cigna MGG,Cigna MGG,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Humana,Humana,23.46,,,,,,,per diem,23.46,23.46,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Humana MGG,Humana MGG,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Optum VA,Optum VA,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,UHC,UHC,23.46,,,,,,,per diem,23.46,23.46,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,UHC MGG,UHC MGG,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,VA,VA,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Wellcare MGG,Wellcare MGG,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Bright Health - commercial,Bright Health - commercial,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,86431,CPT,,,,Inpatient,,,23.46,23.46,Bright Health MGG,Bright Health MGG,23.46,,,,,,,case rate,23.46,23.46,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Aetna,Aetna,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Aetna MGG,Aetna MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,BCBS,BCBS,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,BCBS MGG,BCBS MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Cigna,Cigna,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Cigna MGG,Cigna MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Humana,Humana,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Humana MGG,Humana MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Optum VA,Optum VA,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,UHC,UHC,154.02,,,,,,,per diem,154.02,154.02,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,UHC MGG,UHC MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,VA,VA,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Wellcare MGG,Wellcare MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Bright Health - commercial,Bright Health - commercial,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,87279,CPT,,,,Inpatient,,,154.02,154.02,Bright Health MGG,Bright Health MGG,154.02,,,,,,,case rate,154.02,154.02,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Aetna,Aetna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Aetna MGG,Aetna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,BCBS,BCBS,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,BCBS MGG,BCBS MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Cigna,Cigna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Cigna MGG,Cigna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Humana,Humana,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Humana MGG,Humana MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Optum VA,Optum VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,UHC,UHC,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,UHC MGG,UHC MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,VA,VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Wellcare MGG,Wellcare MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Bright Health - commercial,Bright Health - commercial,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,87279,CPT,,,,Inpatient,,,208.08,208.08,Bright Health MGG,Bright Health MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Aetna,Aetna,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Aetna MGG,Aetna MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,BCBS,BCBS,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,BCBS MGG,BCBS MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Cigna,Cigna,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Cigna MGG,Cigna MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Humana,Humana,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Humana MGG,Humana MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Optum VA,Optum VA,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,UHC,UHC,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,UHC MGG,UHC MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,VA,VA,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Wellcare MGG,Wellcare MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Bright Health - commercial,Bright Health - commercial,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,87279,CPT,,,,Inpatient,,,86.7,86.7,Bright Health MGG,Bright Health MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Aetna,Aetna,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Aetna MGG,Aetna MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,BCBS,BCBS,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,BCBS MGG,BCBS MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Cigna,Cigna,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Cigna MGG,Cigna MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Humana,Humana,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Humana MGG,Humana MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Optum VA,Optum VA,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,UHC,UHC,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,UHC MGG,UHC MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,VA,VA,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Wellcare MGG,Wellcare MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Bright Health - commercial,Bright Health - commercial,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Bright Health MGG,Bright Health MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Aetna,Aetna,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Aetna MGG,Aetna MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,BCBS,BCBS,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,BCBS MGG,BCBS MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Cigna,Cigna,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Cigna MGG,Cigna MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Humana,Humana,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Humana MGG,Humana MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Optum VA,Optum VA,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,UHC,UHC,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,UHC MGG,UHC MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,VA,VA,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Wellcare MGG,Wellcare MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Bright Health - commercial,Bright Health - commercial,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Bright Health MGG,Bright Health MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Aetna,Aetna,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Aetna MGG,Aetna MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,BCBS,BCBS,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,BCBS MGG,BCBS MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Cigna,Cigna,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Cigna MGG,Cigna MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Humana,Humana,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Humana MGG,Humana MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Optum VA,Optum VA,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,UHC,UHC,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,UHC MGG,UHC MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,VA,VA,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Wellcare MGG,Wellcare MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Bright Health - commercial,Bright Health - commercial,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Bright Health MGG,Bright Health MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Aetna,Aetna,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Aetna MGG,Aetna MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,BCBS,BCBS,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,BCBS MGG,BCBS MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Cigna,Cigna,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Cigna MGG,Cigna MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Humana,Humana,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Humana MGG,Humana MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Optum VA,Optum VA,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,UHC,UHC,136.68,,,,,,,per diem,136.68,136.68,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,UHC MGG,UHC MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,VA,VA,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Wellcare MGG,Wellcare MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Bright Health - commercial,Bright Health - commercial,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,87253,CPT,,,,Inpatient,,,136.68,136.68,Bright Health MGG,Bright Health MGG,136.68,,,,,,,case rate,136.68,136.68,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Aetna,Aetna,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Aetna MGG,Aetna MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,BCBS,BCBS,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,BCBS MGG,BCBS MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Cigna,Cigna,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Cigna MGG,Cigna MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Humana,Humana,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Humana MGG,Humana MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Optum VA,Optum VA,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,UHC,UHC,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,UHC MGG,UHC MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,VA,VA,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Wellcare MGG,Wellcare MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Bright Health - commercial,Bright Health - commercial,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,87253,CPT,,,,Inpatient,,,58.14,58.14,Bright Health MGG,Bright Health MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Aetna,Aetna,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Aetna MGG,Aetna MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,BCBS,BCBS,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,BCBS MGG,BCBS MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Cigna,Cigna,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Cigna MGG,Cigna MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Humana,Humana,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Humana MGG,Humana MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Optum VA,Optum VA,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,UHC,UHC,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,UHC MGG,UHC MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,VA,VA,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Wellcare MGG,Wellcare MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Bright Health - commercial,Bright Health - commercial,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,87299,CPT,,,,Inpatient,,,137.7,137.7,Bright Health MGG,Bright Health MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Aetna,Aetna,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Aetna MGG,Aetna MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,BCBS,BCBS,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,BCBS MGG,BCBS MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Cigna,Cigna,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Cigna MGG,Cigna MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Humana,Humana,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Humana MGG,Humana MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Optum VA,Optum VA,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,UHC,UHC,86.7,,,,,,,per diem,86.7,86.7,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,UHC MGG,UHC MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,VA,VA,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Wellcare MGG,Wellcare MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Bright Health - commercial,Bright Health - commercial,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,87299,CPT,,,,Inpatient,,,86.7,86.7,Bright Health MGG,Bright Health MGG,86.7,,,,,,,case rate,86.7,86.7,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Aetna,Aetna,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Aetna MGG,Aetna MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,BCBS,BCBS,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,BCBS MGG,BCBS MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Cigna,Cigna,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Cigna MGG,Cigna MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Humana,Humana,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Humana MGG,Humana MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Optum VA,Optum VA,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,UHC,UHC,150.96,,,,,,,per diem,150.96,150.96,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,UHC MGG,UHC MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,VA,VA,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Wellcare MGG,Wellcare MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Bright Health - commercial,Bright Health - commercial,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,87427,CPT,,,,Inpatient,,,150.96,150.96,Bright Health MGG,Bright Health MGG,150.96,,,,,,,case rate,150.96,150.96,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Aetna,Aetna,290.7,,,,,,,per diem,290.7,290.7,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Aetna MGG,Aetna MGG,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,BCBS,BCBS,290.7,,,,,,,per diem,290.7,290.7,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,BCBS MGG,BCBS MGG,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Cigna,Cigna,290.7,,,,,,,per diem,290.7,290.7,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Cigna MGG,Cigna MGG,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Humana,Humana,290.7,,,,,,,per diem,290.7,290.7,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Humana MGG,Humana MGG,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Optum VA,Optum VA,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,UHC,UHC,290.7,,,,,,,per diem,290.7,290.7,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,UHC MGG,UHC MGG,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,VA,VA,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Wellcare MGG,Wellcare MGG,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Bright Health - commercial,Bright Health - commercial,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,87493,CPT,,,,Inpatient,,,290.7,290.7,Bright Health MGG,Bright Health MGG,290.7,,,,,,,case rate,290.7,290.7,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Aetna,Aetna,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Aetna MGG,Aetna MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,BCBS,BCBS,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,BCBS MGG,BCBS MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Cigna,Cigna,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Cigna MGG,Cigna MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Humana,Humana,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Humana MGG,Humana MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Optum VA,Optum VA,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,UHC,UHC,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,UHC MGG,UHC MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,VA,VA,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Wellcare MGG,Wellcare MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Bright Health - commercial,Bright Health - commercial,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,82272,CPT,,,,Inpatient,,,33.66,33.66,Bright Health MGG,Bright Health MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Aetna,Aetna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Aetna MGG,Aetna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,BCBS,BCBS,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,BCBS MGG,BCBS MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Cigna,Cigna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Cigna MGG,Cigna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Humana,Humana,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Humana MGG,Humana MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Optum VA,Optum VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,UHC,UHC,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,UHC MGG,UHC MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,VA,VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Wellcare MGG,Wellcare MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Bright Health - commercial,Bright Health - commercial,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,80358,CPT,,,,Inpatient,,,73.44,73.44,Bright Health MGG,Bright Health MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Aetna,Aetna,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Aetna MGG,Aetna MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,BCBS,BCBS,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,BCBS MGG,BCBS MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Cigna,Cigna,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Cigna MGG,Cigna MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Humana,Humana,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Humana MGG,Humana MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Optum VA,Optum VA,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,UHC,UHC,306,,,,,,,per diem,306,306,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,UHC MGG,UHC MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,VA,VA,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Wellcare MGG,Wellcare MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Bright Health - commercial,Bright Health - commercial,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,86063,CPT,,,,Inpatient,,,306,306,Bright Health MGG,Bright Health MGG,306,,,,,,,case rate,306,306,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Aetna,Aetna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Aetna MGG,Aetna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,BCBS,BCBS,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,BCBS MGG,BCBS MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Cigna,Cigna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Cigna MGG,Cigna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Humana,Humana,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Humana MGG,Humana MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Optum VA,Optum VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,UHC,UHC,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,UHC MGG,UHC MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,VA,VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Wellcare MGG,Wellcare MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Bright Health - commercial,Bright Health - commercial,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Bright Health MGG,Bright Health MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Aetna,Aetna,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Aetna MGG,Aetna MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,BCBS,BCBS,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,BCBS MGG,BCBS MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Cigna,Cigna,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Cigna MGG,Cigna MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Humana,Humana,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Humana MGG,Humana MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Optum VA,Optum VA,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,UHC,UHC,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,UHC MGG,UHC MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,VA,VA,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Wellcare MGG,Wellcare MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Bright Health - commercial,Bright Health - commercial,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,87425,CPT,,,,Inpatient,,,216.24,216.24,Bright Health MGG,Bright Health MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Aetna,Aetna,267.24,,,,,,,per diem,267.24,267.24,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Aetna MGG,Aetna MGG,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,BCBS,BCBS,267.24,,,,,,,per diem,267.24,267.24,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,BCBS MGG,BCBS MGG,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Cigna,Cigna,267.24,,,,,,,per diem,267.24,267.24,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Cigna MGG,Cigna MGG,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Humana,Humana,267.24,,,,,,,per diem,267.24,267.24,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Humana MGG,Humana MGG,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Optum VA,Optum VA,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,UHC,UHC,267.24,,,,,,,per diem,267.24,267.24,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,UHC MGG,UHC MGG,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,VA,VA,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Wellcare MGG,Wellcare MGG,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Bright Health - commercial,Bright Health - commercial,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,87168,CPT,,,,Inpatient,,,267.24,267.24,Bright Health MGG,Bright Health MGG,267.24,,,,,,,case rate,267.24,267.24,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Aetna,Aetna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Aetna MGG,Aetna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,BCBS,BCBS,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,BCBS MGG,BCBS MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Cigna,Cigna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Cigna MGG,Cigna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Humana,Humana,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Humana MGG,Humana MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Optum VA,Optum VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,UHC,UHC,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,UHC MGG,UHC MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,VA,VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Wellcare MGG,Wellcare MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Bright Health - commercial,Bright Health - commercial,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,87541,CPT,,,,Inpatient,,,138.72,138.72,Bright Health MGG,Bright Health MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Aetna,Aetna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Aetna MGG,Aetna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,BCBS,BCBS,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,BCBS MGG,BCBS MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Cigna,Cigna,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Cigna MGG,Cigna MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Humana,Humana,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Humana MGG,Humana MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Optum VA,Optum VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,UHC,UHC,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,UHC MGG,UHC MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,VA,VA,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Wellcare MGG,Wellcare MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Bright Health - commercial,Bright Health - commercial,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,84081,CPT,,,,Inpatient,,,64.26,64.26,Bright Health MGG,Bright Health MGG,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Aetna,Aetna,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Aetna MGG,Aetna MGG,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,BCBS,BCBS,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,BCBS MGG,BCBS MGG,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Cigna,Cigna,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Cigna MGG,Cigna MGG,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Humana,Humana,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Humana MGG,Humana MGG,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Optum VA,Optum VA,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,UHC,UHC,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,UHC MGG,UHC MGG,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,VA,VA,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Wellcare MGG,Wellcare MGG,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Bright Health - commercial,Bright Health - commercial,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,82664,CPT,,,,Inpatient,,,90.78,90.78,Bright Health MGG,Bright Health MGG,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Aetna,Aetna,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Aetna MGG,Aetna MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,BCBS,BCBS,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,BCBS MGG,BCBS MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Cigna,Cigna,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Cigna MGG,Cigna MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Humana,Humana,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Humana MGG,Humana MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Optum VA,Optum VA,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,UHC,UHC,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,UHC MGG,UHC MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,VA,VA,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Wellcare MGG,Wellcare MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Bright Health - commercial,Bright Health - commercial,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,87153,CPT,,,,Inpatient,,,33.66,33.66,Bright Health MGG,Bright Health MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Aetna,Aetna,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Aetna MGG,Aetna MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,BCBS,BCBS,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,BCBS MGG,BCBS MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Cigna,Cigna,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Cigna MGG,Cigna MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Humana,Humana,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Humana MGG,Humana MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Optum VA,Optum VA,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,UHC,UHC,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,UHC MGG,UHC MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,VA,VA,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Wellcare MGG,Wellcare MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Bright Health - commercial,Bright Health - commercial,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Bright Health MGG,Bright Health MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Aetna,Aetna,190.74,,,,,,,per diem,190.74,190.74,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Aetna MGG,Aetna MGG,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,BCBS,BCBS,190.74,,,,,,,per diem,190.74,190.74,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,BCBS MGG,BCBS MGG,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Cigna,Cigna,190.74,,,,,,,per diem,190.74,190.74,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Cigna MGG,Cigna MGG,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Humana,Humana,190.74,,,,,,,per diem,190.74,190.74,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Humana MGG,Humana MGG,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Optum VA,Optum VA,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,UHC,UHC,190.74,,,,,,,per diem,190.74,190.74,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,UHC MGG,UHC MGG,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,VA,VA,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Wellcare MGG,Wellcare MGG,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Bright Health - commercial,Bright Health - commercial,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,84182,CPT,,,,Inpatient,,,190.74,190.74,Bright Health MGG,Bright Health MGG,190.74,,,,,,,case rate,190.74,190.74,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Aetna,Aetna,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Aetna MGG,Aetna MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,BCBS,BCBS,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,BCBS MGG,BCBS MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Cigna,Cigna,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Cigna MGG,Cigna MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Humana,Humana,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Humana MGG,Humana MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Optum VA,Optum VA,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,UHC,UHC,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,UHC MGG,UHC MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,VA,VA,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Wellcare MGG,Wellcare MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Bright Health - commercial,Bright Health - commercial,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Bright Health MGG,Bright Health MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Aetna,Aetna,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Aetna MGG,Aetna MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,BCBS,BCBS,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,BCBS MGG,BCBS MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Cigna,Cigna,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Cigna MGG,Cigna MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Humana,Humana,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Humana MGG,Humana MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Optum VA,Optum VA,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,UHC,UHC,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,UHC MGG,UHC MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,VA,VA,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Wellcare MGG,Wellcare MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Bright Health - commercial,Bright Health - commercial,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Bright Health MGG,Bright Health MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Aetna,Aetna,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Aetna MGG,Aetna MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,BCBS,BCBS,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,BCBS MGG,BCBS MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Cigna,Cigna,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Cigna MGG,Cigna MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Humana,Humana,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Humana MGG,Humana MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Optum VA,Optum VA,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,UHC,UHC,119.34,,,,,,,per diem,119.34,119.34,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,UHC MGG,UHC MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,VA,VA,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Wellcare MGG,Wellcare MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Bright Health - commercial,Bright Health - commercial,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,86356,CPT,,,,Inpatient,,,119.34,119.34,Bright Health MGG,Bright Health MGG,119.34,,,,,,,case rate,119.34,119.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Aetna,Aetna,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Aetna MGG,Aetna MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,BCBS,BCBS,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,BCBS MGG,BCBS MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Cigna,Cigna,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Cigna MGG,Cigna MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Humana,Humana,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Humana MGG,Humana MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Optum VA,Optum VA,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,UHC,UHC,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,UHC MGG,UHC MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,VA,VA,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Wellcare MGG,Wellcare MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Bright Health - commercial,Bright Health - commercial,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,87274,CPT,,,,Inpatient,,,47.94,47.94,Bright Health MGG,Bright Health MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Aetna,Aetna,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Aetna MGG,Aetna MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,BCBS,BCBS,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,BCBS MGG,BCBS MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Cigna,Cigna,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Cigna MGG,Cigna MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Humana,Humana,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Humana MGG,Humana MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Optum VA,Optum VA,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,UHC,UHC,47.94,,,,,,,per diem,47.94,47.94,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,UHC MGG,UHC MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,VA,VA,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Wellcare MGG,Wellcare MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Bright Health - commercial,Bright Health - commercial,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,87273,CPT,,,,Inpatient,,,47.94,47.94,Bright Health MGG,Bright Health MGG,47.94,,,,,,,case rate,47.94,47.94,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Aetna,Aetna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Aetna MGG,Aetna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,BCBS,BCBS,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,BCBS MGG,BCBS MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Cigna,Cigna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Cigna MGG,Cigna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Humana,Humana,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Humana MGG,Humana MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Optum VA,Optum VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,UHC,UHC,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,UHC MGG,UHC MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,VA,VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Wellcare MGG,Wellcare MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Bright Health - commercial,Bright Health - commercial,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,87591,CPT,,,,Inpatient,,,138.72,138.72,Bright Health MGG,Bright Health MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Aetna,Aetna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Aetna MGG,Aetna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,BCBS,BCBS,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,BCBS MGG,BCBS MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Cigna,Cigna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Cigna MGG,Cigna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Humana,Humana,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Humana MGG,Humana MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Optum VA,Optum VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,UHC,UHC,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,UHC MGG,UHC MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,VA,VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Wellcare MGG,Wellcare MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Bright Health - commercial,Bright Health - commercial,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,87480,CPT,,,,Inpatient,,,141.78,141.78,Bright Health MGG,Bright Health MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Aetna,Aetna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Aetna MGG,Aetna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,BCBS,BCBS,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,BCBS MGG,BCBS MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Cigna,Cigna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Cigna MGG,Cigna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Humana,Humana,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Humana MGG,Humana MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Optum VA,Optum VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,UHC,UHC,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,UHC MGG,UHC MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,VA,VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Wellcare MGG,Wellcare MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Bright Health - commercial,Bright Health - commercial,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,87510,CPT,,,,Inpatient,,,141.78,141.78,Bright Health MGG,Bright Health MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Aetna,Aetna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Aetna MGG,Aetna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,BCBS,BCBS,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,BCBS MGG,BCBS MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Cigna,Cigna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Cigna MGG,Cigna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Humana,Humana,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Humana MGG,Humana MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Optum VA,Optum VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,UHC,UHC,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,UHC MGG,UHC MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,VA,VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Wellcare MGG,Wellcare MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Bright Health - commercial,Bright Health - commercial,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,87660,CPT,,,,Inpatient,,,141.78,141.78,Bright Health MGG,Bright Health MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Aetna,Aetna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Aetna MGG,Aetna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,BCBS,BCBS,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,BCBS MGG,BCBS MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Cigna,Cigna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Cigna MGG,Cigna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Humana,Humana,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Humana MGG,Humana MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Optum VA,Optum VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,UHC,UHC,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,UHC MGG,UHC MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,VA,VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Wellcare MGG,Wellcare MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Bright Health - commercial,Bright Health - commercial,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,87276,CPT,,,,Inpatient,,,41.82,41.82,Bright Health MGG,Bright Health MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,87275,CPT,,,,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Aetna,Aetna,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Aetna MGG,Aetna MGG,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,BCBS,BCBS,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,BCBS MGG,BCBS MGG,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Cigna,Cigna,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Cigna MGG,Cigna MGG,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Humana,Humana,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Humana MGG,Humana MGG,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Optum VA,Optum VA,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,UHC,UHC,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,UHC MGG,UHC MGG,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,VA,VA,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Wellcare MGG,Wellcare MGG,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Bright Health - commercial,Bright Health - commercial,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,87280,CPT,,,,Inpatient,,,403.92,403.92,Bright Health MGG,Bright Health MGG,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Aetna,Aetna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Aetna MGG,Aetna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,BCBS,BCBS,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,BCBS MGG,BCBS MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Cigna,Cigna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Cigna MGG,Cigna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Humana,Humana,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Humana MGG,Humana MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Optum VA,Optum VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,UHC,UHC,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,UHC MGG,UHC MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,VA,VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Wellcare MGG,Wellcare MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Bright Health - commercial,Bright Health - commercial,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,87260,CPT,,,,Inpatient,,,41.82,41.82,Bright Health MGG,Bright Health MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Aetna,Aetna,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Aetna MGG,Aetna MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,BCBS,BCBS,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,BCBS MGG,BCBS MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Cigna,Cigna,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Cigna MGG,Cigna MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Humana,Humana,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Humana MGG,Humana MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Optum VA,Optum VA,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,UHC,UHC,97.92,,,,,,,per diem,97.92,97.92,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,UHC MGG,UHC MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,VA,VA,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Wellcare MGG,Wellcare MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Bright Health - commercial,Bright Health - commercial,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,83661,CPT,,,,Inpatient,,,97.92,97.92,Bright Health MGG,Bright Health MGG,97.92,,,,,,,case rate,97.92,97.92,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Aetna,Aetna,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Aetna MGG,Aetna MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,BCBS,BCBS,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,BCBS MGG,BCBS MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Cigna,Cigna,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Cigna MGG,Cigna MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Humana,Humana,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Humana MGG,Humana MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Optum VA,Optum VA,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,UHC,UHC,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,UHC MGG,UHC MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,VA,VA,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Wellcare MGG,Wellcare MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Bright Health - commercial,Bright Health - commercial,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,87300,CPT,,,,Inpatient,,,66.3,66.3,Bright Health MGG,Bright Health MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Aetna,Aetna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Aetna MGG,Aetna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,BCBS,BCBS,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,BCBS MGG,BCBS MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Cigna,Cigna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Cigna MGG,Cigna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Humana,Humana,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Humana MGG,Humana MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Optum VA,Optum VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,UHC,UHC,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,UHC MGG,UHC MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,VA,VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Wellcare MGG,Wellcare MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Bright Health - commercial,Bright Health - commercial,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,87255,CPT,,,,Inpatient,,,180.54,180.54,Bright Health MGG,Bright Health MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Aetna,Aetna,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Aetna MGG,Aetna MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,BCBS,BCBS,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,BCBS MGG,BCBS MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Cigna,Cigna,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Cigna MGG,Cigna MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Humana,Humana,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Humana MGG,Humana MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Optum VA,Optum VA,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,UHC,UHC,66.3,,,,,,,per diem,66.3,66.3,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,UHC MGG,UHC MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,VA,VA,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Wellcare MGG,Wellcare MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Bright Health - commercial,Bright Health - commercial,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,66.3,66.3,Bright Health MGG,Bright Health MGG,66.3,,,,,,,case rate,66.3,66.3,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Aetna,Aetna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Aetna MGG,Aetna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,BCBS,BCBS,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,BCBS MGG,BCBS MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Cigna,Cigna,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Cigna MGG,Cigna MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Humana,Humana,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Humana MGG,Humana MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Optum VA,Optum VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,UHC,UHC,141.78,,,,,,,per diem,141.78,141.78,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,UHC MGG,UHC MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,VA,VA,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Wellcare MGG,Wellcare MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Bright Health - commercial,Bright Health - commercial,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,87591,CPT,,,,Inpatient,,,141.78,141.78,Bright Health MGG,Bright Health MGG,141.78,,,,,,,case rate,141.78,141.78,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Aetna,Aetna,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Aetna MGG,Aetna MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,BCBS,BCBS,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,BCBS MGG,BCBS MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Cigna,Cigna,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Cigna MGG,Cigna MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Humana,Humana,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Humana MGG,Humana MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Optum VA,Optum VA,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,UHC,UHC,33.66,,,,,,,per diem,33.66,33.66,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,UHC MGG,UHC MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,VA,VA,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Wellcare MGG,Wellcare MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Bright Health - commercial,Bright Health - commercial,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,87265,CPT,,,,Inpatient,,,33.66,33.66,Bright Health MGG,Bright Health MGG,33.66,,,,,,,case rate,33.66,33.66,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Aetna,Aetna,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Aetna MGG,Aetna MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,BCBS,BCBS,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,BCBS MGG,BCBS MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Cigna,Cigna,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Cigna MGG,Cigna MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Humana,Humana,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Humana MGG,Humana MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Optum VA,Optum VA,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,UHC,UHC,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,UHC MGG,UHC MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,VA,VA,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Wellcare MGG,Wellcare MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Bright Health - commercial,Bright Health - commercial,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Bright Health MGG,Bright Health MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Aetna,Aetna,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Aetna MGG,Aetna MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,BCBS,BCBS,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,BCBS MGG,BCBS MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Cigna,Cigna,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Cigna MGG,Cigna MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Humana,Humana,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Humana MGG,Humana MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Optum VA,Optum VA,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,UHC,UHC,176.46,,,,,,,per diem,176.46,176.46,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,UHC MGG,UHC MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,VA,VA,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Wellcare MGG,Wellcare MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Bright Health - commercial,Bright Health - commercial,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,87187,CPT,,,,Inpatient,,,176.46,176.46,Bright Health MGG,Bright Health MGG,176.46,,,,,,,case rate,176.46,176.46,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,87188,CPT,,,91,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Aetna,Aetna,202.67,,,,,,,per diem,202.67,202.67,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Aetna MGG,Aetna MGG,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,BCBS,BCBS,202.67,,,,,,,per diem,202.67,202.67,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,BCBS MGG,BCBS MGG,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Cigna,Cigna,202.67,,,,,,,per diem,202.67,202.67,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Cigna MGG,Cigna MGG,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Humana,Humana,202.67,,,,,,,per diem,202.67,202.67,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Humana MGG,Humana MGG,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Optum VA,Optum VA,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,UHC,UHC,202.67,,,,,,,per diem,202.67,202.67,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,UHC MGG,UHC MGG,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,VA,VA,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Wellcare MGG,Wellcare MGG,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Bright Health - commercial,Bright Health - commercial,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,87188,CPT,,,59,Inpatient,,,202.67,202.67,Bright Health MGG,Bright Health MGG,202.67,,,,,,,case rate,202.67,202.67,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,87188,CPT,,,59,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Aetna,Aetna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Aetna MGG,Aetna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,BCBS,BCBS,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,BCBS MGG,BCBS MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Cigna,Cigna,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Cigna MGG,Cigna MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Humana,Humana,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Humana MGG,Humana MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Optum VA,Optum VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,UHC,UHC,73.44,,,,,,,per diem,73.44,73.44,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,UHC MGG,UHC MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,VA,VA,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Wellcare MGG,Wellcare MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Bright Health - commercial,Bright Health - commercial,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,87107,CPT,,,,Inpatient,,,73.44,73.44,Bright Health MGG,Bright Health MGG,73.44,,,,,,,case rate,73.44,73.44,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna,Aetna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Aetna MGG,Aetna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS,BCBS,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,BCBS MGG,BCBS MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna,Cigna,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Cigna MGG,Cigna MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana,Humana,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Humana MGG,Humana MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Optum VA,Optum VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC,UHC,204,,,,,,,per diem,204,204,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,UHC MGG,UHC MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,VA,VA,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Wellcare MGG,Wellcare MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health - commercial,Bright Health - commercial,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,87188,CPT,,,,Inpatient,,,204,204,Bright Health MGG,Bright Health MGG,204,,,,,,,case rate,204,204,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Aetna,Aetna,1736.04,,,,,,,per diem,1736.04,1736.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Aetna MGG,Aetna MGG,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,BCBS,BCBS,1736.04,,,,,,,per diem,1736.04,1736.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,BCBS MGG,BCBS MGG,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Cigna,Cigna,1736.04,,,,,,,per diem,1736.04,1736.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Cigna MGG,Cigna MGG,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Humana,Humana,1736.04,,,,,,,per diem,1736.04,1736.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Humana MGG,Humana MGG,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Optum VA,Optum VA,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,UHC,UHC,1736.04,,,,,,,per diem,1736.04,1736.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,UHC MGG,UHC MGG,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,VA,VA,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Wellcare MGG,Wellcare MGG,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Bright Health - commercial,Bright Health - commercial,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,87633,CPT,,,,Inpatient,,,1736.04,1736.04,Bright Health MGG,Bright Health MGG,1736.04,,,,,,,case rate,1736.04,1736.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Aetna,Aetna,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Aetna MGG,Aetna MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,BCBS,BCBS,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,BCBS MGG,BCBS MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Cigna,Cigna,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Cigna MGG,Cigna MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Humana,Humana,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Humana MGG,Humana MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Optum VA,Optum VA,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,UHC,UHC,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,UHC MGG,UHC MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,VA,VA,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Wellcare MGG,Wellcare MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Bright Health - commercial,Bright Health - commercial,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,87486,CPT,,,,Inpatient,,,145.86,145.86,Bright Health MGG,Bright Health MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Aetna,Aetna,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Aetna MGG,Aetna MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,BCBS,BCBS,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,BCBS MGG,BCBS MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Cigna,Cigna,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Cigna MGG,Cigna MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Humana,Humana,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Humana MGG,Humana MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Optum VA,Optum VA,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,UHC,UHC,145.86,,,,,,,per diem,145.86,145.86,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,UHC MGG,UHC MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,VA,VA,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Wellcare MGG,Wellcare MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Bright Health - commercial,Bright Health - commercial,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,87581,CPT,,,,Inpatient,,,145.86,145.86,Bright Health MGG,Bright Health MGG,145.86,,,,,,,case rate,145.86,145.86,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Aetna,Aetna,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Aetna MGG,Aetna MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,BCBS,BCBS,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,BCBS MGG,BCBS MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Cigna,Cigna,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Cigna MGG,Cigna MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Humana,Humana,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Humana MGG,Humana MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Optum VA,Optum VA,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,UHC,UHC,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,UHC MGG,UHC MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,VA,VA,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Wellcare MGG,Wellcare MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Bright Health - commercial,Bright Health - commercial,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,87158,CPT,,,,Inpatient,,,36.72,36.72,Bright Health MGG,Bright Health MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Aetna,Aetna,156.06,,,,,,,per diem,156.06,156.06,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Aetna MGG,Aetna MGG,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,BCBS,BCBS,156.06,,,,,,,per diem,156.06,156.06,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,BCBS MGG,BCBS MGG,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Cigna,Cigna,156.06,,,,,,,per diem,156.06,156.06,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Cigna MGG,Cigna MGG,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Humana,Humana,156.06,,,,,,,per diem,156.06,156.06,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Humana MGG,Humana MGG,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Optum VA,Optum VA,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,UHC,UHC,156.06,,,,,,,per diem,156.06,156.06,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,UHC MGG,UHC MGG,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,VA,VA,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Wellcare MGG,Wellcare MGG,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Bright Health - commercial,Bright Health - commercial,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,87265,CPT,,,,Inpatient,,,156.06,156.06,Bright Health MGG,Bright Health MGG,156.06,,,,,,,case rate,156.06,156.06,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Aetna,Aetna,189.72,,,,,,,per diem,189.72,189.72,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Aetna MGG,Aetna MGG,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,BCBS,BCBS,189.72,,,,,,,per diem,189.72,189.72,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,BCBS MGG,BCBS MGG,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Cigna,Cigna,189.72,,,,,,,per diem,189.72,189.72,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Cigna MGG,Cigna MGG,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Humana,Humana,189.72,,,,,,,per diem,189.72,189.72,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Humana MGG,Humana MGG,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Optum VA,Optum VA,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,UHC,UHC,189.72,,,,,,,per diem,189.72,189.72,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,UHC MGG,UHC MGG,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,VA,VA,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Wellcare MGG,Wellcare MGG,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Bright Health - commercial,Bright Health - commercial,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,87273,CPT,,,,Inpatient,,,189.72,189.72,Bright Health MGG,Bright Health MGG,189.72,,,,,,,case rate,189.72,189.72,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Aetna,Aetna,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Aetna MGG,Aetna MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,BCBS,BCBS,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,BCBS MGG,BCBS MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Cigna,Cigna,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Cigna MGG,Cigna MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Humana,Humana,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Humana MGG,Humana MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Optum VA,Optum VA,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,UHC,UHC,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,UHC MGG,UHC MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,VA,VA,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Wellcare MGG,Wellcare MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Bright Health - commercial,Bright Health - commercial,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,87290,CPT,,,,Inpatient,,,94.86,94.86,Bright Health MGG,Bright Health MGG,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Aetna,Aetna,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Aetna MGG,Aetna MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,BCBS,BCBS,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,BCBS MGG,BCBS MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Cigna,Cigna,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Cigna MGG,Cigna MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Humana,Humana,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Humana MGG,Humana MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Optum VA,Optum VA,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,UHC,UHC,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,UHC MGG,UHC MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,VA,VA,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Wellcare MGG,Wellcare MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Bright Health - commercial,Bright Health - commercial,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,87153,CPT,,,,Inpatient,,,217.26,217.26,Bright Health MGG,Bright Health MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Aetna,Aetna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Aetna MGG,Aetna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,BCBS,BCBS,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,BCBS MGG,BCBS MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Cigna,Cigna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Cigna MGG,Cigna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Humana,Humana,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Humana MGG,Humana MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Optum VA,Optum VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,UHC,UHC,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,UHC MGG,UHC MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,VA,VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Wellcare MGG,Wellcare MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Bright Health - commercial,Bright Health - commercial,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,87275,CPT,,,,Inpatient,,,143.82,143.82,Bright Health MGG,Bright Health MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Aetna,Aetna,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Aetna MGG,Aetna MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,BCBS,BCBS,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,BCBS MGG,BCBS MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Cigna,Cigna,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Cigna MGG,Cigna MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Humana,Humana,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Humana MGG,Humana MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Optum VA,Optum VA,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,UHC,UHC,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,UHC MGG,UHC MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,VA,VA,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Wellcare MGG,Wellcare MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Bright Health - commercial,Bright Health - commercial,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,87260,CPT,,,,Inpatient,,,70.38,70.38,Bright Health MGG,Bright Health MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Aetna,Aetna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Aetna MGG,Aetna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,BCBS,BCBS,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,BCBS MGG,BCBS MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Cigna,Cigna,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Cigna MGG,Cigna MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Humana,Humana,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Humana MGG,Humana MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Optum VA,Optum VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,UHC,UHC,143.82,,,,,,,per diem,143.82,143.82,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,UHC MGG,UHC MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,VA,VA,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Wellcare MGG,Wellcare MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Bright Health - commercial,Bright Health - commercial,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,87276,CPT,,,,Inpatient,,,143.82,143.82,Bright Health MGG,Bright Health MGG,143.82,,,,,,,case rate,143.82,143.82,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Aetna,Aetna,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Aetna MGG,Aetna MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,BCBS,BCBS,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,BCBS MGG,BCBS MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Cigna,Cigna,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Cigna MGG,Cigna MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Humana,Humana,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Humana MGG,Humana MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Optum VA,Optum VA,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,UHC,UHC,70.38,,,,,,,per diem,70.38,70.38,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,UHC MGG,UHC MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,VA,VA,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Wellcare MGG,Wellcare MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Bright Health - commercial,Bright Health - commercial,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,87280,CPT,,,,Inpatient,,,70.38,70.38,Bright Health MGG,Bright Health MGG,70.38,,,,,,,case rate,70.38,70.38,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Aetna,Aetna,351.16,,,,,,,per diem,351.16,351.16,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Aetna MGG,Aetna MGG,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,BCBS,BCBS,351.16,,,,,,,per diem,351.16,351.16,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,BCBS MGG,BCBS MGG,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Cigna,Cigna,351.16,,,,,,,per diem,351.16,351.16,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Cigna MGG,Cigna MGG,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Humana,Humana,351.16,,,,,,,per diem,351.16,351.16,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Humana MGG,Humana MGG,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Optum VA,Optum VA,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,UHC,UHC,351.16,,,,,,,per diem,351.16,351.16,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,UHC MGG,UHC MGG,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,VA,VA,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Wellcare MGG,Wellcare MGG,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Bright Health - commercial,Bright Health - commercial,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,87507,CPT,,,,Inpatient,,,351.16,351.16,Bright Health MGG,Bright Health MGG,351.16,,,,,,,case rate,351.16,351.16,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Aetna,Aetna,1087.32,,,,,,,per diem,1087.32,1087.32,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Aetna MGG,Aetna MGG,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,BCBS,BCBS,1087.32,,,,,,,per diem,1087.32,1087.32,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,BCBS MGG,BCBS MGG,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Cigna,Cigna,1087.32,,,,,,,per diem,1087.32,1087.32,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Cigna MGG,Cigna MGG,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Humana,Humana,1087.32,,,,,,,per diem,1087.32,1087.32,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Humana MGG,Humana MGG,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Optum VA,Optum VA,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,UHC,UHC,1087.32,,,,,,,per diem,1087.32,1087.32,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,UHC MGG,UHC MGG,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,VA,VA,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Wellcare MGG,Wellcare MGG,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Bright Health - commercial,Bright Health - commercial,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,87153,CPT,,,,Inpatient,,,1087.32,1087.32,Bright Health MGG,Bright Health MGG,1087.32,,,,,,,case rate,1087.32,1087.32,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Aetna,Aetna,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Aetna MGG,Aetna MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,BCBS,BCBS,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,BCBS MGG,BCBS MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Cigna,Cigna,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Cigna MGG,Cigna MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Humana,Humana,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Humana MGG,Humana MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Optum VA,Optum VA,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,UHC,UHC,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,UHC MGG,UHC MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,VA,VA,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Wellcare MGG,Wellcare MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Bright Health - commercial,Bright Health - commercial,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,16,16,Bright Health MGG,Bright Health MGG,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Aetna,Aetna,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Aetna MGG,Aetna MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,BCBS,BCBS,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,BCBS MGG,BCBS MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Cigna,Cigna,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Cigna MGG,Cigna MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Humana,Humana,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Humana MGG,Humana MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Optum VA,Optum VA,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,UHC,UHC,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,UHC MGG,UHC MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,VA,VA,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Wellcare MGG,Wellcare MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Bright Health - commercial,Bright Health - commercial,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,74.55,74.55,Bright Health MGG,Bright Health MGG,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Aetna,Aetna,40.62,,,,,,,per diem,40.62,40.62,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Aetna MGG,Aetna MGG,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,BCBS,BCBS,40.62,,,,,,,per diem,40.62,40.62,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,BCBS MGG,BCBS MGG,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Cigna,Cigna,40.62,,,,,,,per diem,40.62,40.62,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Cigna MGG,Cigna MGG,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Humana,Humana,40.62,,,,,,,per diem,40.62,40.62,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Humana MGG,Humana MGG,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Optum VA,Optum VA,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,UHC,UHC,40.62,,,,,,,per diem,40.62,40.62,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,UHC MGG,UHC MGG,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,VA,VA,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Wellcare MGG,Wellcare MGG,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Bright Health - commercial,Bright Health - commercial,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,40.62,40.62,Bright Health MGG,Bright Health MGG,40.62,,,,,,,case rate,40.62,40.62,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Aetna,Aetna,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Aetna MGG,Aetna MGG,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,BCBS,BCBS,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,BCBS MGG,BCBS MGG,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Cigna,Cigna,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Cigna MGG,Cigna MGG,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Humana,Humana,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Humana MGG,Humana MGG,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Optum VA,Optum VA,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,UHC,UHC,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,UHC MGG,UHC MGG,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,VA,VA,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Wellcare MGG,Wellcare MGG,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Bright Health - commercial,Bright Health - commercial,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,43.56,43.56,Bright Health MGG,Bright Health MGG,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Aetna,Aetna,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Aetna MGG,Aetna MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,BCBS,BCBS,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,BCBS MGG,BCBS MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Cigna,Cigna,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Cigna MGG,Cigna MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Humana,Humana,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Humana MGG,Humana MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Optum VA,Optum VA,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,UHC,UHC,111.3,,,,,,,per diem,111.3,111.3,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,UHC MGG,UHC MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,VA,VA,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Wellcare MGG,Wellcare MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Bright Health - commercial,Bright Health - commercial,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,111.3,111.3,Bright Health MGG,Bright Health MGG,111.3,,,,,,,case rate,111.3,111.3,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Aetna,Aetna,45.24,,,,,,,per diem,45.24,45.24,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Aetna MGG,Aetna MGG,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,BCBS,BCBS,45.24,,,,,,,per diem,45.24,45.24,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,BCBS MGG,BCBS MGG,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Cigna,Cigna,45.24,,,,,,,per diem,45.24,45.24,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Cigna MGG,Cigna MGG,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Humana,Humana,45.24,,,,,,,per diem,45.24,45.24,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Humana MGG,Humana MGG,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Optum VA,Optum VA,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,UHC,UHC,45.24,,,,,,,per diem,45.24,45.24,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,UHC MGG,UHC MGG,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,VA,VA,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Wellcare MGG,Wellcare MGG,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Bright Health - commercial,Bright Health - commercial,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,45.24,45.24,Bright Health MGG,Bright Health MGG,45.24,,,,,,,case rate,45.24,45.24,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Aetna,Aetna,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Aetna MGG,Aetna MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,BCBS,BCBS,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,BCBS MGG,BCBS MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Cigna,Cigna,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Cigna MGG,Cigna MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Humana,Humana,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Humana MGG,Humana MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Optum VA,Optum VA,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,UHC,UHC,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,UHC MGG,UHC MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,VA,VA,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Wellcare MGG,Wellcare MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Bright Health - commercial,Bright Health - commercial,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,44.1,44.1,Bright Health MGG,Bright Health MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Aetna,Aetna,67,,,,,,,per diem,67,67,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Aetna MGG,Aetna MGG,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,BCBS,BCBS,67,,,,,,,per diem,67,67,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,BCBS MGG,BCBS MGG,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Cigna,Cigna,67,,,,,,,per diem,67,67,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Cigna MGG,Cigna MGG,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Humana,Humana,67,,,,,,,per diem,67,67,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Humana MGG,Humana MGG,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Optum VA,Optum VA,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,UHC,UHC,67,,,,,,,per diem,67,67,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,UHC MGG,UHC MGG,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,VA,VA,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Wellcare MGG,Wellcare MGG,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Bright Health - commercial,Bright Health - commercial,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,67,67,Bright Health MGG,Bright Health MGG,67,,,,,,,case rate,67,67,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Aetna,Aetna,64.86,,,,,,,per diem,64.86,64.86,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Aetna MGG,Aetna MGG,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,BCBS,BCBS,64.86,,,,,,,per diem,64.86,64.86,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,BCBS MGG,BCBS MGG,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Cigna,Cigna,64.86,,,,,,,per diem,64.86,64.86,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Cigna MGG,Cigna MGG,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Humana,Humana,64.86,,,,,,,per diem,64.86,64.86,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Humana MGG,Humana MGG,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Optum VA,Optum VA,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,UHC,UHC,64.86,,,,,,,per diem,64.86,64.86,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,UHC MGG,UHC MGG,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,VA,VA,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Wellcare MGG,Wellcare MGG,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Bright Health - commercial,Bright Health - commercial,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.86,64.86,Bright Health MGG,Bright Health MGG,64.86,,,,,,,case rate,64.86,64.86,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Aetna,Aetna,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Aetna MGG,Aetna MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,BCBS,BCBS,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,BCBS MGG,BCBS MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Cigna,Cigna,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Cigna MGG,Cigna MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Humana,Humana,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Humana MGG,Humana MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Optum VA,Optum VA,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,UHC,UHC,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,UHC MGG,UHC MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,VA,VA,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Wellcare MGG,Wellcare MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Bright Health - commercial,Bright Health - commercial,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,15.75,15.75,Bright Health MGG,Bright Health MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Aetna,Aetna,315.39,,,,,,,per diem,315.39,315.39,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Aetna MGG,Aetna MGG,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,BCBS,BCBS,315.39,,,,,,,per diem,315.39,315.39,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,BCBS MGG,BCBS MGG,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Cigna,Cigna,315.39,,,,,,,per diem,315.39,315.39,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Cigna MGG,Cigna MGG,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Humana,Humana,315.39,,,,,,,per diem,315.39,315.39,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Humana MGG,Humana MGG,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Optum VA,Optum VA,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,UHC,UHC,315.39,,,,,,,per diem,315.39,315.39,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,UHC MGG,UHC MGG,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,VA,VA,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Wellcare MGG,Wellcare MGG,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Bright Health - commercial,Bright Health - commercial,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,315.39,315.39,Bright Health MGG,Bright Health MGG,315.39,,,,,,,case rate,315.39,315.39,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Aetna,Aetna,12.3,,,,,,,per diem,12.3,12.3,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Aetna MGG,Aetna MGG,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,BCBS,BCBS,12.3,,,,,,,per diem,12.3,12.3,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,BCBS MGG,BCBS MGG,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Cigna,Cigna,12.3,,,,,,,per diem,12.3,12.3,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Cigna MGG,Cigna MGG,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Humana,Humana,12.3,,,,,,,per diem,12.3,12.3,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Humana MGG,Humana MGG,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Optum VA,Optum VA,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,UHC,UHC,12.3,,,,,,,per diem,12.3,12.3,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,UHC MGG,UHC MGG,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,VA,VA,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Wellcare MGG,Wellcare MGG,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Bright Health - commercial,Bright Health - commercial,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,12.3,12.3,Bright Health MGG,Bright Health MGG,12.3,,,,,,,case rate,12.3,12.3,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Aetna,Aetna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Aetna MGG,Aetna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,BCBS,BCBS,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,BCBS MGG,BCBS MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Cigna,Cigna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Cigna MGG,Cigna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Humana,Humana,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Humana MGG,Humana MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Optum VA,Optum VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,UHC,UHC,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,UHC MGG,UHC MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,VA,VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Wellcare MGG,Wellcare MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Bright Health - commercial,Bright Health - commercial,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,156,156,Bright Health MGG,Bright Health MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Aetna,Aetna,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Aetna MGG,Aetna MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,BCBS,BCBS,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,BCBS MGG,BCBS MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Cigna,Cigna,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Cigna MGG,Cigna MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Humana,Humana,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Humana MGG,Humana MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Optum VA,Optum VA,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,UHC,UHC,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,UHC MGG,UHC MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,VA,VA,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Wellcare MGG,Wellcare MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Bright Health - commercial,Bright Health - commercial,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,25.38,25.38,Bright Health MGG,Bright Health MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Aetna,Aetna,31.68,,,,,,,per diem,31.68,31.68,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Aetna MGG,Aetna MGG,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,BCBS,BCBS,31.68,,,,,,,per diem,31.68,31.68,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,BCBS MGG,BCBS MGG,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Cigna,Cigna,31.68,,,,,,,per diem,31.68,31.68,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Cigna MGG,Cigna MGG,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Humana,Humana,31.68,,,,,,,per diem,31.68,31.68,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Humana MGG,Humana MGG,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Optum VA,Optum VA,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,UHC,UHC,31.68,,,,,,,per diem,31.68,31.68,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,UHC MGG,UHC MGG,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,VA,VA,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Wellcare MGG,Wellcare MGG,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Bright Health - commercial,Bright Health - commercial,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,31.68,31.68,Bright Health MGG,Bright Health MGG,31.68,,,,,,,case rate,31.68,31.68,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Aetna,Aetna,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Aetna MGG,Aetna MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,BCBS,BCBS,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,BCBS MGG,BCBS MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Cigna,Cigna,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Cigna MGG,Cigna MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Humana,Humana,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Humana MGG,Humana MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Optum VA,Optum VA,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,UHC,UHC,40.17,,,,,,,per diem,40.17,40.17,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,UHC MGG,UHC MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,VA,VA,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Wellcare MGG,Wellcare MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Bright Health - commercial,Bright Health - commercial,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,40.17,40.17,Bright Health MGG,Bright Health MGG,40.17,,,,,,,case rate,40.17,40.17,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Aetna,Aetna,35.73,,,,,,,per diem,35.73,35.73,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Aetna MGG,Aetna MGG,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,BCBS,BCBS,35.73,,,,,,,per diem,35.73,35.73,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,BCBS MGG,BCBS MGG,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Cigna,Cigna,35.73,,,,,,,per diem,35.73,35.73,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Cigna MGG,Cigna MGG,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Humana,Humana,35.73,,,,,,,per diem,35.73,35.73,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Humana MGG,Humana MGG,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Optum VA,Optum VA,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,UHC,UHC,35.73,,,,,,,per diem,35.73,35.73,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,UHC MGG,UHC MGG,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,VA,VA,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Wellcare MGG,Wellcare MGG,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Bright Health - commercial,Bright Health - commercial,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.73,35.73,Bright Health MGG,Bright Health MGG,35.73,,,,,,,case rate,35.73,35.73,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Aetna,Aetna,24.51,,,,,,,per diem,24.51,24.51,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Aetna MGG,Aetna MGG,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,BCBS,BCBS,24.51,,,,,,,per diem,24.51,24.51,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,BCBS MGG,BCBS MGG,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Cigna,Cigna,24.51,,,,,,,per diem,24.51,24.51,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Cigna MGG,Cigna MGG,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Humana,Humana,24.51,,,,,,,per diem,24.51,24.51,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Humana MGG,Humana MGG,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Optum VA,Optum VA,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,UHC,UHC,24.51,,,,,,,per diem,24.51,24.51,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,UHC MGG,UHC MGG,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,VA,VA,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Wellcare MGG,Wellcare MGG,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Bright Health - commercial,Bright Health - commercial,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,24.51,24.51,Bright Health MGG,Bright Health MGG,24.51,,,,,,,case rate,24.51,24.51,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Aetna,Aetna,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Aetna MGG,Aetna MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,BCBS,BCBS,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,BCBS MGG,BCBS MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Cigna,Cigna,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Cigna MGG,Cigna MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Humana,Humana,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Humana MGG,Humana MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Optum VA,Optum VA,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,UHC,UHC,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,UHC MGG,UHC MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,VA,VA,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Wellcare MGG,Wellcare MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Bright Health - commercial,Bright Health - commercial,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,39.84,39.84,Bright Health MGG,Bright Health MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Aetna,Aetna,113.42,,,,,,,per diem,113.42,113.42,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Aetna MGG,Aetna MGG,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,BCBS,BCBS,113.42,,,,,,,per diem,113.42,113.42,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,BCBS MGG,BCBS MGG,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Cigna,Cigna,113.42,,,,,,,per diem,113.42,113.42,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Cigna MGG,Cigna MGG,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Humana,Humana,113.42,,,,,,,per diem,113.42,113.42,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Humana MGG,Humana MGG,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Optum VA,Optum VA,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,UHC,UHC,113.42,,,,,,,per diem,113.42,113.42,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,UHC MGG,UHC MGG,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,VA,VA,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Wellcare MGG,Wellcare MGG,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Bright Health - commercial,Bright Health - commercial,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,113.42,113.42,Bright Health MGG,Bright Health MGG,113.42,,,,,,,case rate,113.42,113.42,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Aetna,Aetna,58.2,,,,,,,per diem,58.2,58.2,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Aetna MGG,Aetna MGG,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,BCBS,BCBS,58.2,,,,,,,per diem,58.2,58.2,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,BCBS MGG,BCBS MGG,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Cigna,Cigna,58.2,,,,,,,per diem,58.2,58.2,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Cigna MGG,Cigna MGG,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Humana,Humana,58.2,,,,,,,per diem,58.2,58.2,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Humana MGG,Humana MGG,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Optum VA,Optum VA,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,UHC,UHC,58.2,,,,,,,per diem,58.2,58.2,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,UHC MGG,UHC MGG,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,VA,VA,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Wellcare MGG,Wellcare MGG,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Bright Health - commercial,Bright Health - commercial,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,58.2,58.2,Bright Health MGG,Bright Health MGG,58.2,,,,,,,case rate,58.2,58.2,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Aetna,Aetna,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Aetna MGG,Aetna MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,BCBS,BCBS,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,BCBS MGG,BCBS MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Cigna,Cigna,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Cigna MGG,Cigna MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Humana,Humana,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Humana MGG,Humana MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Optum VA,Optum VA,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,UHC,UHC,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,UHC MGG,UHC MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,VA,VA,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Wellcare MGG,Wellcare MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Bright Health - commercial,Bright Health - commercial,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,20.37,20.37,Bright Health MGG,Bright Health MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Aetna,Aetna,43.71,,,,,,,per diem,43.71,43.71,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Aetna MGG,Aetna MGG,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,BCBS,BCBS,43.71,,,,,,,per diem,43.71,43.71,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,BCBS MGG,BCBS MGG,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Cigna,Cigna,43.71,,,,,,,per diem,43.71,43.71,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Cigna MGG,Cigna MGG,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Humana,Humana,43.71,,,,,,,per diem,43.71,43.71,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Humana MGG,Humana MGG,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Optum VA,Optum VA,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,UHC,UHC,43.71,,,,,,,per diem,43.71,43.71,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,UHC MGG,UHC MGG,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,VA,VA,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Wellcare MGG,Wellcare MGG,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Bright Health - commercial,Bright Health - commercial,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,43.71,43.71,Bright Health MGG,Bright Health MGG,43.71,,,,,,,case rate,43.71,43.71,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Aetna,Aetna,19.44,,,,,,,per diem,19.44,19.44,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Aetna MGG,Aetna MGG,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,BCBS,BCBS,19.44,,,,,,,per diem,19.44,19.44,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,BCBS MGG,BCBS MGG,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Cigna,Cigna,19.44,,,,,,,per diem,19.44,19.44,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Cigna MGG,Cigna MGG,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Humana,Humana,19.44,,,,,,,per diem,19.44,19.44,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Humana MGG,Humana MGG,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Optum VA,Optum VA,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,UHC,UHC,19.44,,,,,,,per diem,19.44,19.44,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,UHC MGG,UHC MGG,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,VA,VA,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Wellcare MGG,Wellcare MGG,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Bright Health - commercial,Bright Health - commercial,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,19.44,19.44,Bright Health MGG,Bright Health MGG,19.44,,,,,,,case rate,19.44,19.44,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Aetna,Aetna,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Aetna MGG,Aetna MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,BCBS,BCBS,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,BCBS MGG,BCBS MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Cigna,Cigna,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Cigna MGG,Cigna MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Humana,Humana,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Humana MGG,Humana MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Optum VA,Optum VA,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,UHC,UHC,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,UHC MGG,UHC MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,VA,VA,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Wellcare MGG,Wellcare MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Bright Health - commercial,Bright Health - commercial,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,68,68,Bright Health MGG,Bright Health MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Aetna,Aetna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Aetna MGG,Aetna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,BCBS,BCBS,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,BCBS MGG,BCBS MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Cigna,Cigna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Cigna MGG,Cigna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Humana,Humana,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Humana MGG,Humana MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Optum VA,Optum VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,UHC,UHC,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,UHC MGG,UHC MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,VA,VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Wellcare MGG,Wellcare MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Bright Health - commercial,Bright Health - commercial,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,70,70,Bright Health MGG,Bright Health MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Aetna,Aetna,65.46,,,,,,,per diem,65.46,65.46,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Aetna MGG,Aetna MGG,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,BCBS,BCBS,65.46,,,,,,,per diem,65.46,65.46,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,BCBS MGG,BCBS MGG,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Cigna,Cigna,65.46,,,,,,,per diem,65.46,65.46,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Cigna MGG,Cigna MGG,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Humana,Humana,65.46,,,,,,,per diem,65.46,65.46,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Humana MGG,Humana MGG,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Optum VA,Optum VA,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,UHC,UHC,65.46,,,,,,,per diem,65.46,65.46,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,UHC MGG,UHC MGG,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,VA,VA,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Wellcare MGG,Wellcare MGG,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Bright Health - commercial,Bright Health - commercial,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,65.46,65.46,Bright Health MGG,Bright Health MGG,65.46,,,,,,,case rate,65.46,65.46,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Aetna,Aetna,55.89,,,,,,,per diem,55.89,55.89,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Aetna MGG,Aetna MGG,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,BCBS,BCBS,55.89,,,,,,,per diem,55.89,55.89,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,BCBS MGG,BCBS MGG,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Cigna,Cigna,55.89,,,,,,,per diem,55.89,55.89,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Cigna MGG,Cigna MGG,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Humana,Humana,55.89,,,,,,,per diem,55.89,55.89,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Humana MGG,Humana MGG,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Optum VA,Optum VA,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,UHC,UHC,55.89,,,,,,,per diem,55.89,55.89,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,UHC MGG,UHC MGG,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,VA,VA,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Wellcare MGG,Wellcare MGG,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Bright Health - commercial,Bright Health - commercial,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,55.89,55.89,Bright Health MGG,Bright Health MGG,55.89,,,,,,,case rate,55.89,55.89,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Aetna,Aetna,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Aetna MGG,Aetna MGG,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,BCBS,BCBS,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,BCBS MGG,BCBS MGG,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Cigna,Cigna,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Cigna MGG,Cigna MGG,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Humana,Humana,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Humana MGG,Humana MGG,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Optum VA,Optum VA,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,UHC,UHC,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,UHC MGG,UHC MGG,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,VA,VA,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Wellcare MGG,Wellcare MGG,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Bright Health - commercial,Bright Health - commercial,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,19.53,19.53,Bright Health MGG,Bright Health MGG,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Aetna,Aetna,21.18,,,,,,,per diem,21.18,21.18,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Aetna MGG,Aetna MGG,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,BCBS,BCBS,21.18,,,,,,,per diem,21.18,21.18,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,BCBS MGG,BCBS MGG,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Cigna,Cigna,21.18,,,,,,,per diem,21.18,21.18,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Cigna MGG,Cigna MGG,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Humana,Humana,21.18,,,,,,,per diem,21.18,21.18,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Humana MGG,Humana MGG,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Optum VA,Optum VA,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,UHC,UHC,21.18,,,,,,,per diem,21.18,21.18,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,UHC MGG,UHC MGG,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,VA,VA,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Wellcare MGG,Wellcare MGG,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Bright Health - commercial,Bright Health - commercial,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,21.18,21.18,Bright Health MGG,Bright Health MGG,21.18,,,,,,,case rate,21.18,21.18,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Aetna,Aetna,21.3,,,,,,,per diem,21.3,21.3,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Aetna MGG,Aetna MGG,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,BCBS,BCBS,21.3,,,,,,,per diem,21.3,21.3,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,BCBS MGG,BCBS MGG,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Cigna,Cigna,21.3,,,,,,,per diem,21.3,21.3,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Cigna MGG,Cigna MGG,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Humana,Humana,21.3,,,,,,,per diem,21.3,21.3,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Humana MGG,Humana MGG,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Optum VA,Optum VA,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,UHC,UHC,21.3,,,,,,,per diem,21.3,21.3,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,UHC MGG,UHC MGG,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,VA,VA,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Wellcare MGG,Wellcare MGG,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Bright Health - commercial,Bright Health - commercial,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,21.3,21.3,Bright Health MGG,Bright Health MGG,21.3,,,,,,,case rate,21.3,21.3,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Aetna,Aetna,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Aetna MGG,Aetna MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,BCBS,BCBS,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,BCBS MGG,BCBS MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Cigna,Cigna,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Cigna MGG,Cigna MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Humana,Humana,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Humana MGG,Humana MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Optum VA,Optum VA,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,UHC,UHC,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,UHC MGG,UHC MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,VA,VA,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Wellcare MGG,Wellcare MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Bright Health - commercial,Bright Health - commercial,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,40.89,40.89,Bright Health MGG,Bright Health MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Aetna,Aetna,79.62,,,,,,,per diem,79.62,79.62,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Aetna MGG,Aetna MGG,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,BCBS,BCBS,79.62,,,,,,,per diem,79.62,79.62,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,BCBS MGG,BCBS MGG,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Cigna,Cigna,79.62,,,,,,,per diem,79.62,79.62,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Cigna MGG,Cigna MGG,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Humana,Humana,79.62,,,,,,,per diem,79.62,79.62,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Humana MGG,Humana MGG,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Optum VA,Optum VA,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,UHC,UHC,79.62,,,,,,,per diem,79.62,79.62,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,UHC MGG,UHC MGG,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,VA,VA,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Wellcare MGG,Wellcare MGG,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Bright Health - commercial,Bright Health - commercial,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,79.62,79.62,Bright Health MGG,Bright Health MGG,79.62,,,,,,,case rate,79.62,79.62,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Aetna,Aetna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Aetna MGG,Aetna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,BCBS,BCBS,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,BCBS MGG,BCBS MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Cigna,Cigna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Cigna MGG,Cigna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Humana,Humana,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Humana MGG,Humana MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Optum VA,Optum VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,UHC,UHC,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,UHC MGG,UHC MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,VA,VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Wellcare MGG,Wellcare MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Bright Health - commercial,Bright Health - commercial,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,70,70,Bright Health MGG,Bright Health MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Aetna,Aetna,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Aetna MGG,Aetna MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,BCBS,BCBS,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,BCBS MGG,BCBS MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Cigna,Cigna,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Cigna MGG,Cigna MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Humana,Humana,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Humana MGG,Humana MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Optum VA,Optum VA,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,UHC,UHC,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,UHC MGG,UHC MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,VA,VA,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Wellcare MGG,Wellcare MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Bright Health - commercial,Bright Health - commercial,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,51,51,Bright Health MGG,Bright Health MGG,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Aetna,Aetna,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Aetna MGG,Aetna MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,BCBS,BCBS,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,BCBS MGG,BCBS MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Cigna,Cigna,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Cigna MGG,Cigna MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Humana,Humana,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Humana MGG,Humana MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Optum VA,Optum VA,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,UHC,UHC,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,UHC MGG,UHC MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,VA,VA,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Wellcare MGG,Wellcare MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Bright Health - commercial,Bright Health - commercial,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,19.41,19.41,Bright Health MGG,Bright Health MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Aetna,Aetna,35.97,,,,,,,per diem,35.97,35.97,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Aetna MGG,Aetna MGG,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,BCBS,BCBS,35.97,,,,,,,per diem,35.97,35.97,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,BCBS MGG,BCBS MGG,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Cigna,Cigna,35.97,,,,,,,per diem,35.97,35.97,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Cigna MGG,Cigna MGG,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Humana,Humana,35.97,,,,,,,per diem,35.97,35.97,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Humana MGG,Humana MGG,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Optum VA,Optum VA,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,UHC,UHC,35.97,,,,,,,per diem,35.97,35.97,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,UHC MGG,UHC MGG,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,VA,VA,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Wellcare MGG,Wellcare MGG,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Bright Health - commercial,Bright Health - commercial,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,35.97,35.97,Bright Health MGG,Bright Health MGG,35.97,,,,,,,case rate,35.97,35.97,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Aetna,Aetna,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Aetna MGG,Aetna MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,BCBS,BCBS,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,BCBS MGG,BCBS MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Cigna,Cigna,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Cigna MGG,Cigna MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Humana,Humana,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Humana MGG,Humana MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Optum VA,Optum VA,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,UHC,UHC,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,UHC MGG,UHC MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,VA,VA,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Wellcare MGG,Wellcare MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Bright Health - commercial,Bright Health - commercial,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,18.12,18.12,Bright Health MGG,Bright Health MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Aetna,Aetna,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Aetna MGG,Aetna MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,BCBS,BCBS,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,BCBS MGG,BCBS MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Cigna,Cigna,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Cigna MGG,Cigna MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Humana,Humana,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Humana MGG,Humana MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Optum VA,Optum VA,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,UHC,UHC,20.67,,,,,,,per diem,20.67,20.67,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,UHC MGG,UHC MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,VA,VA,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Wellcare MGG,Wellcare MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Bright Health - commercial,Bright Health - commercial,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,20.67,20.67,Bright Health MGG,Bright Health MGG,20.67,,,,,,,case rate,20.67,20.67,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Aetna,Aetna,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Aetna MGG,Aetna MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,BCBS,BCBS,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,BCBS MGG,BCBS MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Cigna,Cigna,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Cigna MGG,Cigna MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Humana,Humana,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Humana MGG,Humana MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Optum VA,Optum VA,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,UHC,UHC,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,UHC MGG,UHC MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,VA,VA,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Wellcare MGG,Wellcare MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Bright Health - commercial,Bright Health - commercial,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,20.1,20.1,Bright Health MGG,Bright Health MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Aetna,Aetna,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Aetna MGG,Aetna MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,BCBS,BCBS,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,BCBS MGG,BCBS MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Cigna,Cigna,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Cigna MGG,Cigna MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Humana,Humana,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Humana MGG,Humana MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Optum VA,Optum VA,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,UHC,UHC,74,,,,,,,per diem,74,74,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,UHC MGG,UHC MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,VA,VA,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Wellcare MGG,Wellcare MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Bright Health - commercial,Bright Health - commercial,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,74,74,Bright Health MGG,Bright Health MGG,74,,,,,,,case rate,74,74,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Aetna,Aetna,117.78,,,,,,,per diem,117.78,117.78,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Aetna MGG,Aetna MGG,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,BCBS,BCBS,117.78,,,,,,,per diem,117.78,117.78,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,BCBS MGG,BCBS MGG,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Cigna,Cigna,117.78,,,,,,,per diem,117.78,117.78,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Cigna MGG,Cigna MGG,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Humana,Humana,117.78,,,,,,,per diem,117.78,117.78,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Humana MGG,Humana MGG,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Optum VA,Optum VA,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,UHC,UHC,117.78,,,,,,,per diem,117.78,117.78,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,UHC MGG,UHC MGG,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,VA,VA,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Wellcare MGG,Wellcare MGG,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Bright Health - commercial,Bright Health - commercial,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,117.78,117.78,Bright Health MGG,Bright Health MGG,117.78,,,,,,,case rate,117.78,117.78,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Aetna,Aetna,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Aetna MGG,Aetna MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,BCBS,BCBS,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,BCBS MGG,BCBS MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Cigna,Cigna,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Cigna MGG,Cigna MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Humana,Humana,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Humana MGG,Humana MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Optum VA,Optum VA,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,UHC,UHC,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,UHC MGG,UHC MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,VA,VA,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Wellcare MGG,Wellcare MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Bright Health - commercial,Bright Health - commercial,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,27.21,27.21,Bright Health MGG,Bright Health MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Aetna,Aetna,28.05,,,,,,,per diem,28.05,28.05,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Aetna MGG,Aetna MGG,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,BCBS,BCBS,28.05,,,,,,,per diem,28.05,28.05,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,BCBS MGG,BCBS MGG,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Cigna,Cigna,28.05,,,,,,,per diem,28.05,28.05,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Cigna MGG,Cigna MGG,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Humana,Humana,28.05,,,,,,,per diem,28.05,28.05,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Humana MGG,Humana MGG,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Optum VA,Optum VA,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,UHC,UHC,28.05,,,,,,,per diem,28.05,28.05,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,UHC MGG,UHC MGG,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,VA,VA,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Wellcare MGG,Wellcare MGG,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Bright Health - commercial,Bright Health - commercial,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,28.05,28.05,Bright Health MGG,Bright Health MGG,28.05,,,,,,,case rate,28.05,28.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Aetna,Aetna,180.05,,,,,,,per diem,180.05,180.05,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Aetna MGG,Aetna MGG,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,BCBS,BCBS,180.05,,,,,,,per diem,180.05,180.05,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,BCBS MGG,BCBS MGG,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Cigna,Cigna,180.05,,,,,,,per diem,180.05,180.05,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Cigna MGG,Cigna MGG,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Humana,Humana,180.05,,,,,,,per diem,180.05,180.05,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Humana MGG,Humana MGG,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Optum VA,Optum VA,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,UHC,UHC,180.05,,,,,,,per diem,180.05,180.05,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,UHC MGG,UHC MGG,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,VA,VA,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Wellcare MGG,Wellcare MGG,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Bright Health - commercial,Bright Health - commercial,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,180.05,180.05,Bright Health MGG,Bright Health MGG,180.05,,,,,,,case rate,180.05,180.05,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Aetna,Aetna,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Aetna MGG,Aetna MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,BCBS,BCBS,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,BCBS MGG,BCBS MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Cigna,Cigna,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Cigna MGG,Cigna MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Humana,Humana,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Humana MGG,Humana MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Optum VA,Optum VA,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,UHC,UHC,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,UHC MGG,UHC MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,VA,VA,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Wellcare MGG,Wellcare MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Bright Health - commercial,Bright Health - commercial,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.22,14.22,Bright Health MGG,Bright Health MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Aetna,Aetna,19.02,,,,,,,per diem,19.02,19.02,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Aetna MGG,Aetna MGG,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,BCBS,BCBS,19.02,,,,,,,per diem,19.02,19.02,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,BCBS MGG,BCBS MGG,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Cigna,Cigna,19.02,,,,,,,per diem,19.02,19.02,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Cigna MGG,Cigna MGG,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Humana,Humana,19.02,,,,,,,per diem,19.02,19.02,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Humana MGG,Humana MGG,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Optum VA,Optum VA,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,UHC,UHC,19.02,,,,,,,per diem,19.02,19.02,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,UHC MGG,UHC MGG,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,VA,VA,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Wellcare MGG,Wellcare MGG,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Bright Health - commercial,Bright Health - commercial,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,19.02,19.02,Bright Health MGG,Bright Health MGG,19.02,,,,,,,case rate,19.02,19.02,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Aetna,Aetna,43.77,,,,,,,per diem,43.77,43.77,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Aetna MGG,Aetna MGG,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,BCBS,BCBS,43.77,,,,,,,per diem,43.77,43.77,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,BCBS MGG,BCBS MGG,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Cigna,Cigna,43.77,,,,,,,per diem,43.77,43.77,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Cigna MGG,Cigna MGG,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Humana,Humana,43.77,,,,,,,per diem,43.77,43.77,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Humana MGG,Humana MGG,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Optum VA,Optum VA,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,UHC,UHC,43.77,,,,,,,per diem,43.77,43.77,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,UHC MGG,UHC MGG,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,VA,VA,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Wellcare MGG,Wellcare MGG,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Bright Health - commercial,Bright Health - commercial,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,43.77,43.77,Bright Health MGG,Bright Health MGG,43.77,,,,,,,case rate,43.77,43.77,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Aetna,Aetna,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Aetna MGG,Aetna MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,BCBS,BCBS,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,BCBS MGG,BCBS MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Cigna,Cigna,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Cigna MGG,Cigna MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Humana,Humana,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Humana MGG,Humana MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Optum VA,Optum VA,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,UHC,UHC,68,,,,,,,per diem,68,68,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,UHC MGG,UHC MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,VA,VA,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Wellcare MGG,Wellcare MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Bright Health - commercial,Bright Health - commercial,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,68,68,Bright Health MGG,Bright Health MGG,68,,,,,,,case rate,68,68,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Aetna,Aetna,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Aetna MGG,Aetna MGG,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,BCBS,BCBS,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,BCBS MGG,BCBS MGG,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Cigna,Cigna,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Cigna MGG,Cigna MGG,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Humana,Humana,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Humana MGG,Humana MGG,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Optum VA,Optum VA,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,UHC,UHC,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,UHC MGG,UHC MGG,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,VA,VA,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Wellcare MGG,Wellcare MGG,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Bright Health - commercial,Bright Health - commercial,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,15.09,15.09,Bright Health MGG,Bright Health MGG,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Aetna,Aetna,44.19,,,,,,,per diem,44.19,44.19,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Aetna MGG,Aetna MGG,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,BCBS,BCBS,44.19,,,,,,,per diem,44.19,44.19,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,BCBS MGG,BCBS MGG,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Cigna,Cigna,44.19,,,,,,,per diem,44.19,44.19,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Cigna MGG,Cigna MGG,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Humana,Humana,44.19,,,,,,,per diem,44.19,44.19,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Humana MGG,Humana MGG,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Optum VA,Optum VA,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,UHC,UHC,44.19,,,,,,,per diem,44.19,44.19,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,UHC MGG,UHC MGG,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,VA,VA,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Wellcare MGG,Wellcare MGG,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Bright Health - commercial,Bright Health - commercial,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,44.19,44.19,Bright Health MGG,Bright Health MGG,44.19,,,,,,,case rate,44.19,44.19,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Aetna,Aetna,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Aetna MGG,Aetna MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,BCBS,BCBS,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,BCBS MGG,BCBS MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Cigna,Cigna,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Cigna MGG,Cigna MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Humana,Humana,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Humana MGG,Humana MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Optum VA,Optum VA,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,UHC,UHC,109,,,,,,,per diem,109,109,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,UHC MGG,UHC MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,VA,VA,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Wellcare MGG,Wellcare MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Bright Health - commercial,Bright Health - commercial,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,109,109,Bright Health MGG,Bright Health MGG,109,,,,,,,case rate,109,109,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Aetna,Aetna,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Aetna MGG,Aetna MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,BCBS,BCBS,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,BCBS MGG,BCBS MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Cigna,Cigna,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Cigna MGG,Cigna MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Humana,Humana,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Humana MGG,Humana MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Optum VA,Optum VA,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,UHC,UHC,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,UHC MGG,UHC MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,VA,VA,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Wellcare MGG,Wellcare MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Bright Health - commercial,Bright Health - commercial,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,20.61,20.61,Bright Health MGG,Bright Health MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Aetna,Aetna,27.06,,,,,,,per diem,27.06,27.06,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Aetna MGG,Aetna MGG,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,BCBS,BCBS,27.06,,,,,,,per diem,27.06,27.06,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,BCBS MGG,BCBS MGG,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Cigna,Cigna,27.06,,,,,,,per diem,27.06,27.06,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Cigna MGG,Cigna MGG,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Humana,Humana,27.06,,,,,,,per diem,27.06,27.06,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Humana MGG,Humana MGG,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Optum VA,Optum VA,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,UHC,UHC,27.06,,,,,,,per diem,27.06,27.06,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,UHC MGG,UHC MGG,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,VA,VA,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Wellcare MGG,Wellcare MGG,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Bright Health - commercial,Bright Health - commercial,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,27.06,27.06,Bright Health MGG,Bright Health MGG,27.06,,,,,,,case rate,27.06,27.06,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Aetna,Aetna,88.5,,,,,,,per diem,88.5,88.5,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Aetna MGG,Aetna MGG,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,BCBS,BCBS,88.5,,,,,,,per diem,88.5,88.5,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,BCBS MGG,BCBS MGG,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Cigna,Cigna,88.5,,,,,,,per diem,88.5,88.5,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Cigna MGG,Cigna MGG,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Humana,Humana,88.5,,,,,,,per diem,88.5,88.5,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Humana MGG,Humana MGG,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Optum VA,Optum VA,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,UHC,UHC,88.5,,,,,,,per diem,88.5,88.5,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,UHC MGG,UHC MGG,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,VA,VA,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Wellcare MGG,Wellcare MGG,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Bright Health - commercial,Bright Health - commercial,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,88.5,88.5,Bright Health MGG,Bright Health MGG,88.5,,,,,,,case rate,88.5,88.5,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Aetna,Aetna,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Aetna MGG,Aetna MGG,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,BCBS,BCBS,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,BCBS MGG,BCBS MGG,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Cigna,Cigna,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Cigna MGG,Cigna MGG,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Humana,Humana,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Humana MGG,Humana MGG,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Optum VA,Optum VA,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,UHC,UHC,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,UHC MGG,UHC MGG,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,VA,VA,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Wellcare MGG,Wellcare MGG,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Bright Health - commercial,Bright Health - commercial,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,54.75,54.75,Bright Health MGG,Bright Health MGG,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Aetna,Aetna,71,,,,,,,per diem,71,71,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Aetna MGG,Aetna MGG,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,BCBS,BCBS,71,,,,,,,per diem,71,71,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,BCBS MGG,BCBS MGG,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Cigna,Cigna,71,,,,,,,per diem,71,71,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Cigna MGG,Cigna MGG,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Humana,Humana,71,,,,,,,per diem,71,71,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Humana MGG,Humana MGG,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Optum VA,Optum VA,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,UHC,UHC,71,,,,,,,per diem,71,71,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,UHC MGG,UHC MGG,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,VA,VA,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Wellcare MGG,Wellcare MGG,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Bright Health - commercial,Bright Health - commercial,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,71,71,Bright Health MGG,Bright Health MGG,71,,,,,,,case rate,71,71,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Aetna,Aetna,37.41,,,,,,,per diem,37.41,37.41,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Aetna MGG,Aetna MGG,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,BCBS,BCBS,37.41,,,,,,,per diem,37.41,37.41,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,BCBS MGG,BCBS MGG,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Cigna,Cigna,37.41,,,,,,,per diem,37.41,37.41,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Cigna MGG,Cigna MGG,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Humana,Humana,37.41,,,,,,,per diem,37.41,37.41,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Humana MGG,Humana MGG,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Optum VA,Optum VA,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,UHC,UHC,37.41,,,,,,,per diem,37.41,37.41,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,UHC MGG,UHC MGG,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,VA,VA,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Wellcare MGG,Wellcare MGG,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Bright Health - commercial,Bright Health - commercial,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,37.41,37.41,Bright Health MGG,Bright Health MGG,37.41,,,,,,,case rate,37.41,37.41,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Aetna,Aetna,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Aetna MGG,Aetna MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,BCBS,BCBS,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,BCBS MGG,BCBS MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Cigna,Cigna,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Cigna MGG,Cigna MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Humana,Humana,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Humana MGG,Humana MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Optum VA,Optum VA,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,UHC,UHC,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,UHC MGG,UHC MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,VA,VA,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Wellcare MGG,Wellcare MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Bright Health - commercial,Bright Health - commercial,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,13.56,13.56,Bright Health MGG,Bright Health MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Aetna,Aetna,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Aetna MGG,Aetna MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,BCBS,BCBS,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,BCBS MGG,BCBS MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Cigna,Cigna,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Cigna MGG,Cigna MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Humana,Humana,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Humana MGG,Humana MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Optum VA,Optum VA,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,UHC,UHC,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,UHC MGG,UHC MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,VA,VA,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Wellcare MGG,Wellcare MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Bright Health - commercial,Bright Health - commercial,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,27,27,Bright Health MGG,Bright Health MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Aetna,Aetna,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Aetna MGG,Aetna MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,BCBS,BCBS,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,BCBS MGG,BCBS MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Cigna,Cigna,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Cigna MGG,Cigna MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Humana,Humana,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Humana MGG,Humana MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Optum VA,Optum VA,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,UHC,UHC,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,UHC MGG,UHC MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,VA,VA,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Wellcare MGG,Wellcare MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Bright Health - commercial,Bright Health - commercial,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY RISK     ,38251574,CDM,302,RC,86141,CPT,,,,Inpatient,,,38.85,38.85,Bright Health MGG,Bright Health MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Aetna,Aetna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Aetna MGG,Aetna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,BCBS,BCBS,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,BCBS MGG,BCBS MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Cigna,Cigna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Cigna MGG,Cigna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Humana,Humana,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Humana MGG,Humana MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Optum VA,Optum VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,UHC,UHC,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,UHC MGG,UHC MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,VA,VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Wellcare MGG,Wellcare MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Bright Health - commercial,Bright Health - commercial,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,9.75,9.75,Bright Health MGG,Bright Health MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Aetna,Aetna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Aetna MGG,Aetna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,BCBS,BCBS,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,BCBS MGG,BCBS MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Cigna,Cigna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Cigna MGG,Cigna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Humana,Humana,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Humana MGG,Humana MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Optum VA,Optum VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,UHC,UHC,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,UHC MGG,UHC MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,VA,VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Wellcare MGG,Wellcare MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Bright Health - commercial,Bright Health - commercial,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,9.75,9.75,Bright Health MGG,Bright Health MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Aetna,Aetna,23.31,,,,,,,per diem,23.31,23.31,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Aetna MGG,Aetna MGG,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,BCBS,BCBS,23.31,,,,,,,per diem,23.31,23.31,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,BCBS MGG,BCBS MGG,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Cigna,Cigna,23.31,,,,,,,per diem,23.31,23.31,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Cigna MGG,Cigna MGG,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Humana,Humana,23.31,,,,,,,per diem,23.31,23.31,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Humana MGG,Humana MGG,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Optum VA,Optum VA,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,UHC,UHC,23.31,,,,,,,per diem,23.31,23.31,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,UHC MGG,UHC MGG,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,VA,VA,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Wellcare MGG,Wellcare MGG,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Bright Health - commercial,Bright Health - commercial,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,23.31,23.31,Bright Health MGG,Bright Health MGG,23.31,,,,,,,case rate,23.31,23.31,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Aetna,Aetna,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Aetna MGG,Aetna MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,BCBS,BCBS,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,BCBS MGG,BCBS MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Cigna,Cigna,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Cigna MGG,Cigna MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Humana,Humana,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Humana MGG,Humana MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Optum VA,Optum VA,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,UHC,UHC,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,UHC MGG,UHC MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,VA,VA,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Wellcare MGG,Wellcare MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Bright Health - commercial,Bright Health - commercial,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,19.41,19.41,Bright Health MGG,Bright Health MGG,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Aetna,Aetna,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Aetna MGG,Aetna MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,BCBS,BCBS,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,BCBS MGG,BCBS MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Cigna,Cigna,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Cigna MGG,Cigna MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Humana,Humana,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Humana MGG,Humana MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Optum VA,Optum VA,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,UHC,UHC,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,UHC MGG,UHC MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,VA,VA,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Wellcare MGG,Wellcare MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Bright Health - commercial,Bright Health - commercial,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,22.92,22.92,Bright Health MGG,Bright Health MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Aetna,Aetna,30.54,,,,,,,per diem,30.54,30.54,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Aetna MGG,Aetna MGG,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,BCBS,BCBS,30.54,,,,,,,per diem,30.54,30.54,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,BCBS MGG,BCBS MGG,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Cigna,Cigna,30.54,,,,,,,per diem,30.54,30.54,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Cigna MGG,Cigna MGG,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Humana,Humana,30.54,,,,,,,per diem,30.54,30.54,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Humana MGG,Humana MGG,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Optum VA,Optum VA,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,UHC,UHC,30.54,,,,,,,per diem,30.54,30.54,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,UHC MGG,UHC MGG,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,VA,VA,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Wellcare MGG,Wellcare MGG,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Bright Health - commercial,Bright Health - commercial,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,30.54,30.54,Bright Health MGG,Bright Health MGG,30.54,,,,,,,case rate,30.54,30.54,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Aetna,Aetna,12.87,,,,,,,per diem,12.87,12.87,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Aetna MGG,Aetna MGG,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,BCBS,BCBS,12.87,,,,,,,per diem,12.87,12.87,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,BCBS MGG,BCBS MGG,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Cigna,Cigna,12.87,,,,,,,per diem,12.87,12.87,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Cigna MGG,Cigna MGG,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Humana,Humana,12.87,,,,,,,per diem,12.87,12.87,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Humana MGG,Humana MGG,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Optum VA,Optum VA,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,UHC,UHC,12.87,,,,,,,per diem,12.87,12.87,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,UHC MGG,UHC MGG,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,VA,VA,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Wellcare MGG,Wellcare MGG,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Bright Health - commercial,Bright Health - commercial,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,12.87,12.87,Bright Health MGG,Bright Health MGG,12.87,,,,,,,case rate,12.87,12.87,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Aetna,Aetna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Aetna MGG,Aetna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,BCBS,BCBS,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,BCBS MGG,BCBS MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Cigna,Cigna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Cigna MGG,Cigna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Humana,Humana,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Humana MGG,Humana MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Optum VA,Optum VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,UHC,UHC,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,UHC MGG,UHC MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,VA,VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Wellcare MGG,Wellcare MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Bright Health - commercial,Bright Health - commercial,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,8.1,8.1,Bright Health MGG,Bright Health MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Aetna,Aetna,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Aetna MGG,Aetna MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,BCBS,BCBS,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,BCBS MGG,BCBS MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Cigna,Cigna,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Cigna MGG,Cigna MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Humana,Humana,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Humana MGG,Humana MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Optum VA,Optum VA,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,UHC,UHC,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,UHC MGG,UHC MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,VA,VA,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Wellcare MGG,Wellcare MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Bright Health - commercial,Bright Health - commercial,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,18.03,18.03,Bright Health MGG,Bright Health MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Aetna,Aetna,30.96,,,,,,,per diem,30.96,30.96,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Aetna MGG,Aetna MGG,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,BCBS,BCBS,30.96,,,,,,,per diem,30.96,30.96,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,BCBS MGG,BCBS MGG,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Cigna,Cigna,30.96,,,,,,,per diem,30.96,30.96,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Cigna MGG,Cigna MGG,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Humana,Humana,30.96,,,,,,,per diem,30.96,30.96,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Humana MGG,Humana MGG,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Optum VA,Optum VA,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,UHC,UHC,30.96,,,,,,,per diem,30.96,30.96,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,UHC MGG,UHC MGG,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,VA,VA,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Wellcare MGG,Wellcare MGG,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Bright Health - commercial,Bright Health - commercial,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,30.96,30.96,Bright Health MGG,Bright Health MGG,30.96,,,,,,,case rate,30.96,30.96,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Aetna,Aetna,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Aetna MGG,Aetna MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,BCBS,BCBS,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,BCBS MGG,BCBS MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Cigna,Cigna,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Cigna MGG,Cigna MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Humana,Humana,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Humana MGG,Humana MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Optum VA,Optum VA,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,UHC,UHC,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,UHC MGG,UHC MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,VA,VA,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Wellcare MGG,Wellcare MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Bright Health - commercial,Bright Health - commercial,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,38.85,38.85,Bright Health MGG,Bright Health MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Aetna,Aetna,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Aetna MGG,Aetna MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,BCBS,BCBS,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,BCBS MGG,BCBS MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Cigna,Cigna,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Cigna MGG,Cigna MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Humana,Humana,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Humana MGG,Humana MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Optum VA,Optum VA,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,UHC,UHC,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,UHC MGG,UHC MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,VA,VA,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Wellcare MGG,Wellcare MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Bright Health - commercial,Bright Health - commercial,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,38.85,38.85,Bright Health MGG,Bright Health MGG,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Aetna,Aetna,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Aetna MGG,Aetna MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,BCBS,BCBS,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,BCBS MGG,BCBS MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Cigna,Cigna,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Cigna MGG,Cigna MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Humana,Humana,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Humana MGG,Humana MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Optum VA,Optum VA,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,UHC,UHC,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,UHC MGG,UHC MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,VA,VA,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Wellcare MGG,Wellcare MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Bright Health - commercial,Bright Health - commercial,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,35.46,35.46,Bright Health MGG,Bright Health MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Aetna,Aetna,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Aetna MGG,Aetna MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,BCBS,BCBS,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,BCBS MGG,BCBS MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Cigna,Cigna,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Cigna MGG,Cigna MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Humana,Humana,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Humana MGG,Humana MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Optum VA,Optum VA,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,UHC,UHC,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,UHC MGG,UHC MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,VA,VA,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Wellcare MGG,Wellcare MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Bright Health - commercial,Bright Health - commercial,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,33.24,33.24,Bright Health MGG,Bright Health MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Aetna,Aetna,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Aetna MGG,Aetna MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,BCBS,BCBS,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,BCBS MGG,BCBS MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Cigna,Cigna,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Cigna MGG,Cigna MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Humana,Humana,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Humana MGG,Humana MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Optum VA,Optum VA,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,UHC,UHC,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,UHC MGG,UHC MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,VA,VA,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Wellcare MGG,Wellcare MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Bright Health - commercial,Bright Health - commercial,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,24.21,24.21,Bright Health MGG,Bright Health MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Aetna,Aetna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Aetna MGG,Aetna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,BCBS,BCBS,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,BCBS MGG,BCBS MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Cigna,Cigna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Cigna MGG,Cigna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Humana,Humana,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Humana MGG,Humana MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Optum VA,Optum VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,UHC,UHC,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,UHC MGG,UHC MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,VA,VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Wellcare MGG,Wellcare MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Bright Health - commercial,Bright Health - commercial,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,18.75,18.75,Bright Health MGG,Bright Health MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Aetna,Aetna,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Aetna MGG,Aetna MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,BCBS,BCBS,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,BCBS MGG,BCBS MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Cigna,Cigna,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Cigna MGG,Cigna MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Humana,Humana,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Humana MGG,Humana MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Optum VA,Optum VA,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,UHC,UHC,35.7,,,,,,,per diem,35.7,35.7,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,UHC MGG,UHC MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,VA,VA,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Wellcare MGG,Wellcare MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Bright Health - commercial,Bright Health - commercial,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,35.7,35.7,Bright Health MGG,Bright Health MGG,35.7,,,,,,,case rate,35.7,35.7,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Aetna,Aetna,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Aetna MGG,Aetna MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,BCBS,BCBS,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,BCBS MGG,BCBS MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Cigna,Cigna,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Cigna MGG,Cigna MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Humana,Humana,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Humana MGG,Humana MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Optum VA,Optum VA,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,UHC,UHC,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,UHC MGG,UHC MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,VA,VA,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Wellcare MGG,Wellcare MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Bright Health - commercial,Bright Health - commercial,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,17.58,17.58,Bright Health MGG,Bright Health MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Aetna,Aetna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Aetna MGG,Aetna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,BCBS,BCBS,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,BCBS MGG,BCBS MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Cigna,Cigna,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Cigna MGG,Cigna MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Humana,Humana,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Humana MGG,Humana MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Optum VA,Optum VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,UHC,UHC,150,,,,,,,per diem,150,150,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,UHC MGG,UHC MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,VA,VA,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Wellcare MGG,Wellcare MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Bright Health - commercial,Bright Health - commercial,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,150,150,Bright Health MGG,Bright Health MGG,150,,,,,,,case rate,150,150,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Aetna,Aetna,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Aetna MGG,Aetna MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,BCBS,BCBS,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,BCBS MGG,BCBS MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Cigna,Cigna,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Cigna MGG,Cigna MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Humana,Humana,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Humana MGG,Humana MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Optum VA,Optum VA,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,UHC,UHC,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,UHC MGG,UHC MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,VA,VA,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Wellcare MGG,Wellcare MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Bright Health - commercial,Bright Health - commercial,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.51,9.51,Bright Health MGG,Bright Health MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Aetna,Aetna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Aetna MGG,Aetna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,BCBS,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,BCBS MGG,BCBS MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Cigna,Cigna,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Cigna MGG,Cigna MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Humana,Humana,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Humana MGG,Humana MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Optum VA,Optum VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,UHC,UHC,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,UHC MGG,UHC MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,VA,VA,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Wellcare MGG,Wellcare MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Bright Health - commercial,Bright Health - commercial,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,56.76,56.76,Bright Health MGG,Bright Health MGG,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Aetna,Aetna,144.18,,,,,,,per diem,144.18,144.18,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Aetna MGG,Aetna MGG,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,BCBS,BCBS,144.18,,,,,,,per diem,144.18,144.18,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,BCBS MGG,BCBS MGG,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Cigna,Cigna,144.18,,,,,,,per diem,144.18,144.18,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Cigna MGG,Cigna MGG,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Humana,Humana,144.18,,,,,,,per diem,144.18,144.18,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Humana MGG,Humana MGG,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Optum VA,Optum VA,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,UHC,UHC,144.18,,,,,,,per diem,144.18,144.18,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,UHC MGG,UHC MGG,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,VA,VA,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Wellcare MGG,Wellcare MGG,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Bright Health - commercial,Bright Health - commercial,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,144.18,144.18,Bright Health MGG,Bright Health MGG,144.18,,,,,,,case rate,144.18,144.18,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Aetna,Aetna,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Aetna MGG,Aetna MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,BCBS,BCBS,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,BCBS MGG,BCBS MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Cigna,Cigna,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Cigna MGG,Cigna MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Humana,Humana,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Humana MGG,Humana MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Optum VA,Optum VA,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,UHC,UHC,52,,,,,,,per diem,52,52,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,UHC MGG,UHC MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,VA,VA,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Wellcare MGG,Wellcare MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Bright Health - commercial,Bright Health - commercial,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,52,52,Bright Health MGG,Bright Health MGG,52,,,,,,,case rate,52,52,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Aetna,Aetna,748.79,,,,,,,per diem,748.79,748.79,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Aetna MGG,Aetna MGG,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,BCBS,BCBS,748.79,,,,,,,per diem,748.79,748.79,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,BCBS MGG,BCBS MGG,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Cigna,Cigna,748.79,,,,,,,per diem,748.79,748.79,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Cigna MGG,Cigna MGG,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Humana,Humana,748.79,,,,,,,per diem,748.79,748.79,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Humana MGG,Humana MGG,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Optum VA,Optum VA,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,UHC,UHC,748.79,,,,,,,per diem,748.79,748.79,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,UHC MGG,UHC MGG,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,VA,VA,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Wellcare MGG,Wellcare MGG,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Bright Health - commercial,Bright Health - commercial,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,748.79,748.79,Bright Health MGG,Bright Health MGG,748.79,,,,,,,case rate,748.79,748.79,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Aetna,Aetna,76.75,,,,,,,per diem,76.75,76.75,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Aetna MGG,Aetna MGG,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,BCBS,BCBS,76.75,,,,,,,per diem,76.75,76.75,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,BCBS MGG,BCBS MGG,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Cigna,Cigna,76.75,,,,,,,per diem,76.75,76.75,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Cigna MGG,Cigna MGG,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Humana,Humana,76.75,,,,,,,per diem,76.75,76.75,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Humana MGG,Humana MGG,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Optum VA,Optum VA,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,UHC,UHC,76.75,,,,,,,per diem,76.75,76.75,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,UHC MGG,UHC MGG,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,VA,VA,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Wellcare MGG,Wellcare MGG,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Bright Health - commercial,Bright Health - commercial,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,76.75,76.75,Bright Health MGG,Bright Health MGG,76.75,,,,,,,case rate,76.75,76.75,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Aetna,Aetna,137.59,,,,,,,per diem,137.59,137.59,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Aetna MGG,Aetna MGG,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,BCBS,BCBS,137.59,,,,,,,per diem,137.59,137.59,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,BCBS MGG,BCBS MGG,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Cigna,Cigna,137.59,,,,,,,per diem,137.59,137.59,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Cigna MGG,Cigna MGG,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Humana,Humana,137.59,,,,,,,per diem,137.59,137.59,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Humana MGG,Humana MGG,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Optum VA,Optum VA,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,UHC,UHC,137.59,,,,,,,per diem,137.59,137.59,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,UHC MGG,UHC MGG,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,VA,VA,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Wellcare MGG,Wellcare MGG,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Bright Health - commercial,Bright Health - commercial,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,137.59,137.59,Bright Health MGG,Bright Health MGG,137.59,,,,,,,case rate,137.59,137.59,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Aetna,Aetna,16.66,,,,,,,per diem,16.66,16.66,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Aetna MGG,Aetna MGG,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,BCBS,BCBS,16.66,,,,,,,per diem,16.66,16.66,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,BCBS MGG,BCBS MGG,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Cigna,Cigna,16.66,,,,,,,per diem,16.66,16.66,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Cigna MGG,Cigna MGG,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Humana,Humana,16.66,,,,,,,per diem,16.66,16.66,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Humana MGG,Humana MGG,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Optum VA,Optum VA,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,UHC,UHC,16.66,,,,,,,per diem,16.66,16.66,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,UHC MGG,UHC MGG,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,VA,VA,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Wellcare MGG,Wellcare MGG,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Bright Health - commercial,Bright Health - commercial,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,16.66,16.66,Bright Health MGG,Bright Health MGG,16.66,,,,,,,case rate,16.66,16.66,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Aetna,Aetna,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Aetna MGG,Aetna MGG,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,BCBS,BCBS,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,BCBS MGG,BCBS MGG,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Cigna,Cigna,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Cigna MGG,Cigna MGG,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Humana,Humana,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Humana MGG,Humana MGG,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Optum VA,Optum VA,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,UHC,UHC,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,UHC MGG,UHC MGG,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,VA,VA,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Wellcare MGG,Wellcare MGG,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Bright Health - commercial,Bright Health - commercial,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,24.96,24.96,Bright Health MGG,Bright Health MGG,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Aetna,Aetna,66.49,,,,,,,per diem,66.49,66.49,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Aetna MGG,Aetna MGG,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,BCBS,BCBS,66.49,,,,,,,per diem,66.49,66.49,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,BCBS MGG,BCBS MGG,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Cigna,Cigna,66.49,,,,,,,per diem,66.49,66.49,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Cigna MGG,Cigna MGG,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Humana,Humana,66.49,,,,,,,per diem,66.49,66.49,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Humana MGG,Humana MGG,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Optum VA,Optum VA,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,UHC,UHC,66.49,,,,,,,per diem,66.49,66.49,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,UHC MGG,UHC MGG,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,VA,VA,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Wellcare MGG,Wellcare MGG,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Bright Health - commercial,Bright Health - commercial,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,66.49,66.49,Bright Health MGG,Bright Health MGG,66.49,,,,,,,case rate,66.49,66.49,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Aetna,Aetna,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Aetna MGG,Aetna MGG,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,BCBS,BCBS,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,BCBS MGG,BCBS MGG,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Cigna,Cigna,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Cigna MGG,Cigna MGG,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Humana,Humana,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Humana MGG,Humana MGG,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Optum VA,Optum VA,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,UHC,UHC,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,UHC MGG,UHC MGG,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,VA,VA,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Wellcare MGG,Wellcare MGG,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Bright Health - commercial,Bright Health - commercial,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,23.37,23.37,Bright Health MGG,Bright Health MGG,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Aetna,Aetna,235,,,,,,,per diem,235,235,"Per diem rate, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Aetna MGG,Aetna MGG,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,BCBS,BCBS,235,,,,,,,per diem,235,235,"Per diem rate, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,BCBS MGG,BCBS MGG,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Cigna,Cigna,235,,,,,,,per diem,235,235,"Per diem rate, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Cigna MGG,Cigna MGG,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Humana,Humana,235,,,,,,,per diem,235,235,"Per diem rate, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Humana MGG,Humana MGG,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Optum VA,Optum VA,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,UHC,UHC,235,,,,,,,per diem,235,235,"Per diem rate, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,UHC MGG,UHC MGG,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,VA,VA,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Wellcare MGG,Wellcare MGG,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Bright Health - commercial,Bright Health - commercial,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
PLATELETS                     ,38251610,CDM,301,RC,,,,,,Inpatient,,,235,235,Bright Health MGG,Bright Health MGG,235,,,,,,,case rate,235,235,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Aetna,Aetna,435.68,,,,,,,per diem,435.68,435.68,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Aetna MGG,Aetna MGG,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,BCBS,BCBS,435.68,,,,,,,per diem,435.68,435.68,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,BCBS MGG,BCBS MGG,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Cigna,Cigna,435.68,,,,,,,per diem,435.68,435.68,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Cigna MGG,Cigna MGG,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Humana,Humana,435.68,,,,,,,per diem,435.68,435.68,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Humana MGG,Humana MGG,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Optum VA,Optum VA,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,UHC,UHC,435.68,,,,,,,per diem,435.68,435.68,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,UHC MGG,UHC MGG,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,VA,VA,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Wellcare MGG,Wellcare MGG,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Bright Health - commercial,Bright Health - commercial,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,435.68,435.68,Bright Health MGG,Bright Health MGG,435.68,,,,,,,case rate,435.68,435.68,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Aetna,Aetna,141.4,,,,,,,per diem,141.4,141.4,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Aetna MGG,Aetna MGG,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,BCBS,BCBS,141.4,,,,,,,per diem,141.4,141.4,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,BCBS MGG,BCBS MGG,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Cigna,Cigna,141.4,,,,,,,per diem,141.4,141.4,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Cigna MGG,Cigna MGG,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Humana,Humana,141.4,,,,,,,per diem,141.4,141.4,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Humana MGG,Humana MGG,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Optum VA,Optum VA,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,UHC,UHC,141.4,,,,,,,per diem,141.4,141.4,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,UHC MGG,UHC MGG,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,VA,VA,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Wellcare MGG,Wellcare MGG,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Bright Health - commercial,Bright Health - commercial,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,141.4,141.4,Bright Health MGG,Bright Health MGG,141.4,,,,,,,case rate,141.4,141.4,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Aetna,Aetna,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Aetna MGG,Aetna MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,BCBS,BCBS,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,BCBS MGG,BCBS MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Cigna,Cigna,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Cigna MGG,Cigna MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Humana,Humana,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Humana MGG,Humana MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Optum VA,Optum VA,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,UHC,UHC,49,,,,,,,per diem,49,49,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,UHC MGG,UHC MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,VA,VA,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Wellcare MGG,Wellcare MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Bright Health - commercial,Bright Health - commercial,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,49,49,Bright Health MGG,Bright Health MGG,49,,,,,,,case rate,49,49,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Aetna,Aetna,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Aetna MGG,Aetna MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,BCBS,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,BCBS MGG,BCBS MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Cigna,Cigna,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Cigna MGG,Cigna MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Humana,Humana,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Humana MGG,Humana MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Optum VA,Optum VA,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,UHC,UHC,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,UHC MGG,UHC MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,VA,VA,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Wellcare MGG,Wellcare MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Bright Health - commercial,Bright Health - commercial,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,46.2,46.2,Bright Health MGG,Bright Health MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Aetna,Aetna,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Aetna MGG,Aetna MGG,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,BCBS,BCBS,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,BCBS MGG,BCBS MGG,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Cigna,Cigna,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Cigna MGG,Cigna MGG,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Humana,Humana,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Humana MGG,Humana MGG,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Optum VA,Optum VA,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,UHC,UHC,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,UHC MGG,UHC MGG,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,VA,VA,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Wellcare MGG,Wellcare MGG,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Bright Health - commercial,Bright Health - commercial,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,45.41,45.41,Bright Health MGG,Bright Health MGG,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Aetna,Aetna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Aetna MGG,Aetna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,BCBS,BCBS,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,BCBS MGG,BCBS MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Cigna,Cigna,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Cigna MGG,Cigna MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Humana,Humana,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Humana MGG,Humana MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Optum VA,Optum VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,UHC,UHC,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,UHC MGG,UHC MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,VA,VA,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Wellcare MGG,Wellcare MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Bright Health - commercial,Bright Health - commercial,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,126.38,126.38,Bright Health MGG,Bright Health MGG,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Aetna,Aetna,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Aetna MGG,Aetna MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,BCBS,BCBS,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,BCBS MGG,BCBS MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Cigna,Cigna,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Cigna MGG,Cigna MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Humana,Humana,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Humana MGG,Humana MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Optum VA,Optum VA,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,UHC,UHC,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,UHC MGG,UHC MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,VA,VA,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Wellcare MGG,Wellcare MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Bright Health - commercial,Bright Health - commercial,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,56.7,56.7,Bright Health MGG,Bright Health MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Aetna,Aetna,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Aetna MGG,Aetna MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,BCBS,BCBS,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,BCBS MGG,BCBS MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Cigna,Cigna,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Cigna MGG,Cigna MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Humana,Humana,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Humana MGG,Humana MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Optum VA,Optum VA,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,UHC,UHC,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,UHC MGG,UHC MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,VA,VA,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Wellcare MGG,Wellcare MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Bright Health - commercial,Bright Health - commercial,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,56.7,56.7,Bright Health MGG,Bright Health MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Aetna,Aetna,313.55,,,,,,,per diem,313.55,313.55,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Aetna MGG,Aetna MGG,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,BCBS,BCBS,313.55,,,,,,,per diem,313.55,313.55,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,BCBS MGG,BCBS MGG,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Cigna,Cigna,313.55,,,,,,,per diem,313.55,313.55,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Cigna MGG,Cigna MGG,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Humana,Humana,313.55,,,,,,,per diem,313.55,313.55,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Humana MGG,Humana MGG,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Optum VA,Optum VA,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,UHC,UHC,313.55,,,,,,,per diem,313.55,313.55,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,UHC MGG,UHC MGG,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,VA,VA,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Wellcare MGG,Wellcare MGG,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Bright Health - commercial,Bright Health - commercial,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,313.55,313.55,Bright Health MGG,Bright Health MGG,313.55,,,,,,,case rate,313.55,313.55,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Aetna,Aetna,183.4,,,,,,,per diem,183.4,183.4,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Aetna MGG,Aetna MGG,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,BCBS,BCBS,183.4,,,,,,,per diem,183.4,183.4,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,BCBS MGG,BCBS MGG,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Cigna,Cigna,183.4,,,,,,,per diem,183.4,183.4,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Cigna MGG,Cigna MGG,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Humana,Humana,183.4,,,,,,,per diem,183.4,183.4,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Humana MGG,Humana MGG,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Optum VA,Optum VA,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,UHC,UHC,183.4,,,,,,,per diem,183.4,183.4,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,UHC MGG,UHC MGG,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,VA,VA,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Wellcare MGG,Wellcare MGG,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Bright Health - commercial,Bright Health - commercial,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,183.4,183.4,Bright Health MGG,Bright Health MGG,183.4,,,,,,,case rate,183.4,183.4,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Aetna,Aetna,339.9,,,,,,,per diem,339.9,339.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Aetna MGG,Aetna MGG,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,BCBS,BCBS,339.9,,,,,,,per diem,339.9,339.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,BCBS MGG,BCBS MGG,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Cigna,Cigna,339.9,,,,,,,per diem,339.9,339.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Cigna MGG,Cigna MGG,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Humana,Humana,339.9,,,,,,,per diem,339.9,339.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Humana MGG,Humana MGG,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Optum VA,Optum VA,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,UHC,UHC,339.9,,,,,,,per diem,339.9,339.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,UHC MGG,UHC MGG,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,VA,VA,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Wellcare MGG,Wellcare MGG,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Bright Health - commercial,Bright Health - commercial,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,339.9,339.9,Bright Health MGG,Bright Health MGG,339.9,,,,,,,case rate,339.9,339.9,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Aetna,Aetna,333.72,,,,,,,per diem,333.72,333.72,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Aetna MGG,Aetna MGG,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,BCBS,BCBS,333.72,,,,,,,per diem,333.72,333.72,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,BCBS MGG,BCBS MGG,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Cigna,Cigna,333.72,,,,,,,per diem,333.72,333.72,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Cigna MGG,Cigna MGG,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Humana,Humana,333.72,,,,,,,per diem,333.72,333.72,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Humana MGG,Humana MGG,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Optum VA,Optum VA,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,UHC,UHC,333.72,,,,,,,per diem,333.72,333.72,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,UHC MGG,UHC MGG,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,VA,VA,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Wellcare MGG,Wellcare MGG,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Bright Health - commercial,Bright Health - commercial,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,333.72,333.72,Bright Health MGG,Bright Health MGG,333.72,,,,,,,case rate,333.72,333.72,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Aetna,Aetna,138.02,,,,,,,per diem,138.02,138.02,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Aetna MGG,Aetna MGG,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,BCBS,BCBS,138.02,,,,,,,per diem,138.02,138.02,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,BCBS MGG,BCBS MGG,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Cigna,Cigna,138.02,,,,,,,per diem,138.02,138.02,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Cigna MGG,Cigna MGG,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Humana,Humana,138.02,,,,,,,per diem,138.02,138.02,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Humana MGG,Humana MGG,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Optum VA,Optum VA,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,UHC,UHC,138.02,,,,,,,per diem,138.02,138.02,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,UHC MGG,UHC MGG,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,VA,VA,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Wellcare MGG,Wellcare MGG,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Bright Health - commercial,Bright Health - commercial,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,138.02,138.02,Bright Health MGG,Bright Health MGG,138.02,,,,,,,case rate,138.02,138.02,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Aetna,Aetna,209,,,,,,,per diem,209,209,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Aetna MGG,Aetna MGG,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,BCBS,BCBS,209,,,,,,,per diem,209,209,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,BCBS MGG,BCBS MGG,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Cigna,Cigna,209,,,,,,,per diem,209,209,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Cigna MGG,Cigna MGG,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Humana,Humana,209,,,,,,,per diem,209,209,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Humana MGG,Humana MGG,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Optum VA,Optum VA,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,UHC,UHC,209,,,,,,,per diem,209,209,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,UHC MGG,UHC MGG,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,VA,VA,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Wellcare MGG,Wellcare MGG,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Bright Health - commercial,Bright Health - commercial,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,209,209,Bright Health MGG,Bright Health MGG,209,,,,,,,case rate,209,209,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Aetna,Aetna,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Aetna MGG,Aetna MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,BCBS,BCBS,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,BCBS MGG,BCBS MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Cigna,Cigna,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Cigna MGG,Cigna MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Humana,Humana,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Humana MGG,Humana MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Optum VA,Optum VA,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,UHC,UHC,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,UHC MGG,UHC MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,VA,VA,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Wellcare MGG,Wellcare MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Bright Health - commercial,Bright Health - commercial,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,160,160,Bright Health MGG,Bright Health MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Aetna,Aetna,91,,,,,,,per diem,91,91,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Aetna MGG,Aetna MGG,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,BCBS,BCBS,91,,,,,,,per diem,91,91,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,BCBS MGG,BCBS MGG,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Cigna,Cigna,91,,,,,,,per diem,91,91,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Cigna MGG,Cigna MGG,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Humana,Humana,91,,,,,,,per diem,91,91,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Humana MGG,Humana MGG,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Optum VA,Optum VA,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,UHC,UHC,91,,,,,,,per diem,91,91,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,UHC MGG,UHC MGG,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,VA,VA,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Wellcare MGG,Wellcare MGG,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Bright Health - commercial,Bright Health - commercial,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,91,91,Bright Health MGG,Bright Health MGG,91,,,,,,,case rate,91,91,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Aetna,Aetna,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Aetna MGG,Aetna MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,BCBS,BCBS,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,BCBS MGG,BCBS MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Cigna,Cigna,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Cigna MGG,Cigna MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Humana,Humana,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Humana MGG,Humana MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Optum VA,Optum VA,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,UHC,UHC,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,UHC MGG,UHC MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,VA,VA,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Wellcare MGG,Wellcare MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Bright Health - commercial,Bright Health - commercial,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,112,112,Bright Health MGG,Bright Health MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Aetna,Aetna,54.18,,,,,,,per diem,54.18,54.18,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Aetna MGG,Aetna MGG,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,BCBS,BCBS,54.18,,,,,,,per diem,54.18,54.18,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,BCBS MGG,BCBS MGG,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Cigna,Cigna,54.18,,,,,,,per diem,54.18,54.18,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Cigna MGG,Cigna MGG,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Humana,Humana,54.18,,,,,,,per diem,54.18,54.18,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Humana MGG,Humana MGG,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Optum VA,Optum VA,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,UHC,UHC,54.18,,,,,,,per diem,54.18,54.18,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,UHC MGG,UHC MGG,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,VA,VA,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Wellcare MGG,Wellcare MGG,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Bright Health - commercial,Bright Health - commercial,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,54.18,54.18,Bright Health MGG,Bright Health MGG,54.18,,,,,,,case rate,54.18,54.18,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Aetna,Aetna,144.4,,,,,,,per diem,144.4,144.4,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Aetna MGG,Aetna MGG,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,BCBS,BCBS,144.4,,,,,,,per diem,144.4,144.4,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,BCBS MGG,BCBS MGG,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Cigna,Cigna,144.4,,,,,,,per diem,144.4,144.4,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Cigna MGG,Cigna MGG,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Humana,Humana,144.4,,,,,,,per diem,144.4,144.4,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Humana MGG,Humana MGG,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Optum VA,Optum VA,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,UHC,UHC,144.4,,,,,,,per diem,144.4,144.4,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,UHC MGG,UHC MGG,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,VA,VA,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Wellcare MGG,Wellcare MGG,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Bright Health - commercial,Bright Health - commercial,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,144.4,144.4,Bright Health MGG,Bright Health MGG,144.4,,,,,,,case rate,144.4,144.4,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Aetna,Aetna,301.5,,,,,,,per diem,301.5,301.5,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Aetna MGG,Aetna MGG,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,BCBS,BCBS,301.5,,,,,,,per diem,301.5,301.5,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,BCBS MGG,BCBS MGG,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Cigna,Cigna,301.5,,,,,,,per diem,301.5,301.5,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Cigna MGG,Cigna MGG,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Humana,Humana,301.5,,,,,,,per diem,301.5,301.5,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Humana MGG,Humana MGG,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Optum VA,Optum VA,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,UHC,UHC,301.5,,,,,,,per diem,301.5,301.5,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,UHC MGG,UHC MGG,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,VA,VA,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Wellcare MGG,Wellcare MGG,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Bright Health - commercial,Bright Health - commercial,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,301.5,301.5,Bright Health MGG,Bright Health MGG,301.5,,,,,,,case rate,301.5,301.5,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Aetna,Aetna,502,,,,,,,per diem,502,502,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Aetna MGG,Aetna MGG,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,BCBS,BCBS,502,,,,,,,per diem,502,502,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,BCBS MGG,BCBS MGG,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Cigna,Cigna,502,,,,,,,per diem,502,502,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Cigna MGG,Cigna MGG,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Humana,Humana,502,,,,,,,per diem,502,502,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Humana MGG,Humana MGG,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Optum VA,Optum VA,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,UHC,UHC,502,,,,,,,per diem,502,502,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,UHC MGG,UHC MGG,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,VA,VA,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Wellcare MGG,Wellcare MGG,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Bright Health - commercial,Bright Health - commercial,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,502,502,Bright Health MGG,Bright Health MGG,502,,,,,,,case rate,502,502,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Aetna,Aetna,69.5,,,,,,,per diem,69.5,69.5,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Aetna MGG,Aetna MGG,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,BCBS,BCBS,69.5,,,,,,,per diem,69.5,69.5,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,BCBS MGG,BCBS MGG,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Cigna,Cigna,69.5,,,,,,,per diem,69.5,69.5,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Cigna MGG,Cigna MGG,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Humana,Humana,69.5,,,,,,,per diem,69.5,69.5,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Humana MGG,Humana MGG,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Optum VA,Optum VA,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,UHC,UHC,69.5,,,,,,,per diem,69.5,69.5,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,UHC MGG,UHC MGG,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,VA,VA,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Wellcare MGG,Wellcare MGG,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Bright Health - commercial,Bright Health - commercial,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,69.5,69.5,Bright Health MGG,Bright Health MGG,69.5,,,,,,,case rate,69.5,69.5,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Aetna,Aetna,417.14,,,,,,,per diem,417.14,417.14,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Aetna MGG,Aetna MGG,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,BCBS,BCBS,417.14,,,,,,,per diem,417.14,417.14,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,BCBS MGG,BCBS MGG,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Cigna,Cigna,417.14,,,,,,,per diem,417.14,417.14,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Cigna MGG,Cigna MGG,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Humana,Humana,417.14,,,,,,,per diem,417.14,417.14,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Humana MGG,Humana MGG,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Optum VA,Optum VA,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,UHC,UHC,417.14,,,,,,,per diem,417.14,417.14,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,UHC MGG,UHC MGG,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,VA,VA,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Wellcare MGG,Wellcare MGG,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Bright Health - commercial,Bright Health - commercial,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,417.14,417.14,Bright Health MGG,Bright Health MGG,417.14,,,,,,,case rate,417.14,417.14,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Aetna,Aetna,25.54,,,,,,,per diem,25.54,25.54,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Aetna MGG,Aetna MGG,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,BCBS,BCBS,25.54,,,,,,,per diem,25.54,25.54,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,BCBS MGG,BCBS MGG,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Cigna,Cigna,25.54,,,,,,,per diem,25.54,25.54,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Cigna MGG,Cigna MGG,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Humana,Humana,25.54,,,,,,,per diem,25.54,25.54,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Humana MGG,Humana MGG,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Optum VA,Optum VA,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,UHC,UHC,25.54,,,,,,,per diem,25.54,25.54,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,UHC MGG,UHC MGG,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,VA,VA,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Wellcare MGG,Wellcare MGG,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Bright Health - commercial,Bright Health - commercial,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,25.54,25.54,Bright Health MGG,Bright Health MGG,25.54,,,,,,,case rate,25.54,25.54,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Aetna,Aetna,430.24,,,,,,,per diem,430.24,430.24,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Aetna MGG,Aetna MGG,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,BCBS,BCBS,430.24,,,,,,,per diem,430.24,430.24,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,BCBS MGG,BCBS MGG,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Cigna,Cigna,430.24,,,,,,,per diem,430.24,430.24,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Cigna MGG,Cigna MGG,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Humana,Humana,430.24,,,,,,,per diem,430.24,430.24,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Humana MGG,Humana MGG,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Optum VA,Optum VA,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,UHC,UHC,430.24,,,,,,,per diem,430.24,430.24,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,UHC MGG,UHC MGG,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,VA,VA,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Wellcare MGG,Wellcare MGG,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Bright Health - commercial,Bright Health - commercial,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,430.24,430.24,Bright Health MGG,Bright Health MGG,430.24,,,,,,,case rate,430.24,430.24,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Aetna,Aetna,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Aetna MGG,Aetna MGG,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,BCBS,BCBS,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,BCBS MGG,BCBS MGG,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Cigna,Cigna,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Cigna MGG,Cigna MGG,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Humana,Humana,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Humana MGG,Humana MGG,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Optum VA,Optum VA,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,UHC,UHC,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,UHC MGG,UHC MGG,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,VA,VA,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Wellcare MGG,Wellcare MGG,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Bright Health - commercial,Bright Health - commercial,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,146,146,Bright Health MGG,Bright Health MGG,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Aetna,Aetna,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Aetna MGG,Aetna MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,BCBS,BCBS,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,BCBS MGG,BCBS MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Cigna,Cigna,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Cigna MGG,Cigna MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Humana,Humana,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Humana MGG,Humana MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Optum VA,Optum VA,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,UHC,UHC,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,UHC MGG,UHC MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,VA,VA,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Wellcare MGG,Wellcare MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Bright Health - commercial,Bright Health - commercial,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,189,189,Bright Health MGG,Bright Health MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Aetna,Aetna,121,,,,,,,per diem,121,121,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Aetna MGG,Aetna MGG,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,BCBS,BCBS,121,,,,,,,per diem,121,121,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,BCBS MGG,BCBS MGG,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Cigna,Cigna,121,,,,,,,per diem,121,121,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Cigna MGG,Cigna MGG,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Humana,Humana,121,,,,,,,per diem,121,121,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Humana MGG,Humana MGG,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Optum VA,Optum VA,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,UHC,UHC,121,,,,,,,per diem,121,121,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,UHC MGG,UHC MGG,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,VA,VA,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Wellcare MGG,Wellcare MGG,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Bright Health - commercial,Bright Health - commercial,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,121,121,Bright Health MGG,Bright Health MGG,121,,,,,,,case rate,121,121,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Aetna,Aetna,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Aetna MGG,Aetna MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,BCBS,BCBS,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,BCBS MGG,BCBS MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Cigna,Cigna,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Cigna MGG,Cigna MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Humana,Humana,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Humana MGG,Humana MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Optum VA,Optum VA,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,UHC,UHC,73,,,,,,,per diem,73,73,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,UHC MGG,UHC MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,VA,VA,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Wellcare MGG,Wellcare MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Bright Health - commercial,Bright Health - commercial,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,73,73,Bright Health MGG,Bright Health MGG,73,,,,,,,case rate,73,73,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Aetna,Aetna,98,,,,,,,per diem,98,98,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Aetna MGG,Aetna MGG,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,BCBS,BCBS,98,,,,,,,per diem,98,98,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,BCBS MGG,BCBS MGG,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Cigna,Cigna,98,,,,,,,per diem,98,98,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Cigna MGG,Cigna MGG,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Humana,Humana,98,,,,,,,per diem,98,98,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Humana MGG,Humana MGG,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Optum VA,Optum VA,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,UHC,UHC,98,,,,,,,per diem,98,98,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,UHC MGG,UHC MGG,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,VA,VA,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Wellcare MGG,Wellcare MGG,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Bright Health - commercial,Bright Health - commercial,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,98,98,Bright Health MGG,Bright Health MGG,98,,,,,,,case rate,98,98,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Aetna,Aetna,82,,,,,,,per diem,82,82,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Aetna MGG,Aetna MGG,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,BCBS,BCBS,82,,,,,,,per diem,82,82,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,BCBS MGG,BCBS MGG,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Cigna,Cigna,82,,,,,,,per diem,82,82,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Cigna MGG,Cigna MGG,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Humana,Humana,82,,,,,,,per diem,82,82,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Humana MGG,Humana MGG,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Optum VA,Optum VA,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,UHC,UHC,82,,,,,,,per diem,82,82,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,UHC MGG,UHC MGG,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,VA,VA,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Wellcare MGG,Wellcare MGG,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Bright Health - commercial,Bright Health - commercial,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,82,82,Bright Health MGG,Bright Health MGG,82,,,,,,,case rate,82,82,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Aetna,Aetna,87,,,,,,,per diem,87,87,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Aetna MGG,Aetna MGG,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,BCBS,BCBS,87,,,,,,,per diem,87,87,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,BCBS MGG,BCBS MGG,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Cigna,Cigna,87,,,,,,,per diem,87,87,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Cigna MGG,Cigna MGG,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Humana,Humana,87,,,,,,,per diem,87,87,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Humana MGG,Humana MGG,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Optum VA,Optum VA,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,UHC,UHC,87,,,,,,,per diem,87,87,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,UHC MGG,UHC MGG,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,VA,VA,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Wellcare MGG,Wellcare MGG,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Bright Health - commercial,Bright Health - commercial,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,87,87,Bright Health MGG,Bright Health MGG,87,,,,,,,case rate,87,87,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Aetna,Aetna,159.5,,,,,,,per diem,159.5,159.5,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Aetna MGG,Aetna MGG,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,BCBS,BCBS,159.5,,,,,,,per diem,159.5,159.5,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,BCBS MGG,BCBS MGG,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Cigna,Cigna,159.5,,,,,,,per diem,159.5,159.5,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Cigna MGG,Cigna MGG,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Humana,Humana,159.5,,,,,,,per diem,159.5,159.5,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Humana MGG,Humana MGG,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Optum VA,Optum VA,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,UHC,UHC,159.5,,,,,,,per diem,159.5,159.5,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,UHC MGG,UHC MGG,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,VA,VA,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Wellcare MGG,Wellcare MGG,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Bright Health - commercial,Bright Health - commercial,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,159.5,159.5,Bright Health MGG,Bright Health MGG,159.5,,,,,,,case rate,159.5,159.5,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Aetna,Aetna,63.45,,,,,,,per diem,63.45,63.45,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Aetna MGG,Aetna MGG,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,BCBS,BCBS,63.45,,,,,,,per diem,63.45,63.45,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,BCBS MGG,BCBS MGG,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Cigna,Cigna,63.45,,,,,,,per diem,63.45,63.45,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Cigna MGG,Cigna MGG,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Humana,Humana,63.45,,,,,,,per diem,63.45,63.45,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Humana MGG,Humana MGG,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Optum VA,Optum VA,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,UHC,UHC,63.45,,,,,,,per diem,63.45,63.45,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,UHC MGG,UHC MGG,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,VA,VA,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Wellcare MGG,Wellcare MGG,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Bright Health - commercial,Bright Health - commercial,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,63.45,63.45,Bright Health MGG,Bright Health MGG,63.45,,,,,,,case rate,63.45,63.45,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Aetna,Aetna,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Aetna MGG,Aetna MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,BCBS,BCBS,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,BCBS MGG,BCBS MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Cigna,Cigna,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Cigna MGG,Cigna MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Humana,Humana,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Humana MGG,Humana MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Optum VA,Optum VA,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,UHC,UHC,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,UHC MGG,UHC MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,VA,VA,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Wellcare MGG,Wellcare MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Bright Health - commercial,Bright Health - commercial,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,50.55,50.55,Bright Health MGG,Bright Health MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Aetna,Aetna,92.83,,,,,,,per diem,92.83,92.83,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Aetna MGG,Aetna MGG,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,BCBS,BCBS,92.83,,,,,,,per diem,92.83,92.83,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,BCBS MGG,BCBS MGG,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Cigna,Cigna,92.83,,,,,,,per diem,92.83,92.83,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Cigna MGG,Cigna MGG,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Humana,Humana,92.83,,,,,,,per diem,92.83,92.83,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Humana MGG,Humana MGG,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Optum VA,Optum VA,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,UHC,UHC,92.83,,,,,,,per diem,92.83,92.83,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,UHC MGG,UHC MGG,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,VA,VA,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Wellcare MGG,Wellcare MGG,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Bright Health - commercial,Bright Health - commercial,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,92.83,92.83,Bright Health MGG,Bright Health MGG,92.83,,,,,,,case rate,92.83,92.83,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Aetna,Aetna,149.01,,,,,,,per diem,149.01,149.01,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Aetna MGG,Aetna MGG,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,BCBS,BCBS,149.01,,,,,,,per diem,149.01,149.01,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,BCBS MGG,BCBS MGG,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Cigna,Cigna,149.01,,,,,,,per diem,149.01,149.01,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Cigna MGG,Cigna MGG,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Humana,Humana,149.01,,,,,,,per diem,149.01,149.01,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Humana MGG,Humana MGG,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Optum VA,Optum VA,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,UHC,UHC,149.01,,,,,,,per diem,149.01,149.01,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,UHC MGG,UHC MGG,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,VA,VA,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Wellcare MGG,Wellcare MGG,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Bright Health - commercial,Bright Health - commercial,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,149.01,149.01,Bright Health MGG,Bright Health MGG,149.01,,,,,,,case rate,149.01,149.01,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Aetna,Aetna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Aetna MGG,Aetna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,BCBS,BCBS,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,BCBS MGG,BCBS MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Cigna,Cigna,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Cigna MGG,Cigna MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Humana,Humana,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Humana MGG,Humana MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Optum VA,Optum VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,UHC,UHC,88,,,,,,,per diem,88,88,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,UHC MGG,UHC MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,VA,VA,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Wellcare MGG,Wellcare MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Bright Health - commercial,Bright Health - commercial,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,88,88,Bright Health MGG,Bright Health MGG,88,,,,,,,case rate,88,88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Aetna,Aetna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Aetna MGG,Aetna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,BCBS,BCBS,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,BCBS MGG,BCBS MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Cigna,Cigna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Cigna MGG,Cigna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Humana,Humana,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Humana MGG,Humana MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Optum VA,Optum VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,UHC,UHC,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,UHC MGG,UHC MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,VA,VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Wellcare MGG,Wellcare MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Bright Health - commercial,Bright Health - commercial,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,70,70,Bright Health MGG,Bright Health MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Aetna,Aetna,1543.65,,,,,,,per diem,1543.65,1543.65,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Aetna MGG,Aetna MGG,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,BCBS,BCBS,1543.65,,,,,,,per diem,1543.65,1543.65,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,BCBS MGG,BCBS MGG,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Cigna,Cigna,1543.65,,,,,,,per diem,1543.65,1543.65,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Cigna MGG,Cigna MGG,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Humana,Humana,1543.65,,,,,,,per diem,1543.65,1543.65,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Humana MGG,Humana MGG,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Optum VA,Optum VA,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,UHC,UHC,1543.65,,,,,,,per diem,1543.65,1543.65,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,UHC MGG,UHC MGG,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,VA,VA,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Wellcare MGG,Wellcare MGG,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Bright Health - commercial,Bright Health - commercial,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1543.65,1543.65,Bright Health MGG,Bright Health MGG,1543.65,,,,,,,case rate,1543.65,1543.65,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Aetna,Aetna,226,,,,,,,per diem,226,226,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Aetna MGG,Aetna MGG,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,BCBS,BCBS,226,,,,,,,per diem,226,226,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,BCBS MGG,BCBS MGG,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Cigna,Cigna,226,,,,,,,per diem,226,226,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Cigna MGG,Cigna MGG,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Humana,Humana,226,,,,,,,per diem,226,226,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Humana MGG,Humana MGG,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Optum VA,Optum VA,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,UHC,UHC,226,,,,,,,per diem,226,226,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,UHC MGG,UHC MGG,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,VA,VA,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Wellcare MGG,Wellcare MGG,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Bright Health - commercial,Bright Health - commercial,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,226,226,Bright Health MGG,Bright Health MGG,226,,,,,,,case rate,226,226,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Aetna,Aetna,179.57,,,,,,,per diem,179.57,179.57,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Aetna MGG,Aetna MGG,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,BCBS,BCBS,179.57,,,,,,,per diem,179.57,179.57,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,BCBS MGG,BCBS MGG,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Cigna,Cigna,179.57,,,,,,,per diem,179.57,179.57,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Cigna MGG,Cigna MGG,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Humana,Humana,179.57,,,,,,,per diem,179.57,179.57,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Humana MGG,Humana MGG,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Optum VA,Optum VA,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,UHC,UHC,179.57,,,,,,,per diem,179.57,179.57,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,UHC MGG,UHC MGG,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,VA,VA,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Wellcare MGG,Wellcare MGG,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Bright Health - commercial,Bright Health - commercial,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,179.57,179.57,Bright Health MGG,Bright Health MGG,179.57,,,,,,,case rate,179.57,179.57,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Aetna,Aetna,163.25,,,,,,,per diem,163.25,163.25,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Aetna MGG,Aetna MGG,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,BCBS,BCBS,163.25,,,,,,,per diem,163.25,163.25,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,BCBS MGG,BCBS MGG,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Cigna,Cigna,163.25,,,,,,,per diem,163.25,163.25,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Cigna MGG,Cigna MGG,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Humana,Humana,163.25,,,,,,,per diem,163.25,163.25,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Humana MGG,Humana MGG,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Optum VA,Optum VA,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,UHC,UHC,163.25,,,,,,,per diem,163.25,163.25,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,UHC MGG,UHC MGG,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,VA,VA,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Wellcare MGG,Wellcare MGG,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Bright Health - commercial,Bright Health - commercial,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,163.25,163.25,Bright Health MGG,Bright Health MGG,163.25,,,,,,,case rate,163.25,163.25,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Aetna,Aetna,21.21,,,,,,,per diem,21.21,21.21,"Per diem rate, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Aetna MGG,Aetna MGG,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,BCBS,BCBS,21.21,,,,,,,per diem,21.21,21.21,"Per diem rate, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,BCBS MGG,BCBS MGG,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Cigna,Cigna,21.21,,,,,,,per diem,21.21,21.21,"Per diem rate, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Cigna MGG,Cigna MGG,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Humana,Humana,21.21,,,,,,,per diem,21.21,21.21,"Per diem rate, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Humana MGG,Humana MGG,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Optum VA,Optum VA,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,UHC,UHC,21.21,,,,,,,per diem,21.21,21.21,"Per diem rate, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,UHC MGG,UHC MGG,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,VA,VA,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Wellcare MGG,Wellcare MGG,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Bright Health - commercial,Bright Health - commercial,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
COLLECT BLOOD FROM VEN ACC    ,38251677,CDM,300,RC,36591,CPT,,,,Inpatient,,,21.21,21.21,Bright Health MGG,Bright Health MGG,21.21,,,,,,,case rate,21.21,21.21,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Aetna,Aetna,181.56,,,,,,,per diem,181.56,181.56,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Aetna MGG,Aetna MGG,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,BCBS,BCBS,181.56,,,,,,,per diem,181.56,181.56,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,BCBS MGG,BCBS MGG,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Cigna,Cigna,181.56,,,,,,,per diem,181.56,181.56,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Cigna MGG,Cigna MGG,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Humana,Humana,181.56,,,,,,,per diem,181.56,181.56,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Humana MGG,Humana MGG,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Optum VA,Optum VA,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,UHC,UHC,181.56,,,,,,,per diem,181.56,181.56,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,UHC MGG,UHC MGG,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,VA,VA,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Wellcare MGG,Wellcare MGG,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Bright Health - commercial,Bright Health - commercial,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,181.56,181.56,Bright Health MGG,Bright Health MGG,181.56,,,,,,,case rate,181.56,181.56,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Aetna,Aetna,52.01,,,,,,,per diem,52.01,52.01,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Aetna MGG,Aetna MGG,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,BCBS,BCBS,52.01,,,,,,,per diem,52.01,52.01,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,BCBS MGG,BCBS MGG,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Cigna,Cigna,52.01,,,,,,,per diem,52.01,52.01,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Cigna MGG,Cigna MGG,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Humana,Humana,52.01,,,,,,,per diem,52.01,52.01,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Humana MGG,Humana MGG,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Optum VA,Optum VA,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,UHC,UHC,52.01,,,,,,,per diem,52.01,52.01,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,UHC MGG,UHC MGG,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,VA,VA,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Wellcare MGG,Wellcare MGG,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Bright Health - commercial,Bright Health - commercial,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,52.01,52.01,Bright Health MGG,Bright Health MGG,52.01,,,,,,,case rate,52.01,52.01,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Aetna,Aetna,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Aetna MGG,Aetna MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,BCBS,BCBS,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,BCBS MGG,BCBS MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Cigna,Cigna,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Cigna MGG,Cigna MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Humana,Humana,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Humana MGG,Humana MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Optum VA,Optum VA,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,UHC,UHC,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,UHC MGG,UHC MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,VA,VA,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Wellcare MGG,Wellcare MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Bright Health - commercial,Bright Health - commercial,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,51.92,51.92,Bright Health MGG,Bright Health MGG,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Aetna,Aetna,131.26,,,,,,,per diem,131.26,131.26,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Aetna MGG,Aetna MGG,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,BCBS,BCBS,131.26,,,,,,,per diem,131.26,131.26,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,BCBS MGG,BCBS MGG,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Cigna,Cigna,131.26,,,,,,,per diem,131.26,131.26,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Cigna MGG,Cigna MGG,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Humana,Humana,131.26,,,,,,,per diem,131.26,131.26,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Humana MGG,Humana MGG,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Optum VA,Optum VA,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,UHC,UHC,131.26,,,,,,,per diem,131.26,131.26,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,UHC MGG,UHC MGG,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,VA,VA,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Wellcare MGG,Wellcare MGG,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Bright Health - commercial,Bright Health - commercial,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,131.26,131.26,Bright Health MGG,Bright Health MGG,131.26,,,,,,,case rate,131.26,131.26,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Aetna,Aetna,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Aetna MGG,Aetna MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,BCBS,BCBS,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,BCBS MGG,BCBS MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Cigna,Cigna,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Cigna MGG,Cigna MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Humana,Humana,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Humana MGG,Humana MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Optum VA,Optum VA,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,UHC,UHC,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,UHC MGG,UHC MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,VA,VA,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Wellcare MGG,Wellcare MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Bright Health - commercial,Bright Health - commercial,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
HEMOGLOBIN/1                  ,38251702,CDM,300,RC,83037,CPT,,,,Inpatient,,,25.14,25.14,Bright Health MGG,Bright Health MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Aetna,Aetna,214.09,,,,,,,per diem,214.09,214.09,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Aetna MGG,Aetna MGG,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,BCBS,BCBS,214.09,,,,,,,per diem,214.09,214.09,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,BCBS MGG,BCBS MGG,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Cigna,Cigna,214.09,,,,,,,per diem,214.09,214.09,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Cigna MGG,Cigna MGG,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Humana,Humana,214.09,,,,,,,per diem,214.09,214.09,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Humana MGG,Humana MGG,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Optum VA,Optum VA,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,UHC,UHC,214.09,,,,,,,per diem,214.09,214.09,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,UHC MGG,UHC MGG,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,VA,VA,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Wellcare MGG,Wellcare MGG,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Bright Health - commercial,Bright Health - commercial,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,214.09,214.09,Bright Health MGG,Bright Health MGG,214.09,,,,,,,case rate,214.09,214.09,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Aetna,Aetna,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Aetna MGG,Aetna MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,BCBS,BCBS,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,BCBS MGG,BCBS MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Cigna,Cigna,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Cigna MGG,Cigna MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Humana,Humana,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Humana MGG,Humana MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Optum VA,Optum VA,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,UHC,UHC,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,UHC MGG,UHC MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,VA,VA,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Wellcare MGG,Wellcare MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Bright Health - commercial,Bright Health - commercial,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,25.92,25.92,Bright Health MGG,Bright Health MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Aetna,Aetna,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Aetna MGG,Aetna MGG,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,BCBS,BCBS,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,BCBS MGG,BCBS MGG,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Cigna,Cigna,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Cigna MGG,Cigna MGG,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Humana,Humana,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Humana MGG,Humana MGG,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Optum VA,Optum VA,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,UHC,UHC,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,UHC MGG,UHC MGG,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,VA,VA,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Wellcare MGG,Wellcare MGG,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Bright Health - commercial,Bright Health - commercial,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,30.33,30.33,Bright Health MGG,Bright Health MGG,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Aetna,Aetna,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Aetna MGG,Aetna MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,BCBS,BCBS,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,BCBS MGG,BCBS MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Cigna,Cigna,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Cigna MGG,Cigna MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Humana,Humana,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Humana MGG,Humana MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Optum VA,Optum VA,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,UHC,UHC,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,UHC MGG,UHC MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,VA,VA,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Wellcare MGG,Wellcare MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Bright Health - commercial,Bright Health - commercial,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.15,12.15,Bright Health MGG,Bright Health MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Aetna,Aetna,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Aetna MGG,Aetna MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,BCBS,BCBS,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,BCBS MGG,BCBS MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Cigna,Cigna,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Cigna MGG,Cigna MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Humana,Humana,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Humana MGG,Humana MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Optum VA,Optum VA,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,UHC,UHC,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,UHC MGG,UHC MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,VA,VA,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Wellcare MGG,Wellcare MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Bright Health - commercial,Bright Health - commercial,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,96,96,Bright Health MGG,Bright Health MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Aetna,Aetna,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Aetna MGG,Aetna MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,BCBS,BCBS,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,BCBS MGG,BCBS MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Cigna,Cigna,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Cigna MGG,Cigna MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Humana,Humana,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Humana MGG,Humana MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Optum VA,Optum VA,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,UHC,UHC,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,UHC MGG,UHC MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,VA,VA,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Wellcare MGG,Wellcare MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Bright Health - commercial,Bright Health - commercial,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,145,145,Bright Health MGG,Bright Health MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Aetna,Aetna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Aetna MGG,Aetna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,BCBS,BCBS,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,BCBS MGG,BCBS MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Cigna,Cigna,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Cigna MGG,Cigna MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Humana,Humana,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Humana MGG,Humana MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Optum VA,Optum VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,UHC,UHC,152,,,,,,,per diem,152,152,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,UHC MGG,UHC MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,VA,VA,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Wellcare MGG,Wellcare MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Bright Health - commercial,Bright Health - commercial,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,152,152,Bright Health MGG,Bright Health MGG,152,,,,,,,case rate,152,152,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Aetna,Aetna,95,,,,,,,per diem,95,95,"Per diem rate, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Aetna MGG,Aetna MGG,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,BCBS,BCBS,95,,,,,,,per diem,95,95,"Per diem rate, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,BCBS MGG,BCBS MGG,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Cigna,Cigna,95,,,,,,,per diem,95,95,"Per diem rate, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Cigna MGG,Cigna MGG,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Humana,Humana,95,,,,,,,per diem,95,95,"Per diem rate, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Humana MGG,Humana MGG,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Optum VA,Optum VA,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,UHC,UHC,95,,,,,,,per diem,95,95,"Per diem rate, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,UHC MGG,UHC MGG,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,VA,VA,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Wellcare MGG,Wellcare MGG,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Bright Health - commercial,Bright Health - commercial,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RABIES ANTIBODY               ,38251711,CDM,302,RC,86382,CPT,,,,Inpatient,,,95,95,Bright Health MGG,Bright Health MGG,95,,,,,,,case rate,95,95,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Aetna,Aetna,16.99,,,,,,,per diem,16.99,16.99,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Aetna MGG,Aetna MGG,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,BCBS,BCBS,16.99,,,,,,,per diem,16.99,16.99,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,BCBS MGG,BCBS MGG,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Cigna,Cigna,16.99,,,,,,,per diem,16.99,16.99,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Cigna MGG,Cigna MGG,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Humana,Humana,16.99,,,,,,,per diem,16.99,16.99,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Humana MGG,Humana MGG,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Optum VA,Optum VA,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,UHC,UHC,16.99,,,,,,,per diem,16.99,16.99,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,UHC MGG,UHC MGG,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,VA,VA,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Wellcare MGG,Wellcare MGG,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Bright Health - commercial,Bright Health - commercial,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,16.99,16.99,Bright Health MGG,Bright Health MGG,16.99,,,,,,,case rate,16.99,16.99,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Aetna,Aetna,444.72,,,,,,,per diem,444.72,444.72,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Aetna MGG,Aetna MGG,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,BCBS,BCBS,444.72,,,,,,,per diem,444.72,444.72,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,BCBS MGG,BCBS MGG,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Cigna,Cigna,444.72,,,,,,,per diem,444.72,444.72,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Cigna MGG,Cigna MGG,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Humana,Humana,444.72,,,,,,,per diem,444.72,444.72,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Humana MGG,Humana MGG,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Optum VA,Optum VA,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,UHC,UHC,444.72,,,,,,,per diem,444.72,444.72,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,UHC MGG,UHC MGG,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,VA,VA,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Wellcare MGG,Wellcare MGG,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Bright Health - commercial,Bright Health - commercial,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,444.72,444.72,Bright Health MGG,Bright Health MGG,444.72,,,,,,,case rate,444.72,444.72,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Aetna,Aetna,1536.08,,,,,,,per diem,1536.08,1536.08,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Aetna MGG,Aetna MGG,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,BCBS,BCBS,1536.08,,,,,,,per diem,1536.08,1536.08,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,BCBS MGG,BCBS MGG,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Cigna,Cigna,1536.08,,,,,,,per diem,1536.08,1536.08,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Cigna MGG,Cigna MGG,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Humana,Humana,1536.08,,,,,,,per diem,1536.08,1536.08,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Humana MGG,Humana MGG,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Optum VA,Optum VA,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,UHC,UHC,1536.08,,,,,,,per diem,1536.08,1536.08,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,UHC MGG,UHC MGG,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,VA,VA,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Wellcare MGG,Wellcare MGG,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Bright Health - commercial,Bright Health - commercial,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1536.08,1536.08,Bright Health MGG,Bright Health MGG,1536.08,,,,,,,case rate,1536.08,1536.08,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Aetna,Aetna,276.26,,,,,,,per diem,276.26,276.26,"Per diem rate, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Aetna MGG,Aetna MGG,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,BCBS,BCBS,276.26,,,,,,,per diem,276.26,276.26,"Per diem rate, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,BCBS MGG,BCBS MGG,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Cigna,Cigna,276.26,,,,,,,per diem,276.26,276.26,"Per diem rate, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Cigna MGG,Cigna MGG,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Humana,Humana,276.26,,,,,,,per diem,276.26,276.26,"Per diem rate, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Humana MGG,Humana MGG,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Optum VA,Optum VA,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,UHC,UHC,276.26,,,,,,,per diem,276.26,276.26,"Per diem rate, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,UHC MGG,UHC MGG,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,VA,VA,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Wellcare MGG,Wellcare MGG,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Bright Health - commercial,Bright Health - commercial,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU RSV & COVID-19 RNA        ,38251722,CDM,306,RC,87637,CPT,0241U,HCPCS,,Inpatient,,,276.26,276.26,Bright Health MGG,Bright Health MGG,276.26,,,,,,,case rate,276.26,276.26,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Aetna,Aetna,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Aetna MGG,Aetna MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,BCBS,BCBS,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,BCBS MGG,BCBS MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Cigna,Cigna,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Cigna MGG,Cigna MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Humana,Humana,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Humana MGG,Humana MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Optum VA,Optum VA,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,UHC,UHC,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,UHC MGG,UHC MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,VA,VA,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Wellcare MGG,Wellcare MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Bright Health - commercial,Bright Health - commercial,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FLU A&B COVID-19 AMP PROBE    ,38251726,CDM,306,RC,87636,CPT,,,,Inpatient,,,136.71,136.71,Bright Health MGG,Bright Health MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Aetna,Aetna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Aetna MGG,Aetna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,BCBS,BCBS,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,BCBS MGG,BCBS MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Cigna,Cigna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Cigna MGG,Cigna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Humana,Humana,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Humana MGG,Humana MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Optum VA,Optum VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,UHC,UHC,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,UHC MGG,UHC MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,VA,VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Wellcare MGG,Wellcare MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Bright Health - commercial,Bright Health - commercial,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AUTOMATED DIFF SO             ,38251738,CDM,301,RC,85004,CPT,,,,Inpatient,,,19.5,19.5,Bright Health MGG,Bright Health MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Aetna,Aetna,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Aetna MGG,Aetna MGG,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,BCBS,BCBS,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,BCBS MGG,BCBS MGG,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Cigna,Cigna,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Cigna MGG,Cigna MGG,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Humana,Humana,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Humana MGG,Humana MGG,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Optum VA,Optum VA,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,UHC,UHC,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,UHC MGG,UHC MGG,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,VA,VA,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Wellcare MGG,Wellcare MGG,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Bright Health - commercial,Bright Health - commercial,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SARS COV CORONAVIR AG IA      ,38251739,CDM,300,RC,87426,CPT,,,,Inpatient,,,105.99,105.99,Bright Health MGG,Bright Health MGG,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Aetna,Aetna,125.95,,,,,,,per diem,125.95,125.95,"Per diem rate, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Aetna MGG,Aetna MGG,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,BCBS,BCBS,125.95,,,,,,,per diem,125.95,125.95,"Per diem rate, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,BCBS MGG,BCBS MGG,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Cigna,Cigna,125.95,,,,,,,per diem,125.95,125.95,"Per diem rate, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Cigna MGG,Cigna MGG,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Humana,Humana,125.95,,,,,,,per diem,125.95,125.95,"Per diem rate, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Humana MGG,Humana MGG,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Optum VA,Optum VA,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,UHC,UHC,125.95,,,,,,,per diem,125.95,125.95,"Per diem rate, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,UHC MGG,UHC MGG,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,VA,VA,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Wellcare MGG,Wellcare MGG,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Bright Health - commercial,Bright Health - commercial,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
HEPATITIS B SURF ANTI SO      ,38251740,CDM,302,RC,86076,CPT,,,,Inpatient,,,125.95,125.95,Bright Health MGG,Bright Health MGG,125.95,,,,,,,case rate,125.95,125.95,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Aetna,Aetna,176.9,,,,,,,per diem,176.9,176.9,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Aetna MGG,Aetna MGG,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,BCBS,BCBS,176.9,,,,,,,per diem,176.9,176.9,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,BCBS MGG,BCBS MGG,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Cigna,Cigna,176.9,,,,,,,per diem,176.9,176.9,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Cigna MGG,Cigna MGG,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Humana,Humana,176.9,,,,,,,per diem,176.9,176.9,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Humana MGG,Humana MGG,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Optum VA,Optum VA,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,UHC,UHC,176.9,,,,,,,per diem,176.9,176.9,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,UHC MGG,UHC MGG,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,VA,VA,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Wellcare MGG,Wellcare MGG,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Bright Health - commercial,Bright Health - commercial,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,176.9,176.9,Bright Health MGG,Bright Health MGG,176.9,,,,,,,case rate,176.9,176.9,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Aetna,Aetna,1735.25,,,,,,,per diem,1735.25,1735.25,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Aetna MGG,Aetna MGG,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,BCBS,BCBS,1735.25,,,,,,,per diem,1735.25,1735.25,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,BCBS MGG,BCBS MGG,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Cigna,Cigna,1735.25,,,,,,,per diem,1735.25,1735.25,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Cigna MGG,Cigna MGG,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Humana,Humana,1735.25,,,,,,,per diem,1735.25,1735.25,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Humana MGG,Humana MGG,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Optum VA,Optum VA,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,UHC,UHC,1735.25,,,,,,,per diem,1735.25,1735.25,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,UHC MGG,UHC MGG,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,VA,VA,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Wellcare MGG,Wellcare MGG,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Bright Health - commercial,Bright Health - commercial,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1735.25,1735.25,Bright Health MGG,Bright Health MGG,1735.25,,,,,,,case rate,1735.25,1735.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Aetna,Aetna,731.64,,,,,,,per diem,731.64,731.64,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Aetna MGG,Aetna MGG,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,BCBS,BCBS,731.64,,,,,,,per diem,731.64,731.64,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,BCBS MGG,BCBS MGG,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Cigna,Cigna,731.64,,,,,,,per diem,731.64,731.64,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Cigna MGG,Cigna MGG,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Humana,Humana,731.64,,,,,,,per diem,731.64,731.64,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Humana MGG,Humana MGG,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Optum VA,Optum VA,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,UHC,UHC,731.64,,,,,,,per diem,731.64,731.64,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,UHC MGG,UHC MGG,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,VA,VA,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Wellcare MGG,Wellcare MGG,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Bright Health - commercial,Bright Health - commercial,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,731.64,731.64,Bright Health MGG,Bright Health MGG,731.64,,,,,,,case rate,731.64,731.64,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Aetna,Aetna,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Aetna MGG,Aetna MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,BCBS,BCBS,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,BCBS MGG,BCBS MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Cigna,Cigna,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Cigna MGG,Cigna MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Humana,Humana,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Humana MGG,Humana MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Optum VA,Optum VA,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,UHC,UHC,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,UHC MGG,UHC MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,VA,VA,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Wellcare MGG,Wellcare MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Bright Health - commercial,Bright Health - commercial,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,322.14,322.14,Bright Health MGG,Bright Health MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Aetna,Aetna,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Aetna MGG,Aetna MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,BCBS,BCBS,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,BCBS MGG,BCBS MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Cigna,Cigna,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Cigna MGG,Cigna MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Humana,Humana,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Humana MGG,Humana MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Optum VA,Optum VA,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,UHC,UHC,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,UHC MGG,UHC MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,VA,VA,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Wellcare MGG,Wellcare MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Bright Health - commercial,Bright Health - commercial,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,167.08,167.08,Bright Health MGG,Bright Health MGG,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Aetna,Aetna,322.19,,,,,,,per diem,322.19,322.19,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Aetna MGG,Aetna MGG,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,BCBS,BCBS,322.19,,,,,,,per diem,322.19,322.19,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,BCBS MGG,BCBS MGG,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Cigna,Cigna,322.19,,,,,,,per diem,322.19,322.19,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Cigna MGG,Cigna MGG,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Humana,Humana,322.19,,,,,,,per diem,322.19,322.19,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Humana MGG,Humana MGG,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Optum VA,Optum VA,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,UHC,UHC,322.19,,,,,,,per diem,322.19,322.19,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,UHC MGG,UHC MGG,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,VA,VA,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Wellcare MGG,Wellcare MGG,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Bright Health - commercial,Bright Health - commercial,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,322.19,322.19,Bright Health MGG,Bright Health MGG,322.19,,,,,,,case rate,322.19,322.19,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Aetna,Aetna,494.68,,,,,,,per diem,494.68,494.68,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Aetna MGG,Aetna MGG,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,BCBS,BCBS,494.68,,,,,,,per diem,494.68,494.68,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,BCBS MGG,BCBS MGG,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Cigna,Cigna,494.68,,,,,,,per diem,494.68,494.68,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Cigna MGG,Cigna MGG,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Humana,Humana,494.68,,,,,,,per diem,494.68,494.68,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Humana MGG,Humana MGG,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Optum VA,Optum VA,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,UHC,UHC,494.68,,,,,,,per diem,494.68,494.68,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,UHC MGG,UHC MGG,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,VA,VA,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Wellcare MGG,Wellcare MGG,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Bright Health - commercial,Bright Health - commercial,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,494.68,494.68,Bright Health MGG,Bright Health MGG,494.68,,,,,,,case rate,494.68,494.68,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Aetna,Aetna,123.4,,,,,,,per diem,123.4,123.4,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Aetna MGG,Aetna MGG,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,BCBS,BCBS,123.4,,,,,,,per diem,123.4,123.4,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,BCBS MGG,BCBS MGG,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Cigna,Cigna,123.4,,,,,,,per diem,123.4,123.4,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Cigna MGG,Cigna MGG,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Humana,Humana,123.4,,,,,,,per diem,123.4,123.4,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Humana MGG,Humana MGG,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Optum VA,Optum VA,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,UHC,UHC,123.4,,,,,,,per diem,123.4,123.4,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,UHC MGG,UHC MGG,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,VA,VA,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Wellcare MGG,Wellcare MGG,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Bright Health - commercial,Bright Health - commercial,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,123.4,123.4,Bright Health MGG,Bright Health MGG,123.4,,,,,,,case rate,123.4,123.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Aetna,Aetna,1490.58,,,,,,,per diem,1490.58,1490.58,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Aetna MGG,Aetna MGG,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,BCBS,BCBS,1490.58,,,,,,,per diem,1490.58,1490.58,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,BCBS MGG,BCBS MGG,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Cigna,Cigna,1490.58,,,,,,,per diem,1490.58,1490.58,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Cigna MGG,Cigna MGG,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Humana,Humana,1490.58,,,,,,,per diem,1490.58,1490.58,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Humana MGG,Humana MGG,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Optum VA,Optum VA,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,UHC,UHC,1490.58,,,,,,,per diem,1490.58,1490.58,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,UHC MGG,UHC MGG,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,VA,VA,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Wellcare MGG,Wellcare MGG,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Bright Health - commercial,Bright Health - commercial,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1490.58,1490.58,Bright Health MGG,Bright Health MGG,1490.58,,,,,,,case rate,1490.58,1490.58,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Aetna,Aetna,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Aetna MGG,Aetna MGG,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,BCBS,BCBS,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,BCBS MGG,BCBS MGG,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Cigna,Cigna,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Cigna MGG,Cigna MGG,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Humana,Humana,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Humana MGG,Humana MGG,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Optum VA,Optum VA,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,UHC,UHC,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,UHC MGG,UHC MGG,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,VA,VA,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Wellcare MGG,Wellcare MGG,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Bright Health - commercial,Bright Health - commercial,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1692.6,1692.6,Bright Health MGG,Bright Health MGG,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Aetna,Aetna,1207.75,,,,,,,per diem,1207.75,1207.75,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Aetna MGG,Aetna MGG,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,BCBS,BCBS,1207.75,,,,,,,per diem,1207.75,1207.75,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,BCBS MGG,BCBS MGG,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Cigna,Cigna,1207.75,,,,,,,per diem,1207.75,1207.75,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Cigna MGG,Cigna MGG,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Humana,Humana,1207.75,,,,,,,per diem,1207.75,1207.75,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Humana MGG,Humana MGG,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Optum VA,Optum VA,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,UHC,UHC,1207.75,,,,,,,per diem,1207.75,1207.75,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,UHC MGG,UHC MGG,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,VA,VA,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Wellcare MGG,Wellcare MGG,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Bright Health - commercial,Bright Health - commercial,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1207.75,1207.75,Bright Health MGG,Bright Health MGG,1207.75,,,,,,,case rate,1207.75,1207.75,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Aetna,Aetna,1310.4,,,,,,,per diem,1310.4,1310.4,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Aetna MGG,Aetna MGG,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,BCBS,BCBS,1310.4,,,,,,,per diem,1310.4,1310.4,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,BCBS MGG,BCBS MGG,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Cigna,Cigna,1310.4,,,,,,,per diem,1310.4,1310.4,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Cigna MGG,Cigna MGG,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Humana,Humana,1310.4,,,,,,,per diem,1310.4,1310.4,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Humana MGG,Humana MGG,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Optum VA,Optum VA,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,UHC,UHC,1310.4,,,,,,,per diem,1310.4,1310.4,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,UHC MGG,UHC MGG,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,VA,VA,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Wellcare MGG,Wellcare MGG,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Bright Health - commercial,Bright Health - commercial,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1310.4,1310.4,Bright Health MGG,Bright Health MGG,1310.4,,,,,,,case rate,1310.4,1310.4,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Aetna,Aetna,406.22,,,,,,,per diem,406.22,406.22,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Aetna MGG,Aetna MGG,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,BCBS,BCBS,406.22,,,,,,,per diem,406.22,406.22,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,BCBS MGG,BCBS MGG,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Cigna,Cigna,406.22,,,,,,,per diem,406.22,406.22,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Cigna MGG,Cigna MGG,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Humana,Humana,406.22,,,,,,,per diem,406.22,406.22,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Humana MGG,Humana MGG,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Optum VA,Optum VA,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,UHC,UHC,406.22,,,,,,,per diem,406.22,406.22,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,UHC MGG,UHC MGG,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,VA,VA,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Wellcare MGG,Wellcare MGG,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Bright Health - commercial,Bright Health - commercial,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,406.22,406.22,Bright Health MGG,Bright Health MGG,406.22,,,,,,,case rate,406.22,406.22,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Aetna,Aetna,103.9,,,,,,,per diem,103.9,103.9,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Aetna MGG,Aetna MGG,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,BCBS,BCBS,103.9,,,,,,,per diem,103.9,103.9,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,BCBS MGG,BCBS MGG,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Cigna,Cigna,103.9,,,,,,,per diem,103.9,103.9,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Cigna MGG,Cigna MGG,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Humana,Humana,103.9,,,,,,,per diem,103.9,103.9,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Humana MGG,Humana MGG,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Optum VA,Optum VA,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,UHC,UHC,103.9,,,,,,,per diem,103.9,103.9,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,UHC MGG,UHC MGG,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,VA,VA,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Wellcare MGG,Wellcare MGG,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Bright Health - commercial,Bright Health - commercial,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,103.9,103.9,Bright Health MGG,Bright Health MGG,103.9,,,,,,,case rate,103.9,103.9,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Aetna,Aetna,62.82,,,,,,,per diem,62.82,62.82,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Aetna MGG,Aetna MGG,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,BCBS,BCBS,62.82,,,,,,,per diem,62.82,62.82,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,BCBS MGG,BCBS MGG,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Cigna,Cigna,62.82,,,,,,,per diem,62.82,62.82,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Cigna MGG,Cigna MGG,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Humana,Humana,62.82,,,,,,,per diem,62.82,62.82,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Humana MGG,Humana MGG,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Optum VA,Optum VA,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,UHC,UHC,62.82,,,,,,,per diem,62.82,62.82,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,UHC MGG,UHC MGG,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,VA,VA,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Wellcare MGG,Wellcare MGG,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Bright Health - commercial,Bright Health - commercial,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,62.82,62.82,Bright Health MGG,Bright Health MGG,62.82,,,,,,,case rate,62.82,62.82,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Aetna,Aetna,361.5,,,,,,,per diem,361.5,361.5,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Aetna MGG,Aetna MGG,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,BCBS,BCBS,361.5,,,,,,,per diem,361.5,361.5,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,BCBS MGG,BCBS MGG,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Cigna,Cigna,361.5,,,,,,,per diem,361.5,361.5,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Cigna MGG,Cigna MGG,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Humana,Humana,361.5,,,,,,,per diem,361.5,361.5,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Humana MGG,Humana MGG,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Optum VA,Optum VA,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,UHC,UHC,361.5,,,,,,,per diem,361.5,361.5,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,UHC MGG,UHC MGG,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,VA,VA,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Wellcare MGG,Wellcare MGG,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Bright Health - commercial,Bright Health - commercial,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,361.5,361.5,Bright Health MGG,Bright Health MGG,361.5,,,,,,,case rate,361.5,361.5,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Aetna,Aetna,520.94,,,,,,,per diem,520.94,520.94,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Aetna MGG,Aetna MGG,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,BCBS,BCBS,520.94,,,,,,,per diem,520.94,520.94,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,BCBS MGG,BCBS MGG,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Cigna,Cigna,520.94,,,,,,,per diem,520.94,520.94,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Cigna MGG,Cigna MGG,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Humana,Humana,520.94,,,,,,,per diem,520.94,520.94,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Humana MGG,Humana MGG,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Optum VA,Optum VA,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,UHC,UHC,520.94,,,,,,,per diem,520.94,520.94,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,UHC MGG,UHC MGG,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,VA,VA,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Wellcare MGG,Wellcare MGG,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Bright Health - commercial,Bright Health - commercial,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,520.94,520.94,Bright Health MGG,Bright Health MGG,520.94,,,,,,,case rate,520.94,520.94,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Aetna,Aetna,27.46,,,,,,,per diem,27.46,27.46,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Aetna MGG,Aetna MGG,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,BCBS,BCBS,27.46,,,,,,,per diem,27.46,27.46,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,BCBS MGG,BCBS MGG,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Cigna,Cigna,27.46,,,,,,,per diem,27.46,27.46,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Cigna MGG,Cigna MGG,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Humana,Humana,27.46,,,,,,,per diem,27.46,27.46,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Humana MGG,Humana MGG,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Optum VA,Optum VA,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,UHC,UHC,27.46,,,,,,,per diem,27.46,27.46,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,UHC MGG,UHC MGG,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,VA,VA,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Wellcare MGG,Wellcare MGG,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Bright Health - commercial,Bright Health - commercial,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,27.46,27.46,Bright Health MGG,Bright Health MGG,27.46,,,,,,,case rate,27.46,27.46,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Aetna,Aetna,78.52,,,,,,,per diem,78.52,78.52,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Aetna MGG,Aetna MGG,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,BCBS,BCBS,78.52,,,,,,,per diem,78.52,78.52,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,BCBS MGG,BCBS MGG,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Cigna,Cigna,78.52,,,,,,,per diem,78.52,78.52,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Cigna MGG,Cigna MGG,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Humana,Humana,78.52,,,,,,,per diem,78.52,78.52,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Humana MGG,Humana MGG,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Optum VA,Optum VA,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,UHC,UHC,78.52,,,,,,,per diem,78.52,78.52,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,UHC MGG,UHC MGG,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,VA,VA,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Wellcare MGG,Wellcare MGG,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Bright Health - commercial,Bright Health - commercial,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,78.52,78.52,Bright Health MGG,Bright Health MGG,78.52,,,,,,,case rate,78.52,78.52,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Aetna,Aetna,411.74,,,,,,,per diem,411.74,411.74,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Aetna MGG,Aetna MGG,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,BCBS,BCBS,411.74,,,,,,,per diem,411.74,411.74,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,BCBS MGG,BCBS MGG,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Cigna,Cigna,411.74,,,,,,,per diem,411.74,411.74,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Cigna MGG,Cigna MGG,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Humana,Humana,411.74,,,,,,,per diem,411.74,411.74,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Humana MGG,Humana MGG,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Optum VA,Optum VA,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,UHC,UHC,411.74,,,,,,,per diem,411.74,411.74,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,UHC MGG,UHC MGG,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,VA,VA,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Wellcare MGG,Wellcare MGG,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Bright Health - commercial,Bright Health - commercial,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,411.74,411.74,Bright Health MGG,Bright Health MGG,411.74,,,,,,,case rate,411.74,411.74,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Aetna,Aetna,1434.89,,,,,,,per diem,1434.89,1434.89,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Aetna MGG,Aetna MGG,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,BCBS,BCBS,1434.89,,,,,,,per diem,1434.89,1434.89,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,BCBS MGG,BCBS MGG,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Cigna,Cigna,1434.89,,,,,,,per diem,1434.89,1434.89,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Cigna MGG,Cigna MGG,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Humana,Humana,1434.89,,,,,,,per diem,1434.89,1434.89,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Humana MGG,Humana MGG,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Optum VA,Optum VA,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,UHC,UHC,1434.89,,,,,,,per diem,1434.89,1434.89,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,UHC MGG,UHC MGG,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,VA,VA,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Wellcare MGG,Wellcare MGG,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Bright Health - commercial,Bright Health - commercial,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1434.89,1434.89,Bright Health MGG,Bright Health MGG,1434.89,,,,,,,case rate,1434.89,1434.89,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Aetna,Aetna,1019.93,,,,,,,per diem,1019.93,1019.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Aetna MGG,Aetna MGG,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,BCBS,BCBS,1019.93,,,,,,,per diem,1019.93,1019.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,BCBS MGG,BCBS MGG,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Cigna,Cigna,1019.93,,,,,,,per diem,1019.93,1019.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Cigna MGG,Cigna MGG,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Humana,Humana,1019.93,,,,,,,per diem,1019.93,1019.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Humana MGG,Humana MGG,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Optum VA,Optum VA,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,UHC,UHC,1019.93,,,,,,,per diem,1019.93,1019.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,UHC MGG,UHC MGG,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,VA,VA,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Wellcare MGG,Wellcare MGG,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Bright Health - commercial,Bright Health - commercial,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1019.93,1019.93,Bright Health MGG,Bright Health MGG,1019.93,,,,,,,case rate,1019.93,1019.93,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Aetna,Aetna,181.9,,,,,,,per diem,181.9,181.9,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Aetna MGG,Aetna MGG,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,BCBS,BCBS,181.9,,,,,,,per diem,181.9,181.9,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,BCBS MGG,BCBS MGG,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Cigna,Cigna,181.9,,,,,,,per diem,181.9,181.9,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Cigna MGG,Cigna MGG,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Humana,Humana,181.9,,,,,,,per diem,181.9,181.9,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Humana MGG,Humana MGG,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Optum VA,Optum VA,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,UHC,UHC,181.9,,,,,,,per diem,181.9,181.9,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,UHC MGG,UHC MGG,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,VA,VA,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Wellcare MGG,Wellcare MGG,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Bright Health - commercial,Bright Health - commercial,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,181.9,181.9,Bright Health MGG,Bright Health MGG,181.9,,,,,,,case rate,181.9,181.9,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Aetna,Aetna,40.98,,,,,,,per diem,40.98,40.98,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Aetna MGG,Aetna MGG,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,BCBS,BCBS,40.98,,,,,,,per diem,40.98,40.98,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,BCBS MGG,BCBS MGG,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Cigna,Cigna,40.98,,,,,,,per diem,40.98,40.98,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Cigna MGG,Cigna MGG,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Humana,Humana,40.98,,,,,,,per diem,40.98,40.98,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Humana MGG,Humana MGG,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Optum VA,Optum VA,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,UHC,UHC,40.98,,,,,,,per diem,40.98,40.98,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,UHC MGG,UHC MGG,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,VA,VA,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Wellcare MGG,Wellcare MGG,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Bright Health - commercial,Bright Health - commercial,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,40.98,40.98,Bright Health MGG,Bright Health MGG,40.98,,,,,,,case rate,40.98,40.98,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Aetna,Aetna,74.15,,,,,,,per diem,74.15,74.15,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Aetna MGG,Aetna MGG,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,BCBS,BCBS,74.15,,,,,,,per diem,74.15,74.15,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,BCBS MGG,BCBS MGG,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Cigna,Cigna,74.15,,,,,,,per diem,74.15,74.15,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Cigna MGG,Cigna MGG,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Humana,Humana,74.15,,,,,,,per diem,74.15,74.15,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Humana MGG,Humana MGG,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Optum VA,Optum VA,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,UHC,UHC,74.15,,,,,,,per diem,74.15,74.15,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,UHC MGG,UHC MGG,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,VA,VA,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Wellcare MGG,Wellcare MGG,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Bright Health - commercial,Bright Health - commercial,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,74.15,74.15,Bright Health MGG,Bright Health MGG,74.15,,,,,,,case rate,74.15,74.15,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Aetna,Aetna,48.05,,,,,,,per diem,48.05,48.05,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Aetna MGG,Aetna MGG,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,BCBS,BCBS,48.05,,,,,,,per diem,48.05,48.05,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,BCBS MGG,BCBS MGG,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Cigna,Cigna,48.05,,,,,,,per diem,48.05,48.05,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Cigna MGG,Cigna MGG,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Humana,Humana,48.05,,,,,,,per diem,48.05,48.05,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Humana MGG,Humana MGG,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Optum VA,Optum VA,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,UHC,UHC,48.05,,,,,,,per diem,48.05,48.05,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,UHC MGG,UHC MGG,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,VA,VA,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Wellcare MGG,Wellcare MGG,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Bright Health - commercial,Bright Health - commercial,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,48.05,48.05,Bright Health MGG,Bright Health MGG,48.05,,,,,,,case rate,48.05,48.05,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Aetna,Aetna,119.08,,,,,,,per diem,119.08,119.08,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Aetna MGG,Aetna MGG,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,BCBS,BCBS,119.08,,,,,,,per diem,119.08,119.08,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,BCBS MGG,BCBS MGG,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Cigna,Cigna,119.08,,,,,,,per diem,119.08,119.08,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Cigna MGG,Cigna MGG,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Humana,Humana,119.08,,,,,,,per diem,119.08,119.08,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Humana MGG,Humana MGG,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Optum VA,Optum VA,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,UHC,UHC,119.08,,,,,,,per diem,119.08,119.08,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,UHC MGG,UHC MGG,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,VA,VA,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Wellcare MGG,Wellcare MGG,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Bright Health - commercial,Bright Health - commercial,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,119.08,119.08,Bright Health MGG,Bright Health MGG,119.08,,,,,,,case rate,119.08,119.08,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Aetna,Aetna,162.76,,,,,,,per diem,162.76,162.76,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Aetna MGG,Aetna MGG,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,BCBS,BCBS,162.76,,,,,,,per diem,162.76,162.76,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,BCBS MGG,BCBS MGG,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Cigna,Cigna,162.76,,,,,,,per diem,162.76,162.76,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Cigna MGG,Cigna MGG,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Humana,Humana,162.76,,,,,,,per diem,162.76,162.76,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Humana MGG,Humana MGG,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Optum VA,Optum VA,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,UHC,UHC,162.76,,,,,,,per diem,162.76,162.76,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,UHC MGG,UHC MGG,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,VA,VA,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Wellcare MGG,Wellcare MGG,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Bright Health - commercial,Bright Health - commercial,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,162.76,162.76,Bright Health MGG,Bright Health MGG,162.76,,,,,,,case rate,162.76,162.76,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Aetna,Aetna,133.22,,,,,,,per diem,133.22,133.22,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Aetna MGG,Aetna MGG,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,BCBS,BCBS,133.22,,,,,,,per diem,133.22,133.22,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,BCBS MGG,BCBS MGG,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Cigna,Cigna,133.22,,,,,,,per diem,133.22,133.22,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Cigna MGG,Cigna MGG,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Humana,Humana,133.22,,,,,,,per diem,133.22,133.22,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Humana MGG,Humana MGG,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Optum VA,Optum VA,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,UHC,UHC,133.22,,,,,,,per diem,133.22,133.22,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,UHC MGG,UHC MGG,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,VA,VA,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Wellcare MGG,Wellcare MGG,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Bright Health - commercial,Bright Health - commercial,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,133.22,133.22,Bright Health MGG,Bright Health MGG,133.22,,,,,,,case rate,133.22,133.22,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Aetna,Aetna,2230.96,,,,,,,per diem,2230.96,2230.96,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Aetna MGG,Aetna MGG,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,BCBS,BCBS,2230.96,,,,,,,per diem,2230.96,2230.96,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,BCBS MGG,BCBS MGG,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Cigna,Cigna,2230.96,,,,,,,per diem,2230.96,2230.96,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Cigna MGG,Cigna MGG,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Humana,Humana,2230.96,,,,,,,per diem,2230.96,2230.96,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Humana MGG,Humana MGG,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Optum VA,Optum VA,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,UHC,UHC,2230.96,,,,,,,per diem,2230.96,2230.96,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,UHC MGG,UHC MGG,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,VA,VA,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Wellcare MGG,Wellcare MGG,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Bright Health - commercial,Bright Health - commercial,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2230.96,2230.96,Bright Health MGG,Bright Health MGG,2230.96,,,,,,,case rate,2230.96,2230.96,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Aetna,Aetna,2231.01,,,,,,,per diem,2231.01,2231.01,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Aetna MGG,Aetna MGG,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,BCBS,BCBS,2231.01,,,,,,,per diem,2231.01,2231.01,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,BCBS MGG,BCBS MGG,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Cigna,Cigna,2231.01,,,,,,,per diem,2231.01,2231.01,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Cigna MGG,Cigna MGG,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Humana,Humana,2231.01,,,,,,,per diem,2231.01,2231.01,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Humana MGG,Humana MGG,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Optum VA,Optum VA,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,UHC,UHC,2231.01,,,,,,,per diem,2231.01,2231.01,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,UHC MGG,UHC MGG,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,VA,VA,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Wellcare MGG,Wellcare MGG,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Bright Health - commercial,Bright Health - commercial,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2231.01,2231.01,Bright Health MGG,Bright Health MGG,2231.01,,,,,,,case rate,2231.01,2231.01,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Aetna,Aetna,345.07,,,,,,,per diem,345.07,345.07,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Aetna MGG,Aetna MGG,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,BCBS,BCBS,345.07,,,,,,,per diem,345.07,345.07,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,BCBS MGG,BCBS MGG,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Cigna,Cigna,345.07,,,,,,,per diem,345.07,345.07,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Cigna MGG,Cigna MGG,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Humana,Humana,345.07,,,,,,,per diem,345.07,345.07,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Humana MGG,Humana MGG,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Optum VA,Optum VA,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,UHC,UHC,345.07,,,,,,,per diem,345.07,345.07,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,UHC MGG,UHC MGG,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,VA,VA,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Wellcare MGG,Wellcare MGG,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Bright Health - commercial,Bright Health - commercial,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,345.07,345.07,Bright Health MGG,Bright Health MGG,345.07,,,,,,,case rate,345.07,345.07,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Aetna,Aetna,139.78,,,,,,,per diem,139.78,139.78,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Aetna MGG,Aetna MGG,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,BCBS,BCBS,139.78,,,,,,,per diem,139.78,139.78,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,BCBS MGG,BCBS MGG,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Cigna,Cigna,139.78,,,,,,,per diem,139.78,139.78,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Cigna MGG,Cigna MGG,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Humana,Humana,139.78,,,,,,,per diem,139.78,139.78,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Humana MGG,Humana MGG,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Optum VA,Optum VA,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,UHC,UHC,139.78,,,,,,,per diem,139.78,139.78,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,UHC MGG,UHC MGG,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,VA,VA,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Wellcare MGG,Wellcare MGG,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Bright Health - commercial,Bright Health - commercial,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,139.78,139.78,Bright Health MGG,Bright Health MGG,139.78,,,,,,,case rate,139.78,139.78,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Aetna,Aetna,136.55,,,,,,,per diem,136.55,136.55,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Aetna MGG,Aetna MGG,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,BCBS,BCBS,136.55,,,,,,,per diem,136.55,136.55,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,BCBS MGG,BCBS MGG,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Cigna,Cigna,136.55,,,,,,,per diem,136.55,136.55,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Cigna MGG,Cigna MGG,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Humana,Humana,136.55,,,,,,,per diem,136.55,136.55,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Humana MGG,Humana MGG,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Optum VA,Optum VA,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,UHC,UHC,136.55,,,,,,,per diem,136.55,136.55,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,UHC MGG,UHC MGG,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,VA,VA,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Wellcare MGG,Wellcare MGG,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Bright Health - commercial,Bright Health - commercial,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,136.55,136.55,Bright Health MGG,Bright Health MGG,136.55,,,,,,,case rate,136.55,136.55,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Aetna,Aetna,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Aetna MGG,Aetna MGG,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,BCBS,BCBS,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,BCBS MGG,BCBS MGG,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Cigna,Cigna,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Cigna MGG,Cigna MGG,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Humana,Humana,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Humana MGG,Humana MGG,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Optum VA,Optum VA,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,UHC,UHC,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,UHC MGG,UHC MGG,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,VA,VA,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Wellcare MGG,Wellcare MGG,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Bright Health - commercial,Bright Health - commercial,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,14.66,14.66,Bright Health MGG,Bright Health MGG,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Aetna,Aetna,1831.28,,,,,,,per diem,1831.28,1831.28,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Aetna MGG,Aetna MGG,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,BCBS,BCBS,1831.28,,,,,,,per diem,1831.28,1831.28,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,BCBS MGG,BCBS MGG,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Cigna,Cigna,1831.28,,,,,,,per diem,1831.28,1831.28,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Cigna MGG,Cigna MGG,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Humana,Humana,1831.28,,,,,,,per diem,1831.28,1831.28,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Humana MGG,Humana MGG,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Optum VA,Optum VA,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,UHC,UHC,1831.28,,,,,,,per diem,1831.28,1831.28,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,UHC MGG,UHC MGG,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,VA,VA,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Wellcare MGG,Wellcare MGG,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Bright Health - commercial,Bright Health - commercial,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1831.28,1831.28,Bright Health MGG,Bright Health MGG,1831.28,,,,,,,case rate,1831.28,1831.28,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Aetna,Aetna,4437.89,,,,,,,per diem,4437.89,4437.89,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Aetna MGG,Aetna MGG,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,BCBS,BCBS,4437.89,,,,,,,per diem,4437.89,4437.89,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,BCBS MGG,BCBS MGG,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Cigna,Cigna,4437.89,,,,,,,per diem,4437.89,4437.89,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Cigna MGG,Cigna MGG,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Humana,Humana,4437.89,,,,,,,per diem,4437.89,4437.89,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Humana MGG,Humana MGG,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Optum VA,Optum VA,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,UHC,UHC,4437.89,,,,,,,per diem,4437.89,4437.89,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,UHC MGG,UHC MGG,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,VA,VA,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Wellcare MGG,Wellcare MGG,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Bright Health - commercial,Bright Health - commercial,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4437.89,4437.89,Bright Health MGG,Bright Health MGG,4437.89,,,,,,,case rate,4437.89,4437.89,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Aetna,Aetna,443.35,,,,,,,per diem,443.35,443.35,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Aetna MGG,Aetna MGG,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,BCBS,BCBS,443.35,,,,,,,per diem,443.35,443.35,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,BCBS MGG,BCBS MGG,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Cigna,Cigna,443.35,,,,,,,per diem,443.35,443.35,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Cigna MGG,Cigna MGG,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Humana,Humana,443.35,,,,,,,per diem,443.35,443.35,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Humana MGG,Humana MGG,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Optum VA,Optum VA,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,UHC,UHC,443.35,,,,,,,per diem,443.35,443.35,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,UHC MGG,UHC MGG,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,VA,VA,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Wellcare MGG,Wellcare MGG,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Bright Health - commercial,Bright Health - commercial,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,443.35,443.35,Bright Health MGG,Bright Health MGG,443.35,,,,,,,case rate,443.35,443.35,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Aetna,Aetna,69.37,,,,,,,per diem,69.37,69.37,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Aetna MGG,Aetna MGG,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,BCBS,BCBS,69.37,,,,,,,per diem,69.37,69.37,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,BCBS MGG,BCBS MGG,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Cigna,Cigna,69.37,,,,,,,per diem,69.37,69.37,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Cigna MGG,Cigna MGG,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Humana,Humana,69.37,,,,,,,per diem,69.37,69.37,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Humana MGG,Humana MGG,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Optum VA,Optum VA,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,UHC,UHC,69.37,,,,,,,per diem,69.37,69.37,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,UHC MGG,UHC MGG,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,VA,VA,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Wellcare MGG,Wellcare MGG,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Bright Health - commercial,Bright Health - commercial,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,69.37,69.37,Bright Health MGG,Bright Health MGG,69.37,,,,,,,case rate,69.37,69.37,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Aetna,Aetna,3194.15,,,,,,,per diem,3194.15,3194.15,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Aetna MGG,Aetna MGG,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,BCBS,BCBS,3194.15,,,,,,,per diem,3194.15,3194.15,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,BCBS MGG,BCBS MGG,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Cigna,Cigna,3194.15,,,,,,,per diem,3194.15,3194.15,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Cigna MGG,Cigna MGG,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Humana,Humana,3194.15,,,,,,,per diem,3194.15,3194.15,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Humana MGG,Humana MGG,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Optum VA,Optum VA,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,UHC,UHC,3194.15,,,,,,,per diem,3194.15,3194.15,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,UHC MGG,UHC MGG,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,VA,VA,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Wellcare MGG,Wellcare MGG,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Bright Health - commercial,Bright Health - commercial,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3194.15,3194.15,Bright Health MGG,Bright Health MGG,3194.15,,,,,,,case rate,3194.15,3194.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Aetna,Aetna,544.65,,,,,,,per diem,544.65,544.65,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Aetna MGG,Aetna MGG,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,BCBS,BCBS,544.65,,,,,,,per diem,544.65,544.65,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,BCBS MGG,BCBS MGG,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Cigna,Cigna,544.65,,,,,,,per diem,544.65,544.65,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Cigna MGG,Cigna MGG,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Humana,Humana,544.65,,,,,,,per diem,544.65,544.65,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Humana MGG,Humana MGG,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Optum VA,Optum VA,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,UHC,UHC,544.65,,,,,,,per diem,544.65,544.65,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,UHC MGG,UHC MGG,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,VA,VA,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Wellcare MGG,Wellcare MGG,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Bright Health - commercial,Bright Health - commercial,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,544.65,544.65,Bright Health MGG,Bright Health MGG,544.65,,,,,,,case rate,544.65,544.65,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Aetna,Aetna,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Aetna MGG,Aetna MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,BCBS,BCBS,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,BCBS MGG,BCBS MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Cigna,Cigna,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Cigna MGG,Cigna MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Humana,Humana,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Humana MGG,Humana MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Optum VA,Optum VA,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,UHC,UHC,22.15,,,,,,,per diem,22.15,22.15,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,UHC MGG,UHC MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,VA,VA,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Wellcare MGG,Wellcare MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Bright Health - commercial,Bright Health - commercial,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,22.15,22.15,Bright Health MGG,Bright Health MGG,22.15,,,,,,,case rate,22.15,22.15,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Aetna,Aetna,628.99,,,,,,,per diem,628.99,628.99,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Aetna MGG,Aetna MGG,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,BCBS,BCBS,628.99,,,,,,,per diem,628.99,628.99,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,BCBS MGG,BCBS MGG,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Cigna,Cigna,628.99,,,,,,,per diem,628.99,628.99,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Cigna MGG,Cigna MGG,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Humana,Humana,628.99,,,,,,,per diem,628.99,628.99,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Humana MGG,Humana MGG,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Optum VA,Optum VA,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,UHC,UHC,628.99,,,,,,,per diem,628.99,628.99,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,UHC MGG,UHC MGG,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,VA,VA,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Wellcare MGG,Wellcare MGG,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Bright Health - commercial,Bright Health - commercial,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,628.99,628.99,Bright Health MGG,Bright Health MGG,628.99,,,,,,,case rate,628.99,628.99,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Aetna,Aetna,173.68,,,,,,,per diem,173.68,173.68,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Aetna MGG,Aetna MGG,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,BCBS,BCBS,173.68,,,,,,,per diem,173.68,173.68,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,BCBS MGG,BCBS MGG,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Cigna,Cigna,173.68,,,,,,,per diem,173.68,173.68,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Cigna MGG,Cigna MGG,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Humana,Humana,173.68,,,,,,,per diem,173.68,173.68,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Humana MGG,Humana MGG,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Optum VA,Optum VA,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,UHC,UHC,173.68,,,,,,,per diem,173.68,173.68,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,UHC MGG,UHC MGG,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,VA,VA,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Wellcare MGG,Wellcare MGG,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Bright Health - commercial,Bright Health - commercial,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,173.68,173.68,Bright Health MGG,Bright Health MGG,173.68,,,,,,,case rate,173.68,173.68,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Aetna,Aetna,23.71,,,,,,,per diem,23.71,23.71,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Aetna MGG,Aetna MGG,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,BCBS,BCBS,23.71,,,,,,,per diem,23.71,23.71,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,BCBS MGG,BCBS MGG,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Cigna,Cigna,23.71,,,,,,,per diem,23.71,23.71,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Cigna MGG,Cigna MGG,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Humana,Humana,23.71,,,,,,,per diem,23.71,23.71,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Humana MGG,Humana MGG,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Optum VA,Optum VA,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,UHC,UHC,23.71,,,,,,,per diem,23.71,23.71,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,UHC MGG,UHC MGG,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,VA,VA,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Wellcare MGG,Wellcare MGG,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Bright Health - commercial,Bright Health - commercial,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,23.71,23.71,Bright Health MGG,Bright Health MGG,23.71,,,,,,,case rate,23.71,23.71,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Aetna,Aetna,722.9,,,,,,,per diem,722.9,722.9,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Aetna MGG,Aetna MGG,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,BCBS,BCBS,722.9,,,,,,,per diem,722.9,722.9,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,BCBS MGG,BCBS MGG,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Cigna,Cigna,722.9,,,,,,,per diem,722.9,722.9,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Cigna MGG,Cigna MGG,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Humana,Humana,722.9,,,,,,,per diem,722.9,722.9,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Humana MGG,Humana MGG,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Optum VA,Optum VA,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,UHC,UHC,722.9,,,,,,,per diem,722.9,722.9,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,UHC MGG,UHC MGG,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,VA,VA,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Wellcare MGG,Wellcare MGG,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Bright Health - commercial,Bright Health - commercial,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,722.9,722.9,Bright Health MGG,Bright Health MGG,722.9,,,,,,,case rate,722.9,722.9,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Aetna,Aetna,208.62,,,,,,,per diem,208.62,208.62,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Aetna MGG,Aetna MGG,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,BCBS,BCBS,208.62,,,,,,,per diem,208.62,208.62,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,BCBS MGG,BCBS MGG,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Cigna,Cigna,208.62,,,,,,,per diem,208.62,208.62,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Cigna MGG,Cigna MGG,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Humana,Humana,208.62,,,,,,,per diem,208.62,208.62,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Humana MGG,Humana MGG,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Optum VA,Optum VA,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,UHC,UHC,208.62,,,,,,,per diem,208.62,208.62,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,UHC MGG,UHC MGG,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,VA,VA,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Wellcare MGG,Wellcare MGG,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Bright Health - commercial,Bright Health - commercial,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,208.62,208.62,Bright Health MGG,Bright Health MGG,208.62,,,,,,,case rate,208.62,208.62,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Aetna,Aetna,28.18,,,,,,,per diem,28.18,28.18,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Aetna MGG,Aetna MGG,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,BCBS,BCBS,28.18,,,,,,,per diem,28.18,28.18,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,BCBS MGG,BCBS MGG,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Cigna,Cigna,28.18,,,,,,,per diem,28.18,28.18,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Cigna MGG,Cigna MGG,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Humana,Humana,28.18,,,,,,,per diem,28.18,28.18,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Humana MGG,Humana MGG,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Optum VA,Optum VA,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,UHC,UHC,28.18,,,,,,,per diem,28.18,28.18,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,UHC MGG,UHC MGG,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,VA,VA,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Wellcare MGG,Wellcare MGG,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Bright Health - commercial,Bright Health - commercial,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,28.18,28.18,Bright Health MGG,Bright Health MGG,28.18,,,,,,,case rate,28.18,28.18,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Aetna,Aetna,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Aetna MGG,Aetna MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,BCBS,BCBS,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,BCBS MGG,BCBS MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Cigna,Cigna,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Cigna MGG,Cigna MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Humana,Humana,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Humana MGG,Humana MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Optum VA,Optum VA,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,UHC,UHC,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,UHC MGG,UHC MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,VA,VA,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Wellcare MGG,Wellcare MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Bright Health - commercial,Bright Health - commercial,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,324.38,324.38,Bright Health MGG,Bright Health MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Aetna,Aetna,4572.26,,,,,,,per diem,4572.26,4572.26,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Aetna MGG,Aetna MGG,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,BCBS,BCBS,4572.26,,,,,,,per diem,4572.26,4572.26,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,BCBS MGG,BCBS MGG,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Cigna,Cigna,4572.26,,,,,,,per diem,4572.26,4572.26,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Cigna MGG,Cigna MGG,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Humana,Humana,4572.26,,,,,,,per diem,4572.26,4572.26,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Humana MGG,Humana MGG,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Optum VA,Optum VA,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,UHC,UHC,4572.26,,,,,,,per diem,4572.26,4572.26,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,UHC MGG,UHC MGG,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,VA,VA,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Wellcare MGG,Wellcare MGG,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Bright Health - commercial,Bright Health - commercial,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4572.26,4572.26,Bright Health MGG,Bright Health MGG,4572.26,,,,,,,case rate,4572.26,4572.26,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Aetna,Aetna,334.15,,,,,,,per diem,334.15,334.15,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Aetna MGG,Aetna MGG,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,BCBS,BCBS,334.15,,,,,,,per diem,334.15,334.15,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,BCBS MGG,BCBS MGG,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Cigna,Cigna,334.15,,,,,,,per diem,334.15,334.15,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Cigna MGG,Cigna MGG,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Humana,Humana,334.15,,,,,,,per diem,334.15,334.15,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Humana MGG,Humana MGG,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Optum VA,Optum VA,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,UHC,UHC,334.15,,,,,,,per diem,334.15,334.15,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,UHC MGG,UHC MGG,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,VA,VA,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Wellcare MGG,Wellcare MGG,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Bright Health - commercial,Bright Health - commercial,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,334.15,334.15,Bright Health MGG,Bright Health MGG,334.15,,,,,,,case rate,334.15,334.15,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Aetna,Aetna,148.51,,,,,,,per diem,148.51,148.51,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Aetna MGG,Aetna MGG,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,BCBS,BCBS,148.51,,,,,,,per diem,148.51,148.51,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,BCBS MGG,BCBS MGG,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Cigna,Cigna,148.51,,,,,,,per diem,148.51,148.51,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Cigna MGG,Cigna MGG,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Humana,Humana,148.51,,,,,,,per diem,148.51,148.51,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Humana MGG,Humana MGG,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Optum VA,Optum VA,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,UHC,UHC,148.51,,,,,,,per diem,148.51,148.51,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,UHC MGG,UHC MGG,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,VA,VA,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Wellcare MGG,Wellcare MGG,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Bright Health - commercial,Bright Health - commercial,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,148.51,148.51,Bright Health MGG,Bright Health MGG,148.51,,,,,,,case rate,148.51,148.51,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Aetna,Aetna,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Aetna MGG,Aetna MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,BCBS,BCBS,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,BCBS MGG,BCBS MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Cigna,Cigna,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Cigna MGG,Cigna MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Humana,Humana,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Humana MGG,Humana MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Optum VA,Optum VA,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,UHC,UHC,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,UHC MGG,UHC MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,VA,VA,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Wellcare MGG,Wellcare MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Bright Health - commercial,Bright Health - commercial,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Bright Health MGG,Bright Health MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Aetna,Aetna,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Aetna MGG,Aetna MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,BCBS,BCBS,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,BCBS MGG,BCBS MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Cigna,Cigna,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Cigna MGG,Cigna MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Humana,Humana,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Humana MGG,Humana MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Optum VA,Optum VA,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,UHC,UHC,58.03,,,,,,,per diem,58.03,58.03,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,UHC MGG,UHC MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,VA,VA,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Wellcare MGG,Wellcare MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Bright Health - commercial,Bright Health - commercial,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,58.03,58.03,Bright Health MGG,Bright Health MGG,58.03,,,,,,,case rate,58.03,58.03,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Aetna,Aetna,646.98,,,,,,,per diem,646.98,646.98,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Aetna MGG,Aetna MGG,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,BCBS,BCBS,646.98,,,,,,,per diem,646.98,646.98,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,BCBS MGG,BCBS MGG,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Cigna,Cigna,646.98,,,,,,,per diem,646.98,646.98,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Cigna MGG,Cigna MGG,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Humana,Humana,646.98,,,,,,,per diem,646.98,646.98,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Humana MGG,Humana MGG,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Optum VA,Optum VA,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,UHC,UHC,646.98,,,,,,,per diem,646.98,646.98,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,UHC MGG,UHC MGG,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,VA,VA,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Wellcare MGG,Wellcare MGG,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Bright Health - commercial,Bright Health - commercial,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,646.98,646.98,Bright Health MGG,Bright Health MGG,646.98,,,,,,,case rate,646.98,646.98,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Aetna,Aetna,1777.78,,,,,,,per diem,1777.78,1777.78,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Aetna MGG,Aetna MGG,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,BCBS,BCBS,1777.78,,,,,,,per diem,1777.78,1777.78,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,BCBS MGG,BCBS MGG,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Cigna,Cigna,1777.78,,,,,,,per diem,1777.78,1777.78,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Cigna MGG,Cigna MGG,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Humana,Humana,1777.78,,,,,,,per diem,1777.78,1777.78,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Humana MGG,Humana MGG,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Optum VA,Optum VA,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,UHC,UHC,1777.78,,,,,,,per diem,1777.78,1777.78,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,UHC MGG,UHC MGG,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,VA,VA,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Wellcare MGG,Wellcare MGG,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Bright Health - commercial,Bright Health - commercial,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1777.78,1777.78,Bright Health MGG,Bright Health MGG,1777.78,,,,,,,case rate,1777.78,1777.78,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Aetna,Aetna,3166.8,,,,,,,per diem,3166.8,3166.8,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Aetna MGG,Aetna MGG,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,BCBS,BCBS,3166.8,,,,,,,per diem,3166.8,3166.8,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,BCBS MGG,BCBS MGG,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Cigna,Cigna,3166.8,,,,,,,per diem,3166.8,3166.8,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Cigna MGG,Cigna MGG,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Humana,Humana,3166.8,,,,,,,per diem,3166.8,3166.8,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Humana MGG,Humana MGG,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Optum VA,Optum VA,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,UHC,UHC,3166.8,,,,,,,per diem,3166.8,3166.8,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,UHC MGG,UHC MGG,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,VA,VA,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Wellcare MGG,Wellcare MGG,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Bright Health - commercial,Bright Health - commercial,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3166.8,3166.8,Bright Health MGG,Bright Health MGG,3166.8,,,,,,,case rate,3166.8,3166.8,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Aetna,Aetna,259.38,,,,,,,per diem,259.38,259.38,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Aetna MGG,Aetna MGG,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,BCBS,BCBS,259.38,,,,,,,per diem,259.38,259.38,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,BCBS MGG,BCBS MGG,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Cigna,Cigna,259.38,,,,,,,per diem,259.38,259.38,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Cigna MGG,Cigna MGG,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Humana,Humana,259.38,,,,,,,per diem,259.38,259.38,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Humana MGG,Humana MGG,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Optum VA,Optum VA,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,UHC,UHC,259.38,,,,,,,per diem,259.38,259.38,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,UHC MGG,UHC MGG,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,VA,VA,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Wellcare MGG,Wellcare MGG,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Bright Health - commercial,Bright Health - commercial,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,259.38,259.38,Bright Health MGG,Bright Health MGG,259.38,,,,,,,case rate,259.38,259.38,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Aetna,Aetna,245.75,,,,,,,per diem,245.75,245.75,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Aetna MGG,Aetna MGG,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,BCBS,BCBS,245.75,,,,,,,per diem,245.75,245.75,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,BCBS MGG,BCBS MGG,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Cigna,Cigna,245.75,,,,,,,per diem,245.75,245.75,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Cigna MGG,Cigna MGG,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Humana,Humana,245.75,,,,,,,per diem,245.75,245.75,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Humana MGG,Humana MGG,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Optum VA,Optum VA,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,UHC,UHC,245.75,,,,,,,per diem,245.75,245.75,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,UHC MGG,UHC MGG,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,VA,VA,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Wellcare MGG,Wellcare MGG,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Bright Health - commercial,Bright Health - commercial,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,245.75,245.75,Bright Health MGG,Bright Health MGG,245.75,,,,,,,case rate,245.75,245.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Aetna,Aetna,370.24,,,,,,,per diem,370.24,370.24,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Aetna MGG,Aetna MGG,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,BCBS,BCBS,370.24,,,,,,,per diem,370.24,370.24,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,BCBS MGG,BCBS MGG,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Cigna,Cigna,370.24,,,,,,,per diem,370.24,370.24,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Cigna MGG,Cigna MGG,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Humana,Humana,370.24,,,,,,,per diem,370.24,370.24,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Humana MGG,Humana MGG,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Optum VA,Optum VA,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,UHC,UHC,370.24,,,,,,,per diem,370.24,370.24,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,UHC MGG,UHC MGG,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,VA,VA,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Wellcare MGG,Wellcare MGG,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Bright Health - commercial,Bright Health - commercial,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,370.24,370.24,Bright Health MGG,Bright Health MGG,370.24,,,,,,,case rate,370.24,370.24,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Aetna,Aetna,1373.74,,,,,,,per diem,1373.74,1373.74,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Aetna MGG,Aetna MGG,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,BCBS,BCBS,1373.74,,,,,,,per diem,1373.74,1373.74,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,BCBS MGG,BCBS MGG,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Cigna,Cigna,1373.74,,,,,,,per diem,1373.74,1373.74,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Cigna MGG,Cigna MGG,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Humana,Humana,1373.74,,,,,,,per diem,1373.74,1373.74,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Humana MGG,Humana MGG,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Optum VA,Optum VA,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,UHC,UHC,1373.74,,,,,,,per diem,1373.74,1373.74,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,UHC MGG,UHC MGG,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,VA,VA,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Wellcare MGG,Wellcare MGG,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Bright Health - commercial,Bright Health - commercial,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1373.74,1373.74,Bright Health MGG,Bright Health MGG,1373.74,,,,,,,case rate,1373.74,1373.74,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Aetna,Aetna,25.06,,,,,,,per diem,25.06,25.06,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Aetna MGG,Aetna MGG,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,BCBS,BCBS,25.06,,,,,,,per diem,25.06,25.06,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,BCBS MGG,BCBS MGG,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Cigna,Cigna,25.06,,,,,,,per diem,25.06,25.06,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Cigna MGG,Cigna MGG,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Humana,Humana,25.06,,,,,,,per diem,25.06,25.06,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Humana MGG,Humana MGG,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Optum VA,Optum VA,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,UHC,UHC,25.06,,,,,,,per diem,25.06,25.06,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,UHC MGG,UHC MGG,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,VA,VA,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Wellcare MGG,Wellcare MGG,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Bright Health - commercial,Bright Health - commercial,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,25.06,25.06,Bright Health MGG,Bright Health MGG,25.06,,,,,,,case rate,25.06,25.06,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Aetna,Aetna,60.01,,,,,,,per diem,60.01,60.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Aetna MGG,Aetna MGG,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,BCBS,BCBS,60.01,,,,,,,per diem,60.01,60.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,BCBS MGG,BCBS MGG,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Cigna,Cigna,60.01,,,,,,,per diem,60.01,60.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Cigna MGG,Cigna MGG,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Humana,Humana,60.01,,,,,,,per diem,60.01,60.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Humana MGG,Humana MGG,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Optum VA,Optum VA,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,UHC,UHC,60.01,,,,,,,per diem,60.01,60.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,UHC MGG,UHC MGG,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,VA,VA,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Wellcare MGG,Wellcare MGG,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Bright Health - commercial,Bright Health - commercial,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,60.01,60.01,Bright Health MGG,Bright Health MGG,60.01,,,,,,,case rate,60.01,60.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Aetna,Aetna,102.96,,,,,,,per diem,102.96,102.96,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Aetna MGG,Aetna MGG,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,BCBS,BCBS,102.96,,,,,,,per diem,102.96,102.96,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,BCBS MGG,BCBS MGG,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Cigna,Cigna,102.96,,,,,,,per diem,102.96,102.96,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Cigna MGG,Cigna MGG,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Humana,Humana,102.96,,,,,,,per diem,102.96,102.96,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Humana MGG,Humana MGG,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Optum VA,Optum VA,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,UHC,UHC,102.96,,,,,,,per diem,102.96,102.96,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,UHC MGG,UHC MGG,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,VA,VA,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Wellcare MGG,Wellcare MGG,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Bright Health - commercial,Bright Health - commercial,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,102.96,102.96,Bright Health MGG,Bright Health MGG,102.96,,,,,,,case rate,102.96,102.96,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Aetna,Aetna,266.45,,,,,,,per diem,266.45,266.45,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Aetna MGG,Aetna MGG,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,BCBS,BCBS,266.45,,,,,,,per diem,266.45,266.45,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,BCBS MGG,BCBS MGG,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Cigna,Cigna,266.45,,,,,,,per diem,266.45,266.45,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Cigna MGG,Cigna MGG,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Humana,Humana,266.45,,,,,,,per diem,266.45,266.45,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Humana MGG,Humana MGG,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Optum VA,Optum VA,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,UHC,UHC,266.45,,,,,,,per diem,266.45,266.45,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,UHC MGG,UHC MGG,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,VA,VA,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Wellcare MGG,Wellcare MGG,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Bright Health - commercial,Bright Health - commercial,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,266.45,266.45,Bright Health MGG,Bright Health MGG,266.45,,,,,,,case rate,266.45,266.45,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Aetna,Aetna,158.6,,,,,,,per diem,158.6,158.6,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Aetna MGG,Aetna MGG,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,BCBS,BCBS,158.6,,,,,,,per diem,158.6,158.6,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,BCBS MGG,BCBS MGG,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Cigna,Cigna,158.6,,,,,,,per diem,158.6,158.6,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Cigna MGG,Cigna MGG,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Humana,Humana,158.6,,,,,,,per diem,158.6,158.6,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Humana MGG,Humana MGG,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Optum VA,Optum VA,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,UHC,UHC,158.6,,,,,,,per diem,158.6,158.6,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,UHC MGG,UHC MGG,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,VA,VA,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Wellcare MGG,Wellcare MGG,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Bright Health - commercial,Bright Health - commercial,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,158.6,158.6,Bright Health MGG,Bright Health MGG,158.6,,,,,,,case rate,158.6,158.6,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Aetna,Aetna,303.58,,,,,,,per diem,303.58,303.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Aetna MGG,Aetna MGG,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,BCBS,BCBS,303.58,,,,,,,per diem,303.58,303.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,BCBS MGG,BCBS MGG,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Cigna,Cigna,303.58,,,,,,,per diem,303.58,303.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Cigna MGG,Cigna MGG,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Humana,Humana,303.58,,,,,,,per diem,303.58,303.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Humana MGG,Humana MGG,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Optum VA,Optum VA,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,UHC,UHC,303.58,,,,,,,per diem,303.58,303.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,UHC MGG,UHC MGG,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,VA,VA,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Wellcare MGG,Wellcare MGG,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Bright Health - commercial,Bright Health - commercial,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,303.58,303.58,Bright Health MGG,Bright Health MGG,303.58,,,,,,,case rate,303.58,303.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Aetna,Aetna,126.67,,,,,,,per diem,126.67,126.67,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Aetna MGG,Aetna MGG,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,BCBS,BCBS,126.67,,,,,,,per diem,126.67,126.67,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,BCBS MGG,BCBS MGG,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Cigna,Cigna,126.67,,,,,,,per diem,126.67,126.67,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Cigna MGG,Cigna MGG,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Humana,Humana,126.67,,,,,,,per diem,126.67,126.67,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Humana MGG,Humana MGG,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Optum VA,Optum VA,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,UHC,UHC,126.67,,,,,,,per diem,126.67,126.67,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,UHC MGG,UHC MGG,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,VA,VA,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Wellcare MGG,Wellcare MGG,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Bright Health - commercial,Bright Health - commercial,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,126.67,126.67,Bright Health MGG,Bright Health MGG,126.67,,,,,,,case rate,126.67,126.67,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Aetna,Aetna,142.58,,,,,,,per diem,142.58,142.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Aetna MGG,Aetna MGG,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,BCBS,BCBS,142.58,,,,,,,per diem,142.58,142.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,BCBS MGG,BCBS MGG,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Cigna,Cigna,142.58,,,,,,,per diem,142.58,142.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Cigna MGG,Cigna MGG,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Humana,Humana,142.58,,,,,,,per diem,142.58,142.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Humana MGG,Humana MGG,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Optum VA,Optum VA,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,UHC,UHC,142.58,,,,,,,per diem,142.58,142.58,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,UHC MGG,UHC MGG,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,VA,VA,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Wellcare MGG,Wellcare MGG,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Bright Health - commercial,Bright Health - commercial,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,142.58,142.58,Bright Health MGG,Bright Health MGG,142.58,,,,,,,case rate,142.58,142.58,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Aetna,Aetna,149.03,,,,,,,per diem,149.03,149.03,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Aetna MGG,Aetna MGG,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,BCBS,BCBS,149.03,,,,,,,per diem,149.03,149.03,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,BCBS MGG,BCBS MGG,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Cigna,Cigna,149.03,,,,,,,per diem,149.03,149.03,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Cigna MGG,Cigna MGG,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Humana,Humana,149.03,,,,,,,per diem,149.03,149.03,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Humana MGG,Humana MGG,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Optum VA,Optum VA,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,UHC,UHC,149.03,,,,,,,per diem,149.03,149.03,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,UHC MGG,UHC MGG,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,VA,VA,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Wellcare MGG,Wellcare MGG,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Bright Health - commercial,Bright Health - commercial,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,149.03,149.03,Bright Health MGG,Bright Health MGG,149.03,,,,,,,case rate,149.03,149.03,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Aetna,Aetna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Aetna MGG,Aetna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,BCBS,BCBS,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,BCBS MGG,BCBS MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Cigna,Cigna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Cigna MGG,Cigna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Humana,Humana,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Humana MGG,Humana MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Optum VA,Optum VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,UHC,UHC,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,UHC MGG,UHC MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,VA,VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Wellcare MGG,Wellcare MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Bright Health - commercial,Bright Health - commercial,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.59,7.59,Bright Health MGG,Bright Health MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Aetna,Aetna,314.7,,,,,,,per diem,314.7,314.7,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Aetna MGG,Aetna MGG,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,BCBS,BCBS,314.7,,,,,,,per diem,314.7,314.7,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,BCBS MGG,BCBS MGG,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Cigna,Cigna,314.7,,,,,,,per diem,314.7,314.7,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Cigna MGG,Cigna MGG,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Humana,Humana,314.7,,,,,,,per diem,314.7,314.7,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Humana MGG,Humana MGG,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Optum VA,Optum VA,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,UHC,UHC,314.7,,,,,,,per diem,314.7,314.7,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,UHC MGG,UHC MGG,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,VA,VA,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Wellcare MGG,Wellcare MGG,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Bright Health - commercial,Bright Health - commercial,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,314.7,314.7,Bright Health MGG,Bright Health MGG,314.7,,,,,,,case rate,314.7,314.7,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Aetna,Aetna,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Aetna MGG,Aetna MGG,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,BCBS,BCBS,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,BCBS MGG,BCBS MGG,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Cigna,Cigna,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Cigna MGG,Cigna MGG,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Humana,Humana,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Humana MGG,Humana MGG,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Optum VA,Optum VA,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,UHC,UHC,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,UHC MGG,UHC MGG,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,VA,VA,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Wellcare MGG,Wellcare MGG,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Bright Health - commercial,Bright Health - commercial,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,39,39,Bright Health MGG,Bright Health MGG,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Aetna,Aetna,76.96,,,,,,,per diem,76.96,76.96,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Aetna MGG,Aetna MGG,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,BCBS,BCBS,76.96,,,,,,,per diem,76.96,76.96,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,BCBS MGG,BCBS MGG,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Cigna,Cigna,76.96,,,,,,,per diem,76.96,76.96,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Cigna MGG,Cigna MGG,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Humana,Humana,76.96,,,,,,,per diem,76.96,76.96,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Humana MGG,Humana MGG,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Optum VA,Optum VA,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,UHC,UHC,76.96,,,,,,,per diem,76.96,76.96,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,UHC MGG,UHC MGG,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,VA,VA,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Wellcare MGG,Wellcare MGG,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Bright Health - commercial,Bright Health - commercial,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,76.96,76.96,Bright Health MGG,Bright Health MGG,76.96,,,,,,,case rate,76.96,76.96,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Aetna,Aetna,248.98,,,,,,,per diem,248.98,248.98,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Aetna MGG,Aetna MGG,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,BCBS,BCBS,248.98,,,,,,,per diem,248.98,248.98,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,BCBS MGG,BCBS MGG,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Cigna,Cigna,248.98,,,,,,,per diem,248.98,248.98,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Cigna MGG,Cigna MGG,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Humana,Humana,248.98,,,,,,,per diem,248.98,248.98,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Humana MGG,Humana MGG,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Optum VA,Optum VA,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,UHC,UHC,248.98,,,,,,,per diem,248.98,248.98,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,UHC MGG,UHC MGG,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,VA,VA,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Wellcare MGG,Wellcare MGG,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Bright Health - commercial,Bright Health - commercial,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,248.98,248.98,Bright Health MGG,Bright Health MGG,248.98,,,,,,,case rate,248.98,248.98,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Aetna,Aetna,2982.3,,,,,,,per diem,2982.3,2982.3,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Aetna MGG,Aetna MGG,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,BCBS,BCBS,2982.3,,,,,,,per diem,2982.3,2982.3,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,BCBS MGG,BCBS MGG,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Cigna,Cigna,2982.3,,,,,,,per diem,2982.3,2982.3,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Cigna MGG,Cigna MGG,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Humana,Humana,2982.3,,,,,,,per diem,2982.3,2982.3,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Humana MGG,Humana MGG,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Optum VA,Optum VA,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,UHC,UHC,2982.3,,,,,,,per diem,2982.3,2982.3,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,UHC MGG,UHC MGG,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,VA,VA,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Wellcare MGG,Wellcare MGG,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Bright Health - commercial,Bright Health - commercial,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,2982.3,2982.3,Bright Health MGG,Bright Health MGG,2982.3,,,,,,,case rate,2982.3,2982.3,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Aetna,Aetna,1703.52,,,,,,,per diem,1703.52,1703.52,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Aetna MGG,Aetna MGG,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,BCBS,BCBS,1703.52,,,,,,,per diem,1703.52,1703.52,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,BCBS MGG,BCBS MGG,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Cigna,Cigna,1703.52,,,,,,,per diem,1703.52,1703.52,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Cigna MGG,Cigna MGG,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Humana,Humana,1703.52,,,,,,,per diem,1703.52,1703.52,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Humana MGG,Humana MGG,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Optum VA,Optum VA,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,UHC,UHC,1703.52,,,,,,,per diem,1703.52,1703.52,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,UHC MGG,UHC MGG,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,VA,VA,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Wellcare MGG,Wellcare MGG,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Bright Health - commercial,Bright Health - commercial,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1703.52,1703.52,Bright Health MGG,Bright Health MGG,1703.52,,,,,,,case rate,1703.52,1703.52,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Aetna,Aetna,412.78,,,,,,,per diem,412.78,412.78,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Aetna MGG,Aetna MGG,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,BCBS,BCBS,412.78,,,,,,,per diem,412.78,412.78,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,BCBS MGG,BCBS MGG,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Cigna,Cigna,412.78,,,,,,,per diem,412.78,412.78,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Cigna MGG,Cigna MGG,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Humana,Humana,412.78,,,,,,,per diem,412.78,412.78,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Humana MGG,Humana MGG,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Optum VA,Optum VA,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,UHC,UHC,412.78,,,,,,,per diem,412.78,412.78,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,UHC MGG,UHC MGG,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,VA,VA,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Wellcare MGG,Wellcare MGG,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Bright Health - commercial,Bright Health - commercial,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,412.78,412.78,Bright Health MGG,Bright Health MGG,412.78,,,,,,,case rate,412.78,412.78,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Aetna,Aetna,159.43,,,,,,,per diem,159.43,159.43,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Aetna MGG,Aetna MGG,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,BCBS,BCBS,159.43,,,,,,,per diem,159.43,159.43,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,BCBS MGG,BCBS MGG,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Cigna,Cigna,159.43,,,,,,,per diem,159.43,159.43,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Cigna MGG,Cigna MGG,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Humana,Humana,159.43,,,,,,,per diem,159.43,159.43,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Humana MGG,Humana MGG,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Optum VA,Optum VA,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,UHC,UHC,159.43,,,,,,,per diem,159.43,159.43,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,UHC MGG,UHC MGG,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,VA,VA,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Wellcare MGG,Wellcare MGG,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Bright Health - commercial,Bright Health - commercial,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,159.43,159.43,Bright Health MGG,Bright Health MGG,159.43,,,,,,,case rate,159.43,159.43,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Aetna,Aetna,373.46,,,,,,,per diem,373.46,373.46,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Aetna MGG,Aetna MGG,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,BCBS,BCBS,373.46,,,,,,,per diem,373.46,373.46,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,BCBS MGG,BCBS MGG,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Cigna,Cigna,373.46,,,,,,,per diem,373.46,373.46,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Cigna MGG,Cigna MGG,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Humana,Humana,373.46,,,,,,,per diem,373.46,373.46,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Humana MGG,Humana MGG,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Optum VA,Optum VA,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,UHC,UHC,373.46,,,,,,,per diem,373.46,373.46,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,UHC MGG,UHC MGG,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,VA,VA,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Wellcare MGG,Wellcare MGG,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Bright Health - commercial,Bright Health - commercial,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,373.46,373.46,Bright Health MGG,Bright Health MGG,373.46,,,,,,,case rate,373.46,373.46,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Aetna,Aetna,10.16,,,,,,,per diem,10.16,10.16,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Aetna MGG,Aetna MGG,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,BCBS,BCBS,10.16,,,,,,,per diem,10.16,10.16,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,BCBS MGG,BCBS MGG,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Cigna,Cigna,10.16,,,,,,,per diem,10.16,10.16,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Cigna MGG,Cigna MGG,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Humana,Humana,10.16,,,,,,,per diem,10.16,10.16,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Humana MGG,Humana MGG,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Optum VA,Optum VA,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,UHC,UHC,10.16,,,,,,,per diem,10.16,10.16,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,UHC MGG,UHC MGG,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,VA,VA,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Wellcare MGG,Wellcare MGG,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Bright Health - commercial,Bright Health - commercial,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.16,10.16,Bright Health MGG,Bright Health MGG,10.16,,,,,,,case rate,10.16,10.16,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Aetna,Aetna,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Aetna MGG,Aetna MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,BCBS,BCBS,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,BCBS MGG,BCBS MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Cigna,Cigna,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Cigna MGG,Cigna MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Humana,Humana,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Humana MGG,Humana MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Optum VA,Optum VA,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,UHC,UHC,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,UHC MGG,UHC MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,VA,VA,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Wellcare MGG,Wellcare MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Bright Health - commercial,Bright Health - commercial,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Bright Health MGG,Bright Health MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Aetna,Aetna,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Aetna MGG,Aetna MGG,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,BCBS,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,BCBS MGG,BCBS MGG,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Cigna,Cigna,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Cigna MGG,Cigna MGG,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Humana,Humana,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Humana MGG,Humana MGG,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Optum VA,Optum VA,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,UHC,UHC,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,UHC MGG,UHC MGG,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,VA,VA,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Wellcare MGG,Wellcare MGG,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Bright Health - commercial,Bright Health - commercial,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,39.57,39.57,Bright Health MGG,Bright Health MGG,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Aetna,Aetna,66.46,,,,,,,per diem,66.46,66.46,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Aetna MGG,Aetna MGG,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,BCBS,BCBS,66.46,,,,,,,per diem,66.46,66.46,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,BCBS MGG,BCBS MGG,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Cigna,Cigna,66.46,,,,,,,per diem,66.46,66.46,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Cigna MGG,Cigna MGG,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Humana,Humana,66.46,,,,,,,per diem,66.46,66.46,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Humana MGG,Humana MGG,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Optum VA,Optum VA,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,UHC,UHC,66.46,,,,,,,per diem,66.46,66.46,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,UHC MGG,UHC MGG,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,VA,VA,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Wellcare MGG,Wellcare MGG,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Bright Health - commercial,Bright Health - commercial,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,66.46,66.46,Bright Health MGG,Bright Health MGG,66.46,,,,,,,case rate,66.46,66.46,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Aetna,Aetna,8369.09,,,,,,,per diem,8369.09,8369.09,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Aetna MGG,Aetna MGG,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,BCBS,BCBS,8369.09,,,,,,,per diem,8369.09,8369.09,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,BCBS MGG,BCBS MGG,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Cigna,Cigna,8369.09,,,,,,,per diem,8369.09,8369.09,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Cigna MGG,Cigna MGG,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Humana,Humana,8369.09,,,,,,,per diem,8369.09,8369.09,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Humana MGG,Humana MGG,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Optum VA,Optum VA,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,UHC,UHC,8369.09,,,,,,,per diem,8369.09,8369.09,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,UHC MGG,UHC MGG,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,VA,VA,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Wellcare MGG,Wellcare MGG,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Bright Health - commercial,Bright Health - commercial,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8369.09,8369.09,Bright Health MGG,Bright Health MGG,8369.09,,,,,,,case rate,8369.09,8369.09,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Aetna,Aetna,125.63,,,,,,,per diem,125.63,125.63,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Aetna MGG,Aetna MGG,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,BCBS,BCBS,125.63,,,,,,,per diem,125.63,125.63,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,BCBS MGG,BCBS MGG,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Cigna,Cigna,125.63,,,,,,,per diem,125.63,125.63,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Cigna MGG,Cigna MGG,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Humana,Humana,125.63,,,,,,,per diem,125.63,125.63,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Humana MGG,Humana MGG,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Optum VA,Optum VA,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,UHC,UHC,125.63,,,,,,,per diem,125.63,125.63,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,UHC MGG,UHC MGG,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,VA,VA,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Wellcare MGG,Wellcare MGG,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Bright Health - commercial,Bright Health - commercial,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,125.63,125.63,Bright Health MGG,Bright Health MGG,125.63,,,,,,,case rate,125.63,125.63,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Aetna,Aetna,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Aetna MGG,Aetna MGG,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,BCBS,BCBS,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,BCBS MGG,BCBS MGG,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Cigna,Cigna,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Cigna MGG,Cigna MGG,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Humana,Humana,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Humana MGG,Humana MGG,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Optum VA,Optum VA,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,UHC,UHC,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,UHC MGG,UHC MGG,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,VA,VA,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Wellcare MGG,Wellcare MGG,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Bright Health - commercial,Bright Health - commercial,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,22.46,22.46,Bright Health MGG,Bright Health MGG,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Aetna,Aetna,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Aetna MGG,Aetna MGG,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,BCBS,BCBS,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,BCBS MGG,BCBS MGG,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Cigna,Cigna,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Cigna MGG,Cigna MGG,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Humana,Humana,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Humana MGG,Humana MGG,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Optum VA,Optum VA,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,UHC,UHC,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,UHC MGG,UHC MGG,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,VA,VA,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Wellcare MGG,Wellcare MGG,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Bright Health - commercial,Bright Health - commercial,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,Bright Health MGG,Bright Health MGG,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Aetna,Aetna,124.59,,,,,,,per diem,124.59,124.59,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Aetna MGG,Aetna MGG,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,BCBS,BCBS,124.59,,,,,,,per diem,124.59,124.59,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,BCBS MGG,BCBS MGG,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Cigna,Cigna,124.59,,,,,,,per diem,124.59,124.59,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Cigna MGG,Cigna MGG,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Humana,Humana,124.59,,,,,,,per diem,124.59,124.59,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Humana MGG,Humana MGG,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Optum VA,Optum VA,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,UHC,UHC,124.59,,,,,,,per diem,124.59,124.59,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,UHC MGG,UHC MGG,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,VA,VA,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Wellcare MGG,Wellcare MGG,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Bright Health - commercial,Bright Health - commercial,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,124.59,124.59,Bright Health MGG,Bright Health MGG,124.59,,,,,,,case rate,124.59,124.59,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Aetna,Aetna,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Aetna MGG,Aetna MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,BCBS,BCBS,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,BCBS MGG,BCBS MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Cigna,Cigna,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Cigna MGG,Cigna MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Humana,Humana,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Humana MGG,Humana MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Optum VA,Optum VA,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,UHC,UHC,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,UHC MGG,UHC MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,VA,VA,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Wellcare MGG,Wellcare MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Bright Health - commercial,Bright Health - commercial,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,63.23,63.23,Bright Health MGG,Bright Health MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Aetna,Aetna,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Aetna MGG,Aetna MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,BCBS,BCBS,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,BCBS MGG,BCBS MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Cigna,Cigna,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Cigna MGG,Cigna MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Humana,Humana,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Humana MGG,Humana MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Optum VA,Optum VA,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,UHC,UHC,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,UHC MGG,UHC MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,VA,VA,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Wellcare MGG,Wellcare MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Bright Health - commercial,Bright Health - commercial,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,63.96,63.96,Bright Health MGG,Bright Health MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Aetna,Aetna,64.48,,,,,,,per diem,64.48,64.48,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Aetna MGG,Aetna MGG,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,BCBS,BCBS,64.48,,,,,,,per diem,64.48,64.48,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,BCBS MGG,BCBS MGG,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Cigna,Cigna,64.48,,,,,,,per diem,64.48,64.48,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Cigna MGG,Cigna MGG,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Humana,Humana,64.48,,,,,,,per diem,64.48,64.48,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Humana MGG,Humana MGG,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Optum VA,Optum VA,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,UHC,UHC,64.48,,,,,,,per diem,64.48,64.48,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,UHC MGG,UHC MGG,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,VA,VA,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Wellcare MGG,Wellcare MGG,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Bright Health - commercial,Bright Health - commercial,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,64.48,64.48,Bright Health MGG,Bright Health MGG,64.48,,,,,,,case rate,64.48,64.48,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Aetna,Aetna,95.47,,,,,,,per diem,95.47,95.47,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Aetna MGG,Aetna MGG,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,BCBS,BCBS,95.47,,,,,,,per diem,95.47,95.47,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,BCBS MGG,BCBS MGG,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Cigna,Cigna,95.47,,,,,,,per diem,95.47,95.47,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Cigna MGG,Cigna MGG,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Humana,Humana,95.47,,,,,,,per diem,95.47,95.47,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Humana MGG,Humana MGG,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Optum VA,Optum VA,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,UHC,UHC,95.47,,,,,,,per diem,95.47,95.47,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,UHC MGG,UHC MGG,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,VA,VA,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Wellcare MGG,Wellcare MGG,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Bright Health - commercial,Bright Health - commercial,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,95.47,95.47,Bright Health MGG,Bright Health MGG,95.47,,,,,,,case rate,95.47,95.47,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Aetna,Aetna,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Aetna MGG,Aetna MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,BCBS,BCBS,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,BCBS MGG,BCBS MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Cigna,Cigna,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Cigna MGG,Cigna MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Humana,Humana,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Humana MGG,Humana MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Optum VA,Optum VA,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,UHC,UHC,50.96,,,,,,,per diem,50.96,50.96,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,UHC MGG,UHC MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,VA,VA,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Wellcare MGG,Wellcare MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Bright Health - commercial,Bright Health - commercial,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,50.96,50.96,Bright Health MGG,Bright Health MGG,50.96,,,,,,,case rate,50.96,50.96,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Aetna,Aetna,317.27,,,,,,,per diem,317.27,317.27,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Aetna MGG,Aetna MGG,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,BCBS,BCBS,317.27,,,,,,,per diem,317.27,317.27,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,BCBS MGG,BCBS MGG,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Cigna,Cigna,317.27,,,,,,,per diem,317.27,317.27,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Cigna MGG,Cigna MGG,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Humana,Humana,317.27,,,,,,,per diem,317.27,317.27,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Humana MGG,Humana MGG,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Optum VA,Optum VA,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,UHC,UHC,317.27,,,,,,,per diem,317.27,317.27,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,UHC MGG,UHC MGG,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,VA,VA,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Wellcare MGG,Wellcare MGG,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Bright Health - commercial,Bright Health - commercial,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,317.27,317.27,Bright Health MGG,Bright Health MGG,317.27,,,,,,,case rate,317.27,317.27,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Aetna,Aetna,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Aetna MGG,Aetna MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,BCBS,BCBS,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,BCBS MGG,BCBS MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Cigna,Cigna,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Cigna MGG,Cigna MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Humana,Humana,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Humana MGG,Humana MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Optum VA,Optum VA,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,UHC,UHC,86.63,,,,,,,per diem,86.63,86.63,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,UHC MGG,UHC MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,VA,VA,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Wellcare MGG,Wellcare MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Bright Health - commercial,Bright Health - commercial,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,86.63,86.63,Bright Health MGG,Bright Health MGG,86.63,,,,,,,case rate,86.63,86.63,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Aetna,Aetna,174.72,,,,,,,per diem,174.72,174.72,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Aetna MGG,Aetna MGG,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,BCBS,BCBS,174.72,,,,,,,per diem,174.72,174.72,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,BCBS MGG,BCBS MGG,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Cigna,Cigna,174.72,,,,,,,per diem,174.72,174.72,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Cigna MGG,Cigna MGG,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Humana,Humana,174.72,,,,,,,per diem,174.72,174.72,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Humana MGG,Humana MGG,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Optum VA,Optum VA,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,UHC,UHC,174.72,,,,,,,per diem,174.72,174.72,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,UHC MGG,UHC MGG,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,VA,VA,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Wellcare MGG,Wellcare MGG,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Bright Health - commercial,Bright Health - commercial,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,174.72,174.72,Bright Health MGG,Bright Health MGG,174.72,,,,,,,case rate,174.72,174.72,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Aetna,Aetna,1289.37,,,,,,,per diem,1289.37,1289.37,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Aetna MGG,Aetna MGG,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,BCBS,BCBS,1289.37,,,,,,,per diem,1289.37,1289.37,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,BCBS MGG,BCBS MGG,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Cigna,Cigna,1289.37,,,,,,,per diem,1289.37,1289.37,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Cigna MGG,Cigna MGG,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Humana,Humana,1289.37,,,,,,,per diem,1289.37,1289.37,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Humana MGG,Humana MGG,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Optum VA,Optum VA,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,UHC,UHC,1289.37,,,,,,,per diem,1289.37,1289.37,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,UHC MGG,UHC MGG,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,VA,VA,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Wellcare MGG,Wellcare MGG,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Bright Health - commercial,Bright Health - commercial,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1289.37,1289.37,Bright Health MGG,Bright Health MGG,1289.37,,,,,,,case rate,1289.37,1289.37,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Aetna,Aetna,981.4,,,,,,,per diem,981.4,981.4,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Aetna MGG,Aetna MGG,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,BCBS,BCBS,981.4,,,,,,,per diem,981.4,981.4,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,BCBS MGG,BCBS MGG,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Cigna,Cigna,981.4,,,,,,,per diem,981.4,981.4,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Cigna MGG,Cigna MGG,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Humana,Humana,981.4,,,,,,,per diem,981.4,981.4,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Humana MGG,Humana MGG,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Optum VA,Optum VA,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,UHC,UHC,981.4,,,,,,,per diem,981.4,981.4,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,UHC MGG,UHC MGG,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,VA,VA,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Wellcare MGG,Wellcare MGG,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Bright Health - commercial,Bright Health - commercial,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,981.4,981.4,Bright Health MGG,Bright Health MGG,981.4,,,,,,,case rate,981.4,981.4,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Aetna,Aetna,92.56,,,,,,,per diem,92.56,92.56,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Aetna MGG,Aetna MGG,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,BCBS,BCBS,92.56,,,,,,,per diem,92.56,92.56,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,BCBS MGG,BCBS MGG,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Cigna,Cigna,92.56,,,,,,,per diem,92.56,92.56,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Cigna MGG,Cigna MGG,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Humana,Humana,92.56,,,,,,,per diem,92.56,92.56,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Humana MGG,Humana MGG,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Optum VA,Optum VA,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,UHC,UHC,92.56,,,,,,,per diem,92.56,92.56,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,UHC MGG,UHC MGG,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,VA,VA,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Wellcare MGG,Wellcare MGG,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Bright Health - commercial,Bright Health - commercial,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,92.56,92.56,Bright Health MGG,Bright Health MGG,92.56,,,,,,,case rate,92.56,92.56,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Aetna,Aetna,553.64,,,,,,,per diem,553.64,553.64,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Aetna MGG,Aetna MGG,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,BCBS,BCBS,553.64,,,,,,,per diem,553.64,553.64,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,BCBS MGG,BCBS MGG,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Cigna,Cigna,553.64,,,,,,,per diem,553.64,553.64,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Cigna MGG,Cigna MGG,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Humana,Humana,553.64,,,,,,,per diem,553.64,553.64,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Humana MGG,Humana MGG,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Optum VA,Optum VA,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,UHC,UHC,553.64,,,,,,,per diem,553.64,553.64,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,UHC MGG,UHC MGG,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,VA,VA,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Wellcare MGG,Wellcare MGG,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Bright Health - commercial,Bright Health - commercial,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,553.64,553.64,Bright Health MGG,Bright Health MGG,553.64,,,,,,,case rate,553.64,553.64,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Aetna,Aetna,382.2,,,,,,,per diem,382.2,382.2,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Aetna MGG,Aetna MGG,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,BCBS,BCBS,382.2,,,,,,,per diem,382.2,382.2,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,BCBS MGG,BCBS MGG,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Cigna,Cigna,382.2,,,,,,,per diem,382.2,382.2,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Cigna MGG,Cigna MGG,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Humana,Humana,382.2,,,,,,,per diem,382.2,382.2,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Humana MGG,Humana MGG,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Optum VA,Optum VA,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,UHC,UHC,382.2,,,,,,,per diem,382.2,382.2,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,UHC MGG,UHC MGG,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,VA,VA,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Wellcare MGG,Wellcare MGG,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Bright Health - commercial,Bright Health - commercial,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,382.2,382.2,Bright Health MGG,Bright Health MGG,382.2,,,,,,,case rate,382.2,382.2,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Aetna,Aetna,420.78,,,,,,,per diem,420.78,420.78,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Aetna MGG,Aetna MGG,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,BCBS,BCBS,420.78,,,,,,,per diem,420.78,420.78,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,BCBS MGG,BCBS MGG,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Cigna,Cigna,420.78,,,,,,,per diem,420.78,420.78,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Cigna MGG,Cigna MGG,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Humana,Humana,420.78,,,,,,,per diem,420.78,420.78,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Humana MGG,Humana MGG,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Optum VA,Optum VA,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,UHC,UHC,420.78,,,,,,,per diem,420.78,420.78,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,UHC MGG,UHC MGG,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,VA,VA,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Wellcare MGG,Wellcare MGG,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Bright Health - commercial,Bright Health - commercial,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,420.78,420.78,Bright Health MGG,Bright Health MGG,420.78,,,,,,,case rate,420.78,420.78,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Aetna,Aetna,784.06,,,,,,,per diem,784.06,784.06,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Aetna MGG,Aetna MGG,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,BCBS,BCBS,784.06,,,,,,,per diem,784.06,784.06,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,BCBS MGG,BCBS MGG,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Cigna,Cigna,784.06,,,,,,,per diem,784.06,784.06,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Cigna MGG,Cigna MGG,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Humana,Humana,784.06,,,,,,,per diem,784.06,784.06,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Humana MGG,Humana MGG,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Optum VA,Optum VA,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,UHC,UHC,784.06,,,,,,,per diem,784.06,784.06,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,UHC MGG,UHC MGG,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,VA,VA,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Wellcare MGG,Wellcare MGG,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Bright Health - commercial,Bright Health - commercial,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,784.06,784.06,Bright Health MGG,Bright Health MGG,784.06,,,,,,,case rate,784.06,784.06,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Aetna,Aetna,17.26,,,,,,,per diem,17.26,17.26,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Aetna MGG,Aetna MGG,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,BCBS,BCBS,17.26,,,,,,,per diem,17.26,17.26,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,BCBS MGG,BCBS MGG,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Cigna,Cigna,17.26,,,,,,,per diem,17.26,17.26,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Cigna MGG,Cigna MGG,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Humana,Humana,17.26,,,,,,,per diem,17.26,17.26,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Humana MGG,Humana MGG,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Optum VA,Optum VA,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,UHC,UHC,17.26,,,,,,,per diem,17.26,17.26,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,UHC MGG,UHC MGG,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,VA,VA,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Wellcare MGG,Wellcare MGG,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Bright Health - commercial,Bright Health - commercial,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,17.26,17.26,Bright Health MGG,Bright Health MGG,17.26,,,,,,,case rate,17.26,17.26,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Aetna,Aetna,441.17,,,,,,,per diem,441.17,441.17,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Aetna MGG,Aetna MGG,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,BCBS,BCBS,441.17,,,,,,,per diem,441.17,441.17,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,BCBS MGG,BCBS MGG,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Cigna,Cigna,441.17,,,,,,,per diem,441.17,441.17,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Cigna MGG,Cigna MGG,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Humana,Humana,441.17,,,,,,,per diem,441.17,441.17,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Humana MGG,Humana MGG,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Optum VA,Optum VA,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,UHC,UHC,441.17,,,,,,,per diem,441.17,441.17,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,UHC MGG,UHC MGG,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,VA,VA,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Wellcare MGG,Wellcare MGG,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Bright Health - commercial,Bright Health - commercial,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,441.17,441.17,Bright Health MGG,Bright Health MGG,441.17,,,,,,,case rate,441.17,441.17,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Aetna,Aetna,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Aetna MGG,Aetna MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,BCBS,BCBS,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,BCBS MGG,BCBS MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Cigna,Cigna,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Cigna MGG,Cigna MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Humana,Humana,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Humana MGG,Humana MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Optum VA,Optum VA,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,UHC,UHC,311.27,,,,,,,per diem,311.27,311.27,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,UHC MGG,UHC MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,VA,VA,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Wellcare MGG,Wellcare MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Bright Health - commercial,Bright Health - commercial,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,311.27,311.27,Bright Health MGG,Bright Health MGG,311.27,,,,,,,case rate,311.27,311.27,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Aetna,Aetna,169.31,,,,,,,per diem,169.31,169.31,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Aetna MGG,Aetna MGG,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,BCBS,BCBS,169.31,,,,,,,per diem,169.31,169.31,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,BCBS MGG,BCBS MGG,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Cigna,Cigna,169.31,,,,,,,per diem,169.31,169.31,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Cigna MGG,Cigna MGG,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Humana,Humana,169.31,,,,,,,per diem,169.31,169.31,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Humana MGG,Humana MGG,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Optum VA,Optum VA,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,UHC,UHC,169.31,,,,,,,per diem,169.31,169.31,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,UHC MGG,UHC MGG,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,VA,VA,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Wellcare MGG,Wellcare MGG,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Bright Health - commercial,Bright Health - commercial,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,169.31,169.31,Bright Health MGG,Bright Health MGG,169.31,,,,,,,case rate,169.31,169.31,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Aetna,Aetna,56.68,,,,,,,per diem,56.68,56.68,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Aetna MGG,Aetna MGG,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,BCBS,BCBS,56.68,,,,,,,per diem,56.68,56.68,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,BCBS MGG,BCBS MGG,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Cigna,Cigna,56.68,,,,,,,per diem,56.68,56.68,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Cigna MGG,Cigna MGG,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Humana,Humana,56.68,,,,,,,per diem,56.68,56.68,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Humana MGG,Humana MGG,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Optum VA,Optum VA,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,UHC,UHC,56.68,,,,,,,per diem,56.68,56.68,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,UHC MGG,UHC MGG,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,VA,VA,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Wellcare MGG,Wellcare MGG,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Bright Health - commercial,Bright Health - commercial,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,56.68,56.68,Bright Health MGG,Bright Health MGG,56.68,,,,,,,case rate,56.68,56.68,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Aetna,Aetna,210.5,,,,,,,per diem,210.5,210.5,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Aetna MGG,Aetna MGG,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,BCBS,BCBS,210.5,,,,,,,per diem,210.5,210.5,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,BCBS MGG,BCBS MGG,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Cigna,Cigna,210.5,,,,,,,per diem,210.5,210.5,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Cigna MGG,Cigna MGG,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Humana,Humana,210.5,,,,,,,per diem,210.5,210.5,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Humana MGG,Humana MGG,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Optum VA,Optum VA,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,UHC,UHC,210.5,,,,,,,per diem,210.5,210.5,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,UHC MGG,UHC MGG,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,VA,VA,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Wellcare MGG,Wellcare MGG,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Bright Health - commercial,Bright Health - commercial,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,210.5,210.5,Bright Health MGG,Bright Health MGG,210.5,,,,,,,case rate,210.5,210.5,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Aetna,Aetna,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Aetna MGG,Aetna MGG,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,BCBS,BCBS,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,BCBS MGG,BCBS MGG,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Cigna,Cigna,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Cigna MGG,Cigna MGG,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Humana,Humana,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Humana MGG,Humana MGG,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Optum VA,Optum VA,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,UHC,UHC,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,UHC MGG,UHC MGG,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,VA,VA,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Wellcare MGG,Wellcare MGG,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Bright Health - commercial,Bright Health - commercial,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,229.32,229.32,Bright Health MGG,Bright Health MGG,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Aetna,Aetna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Aetna MGG,Aetna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,BCBS,BCBS,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,BCBS MGG,BCBS MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Cigna,Cigna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Cigna MGG,Cigna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Humana,Humana,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Humana MGG,Humana MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Optum VA,Optum VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,UHC,UHC,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,UHC MGG,UHC MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,VA,VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Wellcare MGG,Wellcare MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Bright Health - commercial,Bright Health - commercial,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.34,11.34,Bright Health MGG,Bright Health MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Aetna,Aetna,91.94,,,,,,,per diem,91.94,91.94,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Aetna MGG,Aetna MGG,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,BCBS,BCBS,91.94,,,,,,,per diem,91.94,91.94,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,BCBS MGG,BCBS MGG,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Cigna,Cigna,91.94,,,,,,,per diem,91.94,91.94,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Cigna MGG,Cigna MGG,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Humana,Humana,91.94,,,,,,,per diem,91.94,91.94,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Humana MGG,Humana MGG,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Optum VA,Optum VA,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,UHC,UHC,91.94,,,,,,,per diem,91.94,91.94,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,UHC MGG,UHC MGG,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,VA,VA,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Wellcare MGG,Wellcare MGG,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Bright Health - commercial,Bright Health - commercial,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,91.94,91.94,Bright Health MGG,Bright Health MGG,91.94,,,,,,,case rate,91.94,91.94,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Aetna,Aetna,30.58,,,,,,,per diem,30.58,30.58,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Aetna MGG,Aetna MGG,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,BCBS,BCBS,30.58,,,,,,,per diem,30.58,30.58,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,BCBS MGG,BCBS MGG,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Cigna,Cigna,30.58,,,,,,,per diem,30.58,30.58,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Cigna MGG,Cigna MGG,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Humana,Humana,30.58,,,,,,,per diem,30.58,30.58,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Humana MGG,Humana MGG,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Optum VA,Optum VA,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,UHC,UHC,30.58,,,,,,,per diem,30.58,30.58,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,UHC MGG,UHC MGG,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,VA,VA,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Wellcare MGG,Wellcare MGG,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Bright Health - commercial,Bright Health - commercial,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,30.58,30.58,Bright Health MGG,Bright Health MGG,30.58,,,,,,,case rate,30.58,30.58,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Aetna,Aetna,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Aetna MGG,Aetna MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,BCBS,BCBS,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,BCBS MGG,BCBS MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Cigna,Cigna,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Cigna MGG,Cigna MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Humana,Humana,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Humana MGG,Humana MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Optum VA,Optum VA,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,UHC,UHC,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,UHC MGG,UHC MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,VA,VA,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Wellcare MGG,Wellcare MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Bright Health - commercial,Bright Health - commercial,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,130,130,Bright Health MGG,Bright Health MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Aetna,Aetna,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Aetna MGG,Aetna MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,BCBS,BCBS,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,BCBS MGG,BCBS MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Cigna,Cigna,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Cigna MGG,Cigna MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Humana,Humana,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Humana MGG,Humana MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Optum VA,Optum VA,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,UHC,UHC,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,UHC MGG,UHC MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,VA,VA,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Wellcare MGG,Wellcare MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Bright Health - commercial,Bright Health - commercial,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,168.17,168.17,Bright Health MGG,Bright Health MGG,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Aetna,Aetna,68.22,,,,,,,per diem,68.22,68.22,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Aetna MGG,Aetna MGG,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,BCBS,BCBS,68.22,,,,,,,per diem,68.22,68.22,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,BCBS MGG,BCBS MGG,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Cigna,Cigna,68.22,,,,,,,per diem,68.22,68.22,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Cigna MGG,Cigna MGG,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Humana,Humana,68.22,,,,,,,per diem,68.22,68.22,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Humana MGG,Humana MGG,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Optum VA,Optum VA,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,UHC,UHC,68.22,,,,,,,per diem,68.22,68.22,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,UHC MGG,UHC MGG,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,VA,VA,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Wellcare MGG,Wellcare MGG,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Bright Health - commercial,Bright Health - commercial,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,68.22,68.22,Bright Health MGG,Bright Health MGG,68.22,,,,,,,case rate,68.22,68.22,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Aetna,Aetna,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Aetna MGG,Aetna MGG,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,BCBS,BCBS,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,BCBS MGG,BCBS MGG,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Cigna,Cigna,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Cigna MGG,Cigna MGG,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Humana,Humana,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Humana MGG,Humana MGG,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Optum VA,Optum VA,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,UHC,UHC,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,UHC MGG,UHC MGG,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,VA,VA,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Wellcare MGG,Wellcare MGG,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Bright Health - commercial,Bright Health - commercial,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,21.74,21.74,Bright Health MGG,Bright Health MGG,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Aetna,Aetna,442.31,,,,,,,per diem,442.31,442.31,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Aetna MGG,Aetna MGG,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,BCBS,BCBS,442.31,,,,,,,per diem,442.31,442.31,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,BCBS MGG,BCBS MGG,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Cigna,Cigna,442.31,,,,,,,per diem,442.31,442.31,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Cigna MGG,Cigna MGG,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Humana,Humana,442.31,,,,,,,per diem,442.31,442.31,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Humana MGG,Humana MGG,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Optum VA,Optum VA,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,UHC,UHC,442.31,,,,,,,per diem,442.31,442.31,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,UHC MGG,UHC MGG,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,VA,VA,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Wellcare MGG,Wellcare MGG,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Bright Health - commercial,Bright Health - commercial,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,442.31,442.31,Bright Health MGG,Bright Health MGG,442.31,,,,,,,case rate,442.31,442.31,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Aetna,Aetna,234.33,,,,,,,per diem,234.33,234.33,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Aetna MGG,Aetna MGG,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,BCBS,BCBS,234.33,,,,,,,per diem,234.33,234.33,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,BCBS MGG,BCBS MGG,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Cigna,Cigna,234.33,,,,,,,per diem,234.33,234.33,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Cigna MGG,Cigna MGG,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Humana,Humana,234.33,,,,,,,per diem,234.33,234.33,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Humana MGG,Humana MGG,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Optum VA,Optum VA,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,UHC,UHC,234.33,,,,,,,per diem,234.33,234.33,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,UHC MGG,UHC MGG,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,VA,VA,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Wellcare MGG,Wellcare MGG,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Bright Health - commercial,Bright Health - commercial,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,234.33,234.33,Bright Health MGG,Bright Health MGG,234.33,,,,,,,case rate,234.33,234.33,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Aetna,Aetna,28.81,,,,,,,per diem,28.81,28.81,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Aetna MGG,Aetna MGG,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,BCBS,BCBS,28.81,,,,,,,per diem,28.81,28.81,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,BCBS MGG,BCBS MGG,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Cigna,Cigna,28.81,,,,,,,per diem,28.81,28.81,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Cigna MGG,Cigna MGG,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Humana,Humana,28.81,,,,,,,per diem,28.81,28.81,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Humana MGG,Humana MGG,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Optum VA,Optum VA,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,UHC,UHC,28.81,,,,,,,per diem,28.81,28.81,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,UHC MGG,UHC MGG,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,VA,VA,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Wellcare MGG,Wellcare MGG,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Bright Health - commercial,Bright Health - commercial,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,28.81,28.81,Bright Health MGG,Bright Health MGG,28.81,,,,,,,case rate,28.81,28.81,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Aetna,Aetna,30.26,,,,,,,per diem,30.26,30.26,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Aetna MGG,Aetna MGG,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,BCBS,BCBS,30.26,,,,,,,per diem,30.26,30.26,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,BCBS MGG,BCBS MGG,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Cigna,Cigna,30.26,,,,,,,per diem,30.26,30.26,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Cigna MGG,Cigna MGG,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Humana,Humana,30.26,,,,,,,per diem,30.26,30.26,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Humana MGG,Humana MGG,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Optum VA,Optum VA,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,UHC,UHC,30.26,,,,,,,per diem,30.26,30.26,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,UHC MGG,UHC MGG,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,VA,VA,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Wellcare MGG,Wellcare MGG,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Bright Health - commercial,Bright Health - commercial,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,30.26,30.26,Bright Health MGG,Bright Health MGG,30.26,,,,,,,case rate,30.26,30.26,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Aetna,Aetna,52.62,,,,,,,per diem,52.62,52.62,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Aetna MGG,Aetna MGG,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,BCBS,BCBS,52.62,,,,,,,per diem,52.62,52.62,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,BCBS MGG,BCBS MGG,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Cigna,Cigna,52.62,,,,,,,per diem,52.62,52.62,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Cigna MGG,Cigna MGG,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Humana,Humana,52.62,,,,,,,per diem,52.62,52.62,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Humana MGG,Humana MGG,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Optum VA,Optum VA,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,UHC,UHC,52.62,,,,,,,per diem,52.62,52.62,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,UHC MGG,UHC MGG,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,VA,VA,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Wellcare MGG,Wellcare MGG,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Bright Health - commercial,Bright Health - commercial,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,52.62,52.62,Bright Health MGG,Bright Health MGG,52.62,,,,,,,case rate,52.62,52.62,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Aetna,Aetna,12.58,,,,,,,per diem,12.58,12.58,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Aetna MGG,Aetna MGG,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,BCBS,BCBS,12.58,,,,,,,per diem,12.58,12.58,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,BCBS MGG,BCBS MGG,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Cigna,Cigna,12.58,,,,,,,per diem,12.58,12.58,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Cigna MGG,Cigna MGG,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Humana,Humana,12.58,,,,,,,per diem,12.58,12.58,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Humana MGG,Humana MGG,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Optum VA,Optum VA,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,UHC,UHC,12.58,,,,,,,per diem,12.58,12.58,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,UHC MGG,UHC MGG,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,VA,VA,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Wellcare MGG,Wellcare MGG,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Bright Health - commercial,Bright Health - commercial,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,12.58,12.58,Bright Health MGG,Bright Health MGG,12.58,,,,,,,case rate,12.58,12.58,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Aetna,Aetna,20.8,,,,,,,per diem,20.8,20.8,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Aetna MGG,Aetna MGG,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,BCBS,BCBS,20.8,,,,,,,per diem,20.8,20.8,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,BCBS MGG,BCBS MGG,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Cigna,Cigna,20.8,,,,,,,per diem,20.8,20.8,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Cigna MGG,Cigna MGG,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Humana,Humana,20.8,,,,,,,per diem,20.8,20.8,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Humana MGG,Humana MGG,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Optum VA,Optum VA,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,UHC,UHC,20.8,,,,,,,per diem,20.8,20.8,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,UHC MGG,UHC MGG,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,VA,VA,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Wellcare MGG,Wellcare MGG,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Bright Health - commercial,Bright Health - commercial,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,20.8,20.8,Bright Health MGG,Bright Health MGG,20.8,,,,,,,case rate,20.8,20.8,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Aetna,Aetna,60.94,,,,,,,per diem,60.94,60.94,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Aetna MGG,Aetna MGG,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,BCBS,BCBS,60.94,,,,,,,per diem,60.94,60.94,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,BCBS MGG,BCBS MGG,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Cigna,Cigna,60.94,,,,,,,per diem,60.94,60.94,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Cigna MGG,Cigna MGG,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Humana,Humana,60.94,,,,,,,per diem,60.94,60.94,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Humana MGG,Humana MGG,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Optum VA,Optum VA,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,UHC,UHC,60.94,,,,,,,per diem,60.94,60.94,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,UHC MGG,UHC MGG,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,VA,VA,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Wellcare MGG,Wellcare MGG,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Bright Health - commercial,Bright Health - commercial,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,60.94,60.94,Bright Health MGG,Bright Health MGG,60.94,,,,,,,case rate,60.94,60.94,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Aetna,Aetna,71.24,,,,,,,per diem,71.24,71.24,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Aetna MGG,Aetna MGG,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,BCBS,BCBS,71.24,,,,,,,per diem,71.24,71.24,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,BCBS MGG,BCBS MGG,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Cigna,Cigna,71.24,,,,,,,per diem,71.24,71.24,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Cigna MGG,Cigna MGG,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Humana,Humana,71.24,,,,,,,per diem,71.24,71.24,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Humana MGG,Humana MGG,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Optum VA,Optum VA,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,UHC,UHC,71.24,,,,,,,per diem,71.24,71.24,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,UHC MGG,UHC MGG,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,VA,VA,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Wellcare MGG,Wellcare MGG,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Bright Health - commercial,Bright Health - commercial,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,71.24,71.24,Bright Health MGG,Bright Health MGG,71.24,,,,,,,case rate,71.24,71.24,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Aetna,Aetna,1763.64,,,,,,,per diem,1763.64,1763.64,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Aetna MGG,Aetna MGG,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,BCBS,BCBS,1763.64,,,,,,,per diem,1763.64,1763.64,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,BCBS MGG,BCBS MGG,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Cigna,Cigna,1763.64,,,,,,,per diem,1763.64,1763.64,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Cigna MGG,Cigna MGG,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Humana,Humana,1763.64,,,,,,,per diem,1763.64,1763.64,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Humana MGG,Humana MGG,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Optum VA,Optum VA,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,UHC,UHC,1763.64,,,,,,,per diem,1763.64,1763.64,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,UHC MGG,UHC MGG,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,VA,VA,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Wellcare MGG,Wellcare MGG,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Bright Health - commercial,Bright Health - commercial,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1763.64,1763.64,Bright Health MGG,Bright Health MGG,1763.64,,,,,,,case rate,1763.64,1763.64,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Aetna,Aetna,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Aetna MGG,Aetna MGG,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,BCBS,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,BCBS MGG,BCBS MGG,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Cigna,Cigna,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Cigna MGG,Cigna MGG,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Humana,Humana,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Humana MGG,Humana MGG,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Optum VA,Optum VA,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,UHC,UHC,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,UHC MGG,UHC MGG,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,VA,VA,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Wellcare MGG,Wellcare MGG,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Bright Health - commercial,Bright Health - commercial,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,9.67,9.67,Bright Health MGG,Bright Health MGG,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Aetna,Aetna,250.53,,,,,,,per diem,250.53,250.53,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Aetna MGG,Aetna MGG,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,BCBS,BCBS,250.53,,,,,,,per diem,250.53,250.53,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,BCBS MGG,BCBS MGG,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Cigna,Cigna,250.53,,,,,,,per diem,250.53,250.53,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Cigna MGG,Cigna MGG,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Humana,Humana,250.53,,,,,,,per diem,250.53,250.53,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Humana MGG,Humana MGG,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Optum VA,Optum VA,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,UHC,UHC,250.53,,,,,,,per diem,250.53,250.53,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,UHC MGG,UHC MGG,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,VA,VA,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Wellcare MGG,Wellcare MGG,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Bright Health - commercial,Bright Health - commercial,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,250.53,250.53,Bright Health MGG,Bright Health MGG,250.53,,,,,,,case rate,250.53,250.53,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Aetna,Aetna,30.99,,,,,,,per diem,30.99,30.99,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Aetna MGG,Aetna MGG,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,BCBS,BCBS,30.99,,,,,,,per diem,30.99,30.99,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,BCBS MGG,BCBS MGG,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Cigna,Cigna,30.99,,,,,,,per diem,30.99,30.99,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Cigna MGG,Cigna MGG,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Humana,Humana,30.99,,,,,,,per diem,30.99,30.99,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Humana MGG,Humana MGG,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Optum VA,Optum VA,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,UHC,UHC,30.99,,,,,,,per diem,30.99,30.99,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,UHC MGG,UHC MGG,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,VA,VA,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Wellcare MGG,Wellcare MGG,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Bright Health - commercial,Bright Health - commercial,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,30.99,30.99,Bright Health MGG,Bright Health MGG,30.99,,,,,,,case rate,30.99,30.99,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Aetna,Aetna,103,,,,,,,per diem,103,103,"Per diem rate, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Aetna MGG,Aetna MGG,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,BCBS,BCBS,103,,,,,,,per diem,103,103,"Per diem rate, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,BCBS MGG,BCBS MGG,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Cigna,Cigna,103,,,,,,,per diem,103,103,"Per diem rate, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Cigna MGG,Cigna MGG,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Humana,Humana,103,,,,,,,per diem,103,103,"Per diem rate, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Humana MGG,Humana MGG,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Optum VA,Optum VA,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,UHC,UHC,103,,,,,,,per diem,103,103,"Per diem rate, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,UHC MGG,UHC MGG,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,VA,VA,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Wellcare MGG,Wellcare MGG,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Bright Health - commercial,Bright Health - commercial,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
BACTERIAL ANTIGEN             ,38280010,CDM,306,RC,87449,CPT,,,,Inpatient,,,103,103,Bright Health MGG,Bright Health MGG,103,,,,,,,case rate,103,103,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Aetna,Aetna,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Aetna MGG,Aetna MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,BCBS,BCBS,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,BCBS MGG,BCBS MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Cigna,Cigna,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Cigna MGG,Cigna MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Humana,Humana,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Humana MGG,Humana MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Optum VA,Optum VA,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,UHC,UHC,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,UHC MGG,UHC MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,VA,VA,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Wellcare MGG,Wellcare MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Bright Health - commercial,Bright Health - commercial,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,75.44,75.44,Bright Health MGG,Bright Health MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Aetna,Aetna,255.66,,,,,,,per diem,255.66,255.66,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Aetna MGG,Aetna MGG,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,BCBS,BCBS,255.66,,,,,,,per diem,255.66,255.66,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,BCBS MGG,BCBS MGG,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Cigna,Cigna,255.66,,,,,,,per diem,255.66,255.66,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Cigna MGG,Cigna MGG,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Humana,Humana,255.66,,,,,,,per diem,255.66,255.66,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Humana MGG,Humana MGG,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Optum VA,Optum VA,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,UHC,UHC,255.66,,,,,,,per diem,255.66,255.66,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,UHC MGG,UHC MGG,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,VA,VA,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Wellcare MGG,Wellcare MGG,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Bright Health - commercial,Bright Health - commercial,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,255.66,255.66,Bright Health MGG,Bright Health MGG,255.66,,,,,,,case rate,255.66,255.66,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Aetna,Aetna,238.51,,,,,,,per diem,238.51,238.51,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Aetna MGG,Aetna MGG,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,BCBS,BCBS,238.51,,,,,,,per diem,238.51,238.51,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,BCBS MGG,BCBS MGG,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Cigna,Cigna,238.51,,,,,,,per diem,238.51,238.51,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Cigna MGG,Cigna MGG,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Humana,Humana,238.51,,,,,,,per diem,238.51,238.51,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Humana MGG,Humana MGG,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Optum VA,Optum VA,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,UHC,UHC,238.51,,,,,,,per diem,238.51,238.51,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,UHC MGG,UHC MGG,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,VA,VA,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Wellcare MGG,Wellcare MGG,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Bright Health - commercial,Bright Health - commercial,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,238.51,238.51,Bright Health MGG,Bright Health MGG,238.51,,,,,,,case rate,238.51,238.51,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Aetna,Aetna,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Aetna MGG,Aetna MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,BCBS,BCBS,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,BCBS MGG,BCBS MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Cigna,Cigna,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Cigna MGG,Cigna MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Humana,Humana,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Humana MGG,Humana MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Optum VA,Optum VA,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,UHC,UHC,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,UHC MGG,UHC MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,VA,VA,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Wellcare MGG,Wellcare MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Bright Health - commercial,Bright Health - commercial,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,245,245,Bright Health MGG,Bright Health MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Aetna,Aetna,238.57,,,,,,,per diem,238.57,238.57,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Aetna MGG,Aetna MGG,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,BCBS,BCBS,238.57,,,,,,,per diem,238.57,238.57,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,BCBS MGG,BCBS MGG,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Cigna,Cigna,238.57,,,,,,,per diem,238.57,238.57,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Cigna MGG,Cigna MGG,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Humana,Humana,238.57,,,,,,,per diem,238.57,238.57,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Humana MGG,Humana MGG,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Optum VA,Optum VA,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,UHC,UHC,238.57,,,,,,,per diem,238.57,238.57,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,UHC MGG,UHC MGG,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,VA,VA,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Wellcare MGG,Wellcare MGG,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Bright Health - commercial,Bright Health - commercial,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,238.57,238.57,Bright Health MGG,Bright Health MGG,238.57,,,,,,,case rate,238.57,238.57,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Aetna,Aetna,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Aetna MGG,Aetna MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,BCBS,BCBS,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,BCBS MGG,BCBS MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Cigna,Cigna,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Cigna MGG,Cigna MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Humana,Humana,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Humana MGG,Humana MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Optum VA,Optum VA,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,UHC,UHC,257,,,,,,,per diem,257,257,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,UHC MGG,UHC MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,VA,VA,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Wellcare MGG,Wellcare MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Bright Health - commercial,Bright Health - commercial,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,257,257,Bright Health MGG,Bright Health MGG,257,,,,,,,case rate,257,257,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Aetna,Aetna,363.35,,,,,,,per diem,363.35,363.35,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Aetna MGG,Aetna MGG,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,BCBS,BCBS,363.35,,,,,,,per diem,363.35,363.35,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,BCBS MGG,BCBS MGG,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Cigna,Cigna,363.35,,,,,,,per diem,363.35,363.35,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Cigna MGG,Cigna MGG,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Humana,Humana,363.35,,,,,,,per diem,363.35,363.35,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Humana MGG,Humana MGG,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Optum VA,Optum VA,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,UHC,UHC,363.35,,,,,,,per diem,363.35,363.35,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,UHC MGG,UHC MGG,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,VA,VA,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Wellcare MGG,Wellcare MGG,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Bright Health - commercial,Bright Health - commercial,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,363.35,363.35,Bright Health MGG,Bright Health MGG,363.35,,,,,,,case rate,363.35,363.35,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Aetna,Aetna,200,,,,,,,per diem,200,200,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Aetna MGG,Aetna MGG,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,BCBS,BCBS,200,,,,,,,per diem,200,200,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,BCBS MGG,BCBS MGG,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Cigna,Cigna,200,,,,,,,per diem,200,200,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Cigna MGG,Cigna MGG,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Humana,Humana,200,,,,,,,per diem,200,200,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Humana MGG,Humana MGG,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Optum VA,Optum VA,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,UHC,UHC,200,,,,,,,per diem,200,200,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,UHC MGG,UHC MGG,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,VA,VA,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Wellcare MGG,Wellcare MGG,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Bright Health - commercial,Bright Health - commercial,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,200,200,Bright Health MGG,Bright Health MGG,200,,,,,,,case rate,200,200,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Aetna,Aetna,503.88,,,,,,,per diem,503.88,503.88,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Aetna MGG,Aetna MGG,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,BCBS,BCBS,503.88,,,,,,,per diem,503.88,503.88,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,BCBS MGG,BCBS MGG,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Cigna,Cigna,503.88,,,,,,,per diem,503.88,503.88,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Cigna MGG,Cigna MGG,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Humana,Humana,503.88,,,,,,,per diem,503.88,503.88,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Humana MGG,Humana MGG,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Optum VA,Optum VA,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,UHC,UHC,503.88,,,,,,,per diem,503.88,503.88,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,UHC MGG,UHC MGG,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,VA,VA,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Wellcare MGG,Wellcare MGG,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Bright Health - commercial,Bright Health - commercial,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,503.88,503.88,Bright Health MGG,Bright Health MGG,503.88,,,,,,,case rate,503.88,503.88,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Aetna,Aetna,201,,,,,,,per diem,201,201,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Aetna MGG,Aetna MGG,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,BCBS,BCBS,201,,,,,,,per diem,201,201,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,BCBS MGG,BCBS MGG,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Cigna,Cigna,201,,,,,,,per diem,201,201,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Cigna MGG,Cigna MGG,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Humana,Humana,201,,,,,,,per diem,201,201,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Humana MGG,Humana MGG,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Optum VA,Optum VA,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,UHC,UHC,201,,,,,,,per diem,201,201,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,UHC MGG,UHC MGG,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,VA,VA,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Wellcare MGG,Wellcare MGG,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Bright Health - commercial,Bright Health - commercial,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,201,201,Bright Health MGG,Bright Health MGG,201,,,,,,,case rate,201,201,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Aetna,Aetna,66.8,,,,,,,per diem,66.8,66.8,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Aetna MGG,Aetna MGG,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,BCBS,BCBS,66.8,,,,,,,per diem,66.8,66.8,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,BCBS MGG,BCBS MGG,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Cigna,Cigna,66.8,,,,,,,per diem,66.8,66.8,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Cigna MGG,Cigna MGG,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Humana,Humana,66.8,,,,,,,per diem,66.8,66.8,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Humana MGG,Humana MGG,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Optum VA,Optum VA,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,UHC,UHC,66.8,,,,,,,per diem,66.8,66.8,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,UHC MGG,UHC MGG,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,VA,VA,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Wellcare MGG,Wellcare MGG,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Bright Health - commercial,Bright Health - commercial,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,66.8,66.8,Bright Health MGG,Bright Health MGG,66.8,,,,,,,case rate,66.8,66.8,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Aetna,Aetna,88.46,,,,,,,per diem,88.46,88.46,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Aetna MGG,Aetna MGG,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,BCBS,BCBS,88.46,,,,,,,per diem,88.46,88.46,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,BCBS MGG,BCBS MGG,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Cigna,Cigna,88.46,,,,,,,per diem,88.46,88.46,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Cigna MGG,Cigna MGG,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Humana,Humana,88.46,,,,,,,per diem,88.46,88.46,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Humana MGG,Humana MGG,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Optum VA,Optum VA,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,UHC,UHC,88.46,,,,,,,per diem,88.46,88.46,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,UHC MGG,UHC MGG,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,VA,VA,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Wellcare MGG,Wellcare MGG,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Bright Health - commercial,Bright Health - commercial,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,88.46,88.46,Bright Health MGG,Bright Health MGG,88.46,,,,,,,case rate,88.46,88.46,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Aetna,Aetna,227,,,,,,,per diem,227,227,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Aetna MGG,Aetna MGG,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,BCBS,BCBS,227,,,,,,,per diem,227,227,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,BCBS MGG,BCBS MGG,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Cigna,Cigna,227,,,,,,,per diem,227,227,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Cigna MGG,Cigna MGG,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Humana,Humana,227,,,,,,,per diem,227,227,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Humana MGG,Humana MGG,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Optum VA,Optum VA,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,UHC,UHC,227,,,,,,,per diem,227,227,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,UHC MGG,UHC MGG,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,VA,VA,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Wellcare MGG,Wellcare MGG,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Bright Health - commercial,Bright Health - commercial,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,227,227,Bright Health MGG,Bright Health MGG,227,,,,,,,case rate,227,227,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Aetna,Aetna,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Aetna MGG,Aetna MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,BCBS,BCBS,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,BCBS MGG,BCBS MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Cigna,Cigna,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Cigna MGG,Cigna MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Humana,Humana,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Humana MGG,Humana MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Optum VA,Optum VA,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,UHC,UHC,77.52,,,,,,,per diem,77.52,77.52,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,UHC MGG,UHC MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,VA,VA,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Wellcare MGG,Wellcare MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Bright Health - commercial,Bright Health - commercial,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,77.52,77.52,Bright Health MGG,Bright Health MGG,77.52,,,,,,,case rate,77.52,77.52,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Aetna,Aetna,65.69,,,,,,,per diem,65.69,65.69,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Aetna MGG,Aetna MGG,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,BCBS,BCBS,65.69,,,,,,,per diem,65.69,65.69,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,BCBS MGG,BCBS MGG,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Cigna,Cigna,65.69,,,,,,,per diem,65.69,65.69,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Cigna MGG,Cigna MGG,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Humana,Humana,65.69,,,,,,,per diem,65.69,65.69,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Humana MGG,Humana MGG,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Optum VA,Optum VA,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,UHC,UHC,65.69,,,,,,,per diem,65.69,65.69,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,UHC MGG,UHC MGG,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,VA,VA,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Wellcare MGG,Wellcare MGG,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Bright Health - commercial,Bright Health - commercial,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,65.69,65.69,Bright Health MGG,Bright Health MGG,65.69,,,,,,,case rate,65.69,65.69,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Aetna,Aetna,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Aetna MGG,Aetna MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,BCBS,BCBS,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,BCBS MGG,BCBS MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Cigna,Cigna,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Cigna MGG,Cigna MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Humana,Humana,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Humana MGG,Humana MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Optum VA,Optum VA,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,UHC,UHC,75.44,,,,,,,per diem,75.44,75.44,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,UHC MGG,UHC MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,VA,VA,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Wellcare MGG,Wellcare MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Bright Health - commercial,Bright Health - commercial,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,75.44,75.44,Bright Health MGG,Bright Health MGG,75.44,,,,,,,case rate,75.44,75.44,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Aetna,Aetna,223.35,,,,,,,per diem,223.35,223.35,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Aetna MGG,Aetna MGG,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,BCBS,BCBS,223.35,,,,,,,per diem,223.35,223.35,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,BCBS MGG,BCBS MGG,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Cigna,Cigna,223.35,,,,,,,per diem,223.35,223.35,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Cigna MGG,Cigna MGG,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Humana,Humana,223.35,,,,,,,per diem,223.35,223.35,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Humana MGG,Humana MGG,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Optum VA,Optum VA,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,UHC,UHC,223.35,,,,,,,per diem,223.35,223.35,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,UHC MGG,UHC MGG,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,VA,VA,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Wellcare MGG,Wellcare MGG,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Bright Health - commercial,Bright Health - commercial,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,223.35,223.35,Bright Health MGG,Bright Health MGG,223.35,,,,,,,case rate,223.35,223.35,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Aetna,Aetna,1162,,,,,,,per diem,1162,1162,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Aetna MGG,Aetna MGG,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,BCBS,BCBS,1162,,,,,,,per diem,1162,1162,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,BCBS MGG,BCBS MGG,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Cigna,Cigna,1162,,,,,,,per diem,1162,1162,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Cigna MGG,Cigna MGG,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Humana,Humana,1162,,,,,,,per diem,1162,1162,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Humana MGG,Humana MGG,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Optum VA,Optum VA,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,UHC,UHC,1162,,,,,,,per diem,1162,1162,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,UHC MGG,UHC MGG,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,VA,VA,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Wellcare MGG,Wellcare MGG,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Bright Health - commercial,Bright Health - commercial,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCTION MI BRK  ,38287003,CDM,310,RC,81207,CPT,,,,Inpatient,,,1162,1162,Bright Health MGG,Bright Health MGG,1162,,,,,,,case rate,1162,1162,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Aetna,Aetna,380.61,,,,,,,per diem,380.61,380.61,"Per diem rate, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Aetna MGG,Aetna MGG,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,BCBS,BCBS,380.61,,,,,,,per diem,380.61,380.61,"Per diem rate, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,BCBS MGG,BCBS MGG,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Cigna,Cigna,380.61,,,,,,,per diem,380.61,380.61,"Per diem rate, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Cigna MGG,Cigna MGG,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Humana,Humana,380.61,,,,,,,per diem,380.61,380.61,"Per diem rate, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Humana MGG,Humana MGG,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Optum VA,Optum VA,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,UHC,UHC,380.61,,,,,,,per diem,380.61,380.61,"Per diem rate, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,UHC MGG,UHC MGG,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,VA,VA,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Wellcare MGG,Wellcare MGG,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Bright Health - commercial,Bright Health - commercial,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
JAK2 GENE ANALYSIS            ,38287004,CDM,310,RC,81270,CPT,,,,Inpatient,,,380.61,380.61,Bright Health MGG,Bright Health MGG,380.61,,,,,,,case rate,380.61,380.61,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Aetna,Aetna,326.4,,,,,,,per diem,326.4,326.4,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Aetna MGG,Aetna MGG,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,BCBS,BCBS,326.4,,,,,,,per diem,326.4,326.4,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,BCBS MGG,BCBS MGG,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Cigna,Cigna,326.4,,,,,,,per diem,326.4,326.4,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Cigna MGG,Cigna MGG,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Humana,Humana,326.4,,,,,,,per diem,326.4,326.4,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Humana MGG,Humana MGG,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Optum VA,Optum VA,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,UHC,UHC,326.4,,,,,,,per diem,326.4,326.4,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,UHC MGG,UHC MGG,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,VA,VA,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Wellcare MGG,Wellcare MGG,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Bright Health - commercial,Bright Health - commercial,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,326.4,326.4,Bright Health MGG,Bright Health MGG,326.4,,,,,,,case rate,326.4,326.4,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Aetna,Aetna,438.6,,,,,,,per diem,438.6,438.6,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Aetna MGG,Aetna MGG,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,BCBS,BCBS,438.6,,,,,,,per diem,438.6,438.6,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,BCBS MGG,BCBS MGG,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Cigna,Cigna,438.6,,,,,,,per diem,438.6,438.6,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Cigna MGG,Cigna MGG,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Humana,Humana,438.6,,,,,,,per diem,438.6,438.6,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Humana MGG,Humana MGG,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Optum VA,Optum VA,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,UHC,UHC,438.6,,,,,,,per diem,438.6,438.6,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,UHC MGG,UHC MGG,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,VA,VA,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Wellcare MGG,Wellcare MGG,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Bright Health - commercial,Bright Health - commercial,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,438.6,438.6,Bright Health MGG,Bright Health MGG,438.6,,,,,,,case rate,438.6,438.6,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Aetna,Aetna,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Aetna MGG,Aetna MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,BCBS,BCBS,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,BCBS MGG,BCBS MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Cigna,Cigna,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Cigna MGG,Cigna MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Humana,Humana,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Humana MGG,Humana MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Optum VA,Optum VA,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,UHC,UHC,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,UHC MGG,UHC MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,VA,VA,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Wellcare MGG,Wellcare MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Bright Health - commercial,Bright Health - commercial,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,138,138,Bright Health MGG,Bright Health MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Aetna,Aetna,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Aetna MGG,Aetna MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,BCBS,BCBS,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,BCBS MGG,BCBS MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Cigna,Cigna,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Cigna MGG,Cigna MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Humana,Humana,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Humana MGG,Humana MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Optum VA,Optum VA,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,UHC,UHC,138,,,,,,,per diem,138,138,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,UHC MGG,UHC MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,VA,VA,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Wellcare MGG,Wellcare MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Bright Health - commercial,Bright Health - commercial,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,138,138,Bright Health MGG,Bright Health MGG,138,,,,,,,case rate,138,138,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Aetna,Aetna,142.59,,,,,,,per diem,142.59,142.59,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Aetna MGG,Aetna MGG,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,BCBS,BCBS,142.59,,,,,,,per diem,142.59,142.59,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,BCBS MGG,BCBS MGG,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Cigna,Cigna,142.59,,,,,,,per diem,142.59,142.59,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Cigna MGG,Cigna MGG,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Humana,Humana,142.59,,,,,,,per diem,142.59,142.59,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Humana MGG,Humana MGG,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Optum VA,Optum VA,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,UHC,UHC,142.59,,,,,,,per diem,142.59,142.59,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,UHC MGG,UHC MGG,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,VA,VA,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Wellcare MGG,Wellcare MGG,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Bright Health - commercial,Bright Health - commercial,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,142.59,142.59,Bright Health MGG,Bright Health MGG,142.59,,,,,,,case rate,142.59,142.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Aetna,Aetna,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Aetna MGG,Aetna MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,BCBS,BCBS,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,BCBS MGG,BCBS MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Cigna,Cigna,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Cigna MGG,Cigna MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Humana,Humana,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Humana MGG,Humana MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Optum VA,Optum VA,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,UHC,UHC,137.7,,,,,,,per diem,137.7,137.7,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,UHC MGG,UHC MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,VA,VA,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Wellcare MGG,Wellcare MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Bright Health - commercial,Bright Health - commercial,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,137.7,137.7,Bright Health MGG,Bright Health MGG,137.7,,,,,,,case rate,137.7,137.7,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Aetna,Aetna,252.55,,,,,,,per diem,252.55,252.55,"Per diem rate, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Aetna MGG,Aetna MGG,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,BCBS,BCBS,252.55,,,,,,,per diem,252.55,252.55,"Per diem rate, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,BCBS MGG,BCBS MGG,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Cigna,Cigna,252.55,,,,,,,per diem,252.55,252.55,"Per diem rate, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Cigna MGG,Cigna MGG,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Humana,Humana,252.55,,,,,,,per diem,252.55,252.55,"Per diem rate, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Humana MGG,Humana MGG,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Optum VA,Optum VA,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,UHC,UHC,252.55,,,,,,,per diem,252.55,252.55,"Per diem rate, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,UHC MGG,UHC MGG,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,VA,VA,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Wellcare MGG,Wellcare MGG,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Bright Health - commercial,Bright Health - commercial,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
3200282,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,252.55,252.55,Bright Health MGG,Bright Health MGG,252.55,,,,,,,case rate,252.55,252.55,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Aetna,Aetna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Aetna MGG,Aetna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,BCBS,BCBS,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,BCBS MGG,BCBS MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Cigna,Cigna,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Cigna MGG,Cigna MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Humana,Humana,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Humana MGG,Humana MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Optum VA,Optum VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,UHC,UHC,70,,,,,,,per diem,70,70,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,UHC MGG,UHC MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,VA,VA,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Wellcare MGG,Wellcare MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Bright Health - commercial,Bright Health - commercial,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,70,70,Bright Health MGG,Bright Health MGG,70,,,,,,,case rate,70,70,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Aetna,Aetna,188.96,,,,,,,per diem,188.96,188.96,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Aetna MGG,Aetna MGG,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,BCBS,BCBS,188.96,,,,,,,per diem,188.96,188.96,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,BCBS MGG,BCBS MGG,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Cigna,Cigna,188.96,,,,,,,per diem,188.96,188.96,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Cigna MGG,Cigna MGG,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Humana,Humana,188.96,,,,,,,per diem,188.96,188.96,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Humana MGG,Humana MGG,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Optum VA,Optum VA,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,UHC,UHC,188.96,,,,,,,per diem,188.96,188.96,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,UHC MGG,UHC MGG,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,VA,VA,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Wellcare MGG,Wellcare MGG,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Bright Health - commercial,Bright Health - commercial,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,188.96,188.96,Bright Health MGG,Bright Health MGG,188.96,,,,,,,case rate,188.96,188.96,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Aetna,Aetna,45.63,,,,,,,per diem,45.63,45.63,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Aetna MGG,Aetna MGG,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,BCBS,BCBS,45.63,,,,,,,per diem,45.63,45.63,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,BCBS MGG,BCBS MGG,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Cigna,Cigna,45.63,,,,,,,per diem,45.63,45.63,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Cigna MGG,Cigna MGG,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Humana,Humana,45.63,,,,,,,per diem,45.63,45.63,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Humana MGG,Humana MGG,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Optum VA,Optum VA,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,UHC,UHC,45.63,,,,,,,per diem,45.63,45.63,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,UHC MGG,UHC MGG,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,VA,VA,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Wellcare MGG,Wellcare MGG,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Bright Health - commercial,Bright Health - commercial,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,45.63,45.63,Bright Health MGG,Bright Health MGG,45.63,,,,,,,case rate,45.63,45.63,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Aetna,Aetna,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Aetna MGG,Aetna MGG,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,BCBS,BCBS,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,BCBS MGG,BCBS MGG,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Cigna,Cigna,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Cigna MGG,Cigna MGG,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Humana,Humana,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Humana MGG,Humana MGG,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Optum VA,Optum VA,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,UHC,UHC,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,UHC MGG,UHC MGG,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,VA,VA,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Wellcare MGG,Wellcare MGG,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Bright Health - commercial,Bright Health - commercial,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,132.65,132.65,Bright Health MGG,Bright Health MGG,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Aetna,Aetna,95.88,,,,,,,per diem,95.88,95.88,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Aetna MGG,Aetna MGG,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,BCBS,BCBS,95.88,,,,,,,per diem,95.88,95.88,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,BCBS MGG,BCBS MGG,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Cigna,Cigna,95.88,,,,,,,per diem,95.88,95.88,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Cigna MGG,Cigna MGG,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Humana,Humana,95.88,,,,,,,per diem,95.88,95.88,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Humana MGG,Humana MGG,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Optum VA,Optum VA,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,UHC,UHC,95.88,,,,,,,per diem,95.88,95.88,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,UHC MGG,UHC MGG,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,VA,VA,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Wellcare MGG,Wellcare MGG,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Bright Health - commercial,Bright Health - commercial,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,95.88,95.88,Bright Health MGG,Bright Health MGG,95.88,,,,,,,case rate,95.88,95.88,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Aetna,Aetna,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Aetna MGG,Aetna MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,BCBS,BCBS,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,BCBS MGG,BCBS MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Cigna,Cigna,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Cigna MGG,Cigna MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Humana,Humana,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Humana MGG,Humana MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Optum VA,Optum VA,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,UHC,UHC,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,UHC MGG,UHC MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,VA,VA,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Wellcare MGG,Wellcare MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Bright Health - commercial,Bright Health - commercial,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,76.5,76.5,Bright Health MGG,Bright Health MGG,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Aetna,Aetna,90.98,,,,,,,per diem,90.98,90.98,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Aetna MGG,Aetna MGG,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,BCBS,BCBS,90.98,,,,,,,per diem,90.98,90.98,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,BCBS MGG,BCBS MGG,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Cigna,Cigna,90.98,,,,,,,per diem,90.98,90.98,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Cigna MGG,Cigna MGG,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Humana,Humana,90.98,,,,,,,per diem,90.98,90.98,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Humana MGG,Humana MGG,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Optum VA,Optum VA,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,UHC,UHC,90.98,,,,,,,per diem,90.98,90.98,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,UHC MGG,UHC MGG,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,VA,VA,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Wellcare MGG,Wellcare MGG,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Bright Health - commercial,Bright Health - commercial,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,90.98,90.98,Bright Health MGG,Bright Health MGG,90.98,,,,,,,case rate,90.98,90.98,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Aetna,Aetna,87.5,,,,,,,per diem,87.5,87.5,"Per diem rate, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Aetna MGG,Aetna MGG,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,BCBS,BCBS,87.5,,,,,,,per diem,87.5,87.5,"Per diem rate, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,BCBS MGG,BCBS MGG,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Cigna,Cigna,87.5,,,,,,,per diem,87.5,87.5,"Per diem rate, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Cigna MGG,Cigna MGG,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Humana,Humana,87.5,,,,,,,per diem,87.5,87.5,"Per diem rate, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Humana MGG,Humana MGG,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Optum VA,Optum VA,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,UHC,UHC,87.5,,,,,,,per diem,87.5,87.5,"Per diem rate, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,UHC MGG,UHC MGG,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,VA,VA,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Wellcare MGG,Wellcare MGG,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Bright Health - commercial,Bright Health - commercial,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
ANALYTE QUAL/SEMI QNT MULTI   ,38299303,CDM,301,RC,83516,CPT,,,,Inpatient,,,87.5,87.5,Bright Health MGG,Bright Health MGG,87.5,,,,,,,case rate,87.5,87.5,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Aetna,Aetna,200.51,,,,,,,per diem,200.51,200.51,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Aetna MGG,Aetna MGG,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,BCBS,BCBS,200.51,,,,,,,per diem,200.51,200.51,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,BCBS MGG,BCBS MGG,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Cigna,Cigna,200.51,,,,,,,per diem,200.51,200.51,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Cigna MGG,Cigna MGG,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Humana,Humana,200.51,,,,,,,per diem,200.51,200.51,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Humana MGG,Humana MGG,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Optum VA,Optum VA,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,UHC,UHC,200.51,,,,,,,per diem,200.51,200.51,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,UHC MGG,UHC MGG,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,VA,VA,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Wellcare MGG,Wellcare MGG,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Bright Health - commercial,Bright Health - commercial,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,200.51,200.51,Bright Health MGG,Bright Health MGG,200.51,,,,,,,case rate,200.51,200.51,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Aetna,Aetna,128.84,,,,,,,per diem,128.84,128.84,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Aetna MGG,Aetna MGG,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,BCBS,BCBS,128.84,,,,,,,per diem,128.84,128.84,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,BCBS MGG,BCBS MGG,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Cigna,Cigna,128.84,,,,,,,per diem,128.84,128.84,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Cigna MGG,Cigna MGG,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Humana,Humana,128.84,,,,,,,per diem,128.84,128.84,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Humana MGG,Humana MGG,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Optum VA,Optum VA,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,UHC,UHC,128.84,,,,,,,per diem,128.84,128.84,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,UHC MGG,UHC MGG,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,VA,VA,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Wellcare MGG,Wellcare MGG,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Bright Health - commercial,Bright Health - commercial,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,128.84,128.84,Bright Health MGG,Bright Health MGG,128.84,,,,,,,case rate,128.84,128.84,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Aetna,Aetna,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Aetna MGG,Aetna MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,BCBS,BCBS,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,BCBS MGG,BCBS MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Cigna,Cigna,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Cigna MGG,Cigna MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Humana,Humana,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Humana MGG,Humana MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Optum VA,Optum VA,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,UHC,UHC,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,UHC MGG,UHC MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,VA,VA,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Wellcare MGG,Wellcare MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Bright Health - commercial,Bright Health - commercial,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,222,222,Bright Health MGG,Bright Health MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Aetna,Aetna,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Aetna MGG,Aetna MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,BCBS,BCBS,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,BCBS MGG,BCBS MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Cigna,Cigna,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Cigna MGG,Cigna MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Humana,Humana,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Humana MGG,Humana MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Optum VA,Optum VA,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,UHC,UHC,245,,,,,,,per diem,245,245,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,UHC MGG,UHC MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,VA,VA,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Wellcare MGG,Wellcare MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Bright Health - commercial,Bright Health - commercial,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,245,245,Bright Health MGG,Bright Health MGG,245,,,,,,,case rate,245,245,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Aetna,Aetna,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Aetna MGG,Aetna MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,BCBS,BCBS,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,BCBS MGG,BCBS MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Cigna,Cigna,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Cigna MGG,Cigna MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Humana,Humana,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Humana MGG,Humana MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Optum VA,Optum VA,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,UHC,UHC,87.72,,,,,,,per diem,87.72,87.72,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,UHC MGG,UHC MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,VA,VA,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Wellcare MGG,Wellcare MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Bright Health - commercial,Bright Health - commercial,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,87.72,87.72,Bright Health MGG,Bright Health MGG,87.72,,,,,,,case rate,87.72,87.72,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Aetna,Aetna,308.28,,,,,,,per diem,308.28,308.28,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Aetna MGG,Aetna MGG,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,BCBS,BCBS,308.28,,,,,,,per diem,308.28,308.28,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,BCBS MGG,BCBS MGG,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Cigna,Cigna,308.28,,,,,,,per diem,308.28,308.28,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Cigna MGG,Cigna MGG,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Humana,Humana,308.28,,,,,,,per diem,308.28,308.28,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Humana MGG,Humana MGG,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Optum VA,Optum VA,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,UHC,UHC,308.28,,,,,,,per diem,308.28,308.28,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,UHC MGG,UHC MGG,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,VA,VA,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Wellcare MGG,Wellcare MGG,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Bright Health - commercial,Bright Health - commercial,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,308.28,308.28,Bright Health MGG,Bright Health MGG,308.28,,,,,,,case rate,308.28,308.28,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Aetna,Aetna,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Aetna MGG,Aetna MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,BCBS,BCBS,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,BCBS MGG,BCBS MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Cigna,Cigna,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Cigna MGG,Cigna MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Humana,Humana,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Humana MGG,Humana MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Optum VA,Optum VA,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,UHC,UHC,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,UHC MGG,UHC MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,VA,VA,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Wellcare MGG,Wellcare MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Bright Health - commercial,Bright Health - commercial,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,178.5,178.5,Bright Health MGG,Bright Health MGG,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Aetna,Aetna,151.98,,,,,,,per diem,151.98,151.98,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Aetna MGG,Aetna MGG,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,BCBS,BCBS,151.98,,,,,,,per diem,151.98,151.98,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,BCBS MGG,BCBS MGG,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Cigna,Cigna,151.98,,,,,,,per diem,151.98,151.98,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Cigna MGG,Cigna MGG,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Humana,Humana,151.98,,,,,,,per diem,151.98,151.98,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Humana MGG,Humana MGG,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Optum VA,Optum VA,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,UHC,UHC,151.98,,,,,,,per diem,151.98,151.98,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,UHC MGG,UHC MGG,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,VA,VA,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Wellcare MGG,Wellcare MGG,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Bright Health - commercial,Bright Health - commercial,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,151.98,151.98,Bright Health MGG,Bright Health MGG,151.98,,,,,,,case rate,151.98,151.98,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Aetna,Aetna,252.96,,,,,,,per diem,252.96,252.96,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Aetna MGG,Aetna MGG,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,BCBS,BCBS,252.96,,,,,,,per diem,252.96,252.96,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,BCBS MGG,BCBS MGG,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Cigna,Cigna,252.96,,,,,,,per diem,252.96,252.96,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Cigna MGG,Cigna MGG,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Humana,Humana,252.96,,,,,,,per diem,252.96,252.96,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Humana MGG,Humana MGG,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Optum VA,Optum VA,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,UHC,UHC,252.96,,,,,,,per diem,252.96,252.96,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,UHC MGG,UHC MGG,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,VA,VA,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Wellcare MGG,Wellcare MGG,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Bright Health - commercial,Bright Health - commercial,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,252.96,252.96,Bright Health MGG,Bright Health MGG,252.96,,,,,,,case rate,252.96,252.96,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Aetna,Aetna,304.34,,,,,,,per diem,304.34,304.34,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Aetna MGG,Aetna MGG,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,BCBS,BCBS,304.34,,,,,,,per diem,304.34,304.34,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,BCBS MGG,BCBS MGG,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Cigna,Cigna,304.34,,,,,,,per diem,304.34,304.34,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Cigna MGG,Cigna MGG,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Humana,Humana,304.34,,,,,,,per diem,304.34,304.34,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Humana MGG,Humana MGG,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Optum VA,Optum VA,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,UHC,UHC,304.34,,,,,,,per diem,304.34,304.34,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,UHC MGG,UHC MGG,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,VA,VA,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Wellcare MGG,Wellcare MGG,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Bright Health - commercial,Bright Health - commercial,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,304.34,304.34,Bright Health MGG,Bright Health MGG,304.34,,,,,,,case rate,304.34,304.34,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Aetna,Aetna,325,,,,,,,per diem,325,325,"Per diem rate, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Aetna MGG,Aetna MGG,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,BCBS,BCBS,325,,,,,,,per diem,325,325,"Per diem rate, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,BCBS MGG,BCBS MGG,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Cigna,Cigna,325,,,,,,,per diem,325,325,"Per diem rate, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Cigna MGG,Cigna MGG,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Humana,Humana,325,,,,,,,per diem,325,325,"Per diem rate, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Humana MGG,Humana MGG,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Optum VA,Optum VA,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,UHC,UHC,325,,,,,,,per diem,325,325,"Per diem rate, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,UHC MGG,UHC MGG,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,VA,VA,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Wellcare MGG,Wellcare MGG,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Bright Health - commercial,Bright Health - commercial,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
HIV ANTIBODY                  ,38299320,CDM,302,RC,86688,CPT,,,,Inpatient,,,325,325,Bright Health MGG,Bright Health MGG,325,,,,,,,case rate,325,325,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Aetna,Aetna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Aetna MGG,Aetna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,BCBS,BCBS,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,BCBS MGG,BCBS MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Cigna,Cigna,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Cigna MGG,Cigna MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Humana,Humana,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Humana MGG,Humana MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Optum VA,Optum VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,UHC,UHC,60,,,,,,,per diem,60,60,"Per diem rate, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,UHC MGG,UHC MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,VA,VA,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Wellcare MGG,Wellcare MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Bright Health - commercial,Bright Health - commercial,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
FIBRIN DEGREDATION PROD QUANT ,38299322,CDM,305,RC,85370,CPT,,,,Inpatient,,,60,60,Bright Health MGG,Bright Health MGG,60,,,,,,,case rate,60,60,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Aetna,Aetna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Aetna MGG,Aetna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,BCBS,BCBS,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,BCBS MGG,BCBS MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Cigna,Cigna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Cigna MGG,Cigna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Humana,Humana,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Humana MGG,Humana MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Optum VA,Optum VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,UHC,UHC,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,UHC MGG,UHC MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,VA,VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Wellcare MGG,Wellcare MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Bright Health - commercial,Bright Health - commercial,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,48,48,Bright Health MGG,Bright Health MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Aetna,Aetna,191.5,,,,,,,per diem,191.5,191.5,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Aetna MGG,Aetna MGG,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,BCBS,BCBS,191.5,,,,,,,per diem,191.5,191.5,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,BCBS MGG,BCBS MGG,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Cigna,Cigna,191.5,,,,,,,per diem,191.5,191.5,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Cigna MGG,Cigna MGG,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Humana,Humana,191.5,,,,,,,per diem,191.5,191.5,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Humana MGG,Humana MGG,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Optum VA,Optum VA,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,UHC,UHC,191.5,,,,,,,per diem,191.5,191.5,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,UHC MGG,UHC MGG,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,VA,VA,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Wellcare MGG,Wellcare MGG,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Bright Health - commercial,Bright Health - commercial,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,191.5,191.5,Bright Health MGG,Bright Health MGG,191.5,,,,,,,case rate,191.5,191.5,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
AMPLIFIED PROBE TECH EA ORG   ,38299326,CDM,306,RC,87798,CPT,,,,Inpatient,,,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Aetna,Aetna,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Aetna MGG,Aetna MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,BCBS,BCBS,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,BCBS MGG,BCBS MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Cigna,Cigna,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Cigna MGG,Cigna MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Humana,Humana,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Humana MGG,Humana MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Optum VA,Optum VA,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,UHC,UHC,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,UHC MGG,UHC MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,VA,VA,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Wellcare MGG,Wellcare MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Bright Health - commercial,Bright Health - commercial,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,105.06,105.06,Bright Health MGG,Bright Health MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Aetna,Aetna,285.73,,,,,,,per diem,285.73,285.73,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Aetna MGG,Aetna MGG,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,BCBS,BCBS,285.73,,,,,,,per diem,285.73,285.73,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,BCBS MGG,BCBS MGG,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Cigna,Cigna,285.73,,,,,,,per diem,285.73,285.73,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Cigna MGG,Cigna MGG,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Humana,Humana,285.73,,,,,,,per diem,285.73,285.73,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Humana MGG,Humana MGG,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Optum VA,Optum VA,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,UHC,UHC,285.73,,,,,,,per diem,285.73,285.73,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,UHC MGG,UHC MGG,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,VA,VA,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Wellcare MGG,Wellcare MGG,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Bright Health - commercial,Bright Health - commercial,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,285.73,285.73,Bright Health MGG,Bright Health MGG,285.73,,,,,,,case rate,285.73,285.73,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Aetna,Aetna,188.7,,,,,,,per diem,188.7,188.7,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Aetna MGG,Aetna MGG,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,BCBS,BCBS,188.7,,,,,,,per diem,188.7,188.7,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,BCBS MGG,BCBS MGG,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Cigna,Cigna,188.7,,,,,,,per diem,188.7,188.7,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Cigna MGG,Cigna MGG,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Humana,Humana,188.7,,,,,,,per diem,188.7,188.7,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Humana MGG,Humana MGG,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Optum VA,Optum VA,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,UHC,UHC,188.7,,,,,,,per diem,188.7,188.7,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,UHC MGG,UHC MGG,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,VA,VA,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Wellcare MGG,Wellcare MGG,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Bright Health - commercial,Bright Health - commercial,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,188.7,188.7,Bright Health MGG,Bright Health MGG,188.7,,,,,,,case rate,188.7,188.7,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Aetna,Aetna,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Aetna MGG,Aetna MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,BCBS,BCBS,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,BCBS MGG,BCBS MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Cigna,Cigna,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Cigna MGG,Cigna MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Humana,Humana,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Humana MGG,Humana MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Optum VA,Optum VA,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,UHC,UHC,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,UHC MGG,UHC MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,VA,VA,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Wellcare MGG,Wellcare MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Bright Health - commercial,Bright Health - commercial,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,297,297,Bright Health MGG,Bright Health MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Aetna,Aetna,117.63,,,,,,,per diem,117.63,117.63,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Aetna MGG,Aetna MGG,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,BCBS,BCBS,117.63,,,,,,,per diem,117.63,117.63,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,BCBS MGG,BCBS MGG,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Cigna,Cigna,117.63,,,,,,,per diem,117.63,117.63,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Cigna MGG,Cigna MGG,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Humana,Humana,117.63,,,,,,,per diem,117.63,117.63,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Humana MGG,Humana MGG,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Optum VA,Optum VA,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,UHC,UHC,117.63,,,,,,,per diem,117.63,117.63,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,UHC MGG,UHC MGG,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,VA,VA,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Wellcare MGG,Wellcare MGG,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Bright Health - commercial,Bright Health - commercial,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,117.63,117.63,Bright Health MGG,Bright Health MGG,117.63,,,,,,,case rate,117.63,117.63,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Aetna,Aetna,97.5,,,,,,,per diem,97.5,97.5,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Aetna MGG,Aetna MGG,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,BCBS,BCBS,97.5,,,,,,,per diem,97.5,97.5,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,BCBS MGG,BCBS MGG,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Cigna,Cigna,97.5,,,,,,,per diem,97.5,97.5,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Cigna MGG,Cigna MGG,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Humana,Humana,97.5,,,,,,,per diem,97.5,97.5,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Humana MGG,Humana MGG,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Optum VA,Optum VA,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,UHC,UHC,97.5,,,,,,,per diem,97.5,97.5,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,UHC MGG,UHC MGG,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,VA,VA,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Wellcare MGG,Wellcare MGG,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Bright Health - commercial,Bright Health - commercial,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,97.5,97.5,Bright Health MGG,Bright Health MGG,97.5,,,,,,,case rate,97.5,97.5,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Aetna,Aetna,263.71,,,,,,,per diem,263.71,263.71,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Aetna MGG,Aetna MGG,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,BCBS,BCBS,263.71,,,,,,,per diem,263.71,263.71,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,BCBS MGG,BCBS MGG,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Cigna,Cigna,263.71,,,,,,,per diem,263.71,263.71,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Cigna MGG,Cigna MGG,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Humana,Humana,263.71,,,,,,,per diem,263.71,263.71,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Humana MGG,Humana MGG,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Optum VA,Optum VA,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,UHC,UHC,263.71,,,,,,,per diem,263.71,263.71,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,UHC MGG,UHC MGG,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,VA,VA,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Wellcare MGG,Wellcare MGG,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Bright Health - commercial,Bright Health - commercial,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,263.71,263.71,Bright Health MGG,Bright Health MGG,263.71,,,,,,,case rate,263.71,263.71,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Aetna,Aetna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Aetna MGG,Aetna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,BCBS,BCBS,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,BCBS MGG,BCBS MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Cigna,Cigna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Cigna MGG,Cigna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Humana,Humana,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Humana MGG,Humana MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Optum VA,Optum VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,UHC,UHC,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,UHC MGG,UHC MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,VA,VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Wellcare MGG,Wellcare MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Bright Health - commercial,Bright Health - commercial,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,598.74,598.74,Bright Health MGG,Bright Health MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Aetna,Aetna,72.68,,,,,,,per diem,72.68,72.68,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Aetna MGG,Aetna MGG,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,BCBS,BCBS,72.68,,,,,,,per diem,72.68,72.68,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,BCBS MGG,BCBS MGG,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Cigna,Cigna,72.68,,,,,,,per diem,72.68,72.68,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Cigna MGG,Cigna MGG,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Humana,Humana,72.68,,,,,,,per diem,72.68,72.68,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Humana MGG,Humana MGG,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Optum VA,Optum VA,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,UHC,UHC,72.68,,,,,,,per diem,72.68,72.68,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,UHC MGG,UHC MGG,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,VA,VA,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Wellcare MGG,Wellcare MGG,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Bright Health - commercial,Bright Health - commercial,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,72.68,72.68,Bright Health MGG,Bright Health MGG,72.68,,,,,,,case rate,72.68,72.68,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Aetna,Aetna,639.12,,,,,,,per diem,639.12,639.12,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Aetna MGG,Aetna MGG,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,BCBS,BCBS,639.12,,,,,,,per diem,639.12,639.12,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,BCBS MGG,BCBS MGG,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Cigna,Cigna,639.12,,,,,,,per diem,639.12,639.12,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Cigna MGG,Cigna MGG,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Humana,Humana,639.12,,,,,,,per diem,639.12,639.12,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Humana MGG,Humana MGG,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Optum VA,Optum VA,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,UHC,UHC,639.12,,,,,,,per diem,639.12,639.12,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,UHC MGG,UHC MGG,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,VA,VA,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Wellcare MGG,Wellcare MGG,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Bright Health - commercial,Bright Health - commercial,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,639.12,639.12,Bright Health MGG,Bright Health MGG,639.12,,,,,,,case rate,639.12,639.12,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Aetna,Aetna,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Aetna MGG,Aetna MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,BCBS,BCBS,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,BCBS MGG,BCBS MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Cigna,Cigna,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Cigna MGG,Cigna MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Humana,Humana,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Humana MGG,Humana MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Optum VA,Optum VA,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,UHC,UHC,165,,,,,,,per diem,165,165,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,UHC MGG,UHC MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,VA,VA,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Wellcare MGG,Wellcare MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Bright Health - commercial,Bright Health - commercial,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,165,165,Bright Health MGG,Bright Health MGG,165,,,,,,,case rate,165,165,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Aetna,Aetna,21.93,,,,,,,per diem,21.93,21.93,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Aetna MGG,Aetna MGG,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,BCBS,BCBS,21.93,,,,,,,per diem,21.93,21.93,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,BCBS MGG,BCBS MGG,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Cigna,Cigna,21.93,,,,,,,per diem,21.93,21.93,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Cigna MGG,Cigna MGG,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Humana,Humana,21.93,,,,,,,per diem,21.93,21.93,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Humana MGG,Humana MGG,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Optum VA,Optum VA,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,UHC,UHC,21.93,,,,,,,per diem,21.93,21.93,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,UHC MGG,UHC MGG,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,VA,VA,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Wellcare MGG,Wellcare MGG,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Bright Health - commercial,Bright Health - commercial,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,21.93,21.93,Bright Health MGG,Bright Health MGG,21.93,,,,,,,case rate,21.93,21.93,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Aetna,Aetna,235.85,,,,,,,per diem,235.85,235.85,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Aetna MGG,Aetna MGG,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,BCBS,BCBS,235.85,,,,,,,per diem,235.85,235.85,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,BCBS MGG,BCBS MGG,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Cigna,Cigna,235.85,,,,,,,per diem,235.85,235.85,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Cigna MGG,Cigna MGG,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Humana,Humana,235.85,,,,,,,per diem,235.85,235.85,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Humana MGG,Humana MGG,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Optum VA,Optum VA,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,UHC,UHC,235.85,,,,,,,per diem,235.85,235.85,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,UHC MGG,UHC MGG,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,VA,VA,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Wellcare MGG,Wellcare MGG,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Bright Health - commercial,Bright Health - commercial,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,235.85,235.85,Bright Health MGG,Bright Health MGG,235.85,,,,,,,case rate,235.85,235.85,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Aetna,Aetna,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Aetna MGG,Aetna MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,BCBS,BCBS,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,BCBS MGG,BCBS MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Cigna,Cigna,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Cigna MGG,Cigna MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Humana,Humana,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Humana MGG,Humana MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Optum VA,Optum VA,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,UHC,UHC,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,UHC MGG,UHC MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,VA,VA,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Wellcare MGG,Wellcare MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Bright Health - commercial,Bright Health - commercial,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,219,219,Bright Health MGG,Bright Health MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Aetna,Aetna,629.42,,,,,,,per diem,629.42,629.42,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Aetna MGG,Aetna MGG,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,BCBS,BCBS,629.42,,,,,,,per diem,629.42,629.42,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,BCBS MGG,BCBS MGG,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Cigna,Cigna,629.42,,,,,,,per diem,629.42,629.42,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Cigna MGG,Cigna MGG,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Humana,Humana,629.42,,,,,,,per diem,629.42,629.42,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Humana MGG,Humana MGG,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Optum VA,Optum VA,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,UHC,UHC,629.42,,,,,,,per diem,629.42,629.42,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,UHC MGG,UHC MGG,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,VA,VA,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Wellcare MGG,Wellcare MGG,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Bright Health - commercial,Bright Health - commercial,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,629.42,629.42,Bright Health MGG,Bright Health MGG,629.42,,,,,,,case rate,629.42,629.42,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Aetna,Aetna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Aetna MGG,Aetna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,BCBS,BCBS,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,BCBS MGG,BCBS MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Cigna,Cigna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Cigna MGG,Cigna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Humana,Humana,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Humana MGG,Humana MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Optum VA,Optum VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,UHC,UHC,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,UHC MGG,UHC MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,VA,VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Wellcare MGG,Wellcare MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Bright Health - commercial,Bright Health - commercial,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,41.82,41.82,Bright Health MGG,Bright Health MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Aetna,Aetna,154.59,,,,,,,per diem,154.59,154.59,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Aetna MGG,Aetna MGG,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,BCBS,BCBS,154.59,,,,,,,per diem,154.59,154.59,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,BCBS MGG,BCBS MGG,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Cigna,Cigna,154.59,,,,,,,per diem,154.59,154.59,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Cigna MGG,Cigna MGG,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Humana,Humana,154.59,,,,,,,per diem,154.59,154.59,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Humana MGG,Humana MGG,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Optum VA,Optum VA,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,UHC,UHC,154.59,,,,,,,per diem,154.59,154.59,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,UHC MGG,UHC MGG,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,VA,VA,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Wellcare MGG,Wellcare MGG,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Bright Health - commercial,Bright Health - commercial,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,154.59,154.59,Bright Health MGG,Bright Health MGG,154.59,,,,,,,case rate,154.59,154.59,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Aetna,Aetna,48.54,,,,,,,per diem,48.54,48.54,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Aetna MGG,Aetna MGG,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,BCBS,BCBS,48.54,,,,,,,per diem,48.54,48.54,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,BCBS MGG,BCBS MGG,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Cigna,Cigna,48.54,,,,,,,per diem,48.54,48.54,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Cigna MGG,Cigna MGG,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Humana,Humana,48.54,,,,,,,per diem,48.54,48.54,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Humana MGG,Humana MGG,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Optum VA,Optum VA,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,UHC,UHC,48.54,,,,,,,per diem,48.54,48.54,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,UHC MGG,UHC MGG,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,VA,VA,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Wellcare MGG,Wellcare MGG,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Bright Health - commercial,Bright Health - commercial,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,48.54,48.54,Bright Health MGG,Bright Health MGG,48.54,,,,,,,case rate,48.54,48.54,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Aetna,Aetna,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Aetna MGG,Aetna MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,BCBS,BCBS,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,BCBS MGG,BCBS MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Cigna,Cigna,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Cigna MGG,Cigna MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Humana,Humana,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Humana MGG,Humana MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Optum VA,Optum VA,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,UHC,UHC,49.98,,,,,,,per diem,49.98,49.98,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,UHC MGG,UHC MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,VA,VA,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Wellcare MGG,Wellcare MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Bright Health - commercial,Bright Health - commercial,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,49.98,49.98,Bright Health MGG,Bright Health MGG,49.98,,,,,,,case rate,49.98,49.98,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Aetna,Aetna,265.33,,,,,,,per diem,265.33,265.33,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Aetna MGG,Aetna MGG,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,BCBS,BCBS,265.33,,,,,,,per diem,265.33,265.33,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,BCBS MGG,BCBS MGG,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Cigna,Cigna,265.33,,,,,,,per diem,265.33,265.33,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Cigna MGG,Cigna MGG,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Humana,Humana,265.33,,,,,,,per diem,265.33,265.33,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Humana MGG,Humana MGG,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Optum VA,Optum VA,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,UHC,UHC,265.33,,,,,,,per diem,265.33,265.33,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,UHC MGG,UHC MGG,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,VA,VA,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Wellcare MGG,Wellcare MGG,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Bright Health - commercial,Bright Health - commercial,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,265.33,265.33,Bright Health MGG,Bright Health MGG,265.33,,,,,,,case rate,265.33,265.33,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Aetna,Aetna,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Aetna MGG,Aetna MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,BCBS,BCBS,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,BCBS MGG,BCBS MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Cigna,Cigna,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Cigna MGG,Cigna MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Humana,Humana,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Humana MGG,Humana MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Optum VA,Optum VA,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,UHC,UHC,112,,,,,,,per diem,112,112,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,UHC MGG,UHC MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,VA,VA,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Wellcare MGG,Wellcare MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Bright Health - commercial,Bright Health - commercial,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,,,,,,Inpatient,,,112,112,Bright Health MGG,Bright Health MGG,112,,,,,,,case rate,112,112,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Aetna,Aetna,61,,,,,,,per diem,61,61,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Aetna MGG,Aetna MGG,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,BCBS,BCBS,61,,,,,,,per diem,61,61,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,BCBS MGG,BCBS MGG,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Cigna,Cigna,61,,,,,,,per diem,61,61,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Cigna MGG,Cigna MGG,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Humana,Humana,61,,,,,,,per diem,61,61,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Humana MGG,Humana MGG,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Optum VA,Optum VA,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,UHC,UHC,61,,,,,,,per diem,61,61,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,UHC MGG,UHC MGG,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,VA,VA,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Wellcare MGG,Wellcare MGG,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Bright Health - commercial,Bright Health - commercial,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,61,61,Bright Health MGG,Bright Health MGG,61,,,,,,,case rate,61,61,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Aetna,Aetna,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Aetna MGG,Aetna MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,BCBS,BCBS,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,BCBS MGG,BCBS MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Cigna,Cigna,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Cigna MGG,Cigna MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Humana,Humana,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Humana MGG,Humana MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Optum VA,Optum VA,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,UHC,UHC,160,,,,,,,per diem,160,160,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,UHC MGG,UHC MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,VA,VA,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Wellcare MGG,Wellcare MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Bright Health - commercial,Bright Health - commercial,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,160,160,Bright Health MGG,Bright Health MGG,160,,,,,,,case rate,160,160,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Aetna,Aetna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Aetna MGG,Aetna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,BCBS,BCBS,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,BCBS MGG,BCBS MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Cigna,Cigna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Cigna MGG,Cigna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Humana,Humana,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Humana MGG,Humana MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Optum VA,Optum VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,UHC,UHC,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,UHC MGG,UHC MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,VA,VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Wellcare MGG,Wellcare MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Bright Health - commercial,Bright Health - commercial,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,138.72,138.72,Bright Health MGG,Bright Health MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Aetna,Aetna,58.29,,,,,,,per diem,58.29,58.29,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Aetna MGG,Aetna MGG,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,BCBS,BCBS,58.29,,,,,,,per diem,58.29,58.29,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,BCBS MGG,BCBS MGG,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Cigna,Cigna,58.29,,,,,,,per diem,58.29,58.29,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Cigna MGG,Cigna MGG,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Humana,Humana,58.29,,,,,,,per diem,58.29,58.29,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Humana MGG,Humana MGG,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Optum VA,Optum VA,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,UHC,UHC,58.29,,,,,,,per diem,58.29,58.29,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,UHC MGG,UHC MGG,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,VA,VA,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Wellcare MGG,Wellcare MGG,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Bright Health - commercial,Bright Health - commercial,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,58.29,58.29,Bright Health MGG,Bright Health MGG,58.29,,,,,,,case rate,58.29,58.29,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Aetna,Aetna,153.93,,,,,,,per diem,153.93,153.93,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Aetna MGG,Aetna MGG,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,BCBS,BCBS,153.93,,,,,,,per diem,153.93,153.93,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,BCBS MGG,BCBS MGG,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Cigna,Cigna,153.93,,,,,,,per diem,153.93,153.93,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Cigna MGG,Cigna MGG,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Humana,Humana,153.93,,,,,,,per diem,153.93,153.93,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Humana MGG,Humana MGG,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Optum VA,Optum VA,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,UHC,UHC,153.93,,,,,,,per diem,153.93,153.93,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,UHC MGG,UHC MGG,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,VA,VA,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Wellcare MGG,Wellcare MGG,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Bright Health - commercial,Bright Health - commercial,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,153.93,153.93,Bright Health MGG,Bright Health MGG,153.93,,,,,,,case rate,153.93,153.93,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Aetna,Aetna,138.39,,,,,,,per diem,138.39,138.39,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Aetna MGG,Aetna MGG,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,BCBS,BCBS,138.39,,,,,,,per diem,138.39,138.39,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,BCBS MGG,BCBS MGG,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Cigna,Cigna,138.39,,,,,,,per diem,138.39,138.39,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Cigna MGG,Cigna MGG,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Humana,Humana,138.39,,,,,,,per diem,138.39,138.39,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Humana MGG,Humana MGG,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Optum VA,Optum VA,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,UHC,UHC,138.39,,,,,,,per diem,138.39,138.39,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,UHC MGG,UHC MGG,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,VA,VA,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Wellcare MGG,Wellcare MGG,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Bright Health - commercial,Bright Health - commercial,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38300185,CDM,301,RC,80197,CPT,,,,Inpatient,,,138.39,138.39,Bright Health MGG,Bright Health MGG,138.39,,,,,,,case rate,138.39,138.39,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Aetna,Aetna,482,,,,,,,per diem,482,482,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Aetna MGG,Aetna MGG,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,BCBS,BCBS,482,,,,,,,per diem,482,482,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,BCBS MGG,BCBS MGG,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Cigna,Cigna,482,,,,,,,per diem,482,482,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Cigna MGG,Cigna MGG,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Humana,Humana,482,,,,,,,per diem,482,482,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Humana MGG,Humana MGG,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Optum VA,Optum VA,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,UHC,UHC,482,,,,,,,per diem,482,482,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,UHC MGG,UHC MGG,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,VA,VA,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Wellcare MGG,Wellcare MGG,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Bright Health - commercial,Bright Health - commercial,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38300213,CDM,305,RC,85305,CPT,,,,Inpatient,,,482,482,Bright Health MGG,Bright Health MGG,482,,,,,,,case rate,482,482,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Aetna,Aetna,150.5,,,,,,,per diem,150.5,150.5,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Aetna MGG,Aetna MGG,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,BCBS,BCBS,150.5,,,,,,,per diem,150.5,150.5,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,BCBS MGG,BCBS MGG,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Cigna,Cigna,150.5,,,,,,,per diem,150.5,150.5,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Cigna MGG,Cigna MGG,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Humana,Humana,150.5,,,,,,,per diem,150.5,150.5,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Humana MGG,Humana MGG,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Optum VA,Optum VA,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,UHC,UHC,150.5,,,,,,,per diem,150.5,150.5,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,UHC MGG,UHC MGG,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,VA,VA,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Wellcare MGG,Wellcare MGG,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Bright Health - commercial,Bright Health - commercial,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38300250,CDM,301,RC,82248,CPT,,,,Inpatient,,,150.5,150.5,Bright Health MGG,Bright Health MGG,150.5,,,,,,,case rate,150.5,150.5,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Aetna,Aetna,62.84,,,,,,,per diem,62.84,62.84,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Aetna MGG,Aetna MGG,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,BCBS,BCBS,62.84,,,,,,,per diem,62.84,62.84,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,BCBS MGG,BCBS MGG,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Cigna,Cigna,62.84,,,,,,,per diem,62.84,62.84,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Cigna MGG,Cigna MGG,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Humana,Humana,62.84,,,,,,,per diem,62.84,62.84,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Humana MGG,Humana MGG,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Optum VA,Optum VA,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,UHC,UHC,62.84,,,,,,,per diem,62.84,62.84,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,UHC MGG,UHC MGG,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,VA,VA,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Wellcare MGG,Wellcare MGG,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Bright Health - commercial,Bright Health - commercial,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,62.84,62.84,Bright Health MGG,Bright Health MGG,62.84,,,,,,,case rate,62.84,62.84,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Aetna,Aetna,212.5,,,,,,,per diem,212.5,212.5,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Aetna MGG,Aetna MGG,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,BCBS,BCBS,212.5,,,,,,,per diem,212.5,212.5,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,BCBS MGG,BCBS MGG,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Cigna,Cigna,212.5,,,,,,,per diem,212.5,212.5,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Cigna MGG,Cigna MGG,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Humana,Humana,212.5,,,,,,,per diem,212.5,212.5,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Humana MGG,Humana MGG,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Optum VA,Optum VA,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,UHC,UHC,212.5,,,,,,,per diem,212.5,212.5,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,UHC MGG,UHC MGG,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,VA,VA,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Wellcare MGG,Wellcare MGG,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Bright Health - commercial,Bright Health - commercial,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38300490,CDM,300,RC,89050,CPT,,,,Inpatient,,,212.5,212.5,Bright Health MGG,Bright Health MGG,212.5,,,,,,,case rate,212.5,212.5,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38300700,CDM,301,RC,84681,CPT,,,,Inpatient,,,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Aetna,Aetna,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Aetna MGG,Aetna MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,BCBS,BCBS,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,BCBS MGG,BCBS MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Cigna,Cigna,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Cigna MGG,Cigna MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Humana,Humana,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Humana MGG,Humana MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Optum VA,Optum VA,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,UHC,UHC,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,UHC MGG,UHC MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,VA,VA,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Wellcare MGG,Wellcare MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Bright Health - commercial,Bright Health - commercial,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
CREATINE                      ,38300760,CDM,301,RC,82540,CPT,,,,Inpatient,,,55.62,55.62,Bright Health MGG,Bright Health MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Aetna,Aetna,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Aetna MGG,Aetna MGG,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,BCBS,BCBS,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,BCBS MGG,BCBS MGG,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Cigna,Cigna,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Cigna MGG,Cigna MGG,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Humana,Humana,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Humana MGG,Humana MGG,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Optum VA,Optum VA,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,UHC,UHC,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,UHC MGG,UHC MGG,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,VA,VA,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Wellcare MGG,Wellcare MGG,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Bright Health - commercial,Bright Health - commercial,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38300810,CDM,301,RC,82945,CPT,,,,Inpatient,,,48.55,48.55,Bright Health MGG,Bright Health MGG,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Aetna,Aetna,27.71,,,,,,,per diem,27.71,27.71,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Aetna MGG,Aetna MGG,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,BCBS,BCBS,27.71,,,,,,,per diem,27.71,27.71,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,BCBS MGG,BCBS MGG,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Cigna,Cigna,27.71,,,,,,,per diem,27.71,27.71,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Cigna MGG,Cigna MGG,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Humana,Humana,27.71,,,,,,,per diem,27.71,27.71,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Humana MGG,Humana MGG,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Optum VA,Optum VA,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,UHC,UHC,27.71,,,,,,,per diem,27.71,27.71,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,UHC MGG,UHC MGG,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,VA,VA,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Wellcare MGG,Wellcare MGG,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Bright Health - commercial,Bright Health - commercial,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38301020,CDM,305,RC,85007,CPT,,,,Inpatient,,,27.71,27.71,Bright Health MGG,Bright Health MGG,27.71,,,,,,,case rate,27.71,27.71,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Aetna,Aetna,24.17,,,,,,,per diem,24.17,24.17,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Aetna MGG,Aetna MGG,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,BCBS,BCBS,24.17,,,,,,,per diem,24.17,24.17,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,BCBS MGG,BCBS MGG,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Cigna,Cigna,24.17,,,,,,,per diem,24.17,24.17,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Cigna MGG,Cigna MGG,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Humana,Humana,24.17,,,,,,,per diem,24.17,24.17,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Humana MGG,Humana MGG,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Optum VA,Optum VA,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,UHC,UHC,24.17,,,,,,,per diem,24.17,24.17,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,UHC MGG,UHC MGG,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,VA,VA,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Wellcare MGG,Wellcare MGG,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Bright Health - commercial,Bright Health - commercial,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,24.17,24.17,Bright Health MGG,Bright Health MGG,24.17,,,,,,,case rate,24.17,24.17,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Aetna,Aetna,57.55,,,,,,,per diem,57.55,57.55,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Aetna MGG,Aetna MGG,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,BCBS,BCBS,57.55,,,,,,,per diem,57.55,57.55,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,BCBS MGG,BCBS MGG,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Cigna,Cigna,57.55,,,,,,,per diem,57.55,57.55,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Cigna MGG,Cigna MGG,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Humana,Humana,57.55,,,,,,,per diem,57.55,57.55,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Humana MGG,Humana MGG,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Optum VA,Optum VA,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,UHC,UHC,57.55,,,,,,,per diem,57.55,57.55,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,UHC MGG,UHC MGG,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,VA,VA,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Wellcare MGG,Wellcare MGG,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Bright Health - commercial,Bright Health - commercial,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,57.55,57.55,Bright Health MGG,Bright Health MGG,57.55,,,,,,,case rate,57.55,57.55,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Aetna,Aetna,127.71,,,,,,,per diem,127.71,127.71,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Aetna MGG,Aetna MGG,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,BCBS,BCBS,127.71,,,,,,,per diem,127.71,127.71,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,BCBS MGG,BCBS MGG,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Cigna,Cigna,127.71,,,,,,,per diem,127.71,127.71,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Cigna MGG,Cigna MGG,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Humana,Humana,127.71,,,,,,,per diem,127.71,127.71,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Humana MGG,Humana MGG,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Optum VA,Optum VA,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,UHC,UHC,127.71,,,,,,,per diem,127.71,127.71,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,UHC MGG,UHC MGG,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,VA,VA,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Wellcare MGG,Wellcare MGG,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Bright Health - commercial,Bright Health - commercial,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,127.71,127.71,Bright Health MGG,Bright Health MGG,127.71,,,,,,,case rate,127.71,127.71,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Aetna,Aetna,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Aetna MGG,Aetna MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,BCBS,BCBS,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,BCBS MGG,BCBS MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Cigna,Cigna,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Cigna MGG,Cigna MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Humana,Humana,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Humana MGG,Humana MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Optum VA,Optum VA,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,UHC,UHC,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,UHC MGG,UHC MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,VA,VA,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Wellcare MGG,Wellcare MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Bright Health - commercial,Bright Health - commercial,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,129.99,129.99,Bright Health MGG,Bright Health MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Aetna,Aetna,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Aetna MGG,Aetna MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,BCBS,BCBS,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,BCBS MGG,BCBS MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Cigna,Cigna,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Cigna MGG,Cigna MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Humana,Humana,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Humana MGG,Humana MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Optum VA,Optum VA,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,UHC,UHC,129.99,,,,,,,per diem,129.99,129.99,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,UHC MGG,UHC MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,VA,VA,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Wellcare MGG,Wellcare MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Bright Health - commercial,Bright Health - commercial,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,129.99,129.99,Bright Health MGG,Bright Health MGG,129.99,,,,,,,case rate,129.99,129.99,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Aetna,Aetna,24.61,,,,,,,per diem,24.61,24.61,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Aetna MGG,Aetna MGG,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,BCBS,BCBS,24.61,,,,,,,per diem,24.61,24.61,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,BCBS MGG,BCBS MGG,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Cigna,Cigna,24.61,,,,,,,per diem,24.61,24.61,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Cigna MGG,Cigna MGG,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Humana,Humana,24.61,,,,,,,per diem,24.61,24.61,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Humana MGG,Humana MGG,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Optum VA,Optum VA,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,UHC,UHC,24.61,,,,,,,per diem,24.61,24.61,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,UHC MGG,UHC MGG,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,VA,VA,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Wellcare MGG,Wellcare MGG,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Bright Health - commercial,Bright Health - commercial,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38302215,CDM,305,RC,85045,CPT,,,,Inpatient,,,24.61,24.61,Bright Health MGG,Bright Health MGG,24.61,,,,,,,case rate,24.61,24.61,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Aetna,Aetna,80.06,,,,,,,per diem,80.06,80.06,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Aetna MGG,Aetna MGG,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,BCBS,BCBS,80.06,,,,,,,per diem,80.06,80.06,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,BCBS MGG,BCBS MGG,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Cigna,Cigna,80.06,,,,,,,per diem,80.06,80.06,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Cigna MGG,Cigna MGG,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Humana,Humana,80.06,,,,,,,per diem,80.06,80.06,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Humana MGG,Humana MGG,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Optum VA,Optum VA,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,UHC,UHC,80.06,,,,,,,per diem,80.06,80.06,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,UHC MGG,UHC MGG,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,VA,VA,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Wellcare MGG,Wellcare MGG,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Bright Health - commercial,Bright Health - commercial,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38302480,CDM,301,RC,84540,CPT,,,,Inpatient,,,80.06,80.06,Bright Health MGG,Bright Health MGG,80.06,,,,,,,case rate,80.06,80.06,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Aetna,Aetna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Aetna MGG,Aetna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,BCBS,BCBS,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,BCBS MGG,BCBS MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Cigna,Cigna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Cigna MGG,Cigna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Humana,Humana,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Humana MGG,Humana MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Optum VA,Optum VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,UHC,UHC,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,UHC MGG,UHC MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,VA,VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Wellcare MGG,Wellcare MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Bright Health - commercial,Bright Health - commercial,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38302500,CDM,301,RC,80164,CPT,,,,Inpatient,,,75,75,Bright Health MGG,Bright Health MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Aetna,Aetna,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Aetna MGG,Aetna MGG,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,BCBS,BCBS,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,BCBS MGG,BCBS MGG,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Cigna,Cigna,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Cigna MGG,Cigna MGG,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Humana,Humana,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Humana MGG,Humana MGG,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Optum VA,Optum VA,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,UHC,UHC,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,UHC MGG,UHC MGG,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,VA,VA,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Wellcare MGG,Wellcare MGG,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Bright Health - commercial,Bright Health - commercial,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38302550,CDM,305,RC,85048,CPT,,,,Inpatient,,,60.93,60.93,Bright Health MGG,Bright Health MGG,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Aetna,Aetna,268.26,,,,,,,per diem,268.26,268.26,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Aetna MGG,Aetna MGG,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,BCBS,BCBS,268.26,,,,,,,per diem,268.26,268.26,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,BCBS MGG,BCBS MGG,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Cigna,Cigna,268.26,,,,,,,per diem,268.26,268.26,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Cigna MGG,Cigna MGG,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Humana,Humana,268.26,,,,,,,per diem,268.26,268.26,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Humana MGG,Humana MGG,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Optum VA,Optum VA,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,UHC,UHC,268.26,,,,,,,per diem,268.26,268.26,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,UHC MGG,UHC MGG,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,VA,VA,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Wellcare MGG,Wellcare MGG,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Bright Health - commercial,Bright Health - commercial,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38302575,CDM,302,RC,86789,CPT,,,,Inpatient,,,268.26,268.26,Bright Health MGG,Bright Health MGG,268.26,,,,,,,case rate,268.26,268.26,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Aetna,Aetna,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Aetna MGG,Aetna MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,BCBS,BCBS,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,BCBS MGG,BCBS MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Cigna,Cigna,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Cigna MGG,Cigna MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Humana,Humana,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Humana MGG,Humana MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Optum VA,Optum VA,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,UHC,UHC,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,UHC MGG,UHC MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,VA,VA,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Wellcare MGG,Wellcare MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Bright Health - commercial,Bright Health - commercial,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,210.12,210.12,Bright Health MGG,Bright Health MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Aetna,Aetna,4.53,,,,,,,per diem,4.53,4.53,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Aetna MGG,Aetna MGG,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,BCBS,BCBS,4.53,,,,,,,per diem,4.53,4.53,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,BCBS MGG,BCBS MGG,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Cigna,Cigna,4.53,,,,,,,per diem,4.53,4.53,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Cigna MGG,Cigna MGG,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Humana,Humana,4.53,,,,,,,per diem,4.53,4.53,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Humana MGG,Humana MGG,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Optum VA,Optum VA,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,UHC,UHC,4.53,,,,,,,per diem,4.53,4.53,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,UHC MGG,UHC MGG,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,VA,VA,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Wellcare MGG,Wellcare MGG,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Bright Health - commercial,Bright Health - commercial,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,4.53,4.53,Bright Health MGG,Bright Health MGG,4.53,,,,,,,case rate,4.53,4.53,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Aetna,Aetna,355.01,,,,,,,per diem,355.01,355.01,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Aetna MGG,Aetna MGG,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,BCBS,BCBS,355.01,,,,,,,per diem,355.01,355.01,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,BCBS MGG,BCBS MGG,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Cigna,Cigna,355.01,,,,,,,per diem,355.01,355.01,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Cigna MGG,Cigna MGG,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Humana,Humana,355.01,,,,,,,per diem,355.01,355.01,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Humana MGG,Humana MGG,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Optum VA,Optum VA,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,UHC,UHC,355.01,,,,,,,per diem,355.01,355.01,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,UHC MGG,UHC MGG,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,VA,VA,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Wellcare MGG,Wellcare MGG,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Bright Health - commercial,Bright Health - commercial,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,355.01,355.01,Bright Health MGG,Bright Health MGG,355.01,,,,,,,case rate,355.01,355.01,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Aetna,Aetna,75.48,,,,,,,per diem,75.48,75.48,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Aetna MGG,Aetna MGG,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,BCBS,BCBS,75.48,,,,,,,per diem,75.48,75.48,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,BCBS MGG,BCBS MGG,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Cigna,Cigna,75.48,,,,,,,per diem,75.48,75.48,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Cigna MGG,Cigna MGG,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Humana,Humana,75.48,,,,,,,per diem,75.48,75.48,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Humana MGG,Humana MGG,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Optum VA,Optum VA,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,UHC,UHC,75.48,,,,,,,per diem,75.48,75.48,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,UHC MGG,UHC MGG,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,VA,VA,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Wellcare MGG,Wellcare MGG,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Bright Health - commercial,Bright Health - commercial,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,75.48,75.48,Bright Health MGG,Bright Health MGG,75.48,,,,,,,case rate,75.48,75.48,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Aetna,Aetna,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Aetna MGG,Aetna MGG,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,BCBS,BCBS,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,BCBS MGG,BCBS MGG,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Cigna,Cigna,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Cigna MGG,Cigna MGG,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Humana,Humana,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Humana MGG,Humana MGG,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Optum VA,Optum VA,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,UHC,UHC,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,UHC MGG,UHC MGG,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,VA,VA,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Wellcare MGG,Wellcare MGG,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Bright Health - commercial,Bright Health - commercial,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38305656,CDM,300,RC,89190,CPT,,,,Inpatient,,,20.6,20.6,Bright Health MGG,Bright Health MGG,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Aetna,Aetna,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Aetna MGG,Aetna MGG,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,BCBS,BCBS,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,BCBS MGG,BCBS MGG,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Cigna,Cigna,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Cigna MGG,Cigna MGG,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Humana,Humana,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Humana MGG,Humana MGG,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Optum VA,Optum VA,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,UHC,UHC,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,UHC MGG,UHC MGG,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,VA,VA,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Wellcare MGG,Wellcare MGG,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Bright Health - commercial,Bright Health - commercial,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38380020,CDM,305,RC,85032,CPT,,,,Inpatient,,,67.86,67.86,Bright Health MGG,Bright Health MGG,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Aetna,Aetna,145.54,,,,,,,per diem,145.54,145.54,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Aetna MGG,Aetna MGG,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,BCBS,BCBS,145.54,,,,,,,per diem,145.54,145.54,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,BCBS MGG,BCBS MGG,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Cigna,Cigna,145.54,,,,,,,per diem,145.54,145.54,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Cigna MGG,Cigna MGG,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Humana,Humana,145.54,,,,,,,per diem,145.54,145.54,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Humana MGG,Humana MGG,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Optum VA,Optum VA,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,UHC,UHC,145.54,,,,,,,per diem,145.54,145.54,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,UHC MGG,UHC MGG,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,VA,VA,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Wellcare MGG,Wellcare MGG,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Bright Health - commercial,Bright Health - commercial,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38393950,CDM,306,RC,87324,CPT,,,,Inpatient,,,145.54,145.54,Bright Health MGG,Bright Health MGG,145.54,,,,,,,case rate,145.54,145.54,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Aetna,Aetna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Aetna MGG,Aetna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,BCBS,BCBS,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,BCBS MGG,BCBS MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Cigna,Cigna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Cigna MGG,Cigna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Humana,Humana,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Humana MGG,Humana MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Optum VA,Optum VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,UHC,UHC,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,UHC MGG,UHC MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,VA,VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Wellcare MGG,Wellcare MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Bright Health - commercial,Bright Health - commercial,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38399306,CDM,301,RC,83630,CPT,,,,Inpatient,,,63,63,Bright Health MGG,Bright Health MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Aetna,Aetna,1408,,,,,,,per diem,1408,1408,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Aetna MGG,Aetna MGG,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,BCBS,BCBS,1408,,,,,,,per diem,1408,1408,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,BCBS MGG,BCBS MGG,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Cigna,Cigna,1408,,,,,,,per diem,1408,1408,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Cigna MGG,Cigna MGG,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Humana,Humana,1408,,,,,,,per diem,1408,1408,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Humana MGG,Humana MGG,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Optum VA,Optum VA,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,UHC,UHC,1408,,,,,,,per diem,1408,1408,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,UHC MGG,UHC MGG,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,VA,VA,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Wellcare MGG,Wellcare MGG,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Bright Health - commercial,Bright Health - commercial,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1408,1408,Bright Health MGG,Bright Health MGG,1408,,,,,,,case rate,1408,1408,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Aetna,Aetna,2006.1,,,,,,,per diem,2006.1,2006.1,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Aetna MGG,Aetna MGG,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,BCBS,BCBS,2006.1,,,,,,,per diem,2006.1,2006.1,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,BCBS MGG,BCBS MGG,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Cigna,Cigna,2006.1,,,,,,,per diem,2006.1,2006.1,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Cigna MGG,Cigna MGG,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Humana,Humana,2006.1,,,,,,,per diem,2006.1,2006.1,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Humana MGG,Humana MGG,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Optum VA,Optum VA,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,UHC,UHC,2006.1,,,,,,,per diem,2006.1,2006.1,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,UHC MGG,UHC MGG,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,VA,VA,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Wellcare MGG,Wellcare MGG,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Bright Health - commercial,Bright Health - commercial,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2006.1,2006.1,Bright Health MGG,Bright Health MGG,2006.1,,,,,,,case rate,2006.1,2006.1,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Aetna,Aetna,1223,,,,,,,per diem,1223,1223,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Aetna MGG,Aetna MGG,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,BCBS,BCBS,1223,,,,,,,per diem,1223,1223,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,BCBS MGG,BCBS MGG,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Cigna,Cigna,1223,,,,,,,per diem,1223,1223,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Cigna MGG,Cigna MGG,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Humana,Humana,1223,,,,,,,per diem,1223,1223,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Humana MGG,Humana MGG,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Optum VA,Optum VA,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,UHC,UHC,1223,,,,,,,per diem,1223,1223,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,UHC MGG,UHC MGG,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,VA,VA,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Wellcare MGG,Wellcare MGG,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Bright Health - commercial,Bright Health - commercial,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1223,1223,Bright Health MGG,Bright Health MGG,1223,,,,,,,case rate,1223,1223,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Aetna,Aetna,1314.55,,,,,,,per diem,1314.55,1314.55,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Aetna MGG,Aetna MGG,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,BCBS,BCBS,1314.55,,,,,,,per diem,1314.55,1314.55,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,BCBS MGG,BCBS MGG,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Cigna,Cigna,1314.55,,,,,,,per diem,1314.55,1314.55,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Cigna MGG,Cigna MGG,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Humana,Humana,1314.55,,,,,,,per diem,1314.55,1314.55,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Humana MGG,Humana MGG,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Optum VA,Optum VA,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,UHC,UHC,1314.55,,,,,,,per diem,1314.55,1314.55,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,UHC MGG,UHC MGG,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,VA,VA,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Wellcare MGG,Wellcare MGG,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Bright Health - commercial,Bright Health - commercial,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1314.55,1314.55,Bright Health MGG,Bright Health MGG,1314.55,,,,,,,case rate,1314.55,1314.55,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Aetna,Aetna,5427.24,,,,,,,per diem,5427.24,5427.24,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Aetna MGG,Aetna MGG,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,BCBS,BCBS,5427.24,,,,,,,per diem,5427.24,5427.24,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,BCBS MGG,BCBS MGG,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Cigna,Cigna,5427.24,,,,,,,per diem,5427.24,5427.24,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Cigna MGG,Cigna MGG,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Humana,Humana,5427.24,,,,,,,per diem,5427.24,5427.24,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Humana MGG,Humana MGG,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Optum VA,Optum VA,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,UHC,UHC,5427.24,,,,,,,per diem,5427.24,5427.24,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,UHC MGG,UHC MGG,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,VA,VA,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Wellcare MGG,Wellcare MGG,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Bright Health - commercial,Bright Health - commercial,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5427.24,5427.24,Bright Health MGG,Bright Health MGG,5427.24,,,,,,,case rate,5427.24,5427.24,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Aetna,Aetna,4392.15,,,,,,,per diem,4392.15,4392.15,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Aetna MGG,Aetna MGG,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,BCBS,BCBS,4392.15,,,,,,,per diem,4392.15,4392.15,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,BCBS MGG,BCBS MGG,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Cigna,Cigna,4392.15,,,,,,,per diem,4392.15,4392.15,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Cigna MGG,Cigna MGG,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Humana,Humana,4392.15,,,,,,,per diem,4392.15,4392.15,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Humana MGG,Humana MGG,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Optum VA,Optum VA,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,UHC,UHC,4392.15,,,,,,,per diem,4392.15,4392.15,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,UHC MGG,UHC MGG,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,VA,VA,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Wellcare MGG,Wellcare MGG,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Bright Health - commercial,Bright Health - commercial,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4392.15,4392.15,Bright Health MGG,Bright Health MGG,4392.15,,,,,,,case rate,4392.15,4392.15,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Aetna,Aetna,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Aetna MGG,Aetna MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,BCBS,BCBS,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,BCBS MGG,BCBS MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Cigna,Cigna,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Cigna MGG,Cigna MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Humana,Humana,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Humana MGG,Humana MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Optum VA,Optum VA,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,UHC,UHC,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,UHC MGG,UHC MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,VA,VA,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Wellcare MGG,Wellcare MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Bright Health - commercial,Bright Health - commercial,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,366,366,Bright Health MGG,Bright Health MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Aetna,Aetna,1406.25,,,,,,,per diem,1406.25,1406.25,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Aetna MGG,Aetna MGG,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,BCBS,BCBS,1406.25,,,,,,,per diem,1406.25,1406.25,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,BCBS MGG,BCBS MGG,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Cigna,Cigna,1406.25,,,,,,,per diem,1406.25,1406.25,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Cigna MGG,Cigna MGG,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Humana,Humana,1406.25,,,,,,,per diem,1406.25,1406.25,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Humana MGG,Humana MGG,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Optum VA,Optum VA,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,UHC,UHC,1406.25,,,,,,,per diem,1406.25,1406.25,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,UHC MGG,UHC MGG,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,VA,VA,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Wellcare MGG,Wellcare MGG,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Bright Health - commercial,Bright Health - commercial,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1406.25,1406.25,Bright Health MGG,Bright Health MGG,1406.25,,,,,,,case rate,1406.25,1406.25,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Aetna,Aetna,3048.11,,,,,,,per diem,3048.11,3048.11,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Aetna MGG,Aetna MGG,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,BCBS,BCBS,3048.11,,,,,,,per diem,3048.11,3048.11,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,BCBS MGG,BCBS MGG,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Cigna,Cigna,3048.11,,,,,,,per diem,3048.11,3048.11,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Cigna MGG,Cigna MGG,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Humana,Humana,3048.11,,,,,,,per diem,3048.11,3048.11,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Humana MGG,Humana MGG,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Optum VA,Optum VA,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,UHC,UHC,3048.11,,,,,,,per diem,3048.11,3048.11,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,UHC MGG,UHC MGG,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,VA,VA,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Wellcare MGG,Wellcare MGG,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Bright Health - commercial,Bright Health - commercial,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3048.11,3048.11,Bright Health MGG,Bright Health MGG,3048.11,,,,,,,case rate,3048.11,3048.11,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Aetna,Aetna,330,,,,,,,per diem,330,330,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Aetna MGG,Aetna MGG,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,BCBS,BCBS,330,,,,,,,per diem,330,330,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,BCBS MGG,BCBS MGG,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Cigna,Cigna,330,,,,,,,per diem,330,330,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Cigna MGG,Cigna MGG,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Humana,Humana,330,,,,,,,per diem,330,330,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Humana MGG,Humana MGG,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Optum VA,Optum VA,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,UHC,UHC,330,,,,,,,per diem,330,330,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,UHC MGG,UHC MGG,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,VA,VA,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Wellcare MGG,Wellcare MGG,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Bright Health - commercial,Bright Health - commercial,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,330,330,Bright Health MGG,Bright Health MGG,330,,,,,,,case rate,330,330,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Aetna,Aetna,682,,,,,,,per diem,682,682,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Aetna MGG,Aetna MGG,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,BCBS,BCBS,682,,,,,,,per diem,682,682,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,BCBS MGG,BCBS MGG,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Cigna,Cigna,682,,,,,,,per diem,682,682,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Cigna MGG,Cigna MGG,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Humana,Humana,682,,,,,,,per diem,682,682,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Humana MGG,Humana MGG,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Optum VA,Optum VA,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,UHC,UHC,682,,,,,,,per diem,682,682,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,UHC MGG,UHC MGG,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,VA,VA,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Wellcare MGG,Wellcare MGG,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Bright Health - commercial,Bright Health - commercial,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,682,682,Bright Health MGG,Bright Health MGG,682,,,,,,,case rate,682,682,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Aetna,Aetna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Aetna MGG,Aetna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,BCBS,BCBS,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,BCBS MGG,BCBS MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Cigna,Cigna,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Cigna MGG,Cigna MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Humana,Humana,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Humana MGG,Humana MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Optum VA,Optum VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,UHC,UHC,195,,,,,,,per diem,195,195,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,UHC MGG,UHC MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,VA,VA,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Wellcare MGG,Wellcare MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Bright Health - commercial,Bright Health - commercial,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,195,195,Bright Health MGG,Bright Health MGG,195,,,,,,,case rate,195,195,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Aetna,Aetna,857,,,,,,,per diem,857,857,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Aetna MGG,Aetna MGG,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,BCBS,BCBS,857,,,,,,,per diem,857,857,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,BCBS MGG,BCBS MGG,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Cigna,Cigna,857,,,,,,,per diem,857,857,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Cigna MGG,Cigna MGG,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Humana,Humana,857,,,,,,,per diem,857,857,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Humana MGG,Humana MGG,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Optum VA,Optum VA,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,UHC,UHC,857,,,,,,,per diem,857,857,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,UHC MGG,UHC MGG,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,VA,VA,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Wellcare MGG,Wellcare MGG,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Bright Health - commercial,Bright Health - commercial,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,857,857,Bright Health MGG,Bright Health MGG,857,,,,,,,case rate,857,857,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Aetna,Aetna,777,,,,,,,per diem,777,777,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Aetna MGG,Aetna MGG,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,BCBS,BCBS,777,,,,,,,per diem,777,777,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,BCBS MGG,BCBS MGG,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Cigna,Cigna,777,,,,,,,per diem,777,777,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Cigna MGG,Cigna MGG,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Humana,Humana,777,,,,,,,per diem,777,777,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Humana MGG,Humana MGG,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Optum VA,Optum VA,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,UHC,UHC,777,,,,,,,per diem,777,777,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,UHC MGG,UHC MGG,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,VA,VA,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Wellcare MGG,Wellcare MGG,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Bright Health - commercial,Bright Health - commercial,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,777,777,Bright Health MGG,Bright Health MGG,777,,,,,,,case rate,777,777,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Aetna,Aetna,2322,,,,,,,per diem,2322,2322,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Aetna MGG,Aetna MGG,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,BCBS,BCBS,2322,,,,,,,per diem,2322,2322,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,BCBS MGG,BCBS MGG,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Cigna,Cigna,2322,,,,,,,per diem,2322,2322,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Cigna MGG,Cigna MGG,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Humana,Humana,2322,,,,,,,per diem,2322,2322,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Humana MGG,Humana MGG,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Optum VA,Optum VA,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,UHC,UHC,2322,,,,,,,per diem,2322,2322,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,UHC MGG,UHC MGG,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,VA,VA,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Wellcare MGG,Wellcare MGG,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Bright Health - commercial,Bright Health - commercial,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2322,2322,Bright Health MGG,Bright Health MGG,2322,,,,,,,case rate,2322,2322,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Aetna,Aetna,496,,,,,,,per diem,496,496,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Aetna MGG,Aetna MGG,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,BCBS,BCBS,496,,,,,,,per diem,496,496,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,BCBS MGG,BCBS MGG,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Cigna,Cigna,496,,,,,,,per diem,496,496,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Cigna MGG,Cigna MGG,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Humana,Humana,496,,,,,,,per diem,496,496,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Humana MGG,Humana MGG,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Optum VA,Optum VA,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,UHC,UHC,496,,,,,,,per diem,496,496,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,UHC MGG,UHC MGG,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,VA,VA,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Wellcare MGG,Wellcare MGG,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Bright Health - commercial,Bright Health - commercial,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,496,496,Bright Health MGG,Bright Health MGG,496,,,,,,,case rate,496,496,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Aetna,Aetna,1500,,,,,,,per diem,1500,1500,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Aetna MGG,Aetna MGG,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,BCBS,BCBS,1500,,,,,,,per diem,1500,1500,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,BCBS MGG,BCBS MGG,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Cigna,Cigna,1500,,,,,,,per diem,1500,1500,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Cigna MGG,Cigna MGG,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Humana,Humana,1500,,,,,,,per diem,1500,1500,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Humana MGG,Humana MGG,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Optum VA,Optum VA,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,UHC,UHC,1500,,,,,,,per diem,1500,1500,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,UHC MGG,UHC MGG,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,VA,VA,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Wellcare MGG,Wellcare MGG,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Bright Health - commercial,Bright Health - commercial,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1500,1500,Bright Health MGG,Bright Health MGG,1500,,,,,,,case rate,1500,1500,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Aetna,Aetna,2660,,,,,,,per diem,2660,2660,"Per diem rate, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Aetna MGG,Aetna MGG,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,BCBS,BCBS,2660,,,,,,,per diem,2660,2660,"Per diem rate, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,BCBS MGG,BCBS MGG,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Cigna,Cigna,2660,,,,,,,per diem,2660,2660,"Per diem rate, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Cigna MGG,Cigna MGG,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Humana,Humana,2660,,,,,,,per diem,2660,2660,"Per diem rate, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Humana MGG,Humana MGG,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Optum VA,Optum VA,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,UHC,UHC,2660,,,,,,,per diem,2660,2660,"Per diem rate, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,UHC MGG,UHC MGG,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,VA,VA,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Wellcare MGG,Wellcare MGG,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Bright Health - commercial,Bright Health - commercial,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
EGD W/BIOPSY(S)               ,38504105,CDM,750,RC,43239,CPT,,,,Inpatient,,,2660,2660,Bright Health MGG,Bright Health MGG,2660,,,,,,,case rate,2660,2660,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Aetna,Aetna,76,,,,,,,per diem,76,76,"Per diem rate, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Aetna MGG,Aetna MGG,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,BCBS,BCBS,76,,,,,,,per diem,76,76,"Per diem rate, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,BCBS MGG,BCBS MGG,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Cigna,Cigna,76,,,,,,,per diem,76,76,"Per diem rate, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Cigna MGG,Cigna MGG,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Humana,Humana,76,,,,,,,per diem,76,76,"Per diem rate, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Humana MGG,Humana MGG,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Optum VA,Optum VA,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,UHC,UHC,76,,,,,,,per diem,76,76,"Per diem rate, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,UHC MGG,UHC MGG,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,VA,VA,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Wellcare MGG,Wellcare MGG,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Bright Health - commercial,Bright Health - commercial,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
OUTSIDE SERVICE-INTERV RAD    ,38599989,CDM,320,RC,,,,,,Inpatient,,,76,76,Bright Health MGG,Bright Health MGG,76,,,,,,,case rate,76,76,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Aetna,Aetna,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Aetna MGG,Aetna MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,BCBS,BCBS,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,BCBS MGG,BCBS MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Cigna,Cigna,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Cigna MGG,Cigna MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Humana,Humana,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Humana MGG,Humana MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Optum VA,Optum VA,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,UHC,UHC,130,,,,,,,per diem,130,130,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,UHC MGG,UHC MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,VA,VA,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Wellcare MGG,Wellcare MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Bright Health - commercial,Bright Health - commercial,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,130,130,Bright Health MGG,Bright Health MGG,130,,,,,,,case rate,130,130,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Aetna,Aetna,2094.43,,,,,,,per diem,2094.43,2094.43,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Aetna MGG,Aetna MGG,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,BCBS,BCBS,2094.43,,,,,,,per diem,2094.43,2094.43,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,BCBS MGG,BCBS MGG,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Cigna,Cigna,2094.43,,,,,,,per diem,2094.43,2094.43,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Cigna MGG,Cigna MGG,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Humana,Humana,2094.43,,,,,,,per diem,2094.43,2094.43,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Humana MGG,Humana MGG,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Optum VA,Optum VA,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,UHC,UHC,2094.43,,,,,,,per diem,2094.43,2094.43,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,UHC MGG,UHC MGG,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,VA,VA,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Wellcare MGG,Wellcare MGG,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Bright Health - commercial,Bright Health - commercial,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2094.43,2094.43,Bright Health MGG,Bright Health MGG,2094.43,,,,,,,case rate,2094.43,2094.43,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Aetna,Aetna,1269.18,,,,,,,per diem,1269.18,1269.18,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Aetna MGG,Aetna MGG,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,BCBS,BCBS,1269.18,,,,,,,per diem,1269.18,1269.18,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,BCBS MGG,BCBS MGG,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Cigna,Cigna,1269.18,,,,,,,per diem,1269.18,1269.18,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Cigna MGG,Cigna MGG,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Humana,Humana,1269.18,,,,,,,per diem,1269.18,1269.18,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Humana MGG,Humana MGG,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Optum VA,Optum VA,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,UHC,UHC,1269.18,,,,,,,per diem,1269.18,1269.18,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,UHC MGG,UHC MGG,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,VA,VA,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Wellcare MGG,Wellcare MGG,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Bright Health - commercial,Bright Health - commercial,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1269.18,1269.18,Bright Health MGG,Bright Health MGG,1269.18,,,,,,,case rate,1269.18,1269.18,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Aetna,Aetna,519.19,,,,,,,per diem,519.19,519.19,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Aetna MGG,Aetna MGG,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,BCBS,BCBS,519.19,,,,,,,per diem,519.19,519.19,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,BCBS MGG,BCBS MGG,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Cigna,Cigna,519.19,,,,,,,per diem,519.19,519.19,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Cigna MGG,Cigna MGG,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Humana,Humana,519.19,,,,,,,per diem,519.19,519.19,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Humana MGG,Humana MGG,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Optum VA,Optum VA,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,UHC,UHC,519.19,,,,,,,per diem,519.19,519.19,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,UHC MGG,UHC MGG,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,VA,VA,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Wellcare MGG,Wellcare MGG,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Bright Health - commercial,Bright Health - commercial,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,519.19,519.19,Bright Health MGG,Bright Health MGG,519.19,,,,,,,case rate,519.19,519.19,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Aetna,Aetna,166.44,,,,,,,per diem,166.44,166.44,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Aetna MGG,Aetna MGG,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,BCBS,BCBS,166.44,,,,,,,per diem,166.44,166.44,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,BCBS MGG,BCBS MGG,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Cigna,Cigna,166.44,,,,,,,per diem,166.44,166.44,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Cigna MGG,Cigna MGG,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Humana,Humana,166.44,,,,,,,per diem,166.44,166.44,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Humana MGG,Humana MGG,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Optum VA,Optum VA,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,UHC,UHC,166.44,,,,,,,per diem,166.44,166.44,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,UHC MGG,UHC MGG,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,VA,VA,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Wellcare MGG,Wellcare MGG,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Bright Health - commercial,Bright Health - commercial,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,166.44,166.44,Bright Health MGG,Bright Health MGG,166.44,,,,,,,case rate,166.44,166.44,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Aetna,Aetna,202.04,,,,,,,per diem,202.04,202.04,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Aetna MGG,Aetna MGG,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,BCBS,BCBS,202.04,,,,,,,per diem,202.04,202.04,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,BCBS MGG,BCBS MGG,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Cigna,Cigna,202.04,,,,,,,per diem,202.04,202.04,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Cigna MGG,Cigna MGG,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Humana,Humana,202.04,,,,,,,per diem,202.04,202.04,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Humana MGG,Humana MGG,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Optum VA,Optum VA,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,UHC,UHC,202.04,,,,,,,per diem,202.04,202.04,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,UHC MGG,UHC MGG,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,VA,VA,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Wellcare MGG,Wellcare MGG,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Bright Health - commercial,Bright Health - commercial,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,202.04,202.04,Bright Health MGG,Bright Health MGG,202.04,,,,,,,case rate,202.04,202.04,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Aetna,Aetna,1493.29,,,,,,,per diem,1493.29,1493.29,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Aetna MGG,Aetna MGG,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,BCBS,BCBS,1493.29,,,,,,,per diem,1493.29,1493.29,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,BCBS MGG,BCBS MGG,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Cigna,Cigna,1493.29,,,,,,,per diem,1493.29,1493.29,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Cigna MGG,Cigna MGG,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Humana,Humana,1493.29,,,,,,,per diem,1493.29,1493.29,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Humana MGG,Humana MGG,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Optum VA,Optum VA,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,UHC,UHC,1493.29,,,,,,,per diem,1493.29,1493.29,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,UHC MGG,UHC MGG,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,VA,VA,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Wellcare MGG,Wellcare MGG,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Bright Health - commercial,Bright Health - commercial,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,93225,CPT,,,,Inpatient,,,1493.29,1493.29,Bright Health MGG,Bright Health MGG,1493.29,,,,,,,case rate,1493.29,1493.29,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Aetna,Aetna,776.17,,,,,,,per diem,776.17,776.17,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Aetna MGG,Aetna MGG,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,BCBS,BCBS,776.17,,,,,,,per diem,776.17,776.17,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,BCBS MGG,BCBS MGG,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Cigna,Cigna,776.17,,,,,,,per diem,776.17,776.17,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Cigna MGG,Cigna MGG,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Humana,Humana,776.17,,,,,,,per diem,776.17,776.17,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Humana MGG,Humana MGG,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Optum VA,Optum VA,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,UHC,UHC,776.17,,,,,,,per diem,776.17,776.17,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,UHC MGG,UHC MGG,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,VA,VA,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Wellcare MGG,Wellcare MGG,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Bright Health - commercial,Bright Health - commercial,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,776.17,776.17,Bright Health MGG,Bright Health MGG,776.17,,,,,,,case rate,776.17,776.17,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Aetna,Aetna,2.5,,,,,,,per diem,2.5,2.5,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Aetna MGG,Aetna MGG,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,BCBS,BCBS,2.5,,,,,,,per diem,2.5,2.5,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,BCBS MGG,BCBS MGG,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Cigna,Cigna,2.5,,,,,,,per diem,2.5,2.5,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Cigna MGG,Cigna MGG,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Humana,Humana,2.5,,,,,,,per diem,2.5,2.5,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Humana MGG,Humana MGG,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Optum VA,Optum VA,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,UHC,UHC,2.5,,,,,,,per diem,2.5,2.5,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,UHC MGG,UHC MGG,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,VA,VA,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Wellcare MGG,Wellcare MGG,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Bright Health - commercial,Bright Health - commercial,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.5,2.5,Bright Health MGG,Bright Health MGG,2.5,,,,,,,case rate,2.5,2.5,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Aetna,Aetna,19.83,,,,,,,per diem,19.83,19.83,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Aetna MGG,Aetna MGG,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,BCBS,BCBS,19.83,,,,,,,per diem,19.83,19.83,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,BCBS MGG,BCBS MGG,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Cigna,Cigna,19.83,,,,,,,per diem,19.83,19.83,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Cigna MGG,Cigna MGG,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Humana,Humana,19.83,,,,,,,per diem,19.83,19.83,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Humana MGG,Humana MGG,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Optum VA,Optum VA,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,UHC,UHC,19.83,,,,,,,per diem,19.83,19.83,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,UHC MGG,UHC MGG,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,VA,VA,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Wellcare MGG,Wellcare MGG,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Bright Health - commercial,Bright Health - commercial,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,19.83,19.83,Bright Health MGG,Bright Health MGG,19.83,,,,,,,case rate,19.83,19.83,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Aetna,Aetna,677.78,,,,,,,per diem,677.78,677.78,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Aetna MGG,Aetna MGG,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,BCBS,BCBS,677.78,,,,,,,per diem,677.78,677.78,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,BCBS MGG,BCBS MGG,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Cigna,Cigna,677.78,,,,,,,per diem,677.78,677.78,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Cigna MGG,Cigna MGG,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Humana,Humana,677.78,,,,,,,per diem,677.78,677.78,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Humana MGG,Humana MGG,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Optum VA,Optum VA,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,UHC,UHC,677.78,,,,,,,per diem,677.78,677.78,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,UHC MGG,UHC MGG,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,VA,VA,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Wellcare MGG,Wellcare MGG,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Bright Health - commercial,Bright Health - commercial,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,677.78,677.78,Bright Health MGG,Bright Health MGG,677.78,,,,,,,case rate,677.78,677.78,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Aetna,Aetna,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Aetna MGG,Aetna MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,BCBS,BCBS,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,BCBS MGG,BCBS MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Cigna,Cigna,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Cigna MGG,Cigna MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Humana,Humana,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Humana MGG,Humana MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Optum VA,Optum VA,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,UHC,UHC,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,UHC MGG,UHC MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,VA,VA,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Wellcare MGG,Wellcare MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Bright Health - commercial,Bright Health - commercial,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2213.44,2213.44,Bright Health MGG,Bright Health MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Aetna,Aetna,638,,,,,,,per diem,638,638,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Aetna MGG,Aetna MGG,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,BCBS,BCBS,638,,,,,,,per diem,638,638,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,BCBS MGG,BCBS MGG,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Cigna,Cigna,638,,,,,,,per diem,638,638,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Cigna MGG,Cigna MGG,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Humana,Humana,638,,,,,,,per diem,638,638,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Humana MGG,Humana MGG,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Optum VA,Optum VA,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,UHC,UHC,638,,,,,,,per diem,638,638,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,UHC MGG,UHC MGG,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,VA,VA,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Wellcare MGG,Wellcare MGG,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Bright Health - commercial,Bright Health - commercial,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,638,638,Bright Health MGG,Bright Health MGG,638,,,,,,,case rate,638,638,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Aetna,Aetna,475.57,,,,,,,per diem,475.57,475.57,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Aetna MGG,Aetna MGG,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,BCBS,BCBS,475.57,,,,,,,per diem,475.57,475.57,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,BCBS MGG,BCBS MGG,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Cigna,Cigna,475.57,,,,,,,per diem,475.57,475.57,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Cigna MGG,Cigna MGG,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Humana,Humana,475.57,,,,,,,per diem,475.57,475.57,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Humana MGG,Humana MGG,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Optum VA,Optum VA,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,UHC,UHC,475.57,,,,,,,per diem,475.57,475.57,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,UHC MGG,UHC MGG,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,VA,VA,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Wellcare MGG,Wellcare MGG,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Bright Health - commercial,Bright Health - commercial,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,475.57,475.57,Bright Health MGG,Bright Health MGG,475.57,,,,,,,case rate,475.57,475.57,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Aetna,Aetna,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Aetna MGG,Aetna MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,BCBS,BCBS,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,BCBS MGG,BCBS MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Cigna,Cigna,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Cigna MGG,Cigna MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Humana,Humana,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Humana MGG,Humana MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Optum VA,Optum VA,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,UHC,UHC,878,,,,,,,per diem,878,878,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,UHC MGG,UHC MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,VA,VA,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Wellcare MGG,Wellcare MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Bright Health - commercial,Bright Health - commercial,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,878,878,Bright Health MGG,Bright Health MGG,878,,,,,,,case rate,878,878,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Aetna,Aetna,1308,,,,,,,per diem,1308,1308,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Aetna MGG,Aetna MGG,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,BCBS,BCBS,1308,,,,,,,per diem,1308,1308,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,BCBS MGG,BCBS MGG,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Cigna,Cigna,1308,,,,,,,per diem,1308,1308,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Cigna MGG,Cigna MGG,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Humana,Humana,1308,,,,,,,per diem,1308,1308,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Humana MGG,Humana MGG,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Optum VA,Optum VA,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,UHC,UHC,1308,,,,,,,per diem,1308,1308,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,UHC MGG,UHC MGG,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,VA,VA,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Wellcare MGG,Wellcare MGG,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Bright Health - commercial,Bright Health - commercial,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1308,1308,Bright Health MGG,Bright Health MGG,1308,,,,,,,case rate,1308,1308,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Aetna,Aetna,1246,,,,,,,per diem,1246,1246,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Aetna MGG,Aetna MGG,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,BCBS,BCBS,1246,,,,,,,per diem,1246,1246,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,BCBS MGG,BCBS MGG,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Cigna,Cigna,1246,,,,,,,per diem,1246,1246,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Cigna MGG,Cigna MGG,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Humana,Humana,1246,,,,,,,per diem,1246,1246,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Humana MGG,Humana MGG,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Optum VA,Optum VA,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,UHC,UHC,1246,,,,,,,per diem,1246,1246,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,UHC MGG,UHC MGG,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,VA,VA,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Wellcare MGG,Wellcare MGG,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Bright Health - commercial,Bright Health - commercial,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1246,1246,Bright Health MGG,Bright Health MGG,1246,,,,,,,case rate,1246,1246,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Aetna,Aetna,1040,,,,,,,per diem,1040,1040,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Aetna MGG,Aetna MGG,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,BCBS,BCBS,1040,,,,,,,per diem,1040,1040,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,BCBS MGG,BCBS MGG,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Cigna,Cigna,1040,,,,,,,per diem,1040,1040,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Cigna MGG,Cigna MGG,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Humana,Humana,1040,,,,,,,per diem,1040,1040,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Humana MGG,Humana MGG,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Optum VA,Optum VA,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,UHC,UHC,1040,,,,,,,per diem,1040,1040,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,UHC MGG,UHC MGG,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,VA,VA,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Wellcare MGG,Wellcare MGG,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Bright Health - commercial,Bright Health - commercial,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1040,1040,Bright Health MGG,Bright Health MGG,1040,,,,,,,case rate,1040,1040,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Aetna,Aetna,1303,,,,,,,per diem,1303,1303,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Aetna MGG,Aetna MGG,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,BCBS,BCBS,1303,,,,,,,per diem,1303,1303,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,BCBS MGG,BCBS MGG,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Cigna,Cigna,1303,,,,,,,per diem,1303,1303,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Cigna MGG,Cigna MGG,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Humana,Humana,1303,,,,,,,per diem,1303,1303,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Humana MGG,Humana MGG,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Optum VA,Optum VA,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,UHC,UHC,1303,,,,,,,per diem,1303,1303,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,UHC MGG,UHC MGG,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,VA,VA,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Wellcare MGG,Wellcare MGG,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Bright Health - commercial,Bright Health - commercial,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1303,1303,Bright Health MGG,Bright Health MGG,1303,,,,,,,case rate,1303,1303,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Aetna,Aetna,20409,,,,,,,per diem,20409,20409,"Per diem rate, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Aetna MGG,Aetna MGG,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,BCBS,BCBS,20409,,,,,,,per diem,20409,20409,"Per diem rate, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,BCBS MGG,BCBS MGG,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Cigna,Cigna,20409,,,,,,,per diem,20409,20409,"Per diem rate, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Cigna MGG,Cigna MGG,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Humana,Humana,20409,,,,,,,per diem,20409,20409,"Per diem rate, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Humana MGG,Humana MGG,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Optum VA,Optum VA,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,UHC,UHC,20409,,,,,,,per diem,20409,20409,"Per diem rate, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,UHC MGG,UHC MGG,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,VA,VA,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Wellcare MGG,Wellcare MGG,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Bright Health - commercial,Bright Health - commercial,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
OUTSIDE STAC ER SERVICE       ,67099999,CDM,450,RC,,,,,,Inpatient,,,20409,20409,Bright Health MGG,Bright Health MGG,20409,,,,,,,case rate,20409,20409,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Aetna,Aetna,1779.75,,,,,,,per diem,1779.75,1779.75,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Aetna MGG,Aetna MGG,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,BCBS,BCBS,1779.75,,,,,,,per diem,1779.75,1779.75,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,BCBS MGG,BCBS MGG,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Cigna,Cigna,1779.75,,,,,,,per diem,1779.75,1779.75,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Cigna MGG,Cigna MGG,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Humana,Humana,1779.75,,,,,,,per diem,1779.75,1779.75,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Humana MGG,Humana MGG,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Optum VA,Optum VA,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,UHC,UHC,1779.75,,,,,,,per diem,1779.75,1779.75,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,UHC MGG,UHC MGG,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,VA,VA,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Wellcare MGG,Wellcare MGG,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Bright Health - commercial,Bright Health - commercial,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,1779.75,1779.75,Bright Health MGG,Bright Health MGG,1779.75,,,,,,,case rate,1779.75,1779.75,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Aetna,Aetna,1063.71,,,,,,,per diem,1063.71,1063.71,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Aetna MGG,Aetna MGG,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,BCBS,BCBS,1063.71,,,,,,,per diem,1063.71,1063.71,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,BCBS MGG,BCBS MGG,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Cigna,Cigna,1063.71,,,,,,,per diem,1063.71,1063.71,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Cigna MGG,Cigna MGG,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Humana,Humana,1063.71,,,,,,,per diem,1063.71,1063.71,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Humana MGG,Humana MGG,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Optum VA,Optum VA,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,UHC,UHC,1063.71,,,,,,,per diem,1063.71,1063.71,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,UHC MGG,UHC MGG,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,VA,VA,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Wellcare MGG,Wellcare MGG,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Bright Health - commercial,Bright Health - commercial,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,1063.71,1063.71,Bright Health MGG,Bright Health MGG,1063.71,,,,,,,case rate,1063.71,1063.71,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Aetna,Aetna,935.64,,,,,,,per diem,935.64,935.64,"Per diem rate, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Aetna MGG,Aetna MGG,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,BCBS,BCBS,935.64,,,,,,,per diem,935.64,935.64,"Per diem rate, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,BCBS MGG,BCBS MGG,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Cigna,Cigna,935.64,,,,,,,per diem,935.64,935.64,"Per diem rate, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Cigna MGG,Cigna MGG,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Humana,Humana,935.64,,,,,,,per diem,935.64,935.64,"Per diem rate, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Humana MGG,Humana MGG,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Optum VA,Optum VA,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,UHC,UHC,935.64,,,,,,,per diem,935.64,935.64,"Per diem rate, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,UHC MGG,UHC MGG,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,VA,VA,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Wellcare MGG,Wellcare MGG,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Bright Health - commercial,Bright Health - commercial,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
CONT CYCLING PERIT DIALYSIS   ,68000325,CDM,804,RC,,,,,,Inpatient,,,935.64,935.64,Bright Health MGG,Bright Health MGG,935.64,,,,,,,case rate,935.64,935.64,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Aetna,Aetna,1728.34,,,,,,,per diem,1728.34,1728.34,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Aetna MGG,Aetna MGG,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,BCBS,BCBS,1728.34,,,,,,,per diem,1728.34,1728.34,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,BCBS MGG,BCBS MGG,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Cigna,Cigna,1728.34,,,,,,,per diem,1728.34,1728.34,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Cigna MGG,Cigna MGG,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Humana,Humana,1728.34,,,,,,,per diem,1728.34,1728.34,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Humana MGG,Humana MGG,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Optum VA,Optum VA,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,UHC,UHC,1728.34,,,,,,,per diem,1728.34,1728.34,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,UHC MGG,UHC MGG,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,VA,VA,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Wellcare MGG,Wellcare MGG,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Bright Health - commercial,Bright Health - commercial,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,1728.34,1728.34,Bright Health MGG,Bright Health MGG,1728.34,,,,,,,case rate,1728.34,1728.34,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Aetna,Aetna,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Aetna MGG,Aetna MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,BCBS,BCBS,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,BCBS MGG,BCBS MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Cigna,Cigna,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Cigna MGG,Cigna MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Humana,Humana,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Humana MGG,Humana MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Optum VA,Optum VA,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,UHC,UHC,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,UHC MGG,UHC MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,VA,VA,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Wellcare MGG,Wellcare MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Bright Health - commercial,Bright Health - commercial,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,163.11,163.11,Bright Health MGG,Bright Health MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Aetna,Aetna,1423.49,,,,,,,per diem,1423.49,1423.49,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Aetna MGG,Aetna MGG,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,BCBS,BCBS,1423.49,,,,,,,per diem,1423.49,1423.49,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,BCBS MGG,BCBS MGG,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Cigna,Cigna,1423.49,,,,,,,per diem,1423.49,1423.49,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Cigna MGG,Cigna MGG,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Humana,Humana,1423.49,,,,,,,per diem,1423.49,1423.49,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Humana MGG,Humana MGG,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Optum VA,Optum VA,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,UHC,UHC,1423.49,,,,,,,per diem,1423.49,1423.49,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,UHC MGG,UHC MGG,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,VA,VA,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Wellcare MGG,Wellcare MGG,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Bright Health - commercial,Bright Health - commercial,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1423.49,1423.49,Bright Health MGG,Bright Health MGG,1423.49,,,,,,,case rate,1423.49,1423.49,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Aetna,Aetna,1367.1,,,,,,,per diem,1367.1,1367.1,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Aetna MGG,Aetna MGG,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,BCBS,BCBS,1367.1,,,,,,,per diem,1367.1,1367.1,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,BCBS MGG,BCBS MGG,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Cigna,Cigna,1367.1,,,,,,,per diem,1367.1,1367.1,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Cigna MGG,Cigna MGG,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Humana,Humana,1367.1,,,,,,,per diem,1367.1,1367.1,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Humana MGG,Humana MGG,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Optum VA,Optum VA,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,UHC,UHC,1367.1,,,,,,,per diem,1367.1,1367.1,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,UHC MGG,UHC MGG,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,VA,VA,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Wellcare MGG,Wellcare MGG,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Bright Health - commercial,Bright Health - commercial,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,1367.1,1367.1,Bright Health MGG,Bright Health MGG,1367.1,,,,,,,case rate,1367.1,1367.1,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Aetna,Aetna,1276.33,,,,,,,per diem,1276.33,1276.33,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Aetna MGG,Aetna MGG,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,BCBS,BCBS,1276.33,,,,,,,per diem,1276.33,1276.33,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,BCBS MGG,BCBS MGG,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Cigna,Cigna,1276.33,,,,,,,per diem,1276.33,1276.33,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Cigna MGG,Cigna MGG,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Humana,Humana,1276.33,,,,,,,per diem,1276.33,1276.33,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Humana MGG,Humana MGG,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Optum VA,Optum VA,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,UHC,UHC,1276.33,,,,,,,per diem,1276.33,1276.33,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,UHC MGG,UHC MGG,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,VA,VA,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Wellcare MGG,Wellcare MGG,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Bright Health - commercial,Bright Health - commercial,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1276.33,1276.33,Bright Health MGG,Bright Health MGG,1276.33,,,,,,,case rate,1276.33,1276.33,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Aetna,Aetna,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Aetna MGG,Aetna MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,BCBS,BCBS,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,BCBS MGG,BCBS MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Cigna,Cigna,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Cigna MGG,Cigna MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Humana,Humana,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Humana MGG,Humana MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Optum VA,Optum VA,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,UHC,UHC,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,UHC MGG,UHC MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,VA,VA,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Wellcare MGG,Wellcare MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Bright Health - commercial,Bright Health - commercial,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,963.69,963.69,Bright Health MGG,Bright Health MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Aetna,Aetna,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Aetna MGG,Aetna MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,BCBS,BCBS,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,BCBS MGG,BCBS MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Cigna,Cigna,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Cigna MGG,Cigna MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Humana,Humana,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Humana MGG,Humana MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Optum VA,Optum VA,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,UHC,UHC,163.11,,,,,,,per diem,163.11,163.11,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,UHC MGG,UHC MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,VA,VA,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Wellcare MGG,Wellcare MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Bright Health - commercial,Bright Health - commercial,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,163.11,163.11,Bright Health MGG,Bright Health MGG,163.11,,,,,,,case rate,163.11,163.11,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Aetna,Aetna,1620.73,,,,,,,per diem,1620.73,1620.73,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Aetna MGG,Aetna MGG,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,BCBS,BCBS,1620.73,,,,,,,per diem,1620.73,1620.73,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,BCBS MGG,BCBS MGG,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Cigna,Cigna,1620.73,,,,,,,per diem,1620.73,1620.73,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Cigna MGG,Cigna MGG,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Humana,Humana,1620.73,,,,,,,per diem,1620.73,1620.73,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Humana MGG,Humana MGG,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Optum VA,Optum VA,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,UHC,UHC,1620.73,,,,,,,per diem,1620.73,1620.73,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,UHC MGG,UHC MGG,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,VA,VA,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Wellcare MGG,Wellcare MGG,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Bright Health - commercial,Bright Health - commercial,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1620.73,1620.73,Bright Health MGG,Bright Health MGG,1620.73,,,,,,,case rate,1620.73,1620.73,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Aetna,Aetna,464.25,,,,,,,per diem,464.25,464.25,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Aetna MGG,Aetna MGG,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,BCBS,BCBS,464.25,,,,,,,per diem,464.25,464.25,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,BCBS MGG,BCBS MGG,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Cigna,Cigna,464.25,,,,,,,per diem,464.25,464.25,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Cigna MGG,Cigna MGG,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Humana,Humana,464.25,,,,,,,per diem,464.25,464.25,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Humana MGG,Humana MGG,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Optum VA,Optum VA,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,UHC,UHC,464.25,,,,,,,per diem,464.25,464.25,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,UHC MGG,UHC MGG,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,VA,VA,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Wellcare MGG,Wellcare MGG,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Bright Health - commercial,Bright Health - commercial,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,464.25,464.25,Bright Health MGG,Bright Health MGG,464.25,,,,,,,case rate,464.25,464.25,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Aetna,Aetna,343,,,,,,,per diem,343,343,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Aetna MGG,Aetna MGG,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,BCBS,BCBS,343,,,,,,,per diem,343,343,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,BCBS MGG,BCBS MGG,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Cigna,Cigna,343,,,,,,,per diem,343,343,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Cigna MGG,Cigna MGG,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Humana,Humana,343,,,,,,,per diem,343,343,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Humana MGG,Humana MGG,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Optum VA,Optum VA,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,UHC,UHC,343,,,,,,,per diem,343,343,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,UHC MGG,UHC MGG,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,VA,VA,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Wellcare MGG,Wellcare MGG,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Bright Health - commercial,Bright Health - commercial,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,343,343,Bright Health MGG,Bright Health MGG,343,,,,,,,case rate,343,343,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Aetna,Aetna,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Aetna MGG,Aetna MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,BCBS,BCBS,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,BCBS MGG,BCBS MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Cigna,Cigna,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Cigna MGG,Cigna MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Humana,Humana,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Humana MGG,Humana MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Optum VA,Optum VA,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,UHC,UHC,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,UHC MGG,UHC MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,VA,VA,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Wellcare MGG,Wellcare MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Bright Health - commercial,Bright Health - commercial,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,86.25,86.25,Bright Health MGG,Bright Health MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Aetna,Aetna,202.59,,,,,,,per diem,202.59,202.59,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Aetna MGG,Aetna MGG,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,BCBS,BCBS,202.59,,,,,,,per diem,202.59,202.59,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,BCBS MGG,BCBS MGG,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Cigna,Cigna,202.59,,,,,,,per diem,202.59,202.59,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Cigna MGG,Cigna MGG,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Humana,Humana,202.59,,,,,,,per diem,202.59,202.59,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Humana MGG,Humana MGG,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Optum VA,Optum VA,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,UHC,UHC,202.59,,,,,,,per diem,202.59,202.59,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,UHC MGG,UHC MGG,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,VA,VA,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Wellcare MGG,Wellcare MGG,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Bright Health - commercial,Bright Health - commercial,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,202.59,202.59,Bright Health MGG,Bright Health MGG,202.59,,,,,,,case rate,202.59,202.59,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Aetna,Aetna,1204.62,,,,,,,per diem,1204.62,1204.62,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Aetna MGG,Aetna MGG,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,BCBS,BCBS,1204.62,,,,,,,per diem,1204.62,1204.62,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,BCBS MGG,BCBS MGG,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Cigna,Cigna,1204.62,,,,,,,per diem,1204.62,1204.62,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Cigna MGG,Cigna MGG,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Humana,Humana,1204.62,,,,,,,per diem,1204.62,1204.62,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Humana MGG,Humana MGG,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Optum VA,Optum VA,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,UHC,UHC,1204.62,,,,,,,per diem,1204.62,1204.62,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,UHC MGG,UHC MGG,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,VA,VA,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Wellcare MGG,Wellcare MGG,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Bright Health - commercial,Bright Health - commercial,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1204.62,1204.62,Bright Health MGG,Bright Health MGG,1204.62,,,,,,,case rate,1204.62,1204.62,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Aetna,Aetna,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Aetna MGG,Aetna MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,BCBS,BCBS,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,BCBS MGG,BCBS MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Cigna,Cigna,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Cigna MGG,Cigna MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Humana,Humana,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Humana MGG,Humana MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Optum VA,Optum VA,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,UHC,UHC,963.69,,,,,,,per diem,963.69,963.69,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,UHC MGG,UHC MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,VA,VA,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Wellcare MGG,Wellcare MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Bright Health - commercial,Bright Health - commercial,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,963.69,963.69,Bright Health MGG,Bright Health MGG,963.69,,,,,,,case rate,963.69,963.69,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Aetna,Aetna,481.83,,,,,,,per diem,481.83,481.83,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Aetna MGG,Aetna MGG,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,BCBS,BCBS,481.83,,,,,,,per diem,481.83,481.83,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,BCBS MGG,BCBS MGG,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Cigna,Cigna,481.83,,,,,,,per diem,481.83,481.83,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Cigna MGG,Cigna MGG,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Humana,Humana,481.83,,,,,,,per diem,481.83,481.83,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Humana MGG,Humana MGG,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Optum VA,Optum VA,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,UHC,UHC,481.83,,,,,,,per diem,481.83,481.83,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,UHC MGG,UHC MGG,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,VA,VA,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Wellcare MGG,Wellcare MGG,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Bright Health - commercial,Bright Health - commercial,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,481.83,481.83,Bright Health MGG,Bright Health MGG,481.83,,,,,,,case rate,481.83,481.83,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Aetna,Aetna,1709.79,,,,,,,per diem,1709.79,1709.79,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Aetna MGG,Aetna MGG,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,BCBS,BCBS,1709.79,,,,,,,per diem,1709.79,1709.79,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,BCBS MGG,BCBS MGG,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Cigna,Cigna,1709.79,,,,,,,per diem,1709.79,1709.79,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Cigna MGG,Cigna MGG,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Humana,Humana,1709.79,,,,,,,per diem,1709.79,1709.79,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Humana MGG,Humana MGG,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Optum VA,Optum VA,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,UHC,UHC,1709.79,,,,,,,per diem,1709.79,1709.79,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,UHC MGG,UHC MGG,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,VA,VA,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Wellcare MGG,Wellcare MGG,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Bright Health - commercial,Bright Health - commercial,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1709.79,1709.79,Bright Health MGG,Bright Health MGG,1709.79,,,,,,,case rate,1709.79,1709.79,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Aetna,Aetna,1687.5,,,,,,,per diem,1687.5,1687.5,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Aetna MGG,Aetna MGG,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,BCBS,BCBS,1687.5,,,,,,,per diem,1687.5,1687.5,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,BCBS MGG,BCBS MGG,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Cigna,Cigna,1687.5,,,,,,,per diem,1687.5,1687.5,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Cigna MGG,Cigna MGG,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Humana,Humana,1687.5,,,,,,,per diem,1687.5,1687.5,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Humana MGG,Humana MGG,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Optum VA,Optum VA,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,UHC,UHC,1687.5,,,,,,,per diem,1687.5,1687.5,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,UHC MGG,UHC MGG,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,VA,VA,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Wellcare MGG,Wellcare MGG,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Bright Health - commercial,Bright Health - commercial,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1687.5,1687.5,Bright Health MGG,Bright Health MGG,1687.5,,,,,,,case rate,1687.5,1687.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Aetna,Aetna,1912.5,,,,,,,per diem,1912.5,1912.5,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Aetna MGG,Aetna MGG,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,BCBS,BCBS,1912.5,,,,,,,per diem,1912.5,1912.5,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,BCBS MGG,BCBS MGG,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Cigna,Cigna,1912.5,,,,,,,per diem,1912.5,1912.5,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Cigna MGG,Cigna MGG,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Humana,Humana,1912.5,,,,,,,per diem,1912.5,1912.5,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Humana MGG,Humana MGG,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Optum VA,Optum VA,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,UHC,UHC,1912.5,,,,,,,per diem,1912.5,1912.5,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,UHC MGG,UHC MGG,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,VA,VA,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Wellcare MGG,Wellcare MGG,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Bright Health - commercial,Bright Health - commercial,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,1912.5,1912.5,Bright Health MGG,Bright Health MGG,1912.5,,,,,,,case rate,1912.5,1912.5,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Aetna,Aetna,771.82,,,,,,,per diem,771.82,771.82,"Per diem rate, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Aetna MGG,Aetna MGG,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,BCBS,BCBS,771.82,,,,,,,per diem,771.82,771.82,"Per diem rate, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,BCBS MGG,BCBS MGG,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Cigna,Cigna,771.82,,,,,,,per diem,771.82,771.82,"Per diem rate, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Cigna MGG,Cigna MGG,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Humana,Humana,771.82,,,,,,,per diem,771.82,771.82,"Per diem rate, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Humana MGG,Humana MGG,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Optum VA,Optum VA,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,UHC,UHC,771.82,,,,,,,per diem,771.82,771.82,"Per diem rate, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,UHC MGG,UHC MGG,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,VA,VA,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Wellcare MGG,Wellcare MGG,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Bright Health - commercial,Bright Health - commercial,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
HEMODIALYSIS REPEAT PROCEDURE ,68000500,CDM,801,RC,90937,CPT,,,,Inpatient,,,771.82,771.82,Bright Health MGG,Bright Health MGG,771.82,,,,,,,case rate,771.82,771.82,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Aetna,Aetna,1800,,,,,,,per diem,1800,1800,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Aetna MGG,Aetna MGG,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,BCBS,BCBS,1800,,,,,,,per diem,1800,1800,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,BCBS MGG,BCBS MGG,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Cigna,Cigna,1800,,,,,,,per diem,1800,1800,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Cigna MGG,Cigna MGG,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Humana,Humana,1800,,,,,,,per diem,1800,1800,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Humana MGG,Humana MGG,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Optum VA,Optum VA,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,UHC,UHC,1800,,,,,,,per diem,1800,1800,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,UHC MGG,UHC MGG,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,VA,VA,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Wellcare MGG,Wellcare MGG,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Bright Health - commercial,Bright Health - commercial,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1800,1800,Bright Health MGG,Bright Health MGG,1800,,,,,,,case rate,1800,1800,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Aetna,Aetna,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Aetna MGG,Aetna MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,BCBS,BCBS,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,BCBS MGG,BCBS MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Cigna,Cigna,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Cigna MGG,Cigna MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Humana,Humana,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Humana MGG,Humana MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Optum VA,Optum VA,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,UHC,UHC,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,UHC MGG,UHC MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,VA,VA,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Wellcare MGG,Wellcare MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Bright Health - commercial,Bright Health - commercial,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1350,1350,Bright Health MGG,Bright Health MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Aetna,Aetna,231.5,,,,,,,per diem,231.5,231.5,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Aetna MGG,Aetna MGG,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,BCBS,BCBS,231.5,,,,,,,per diem,231.5,231.5,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,BCBS MGG,BCBS MGG,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Cigna,Cigna,231.5,,,,,,,per diem,231.5,231.5,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Cigna MGG,Cigna MGG,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Humana,Humana,231.5,,,,,,,per diem,231.5,231.5,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Humana MGG,Humana MGG,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Optum VA,Optum VA,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,UHC,UHC,231.5,,,,,,,per diem,231.5,231.5,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,UHC MGG,UHC MGG,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,VA,VA,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Wellcare MGG,Wellcare MGG,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Bright Health - commercial,Bright Health - commercial,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,231.5,231.5,Bright Health MGG,Bright Health MGG,231.5,,,,,,,case rate,231.5,231.5,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Aetna,Aetna,199.03,,,,,,,per diem,199.03,199.03,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Aetna MGG,Aetna MGG,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,BCBS,BCBS,199.03,,,,,,,per diem,199.03,199.03,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,BCBS MGG,BCBS MGG,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Cigna,Cigna,199.03,,,,,,,per diem,199.03,199.03,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Cigna MGG,Cigna MGG,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Humana,Humana,199.03,,,,,,,per diem,199.03,199.03,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Humana MGG,Humana MGG,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Optum VA,Optum VA,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,UHC,UHC,199.03,,,,,,,per diem,199.03,199.03,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,UHC MGG,UHC MGG,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,VA,VA,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Wellcare MGG,Wellcare MGG,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Bright Health - commercial,Bright Health - commercial,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,199.03,199.03,Bright Health MGG,Bright Health MGG,199.03,,,,,,,case rate,199.03,199.03,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Aetna,Aetna,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Aetna MGG,Aetna MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,BCBS,BCBS,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,BCBS MGG,BCBS MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Cigna,Cigna,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Cigna MGG,Cigna MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Humana,Humana,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Humana MGG,Humana MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Optum VA,Optum VA,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,UHC,UHC,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,UHC MGG,UHC MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,VA,VA,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Wellcare MGG,Wellcare MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Bright Health - commercial,Bright Health - commercial,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,167,167,Bright Health MGG,Bright Health MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Aetna,Aetna,131.45,,,,,,,per diem,131.45,131.45,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Aetna MGG,Aetna MGG,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,BCBS,BCBS,131.45,,,,,,,per diem,131.45,131.45,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,BCBS MGG,BCBS MGG,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Cigna,Cigna,131.45,,,,,,,per diem,131.45,131.45,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Cigna MGG,Cigna MGG,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Humana,Humana,131.45,,,,,,,per diem,131.45,131.45,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Humana MGG,Humana MGG,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Optum VA,Optum VA,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,UHC,UHC,131.45,,,,,,,per diem,131.45,131.45,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,UHC MGG,UHC MGG,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,VA,VA,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Wellcare MGG,Wellcare MGG,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Bright Health - commercial,Bright Health - commercial,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,131.45,131.45,Bright Health MGG,Bright Health MGG,131.45,,,,,,,case rate,131.45,131.45,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Aetna,Aetna,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Aetna MGG,Aetna MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,BCBS,BCBS,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,BCBS MGG,BCBS MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Cigna,Cigna,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Cigna MGG,Cigna MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Humana,Humana,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Humana MGG,Humana MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Optum VA,Optum VA,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,UHC,UHC,99,,,,,,,per diem,99,99,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,UHC MGG,UHC MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,VA,VA,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Wellcare MGG,Wellcare MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Bright Health - commercial,Bright Health - commercial,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,99,99,Bright Health MGG,Bright Health MGG,99,,,,,,,case rate,99,99,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Aetna,Aetna,161.98,,,,,,,per diem,161.98,161.98,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Aetna MGG,Aetna MGG,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,BCBS,BCBS,161.98,,,,,,,per diem,161.98,161.98,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,BCBS MGG,BCBS MGG,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Cigna,Cigna,161.98,,,,,,,per diem,161.98,161.98,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Cigna MGG,Cigna MGG,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Humana,Humana,161.98,,,,,,,per diem,161.98,161.98,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Humana MGG,Humana MGG,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Optum VA,Optum VA,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,UHC,UHC,161.98,,,,,,,per diem,161.98,161.98,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,UHC MGG,UHC MGG,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,VA,VA,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Wellcare MGG,Wellcare MGG,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Bright Health - commercial,Bright Health - commercial,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,161.98,161.98,Bright Health MGG,Bright Health MGG,161.98,,,,,,,case rate,161.98,161.98,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Aetna,Aetna,196.91,,,,,,,per diem,196.91,196.91,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Aetna MGG,Aetna MGG,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,BCBS,BCBS,196.91,,,,,,,per diem,196.91,196.91,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,BCBS MGG,BCBS MGG,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Cigna,Cigna,196.91,,,,,,,per diem,196.91,196.91,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Cigna MGG,Cigna MGG,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Humana,Humana,196.91,,,,,,,per diem,196.91,196.91,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Humana MGG,Humana MGG,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Optum VA,Optum VA,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,UHC,UHC,196.91,,,,,,,per diem,196.91,196.91,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,UHC MGG,UHC MGG,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,VA,VA,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Wellcare MGG,Wellcare MGG,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Bright Health - commercial,Bright Health - commercial,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,196.91,196.91,Bright Health MGG,Bright Health MGG,196.91,,,,,,,case rate,196.91,196.91,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Aetna,Aetna,280.27,,,,,,,per diem,280.27,280.27,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Aetna MGG,Aetna MGG,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,BCBS,BCBS,280.27,,,,,,,per diem,280.27,280.27,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,BCBS MGG,BCBS MGG,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Cigna,Cigna,280.27,,,,,,,per diem,280.27,280.27,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Cigna MGG,Cigna MGG,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Humana,Humana,280.27,,,,,,,per diem,280.27,280.27,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Humana MGG,Humana MGG,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Optum VA,Optum VA,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,UHC,UHC,280.27,,,,,,,per diem,280.27,280.27,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,UHC MGG,UHC MGG,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,VA,VA,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Wellcare MGG,Wellcare MGG,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Bright Health - commercial,Bright Health - commercial,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,280.27,280.27,Bright Health MGG,Bright Health MGG,280.27,,,,,,,case rate,280.27,280.27,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Aetna,Aetna,80,,,,,,,per diem,80,80,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Aetna MGG,Aetna MGG,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,BCBS,BCBS,80,,,,,,,per diem,80,80,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,BCBS MGG,BCBS MGG,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Cigna,Cigna,80,,,,,,,per diem,80,80,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Cigna MGG,Cigna MGG,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Humana,Humana,80,,,,,,,per diem,80,80,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Humana MGG,Humana MGG,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Optum VA,Optum VA,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,UHC,UHC,80,,,,,,,per diem,80,80,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,UHC MGG,UHC MGG,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,VA,VA,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Wellcare MGG,Wellcare MGG,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Bright Health - commercial,Bright Health - commercial,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,80,80,Bright Health MGG,Bright Health MGG,80,,,,,,,case rate,80,80,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Aetna,Aetna,85.89,,,,,,,per diem,85.89,85.89,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Aetna MGG,Aetna MGG,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,BCBS,BCBS,85.89,,,,,,,per diem,85.89,85.89,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,BCBS MGG,BCBS MGG,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Cigna,Cigna,85.89,,,,,,,per diem,85.89,85.89,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Cigna MGG,Cigna MGG,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Humana,Humana,85.89,,,,,,,per diem,85.89,85.89,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Humana MGG,Humana MGG,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Optum VA,Optum VA,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,UHC,UHC,85.89,,,,,,,per diem,85.89,85.89,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,UHC MGG,UHC MGG,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,VA,VA,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Wellcare MGG,Wellcare MGG,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Bright Health - commercial,Bright Health - commercial,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,85.89,85.89,Bright Health MGG,Bright Health MGG,85.89,,,,,,,case rate,85.89,85.89,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Aetna,Aetna,191.33,,,,,,,per diem,191.33,191.33,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Aetna MGG,Aetna MGG,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,BCBS,BCBS,191.33,,,,,,,per diem,191.33,191.33,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,BCBS MGG,BCBS MGG,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Cigna,Cigna,191.33,,,,,,,per diem,191.33,191.33,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Cigna MGG,Cigna MGG,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Humana,Humana,191.33,,,,,,,per diem,191.33,191.33,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Humana MGG,Humana MGG,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Optum VA,Optum VA,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,UHC,UHC,191.33,,,,,,,per diem,191.33,191.33,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,UHC MGG,UHC MGG,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,VA,VA,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Wellcare MGG,Wellcare MGG,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Bright Health - commercial,Bright Health - commercial,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,191.33,191.33,Bright Health MGG,Bright Health MGG,191.33,,,,,,,case rate,191.33,191.33,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Aetna,Aetna,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Aetna MGG,Aetna MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,BCBS,BCBS,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,BCBS MGG,BCBS MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Cigna,Cigna,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Cigna MGG,Cigna MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Humana,Humana,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Humana MGG,Humana MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Optum VA,Optum VA,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,UHC,UHC,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,UHC MGG,UHC MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,VA,VA,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Wellcare MGG,Wellcare MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Bright Health - commercial,Bright Health - commercial,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RETICULOCYTE SEPARATION       ,72000305,CDM,300,RC,86972,CPT,,,,Inpatient,,,189,189,Bright Health MGG,Bright Health MGG,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Aetna,Aetna,658.53,,,,,,,per diem,658.53,658.53,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Aetna MGG,Aetna MGG,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,BCBS,BCBS,658.53,,,,,,,per diem,658.53,658.53,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,BCBS MGG,BCBS MGG,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Cigna,Cigna,658.53,,,,,,,per diem,658.53,658.53,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Cigna MGG,Cigna MGG,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Humana,Humana,658.53,,,,,,,per diem,658.53,658.53,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Humana MGG,Humana MGG,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Optum VA,Optum VA,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,UHC,UHC,658.53,,,,,,,per diem,658.53,658.53,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,UHC MGG,UHC MGG,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,VA,VA,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Wellcare MGG,Wellcare MGG,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Bright Health - commercial,Bright Health - commercial,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,658.53,658.53,Bright Health MGG,Bright Health MGG,658.53,,,,,,,case rate,658.53,658.53,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Aetna,Aetna,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Aetna MGG,Aetna MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,BCBS,BCBS,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,BCBS MGG,BCBS MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Cigna,Cigna,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Cigna MGG,Cigna MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Humana,Humana,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Humana MGG,Humana MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Optum VA,Optum VA,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,UHC,UHC,160.14,,,,,,,per diem,160.14,160.14,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,UHC MGG,UHC MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,VA,VA,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Wellcare MGG,Wellcare MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Bright Health - commercial,Bright Health - commercial,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,160.14,160.14,Bright Health MGG,Bright Health MGG,160.14,,,,,,,case rate,160.14,160.14,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Aetna,Aetna,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Aetna MGG,Aetna MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,BCBS,BCBS,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,BCBS MGG,BCBS MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Cigna,Cigna,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Cigna MGG,Cigna MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Humana,Humana,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Humana MGG,Humana MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Optum VA,Optum VA,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,UHC,UHC,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,UHC MGG,UHC MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,VA,VA,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Wellcare MGG,Wellcare MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Bright Health - commercial,Bright Health - commercial,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,211.4,211.4,Bright Health MGG,Bright Health MGG,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Aetna,Aetna,92.82,,,,,,,per diem,92.82,92.82,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Aetna MGG,Aetna MGG,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,BCBS,BCBS,92.82,,,,,,,per diem,92.82,92.82,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,BCBS MGG,BCBS MGG,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Cigna,Cigna,92.82,,,,,,,per diem,92.82,92.82,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Cigna MGG,Cigna MGG,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Humana,Humana,92.82,,,,,,,per diem,92.82,92.82,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Humana MGG,Humana MGG,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Optum VA,Optum VA,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,UHC,UHC,92.82,,,,,,,per diem,92.82,92.82,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,UHC MGG,UHC MGG,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,VA,VA,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Wellcare MGG,Wellcare MGG,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Bright Health - commercial,Bright Health - commercial,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,92.82,92.82,Bright Health MGG,Bright Health MGG,92.82,,,,,,,case rate,92.82,92.82,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Aetna,Aetna,123.47,,,,,,,per diem,123.47,123.47,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Aetna MGG,Aetna MGG,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,BCBS,BCBS,123.47,,,,,,,per diem,123.47,123.47,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,BCBS MGG,BCBS MGG,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Cigna,Cigna,123.47,,,,,,,per diem,123.47,123.47,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Cigna MGG,Cigna MGG,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Humana,Humana,123.47,,,,,,,per diem,123.47,123.47,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Humana MGG,Humana MGG,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Optum VA,Optum VA,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,UHC,UHC,123.47,,,,,,,per diem,123.47,123.47,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,UHC MGG,UHC MGG,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,VA,VA,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Wellcare MGG,Wellcare MGG,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Bright Health - commercial,Bright Health - commercial,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,123.47,123.47,Bright Health MGG,Bright Health MGG,123.47,,,,,,,case rate,123.47,123.47,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Aetna,Aetna,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Aetna MGG,Aetna MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,BCBS,BCBS,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,BCBS MGG,BCBS MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Cigna,Cigna,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Cigna MGG,Cigna MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Humana,Humana,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Humana MGG,Humana MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Optum VA,Optum VA,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,UHC,UHC,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,UHC MGG,UHC MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,VA,VA,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Wellcare MGG,Wellcare MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Bright Health - commercial,Bright Health - commercial,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
IRRADIATION OF BLOOD          ,72000575,CDM,300,RC,86945,CPT,,,,Inpatient,,,360,360,Bright Health MGG,Bright Health MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Aetna,Aetna,81.07,,,,,,,per diem,81.07,81.07,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Aetna MGG,Aetna MGG,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,BCBS,BCBS,81.07,,,,,,,per diem,81.07,81.07,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,BCBS MGG,BCBS MGG,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Cigna,Cigna,81.07,,,,,,,per diem,81.07,81.07,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Cigna MGG,Cigna MGG,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Humana,Humana,81.07,,,,,,,per diem,81.07,81.07,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Humana MGG,Humana MGG,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Optum VA,Optum VA,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,UHC,UHC,81.07,,,,,,,per diem,81.07,81.07,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,UHC MGG,UHC MGG,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,VA,VA,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Wellcare MGG,Wellcare MGG,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Bright Health - commercial,Bright Health - commercial,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,81.07,81.07,Bright Health MGG,Bright Health MGG,81.07,,,,,,,case rate,81.07,81.07,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Aetna,Aetna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Aetna MGG,Aetna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,BCBS,BCBS,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,BCBS MGG,BCBS MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Cigna,Cigna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Cigna MGG,Cigna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Humana,Humana,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Humana MGG,Humana MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Optum VA,Optum VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,UHC,UHC,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,UHC MGG,UHC MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,VA,VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Wellcare MGG,Wellcare MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Bright Health - commercial,Bright Health - commercial,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,84,84,Bright Health MGG,Bright Health MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Aetna,Aetna,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Aetna MGG,Aetna MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,BCBS,BCBS,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,BCBS MGG,BCBS MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Cigna,Cigna,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Cigna MGG,Cigna MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Humana,Humana,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Humana MGG,Humana MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Optum VA,Optum VA,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,UHC,UHC,167,,,,,,,per diem,167,167,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,UHC MGG,UHC MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,VA,VA,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Wellcare MGG,Wellcare MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Bright Health - commercial,Bright Health - commercial,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,167,167,Bright Health MGG,Bright Health MGG,167,,,,,,,case rate,167,167,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Aetna,Aetna,104.54,,,,,,,per diem,104.54,104.54,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Aetna MGG,Aetna MGG,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,BCBS,BCBS,104.54,,,,,,,per diem,104.54,104.54,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,BCBS MGG,BCBS MGG,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Cigna,Cigna,104.54,,,,,,,per diem,104.54,104.54,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Cigna MGG,Cigna MGG,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Humana,Humana,104.54,,,,,,,per diem,104.54,104.54,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Humana MGG,Humana MGG,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Optum VA,Optum VA,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,UHC,UHC,104.54,,,,,,,per diem,104.54,104.54,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,UHC MGG,UHC MGG,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,VA,VA,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Wellcare MGG,Wellcare MGG,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Bright Health - commercial,Bright Health - commercial,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,104.54,104.54,Bright Health MGG,Bright Health MGG,104.54,,,,,,,case rate,104.54,104.54,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Aetna,Aetna,43.23,,,,,,,per diem,43.23,43.23,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Aetna MGG,Aetna MGG,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,BCBS,BCBS,43.23,,,,,,,per diem,43.23,43.23,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,BCBS MGG,BCBS MGG,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Cigna,Cigna,43.23,,,,,,,per diem,43.23,43.23,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Cigna MGG,Cigna MGG,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Humana,Humana,43.23,,,,,,,per diem,43.23,43.23,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Humana MGG,Humana MGG,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Optum VA,Optum VA,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,UHC,UHC,43.23,,,,,,,per diem,43.23,43.23,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,UHC MGG,UHC MGG,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,VA,VA,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Wellcare MGG,Wellcare MGG,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Bright Health - commercial,Bright Health - commercial,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,43.23,43.23,Bright Health MGG,Bright Health MGG,43.23,,,,,,,case rate,43.23,43.23,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Aetna,Aetna,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Aetna MGG,Aetna MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,BCBS,BCBS,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,BCBS MGG,BCBS MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Cigna,Cigna,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Cigna MGG,Cigna MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Humana,Humana,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Humana MGG,Humana MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Optum VA,Optum VA,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,UHC,UHC,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,UHC MGG,UHC MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,VA,VA,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Wellcare MGG,Wellcare MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Bright Health - commercial,Bright Health - commercial,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2553.67,2553.67,Bright Health MGG,Bright Health MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Aetna,Aetna,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Aetna MGG,Aetna MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,BCBS,BCBS,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,BCBS MGG,BCBS MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Cigna,Cigna,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Cigna MGG,Cigna MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Humana,Humana,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Humana MGG,Humana MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Optum VA,Optum VA,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,UHC,UHC,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,UHC MGG,UHC MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,VA,VA,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Wellcare MGG,Wellcare MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Bright Health - commercial,Bright Health - commercial,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2553.67,2553.67,Bright Health MGG,Bright Health MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Aetna,Aetna,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Aetna MGG,Aetna MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,BCBS,BCBS,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,BCBS MGG,BCBS MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Cigna,Cigna,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Cigna MGG,Cigna MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Humana,Humana,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Humana MGG,Humana MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Optum VA,Optum VA,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,UHC,UHC,2553.67,,,,,,,per diem,2553.67,2553.67,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,UHC MGG,UHC MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,VA,VA,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Wellcare MGG,Wellcare MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Bright Health - commercial,Bright Health - commercial,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2553.67,2553.67,Bright Health MGG,Bright Health MGG,2553.67,,,,,,,case rate,2553.67,2553.67,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Aetna,Aetna,447.08,,,,,,,per diem,447.08,447.08,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Aetna MGG,Aetna MGG,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,BCBS,BCBS,447.08,,,,,,,per diem,447.08,447.08,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,BCBS MGG,BCBS MGG,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Cigna,Cigna,447.08,,,,,,,per diem,447.08,447.08,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Cigna MGG,Cigna MGG,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Humana,Humana,447.08,,,,,,,per diem,447.08,447.08,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Humana MGG,Humana MGG,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Optum VA,Optum VA,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,UHC,UHC,447.08,,,,,,,per diem,447.08,447.08,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,UHC MGG,UHC MGG,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,VA,VA,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Wellcare MGG,Wellcare MGG,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Bright Health - commercial,Bright Health - commercial,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,447.08,447.08,Bright Health MGG,Bright Health MGG,447.08,,,,,,,case rate,447.08,447.08,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Aetna,Aetna,757,,,,,,,per diem,757,757,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Aetna MGG,Aetna MGG,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,BCBS,BCBS,757,,,,,,,per diem,757,757,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,BCBS MGG,BCBS MGG,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Cigna,Cigna,757,,,,,,,per diem,757,757,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Cigna MGG,Cigna MGG,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Humana,Humana,757,,,,,,,per diem,757,757,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Humana MGG,Humana MGG,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Optum VA,Optum VA,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,UHC,UHC,757,,,,,,,per diem,757,757,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,UHC MGG,UHC MGG,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,VA,VA,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Wellcare MGG,Wellcare MGG,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Bright Health - commercial,Bright Health - commercial,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,757,757,Bright Health MGG,Bright Health MGG,757,,,,,,,case rate,757,757,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Aetna,Aetna,208.15,,,,,,,per diem,208.15,208.15,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Aetna MGG,Aetna MGG,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,BCBS,BCBS,208.15,,,,,,,per diem,208.15,208.15,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,BCBS MGG,BCBS MGG,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Cigna,Cigna,208.15,,,,,,,per diem,208.15,208.15,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Cigna MGG,Cigna MGG,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Humana,Humana,208.15,,,,,,,per diem,208.15,208.15,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Humana MGG,Humana MGG,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Optum VA,Optum VA,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,UHC,UHC,208.15,,,,,,,per diem,208.15,208.15,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,UHC MGG,UHC MGG,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,VA,VA,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Wellcare MGG,Wellcare MGG,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Bright Health - commercial,Bright Health - commercial,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,208.15,208.15,Bright Health MGG,Bright Health MGG,208.15,,,,,,,case rate,208.15,208.15,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Aetna,Aetna,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Aetna MGG,Aetna MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,BCBS,BCBS,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,BCBS MGG,BCBS MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Cigna,Cigna,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Cigna MGG,Cigna MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Humana,Humana,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Humana MGG,Humana MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Optum VA,Optum VA,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,UHC,UHC,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,UHC MGG,UHC MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,VA,VA,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Wellcare MGG,Wellcare MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Bright Health - commercial,Bright Health - commercial,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,303.96,303.96,Bright Health MGG,Bright Health MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Aetna,Aetna,691,,,,,,,per diem,691,691,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Aetna MGG,Aetna MGG,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,BCBS,BCBS,691,,,,,,,per diem,691,691,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,BCBS MGG,BCBS MGG,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Cigna,Cigna,691,,,,,,,per diem,691,691,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Cigna MGG,Cigna MGG,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Humana,Humana,691,,,,,,,per diem,691,691,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Humana MGG,Humana MGG,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Optum VA,Optum VA,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,UHC,UHC,691,,,,,,,per diem,691,691,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,UHC MGG,UHC MGG,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,VA,VA,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Wellcare MGG,Wellcare MGG,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Bright Health - commercial,Bright Health - commercial,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,691,691,Bright Health MGG,Bright Health MGG,691,,,,,,,case rate,691,691,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Aetna,Aetna,176.1,,,,,,,per diem,176.1,176.1,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Aetna MGG,Aetna MGG,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,BCBS,BCBS,176.1,,,,,,,per diem,176.1,176.1,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,BCBS MGG,BCBS MGG,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Cigna,Cigna,176.1,,,,,,,per diem,176.1,176.1,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Cigna MGG,Cigna MGG,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Humana,Humana,176.1,,,,,,,per diem,176.1,176.1,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Humana MGG,Humana MGG,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Optum VA,Optum VA,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,UHC,UHC,176.1,,,,,,,per diem,176.1,176.1,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,UHC MGG,UHC MGG,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,VA,VA,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Wellcare MGG,Wellcare MGG,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Bright Health - commercial,Bright Health - commercial,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,176.1,176.1,Bright Health MGG,Bright Health MGG,176.1,,,,,,,case rate,176.1,176.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Aetna,Aetna,281.1,,,,,,,per diem,281.1,281.1,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Aetna MGG,Aetna MGG,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,BCBS,BCBS,281.1,,,,,,,per diem,281.1,281.1,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,BCBS MGG,BCBS MGG,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Cigna,Cigna,281.1,,,,,,,per diem,281.1,281.1,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Cigna MGG,Cigna MGG,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Humana,Humana,281.1,,,,,,,per diem,281.1,281.1,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Humana MGG,Humana MGG,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Optum VA,Optum VA,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,UHC,UHC,281.1,,,,,,,per diem,281.1,281.1,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,UHC MGG,UHC MGG,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,VA,VA,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Wellcare MGG,Wellcare MGG,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Bright Health - commercial,Bright Health - commercial,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,281.1,281.1,Bright Health MGG,Bright Health MGG,281.1,,,,,,,case rate,281.1,281.1,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Aetna,Aetna,219.3,,,,,,,per diem,219.3,219.3,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Aetna MGG,Aetna MGG,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,BCBS,BCBS,219.3,,,,,,,per diem,219.3,219.3,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,BCBS MGG,BCBS MGG,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Cigna,Cigna,219.3,,,,,,,per diem,219.3,219.3,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Cigna MGG,Cigna MGG,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Humana,Humana,219.3,,,,,,,per diem,219.3,219.3,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Humana MGG,Humana MGG,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Optum VA,Optum VA,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,UHC,UHC,219.3,,,,,,,per diem,219.3,219.3,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,UHC MGG,UHC MGG,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,VA,VA,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Wellcare MGG,Wellcare MGG,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Bright Health - commercial,Bright Health - commercial,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,219.3,219.3,Bright Health MGG,Bright Health MGG,219.3,,,,,,,case rate,219.3,219.3,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Aetna,Aetna,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Aetna MGG,Aetna MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,BCBS,BCBS,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,BCBS MGG,BCBS MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Cigna,Cigna,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Cigna MGG,Cigna MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Humana,Humana,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Humana MGG,Humana MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Optum VA,Optum VA,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,UHC,UHC,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,UHC MGG,UHC MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,VA,VA,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Wellcare MGG,Wellcare MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Bright Health - commercial,Bright Health - commercial,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,139.2,139.2,Bright Health MGG,Bright Health MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Aetna,Aetna,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Aetna MGG,Aetna MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,BCBS,BCBS,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,BCBS MGG,BCBS MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Cigna,Cigna,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Cigna MGG,Cigna MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Humana,Humana,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Humana MGG,Humana MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Optum VA,Optum VA,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,UHC,UHC,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,UHC MGG,UHC MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,VA,VA,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Wellcare MGG,Wellcare MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Bright Health - commercial,Bright Health - commercial,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,102,102,Bright Health MGG,Bright Health MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Aetna,Aetna,262.8,,,,,,,per diem,262.8,262.8,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Aetna MGG,Aetna MGG,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,BCBS,BCBS,262.8,,,,,,,per diem,262.8,262.8,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,BCBS MGG,BCBS MGG,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Cigna,Cigna,262.8,,,,,,,per diem,262.8,262.8,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Cigna MGG,Cigna MGG,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Humana,Humana,262.8,,,,,,,per diem,262.8,262.8,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Humana MGG,Humana MGG,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Optum VA,Optum VA,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,UHC,UHC,262.8,,,,,,,per diem,262.8,262.8,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,UHC MGG,UHC MGG,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,VA,VA,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Wellcare MGG,Wellcare MGG,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Bright Health - commercial,Bright Health - commercial,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,262.8,262.8,Bright Health MGG,Bright Health MGG,262.8,,,,,,,case rate,262.8,262.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Aetna,Aetna,373.8,,,,,,,per diem,373.8,373.8,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Aetna MGG,Aetna MGG,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,BCBS,BCBS,373.8,,,,,,,per diem,373.8,373.8,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,BCBS MGG,BCBS MGG,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Cigna,Cigna,373.8,,,,,,,per diem,373.8,373.8,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Cigna MGG,Cigna MGG,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Humana,Humana,373.8,,,,,,,per diem,373.8,373.8,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Humana MGG,Humana MGG,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Optum VA,Optum VA,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,UHC,UHC,373.8,,,,,,,per diem,373.8,373.8,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,UHC MGG,UHC MGG,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,VA,VA,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Wellcare MGG,Wellcare MGG,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Bright Health - commercial,Bright Health - commercial,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,373.8,373.8,Bright Health MGG,Bright Health MGG,373.8,,,,,,,case rate,373.8,373.8,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Aetna,Aetna,1989,,,,,,,per diem,1989,1989,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Aetna MGG,Aetna MGG,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,BCBS,BCBS,1989,,,,,,,per diem,1989,1989,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,BCBS MGG,BCBS MGG,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Cigna,Cigna,1989,,,,,,,per diem,1989,1989,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Cigna MGG,Cigna MGG,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Humana,Humana,1989,,,,,,,per diem,1989,1989,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Humana MGG,Humana MGG,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Optum VA,Optum VA,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,UHC,UHC,1989,,,,,,,per diem,1989,1989,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,UHC MGG,UHC MGG,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,VA,VA,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Wellcare MGG,Wellcare MGG,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Bright Health - commercial,Bright Health - commercial,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,1989,1989,Bright Health MGG,Bright Health MGG,1989,,,,,,,case rate,1989,1989,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Aetna,Aetna,4414,,,,,,,per diem,4414,4414,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Aetna MGG,Aetna MGG,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,BCBS,BCBS,4414,,,,,,,per diem,4414,4414,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,BCBS MGG,BCBS MGG,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Cigna,Cigna,4414,,,,,,,per diem,4414,4414,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Cigna MGG,Cigna MGG,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Humana,Humana,4414,,,,,,,per diem,4414,4414,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Humana MGG,Humana MGG,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Optum VA,Optum VA,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,UHC,UHC,4414,,,,,,,per diem,4414,4414,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,UHC MGG,UHC MGG,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,VA,VA,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Wellcare MGG,Wellcare MGG,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Bright Health - commercial,Bright Health - commercial,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4414,4414,Bright Health MGG,Bright Health MGG,4414,,,,,,,case rate,4414,4414,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Aetna,Aetna,406,,,,,,,per diem,406,406,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Aetna MGG,Aetna MGG,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,BCBS,BCBS,406,,,,,,,per diem,406,406,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,BCBS MGG,BCBS MGG,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Cigna,Cigna,406,,,,,,,per diem,406,406,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Cigna MGG,Cigna MGG,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Humana,Humana,406,,,,,,,per diem,406,406,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Humana MGG,Humana MGG,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Optum VA,Optum VA,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,UHC,UHC,406,,,,,,,per diem,406,406,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,UHC MGG,UHC MGG,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,VA,VA,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Wellcare MGG,Wellcare MGG,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Bright Health - commercial,Bright Health - commercial,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,406,406,Bright Health MGG,Bright Health MGG,406,,,,,,,case rate,406,406,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Aetna,Aetna,473,,,,,,,per diem,473,473,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Aetna MGG,Aetna MGG,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,BCBS,BCBS,473,,,,,,,per diem,473,473,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,BCBS MGG,BCBS MGG,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Cigna,Cigna,473,,,,,,,per diem,473,473,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Cigna MGG,Cigna MGG,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Humana,Humana,473,,,,,,,per diem,473,473,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Humana MGG,Humana MGG,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Optum VA,Optum VA,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,UHC,UHC,473,,,,,,,per diem,473,473,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,UHC MGG,UHC MGG,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,VA,VA,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Wellcare MGG,Wellcare MGG,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Bright Health - commercial,Bright Health - commercial,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,473,473,Bright Health MGG,Bright Health MGG,473,,,,,,,case rate,473,473,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Aetna,Aetna,69,,,,,,,per diem,69,69,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Aetna MGG,Aetna MGG,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,BCBS,BCBS,69,,,,,,,per diem,69,69,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,BCBS MGG,BCBS MGG,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Cigna,Cigna,69,,,,,,,per diem,69,69,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Cigna MGG,Cigna MGG,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Humana,Humana,69,,,,,,,per diem,69,69,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Humana MGG,Humana MGG,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Optum VA,Optum VA,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,UHC,UHC,69,,,,,,,per diem,69,69,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,UHC MGG,UHC MGG,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,VA,VA,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Wellcare MGG,Wellcare MGG,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Bright Health - commercial,Bright Health - commercial,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE-PROC ONLY     ,72060001,CDM,390,RC,P9012,HCPCS,,,,Inpatient,,,69,69,Bright Health MGG,Bright Health MGG,69,,,,,,,case rate,69,69,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Aetna,Aetna,195.2,,,,,,,per diem,195.2,195.2,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Aetna MGG,Aetna MGG,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,BCBS,BCBS,195.2,,,,,,,per diem,195.2,195.2,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,BCBS MGG,BCBS MGG,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Cigna,Cigna,195.2,,,,,,,per diem,195.2,195.2,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Cigna MGG,Cigna MGG,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Humana,Humana,195.2,,,,,,,per diem,195.2,195.2,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Humana MGG,Humana MGG,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Optum VA,Optum VA,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,UHC,UHC,195.2,,,,,,,per diem,195.2,195.2,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,UHC MGG,UHC MGG,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,VA,VA,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Wellcare MGG,Wellcare MGG,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Bright Health - commercial,Bright Health - commercial,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,195.2,195.2,Bright Health MGG,Bright Health MGG,195.2,,,,,,,case rate,195.2,195.2,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Aetna,Aetna,207,,,,,,,per diem,207,207,"Per diem rate, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Aetna MGG,Aetna MGG,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,BCBS,BCBS,207,,,,,,,per diem,207,207,"Per diem rate, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,BCBS MGG,BCBS MGG,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Cigna,Cigna,207,,,,,,,per diem,207,207,"Per diem rate, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Cigna MGG,Cigna MGG,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Humana,Humana,207,,,,,,,per diem,207,207,"Per diem rate, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Humana MGG,Humana MGG,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Optum VA,Optum VA,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,UHC,UHC,207,,,,,,,per diem,207,207,"Per diem rate, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,UHC MGG,UHC MGG,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,VA,VA,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Wellcare MGG,Wellcare MGG,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Bright Health - commercial,Bright Health - commercial,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
PLATELETS-PROC ONLY           ,72060004,CDM,390,RC,P9019,HCPCS,,,,Inpatient,,,207,207,Bright Health MGG,Bright Health MGG,207,,,,,,,case rate,207,207,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Aetna,Aetna,442.56,,,,,,,per diem,442.56,442.56,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Aetna MGG,Aetna MGG,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,BCBS,BCBS,442.56,,,,,,,per diem,442.56,442.56,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,BCBS MGG,BCBS MGG,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Cigna,Cigna,442.56,,,,,,,per diem,442.56,442.56,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Cigna MGG,Cigna MGG,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Humana,Humana,442.56,,,,,,,per diem,442.56,442.56,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Humana MGG,Humana MGG,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Optum VA,Optum VA,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,UHC,UHC,442.56,,,,,,,per diem,442.56,442.56,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,UHC MGG,UHC MGG,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,VA,VA,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Wellcare MGG,Wellcare MGG,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Bright Health - commercial,Bright Health - commercial,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,442.56,442.56,Bright Health MGG,Bright Health MGG,442.56,,,,,,,case rate,442.56,442.56,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Aetna,Aetna,608.66,,,,,,,per diem,608.66,608.66,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Aetna MGG,Aetna MGG,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,BCBS,BCBS,608.66,,,,,,,per diem,608.66,608.66,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,BCBS MGG,BCBS MGG,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Cigna,Cigna,608.66,,,,,,,per diem,608.66,608.66,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Cigna MGG,Cigna MGG,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Humana,Humana,608.66,,,,,,,per diem,608.66,608.66,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Humana MGG,Humana MGG,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Optum VA,Optum VA,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,UHC,UHC,608.66,,,,,,,per diem,608.66,608.66,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,UHC MGG,UHC MGG,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,VA,VA,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Wellcare MGG,Wellcare MGG,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Bright Health - commercial,Bright Health - commercial,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,608.66,608.66,Bright Health MGG,Bright Health MGG,608.66,,,,,,,case rate,608.66,608.66,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Aetna,Aetna,2179.5,,,,,,,per diem,2179.5,2179.5,"Per diem rate, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Aetna MGG,Aetna MGG,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,BCBS,BCBS,2179.5,,,,,,,per diem,2179.5,2179.5,"Per diem rate, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,BCBS MGG,BCBS MGG,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Cigna,Cigna,2179.5,,,,,,,per diem,2179.5,2179.5,"Per diem rate, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Cigna MGG,Cigna MGG,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Humana,Humana,2179.5,,,,,,,per diem,2179.5,2179.5,"Per diem rate, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Humana MGG,Humana MGG,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Optum VA,Optum VA,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,UHC,UHC,2179.5,,,,,,,per diem,2179.5,2179.5,"Per diem rate, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,UHC MGG,UHC MGG,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,VA,VA,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Wellcare MGG,Wellcare MGG,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Bright Health - commercial,Bright Health - commercial,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS IRRAD-PROC ONLY     ,72060008,CDM,390,RC,P9032,HCPCS,,,,Inpatient,,,2179.5,2179.5,Bright Health MGG,Bright Health MGG,2179.5,,,,,,,case rate,2179.5,2179.5,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Aetna,Aetna,2270,,,,,,,per diem,2270,2270,"Per diem rate, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Aetna MGG,Aetna MGG,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,BCBS,BCBS,2270,,,,,,,per diem,2270,2270,"Per diem rate, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,BCBS MGG,BCBS MGG,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Cigna,Cigna,2270,,,,,,,per diem,2270,2270,"Per diem rate, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Cigna MGG,Cigna MGG,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Humana,Humana,2270,,,,,,,per diem,2270,2270,"Per diem rate, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Humana MGG,Humana MGG,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Optum VA,Optum VA,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,UHC,UHC,2270,,,,,,,per diem,2270,2270,"Per diem rate, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,UHC MGG,UHC MGG,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,VA,VA,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Wellcare MGG,Wellcare MGG,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Bright Health - commercial,Bright Health - commercial,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER-PROC ONLY      ,72060010,CDM,390,RC,P9034,HCPCS,,,,Inpatient,,,2270,2270,Bright Health MGG,Bright Health MGG,2270,,,,,,,case rate,2270,2270,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Aetna,Aetna,986.12,,,,,,,per diem,986.12,986.12,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Aetna MGG,Aetna MGG,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,BCBS,BCBS,986.12,,,,,,,per diem,986.12,986.12,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,BCBS MGG,BCBS MGG,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Cigna,Cigna,986.12,,,,,,,per diem,986.12,986.12,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Cigna MGG,Cigna MGG,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Humana,Humana,986.12,,,,,,,per diem,986.12,986.12,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Humana MGG,Humana MGG,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Optum VA,Optum VA,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,UHC,UHC,986.12,,,,,,,per diem,986.12,986.12,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,UHC MGG,UHC MGG,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,VA,VA,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Wellcare MGG,Wellcare MGG,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Bright Health - commercial,Bright Health - commercial,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,986.12,986.12,Bright Health MGG,Bright Health MGG,986.12,,,,,,,case rate,986.12,986.12,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Aetna,Aetna,1667,,,,,,,per diem,1667,1667,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Aetna MGG,Aetna MGG,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,BCBS,BCBS,1667,,,,,,,per diem,1667,1667,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,BCBS MGG,BCBS MGG,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Cigna,Cigna,1667,,,,,,,per diem,1667,1667,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Cigna MGG,Cigna MGG,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Humana,Humana,1667,,,,,,,per diem,1667,1667,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Humana MGG,Humana MGG,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Optum VA,Optum VA,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,UHC,UHC,1667,,,,,,,per diem,1667,1667,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,UHC MGG,UHC MGG,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,VA,VA,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Wellcare MGG,Wellcare MGG,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Bright Health - commercial,Bright Health - commercial,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1667,1667,Bright Health MGG,Bright Health MGG,1667,,,,,,,case rate,1667,1667,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Aetna,Aetna,746.28,,,,,,,per diem,746.28,746.28,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Aetna MGG,Aetna MGG,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,BCBS,BCBS,746.28,,,,,,,per diem,746.28,746.28,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,BCBS MGG,BCBS MGG,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Cigna,Cigna,746.28,,,,,,,per diem,746.28,746.28,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Cigna MGG,Cigna MGG,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Humana,Humana,746.28,,,,,,,per diem,746.28,746.28,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Humana MGG,Humana MGG,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Optum VA,Optum VA,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,UHC,UHC,746.28,,,,,,,per diem,746.28,746.28,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,UHC MGG,UHC MGG,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,VA,VA,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Wellcare MGG,Wellcare MGG,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Bright Health - commercial,Bright Health - commercial,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,746.28,746.28,Bright Health MGG,Bright Health MGG,746.28,,,,,,,case rate,746.28,746.28,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Aetna,Aetna,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Aetna MGG,Aetna MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,BCBS,BCBS,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,BCBS MGG,BCBS MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Cigna,Cigna,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Cigna MGG,Cigna MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Humana,Humana,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Humana MGG,Humana MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Optum VA,Optum VA,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,UHC,UHC,219,,,,,,,per diem,219,219,"Per diem rate, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,UHC MGG,UHC MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,VA,VA,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Wellcare MGG,Wellcare MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Bright Health - commercial,Bright Health - commercial,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
FFP 8-24HRS-PROC ONLY         ,72060020,CDM,390,RC,P9059,HCPCS,,,,Inpatient,,,219,219,Bright Health MGG,Bright Health MGG,219,,,,,,,case rate,219,219,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Aetna,Aetna,651,,,,,,,per diem,651,651,"Per diem rate, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Aetna MGG,Aetna MGG,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,BCBS,BCBS,651,,,,,,,per diem,651,651,"Per diem rate, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,BCBS MGG,BCBS MGG,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Cigna,Cigna,651,,,,,,,per diem,651,651,"Per diem rate, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Cigna MGG,Cigna MGG,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Humana,Humana,651,,,,,,,per diem,651,651,"Per diem rate, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Humana MGG,Humana MGG,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Optum VA,Optum VA,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,UHC,UHC,651,,,,,,,per diem,651,651,"Per diem rate, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,UHC MGG,UHC MGG,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,VA,VA,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Wellcare MGG,Wellcare MGG,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Bright Health - commercial,Bright Health - commercial,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
NEUTRALIZATION                ,72099982,CDM,390,RC,86977,CPT,,,,Inpatient,,,651,651,Bright Health MGG,Bright Health MGG,651,,,,,,,case rate,651,651,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Aetna,Aetna,518.18,,,,,,,per diem,518.18,518.18,"Per diem rate, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Aetna MGG,Aetna MGG,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,BCBS,BCBS,518.18,,,,,,,per diem,518.18,518.18,"Per diem rate, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,BCBS MGG,BCBS MGG,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Cigna,Cigna,518.18,,,,,,,per diem,518.18,518.18,"Per diem rate, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Cigna MGG,Cigna MGG,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Humana,Humana,518.18,,,,,,,per diem,518.18,518.18,"Per diem rate, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Humana MGG,Humana MGG,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Optum VA,Optum VA,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,UHC,UHC,518.18,,,,,,,per diem,518.18,518.18,"Per diem rate, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,UHC MGG,UHC MGG,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,VA,VA,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Wellcare MGG,Wellcare MGG,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Bright Health - commercial,Bright Health - commercial,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
SPINE THORACIC MIN 4 VIEWS    ,73499890,CDM,320,RC,72074,CPT,,,,Inpatient,,,518.18,518.18,Bright Health MGG,Bright Health MGG,518.18,,,,,,,case rate,518.18,518.18,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Aetna,Aetna,1128.12,,,,,,,per diem,1128.12,1128.12,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Aetna MGG,Aetna MGG,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,BCBS,BCBS,1128.12,,,,,,,per diem,1128.12,1128.12,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,BCBS MGG,BCBS MGG,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Cigna,Cigna,1128.12,,,,,,,per diem,1128.12,1128.12,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Cigna MGG,Cigna MGG,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Humana,Humana,1128.12,,,,,,,per diem,1128.12,1128.12,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Humana MGG,Humana MGG,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Optum VA,Optum VA,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,UHC,UHC,1128.12,,,,,,,per diem,1128.12,1128.12,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,UHC MGG,UHC MGG,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,VA,VA,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Wellcare MGG,Wellcare MGG,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Bright Health - commercial,Bright Health - commercial,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1128.12,1128.12,Bright Health MGG,Bright Health MGG,1128.12,,,,,,,case rate,1128.12,1128.12,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Aetna,Aetna,779.28,,,,,,,per diem,779.28,779.28,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Aetna MGG,Aetna MGG,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,BCBS,BCBS,779.28,,,,,,,per diem,779.28,779.28,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,BCBS MGG,BCBS MGG,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Cigna,Cigna,779.28,,,,,,,per diem,779.28,779.28,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Cigna MGG,Cigna MGG,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Humana,Humana,779.28,,,,,,,per diem,779.28,779.28,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Humana MGG,Humana MGG,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Optum VA,Optum VA,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,UHC,UHC,779.28,,,,,,,per diem,779.28,779.28,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,UHC MGG,UHC MGG,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,VA,VA,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Wellcare MGG,Wellcare MGG,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Bright Health - commercial,Bright Health - commercial,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,779.28,779.28,Bright Health MGG,Bright Health MGG,779.28,,,,,,,case rate,779.28,779.28,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Aetna,Aetna,498.78,,,,,,,per diem,498.78,498.78,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Aetna MGG,Aetna MGG,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,BCBS,BCBS,498.78,,,,,,,per diem,498.78,498.78,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,BCBS MGG,BCBS MGG,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Cigna,Cigna,498.78,,,,,,,per diem,498.78,498.78,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Cigna MGG,Cigna MGG,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Humana,Humana,498.78,,,,,,,per diem,498.78,498.78,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Humana MGG,Humana MGG,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Optum VA,Optum VA,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,UHC,UHC,498.78,,,,,,,per diem,498.78,498.78,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,UHC MGG,UHC MGG,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,VA,VA,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Wellcare MGG,Wellcare MGG,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Bright Health - commercial,Bright Health - commercial,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,498.78,498.78,Bright Health MGG,Bright Health MGG,498.78,,,,,,,case rate,498.78,498.78,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Aetna,Aetna,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Aetna MGG,Aetna MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,BCBS,BCBS,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,BCBS MGG,BCBS MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Cigna,Cigna,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Cigna MGG,Cigna MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Humana,Humana,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Humana MGG,Humana MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Optum VA,Optum VA,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,UHC,UHC,1055.7,,,,,,,per diem,1055.7,1055.7,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,UHC MGG,UHC MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,VA,VA,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Wellcare MGG,Wellcare MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Bright Health - commercial,Bright Health - commercial,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1055.7,1055.7,Bright Health MGG,Bright Health MGG,1055.7,,,,,,,case rate,1055.7,1055.7,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Aetna,Aetna,948.72,,,,,,,per diem,948.72,948.72,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Aetna MGG,Aetna MGG,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,BCBS,BCBS,948.72,,,,,,,per diem,948.72,948.72,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,BCBS MGG,BCBS MGG,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Cigna,Cigna,948.72,,,,,,,per diem,948.72,948.72,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Cigna MGG,Cigna MGG,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Humana,Humana,948.72,,,,,,,per diem,948.72,948.72,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Humana MGG,Humana MGG,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Optum VA,Optum VA,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,UHC,UHC,948.72,,,,,,,per diem,948.72,948.72,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,UHC MGG,UHC MGG,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,VA,VA,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Wellcare MGG,Wellcare MGG,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Bright Health - commercial,Bright Health - commercial,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,948.72,948.72,Bright Health MGG,Bright Health MGG,948.72,,,,,,,case rate,948.72,948.72,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Aetna,Aetna,1200,,,,,,,per diem,1200,1200,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Aetna MGG,Aetna MGG,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,BCBS,BCBS,1200,,,,,,,per diem,1200,1200,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,BCBS MGG,BCBS MGG,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Cigna,Cigna,1200,,,,,,,per diem,1200,1200,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Cigna MGG,Cigna MGG,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Humana,Humana,1200,,,,,,,per diem,1200,1200,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Humana MGG,Humana MGG,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Optum VA,Optum VA,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,UHC,UHC,1200,,,,,,,per diem,1200,1200,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,UHC MGG,UHC MGG,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,VA,VA,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Wellcare MGG,Wellcare MGG,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Bright Health - commercial,Bright Health - commercial,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1200,1200,Bright Health MGG,Bright Health MGG,1200,,,,,,,case rate,1200,1200,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Aetna,Aetna,800.37,,,,,,,per diem,800.37,800.37,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Aetna MGG,Aetna MGG,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,BCBS,BCBS,800.37,,,,,,,per diem,800.37,800.37,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,BCBS MGG,BCBS MGG,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Cigna,Cigna,800.37,,,,,,,per diem,800.37,800.37,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Cigna MGG,Cigna MGG,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Humana,Humana,800.37,,,,,,,per diem,800.37,800.37,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Humana MGG,Humana MGG,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Optum VA,Optum VA,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,UHC,UHC,800.37,,,,,,,per diem,800.37,800.37,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,UHC MGG,UHC MGG,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,VA,VA,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Wellcare MGG,Wellcare MGG,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Bright Health - commercial,Bright Health - commercial,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,800.37,800.37,Bright Health MGG,Bright Health MGG,800.37,,,,,,,case rate,800.37,800.37,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Aetna,Aetna,5924.96,,,,,,,per diem,5924.96,5924.96,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Aetna MGG,Aetna MGG,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,BCBS,BCBS,5924.96,,,,,,,per diem,5924.96,5924.96,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,BCBS MGG,BCBS MGG,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Cigna,Cigna,5924.96,,,,,,,per diem,5924.96,5924.96,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Cigna MGG,Cigna MGG,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Humana,Humana,5924.96,,,,,,,per diem,5924.96,5924.96,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Humana MGG,Humana MGG,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Optum VA,Optum VA,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,UHC,UHC,5924.96,,,,,,,per diem,5924.96,5924.96,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,UHC MGG,UHC MGG,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,VA,VA,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Wellcare MGG,Wellcare MGG,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Bright Health - commercial,Bright Health - commercial,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,5924.96,5924.96,Bright Health MGG,Bright Health MGG,5924.96,,,,,,,case rate,5924.96,5924.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Aetna,Aetna,725.96,,,,,,,per diem,725.96,725.96,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Aetna MGG,Aetna MGG,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,BCBS,BCBS,725.96,,,,,,,per diem,725.96,725.96,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,BCBS MGG,BCBS MGG,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Cigna,Cigna,725.96,,,,,,,per diem,725.96,725.96,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Cigna MGG,Cigna MGG,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Humana,Humana,725.96,,,,,,,per diem,725.96,725.96,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Humana MGG,Humana MGG,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Optum VA,Optum VA,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,UHC,UHC,725.96,,,,,,,per diem,725.96,725.96,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,UHC MGG,UHC MGG,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,VA,VA,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Wellcare MGG,Wellcare MGG,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Bright Health - commercial,Bright Health - commercial,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,725.96,725.96,Bright Health MGG,Bright Health MGG,725.96,,,,,,,case rate,725.96,725.96,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Aetna,Aetna,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Aetna MGG,Aetna MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,BCBS,BCBS,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,BCBS MGG,BCBS MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Cigna,Cigna,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Cigna MGG,Cigna MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Humana,Humana,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Humana MGG,Humana MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Optum VA,Optum VA,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,UHC,UHC,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,UHC MGG,UHC MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,VA,VA,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Wellcare MGG,Wellcare MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Bright Health - commercial,Bright Health - commercial,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2204.22,2204.22,Bright Health MGG,Bright Health MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Aetna,Aetna,1657.5,,,,,,,per diem,1657.5,1657.5,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Aetna MGG,Aetna MGG,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,BCBS,BCBS,1657.5,,,,,,,per diem,1657.5,1657.5,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,BCBS MGG,BCBS MGG,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Cigna,Cigna,1657.5,,,,,,,per diem,1657.5,1657.5,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Cigna MGG,Cigna MGG,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Humana,Humana,1657.5,,,,,,,per diem,1657.5,1657.5,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Humana MGG,Humana MGG,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Optum VA,Optum VA,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,UHC,UHC,1657.5,,,,,,,per diem,1657.5,1657.5,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,UHC MGG,UHC MGG,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,VA,VA,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Wellcare MGG,Wellcare MGG,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Bright Health - commercial,Bright Health - commercial,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1657.5,1657.5,Bright Health MGG,Bright Health MGG,1657.5,,,,,,,case rate,1657.5,1657.5,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Aetna,Aetna,4421.7,,,,,,,per diem,4421.7,4421.7,"Per diem rate, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Aetna MGG,Aetna MGG,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,BCBS,BCBS,4421.7,,,,,,,per diem,4421.7,4421.7,"Per diem rate, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,BCBS MGG,BCBS MGG,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Cigna,Cigna,4421.7,,,,,,,per diem,4421.7,4421.7,"Per diem rate, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Cigna MGG,Cigna MGG,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Humana,Humana,4421.7,,,,,,,per diem,4421.7,4421.7,"Per diem rate, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Humana MGG,Humana MGG,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Optum VA,Optum VA,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,UHC,UHC,4421.7,,,,,,,per diem,4421.7,4421.7,"Per diem rate, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,UHC MGG,UHC MGG,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,VA,VA,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Wellcare MGG,Wellcare MGG,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Bright Health - commercial,Bright Health - commercial,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
EEG LOCAL SEIZURE PRE SURG    ,73510012,CDM,740,RC,95951,CPT,,,,Inpatient,,,4421.7,4421.7,Bright Health MGG,Bright Health MGG,4421.7,,,,,,,case rate,4421.7,4421.7,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Aetna,Aetna,610.98,,,,,,,per diem,610.98,610.98,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Aetna MGG,Aetna MGG,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,BCBS,BCBS,610.98,,,,,,,per diem,610.98,610.98,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,BCBS MGG,BCBS MGG,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Cigna,Cigna,610.98,,,,,,,per diem,610.98,610.98,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Cigna MGG,Cigna MGG,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Humana,Humana,610.98,,,,,,,per diem,610.98,610.98,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Humana MGG,Humana MGG,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Optum VA,Optum VA,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,UHC,UHC,610.98,,,,,,,per diem,610.98,610.98,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,UHC MGG,UHC MGG,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,VA,VA,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Wellcare MGG,Wellcare MGG,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Bright Health - commercial,Bright Health - commercial,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,93312,CPT,,,,Inpatient,,,610.98,610.98,Bright Health MGG,Bright Health MGG,610.98,,,,,,,case rate,610.98,610.98,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Aetna,Aetna,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Aetna MGG,Aetna MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,BCBS,BCBS,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,BCBS MGG,BCBS MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Cigna,Cigna,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Cigna MGG,Cigna MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Humana,Humana,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Humana MGG,Humana MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Optum VA,Optum VA,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,UHC,UHC,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,UHC MGG,UHC MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,VA,VA,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Wellcare MGG,Wellcare MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Bright Health - commercial,Bright Health - commercial,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,95978,CPT,,,,Inpatient,,,670.14,670.14,Bright Health MGG,Bright Health MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Aetna,Aetna,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Aetna MGG,Aetna MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,BCBS,BCBS,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,BCBS MGG,BCBS MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Cigna,Cigna,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Cigna MGG,Cigna MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Humana,Humana,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Humana MGG,Humana MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Optum VA,Optum VA,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,UHC,UHC,670.14,,,,,,,per diem,670.14,670.14,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,UHC MGG,UHC MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,VA,VA,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Wellcare MGG,Wellcare MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Bright Health - commercial,Bright Health - commercial,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,95979,CPT,,,,Inpatient,,,670.14,670.14,Bright Health MGG,Bright Health MGG,670.14,,,,,,,case rate,670.14,670.14,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Aetna,Aetna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Aetna MGG,Aetna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,BCBS,BCBS,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,BCBS MGG,BCBS MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Cigna,Cigna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Cigna MGG,Cigna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Humana,Humana,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Humana MGG,Humana MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Optum VA,Optum VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,UHC,UHC,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,UHC MGG,UHC MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,VA,VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Wellcare MGG,Wellcare MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Bright Health - commercial,Bright Health - commercial,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,95933,CPT,,,,Inpatient,,,180.54,180.54,Bright Health MGG,Bright Health MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Aetna,Aetna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Aetna MGG,Aetna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,BCBS,BCBS,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,BCBS MGG,BCBS MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Cigna,Cigna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Cigna MGG,Cigna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Humana,Humana,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Humana MGG,Humana MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Optum VA,Optum VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,UHC,UHC,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,UHC MGG,UHC MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,VA,VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Wellcare MGG,Wellcare MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Bright Health - commercial,Bright Health - commercial,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,95929,CPT,,,,Inpatient,,,875.16,875.16,Bright Health MGG,Bright Health MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Aetna,Aetna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Aetna MGG,Aetna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,BCBS,BCBS,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,BCBS MGG,BCBS MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Cigna,Cigna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Cigna MGG,Cigna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Humana,Humana,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Humana MGG,Humana MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Optum VA,Optum VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,UHC,UHC,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,UHC MGG,UHC MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,VA,VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Wellcare MGG,Wellcare MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Bright Health - commercial,Bright Health - commercial,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,95928,CPT,,,,Inpatient,,,875.16,875.16,Bright Health MGG,Bright Health MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Aetna,Aetna,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Aetna MGG,Aetna MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,BCBS,BCBS,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,BCBS MGG,BCBS MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Cigna,Cigna,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Cigna MGG,Cigna MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Humana,Humana,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Humana MGG,Humana MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Optum VA,Optum VA,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,UHC,UHC,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,UHC MGG,UHC MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,VA,VA,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Wellcare MGG,Wellcare MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Bright Health - commercial,Bright Health - commercial,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Bright Health MGG,Bright Health MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Aetna,Aetna,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Aetna MGG,Aetna MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,BCBS,BCBS,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,BCBS MGG,BCBS MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Cigna,Cigna,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Cigna MGG,Cigna MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Humana,Humana,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Humana MGG,Humana MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Optum VA,Optum VA,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,UHC,UHC,1621.8,,,,,,,per diem,1621.8,1621.8,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,UHC MGG,UHC MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,VA,VA,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Wellcare MGG,Wellcare MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Bright Health - commercial,Bright Health - commercial,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,93017,CPT,,,,Inpatient,,,1621.8,1621.8,Bright Health MGG,Bright Health MGG,1621.8,,,,,,,case rate,1621.8,1621.8,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Aetna,Aetna,220.32,,,,,,,per diem,220.32,220.32,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Aetna MGG,Aetna MGG,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,BCBS,BCBS,220.32,,,,,,,per diem,220.32,220.32,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,BCBS MGG,BCBS MGG,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Cigna,Cigna,220.32,,,,,,,per diem,220.32,220.32,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Cigna MGG,Cigna MGG,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Humana,Humana,220.32,,,,,,,per diem,220.32,220.32,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Humana MGG,Humana MGG,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Optum VA,Optum VA,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,UHC,UHC,220.32,,,,,,,per diem,220.32,220.32,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,UHC MGG,UHC MGG,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,VA,VA,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Wellcare MGG,Wellcare MGG,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Bright Health - commercial,Bright Health - commercial,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,93041,CPT,,,,Inpatient,,,220.32,220.32,Bright Health MGG,Bright Health MGG,220.32,,,,,,,case rate,220.32,220.32,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Aetna,Aetna,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Aetna MGG,Aetna MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,BCBS,BCBS,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,BCBS MGG,BCBS MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Cigna,Cigna,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Cigna MGG,Cigna MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Humana,Humana,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Humana MGG,Humana MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Optum VA,Optum VA,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,UHC,UHC,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,UHC MGG,UHC MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,VA,VA,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Wellcare MGG,Wellcare MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Bright Health - commercial,Bright Health - commercial,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,93351,CPT,,,,Inpatient,,,1803.36,1803.36,Bright Health MGG,Bright Health MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Aetna,Aetna,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Aetna MGG,Aetna MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,BCBS,BCBS,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,BCBS MGG,BCBS MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Cigna,Cigna,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Cigna MGG,Cigna MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Humana,Humana,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Humana MGG,Humana MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Optum VA,Optum VA,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,UHC,UHC,715.02,,,,,,,per diem,715.02,715.02,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,UHC MGG,UHC MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,VA,VA,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Wellcare MGG,Wellcare MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Bright Health - commercial,Bright Health - commercial,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,95955,CPT,,,,Inpatient,,,715.02,715.02,Bright Health MGG,Bright Health MGG,715.02,,,,,,,case rate,715.02,715.02,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Aetna,Aetna,2072.64,,,,,,,per diem,2072.64,2072.64,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Aetna MGG,Aetna MGG,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,BCBS,BCBS,2072.64,,,,,,,per diem,2072.64,2072.64,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,BCBS MGG,BCBS MGG,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Cigna,Cigna,2072.64,,,,,,,per diem,2072.64,2072.64,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Cigna MGG,Cigna MGG,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Humana,Humana,2072.64,,,,,,,per diem,2072.64,2072.64,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Humana MGG,Humana MGG,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Optum VA,Optum VA,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,UHC,UHC,2072.64,,,,,,,per diem,2072.64,2072.64,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,UHC MGG,UHC MGG,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,VA,VA,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Wellcare MGG,Wellcare MGG,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Bright Health - commercial,Bright Health - commercial,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,95950,CPT,,,,Inpatient,,,2072.64,2072.64,Bright Health MGG,Bright Health MGG,2072.64,,,,,,,case rate,2072.64,2072.64,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Aetna,Aetna,373.32,,,,,,,per diem,373.32,373.32,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Aetna MGG,Aetna MGG,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,BCBS,BCBS,373.32,,,,,,,per diem,373.32,373.32,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,BCBS MGG,BCBS MGG,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Cigna,Cigna,373.32,,,,,,,per diem,373.32,373.32,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Cigna MGG,Cigna MGG,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Humana,Humana,373.32,,,,,,,per diem,373.32,373.32,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Humana MGG,Humana MGG,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Optum VA,Optum VA,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,UHC,UHC,373.32,,,,,,,per diem,373.32,373.32,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,UHC MGG,UHC MGG,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,VA,VA,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Wellcare MGG,Wellcare MGG,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Bright Health - commercial,Bright Health - commercial,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,95868,CPT,,,,Inpatient,,,373.32,373.32,Bright Health MGG,Bright Health MGG,373.32,,,,,,,case rate,373.32,373.32,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Aetna,Aetna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Aetna MGG,Aetna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,BCBS,BCBS,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,BCBS MGG,BCBS MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Cigna,Cigna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Cigna MGG,Cigna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Humana,Humana,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Humana MGG,Humana MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Optum VA,Optum VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,UHC,UHC,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,UHC MGG,UHC MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,VA,VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Wellcare MGG,Wellcare MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Bright Health - commercial,Bright Health - commercial,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Bright Health MGG,Bright Health MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Aetna,Aetna,123.42,,,,,,,per diem,123.42,123.42,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Aetna MGG,Aetna MGG,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,BCBS,BCBS,123.42,,,,,,,per diem,123.42,123.42,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,BCBS MGG,BCBS MGG,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Cigna,Cigna,123.42,,,,,,,per diem,123.42,123.42,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Cigna MGG,Cigna MGG,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Humana,Humana,123.42,,,,,,,per diem,123.42,123.42,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Humana MGG,Humana MGG,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Optum VA,Optum VA,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,UHC,UHC,123.42,,,,,,,per diem,123.42,123.42,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,UHC MGG,UHC MGG,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,VA,VA,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Wellcare MGG,Wellcare MGG,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Bright Health - commercial,Bright Health - commercial,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,95940,CPT,,,,Inpatient,,,123.42,123.42,Bright Health MGG,Bright Health MGG,123.42,,,,,,,case rate,123.42,123.42,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Aetna,Aetna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Aetna MGG,Aetna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,BCBS,BCBS,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,BCBS MGG,BCBS MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Cigna,Cigna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Cigna MGG,Cigna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Humana,Humana,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Humana MGG,Humana MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Optum VA,Optum VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,UHC,UHC,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,UHC MGG,UHC MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,VA,VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Wellcare MGG,Wellcare MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Bright Health - commercial,Bright Health - commercial,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,95875,CPT,,,,Inpatient,,,180.54,180.54,Bright Health MGG,Bright Health MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Aetna,Aetna,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Aetna MGG,Aetna MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,BCBS,BCBS,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,BCBS MGG,BCBS MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Cigna,Cigna,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Cigna MGG,Cigna MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Humana,Humana,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Humana MGG,Humana MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Optum VA,Optum VA,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,UHC,UHC,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,UHC MGG,UHC MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,VA,VA,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Wellcare MGG,Wellcare MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Bright Health - commercial,Bright Health - commercial,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,95886,CPT,,,,Inpatient,,,453.9,453.9,Bright Health MGG,Bright Health MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Aetna,Aetna,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Aetna MGG,Aetna MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,BCBS,BCBS,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,BCBS MGG,BCBS MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Cigna,Cigna,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Cigna MGG,Cigna MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Humana,Humana,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Humana MGG,Humana MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Optum VA,Optum VA,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,UHC,UHC,453.9,,,,,,,per diem,453.9,453.9,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,UHC MGG,UHC MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,VA,VA,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Wellcare MGG,Wellcare MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Bright Health - commercial,Bright Health - commercial,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,95885,CPT,,,,Inpatient,,,453.9,453.9,Bright Health MGG,Bright Health MGG,453.9,,,,,,,case rate,453.9,453.9,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Aetna,Aetna,238.68,,,,,,,per diem,238.68,238.68,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Aetna MGG,Aetna MGG,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,BCBS,BCBS,238.68,,,,,,,per diem,238.68,238.68,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,BCBS MGG,BCBS MGG,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Cigna,Cigna,238.68,,,,,,,per diem,238.68,238.68,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Cigna MGG,Cigna MGG,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Humana,Humana,238.68,,,,,,,per diem,238.68,238.68,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Humana MGG,Humana MGG,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Optum VA,Optum VA,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,UHC,UHC,238.68,,,,,,,per diem,238.68,238.68,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,UHC MGG,UHC MGG,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,VA,VA,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Wellcare MGG,Wellcare MGG,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Bright Health - commercial,Bright Health - commercial,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,95887,CPT,,,,Inpatient,,,238.68,238.68,Bright Health MGG,Bright Health MGG,238.68,,,,,,,case rate,238.68,238.68,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Aetna,Aetna,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Aetna MGG,Aetna MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,BCBS,BCBS,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,BCBS MGG,BCBS MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Cigna,Cigna,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Cigna MGG,Cigna MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Humana,Humana,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Humana MGG,Humana MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Optum VA,Optum VA,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,UHC,UHC,285.6,,,,,,,per diem,285.6,285.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,UHC MGG,UHC MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,VA,VA,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Wellcare MGG,Wellcare MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Bright Health - commercial,Bright Health - commercial,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,95860,CPT,,,,Inpatient,,,285.6,285.6,Bright Health MGG,Bright Health MGG,285.6,,,,,,,case rate,285.6,285.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Aetna,Aetna,462.06,,,,,,,per diem,462.06,462.06,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Aetna MGG,Aetna MGG,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,BCBS,BCBS,462.06,,,,,,,per diem,462.06,462.06,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,BCBS MGG,BCBS MGG,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Cigna,Cigna,462.06,,,,,,,per diem,462.06,462.06,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Cigna MGG,Cigna MGG,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Humana,Humana,462.06,,,,,,,per diem,462.06,462.06,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Humana MGG,Humana MGG,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Optum VA,Optum VA,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,UHC,UHC,462.06,,,,,,,per diem,462.06,462.06,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,UHC MGG,UHC MGG,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,VA,VA,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Wellcare MGG,Wellcare MGG,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Bright Health - commercial,Bright Health - commercial,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,95861,CPT,,,,Inpatient,,,462.06,462.06,Bright Health MGG,Bright Health MGG,462.06,,,,,,,case rate,462.06,462.06,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Aetna,Aetna,534.48,,,,,,,per diem,534.48,534.48,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Aetna MGG,Aetna MGG,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,BCBS,BCBS,534.48,,,,,,,per diem,534.48,534.48,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,BCBS MGG,BCBS MGG,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Cigna,Cigna,534.48,,,,,,,per diem,534.48,534.48,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Cigna MGG,Cigna MGG,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Humana,Humana,534.48,,,,,,,per diem,534.48,534.48,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Humana MGG,Humana MGG,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Optum VA,Optum VA,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,UHC,UHC,534.48,,,,,,,per diem,534.48,534.48,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,UHC MGG,UHC MGG,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,VA,VA,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Wellcare MGG,Wellcare MGG,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Bright Health - commercial,Bright Health - commercial,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,95863,CPT,,,,Inpatient,,,534.48,534.48,Bright Health MGG,Bright Health MGG,534.48,,,,,,,case rate,534.48,534.48,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Aetna,Aetna,784.38,,,,,,,per diem,784.38,784.38,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Aetna MGG,Aetna MGG,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,BCBS,BCBS,784.38,,,,,,,per diem,784.38,784.38,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,BCBS MGG,BCBS MGG,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Cigna,Cigna,784.38,,,,,,,per diem,784.38,784.38,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Cigna MGG,Cigna MGG,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Humana,Humana,784.38,,,,,,,per diem,784.38,784.38,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Humana MGG,Humana MGG,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Optum VA,Optum VA,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,UHC,UHC,784.38,,,,,,,per diem,784.38,784.38,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,UHC MGG,UHC MGG,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,VA,VA,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Wellcare MGG,Wellcare MGG,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Bright Health - commercial,Bright Health - commercial,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,95864,CPT,,,,Inpatient,,,784.38,784.38,Bright Health MGG,Bright Health MGG,784.38,,,,,,,case rate,784.38,784.38,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Aetna,Aetna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Aetna MGG,Aetna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,BCBS,BCBS,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,BCBS MGG,BCBS MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Cigna,Cigna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Cigna MGG,Cigna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Humana,Humana,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Humana MGG,Humana MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Optum VA,Optum VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,UHC,UHC,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,UHC MGG,UHC MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,VA,VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Wellcare MGG,Wellcare MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Bright Health - commercial,Bright Health - commercial,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,95907,CPT,,,,Inpatient,,,233.58,233.58,Bright Health MGG,Bright Health MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Aetna,Aetna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Aetna MGG,Aetna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,BCBS,BCBS,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,BCBS MGG,BCBS MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Cigna,Cigna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Cigna MGG,Cigna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Humana,Humana,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Humana MGG,Humana MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Optum VA,Optum VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,UHC,UHC,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,UHC MGG,UHC MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,VA,VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Wellcare MGG,Wellcare MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Bright Health - commercial,Bright Health - commercial,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,95908,CPT,,,,Inpatient,,,233.58,233.58,Bright Health MGG,Bright Health MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Aetna,Aetna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Aetna MGG,Aetna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,BCBS,BCBS,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,BCBS MGG,BCBS MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Cigna,Cigna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Cigna MGG,Cigna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Humana,Humana,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Humana MGG,Humana MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Optum VA,Optum VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,UHC,UHC,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,UHC MGG,UHC MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,VA,VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Wellcare MGG,Wellcare MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Bright Health - commercial,Bright Health - commercial,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,95909,CPT,,,,Inpatient,,,233.58,233.58,Bright Health MGG,Bright Health MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Aetna,Aetna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Aetna MGG,Aetna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,BCBS,BCBS,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,BCBS MGG,BCBS MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Cigna,Cigna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Cigna MGG,Cigna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Humana,Humana,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Humana MGG,Humana MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Optum VA,Optum VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,UHC,UHC,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,UHC MGG,UHC MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,VA,VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Wellcare MGG,Wellcare MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Bright Health - commercial,Bright Health - commercial,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,95910,CPT,,,,Inpatient,,,233.58,233.58,Bright Health MGG,Bright Health MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Aetna,Aetna,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Aetna MGG,Aetna MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,BCBS,BCBS,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,BCBS MGG,BCBS MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Cigna,Cigna,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Cigna MGG,Cigna MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Humana,Humana,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Humana MGG,Humana MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Optum VA,Optum VA,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,UHC,UHC,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,UHC MGG,UHC MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,VA,VA,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Wellcare MGG,Wellcare MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Bright Health - commercial,Bright Health - commercial,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,95913,CPT,,,,Inpatient,,,431.46,431.46,Bright Health MGG,Bright Health MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Aetna,Aetna,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Aetna MGG,Aetna MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,BCBS,BCBS,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,BCBS MGG,BCBS MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Cigna,Cigna,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Cigna MGG,Cigna MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Humana,Humana,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Humana MGG,Humana MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Optum VA,Optum VA,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,UHC,UHC,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,UHC MGG,UHC MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,VA,VA,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Wellcare MGG,Wellcare MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Bright Health - commercial,Bright Health - commercial,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,95912,CPT,,,,Inpatient,,,431.46,431.46,Bright Health MGG,Bright Health MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Aetna,Aetna,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Aetna MGG,Aetna MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,BCBS,BCBS,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,BCBS MGG,BCBS MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Cigna,Cigna,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Cigna MGG,Cigna MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Humana,Humana,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Humana MGG,Humana MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Optum VA,Optum VA,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,UHC,UHC,431.46,,,,,,,per diem,431.46,431.46,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,UHC MGG,UHC MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,VA,VA,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Wellcare MGG,Wellcare MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Bright Health - commercial,Bright Health - commercial,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,95911,CPT,,,,Inpatient,,,431.46,431.46,Bright Health MGG,Bright Health MGG,431.46,,,,,,,case rate,431.46,431.46,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Aetna,Aetna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Aetna MGG,Aetna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,BCBS,BCBS,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,BCBS MGG,BCBS MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Cigna,Cigna,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Cigna MGG,Cigna MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Humana,Humana,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Humana MGG,Humana MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Optum VA,Optum VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,UHC,UHC,180.54,,,,,,,per diem,180.54,180.54,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,UHC MGG,UHC MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,VA,VA,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Wellcare MGG,Wellcare MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Bright Health - commercial,Bright Health - commercial,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,95937,CPT,,,,Inpatient,,,180.54,180.54,Bright Health MGG,Bright Health MGG,180.54,,,,,,,case rate,180.54,180.54,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Aetna,Aetna,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Aetna MGG,Aetna MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,BCBS,BCBS,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,BCBS MGG,BCBS MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Cigna,Cigna,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Cigna MGG,Cigna MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Humana,Humana,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Humana MGG,Humana MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Optum VA,Optum VA,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,UHC,UHC,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,UHC MGG,UHC MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,VA,VA,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Wellcare MGG,Wellcare MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Bright Health - commercial,Bright Health - commercial,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,93315,CPT,,,,Inpatient,,,714,714,Bright Health MGG,Bright Health MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Aetna,Aetna,4149.36,,,,,,,per diem,4149.36,4149.36,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Aetna MGG,Aetna MGG,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,BCBS,BCBS,4149.36,,,,,,,per diem,4149.36,4149.36,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,BCBS MGG,BCBS MGG,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Cigna,Cigna,4149.36,,,,,,,per diem,4149.36,4149.36,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Cigna MGG,Cigna MGG,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Humana,Humana,4149.36,,,,,,,per diem,4149.36,4149.36,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Humana MGG,Humana MGG,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Optum VA,Optum VA,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,UHC,UHC,4149.36,,,,,,,per diem,4149.36,4149.36,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,UHC MGG,UHC MGG,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,VA,VA,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Wellcare MGG,Wellcare MGG,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Bright Health - commercial,Bright Health - commercial,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,95811,CPT,,,,Inpatient,,,4149.36,4149.36,Bright Health MGG,Bright Health MGG,4149.36,,,,,,,case rate,4149.36,4149.36,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Aetna,Aetna,3942.3,,,,,,,per diem,3942.3,3942.3,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Aetna MGG,Aetna MGG,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,BCBS,BCBS,3942.3,,,,,,,per diem,3942.3,3942.3,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,BCBS MGG,BCBS MGG,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Cigna,Cigna,3942.3,,,,,,,per diem,3942.3,3942.3,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Cigna MGG,Cigna MGG,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Humana,Humana,3942.3,,,,,,,per diem,3942.3,3942.3,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Humana MGG,Humana MGG,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Optum VA,Optum VA,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,UHC,UHC,3942.3,,,,,,,per diem,3942.3,3942.3,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,UHC MGG,UHC MGG,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,VA,VA,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Wellcare MGG,Wellcare MGG,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Bright Health - commercial,Bright Health - commercial,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,95810,CPT,,,,Inpatient,,,3942.3,3942.3,Bright Health MGG,Bright Health MGG,3942.3,,,,,,,case rate,3942.3,3942.3,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Aetna,Aetna,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Aetna MGG,Aetna MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,BCBS,BCBS,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,BCBS MGG,BCBS MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Cigna,Cigna,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Cigna MGG,Cigna MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Humana,Humana,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Humana MGG,Humana MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Optum VA,Optum VA,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,UHC,UHC,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,UHC MGG,UHC MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,VA,VA,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Wellcare MGG,Wellcare MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Bright Health - commercial,Bright Health - commercial,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,95926,CPT,,,,Inpatient,,,1028.16,1028.16,Bright Health MGG,Bright Health MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Aetna,Aetna,1775.82,,,,,,,per diem,1775.82,1775.82,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Aetna MGG,Aetna MGG,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,BCBS,BCBS,1775.82,,,,,,,per diem,1775.82,1775.82,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,BCBS MGG,BCBS MGG,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Cigna,Cigna,1775.82,,,,,,,per diem,1775.82,1775.82,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Cigna MGG,Cigna MGG,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Humana,Humana,1775.82,,,,,,,per diem,1775.82,1775.82,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Humana MGG,Humana MGG,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Optum VA,Optum VA,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,UHC,UHC,1775.82,,,,,,,per diem,1775.82,1775.82,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,UHC MGG,UHC MGG,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,VA,VA,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Wellcare MGG,Wellcare MGG,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Bright Health - commercial,Bright Health - commercial,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,93315,CPT,,,,Inpatient,,,1775.82,1775.82,Bright Health MGG,Bright Health MGG,1775.82,,,,,,,case rate,1775.82,1775.82,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Aetna,Aetna,1091.4,,,,,,,per diem,1091.4,1091.4,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Aetna MGG,Aetna MGG,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,BCBS,BCBS,1091.4,,,,,,,per diem,1091.4,1091.4,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,BCBS MGG,BCBS MGG,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Cigna,Cigna,1091.4,,,,,,,per diem,1091.4,1091.4,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Cigna MGG,Cigna MGG,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Humana,Humana,1091.4,,,,,,,per diem,1091.4,1091.4,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Humana MGG,Humana MGG,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Optum VA,Optum VA,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,UHC,UHC,1091.4,,,,,,,per diem,1091.4,1091.4,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,UHC MGG,UHC MGG,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,VA,VA,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Wellcare MGG,Wellcare MGG,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Bright Health - commercial,Bright Health - commercial,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,95930,CPT,,,,Inpatient,,,1091.4,1091.4,Bright Health MGG,Bright Health MGG,1091.4,,,,,,,case rate,1091.4,1091.4,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Aetna,Aetna,2664.05,,,,,,,per diem,2664.05,2664.05,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Aetna MGG,Aetna MGG,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,BCBS,BCBS,2664.05,,,,,,,per diem,2664.05,2664.05,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,BCBS MGG,BCBS MGG,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Cigna,Cigna,2664.05,,,,,,,per diem,2664.05,2664.05,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Cigna MGG,Cigna MGG,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Humana,Humana,2664.05,,,,,,,per diem,2664.05,2664.05,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Humana MGG,Humana MGG,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Optum VA,Optum VA,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,UHC,UHC,2664.05,,,,,,,per diem,2664.05,2664.05,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,UHC MGG,UHC MGG,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,VA,VA,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Wellcare MGG,Wellcare MGG,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Bright Health - commercial,Bright Health - commercial,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,C8921,CPT,,,,Inpatient,,,2664.05,2664.05,Bright Health MGG,Bright Health MGG,2664.05,,,,,,,case rate,2664.05,2664.05,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Aetna,Aetna,2910.06,,,,,,,per diem,2910.06,2910.06,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Aetna MGG,Aetna MGG,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,BCBS,BCBS,2910.06,,,,,,,per diem,2910.06,2910.06,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,BCBS MGG,BCBS MGG,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Cigna,Cigna,2910.06,,,,,,,per diem,2910.06,2910.06,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Cigna MGG,Cigna MGG,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Humana,Humana,2910.06,,,,,,,per diem,2910.06,2910.06,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Humana MGG,Humana MGG,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Optum VA,Optum VA,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,UHC,UHC,2910.06,,,,,,,per diem,2910.06,2910.06,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,UHC MGG,UHC MGG,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,VA,VA,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Wellcare MGG,Wellcare MGG,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Bright Health - commercial,Bright Health - commercial,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,C8922,CPT,,,,Inpatient,,,2910.06,2910.06,Bright Health MGG,Bright Health MGG,2910.06,,,,,,,case rate,2910.06,2910.06,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Aetna,Aetna,1181.16,,,,,,,per diem,1181.16,1181.16,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Aetna MGG,Aetna MGG,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,BCBS,BCBS,1181.16,,,,,,,per diem,1181.16,1181.16,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,BCBS MGG,BCBS MGG,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Cigna,Cigna,1181.16,,,,,,,per diem,1181.16,1181.16,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Cigna MGG,Cigna MGG,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Humana,Humana,1181.16,,,,,,,per diem,1181.16,1181.16,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Humana MGG,Humana MGG,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Optum VA,Optum VA,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,UHC,UHC,1181.16,,,,,,,per diem,1181.16,1181.16,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,UHC MGG,UHC MGG,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,VA,VA,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Wellcare MGG,Wellcare MGG,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Bright Health - commercial,Bright Health - commercial,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,C8923,CPT,,,,Inpatient,,,1181.16,1181.16,Bright Health MGG,Bright Health MGG,1181.16,,,,,,,case rate,1181.16,1181.16,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Aetna,Aetna,1036.32,,,,,,,per diem,1036.32,1036.32,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Aetna MGG,Aetna MGG,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,BCBS,BCBS,1036.32,,,,,,,per diem,1036.32,1036.32,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,BCBS MGG,BCBS MGG,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Cigna,Cigna,1036.32,,,,,,,per diem,1036.32,1036.32,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Cigna MGG,Cigna MGG,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Humana,Humana,1036.32,,,,,,,per diem,1036.32,1036.32,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Humana MGG,Humana MGG,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Optum VA,Optum VA,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,UHC,UHC,1036.32,,,,,,,per diem,1036.32,1036.32,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,UHC MGG,UHC MGG,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,VA,VA,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Wellcare MGG,Wellcare MGG,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Bright Health - commercial,Bright Health - commercial,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,C8924,CPT,,,,Inpatient,,,1036.32,1036.32,Bright Health MGG,Bright Health MGG,1036.32,,,,,,,case rate,1036.32,1036.32,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Aetna,Aetna,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Aetna MGG,Aetna MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,BCBS,BCBS,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,BCBS MGG,BCBS MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Cigna,Cigna,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Cigna MGG,Cigna MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Humana,Humana,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Humana MGG,Humana MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Optum VA,Optum VA,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,UHC,UHC,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,UHC MGG,UHC MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,VA,VA,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Wellcare MGG,Wellcare MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Bright Health - commercial,Bright Health - commercial,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,C8928,CPT,,,,Inpatient,,,1803.36,1803.36,Bright Health MGG,Bright Health MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Aetna,Aetna,2641.08,,,,,,,per diem,2641.08,2641.08,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Aetna MGG,Aetna MGG,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,BCBS,BCBS,2641.08,,,,,,,per diem,2641.08,2641.08,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,BCBS MGG,BCBS MGG,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Cigna,Cigna,2641.08,,,,,,,per diem,2641.08,2641.08,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Cigna MGG,Cigna MGG,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Humana,Humana,2641.08,,,,,,,per diem,2641.08,2641.08,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Humana MGG,Humana MGG,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Optum VA,Optum VA,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,UHC,UHC,2641.08,,,,,,,per diem,2641.08,2641.08,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,UHC MGG,UHC MGG,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,VA,VA,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Wellcare MGG,Wellcare MGG,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Bright Health - commercial,Bright Health - commercial,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2641.08,2641.08,Bright Health MGG,Bright Health MGG,2641.08,,,,,,,case rate,2641.08,2641.08,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Aetna,Aetna,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Aetna MGG,Aetna MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,BCBS,BCBS,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,BCBS MGG,BCBS MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Cigna,Cigna,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Cigna MGG,Cigna MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Humana,Humana,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Humana MGG,Humana MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Optum VA,Optum VA,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,UHC,UHC,1803.36,,,,,,,per diem,1803.36,1803.36,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,UHC MGG,UHC MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,VA,VA,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Wellcare MGG,Wellcare MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Bright Health - commercial,Bright Health - commercial,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,C8930,CPT,,,,Inpatient,,,1803.36,1803.36,Bright Health MGG,Bright Health MGG,1803.36,,,,,,,case rate,1803.36,1803.36,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Aetna,Aetna,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Aetna MGG,Aetna MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,BCBS,BCBS,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,BCBS MGG,BCBS MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Cigna,Cigna,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Cigna MGG,Cigna MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Humana,Humana,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Humana MGG,Humana MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Optum VA,Optum VA,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,UHC,UHC,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,UHC MGG,UHC MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,VA,VA,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Wellcare MGG,Wellcare MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Bright Health - commercial,Bright Health - commercial,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1138.32,1138.32,Bright Health MGG,Bright Health MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Aetna,Aetna,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Aetna MGG,Aetna MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,BCBS,BCBS,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,BCBS MGG,BCBS MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Cigna,Cigna,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Cigna MGG,Cigna MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Humana,Humana,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Humana MGG,Humana MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Optum VA,Optum VA,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,UHC,UHC,714,,,,,,,per diem,714,714,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,UHC MGG,UHC MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,VA,VA,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Wellcare MGG,Wellcare MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Bright Health - commercial,Bright Health - commercial,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,93313,CPT,,,,Inpatient,,,714,714,Bright Health MGG,Bright Health MGG,714,,,,,,,case rate,714,714,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Aetna,Aetna,255,,,,,,,per diem,255,255,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Aetna MGG,Aetna MGG,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,BCBS,BCBS,255,,,,,,,per diem,255,255,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,BCBS MGG,BCBS MGG,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Cigna,Cigna,255,,,,,,,per diem,255,255,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Cigna MGG,Cigna MGG,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Humana,Humana,255,,,,,,,per diem,255,255,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Humana MGG,Humana MGG,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Optum VA,Optum VA,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,UHC,UHC,255,,,,,,,per diem,255,255,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,UHC MGG,UHC MGG,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,VA,VA,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Wellcare MGG,Wellcare MGG,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Bright Health - commercial,Bright Health - commercial,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,93321,CPT,,,,Inpatient,,,255,255,Bright Health MGG,Bright Health MGG,255,,,,,,,case rate,255,255,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Aetna,Aetna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Aetna MGG,Aetna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,BCBS,BCBS,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,BCBS MGG,BCBS MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Cigna,Cigna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Cigna MGG,Cigna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Humana,Humana,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Humana MGG,Humana MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Optum VA,Optum VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,UHC,UHC,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,UHC MGG,UHC MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,VA,VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Wellcare MGG,Wellcare MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Bright Health - commercial,Bright Health - commercial,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Bright Health MGG,Bright Health MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Aetna,Aetna,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Aetna MGG,Aetna MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,BCBS,BCBS,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,BCBS MGG,BCBS MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Cigna,Cigna,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Cigna MGG,Cigna MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Humana,Humana,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Humana MGG,Humana MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Optum VA,Optum VA,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,UHC,UHC,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,UHC MGG,UHC MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,VA,VA,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Wellcare MGG,Wellcare MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Bright Health - commercial,Bright Health - commercial,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,0399T,CPT,,,,Inpatient,,,792.54,792.54,Bright Health MGG,Bright Health MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Aetna,Aetna,5681.4,,,,,,,per diem,5681.4,5681.4,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Aetna MGG,Aetna MGG,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,BCBS,BCBS,5681.4,,,,,,,per diem,5681.4,5681.4,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,BCBS MGG,BCBS MGG,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Cigna,Cigna,5681.4,,,,,,,per diem,5681.4,5681.4,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Cigna MGG,Cigna MGG,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Humana,Humana,5681.4,,,,,,,per diem,5681.4,5681.4,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Humana MGG,Humana MGG,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Optum VA,Optum VA,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,UHC,UHC,5681.4,,,,,,,per diem,5681.4,5681.4,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,UHC MGG,UHC MGG,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,VA,VA,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Wellcare MGG,Wellcare MGG,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Bright Health - commercial,Bright Health - commercial,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,82000,CPT,,,79,Inpatient,,,5681.4,5681.4,Bright Health MGG,Bright Health MGG,5681.4,,,,,,,case rate,5681.4,5681.4,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Aetna,Aetna,385.56,,,,,,,per diem,385.56,385.56,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Aetna MGG,Aetna MGG,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,BCBS,BCBS,385.56,,,,,,,per diem,385.56,385.56,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,BCBS MGG,BCBS MGG,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Cigna,Cigna,385.56,,,,,,,per diem,385.56,385.56,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Cigna MGG,Cigna MGG,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Humana,Humana,385.56,,,,,,,per diem,385.56,385.56,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Humana MGG,Humana MGG,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Optum VA,Optum VA,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,UHC,UHC,385.56,,,,,,,per diem,385.56,385.56,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,UHC MGG,UHC MGG,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,VA,VA,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Wellcare MGG,Wellcare MGG,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Bright Health - commercial,Bright Health - commercial,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,82000,CPT,,,23,Inpatient,,,385.56,385.56,Bright Health MGG,Bright Health MGG,385.56,,,,,,,case rate,385.56,385.56,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Aetna,Aetna,1.58,,,,,,,per diem,1.58,1.58,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Aetna MGG,Aetna MGG,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,BCBS,BCBS,1.58,,,,,,,per diem,1.58,1.58,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,BCBS MGG,BCBS MGG,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Cigna,Cigna,1.58,,,,,,,per diem,1.58,1.58,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Cigna MGG,Cigna MGG,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Humana,Humana,1.58,,,,,,,per diem,1.58,1.58,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Humana MGG,Humana MGG,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Optum VA,Optum VA,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,UHC,UHC,1.58,,,,,,,per diem,1.58,1.58,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,UHC MGG,UHC MGG,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,VA,VA,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Wellcare MGG,Wellcare MGG,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Bright Health - commercial,Bright Health - commercial,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.58,1.58,Bright Health MGG,Bright Health MGG,1.58,,,,,,,case rate,1.58,1.58,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Aetna,Aetna,46.22,,,,,,,per diem,46.22,46.22,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Aetna MGG,Aetna MGG,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,BCBS,BCBS,46.22,,,,,,,per diem,46.22,46.22,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,BCBS MGG,BCBS MGG,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Cigna,Cigna,46.22,,,,,,,per diem,46.22,46.22,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Cigna MGG,Cigna MGG,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Humana,Humana,46.22,,,,,,,per diem,46.22,46.22,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Humana MGG,Humana MGG,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Optum VA,Optum VA,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,UHC,UHC,46.22,,,,,,,per diem,46.22,46.22,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,UHC MGG,UHC MGG,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,VA,VA,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Wellcare MGG,Wellcare MGG,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Bright Health - commercial,Bright Health - commercial,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.22,46.22,Bright Health MGG,Bright Health MGG,46.22,,,,,,,case rate,46.22,46.22,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Aetna,Aetna,1.15,,,,,,,per diem,1.15,1.15,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Aetna MGG,Aetna MGG,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,BCBS,BCBS,1.15,,,,,,,per diem,1.15,1.15,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,BCBS MGG,BCBS MGG,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Cigna,Cigna,1.15,,,,,,,per diem,1.15,1.15,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Cigna MGG,Cigna MGG,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Humana,Humana,1.15,,,,,,,per diem,1.15,1.15,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Humana MGG,Humana MGG,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Optum VA,Optum VA,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,UHC,UHC,1.15,,,,,,,per diem,1.15,1.15,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,UHC MGG,UHC MGG,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,VA,VA,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Wellcare MGG,Wellcare MGG,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Bright Health - commercial,Bright Health - commercial,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,,,,,,Inpatient,,,1.15,1.15,Bright Health MGG,Bright Health MGG,1.15,,,,,,,case rate,1.15,1.15,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Aetna,Aetna,1.67,,,,,,,per diem,1.67,1.67,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Aetna MGG,Aetna MGG,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,BCBS,BCBS,1.67,,,,,,,per diem,1.67,1.67,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,BCBS MGG,BCBS MGG,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Cigna,Cigna,1.67,,,,,,,per diem,1.67,1.67,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Cigna MGG,Cigna MGG,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Humana,Humana,1.67,,,,,,,per diem,1.67,1.67,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Humana MGG,Humana MGG,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Optum VA,Optum VA,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,UHC,UHC,1.67,,,,,,,per diem,1.67,1.67,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,UHC MGG,UHC MGG,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,VA,VA,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Wellcare MGG,Wellcare MGG,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Bright Health - commercial,Bright Health - commercial,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.67,1.67,Bright Health MGG,Bright Health MGG,1.67,,,,,,,case rate,1.67,1.67,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Aetna,Aetna,275.9,,,,,,,per diem,275.9,275.9,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Aetna MGG,Aetna MGG,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,BCBS,BCBS,275.9,,,,,,,per diem,275.9,275.9,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,BCBS MGG,BCBS MGG,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Cigna,Cigna,275.9,,,,,,,per diem,275.9,275.9,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Cigna MGG,Cigna MGG,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Humana,Humana,275.9,,,,,,,per diem,275.9,275.9,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Humana MGG,Humana MGG,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Optum VA,Optum VA,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,UHC,UHC,275.9,,,,,,,per diem,275.9,275.9,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,UHC MGG,UHC MGG,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,VA,VA,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Wellcare MGG,Wellcare MGG,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Bright Health - commercial,Bright Health - commercial,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,275.9,275.9,Bright Health MGG,Bright Health MGG,275.9,,,,,,,case rate,275.9,275.9,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Aetna,Aetna,641.44,,,,,,,per diem,641.44,641.44,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Aetna MGG,Aetna MGG,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,BCBS,BCBS,641.44,,,,,,,per diem,641.44,641.44,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,BCBS MGG,BCBS MGG,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Cigna,Cigna,641.44,,,,,,,per diem,641.44,641.44,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Cigna MGG,Cigna MGG,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Humana,Humana,641.44,,,,,,,per diem,641.44,641.44,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Humana MGG,Humana MGG,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Optum VA,Optum VA,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,UHC,UHC,641.44,,,,,,,per diem,641.44,641.44,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,UHC MGG,UHC MGG,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,VA,VA,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Wellcare MGG,Wellcare MGG,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Bright Health - commercial,Bright Health - commercial,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,641.44,641.44,Bright Health MGG,Bright Health MGG,641.44,,,,,,,case rate,641.44,641.44,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Aetna,Aetna,303.66,,,,,,,per diem,303.66,303.66,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Aetna MGG,Aetna MGG,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,BCBS,BCBS,303.66,,,,,,,per diem,303.66,303.66,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,BCBS MGG,BCBS MGG,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Cigna,Cigna,303.66,,,,,,,per diem,303.66,303.66,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Cigna MGG,Cigna MGG,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Humana,Humana,303.66,,,,,,,per diem,303.66,303.66,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Humana MGG,Humana MGG,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Optum VA,Optum VA,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,UHC,UHC,303.66,,,,,,,per diem,303.66,303.66,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,UHC MGG,UHC MGG,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,VA,VA,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Wellcare MGG,Wellcare MGG,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Bright Health - commercial,Bright Health - commercial,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,,,,,,Inpatient,,,303.66,303.66,Bright Health MGG,Bright Health MGG,303.66,,,,,,,case rate,303.66,303.66,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Aetna,Aetna,327.5,,,,,,,per diem,327.5,327.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Aetna MGG,Aetna MGG,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,BCBS,BCBS,327.5,,,,,,,per diem,327.5,327.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,BCBS MGG,BCBS MGG,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Cigna,Cigna,327.5,,,,,,,per diem,327.5,327.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Cigna MGG,Cigna MGG,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Humana,Humana,327.5,,,,,,,per diem,327.5,327.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Humana MGG,Humana MGG,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Optum VA,Optum VA,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,UHC,UHC,327.5,,,,,,,per diem,327.5,327.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,UHC MGG,UHC MGG,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,VA,VA,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Wellcare MGG,Wellcare MGG,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Bright Health - commercial,Bright Health - commercial,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,327.5,327.5,Bright Health MGG,Bright Health MGG,327.5,,,,,,,case rate,327.5,327.5,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Aetna,Aetna,362.8,,,,,,,per diem,362.8,362.8,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Aetna MGG,Aetna MGG,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,BCBS,BCBS,362.8,,,,,,,per diem,362.8,362.8,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,BCBS MGG,BCBS MGG,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Cigna,Cigna,362.8,,,,,,,per diem,362.8,362.8,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Cigna MGG,Cigna MGG,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Humana,Humana,362.8,,,,,,,per diem,362.8,362.8,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Humana MGG,Humana MGG,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Optum VA,Optum VA,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,UHC,UHC,362.8,,,,,,,per diem,362.8,362.8,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,UHC MGG,UHC MGG,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,VA,VA,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Wellcare MGG,Wellcare MGG,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Bright Health - commercial,Bright Health - commercial,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,362.8,362.8,Bright Health MGG,Bright Health MGG,362.8,,,,,,,case rate,362.8,362.8,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Aetna,Aetna,304,,,,,,,per diem,304,304,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Aetna MGG,Aetna MGG,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,BCBS,BCBS,304,,,,,,,per diem,304,304,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,BCBS MGG,BCBS MGG,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Cigna,Cigna,304,,,,,,,per diem,304,304,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Cigna MGG,Cigna MGG,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Humana,Humana,304,,,,,,,per diem,304,304,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Humana MGG,Humana MGG,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Optum VA,Optum VA,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,UHC,UHC,304,,,,,,,per diem,304,304,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,UHC MGG,UHC MGG,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,VA,VA,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Wellcare MGG,Wellcare MGG,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Bright Health - commercial,Bright Health - commercial,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,304,304,Bright Health MGG,Bright Health MGG,304,,,,,,,case rate,304,304,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Aetna,Aetna,341.4,,,,,,,per diem,341.4,341.4,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Aetna MGG,Aetna MGG,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,BCBS,BCBS,341.4,,,,,,,per diem,341.4,341.4,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,BCBS MGG,BCBS MGG,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Cigna,Cigna,341.4,,,,,,,per diem,341.4,341.4,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Cigna MGG,Cigna MGG,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Humana,Humana,341.4,,,,,,,per diem,341.4,341.4,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Humana MGG,Humana MGG,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Optum VA,Optum VA,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,UHC,UHC,341.4,,,,,,,per diem,341.4,341.4,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,UHC MGG,UHC MGG,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,VA,VA,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Wellcare MGG,Wellcare MGG,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Bright Health - commercial,Bright Health - commercial,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,341.4,341.4,Bright Health MGG,Bright Health MGG,341.4,,,,,,,case rate,341.4,341.4,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Aetna,Aetna,328.17,,,,,,,per diem,328.17,328.17,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Aetna MGG,Aetna MGG,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,BCBS,BCBS,328.17,,,,,,,per diem,328.17,328.17,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,BCBS MGG,BCBS MGG,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Cigna,Cigna,328.17,,,,,,,per diem,328.17,328.17,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Cigna MGG,Cigna MGG,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Humana,Humana,328.17,,,,,,,per diem,328.17,328.17,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Humana MGG,Humana MGG,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Optum VA,Optum VA,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,UHC,UHC,328.17,,,,,,,per diem,328.17,328.17,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,UHC MGG,UHC MGG,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,VA,VA,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Wellcare MGG,Wellcare MGG,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Bright Health - commercial,Bright Health - commercial,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,328.17,328.17,Bright Health MGG,Bright Health MGG,328.17,,,,,,,case rate,328.17,328.17,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Aetna,Aetna,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Aetna MGG,Aetna MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,BCBS,BCBS,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,BCBS MGG,BCBS MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Cigna,Cigna,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Cigna MGG,Cigna MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Humana,Humana,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Humana MGG,Humana MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Optum VA,Optum VA,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,UHC,UHC,1028.16,,,,,,,per diem,1028.16,1028.16,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,UHC MGG,UHC MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,VA,VA,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Wellcare MGG,Wellcare MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Bright Health - commercial,Bright Health - commercial,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1028.16,1028.16,Bright Health MGG,Bright Health MGG,1028.16,,,,,,,case rate,1028.16,1028.16,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Aetna,Aetna,460,,,,,,,per diem,460,460,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Aetna MGG,Aetna MGG,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,BCBS,BCBS,460,,,,,,,per diem,460,460,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,BCBS MGG,BCBS MGG,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Cigna,Cigna,460,,,,,,,per diem,460,460,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Cigna MGG,Cigna MGG,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Humana,Humana,460,,,,,,,per diem,460,460,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Humana MGG,Humana MGG,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Optum VA,Optum VA,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,UHC,UHC,460,,,,,,,per diem,460,460,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,UHC MGG,UHC MGG,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,VA,VA,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Wellcare MGG,Wellcare MGG,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Bright Health - commercial,Bright Health - commercial,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,,,,,,Inpatient,,,460,460,Bright Health MGG,Bright Health MGG,460,,,,,,,case rate,460,460,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Aetna,Aetna,165.6,,,,,,,per diem,165.6,165.6,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Aetna MGG,Aetna MGG,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,BCBS,BCBS,165.6,,,,,,,per diem,165.6,165.6,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,BCBS MGG,BCBS MGG,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Cigna,Cigna,165.6,,,,,,,per diem,165.6,165.6,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Cigna MGG,Cigna MGG,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Humana,Humana,165.6,,,,,,,per diem,165.6,165.6,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Humana MGG,Humana MGG,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Optum VA,Optum VA,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,UHC,UHC,165.6,,,,,,,per diem,165.6,165.6,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,UHC MGG,UHC MGG,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,VA,VA,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Wellcare MGG,Wellcare MGG,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Bright Health - commercial,Bright Health - commercial,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,,,,,,Inpatient,,,165.6,165.6,Bright Health MGG,Bright Health MGG,165.6,,,,,,,case rate,165.6,165.6,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Aetna,Aetna,441.14,,,,,,,per diem,441.14,441.14,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Aetna MGG,Aetna MGG,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,BCBS,BCBS,441.14,,,,,,,per diem,441.14,441.14,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,BCBS MGG,BCBS MGG,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Cigna,Cigna,441.14,,,,,,,per diem,441.14,441.14,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Cigna MGG,Cigna MGG,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Humana,Humana,441.14,,,,,,,per diem,441.14,441.14,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Humana MGG,Humana MGG,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Optum VA,Optum VA,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,UHC,UHC,441.14,,,,,,,per diem,441.14,441.14,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,UHC MGG,UHC MGG,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,VA,VA,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Wellcare MGG,Wellcare MGG,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Bright Health - commercial,Bright Health - commercial,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,441.14,441.14,Bright Health MGG,Bright Health MGG,441.14,,,,,,,case rate,441.14,441.14,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Aetna,Aetna,507.59,,,,,,,per diem,507.59,507.59,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Aetna MGG,Aetna MGG,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,BCBS,BCBS,507.59,,,,,,,per diem,507.59,507.59,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,BCBS MGG,BCBS MGG,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Cigna,Cigna,507.59,,,,,,,per diem,507.59,507.59,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Cigna MGG,Cigna MGG,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Humana,Humana,507.59,,,,,,,per diem,507.59,507.59,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Humana MGG,Humana MGG,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Optum VA,Optum VA,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,UHC,UHC,507.59,,,,,,,per diem,507.59,507.59,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,UHC MGG,UHC MGG,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,VA,VA,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Wellcare MGG,Wellcare MGG,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Bright Health - commercial,Bright Health - commercial,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,,,,,,Inpatient,,,507.59,507.59,Bright Health MGG,Bright Health MGG,507.59,,,,,,,case rate,507.59,507.59,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Aetna,Aetna,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Aetna MGG,Aetna MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,BCBS,BCBS,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,BCBS MGG,BCBS MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Cigna,Cigna,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Cigna MGG,Cigna MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Humana,Humana,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Humana MGG,Humana MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Optum VA,Optum VA,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,UHC,UHC,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,UHC MGG,UHC MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,VA,VA,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Wellcare MGG,Wellcare MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Bright Health - commercial,Bright Health - commercial,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Bright Health MGG,Bright Health MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Aetna,Aetna,353.5,,,,,,,per diem,353.5,353.5,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Aetna MGG,Aetna MGG,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,BCBS,BCBS,353.5,,,,,,,per diem,353.5,353.5,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,BCBS MGG,BCBS MGG,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Cigna,Cigna,353.5,,,,,,,per diem,353.5,353.5,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Cigna MGG,Cigna MGG,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Humana,Humana,353.5,,,,,,,per diem,353.5,353.5,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Humana MGG,Humana MGG,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Optum VA,Optum VA,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,UHC,UHC,353.5,,,,,,,per diem,353.5,353.5,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,UHC MGG,UHC MGG,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,VA,VA,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Wellcare MGG,Wellcare MGG,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Bright Health - commercial,Bright Health - commercial,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,353.5,353.5,Bright Health MGG,Bright Health MGG,353.5,,,,,,,case rate,353.5,353.5,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Aetna,Aetna,1439.22,,,,,,,per diem,1439.22,1439.22,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Aetna MGG,Aetna MGG,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,BCBS,BCBS,1439.22,,,,,,,per diem,1439.22,1439.22,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,BCBS MGG,BCBS MGG,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Cigna,Cigna,1439.22,,,,,,,per diem,1439.22,1439.22,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Cigna MGG,Cigna MGG,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Humana,Humana,1439.22,,,,,,,per diem,1439.22,1439.22,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Humana MGG,Humana MGG,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Optum VA,Optum VA,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,UHC,UHC,1439.22,,,,,,,per diem,1439.22,1439.22,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,UHC MGG,UHC MGG,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,VA,VA,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Wellcare MGG,Wellcare MGG,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Bright Health - commercial,Bright Health - commercial,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1439.22,1439.22,Bright Health MGG,Bright Health MGG,1439.22,,,,,,,case rate,1439.22,1439.22,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Aetna,Aetna,773.51,,,,,,,per diem,773.51,773.51,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Aetna MGG,Aetna MGG,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,BCBS,BCBS,773.51,,,,,,,per diem,773.51,773.51,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,BCBS MGG,BCBS MGG,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Cigna,Cigna,773.51,,,,,,,per diem,773.51,773.51,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Cigna MGG,Cigna MGG,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Humana,Humana,773.51,,,,,,,per diem,773.51,773.51,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Humana MGG,Humana MGG,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Optum VA,Optum VA,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,UHC,UHC,773.51,,,,,,,per diem,773.51,773.51,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,UHC MGG,UHC MGG,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,VA,VA,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Wellcare MGG,Wellcare MGG,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Bright Health - commercial,Bright Health - commercial,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,773.51,773.51,Bright Health MGG,Bright Health MGG,773.51,,,,,,,case rate,773.51,773.51,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Aetna,Aetna,710.75,,,,,,,per diem,710.75,710.75,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Aetna MGG,Aetna MGG,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,BCBS,BCBS,710.75,,,,,,,per diem,710.75,710.75,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,BCBS MGG,BCBS MGG,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Cigna,Cigna,710.75,,,,,,,per diem,710.75,710.75,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Cigna MGG,Cigna MGG,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Humana,Humana,710.75,,,,,,,per diem,710.75,710.75,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Humana MGG,Humana MGG,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Optum VA,Optum VA,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,UHC,UHC,710.75,,,,,,,per diem,710.75,710.75,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,UHC MGG,UHC MGG,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,VA,VA,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Wellcare MGG,Wellcare MGG,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Bright Health - commercial,Bright Health - commercial,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,710.75,710.75,Bright Health MGG,Bright Health MGG,710.75,,,,,,,case rate,710.75,710.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Aetna,Aetna,503.62,,,,,,,per diem,503.62,503.62,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Aetna MGG,Aetna MGG,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,BCBS,BCBS,503.62,,,,,,,per diem,503.62,503.62,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,BCBS MGG,BCBS MGG,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Cigna,Cigna,503.62,,,,,,,per diem,503.62,503.62,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Cigna MGG,Cigna MGG,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Humana,Humana,503.62,,,,,,,per diem,503.62,503.62,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Humana MGG,Humana MGG,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Optum VA,Optum VA,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,UHC,UHC,503.62,,,,,,,per diem,503.62,503.62,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,UHC MGG,UHC MGG,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,VA,VA,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Wellcare MGG,Wellcare MGG,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Bright Health - commercial,Bright Health - commercial,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,503.62,503.62,Bright Health MGG,Bright Health MGG,503.62,,,,,,,case rate,503.62,503.62,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Aetna,Aetna,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Aetna MGG,Aetna MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,BCBS,BCBS,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,BCBS MGG,BCBS MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Cigna,Cigna,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Cigna MGG,Cigna MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Humana,Humana,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Humana MGG,Humana MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Optum VA,Optum VA,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,UHC,UHC,222,,,,,,,per diem,222,222,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,UHC MGG,UHC MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,VA,VA,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Wellcare MGG,Wellcare MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Bright Health - commercial,Bright Health - commercial,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,222,222,Bright Health MGG,Bright Health MGG,222,,,,,,,case rate,222,222,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Aetna,Aetna,281.21,,,,,,,per diem,281.21,281.21,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Aetna MGG,Aetna MGG,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,BCBS,BCBS,281.21,,,,,,,per diem,281.21,281.21,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,BCBS MGG,BCBS MGG,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Cigna,Cigna,281.21,,,,,,,per diem,281.21,281.21,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Cigna MGG,Cigna MGG,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Humana,Humana,281.21,,,,,,,per diem,281.21,281.21,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Humana MGG,Humana MGG,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Optum VA,Optum VA,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,UHC,UHC,281.21,,,,,,,per diem,281.21,281.21,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,UHC MGG,UHC MGG,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,VA,VA,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Wellcare MGG,Wellcare MGG,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Bright Health - commercial,Bright Health - commercial,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,281.21,281.21,Bright Health MGG,Bright Health MGG,281.21,,,,,,,case rate,281.21,281.21,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Aetna,Aetna,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Aetna MGG,Aetna MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,BCBS,BCBS,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,BCBS MGG,BCBS MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Cigna,Cigna,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Cigna MGG,Cigna MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Humana,Humana,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Humana MGG,Humana MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Optum VA,Optum VA,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,UHC,UHC,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,UHC MGG,UHC MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,VA,VA,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Wellcare MGG,Wellcare MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Bright Health - commercial,Bright Health - commercial,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,365,365,Bright Health MGG,Bright Health MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Aetna,Aetna,1560,,,,,,,per diem,1560,1560,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Aetna MGG,Aetna MGG,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,BCBS,BCBS,1560,,,,,,,per diem,1560,1560,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,BCBS MGG,BCBS MGG,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Cigna,Cigna,1560,,,,,,,per diem,1560,1560,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Cigna MGG,Cigna MGG,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Humana,Humana,1560,,,,,,,per diem,1560,1560,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Humana MGG,Humana MGG,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Optum VA,Optum VA,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,UHC,UHC,1560,,,,,,,per diem,1560,1560,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,UHC MGG,UHC MGG,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,VA,VA,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Wellcare MGG,Wellcare MGG,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Bright Health - commercial,Bright Health - commercial,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,1560,1560,Bright Health MGG,Bright Health MGG,1560,,,,,,,case rate,1560,1560,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Aetna,Aetna,521.11,,,,,,,per diem,521.11,521.11,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Aetna MGG,Aetna MGG,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,BCBS,BCBS,521.11,,,,,,,per diem,521.11,521.11,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,BCBS MGG,BCBS MGG,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Cigna,Cigna,521.11,,,,,,,per diem,521.11,521.11,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Cigna MGG,Cigna MGG,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Humana,Humana,521.11,,,,,,,per diem,521.11,521.11,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Humana MGG,Humana MGG,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Optum VA,Optum VA,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,UHC,UHC,521.11,,,,,,,per diem,521.11,521.11,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,UHC MGG,UHC MGG,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,VA,VA,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Wellcare MGG,Wellcare MGG,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Bright Health - commercial,Bright Health - commercial,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,521.11,521.11,Bright Health MGG,Bright Health MGG,521.11,,,,,,,case rate,521.11,521.11,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Aetna,Aetna,317.49,,,,,,,per diem,317.49,317.49,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Aetna MGG,Aetna MGG,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,BCBS,BCBS,317.49,,,,,,,per diem,317.49,317.49,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,BCBS MGG,BCBS MGG,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Cigna,Cigna,317.49,,,,,,,per diem,317.49,317.49,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Cigna MGG,Cigna MGG,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Humana,Humana,317.49,,,,,,,per diem,317.49,317.49,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Humana MGG,Humana MGG,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Optum VA,Optum VA,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,UHC,UHC,317.49,,,,,,,per diem,317.49,317.49,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,UHC MGG,UHC MGG,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,VA,VA,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Wellcare MGG,Wellcare MGG,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Bright Health - commercial,Bright Health - commercial,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,317.49,317.49,Bright Health MGG,Bright Health MGG,317.49,,,,,,,case rate,317.49,317.49,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Aetna,Aetna,337.5,,,,,,,per diem,337.5,337.5,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Aetna MGG,Aetna MGG,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,BCBS,BCBS,337.5,,,,,,,per diem,337.5,337.5,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,BCBS MGG,BCBS MGG,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Cigna,Cigna,337.5,,,,,,,per diem,337.5,337.5,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Cigna MGG,Cigna MGG,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Humana,Humana,337.5,,,,,,,per diem,337.5,337.5,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Humana MGG,Humana MGG,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Optum VA,Optum VA,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,UHC,UHC,337.5,,,,,,,per diem,337.5,337.5,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,UHC MGG,UHC MGG,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,VA,VA,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Wellcare MGG,Wellcare MGG,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Bright Health - commercial,Bright Health - commercial,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,337.5,337.5,Bright Health MGG,Bright Health MGG,337.5,,,,,,,case rate,337.5,337.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Aetna,Aetna,196,,,,,,,per diem,196,196,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Aetna MGG,Aetna MGG,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,BCBS,BCBS,196,,,,,,,per diem,196,196,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,BCBS MGG,BCBS MGG,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Cigna,Cigna,196,,,,,,,per diem,196,196,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Cigna MGG,Cigna MGG,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Humana,Humana,196,,,,,,,per diem,196,196,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Humana MGG,Humana MGG,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Optum VA,Optum VA,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,UHC,UHC,196,,,,,,,per diem,196,196,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,UHC MGG,UHC MGG,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,VA,VA,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Wellcare MGG,Wellcare MGG,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Bright Health - commercial,Bright Health - commercial,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,196,196,Bright Health MGG,Bright Health MGG,196,,,,,,,case rate,196,196,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Aetna,Aetna,732.34,,,,,,,per diem,732.34,732.34,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Aetna MGG,Aetna MGG,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,BCBS,BCBS,732.34,,,,,,,per diem,732.34,732.34,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,BCBS MGG,BCBS MGG,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Cigna,Cigna,732.34,,,,,,,per diem,732.34,732.34,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Cigna MGG,Cigna MGG,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Humana,Humana,732.34,,,,,,,per diem,732.34,732.34,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Humana MGG,Humana MGG,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Optum VA,Optum VA,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,UHC,UHC,732.34,,,,,,,per diem,732.34,732.34,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,UHC MGG,UHC MGG,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,VA,VA,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Wellcare MGG,Wellcare MGG,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Bright Health - commercial,Bright Health - commercial,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,732.34,732.34,Bright Health MGG,Bright Health MGG,732.34,,,,,,,case rate,732.34,732.34,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Aetna,Aetna,787.49,,,,,,,per diem,787.49,787.49,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Aetna MGG,Aetna MGG,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,BCBS,BCBS,787.49,,,,,,,per diem,787.49,787.49,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,BCBS MGG,BCBS MGG,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Cigna,Cigna,787.49,,,,,,,per diem,787.49,787.49,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Cigna MGG,Cigna MGG,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Humana,Humana,787.49,,,,,,,per diem,787.49,787.49,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Humana MGG,Humana MGG,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Optum VA,Optum VA,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,UHC,UHC,787.49,,,,,,,per diem,787.49,787.49,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,UHC MGG,UHC MGG,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,VA,VA,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Wellcare MGG,Wellcare MGG,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Bright Health - commercial,Bright Health - commercial,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,787.49,787.49,Bright Health MGG,Bright Health MGG,787.49,,,,,,,case rate,787.49,787.49,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Aetna,Aetna,231.33,,,,,,,per diem,231.33,231.33,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Aetna MGG,Aetna MGG,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,BCBS,BCBS,231.33,,,,,,,per diem,231.33,231.33,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,BCBS MGG,BCBS MGG,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Cigna,Cigna,231.33,,,,,,,per diem,231.33,231.33,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Cigna MGG,Cigna MGG,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Humana,Humana,231.33,,,,,,,per diem,231.33,231.33,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Humana MGG,Humana MGG,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Optum VA,Optum VA,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,UHC,UHC,231.33,,,,,,,per diem,231.33,231.33,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,UHC MGG,UHC MGG,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,VA,VA,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Wellcare MGG,Wellcare MGG,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Bright Health - commercial,Bright Health - commercial,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,231.33,231.33,Bright Health MGG,Bright Health MGG,231.33,,,,,,,case rate,231.33,231.33,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Aetna,Aetna,298,,,,,,,per diem,298,298,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Aetna MGG,Aetna MGG,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,BCBS,BCBS,298,,,,,,,per diem,298,298,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,BCBS MGG,BCBS MGG,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Cigna,Cigna,298,,,,,,,per diem,298,298,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Cigna MGG,Cigna MGG,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Humana,Humana,298,,,,,,,per diem,298,298,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Humana MGG,Humana MGG,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Optum VA,Optum VA,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,UHC,UHC,298,,,,,,,per diem,298,298,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,UHC MGG,UHC MGG,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,VA,VA,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Wellcare MGG,Wellcare MGG,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Bright Health - commercial,Bright Health - commercial,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,298,298,Bright Health MGG,Bright Health MGG,298,,,,,,,case rate,298,298,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Aetna,Aetna,297.75,,,,,,,per diem,297.75,297.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Aetna MGG,Aetna MGG,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,BCBS,BCBS,297.75,,,,,,,per diem,297.75,297.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,BCBS MGG,BCBS MGG,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Cigna,Cigna,297.75,,,,,,,per diem,297.75,297.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Cigna MGG,Cigna MGG,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Humana,Humana,297.75,,,,,,,per diem,297.75,297.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Humana MGG,Humana MGG,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Optum VA,Optum VA,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,UHC,UHC,297.75,,,,,,,per diem,297.75,297.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,UHC MGG,UHC MGG,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,VA,VA,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Wellcare MGG,Wellcare MGG,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Bright Health - commercial,Bright Health - commercial,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,297.75,297.75,Bright Health MGG,Bright Health MGG,297.75,,,,,,,case rate,297.75,297.75,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Aetna,Aetna,736.44,,,,,,,per diem,736.44,736.44,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Aetna MGG,Aetna MGG,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,BCBS,BCBS,736.44,,,,,,,per diem,736.44,736.44,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,BCBS MGG,BCBS MGG,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Cigna,Cigna,736.44,,,,,,,per diem,736.44,736.44,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Cigna MGG,Cigna MGG,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Humana,Humana,736.44,,,,,,,per diem,736.44,736.44,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Humana MGG,Humana MGG,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Optum VA,Optum VA,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,UHC,UHC,736.44,,,,,,,per diem,736.44,736.44,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,UHC MGG,UHC MGG,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,VA,VA,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Wellcare MGG,Wellcare MGG,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Bright Health - commercial,Bright Health - commercial,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,736.44,736.44,Bright Health MGG,Bright Health MGG,736.44,,,,,,,case rate,736.44,736.44,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Aetna,Aetna,225.93,,,,,,,per diem,225.93,225.93,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Aetna MGG,Aetna MGG,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,BCBS,BCBS,225.93,,,,,,,per diem,225.93,225.93,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,BCBS MGG,BCBS MGG,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Cigna,Cigna,225.93,,,,,,,per diem,225.93,225.93,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Cigna MGG,Cigna MGG,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Humana,Humana,225.93,,,,,,,per diem,225.93,225.93,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Humana MGG,Humana MGG,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Optum VA,Optum VA,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,UHC,UHC,225.93,,,,,,,per diem,225.93,225.93,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,UHC MGG,UHC MGG,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,VA,VA,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Wellcare MGG,Wellcare MGG,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Bright Health - commercial,Bright Health - commercial,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,225.93,225.93,Bright Health MGG,Bright Health MGG,225.93,,,,,,,case rate,225.93,225.93,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Aetna,Aetna,436.2,,,,,,,per diem,436.2,436.2,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Aetna MGG,Aetna MGG,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,BCBS,BCBS,436.2,,,,,,,per diem,436.2,436.2,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,BCBS MGG,BCBS MGG,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Cigna,Cigna,436.2,,,,,,,per diem,436.2,436.2,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Cigna MGG,Cigna MGG,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Humana,Humana,436.2,,,,,,,per diem,436.2,436.2,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Humana MGG,Humana MGG,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Optum VA,Optum VA,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,UHC,UHC,436.2,,,,,,,per diem,436.2,436.2,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,UHC MGG,UHC MGG,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,VA,VA,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Wellcare MGG,Wellcare MGG,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Bright Health - commercial,Bright Health - commercial,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,436.2,436.2,Bright Health MGG,Bright Health MGG,436.2,,,,,,,case rate,436.2,436.2,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Aetna,Aetna,347.33,,,,,,,per diem,347.33,347.33,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Aetna MGG,Aetna MGG,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,BCBS,BCBS,347.33,,,,,,,per diem,347.33,347.33,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,BCBS MGG,BCBS MGG,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Cigna,Cigna,347.33,,,,,,,per diem,347.33,347.33,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Cigna MGG,Cigna MGG,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Humana,Humana,347.33,,,,,,,per diem,347.33,347.33,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Humana MGG,Humana MGG,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Optum VA,Optum VA,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,UHC,UHC,347.33,,,,,,,per diem,347.33,347.33,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,UHC MGG,UHC MGG,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,VA,VA,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Wellcare MGG,Wellcare MGG,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Bright Health - commercial,Bright Health - commercial,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,347.33,347.33,Bright Health MGG,Bright Health MGG,347.33,,,,,,,case rate,347.33,347.33,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Aetna,Aetna,242.8,,,,,,,per diem,242.8,242.8,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Aetna MGG,Aetna MGG,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,BCBS,BCBS,242.8,,,,,,,per diem,242.8,242.8,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,BCBS MGG,BCBS MGG,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Cigna,Cigna,242.8,,,,,,,per diem,242.8,242.8,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Cigna MGG,Cigna MGG,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Humana,Humana,242.8,,,,,,,per diem,242.8,242.8,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Humana MGG,Humana MGG,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Optum VA,Optum VA,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,UHC,UHC,242.8,,,,,,,per diem,242.8,242.8,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,UHC MGG,UHC MGG,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,VA,VA,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Wellcare MGG,Wellcare MGG,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Bright Health - commercial,Bright Health - commercial,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,242.8,242.8,Bright Health MGG,Bright Health MGG,242.8,,,,,,,case rate,242.8,242.8,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Aetna,Aetna,276,,,,,,,per diem,276,276,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Aetna MGG,Aetna MGG,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,BCBS,BCBS,276,,,,,,,per diem,276,276,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,BCBS MGG,BCBS MGG,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Cigna,Cigna,276,,,,,,,per diem,276,276,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Cigna MGG,Cigna MGG,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Humana,Humana,276,,,,,,,per diem,276,276,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Humana MGG,Humana MGG,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Optum VA,Optum VA,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,UHC,UHC,276,,,,,,,per diem,276,276,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,UHC MGG,UHC MGG,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,VA,VA,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Wellcare MGG,Wellcare MGG,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Bright Health - commercial,Bright Health - commercial,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,,,,,,Inpatient,,,276,276,Bright Health MGG,Bright Health MGG,276,,,,,,,case rate,276,276,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Aetna,Aetna,339.5,,,,,,,per diem,339.5,339.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Aetna MGG,Aetna MGG,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,BCBS,BCBS,339.5,,,,,,,per diem,339.5,339.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,BCBS MGG,BCBS MGG,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Cigna,Cigna,339.5,,,,,,,per diem,339.5,339.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Cigna MGG,Cigna MGG,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Humana,Humana,339.5,,,,,,,per diem,339.5,339.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Humana MGG,Humana MGG,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Optum VA,Optum VA,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,UHC,UHC,339.5,,,,,,,per diem,339.5,339.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,UHC MGG,UHC MGG,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,VA,VA,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Wellcare MGG,Wellcare MGG,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Bright Health - commercial,Bright Health - commercial,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,339.5,339.5,Bright Health MGG,Bright Health MGG,339.5,,,,,,,case rate,339.5,339.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Aetna,Aetna,388.5,,,,,,,per diem,388.5,388.5,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Aetna MGG,Aetna MGG,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,BCBS,BCBS,388.5,,,,,,,per diem,388.5,388.5,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,BCBS MGG,BCBS MGG,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Cigna,Cigna,388.5,,,,,,,per diem,388.5,388.5,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Cigna MGG,Cigna MGG,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Humana,Humana,388.5,,,,,,,per diem,388.5,388.5,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Humana MGG,Humana MGG,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Optum VA,Optum VA,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,UHC,UHC,388.5,,,,,,,per diem,388.5,388.5,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,UHC MGG,UHC MGG,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,VA,VA,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Wellcare MGG,Wellcare MGG,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Bright Health - commercial,Bright Health - commercial,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,388.5,388.5,Bright Health MGG,Bright Health MGG,388.5,,,,,,,case rate,388.5,388.5,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Aetna,Aetna,358.33,,,,,,,per diem,358.33,358.33,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Aetna MGG,Aetna MGG,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,BCBS,BCBS,358.33,,,,,,,per diem,358.33,358.33,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,BCBS MGG,BCBS MGG,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Cigna,Cigna,358.33,,,,,,,per diem,358.33,358.33,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Cigna MGG,Cigna MGG,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Humana,Humana,358.33,,,,,,,per diem,358.33,358.33,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Humana MGG,Humana MGG,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Optum VA,Optum VA,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,UHC,UHC,358.33,,,,,,,per diem,358.33,358.33,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,UHC MGG,UHC MGG,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,VA,VA,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Wellcare MGG,Wellcare MGG,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Bright Health - commercial,Bright Health - commercial,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,358.33,358.33,Bright Health MGG,Bright Health MGG,358.33,,,,,,,case rate,358.33,358.33,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Aetna,Aetna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Aetna MGG,Aetna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,BCBS,BCBS,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,BCBS MGG,BCBS MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Cigna,Cigna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Cigna MGG,Cigna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Humana,Humana,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Humana MGG,Humana MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Optum VA,Optum VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,UHC,UHC,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,UHC MGG,UHC MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,VA,VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Wellcare MGG,Wellcare MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Bright Health - commercial,Bright Health - commercial,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,894.54,894.54,Bright Health MGG,Bright Health MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Aetna,Aetna,541.48,,,,,,,per diem,541.48,541.48,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Aetna MGG,Aetna MGG,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,BCBS,BCBS,541.48,,,,,,,per diem,541.48,541.48,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,BCBS MGG,BCBS MGG,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Cigna,Cigna,541.48,,,,,,,per diem,541.48,541.48,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Cigna MGG,Cigna MGG,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Humana,Humana,541.48,,,,,,,per diem,541.48,541.48,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Humana MGG,Humana MGG,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Optum VA,Optum VA,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,UHC,UHC,541.48,,,,,,,per diem,541.48,541.48,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,UHC MGG,UHC MGG,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,VA,VA,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Wellcare MGG,Wellcare MGG,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Bright Health - commercial,Bright Health - commercial,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,541.48,541.48,Bright Health MGG,Bright Health MGG,541.48,,,,,,,case rate,541.48,541.48,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Aetna,Aetna,947.64,,,,,,,per diem,947.64,947.64,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Aetna MGG,Aetna MGG,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,BCBS,BCBS,947.64,,,,,,,per diem,947.64,947.64,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,BCBS MGG,BCBS MGG,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Cigna,Cigna,947.64,,,,,,,per diem,947.64,947.64,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Cigna MGG,Cigna MGG,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Humana,Humana,947.64,,,,,,,per diem,947.64,947.64,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Humana MGG,Humana MGG,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Optum VA,Optum VA,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,UHC,UHC,947.64,,,,,,,per diem,947.64,947.64,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,UHC MGG,UHC MGG,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,VA,VA,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Wellcare MGG,Wellcare MGG,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Bright Health - commercial,Bright Health - commercial,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,947.64,947.64,Bright Health MGG,Bright Health MGG,947.64,,,,,,,case rate,947.64,947.64,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Aetna,Aetna,458.09,,,,,,,per diem,458.09,458.09,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Aetna MGG,Aetna MGG,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,BCBS,BCBS,458.09,,,,,,,per diem,458.09,458.09,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,BCBS MGG,BCBS MGG,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Cigna,Cigna,458.09,,,,,,,per diem,458.09,458.09,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Cigna MGG,Cigna MGG,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Humana,Humana,458.09,,,,,,,per diem,458.09,458.09,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Humana MGG,Humana MGG,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Optum VA,Optum VA,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,UHC,UHC,458.09,,,,,,,per diem,458.09,458.09,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,UHC MGG,UHC MGG,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,VA,VA,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Wellcare MGG,Wellcare MGG,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Bright Health - commercial,Bright Health - commercial,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,G0204,HCPCS,,,,Inpatient,,,458.09,458.09,Bright Health MGG,Bright Health MGG,458.09,,,,,,,case rate,458.09,458.09,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Aetna,Aetna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Aetna MGG,Aetna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,BCBS,BCBS,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,BCBS MGG,BCBS MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Cigna,Cigna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Cigna MGG,Cigna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Humana,Humana,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Humana MGG,Humana MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Optum VA,Optum VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,UHC,UHC,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,UHC MGG,UHC MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,VA,VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Wellcare MGG,Wellcare MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Bright Health - commercial,Bright Health - commercial,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,200.94,200.94,Bright Health MGG,Bright Health MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Aetna,Aetna,902.21,,,,,,,per diem,902.21,902.21,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Aetna MGG,Aetna MGG,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,BCBS,BCBS,902.21,,,,,,,per diem,902.21,902.21,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,BCBS MGG,BCBS MGG,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Cigna,Cigna,902.21,,,,,,,per diem,902.21,902.21,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Cigna MGG,Cigna MGG,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Humana,Humana,902.21,,,,,,,per diem,902.21,902.21,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Humana MGG,Humana MGG,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Optum VA,Optum VA,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,UHC,UHC,902.21,,,,,,,per diem,902.21,902.21,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,UHC MGG,UHC MGG,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,VA,VA,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Wellcare MGG,Wellcare MGG,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Bright Health - commercial,Bright Health - commercial,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,902.21,902.21,Bright Health MGG,Bright Health MGG,902.21,,,,,,,case rate,902.21,902.21,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Aetna,Aetna,186.76,,,,,,,per diem,186.76,186.76,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Aetna MGG,Aetna MGG,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,BCBS,BCBS,186.76,,,,,,,per diem,186.76,186.76,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,BCBS MGG,BCBS MGG,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Cigna,Cigna,186.76,,,,,,,per diem,186.76,186.76,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Cigna MGG,Cigna MGG,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Humana,Humana,186.76,,,,,,,per diem,186.76,186.76,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Humana MGG,Humana MGG,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Optum VA,Optum VA,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,UHC,UHC,186.76,,,,,,,per diem,186.76,186.76,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,UHC MGG,UHC MGG,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,VA,VA,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Wellcare MGG,Wellcare MGG,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Bright Health - commercial,Bright Health - commercial,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,186.76,186.76,Bright Health MGG,Bright Health MGG,186.76,,,,,,,case rate,186.76,186.76,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Aetna,Aetna,1823.19,,,,,,,per diem,1823.19,1823.19,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Aetna MGG,Aetna MGG,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,BCBS,BCBS,1823.19,,,,,,,per diem,1823.19,1823.19,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,BCBS MGG,BCBS MGG,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Cigna,Cigna,1823.19,,,,,,,per diem,1823.19,1823.19,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Cigna MGG,Cigna MGG,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Humana,Humana,1823.19,,,,,,,per diem,1823.19,1823.19,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Humana MGG,Humana MGG,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Optum VA,Optum VA,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,UHC,UHC,1823.19,,,,,,,per diem,1823.19,1823.19,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,UHC MGG,UHC MGG,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,VA,VA,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Wellcare MGG,Wellcare MGG,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Bright Health - commercial,Bright Health - commercial,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1823.19,1823.19,Bright Health MGG,Bright Health MGG,1823.19,,,,,,,case rate,1823.19,1823.19,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Aetna,Aetna,1183.41,,,,,,,per diem,1183.41,1183.41,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Aetna MGG,Aetna MGG,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,BCBS,BCBS,1183.41,,,,,,,per diem,1183.41,1183.41,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,BCBS MGG,BCBS MGG,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Cigna,Cigna,1183.41,,,,,,,per diem,1183.41,1183.41,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Cigna MGG,Cigna MGG,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Humana,Humana,1183.41,,,,,,,per diem,1183.41,1183.41,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Humana MGG,Humana MGG,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Optum VA,Optum VA,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,UHC,UHC,1183.41,,,,,,,per diem,1183.41,1183.41,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,UHC MGG,UHC MGG,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,VA,VA,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Wellcare MGG,Wellcare MGG,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Bright Health - commercial,Bright Health - commercial,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1183.41,1183.41,Bright Health MGG,Bright Health MGG,1183.41,,,,,,,case rate,1183.41,1183.41,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Aetna,Aetna,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Aetna MGG,Aetna MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,BCBS,BCBS,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,BCBS MGG,BCBS MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Cigna,Cigna,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Cigna MGG,Cigna MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Humana,Humana,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Humana MGG,Humana MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Optum VA,Optum VA,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,UHC,UHC,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,UHC MGG,UHC MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,VA,VA,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Wellcare MGG,Wellcare MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Bright Health - commercial,Bright Health - commercial,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Bright Health MGG,Bright Health MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Aetna,Aetna,527.58,,,,,,,per diem,527.58,527.58,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Aetna MGG,Aetna MGG,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,BCBS,BCBS,527.58,,,,,,,per diem,527.58,527.58,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,BCBS MGG,BCBS MGG,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Cigna,Cigna,527.58,,,,,,,per diem,527.58,527.58,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Cigna MGG,Cigna MGG,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Humana,Humana,527.58,,,,,,,per diem,527.58,527.58,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Humana MGG,Humana MGG,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Optum VA,Optum VA,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,UHC,UHC,527.58,,,,,,,per diem,527.58,527.58,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,UHC MGG,UHC MGG,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,VA,VA,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Wellcare MGG,Wellcare MGG,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Bright Health - commercial,Bright Health - commercial,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,527.58,527.58,Bright Health MGG,Bright Health MGG,527.58,,,,,,,case rate,527.58,527.58,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Aetna,Aetna,338.83,,,,,,,per diem,338.83,338.83,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Aetna MGG,Aetna MGG,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,BCBS,BCBS,338.83,,,,,,,per diem,338.83,338.83,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,BCBS MGG,BCBS MGG,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Cigna,Cigna,338.83,,,,,,,per diem,338.83,338.83,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Cigna MGG,Cigna MGG,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Humana,Humana,338.83,,,,,,,per diem,338.83,338.83,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Humana MGG,Humana MGG,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Optum VA,Optum VA,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,UHC,UHC,338.83,,,,,,,per diem,338.83,338.83,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,UHC MGG,UHC MGG,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,VA,VA,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Wellcare MGG,Wellcare MGG,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Bright Health - commercial,Bright Health - commercial,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,338.83,338.83,Bright Health MGG,Bright Health MGG,338.83,,,,,,,case rate,338.83,338.83,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Aetna,Aetna,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Aetna MGG,Aetna MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,BCBS,BCBS,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,BCBS MGG,BCBS MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Cigna,Cigna,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Cigna MGG,Cigna MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Humana,Humana,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Humana MGG,Humana MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Optum VA,Optum VA,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,UHC,UHC,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,UHC MGG,UHC MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,VA,VA,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Wellcare MGG,Wellcare MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Bright Health - commercial,Bright Health - commercial,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,225,225,Bright Health MGG,Bright Health MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Aetna,Aetna,696.74,,,,,,,per diem,696.74,696.74,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Aetna MGG,Aetna MGG,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,BCBS,BCBS,696.74,,,,,,,per diem,696.74,696.74,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,BCBS MGG,BCBS MGG,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Cigna,Cigna,696.74,,,,,,,per diem,696.74,696.74,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Cigna MGG,Cigna MGG,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Humana,Humana,696.74,,,,,,,per diem,696.74,696.74,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Humana MGG,Humana MGG,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Optum VA,Optum VA,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,UHC,UHC,696.74,,,,,,,per diem,696.74,696.74,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,UHC MGG,UHC MGG,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,VA,VA,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Wellcare MGG,Wellcare MGG,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Bright Health - commercial,Bright Health - commercial,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,696.74,696.74,Bright Health MGG,Bright Health MGG,696.74,,,,,,,case rate,696.74,696.74,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Aetna,Aetna,266,,,,,,,per diem,266,266,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Aetna MGG,Aetna MGG,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,BCBS,BCBS,266,,,,,,,per diem,266,266,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,BCBS MGG,BCBS MGG,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Cigna,Cigna,266,,,,,,,per diem,266,266,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Cigna MGG,Cigna MGG,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Humana,Humana,266,,,,,,,per diem,266,266,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Humana MGG,Humana MGG,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Optum VA,Optum VA,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,UHC,UHC,266,,,,,,,per diem,266,266,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,UHC MGG,UHC MGG,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,VA,VA,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Wellcare MGG,Wellcare MGG,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Bright Health - commercial,Bright Health - commercial,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,266,266,Bright Health MGG,Bright Health MGG,266,,,,,,,case rate,266,266,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Aetna,Aetna,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Aetna MGG,Aetna MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,BCBS,BCBS,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,BCBS MGG,BCBS MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Cigna,Cigna,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Cigna MGG,Cigna MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Humana,Humana,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Humana MGG,Humana MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Optum VA,Optum VA,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,UHC,UHC,353,,,,,,,per diem,353,353,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,UHC MGG,UHC MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,VA,VA,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Wellcare MGG,Wellcare MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Bright Health - commercial,Bright Health - commercial,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,353,353,Bright Health MGG,Bright Health MGG,353,,,,,,,case rate,353,353,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Aetna,Aetna,917.33,,,,,,,per diem,917.33,917.33,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Aetna MGG,Aetna MGG,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,BCBS,BCBS,917.33,,,,,,,per diem,917.33,917.33,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,BCBS MGG,BCBS MGG,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Cigna,Cigna,917.33,,,,,,,per diem,917.33,917.33,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Cigna MGG,Cigna MGG,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Humana,Humana,917.33,,,,,,,per diem,917.33,917.33,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Humana MGG,Humana MGG,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Optum VA,Optum VA,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,UHC,UHC,917.33,,,,,,,per diem,917.33,917.33,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,UHC MGG,UHC MGG,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,VA,VA,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Wellcare MGG,Wellcare MGG,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Bright Health - commercial,Bright Health - commercial,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,917.33,917.33,Bright Health MGG,Bright Health MGG,917.33,,,,,,,case rate,917.33,917.33,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Aetna,Aetna,438.47,,,,,,,per diem,438.47,438.47,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Aetna MGG,Aetna MGG,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,BCBS,BCBS,438.47,,,,,,,per diem,438.47,438.47,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,BCBS MGG,BCBS MGG,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Cigna,Cigna,438.47,,,,,,,per diem,438.47,438.47,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Cigna MGG,Cigna MGG,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Humana,Humana,438.47,,,,,,,per diem,438.47,438.47,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Humana MGG,Humana MGG,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Optum VA,Optum VA,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,UHC,UHC,438.47,,,,,,,per diem,438.47,438.47,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,UHC MGG,UHC MGG,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,VA,VA,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Wellcare MGG,Wellcare MGG,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Bright Health - commercial,Bright Health - commercial,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,438.47,438.47,Bright Health MGG,Bright Health MGG,438.47,,,,,,,case rate,438.47,438.47,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Aetna,Aetna,666.28,,,,,,,per diem,666.28,666.28,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Aetna MGG,Aetna MGG,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,BCBS,BCBS,666.28,,,,,,,per diem,666.28,666.28,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,BCBS MGG,BCBS MGG,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Cigna,Cigna,666.28,,,,,,,per diem,666.28,666.28,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Cigna MGG,Cigna MGG,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Humana,Humana,666.28,,,,,,,per diem,666.28,666.28,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Humana MGG,Humana MGG,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Optum VA,Optum VA,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,UHC,UHC,666.28,,,,,,,per diem,666.28,666.28,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,UHC MGG,UHC MGG,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,VA,VA,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Wellcare MGG,Wellcare MGG,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Bright Health - commercial,Bright Health - commercial,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,666.28,666.28,Bright Health MGG,Bright Health MGG,666.28,,,,,,,case rate,666.28,666.28,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Aetna,Aetna,360.5,,,,,,,per diem,360.5,360.5,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Aetna MGG,Aetna MGG,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,BCBS,BCBS,360.5,,,,,,,per diem,360.5,360.5,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,BCBS MGG,BCBS MGG,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Cigna,Cigna,360.5,,,,,,,per diem,360.5,360.5,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Cigna MGG,Cigna MGG,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Humana,Humana,360.5,,,,,,,per diem,360.5,360.5,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Humana MGG,Humana MGG,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Optum VA,Optum VA,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,UHC,UHC,360.5,,,,,,,per diem,360.5,360.5,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,UHC MGG,UHC MGG,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,VA,VA,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Wellcare MGG,Wellcare MGG,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Bright Health - commercial,Bright Health - commercial,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,360.5,360.5,Bright Health MGG,Bright Health MGG,360.5,,,,,,,case rate,360.5,360.5,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Aetna,Aetna,260.58,,,,,,,per diem,260.58,260.58,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Aetna MGG,Aetna MGG,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,BCBS,BCBS,260.58,,,,,,,per diem,260.58,260.58,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,BCBS MGG,BCBS MGG,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Cigna,Cigna,260.58,,,,,,,per diem,260.58,260.58,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Cigna MGG,Cigna MGG,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Humana,Humana,260.58,,,,,,,per diem,260.58,260.58,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Humana MGG,Humana MGG,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Optum VA,Optum VA,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,UHC,UHC,260.58,,,,,,,per diem,260.58,260.58,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,UHC MGG,UHC MGG,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,VA,VA,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Wellcare MGG,Wellcare MGG,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Bright Health - commercial,Bright Health - commercial,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,260.58,260.58,Bright Health MGG,Bright Health MGG,260.58,,,,,,,case rate,260.58,260.58,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Aetna,Aetna,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Aetna MGG,Aetna MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,BCBS,BCBS,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,BCBS MGG,BCBS MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Cigna,Cigna,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Cigna MGG,Cigna MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Humana,Humana,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Humana MGG,Humana MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Optum VA,Optum VA,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,UHC,UHC,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,UHC MGG,UHC MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,VA,VA,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Wellcare MGG,Wellcare MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Bright Health - commercial,Bright Health - commercial,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,,Inpatient,,,328.04,328.04,Bright Health MGG,Bright Health MGG,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Aetna,Aetna,1133.73,,,,,,,per diem,1133.73,1133.73,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Aetna MGG,Aetna MGG,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,BCBS,BCBS,1133.73,,,,,,,per diem,1133.73,1133.73,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,BCBS MGG,BCBS MGG,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Cigna,Cigna,1133.73,,,,,,,per diem,1133.73,1133.73,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Cigna MGG,Cigna MGG,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Humana,Humana,1133.73,,,,,,,per diem,1133.73,1133.73,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Humana MGG,Humana MGG,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Optum VA,Optum VA,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,UHC,UHC,1133.73,,,,,,,per diem,1133.73,1133.73,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,UHC MGG,UHC MGG,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,VA,VA,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Wellcare MGG,Wellcare MGG,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Bright Health - commercial,Bright Health - commercial,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1133.73,1133.73,Bright Health MGG,Bright Health MGG,1133.73,,,,,,,case rate,1133.73,1133.73,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Aetna,Aetna,302.75,,,,,,,per diem,302.75,302.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Aetna MGG,Aetna MGG,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,BCBS,BCBS,302.75,,,,,,,per diem,302.75,302.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,BCBS MGG,BCBS MGG,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Cigna,Cigna,302.75,,,,,,,per diem,302.75,302.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Cigna MGG,Cigna MGG,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Humana,Humana,302.75,,,,,,,per diem,302.75,302.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Humana MGG,Humana MGG,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Optum VA,Optum VA,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,UHC,UHC,302.75,,,,,,,per diem,302.75,302.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,UHC MGG,UHC MGG,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,VA,VA,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Wellcare MGG,Wellcare MGG,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Bright Health - commercial,Bright Health - commercial,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,302.75,302.75,Bright Health MGG,Bright Health MGG,302.75,,,,,,,case rate,302.75,302.75,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Aetna,Aetna,439.87,,,,,,,per diem,439.87,439.87,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Aetna MGG,Aetna MGG,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,BCBS,BCBS,439.87,,,,,,,per diem,439.87,439.87,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,BCBS MGG,BCBS MGG,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Cigna,Cigna,439.87,,,,,,,per diem,439.87,439.87,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Cigna MGG,Cigna MGG,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Humana,Humana,439.87,,,,,,,per diem,439.87,439.87,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Humana MGG,Humana MGG,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Optum VA,Optum VA,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,UHC,UHC,439.87,,,,,,,per diem,439.87,439.87,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,UHC MGG,UHC MGG,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,VA,VA,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Wellcare MGG,Wellcare MGG,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Bright Health - commercial,Bright Health - commercial,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,439.87,439.87,Bright Health MGG,Bright Health MGG,439.87,,,,,,,case rate,439.87,439.87,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Aetna,Aetna,725.93,,,,,,,per diem,725.93,725.93,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Aetna MGG,Aetna MGG,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,BCBS,BCBS,725.93,,,,,,,per diem,725.93,725.93,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,BCBS MGG,BCBS MGG,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Cigna,Cigna,725.93,,,,,,,per diem,725.93,725.93,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Cigna MGG,Cigna MGG,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Humana,Humana,725.93,,,,,,,per diem,725.93,725.93,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Humana MGG,Humana MGG,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Optum VA,Optum VA,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,UHC,UHC,725.93,,,,,,,per diem,725.93,725.93,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,UHC MGG,UHC MGG,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,VA,VA,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Wellcare MGG,Wellcare MGG,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Bright Health - commercial,Bright Health - commercial,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,725.93,725.93,Bright Health MGG,Bright Health MGG,725.93,,,,,,,case rate,725.93,725.93,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Aetna,Aetna,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Aetna MGG,Aetna MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,BCBS,BCBS,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,BCBS MGG,BCBS MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Cigna,Cigna,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Cigna MGG,Cigna MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Humana,Humana,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Humana MGG,Humana MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Optum VA,Optum VA,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,UHC,UHC,628.32,,,,,,,per diem,628.32,628.32,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,UHC MGG,UHC MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,VA,VA,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Wellcare MGG,Wellcare MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Bright Health - commercial,Bright Health - commercial,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,628.32,628.32,Bright Health MGG,Bright Health MGG,628.32,,,,,,,case rate,628.32,628.32,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Aetna,Aetna,472.62,,,,,,,per diem,472.62,472.62,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Aetna MGG,Aetna MGG,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,BCBS,BCBS,472.62,,,,,,,per diem,472.62,472.62,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,BCBS MGG,BCBS MGG,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Cigna,Cigna,472.62,,,,,,,per diem,472.62,472.62,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Cigna MGG,Cigna MGG,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Humana,Humana,472.62,,,,,,,per diem,472.62,472.62,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Humana MGG,Humana MGG,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Optum VA,Optum VA,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,UHC,UHC,472.62,,,,,,,per diem,472.62,472.62,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,UHC MGG,UHC MGG,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,VA,VA,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Wellcare MGG,Wellcare MGG,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Bright Health - commercial,Bright Health - commercial,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,472.62,472.62,Bright Health MGG,Bright Health MGG,472.62,,,,,,,case rate,472.62,472.62,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Aetna,Aetna,313.35,,,,,,,per diem,313.35,313.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Aetna MGG,Aetna MGG,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,BCBS,BCBS,313.35,,,,,,,per diem,313.35,313.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,BCBS MGG,BCBS MGG,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Cigna,Cigna,313.35,,,,,,,per diem,313.35,313.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Cigna MGG,Cigna MGG,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Humana,Humana,313.35,,,,,,,per diem,313.35,313.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Humana MGG,Humana MGG,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Optum VA,Optum VA,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,UHC,UHC,313.35,,,,,,,per diem,313.35,313.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,UHC MGG,UHC MGG,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,VA,VA,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Wellcare MGG,Wellcare MGG,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Bright Health - commercial,Bright Health - commercial,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,313.35,313.35,Bright Health MGG,Bright Health MGG,313.35,,,,,,,case rate,313.35,313.35,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Aetna,Aetna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Aetna MGG,Aetna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,BCBS,BCBS,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,BCBS MGG,BCBS MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Cigna,Cigna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Cigna MGG,Cigna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Humana,Humana,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Humana MGG,Humana MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Optum VA,Optum VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,UHC,UHC,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,UHC MGG,UHC MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,VA,VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Wellcare MGG,Wellcare MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Bright Health - commercial,Bright Health - commercial,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,915.96,915.96,Bright Health MGG,Bright Health MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Aetna,Aetna,643.84,,,,,,,per diem,643.84,643.84,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Aetna MGG,Aetna MGG,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,BCBS,BCBS,643.84,,,,,,,per diem,643.84,643.84,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,BCBS MGG,BCBS MGG,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Cigna,Cigna,643.84,,,,,,,per diem,643.84,643.84,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Cigna MGG,Cigna MGG,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Humana,Humana,643.84,,,,,,,per diem,643.84,643.84,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Humana MGG,Humana MGG,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Optum VA,Optum VA,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,UHC,UHC,643.84,,,,,,,per diem,643.84,643.84,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,UHC MGG,UHC MGG,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,VA,VA,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Wellcare MGG,Wellcare MGG,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Bright Health - commercial,Bright Health - commercial,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,643.84,643.84,Bright Health MGG,Bright Health MGG,643.84,,,,,,,case rate,643.84,643.84,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Aetna,Aetna,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Aetna MGG,Aetna MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,BCBS,BCBS,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,BCBS MGG,BCBS MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Cigna,Cigna,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Cigna MGG,Cigna MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Humana,Humana,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Humana MGG,Humana MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Optum VA,Optum VA,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,UHC,UHC,324.38,,,,,,,per diem,324.38,324.38,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,UHC MGG,UHC MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,VA,VA,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Wellcare MGG,Wellcare MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Bright Health - commercial,Bright Health - commercial,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,324.38,324.38,Bright Health MGG,Bright Health MGG,324.38,,,,,,,case rate,324.38,324.38,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Aetna,Aetna,386.09,,,,,,,per diem,386.09,386.09,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Aetna MGG,Aetna MGG,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,BCBS,BCBS,386.09,,,,,,,per diem,386.09,386.09,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,BCBS MGG,BCBS MGG,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Cigna,Cigna,386.09,,,,,,,per diem,386.09,386.09,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Cigna MGG,Cigna MGG,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Humana,Humana,386.09,,,,,,,per diem,386.09,386.09,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Humana MGG,Humana MGG,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Optum VA,Optum VA,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,UHC,UHC,386.09,,,,,,,per diem,386.09,386.09,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,UHC MGG,UHC MGG,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,VA,VA,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Wellcare MGG,Wellcare MGG,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Bright Health - commercial,Bright Health - commercial,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,386.09,386.09,Bright Health MGG,Bright Health MGG,386.09,,,,,,,case rate,386.09,386.09,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Aetna,Aetna,439.06,,,,,,,per diem,439.06,439.06,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Aetna MGG,Aetna MGG,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,BCBS,BCBS,439.06,,,,,,,per diem,439.06,439.06,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,BCBS MGG,BCBS MGG,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Cigna,Cigna,439.06,,,,,,,per diem,439.06,439.06,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Cigna MGG,Cigna MGG,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Humana,Humana,439.06,,,,,,,per diem,439.06,439.06,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Humana MGG,Humana MGG,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Optum VA,Optum VA,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,UHC,UHC,439.06,,,,,,,per diem,439.06,439.06,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,UHC MGG,UHC MGG,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,VA,VA,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Wellcare MGG,Wellcare MGG,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Bright Health - commercial,Bright Health - commercial,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,439.06,439.06,Bright Health MGG,Bright Health MGG,439.06,,,,,,,case rate,439.06,439.06,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Aetna,Aetna,397.75,,,,,,,per diem,397.75,397.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Aetna MGG,Aetna MGG,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,BCBS,BCBS,397.75,,,,,,,per diem,397.75,397.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,BCBS MGG,BCBS MGG,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Cigna,Cigna,397.75,,,,,,,per diem,397.75,397.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Cigna MGG,Cigna MGG,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Humana,Humana,397.75,,,,,,,per diem,397.75,397.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Humana MGG,Humana MGG,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Optum VA,Optum VA,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,UHC,UHC,397.75,,,,,,,per diem,397.75,397.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,UHC MGG,UHC MGG,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,VA,VA,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Wellcare MGG,Wellcare MGG,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Bright Health - commercial,Bright Health - commercial,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,397.75,397.75,Bright Health MGG,Bright Health MGG,397.75,,,,,,,case rate,397.75,397.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Aetna,Aetna,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Aetna MGG,Aetna MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,BCBS,BCBS,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,BCBS MGG,BCBS MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Cigna,Cigna,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Cigna MGG,Cigna MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Humana,Humana,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Humana MGG,Humana MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Optum VA,Optum VA,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,UHC,UHC,290.5,,,,,,,per diem,290.5,290.5,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,UHC MGG,UHC MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,VA,VA,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Wellcare MGG,Wellcare MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Bright Health - commercial,Bright Health - commercial,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,290.5,290.5,Bright Health MGG,Bright Health MGG,290.5,,,,,,,case rate,290.5,290.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Aetna,Aetna,510,,,,,,,per diem,510,510,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Aetna MGG,Aetna MGG,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,BCBS,BCBS,510,,,,,,,per diem,510,510,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,BCBS MGG,BCBS MGG,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Cigna,Cigna,510,,,,,,,per diem,510,510,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Cigna MGG,Cigna MGG,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Humana,Humana,510,,,,,,,per diem,510,510,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Humana MGG,Humana MGG,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Optum VA,Optum VA,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,UHC,UHC,510,,,,,,,per diem,510,510,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,UHC MGG,UHC MGG,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,VA,VA,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Wellcare MGG,Wellcare MGG,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Bright Health - commercial,Bright Health - commercial,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,510,510,Bright Health MGG,Bright Health MGG,510,,,,,,,case rate,510,510,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Aetna,Aetna,448.84,,,,,,,per diem,448.84,448.84,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Aetna MGG,Aetna MGG,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,BCBS,BCBS,448.84,,,,,,,per diem,448.84,448.84,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,BCBS MGG,BCBS MGG,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Cigna,Cigna,448.84,,,,,,,per diem,448.84,448.84,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Cigna MGG,Cigna MGG,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Humana,Humana,448.84,,,,,,,per diem,448.84,448.84,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Humana MGG,Humana MGG,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Optum VA,Optum VA,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,UHC,UHC,448.84,,,,,,,per diem,448.84,448.84,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,UHC MGG,UHC MGG,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,VA,VA,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Wellcare MGG,Wellcare MGG,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Bright Health - commercial,Bright Health - commercial,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,448.84,448.84,Bright Health MGG,Bright Health MGG,448.84,,,,,,,case rate,448.84,448.84,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Aetna,Aetna,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Aetna MGG,Aetna MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,BCBS,BCBS,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,BCBS MGG,BCBS MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Cigna,Cigna,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Cigna MGG,Cigna MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Humana,Humana,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Humana MGG,Humana MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Optum VA,Optum VA,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,UHC,UHC,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,UHC MGG,UHC MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,VA,VA,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Wellcare MGG,Wellcare MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Bright Health - commercial,Bright Health - commercial,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,880.26,880.26,Bright Health MGG,Bright Health MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Aetna,Aetna,2724.42,,,,,,,per diem,2724.42,2724.42,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Aetna MGG,Aetna MGG,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,BCBS,BCBS,2724.42,,,,,,,per diem,2724.42,2724.42,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,BCBS MGG,BCBS MGG,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Cigna,Cigna,2724.42,,,,,,,per diem,2724.42,2724.42,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Cigna MGG,Cigna MGG,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Humana,Humana,2724.42,,,,,,,per diem,2724.42,2724.42,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Humana MGG,Humana MGG,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Optum VA,Optum VA,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,UHC,UHC,2724.42,,,,,,,per diem,2724.42,2724.42,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,UHC MGG,UHC MGG,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,VA,VA,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Wellcare MGG,Wellcare MGG,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Bright Health - commercial,Bright Health - commercial,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2724.42,2724.42,Bright Health MGG,Bright Health MGG,2724.42,,,,,,,case rate,2724.42,2724.42,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Aetna,Aetna,3899.84,,,,,,,per diem,3899.84,3899.84,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Aetna MGG,Aetna MGG,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,BCBS,BCBS,3899.84,,,,,,,per diem,3899.84,3899.84,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,BCBS MGG,BCBS MGG,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Cigna,Cigna,3899.84,,,,,,,per diem,3899.84,3899.84,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Cigna MGG,Cigna MGG,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Humana,Humana,3899.84,,,,,,,per diem,3899.84,3899.84,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Humana MGG,Humana MGG,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Optum VA,Optum VA,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,UHC,UHC,3899.84,,,,,,,per diem,3899.84,3899.84,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,UHC MGG,UHC MGG,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,VA,VA,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Wellcare MGG,Wellcare MGG,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Bright Health - commercial,Bright Health - commercial,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,3899.84,3899.84,Bright Health MGG,Bright Health MGG,3899.84,,,,,,,case rate,3899.84,3899.84,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Aetna,Aetna,395.5,,,,,,,per diem,395.5,395.5,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Aetna MGG,Aetna MGG,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,BCBS,BCBS,395.5,,,,,,,per diem,395.5,395.5,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,BCBS MGG,BCBS MGG,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Cigna,Cigna,395.5,,,,,,,per diem,395.5,395.5,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Cigna MGG,Cigna MGG,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Humana,Humana,395.5,,,,,,,per diem,395.5,395.5,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Humana MGG,Humana MGG,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Optum VA,Optum VA,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,UHC,UHC,395.5,,,,,,,per diem,395.5,395.5,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,UHC MGG,UHC MGG,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,VA,VA,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Wellcare MGG,Wellcare MGG,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Bright Health - commercial,Bright Health - commercial,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,395.5,395.5,Bright Health MGG,Bright Health MGG,395.5,,,,,,,case rate,395.5,395.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Aetna,Aetna,268.33,,,,,,,per diem,268.33,268.33,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Aetna MGG,Aetna MGG,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,BCBS,BCBS,268.33,,,,,,,per diem,268.33,268.33,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,BCBS MGG,BCBS MGG,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Cigna,Cigna,268.33,,,,,,,per diem,268.33,268.33,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Cigna MGG,Cigna MGG,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Humana,Humana,268.33,,,,,,,per diem,268.33,268.33,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Humana MGG,Humana MGG,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Optum VA,Optum VA,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,UHC,UHC,268.33,,,,,,,per diem,268.33,268.33,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,UHC MGG,UHC MGG,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,VA,VA,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Wellcare MGG,Wellcare MGG,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Bright Health - commercial,Bright Health - commercial,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,268.33,268.33,Bright Health MGG,Bright Health MGG,268.33,,,,,,,case rate,268.33,268.33,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Aetna,Aetna,3709.74,,,,,,,per diem,3709.74,3709.74,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Aetna MGG,Aetna MGG,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,BCBS,BCBS,3709.74,,,,,,,per diem,3709.74,3709.74,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,BCBS MGG,BCBS MGG,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Cigna,Cigna,3709.74,,,,,,,per diem,3709.74,3709.74,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Cigna MGG,Cigna MGG,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Humana,Humana,3709.74,,,,,,,per diem,3709.74,3709.74,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Humana MGG,Humana MGG,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Optum VA,Optum VA,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,UHC,UHC,3709.74,,,,,,,per diem,3709.74,3709.74,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,UHC MGG,UHC MGG,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,VA,VA,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Wellcare MGG,Wellcare MGG,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Bright Health - commercial,Bright Health - commercial,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3709.74,3709.74,Bright Health MGG,Bright Health MGG,3709.74,,,,,,,case rate,3709.74,3709.74,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Aetna,Aetna,323.97,,,,,,,per diem,323.97,323.97,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Aetna MGG,Aetna MGG,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,BCBS,BCBS,323.97,,,,,,,per diem,323.97,323.97,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,BCBS MGG,BCBS MGG,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Cigna,Cigna,323.97,,,,,,,per diem,323.97,323.97,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Cigna MGG,Cigna MGG,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Humana,Humana,323.97,,,,,,,per diem,323.97,323.97,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Humana MGG,Humana MGG,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Optum VA,Optum VA,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,UHC,UHC,323.97,,,,,,,per diem,323.97,323.97,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,UHC MGG,UHC MGG,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,VA,VA,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Wellcare MGG,Wellcare MGG,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Bright Health - commercial,Bright Health - commercial,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,323.97,323.97,Bright Health MGG,Bright Health MGG,323.97,,,,,,,case rate,323.97,323.97,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Aetna,Aetna,337.72,,,,,,,per diem,337.72,337.72,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Aetna MGG,Aetna MGG,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,BCBS,BCBS,337.72,,,,,,,per diem,337.72,337.72,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,BCBS MGG,BCBS MGG,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Cigna,Cigna,337.72,,,,,,,per diem,337.72,337.72,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Cigna MGG,Cigna MGG,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Humana,Humana,337.72,,,,,,,per diem,337.72,337.72,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Humana MGG,Humana MGG,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Optum VA,Optum VA,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,UHC,UHC,337.72,,,,,,,per diem,337.72,337.72,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,UHC MGG,UHC MGG,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,VA,VA,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Wellcare MGG,Wellcare MGG,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Bright Health - commercial,Bright Health - commercial,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,337.72,337.72,Bright Health MGG,Bright Health MGG,337.72,,,,,,,case rate,337.72,337.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Aetna,Aetna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Aetna MGG,Aetna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,BCBS,BCBS,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,BCBS MGG,BCBS MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Cigna,Cigna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Cigna MGG,Cigna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Humana,Humana,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Humana MGG,Humana MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Optum VA,Optum VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,UHC,UHC,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,UHC MGG,UHC MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,VA,VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Wellcare MGG,Wellcare MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Bright Health - commercial,Bright Health - commercial,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,894.54,894.54,Bright Health MGG,Bright Health MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Aetna,Aetna,1566.72,,,,,,,per diem,1566.72,1566.72,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Aetna MGG,Aetna MGG,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,BCBS,BCBS,1566.72,,,,,,,per diem,1566.72,1566.72,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,BCBS MGG,BCBS MGG,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Cigna,Cigna,1566.72,,,,,,,per diem,1566.72,1566.72,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Cigna MGG,Cigna MGG,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Humana,Humana,1566.72,,,,,,,per diem,1566.72,1566.72,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Humana MGG,Humana MGG,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Optum VA,Optum VA,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,UHC,UHC,1566.72,,,,,,,per diem,1566.72,1566.72,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,UHC MGG,UHC MGG,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,VA,VA,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Wellcare MGG,Wellcare MGG,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Bright Health - commercial,Bright Health - commercial,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1566.72,1566.72,Bright Health MGG,Bright Health MGG,1566.72,,,,,,,case rate,1566.72,1566.72,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Aetna,Aetna,1723.48,,,,,,,per diem,1723.48,1723.48,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Aetna MGG,Aetna MGG,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,BCBS,BCBS,1723.48,,,,,,,per diem,1723.48,1723.48,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,BCBS MGG,BCBS MGG,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Cigna,Cigna,1723.48,,,,,,,per diem,1723.48,1723.48,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Cigna MGG,Cigna MGG,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Humana,Humana,1723.48,,,,,,,per diem,1723.48,1723.48,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Humana MGG,Humana MGG,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Optum VA,Optum VA,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,UHC,UHC,1723.48,,,,,,,per diem,1723.48,1723.48,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,UHC MGG,UHC MGG,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,VA,VA,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Wellcare MGG,Wellcare MGG,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Bright Health - commercial,Bright Health - commercial,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1723.48,1723.48,Bright Health MGG,Bright Health MGG,1723.48,,,,,,,case rate,1723.48,1723.48,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Aetna,Aetna,8016.18,,,,,,,per diem,8016.18,8016.18,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Aetna MGG,Aetna MGG,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,BCBS,BCBS,8016.18,,,,,,,per diem,8016.18,8016.18,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,BCBS MGG,BCBS MGG,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Cigna,Cigna,8016.18,,,,,,,per diem,8016.18,8016.18,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Cigna MGG,Cigna MGG,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Humana,Humana,8016.18,,,,,,,per diem,8016.18,8016.18,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Humana MGG,Humana MGG,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Optum VA,Optum VA,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,UHC,UHC,8016.18,,,,,,,per diem,8016.18,8016.18,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,UHC MGG,UHC MGG,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,VA,VA,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Wellcare MGG,Wellcare MGG,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Bright Health - commercial,Bright Health - commercial,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8016.18,8016.18,Bright Health MGG,Bright Health MGG,8016.18,,,,,,,case rate,8016.18,8016.18,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Aetna,Aetna,278.5,,,,,,,per diem,278.5,278.5,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Aetna MGG,Aetna MGG,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,BCBS,BCBS,278.5,,,,,,,per diem,278.5,278.5,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,BCBS MGG,BCBS MGG,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Cigna,Cigna,278.5,,,,,,,per diem,278.5,278.5,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Cigna MGG,Cigna MGG,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Humana,Humana,278.5,,,,,,,per diem,278.5,278.5,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Humana MGG,Humana MGG,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Optum VA,Optum VA,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,UHC,UHC,278.5,,,,,,,per diem,278.5,278.5,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,UHC MGG,UHC MGG,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,VA,VA,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Wellcare MGG,Wellcare MGG,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Bright Health - commercial,Bright Health - commercial,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,278.5,278.5,Bright Health MGG,Bright Health MGG,278.5,,,,,,,case rate,278.5,278.5,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Aetna,Aetna,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Aetna MGG,Aetna MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,BCBS,BCBS,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,BCBS MGG,BCBS MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Cigna,Cigna,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Cigna MGG,Cigna MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Humana,Humana,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Humana MGG,Humana MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Optum VA,Optum VA,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,UHC,UHC,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,UHC MGG,UHC MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,VA,VA,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Wellcare MGG,Wellcare MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Bright Health - commercial,Bright Health - commercial,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Bright Health MGG,Bright Health MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Aetna,Aetna,4525.74,,,,,,,per diem,4525.74,4525.74,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Aetna MGG,Aetna MGG,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,BCBS,BCBS,4525.74,,,,,,,per diem,4525.74,4525.74,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,BCBS MGG,BCBS MGG,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Cigna,Cigna,4525.74,,,,,,,per diem,4525.74,4525.74,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Cigna MGG,Cigna MGG,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Humana,Humana,4525.74,,,,,,,per diem,4525.74,4525.74,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Humana MGG,Humana MGG,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Optum VA,Optum VA,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,UHC,UHC,4525.74,,,,,,,per diem,4525.74,4525.74,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,UHC MGG,UHC MGG,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,VA,VA,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Wellcare MGG,Wellcare MGG,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Bright Health - commercial,Bright Health - commercial,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4525.74,4525.74,Bright Health MGG,Bright Health MGG,4525.74,,,,,,,case rate,4525.74,4525.74,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Aetna,Aetna,6827.88,,,,,,,per diem,6827.88,6827.88,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Aetna MGG,Aetna MGG,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,BCBS,BCBS,6827.88,,,,,,,per diem,6827.88,6827.88,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,BCBS MGG,BCBS MGG,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Cigna,Cigna,6827.88,,,,,,,per diem,6827.88,6827.88,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Cigna MGG,Cigna MGG,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Humana,Humana,6827.88,,,,,,,per diem,6827.88,6827.88,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Humana MGG,Humana MGG,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Optum VA,Optum VA,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,UHC,UHC,6827.88,,,,,,,per diem,6827.88,6827.88,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,UHC MGG,UHC MGG,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,VA,VA,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Wellcare MGG,Wellcare MGG,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Bright Health - commercial,Bright Health - commercial,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,6827.88,6827.88,Bright Health MGG,Bright Health MGG,6827.88,,,,,,,case rate,6827.88,6827.88,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Aetna,Aetna,6491.28,,,,,,,per diem,6491.28,6491.28,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Aetna MGG,Aetna MGG,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,BCBS,BCBS,6491.28,,,,,,,per diem,6491.28,6491.28,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,BCBS MGG,BCBS MGG,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Cigna,Cigna,6491.28,,,,,,,per diem,6491.28,6491.28,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Cigna MGG,Cigna MGG,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Humana,Humana,6491.28,,,,,,,per diem,6491.28,6491.28,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Humana MGG,Humana MGG,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Optum VA,Optum VA,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,UHC,UHC,6491.28,,,,,,,per diem,6491.28,6491.28,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,UHC MGG,UHC MGG,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,VA,VA,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Wellcare MGG,Wellcare MGG,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Bright Health - commercial,Bright Health - commercial,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6491.28,6491.28,Bright Health MGG,Bright Health MGG,6491.28,,,,,,,case rate,6491.28,6491.28,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Aetna,Aetna,1207.68,,,,,,,per diem,1207.68,1207.68,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Aetna MGG,Aetna MGG,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,BCBS,BCBS,1207.68,,,,,,,per diem,1207.68,1207.68,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,BCBS MGG,BCBS MGG,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Cigna,Cigna,1207.68,,,,,,,per diem,1207.68,1207.68,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Cigna MGG,Cigna MGG,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Humana,Humana,1207.68,,,,,,,per diem,1207.68,1207.68,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Humana MGG,Humana MGG,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Optum VA,Optum VA,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,UHC,UHC,1207.68,,,,,,,per diem,1207.68,1207.68,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,UHC MGG,UHC MGG,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,VA,VA,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Wellcare MGG,Wellcare MGG,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Bright Health - commercial,Bright Health - commercial,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1207.68,1207.68,Bright Health MGG,Bright Health MGG,1207.68,,,,,,,case rate,1207.68,1207.68,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Aetna,Aetna,1133.19,,,,,,,per diem,1133.19,1133.19,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Aetna MGG,Aetna MGG,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,BCBS,BCBS,1133.19,,,,,,,per diem,1133.19,1133.19,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,BCBS MGG,BCBS MGG,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Cigna,Cigna,1133.19,,,,,,,per diem,1133.19,1133.19,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Cigna MGG,Cigna MGG,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Humana,Humana,1133.19,,,,,,,per diem,1133.19,1133.19,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Humana MGG,Humana MGG,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Optum VA,Optum VA,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,UHC,UHC,1133.19,,,,,,,per diem,1133.19,1133.19,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,UHC MGG,UHC MGG,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,VA,VA,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Wellcare MGG,Wellcare MGG,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Bright Health - commercial,Bright Health - commercial,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1133.19,1133.19,Bright Health MGG,Bright Health MGG,1133.19,,,,,,,case rate,1133.19,1133.19,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Aetna,Aetna,1135.89,,,,,,,per diem,1135.89,1135.89,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Aetna MGG,Aetna MGG,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,BCBS,BCBS,1135.89,,,,,,,per diem,1135.89,1135.89,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,BCBS MGG,BCBS MGG,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Cigna,Cigna,1135.89,,,,,,,per diem,1135.89,1135.89,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Cigna MGG,Cigna MGG,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Humana,Humana,1135.89,,,,,,,per diem,1135.89,1135.89,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Humana MGG,Humana MGG,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Optum VA,Optum VA,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,UHC,UHC,1135.89,,,,,,,per diem,1135.89,1135.89,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,UHC MGG,UHC MGG,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,VA,VA,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Wellcare MGG,Wellcare MGG,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Bright Health - commercial,Bright Health - commercial,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1135.89,1135.89,Bright Health MGG,Bright Health MGG,1135.89,,,,,,,case rate,1135.89,1135.89,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Aetna,Aetna,4463.52,,,,,,,per diem,4463.52,4463.52,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Aetna MGG,Aetna MGG,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,BCBS,BCBS,4463.52,,,,,,,per diem,4463.52,4463.52,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,BCBS MGG,BCBS MGG,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Cigna,Cigna,4463.52,,,,,,,per diem,4463.52,4463.52,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Cigna MGG,Cigna MGG,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Humana,Humana,4463.52,,,,,,,per diem,4463.52,4463.52,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Humana MGG,Humana MGG,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Optum VA,Optum VA,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,UHC,UHC,4463.52,,,,,,,per diem,4463.52,4463.52,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,UHC MGG,UHC MGG,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,VA,VA,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Wellcare MGG,Wellcare MGG,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Bright Health - commercial,Bright Health - commercial,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4463.52,4463.52,Bright Health MGG,Bright Health MGG,4463.52,,,,,,,case rate,4463.52,4463.52,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Aetna,Aetna,316.14,,,,,,,per diem,316.14,316.14,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Aetna MGG,Aetna MGG,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,BCBS,BCBS,316.14,,,,,,,per diem,316.14,316.14,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,BCBS MGG,BCBS MGG,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Cigna,Cigna,316.14,,,,,,,per diem,316.14,316.14,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Cigna MGG,Cigna MGG,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Humana,Humana,316.14,,,,,,,per diem,316.14,316.14,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Humana MGG,Humana MGG,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Optum VA,Optum VA,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,UHC,UHC,316.14,,,,,,,per diem,316.14,316.14,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,UHC MGG,UHC MGG,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,VA,VA,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Wellcare MGG,Wellcare MGG,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Bright Health - commercial,Bright Health - commercial,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,316.14,316.14,Bright Health MGG,Bright Health MGG,316.14,,,,,,,case rate,316.14,316.14,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Aetna,Aetna,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Aetna MGG,Aetna MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,BCBS,BCBS,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,BCBS MGG,BCBS MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Cigna,Cigna,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Cigna MGG,Cigna MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Humana,Humana,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Humana MGG,Humana MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Optum VA,Optum VA,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,UHC,UHC,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,UHC MGG,UHC MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,VA,VA,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Wellcare MGG,Wellcare MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Bright Health - commercial,Bright Health - commercial,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,,,,,,Inpatient,,,366,366,Bright Health MGG,Bright Health MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Aetna,Aetna,878.36,,,,,,,per diem,878.36,878.36,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Aetna MGG,Aetna MGG,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,BCBS,BCBS,878.36,,,,,,,per diem,878.36,878.36,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,BCBS MGG,BCBS MGG,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Cigna,Cigna,878.36,,,,,,,per diem,878.36,878.36,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Cigna MGG,Cigna MGG,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Humana,Humana,878.36,,,,,,,per diem,878.36,878.36,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Humana MGG,Humana MGG,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Optum VA,Optum VA,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,UHC,UHC,878.36,,,,,,,per diem,878.36,878.36,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,UHC MGG,UHC MGG,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,VA,VA,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Wellcare MGG,Wellcare MGG,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Bright Health - commercial,Bright Health - commercial,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,878.36,878.36,Bright Health MGG,Bright Health MGG,878.36,,,,,,,case rate,878.36,878.36,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Aetna,Aetna,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Aetna MGG,Aetna MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,BCBS,BCBS,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,BCBS MGG,BCBS MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Cigna,Cigna,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Cigna MGG,Cigna MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Humana,Humana,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Humana MGG,Humana MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Optum VA,Optum VA,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,UHC,UHC,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,UHC MGG,UHC MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,VA,VA,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Wellcare MGG,Wellcare MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Bright Health - commercial,Bright Health - commercial,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Bright Health MGG,Bright Health MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Aetna,Aetna,172.25,,,,,,,per diem,172.25,172.25,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Aetna MGG,Aetna MGG,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,BCBS,BCBS,172.25,,,,,,,per diem,172.25,172.25,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,BCBS MGG,BCBS MGG,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Cigna,Cigna,172.25,,,,,,,per diem,172.25,172.25,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Cigna MGG,Cigna MGG,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Humana,Humana,172.25,,,,,,,per diem,172.25,172.25,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Humana MGG,Humana MGG,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Optum VA,Optum VA,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,UHC,UHC,172.25,,,,,,,per diem,172.25,172.25,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,UHC MGG,UHC MGG,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,VA,VA,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Wellcare MGG,Wellcare MGG,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Bright Health - commercial,Bright Health - commercial,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,172.25,172.25,Bright Health MGG,Bright Health MGG,172.25,,,,,,,case rate,172.25,172.25,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Aetna,Aetna,233,,,,,,,per diem,233,233,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Aetna MGG,Aetna MGG,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,BCBS,BCBS,233,,,,,,,per diem,233,233,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,BCBS MGG,BCBS MGG,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Cigna,Cigna,233,,,,,,,per diem,233,233,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Cigna MGG,Cigna MGG,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Humana,Humana,233,,,,,,,per diem,233,233,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Humana MGG,Humana MGG,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Optum VA,Optum VA,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,UHC,UHC,233,,,,,,,per diem,233,233,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,UHC MGG,UHC MGG,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,VA,VA,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Wellcare MGG,Wellcare MGG,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Bright Health - commercial,Bright Health - commercial,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,,,,,,Inpatient,,,233,233,Bright Health MGG,Bright Health MGG,233,,,,,,,case rate,233,233,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Aetna,Aetna,198,,,,,,,per diem,198,198,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Aetna MGG,Aetna MGG,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,BCBS,BCBS,198,,,,,,,per diem,198,198,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,BCBS MGG,BCBS MGG,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Cigna,Cigna,198,,,,,,,per diem,198,198,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Cigna MGG,Cigna MGG,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Humana,Humana,198,,,,,,,per diem,198,198,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Humana MGG,Humana MGG,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Optum VA,Optum VA,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,UHC,UHC,198,,,,,,,per diem,198,198,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,UHC MGG,UHC MGG,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,VA,VA,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Wellcare MGG,Wellcare MGG,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Bright Health - commercial,Bright Health - commercial,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,198,198,Bright Health MGG,Bright Health MGG,198,,,,,,,case rate,198,198,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Aetna,Aetna,417.18,,,,,,,per diem,417.18,417.18,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Aetna MGG,Aetna MGG,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,BCBS,BCBS,417.18,,,,,,,per diem,417.18,417.18,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,BCBS MGG,BCBS MGG,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Cigna,Cigna,417.18,,,,,,,per diem,417.18,417.18,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Cigna MGG,Cigna MGG,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Humana,Humana,417.18,,,,,,,per diem,417.18,417.18,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Humana MGG,Humana MGG,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Optum VA,Optum VA,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,UHC,UHC,417.18,,,,,,,per diem,417.18,417.18,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,UHC MGG,UHC MGG,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,VA,VA,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Wellcare MGG,Wellcare MGG,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Bright Health - commercial,Bright Health - commercial,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,417.18,417.18,Bright Health MGG,Bright Health MGG,417.18,,,,,,,case rate,417.18,417.18,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Aetna,Aetna,846.6,,,,,,,per diem,846.6,846.6,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Aetna MGG,Aetna MGG,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,BCBS,BCBS,846.6,,,,,,,per diem,846.6,846.6,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,BCBS MGG,BCBS MGG,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Cigna,Cigna,846.6,,,,,,,per diem,846.6,846.6,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Cigna MGG,Cigna MGG,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Humana,Humana,846.6,,,,,,,per diem,846.6,846.6,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Humana MGG,Humana MGG,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Optum VA,Optum VA,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,UHC,UHC,846.6,,,,,,,per diem,846.6,846.6,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,UHC MGG,UHC MGG,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,VA,VA,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Wellcare MGG,Wellcare MGG,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Bright Health - commercial,Bright Health - commercial,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,,,,,,Inpatient,,,846.6,846.6,Bright Health MGG,Bright Health MGG,846.6,,,,,,,case rate,846.6,846.6,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Aetna,Aetna,808.95,,,,,,,per diem,808.95,808.95,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Aetna MGG,Aetna MGG,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,BCBS,BCBS,808.95,,,,,,,per diem,808.95,808.95,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,BCBS MGG,BCBS MGG,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Cigna,Cigna,808.95,,,,,,,per diem,808.95,808.95,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Cigna MGG,Cigna MGG,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Humana,Humana,808.95,,,,,,,per diem,808.95,808.95,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Humana MGG,Humana MGG,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Optum VA,Optum VA,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,UHC,UHC,808.95,,,,,,,per diem,808.95,808.95,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,UHC MGG,UHC MGG,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,VA,VA,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Wellcare MGG,Wellcare MGG,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Bright Health - commercial,Bright Health - commercial,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,808.95,808.95,Bright Health MGG,Bright Health MGG,808.95,,,,,,,case rate,808.95,808.95,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Aetna,Aetna,741.21,,,,,,,per diem,741.21,741.21,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Aetna MGG,Aetna MGG,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,BCBS,BCBS,741.21,,,,,,,per diem,741.21,741.21,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,BCBS MGG,BCBS MGG,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Cigna,Cigna,741.21,,,,,,,per diem,741.21,741.21,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Cigna MGG,Cigna MGG,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Humana,Humana,741.21,,,,,,,per diem,741.21,741.21,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Humana MGG,Humana MGG,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Optum VA,Optum VA,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,UHC,UHC,741.21,,,,,,,per diem,741.21,741.21,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,UHC MGG,UHC MGG,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,VA,VA,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Wellcare MGG,Wellcare MGG,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Bright Health - commercial,Bright Health - commercial,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,741.21,741.21,Bright Health MGG,Bright Health MGG,741.21,,,,,,,case rate,741.21,741.21,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Aetna,Aetna,199.09,,,,,,,per diem,199.09,199.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Aetna MGG,Aetna MGG,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,BCBS,BCBS,199.09,,,,,,,per diem,199.09,199.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,BCBS MGG,BCBS MGG,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Cigna,Cigna,199.09,,,,,,,per diem,199.09,199.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Cigna MGG,Cigna MGG,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Humana,Humana,199.09,,,,,,,per diem,199.09,199.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Humana MGG,Humana MGG,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Optum VA,Optum VA,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,UHC,UHC,199.09,,,,,,,per diem,199.09,199.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,UHC MGG,UHC MGG,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,VA,VA,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Wellcare MGG,Wellcare MGG,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Bright Health - commercial,Bright Health - commercial,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,199.09,199.09,Bright Health MGG,Bright Health MGG,199.09,,,,,,,case rate,199.09,199.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Aetna,Aetna,235.32,,,,,,,per diem,235.32,235.32,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Aetna MGG,Aetna MGG,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,BCBS,BCBS,235.32,,,,,,,per diem,235.32,235.32,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,BCBS MGG,BCBS MGG,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Cigna,Cigna,235.32,,,,,,,per diem,235.32,235.32,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Cigna MGG,Cigna MGG,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Humana,Humana,235.32,,,,,,,per diem,235.32,235.32,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Humana MGG,Humana MGG,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Optum VA,Optum VA,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,UHC,UHC,235.32,,,,,,,per diem,235.32,235.32,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,UHC MGG,UHC MGG,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,VA,VA,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Wellcare MGG,Wellcare MGG,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Bright Health - commercial,Bright Health - commercial,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,235.32,235.32,Bright Health MGG,Bright Health MGG,235.32,,,,,,,case rate,235.32,235.32,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Aetna,Aetna,153.42,,,,,,,per diem,153.42,153.42,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Aetna MGG,Aetna MGG,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,BCBS,BCBS,153.42,,,,,,,per diem,153.42,153.42,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,BCBS MGG,BCBS MGG,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Cigna,Cigna,153.42,,,,,,,per diem,153.42,153.42,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Cigna MGG,Cigna MGG,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Humana,Humana,153.42,,,,,,,per diem,153.42,153.42,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Humana MGG,Humana MGG,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Optum VA,Optum VA,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,UHC,UHC,153.42,,,,,,,per diem,153.42,153.42,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,UHC MGG,UHC MGG,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,VA,VA,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Wellcare MGG,Wellcare MGG,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Bright Health - commercial,Bright Health - commercial,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,153.42,153.42,Bright Health MGG,Bright Health MGG,153.42,,,,,,,case rate,153.42,153.42,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Aetna,Aetna,250.88,,,,,,,per diem,250.88,250.88,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Aetna MGG,Aetna MGG,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,BCBS,BCBS,250.88,,,,,,,per diem,250.88,250.88,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,BCBS MGG,BCBS MGG,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Cigna,Cigna,250.88,,,,,,,per diem,250.88,250.88,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Cigna MGG,Cigna MGG,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Humana,Humana,250.88,,,,,,,per diem,250.88,250.88,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Humana MGG,Humana MGG,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Optum VA,Optum VA,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,UHC,UHC,250.88,,,,,,,per diem,250.88,250.88,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,UHC MGG,UHC MGG,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,VA,VA,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Wellcare MGG,Wellcare MGG,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Bright Health - commercial,Bright Health - commercial,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,250.88,250.88,Bright Health MGG,Bright Health MGG,250.88,,,,,,,case rate,250.88,250.88,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Aetna,Aetna,185.73,,,,,,,per diem,185.73,185.73,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Aetna MGG,Aetna MGG,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,BCBS,BCBS,185.73,,,,,,,per diem,185.73,185.73,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,BCBS MGG,BCBS MGG,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Cigna,Cigna,185.73,,,,,,,per diem,185.73,185.73,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Cigna MGG,Cigna MGG,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Humana,Humana,185.73,,,,,,,per diem,185.73,185.73,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Humana MGG,Humana MGG,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Optum VA,Optum VA,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,UHC,UHC,185.73,,,,,,,per diem,185.73,185.73,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,UHC MGG,UHC MGG,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,VA,VA,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Wellcare MGG,Wellcare MGG,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Bright Health - commercial,Bright Health - commercial,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,185.73,185.73,Bright Health MGG,Bright Health MGG,185.73,,,,,,,case rate,185.73,185.73,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Aetna,Aetna,1573.86,,,,,,,per diem,1573.86,1573.86,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Aetna MGG,Aetna MGG,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,BCBS,BCBS,1573.86,,,,,,,per diem,1573.86,1573.86,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,BCBS MGG,BCBS MGG,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Cigna,Cigna,1573.86,,,,,,,per diem,1573.86,1573.86,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Cigna MGG,Cigna MGG,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Humana,Humana,1573.86,,,,,,,per diem,1573.86,1573.86,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Humana MGG,Humana MGG,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Optum VA,Optum VA,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,UHC,UHC,1573.86,,,,,,,per diem,1573.86,1573.86,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,UHC MGG,UHC MGG,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,VA,VA,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Wellcare MGG,Wellcare MGG,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Bright Health - commercial,Bright Health - commercial,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1573.86,1573.86,Bright Health MGG,Bright Health MGG,1573.86,,,,,,,case rate,1573.86,1573.86,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Aetna,Aetna,873.12,,,,,,,per diem,873.12,873.12,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Aetna MGG,Aetna MGG,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,BCBS,BCBS,873.12,,,,,,,per diem,873.12,873.12,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,BCBS MGG,BCBS MGG,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Cigna,Cigna,873.12,,,,,,,per diem,873.12,873.12,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Cigna MGG,Cigna MGG,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Humana,Humana,873.12,,,,,,,per diem,873.12,873.12,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Humana MGG,Humana MGG,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Optum VA,Optum VA,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,UHC,UHC,873.12,,,,,,,per diem,873.12,873.12,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,UHC MGG,UHC MGG,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,VA,VA,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Wellcare MGG,Wellcare MGG,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Bright Health - commercial,Bright Health - commercial,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,873.12,873.12,Bright Health MGG,Bright Health MGG,873.12,,,,,,,case rate,873.12,873.12,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Aetna,Aetna,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Aetna MGG,Aetna MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,BCBS,BCBS,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,BCBS MGG,BCBS MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Cigna,Cigna,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Cigna MGG,Cigna MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Humana,Humana,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Humana MGG,Humana MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Optum VA,Optum VA,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,UHC,UHC,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,UHC MGG,UHC MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,VA,VA,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Wellcare MGG,Wellcare MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Bright Health - commercial,Bright Health - commercial,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,655.86,655.86,Bright Health MGG,Bright Health MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Aetna,Aetna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Aetna MGG,Aetna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,BCBS,BCBS,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,BCBS MGG,BCBS MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Cigna,Cigna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Cigna MGG,Cigna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Humana,Humana,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Humana MGG,Humana MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Optum VA,Optum VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,UHC,UHC,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,UHC MGG,UHC MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,VA,VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Wellcare MGG,Wellcare MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Bright Health - commercial,Bright Health - commercial,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Bright Health MGG,Bright Health MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Aetna,Aetna,1428,,,,,,,per diem,1428,1428,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Aetna MGG,Aetna MGG,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,BCBS,BCBS,1428,,,,,,,per diem,1428,1428,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,BCBS MGG,BCBS MGG,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Cigna,Cigna,1428,,,,,,,per diem,1428,1428,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Cigna MGG,Cigna MGG,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Humana,Humana,1428,,,,,,,per diem,1428,1428,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Humana MGG,Humana MGG,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Optum VA,Optum VA,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,UHC,UHC,1428,,,,,,,per diem,1428,1428,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,UHC MGG,UHC MGG,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,VA,VA,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Wellcare MGG,Wellcare MGG,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Bright Health - commercial,Bright Health - commercial,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1428,1428,Bright Health MGG,Bright Health MGG,1428,,,,,,,case rate,1428,1428,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Aetna,Aetna,165.25,,,,,,,per diem,165.25,165.25,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Aetna MGG,Aetna MGG,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,BCBS,BCBS,165.25,,,,,,,per diem,165.25,165.25,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,BCBS MGG,BCBS MGG,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Cigna,Cigna,165.25,,,,,,,per diem,165.25,165.25,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Cigna MGG,Cigna MGG,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Humana,Humana,165.25,,,,,,,per diem,165.25,165.25,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Humana MGG,Humana MGG,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Optum VA,Optum VA,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,UHC,UHC,165.25,,,,,,,per diem,165.25,165.25,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,UHC MGG,UHC MGG,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,VA,VA,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Wellcare MGG,Wellcare MGG,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Bright Health - commercial,Bright Health - commercial,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,165.25,165.25,Bright Health MGG,Bright Health MGG,165.25,,,,,,,case rate,165.25,165.25,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Aetna,Aetna,276.5,,,,,,,per diem,276.5,276.5,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Aetna MGG,Aetna MGG,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,BCBS,BCBS,276.5,,,,,,,per diem,276.5,276.5,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,BCBS MGG,BCBS MGG,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Cigna,Cigna,276.5,,,,,,,per diem,276.5,276.5,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Cigna MGG,Cigna MGG,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Humana,Humana,276.5,,,,,,,per diem,276.5,276.5,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Humana MGG,Humana MGG,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Optum VA,Optum VA,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,UHC,UHC,276.5,,,,,,,per diem,276.5,276.5,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,UHC MGG,UHC MGG,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,VA,VA,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Wellcare MGG,Wellcare MGG,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Bright Health - commercial,Bright Health - commercial,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,276.5,276.5,Bright Health MGG,Bright Health MGG,276.5,,,,,,,case rate,276.5,276.5,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Aetna,Aetna,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Aetna MGG,Aetna MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,BCBS,BCBS,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,BCBS MGG,BCBS MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Cigna,Cigna,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Cigna MGG,Cigna MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Humana,Humana,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Humana MGG,Humana MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Optum VA,Optum VA,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,UHC,UHC,256,,,,,,,per diem,256,256,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,UHC MGG,UHC MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,VA,VA,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Wellcare MGG,Wellcare MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Bright Health - commercial,Bright Health - commercial,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,256,256,Bright Health MGG,Bright Health MGG,256,,,,,,,case rate,256,256,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Aetna,Aetna,303.83,,,,,,,per diem,303.83,303.83,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Aetna MGG,Aetna MGG,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,BCBS,BCBS,303.83,,,,,,,per diem,303.83,303.83,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,BCBS MGG,BCBS MGG,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Cigna,Cigna,303.83,,,,,,,per diem,303.83,303.83,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Cigna MGG,Cigna MGG,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Humana,Humana,303.83,,,,,,,per diem,303.83,303.83,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Humana MGG,Humana MGG,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Optum VA,Optum VA,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,UHC,UHC,303.83,,,,,,,per diem,303.83,303.83,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,UHC MGG,UHC MGG,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,VA,VA,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Wellcare MGG,Wellcare MGG,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Bright Health - commercial,Bright Health - commercial,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,303.83,303.83,Bright Health MGG,Bright Health MGG,303.83,,,,,,,case rate,303.83,303.83,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Aetna,Aetna,312,,,,,,,per diem,312,312,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Aetna MGG,Aetna MGG,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,BCBS,BCBS,312,,,,,,,per diem,312,312,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,BCBS MGG,BCBS MGG,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Cigna,Cigna,312,,,,,,,per diem,312,312,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Cigna MGG,Cigna MGG,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Humana,Humana,312,,,,,,,per diem,312,312,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Humana MGG,Humana MGG,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Optum VA,Optum VA,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,UHC,UHC,312,,,,,,,per diem,312,312,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,UHC MGG,UHC MGG,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,VA,VA,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Wellcare MGG,Wellcare MGG,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Bright Health - commercial,Bright Health - commercial,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,312,312,Bright Health MGG,Bright Health MGG,312,,,,,,,case rate,312,312,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Aetna,Aetna,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Aetna MGG,Aetna MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,BCBS,BCBS,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,BCBS MGG,BCBS MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Cigna,Cigna,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Cigna MGG,Cigna MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Humana,Humana,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Humana MGG,Humana MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Optum VA,Optum VA,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,UHC,UHC,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,UHC MGG,UHC MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,VA,VA,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Wellcare MGG,Wellcare MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Bright Health - commercial,Bright Health - commercial,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,100,100,Bright Health MGG,Bright Health MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Aetna,Aetna,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Aetna MGG,Aetna MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,BCBS,BCBS,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,BCBS MGG,BCBS MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Cigna,Cigna,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Cigna MGG,Cigna MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Humana,Humana,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Humana MGG,Humana MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Optum VA,Optum VA,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,UHC,UHC,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,UHC MGG,UHC MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,VA,VA,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Wellcare MGG,Wellcare MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Bright Health - commercial,Bright Health - commercial,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,163.68,163.68,Bright Health MGG,Bright Health MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Aetna,Aetna,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Aetna MGG,Aetna MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,BCBS,BCBS,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,BCBS MGG,BCBS MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Cigna,Cigna,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Cigna MGG,Cigna MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Humana,Humana,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Humana MGG,Humana MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Optum VA,Optum VA,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,UHC,UHC,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,UHC MGG,UHC MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,VA,VA,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Wellcare MGG,Wellcare MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Bright Health - commercial,Bright Health - commercial,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,220.5,220.5,Bright Health MGG,Bright Health MGG,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Aetna,Aetna,527.67,,,,,,,per diem,527.67,527.67,"Per diem rate, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Aetna MGG,Aetna MGG,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,BCBS,BCBS,527.67,,,,,,,per diem,527.67,527.67,"Per diem rate, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,BCBS MGG,BCBS MGG,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Cigna,Cigna,527.67,,,,,,,per diem,527.67,527.67,"Per diem rate, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Cigna MGG,Cigna MGG,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Humana,Humana,527.67,,,,,,,per diem,527.67,527.67,"Per diem rate, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Humana MGG,Humana MGG,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Optum VA,Optum VA,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,UHC,UHC,527.67,,,,,,,per diem,527.67,527.67,"Per diem rate, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,UHC MGG,UHC MGG,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,VA,VA,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Wellcare MGG,Wellcare MGG,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Bright Health - commercial,Bright Health - commercial,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
CLAVICLE LT                   ,74010036,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,527.67,527.67,Bright Health MGG,Bright Health MGG,527.67,,,,,,,case rate,527.67,527.67,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Aetna,Aetna,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Aetna MGG,Aetna MGG,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,BCBS,BCBS,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,BCBS MGG,BCBS MGG,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Cigna,Cigna,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Cigna MGG,Cigna MGG,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Humana,Humana,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Humana MGG,Humana MGG,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Optum VA,Optum VA,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,UHC,UHC,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,UHC MGG,UHC MGG,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,VA,VA,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Wellcare MGG,Wellcare MGG,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Bright Health - commercial,Bright Health - commercial,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,136.5,136.5,Bright Health MGG,Bright Health MGG,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Aetna,Aetna,226.5,,,,,,,per diem,226.5,226.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Aetna MGG,Aetna MGG,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,BCBS,BCBS,226.5,,,,,,,per diem,226.5,226.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,BCBS MGG,BCBS MGG,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Cigna,Cigna,226.5,,,,,,,per diem,226.5,226.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Cigna MGG,Cigna MGG,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Humana,Humana,226.5,,,,,,,per diem,226.5,226.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Humana MGG,Humana MGG,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Optum VA,Optum VA,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,UHC,UHC,226.5,,,,,,,per diem,226.5,226.5,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,UHC MGG,UHC MGG,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,VA,VA,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Wellcare MGG,Wellcare MGG,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Bright Health - commercial,Bright Health - commercial,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,226.5,226.5,Bright Health MGG,Bright Health MGG,226.5,,,,,,,case rate,226.5,226.5,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Aetna,Aetna,313.86,,,,,,,per diem,313.86,313.86,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Aetna MGG,Aetna MGG,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,BCBS,BCBS,313.86,,,,,,,per diem,313.86,313.86,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,BCBS MGG,BCBS MGG,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Cigna,Cigna,313.86,,,,,,,per diem,313.86,313.86,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Cigna MGG,Cigna MGG,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Humana,Humana,313.86,,,,,,,per diem,313.86,313.86,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Humana MGG,Humana MGG,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Optum VA,Optum VA,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,UHC,UHC,313.86,,,,,,,per diem,313.86,313.86,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,UHC MGG,UHC MGG,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,VA,VA,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Wellcare MGG,Wellcare MGG,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Bright Health - commercial,Bright Health - commercial,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,313.86,313.86,Bright Health MGG,Bright Health MGG,313.86,,,,,,,case rate,313.86,313.86,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Aetna,Aetna,424,,,,,,,per diem,424,424,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Aetna MGG,Aetna MGG,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,BCBS,BCBS,424,,,,,,,per diem,424,424,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,BCBS MGG,BCBS MGG,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Cigna,Cigna,424,,,,,,,per diem,424,424,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Cigna MGG,Cigna MGG,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Humana,Humana,424,,,,,,,per diem,424,424,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Humana MGG,Humana MGG,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Optum VA,Optum VA,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,UHC,UHC,424,,,,,,,per diem,424,424,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,UHC MGG,UHC MGG,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,VA,VA,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Wellcare MGG,Wellcare MGG,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Bright Health - commercial,Bright Health - commercial,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,424,424,Bright Health MGG,Bright Health MGG,424,,,,,,,case rate,424,424,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Aetna,Aetna,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Aetna MGG,Aetna MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,BCBS,BCBS,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,BCBS MGG,BCBS MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Cigna,Cigna,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Cigna MGG,Cigna MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Humana,Humana,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Humana MGG,Humana MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Optum VA,Optum VA,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,UHC,UHC,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,UHC MGG,UHC MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,VA,VA,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Wellcare MGG,Wellcare MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Bright Health - commercial,Bright Health - commercial,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY RT            ,74010041,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,7832.85,7832.85,Bright Health MGG,Bright Health MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Aetna,Aetna,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Aetna MGG,Aetna MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,BCBS,BCBS,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,BCBS MGG,BCBS MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Cigna,Cigna,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Cigna MGG,Cigna MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Humana,Humana,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Humana MGG,Humana MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Optum VA,Optum VA,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,UHC,UHC,7832.85,,,,,,,per diem,7832.85,7832.85,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,UHC MGG,UHC MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,VA,VA,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Wellcare MGG,Wellcare MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Bright Health - commercial,Bright Health - commercial,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY LT            ,74010042,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,7832.85,7832.85,Bright Health MGG,Bright Health MGG,7832.85,,,,,,,case rate,7832.85,7832.85,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Aetna,Aetna,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Aetna MGG,Aetna MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,BCBS,BCBS,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,BCBS MGG,BCBS MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Cigna,Cigna,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Cigna MGG,Cigna MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Humana,Humana,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Humana MGG,Humana MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Optum VA,Optum VA,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,UHC,UHC,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,UHC MGG,UHC MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,VA,VA,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Wellcare MGG,Wellcare MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Bright Health - commercial,Bright Health - commercial,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,100,100,Bright Health MGG,Bright Health MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Aetna,Aetna,322.7,,,,,,,per diem,322.7,322.7,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Aetna MGG,Aetna MGG,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,BCBS,BCBS,322.7,,,,,,,per diem,322.7,322.7,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,BCBS MGG,BCBS MGG,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Cigna,Cigna,322.7,,,,,,,per diem,322.7,322.7,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Cigna MGG,Cigna MGG,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Humana,Humana,322.7,,,,,,,per diem,322.7,322.7,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Humana MGG,Humana MGG,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Optum VA,Optum VA,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,UHC,UHC,322.7,,,,,,,per diem,322.7,322.7,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,UHC MGG,UHC MGG,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,VA,VA,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Wellcare MGG,Wellcare MGG,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Bright Health - commercial,Bright Health - commercial,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,322.7,322.7,Bright Health MGG,Bright Health MGG,322.7,,,,,,,case rate,322.7,322.7,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Aetna,Aetna,293.75,,,,,,,per diem,293.75,293.75,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Aetna MGG,Aetna MGG,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,BCBS,BCBS,293.75,,,,,,,per diem,293.75,293.75,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,BCBS MGG,BCBS MGG,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Cigna,Cigna,293.75,,,,,,,per diem,293.75,293.75,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Cigna MGG,Cigna MGG,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Humana,Humana,293.75,,,,,,,per diem,293.75,293.75,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Humana MGG,Humana MGG,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Optum VA,Optum VA,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,UHC,UHC,293.75,,,,,,,per diem,293.75,293.75,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,UHC MGG,UHC MGG,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,VA,VA,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Wellcare MGG,Wellcare MGG,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Bright Health - commercial,Bright Health - commercial,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,293.75,293.75,Bright Health MGG,Bright Health MGG,293.75,,,,,,,case rate,293.75,293.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Aetna,Aetna,344,,,,,,,per diem,344,344,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Aetna MGG,Aetna MGG,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,BCBS,BCBS,344,,,,,,,per diem,344,344,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,BCBS MGG,BCBS MGG,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Cigna,Cigna,344,,,,,,,per diem,344,344,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Cigna MGG,Cigna MGG,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Humana,Humana,344,,,,,,,per diem,344,344,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Humana MGG,Humana MGG,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Optum VA,Optum VA,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,UHC,UHC,344,,,,,,,per diem,344,344,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,UHC MGG,UHC MGG,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,VA,VA,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Wellcare MGG,Wellcare MGG,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Bright Health - commercial,Bright Health - commercial,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS RT         ,74010052,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,344,344,Bright Health MGG,Bright Health MGG,344,,,,,,,case rate,344,344,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Aetna,Aetna,296.5,,,,,,,per diem,296.5,296.5,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Aetna MGG,Aetna MGG,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,BCBS,BCBS,296.5,,,,,,,per diem,296.5,296.5,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,BCBS MGG,BCBS MGG,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Cigna,Cigna,296.5,,,,,,,per diem,296.5,296.5,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Cigna MGG,Cigna MGG,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Humana,Humana,296.5,,,,,,,per diem,296.5,296.5,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Humana MGG,Humana MGG,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Optum VA,Optum VA,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,UHC,UHC,296.5,,,,,,,per diem,296.5,296.5,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,UHC MGG,UHC MGG,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,VA,VA,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Wellcare MGG,Wellcare MGG,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Bright Health - commercial,Bright Health - commercial,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,296.5,296.5,Bright Health MGG,Bright Health MGG,296.5,,,,,,,case rate,296.5,296.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Aetna,Aetna,269.31,,,,,,,per diem,269.31,269.31,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Aetna MGG,Aetna MGG,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,BCBS,BCBS,269.31,,,,,,,per diem,269.31,269.31,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,BCBS MGG,BCBS MGG,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Cigna,Cigna,269.31,,,,,,,per diem,269.31,269.31,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Cigna MGG,Cigna MGG,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Humana,Humana,269.31,,,,,,,per diem,269.31,269.31,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Humana MGG,Humana MGG,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Optum VA,Optum VA,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,UHC,UHC,269.31,,,,,,,per diem,269.31,269.31,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,UHC MGG,UHC MGG,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,VA,VA,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Wellcare MGG,Wellcare MGG,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Bright Health - commercial,Bright Health - commercial,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,269.31,269.31,Bright Health MGG,Bright Health MGG,269.31,,,,,,,case rate,269.31,269.31,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Aetna,Aetna,314.29,,,,,,,per diem,314.29,314.29,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Aetna MGG,Aetna MGG,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,BCBS,BCBS,314.29,,,,,,,per diem,314.29,314.29,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,BCBS MGG,BCBS MGG,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Cigna,Cigna,314.29,,,,,,,per diem,314.29,314.29,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Cigna MGG,Cigna MGG,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Humana,Humana,314.29,,,,,,,per diem,314.29,314.29,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Humana MGG,Humana MGG,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Optum VA,Optum VA,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,UHC,UHC,314.29,,,,,,,per diem,314.29,314.29,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,UHC MGG,UHC MGG,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,VA,VA,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Wellcare MGG,Wellcare MGG,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Bright Health - commercial,Bright Health - commercial,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,314.29,314.29,Bright Health MGG,Bright Health MGG,314.29,,,,,,,case rate,314.29,314.29,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Aetna,Aetna,282,,,,,,,per diem,282,282,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Aetna MGG,Aetna MGG,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,BCBS,BCBS,282,,,,,,,per diem,282,282,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,BCBS MGG,BCBS MGG,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Cigna,Cigna,282,,,,,,,per diem,282,282,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Cigna MGG,Cigna MGG,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Humana,Humana,282,,,,,,,per diem,282,282,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Humana MGG,Humana MGG,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Optum VA,Optum VA,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,UHC,UHC,282,,,,,,,per diem,282,282,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,UHC MGG,UHC MGG,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,VA,VA,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Wellcare MGG,Wellcare MGG,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Bright Health - commercial,Bright Health - commercial,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,282,282,Bright Health MGG,Bright Health MGG,282,,,,,,,case rate,282,282,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Aetna,Aetna,355,,,,,,,per diem,355,355,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Aetna MGG,Aetna MGG,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,BCBS,BCBS,355,,,,,,,per diem,355,355,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,BCBS MGG,BCBS MGG,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Cigna,Cigna,355,,,,,,,per diem,355,355,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Cigna MGG,Cigna MGG,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Humana,Humana,355,,,,,,,per diem,355,355,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Humana MGG,Humana MGG,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Optum VA,Optum VA,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,UHC,UHC,355,,,,,,,per diem,355,355,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,UHC MGG,UHC MGG,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,VA,VA,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Wellcare MGG,Wellcare MGG,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Bright Health - commercial,Bright Health - commercial,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,355,355,Bright Health MGG,Bright Health MGG,355,,,,,,,case rate,355,355,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Aetna,Aetna,225.53,,,,,,,per diem,225.53,225.53,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Aetna MGG,Aetna MGG,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,BCBS,BCBS,225.53,,,,,,,per diem,225.53,225.53,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,BCBS MGG,BCBS MGG,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Cigna,Cigna,225.53,,,,,,,per diem,225.53,225.53,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Cigna MGG,Cigna MGG,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Humana,Humana,225.53,,,,,,,per diem,225.53,225.53,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Humana MGG,Humana MGG,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Optum VA,Optum VA,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,UHC,UHC,225.53,,,,,,,per diem,225.53,225.53,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,UHC MGG,UHC MGG,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,VA,VA,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Wellcare MGG,Wellcare MGG,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Bright Health - commercial,Bright Health - commercial,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,225.53,225.53,Bright Health MGG,Bright Health MGG,225.53,,,,,,,case rate,225.53,225.53,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Aetna,Aetna,260.18,,,,,,,per diem,260.18,260.18,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Aetna MGG,Aetna MGG,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,BCBS,BCBS,260.18,,,,,,,per diem,260.18,260.18,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,BCBS MGG,BCBS MGG,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Cigna,Cigna,260.18,,,,,,,per diem,260.18,260.18,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Cigna MGG,Cigna MGG,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Humana,Humana,260.18,,,,,,,per diem,260.18,260.18,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Humana MGG,Humana MGG,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Optum VA,Optum VA,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,UHC,UHC,260.18,,,,,,,per diem,260.18,260.18,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,UHC MGG,UHC MGG,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,VA,VA,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Wellcare MGG,Wellcare MGG,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Bright Health - commercial,Bright Health - commercial,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,260.18,260.18,Bright Health MGG,Bright Health MGG,260.18,,,,,,,case rate,260.18,260.18,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Aetna,Aetna,266.69,,,,,,,per diem,266.69,266.69,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Aetna MGG,Aetna MGG,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,BCBS,BCBS,266.69,,,,,,,per diem,266.69,266.69,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,BCBS MGG,BCBS MGG,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Cigna,Cigna,266.69,,,,,,,per diem,266.69,266.69,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Cigna MGG,Cigna MGG,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Humana,Humana,266.69,,,,,,,per diem,266.69,266.69,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Humana MGG,Humana MGG,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Optum VA,Optum VA,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,UHC,UHC,266.69,,,,,,,per diem,266.69,266.69,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,UHC MGG,UHC MGG,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,VA,VA,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Wellcare MGG,Wellcare MGG,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Bright Health - commercial,Bright Health - commercial,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,266.69,266.69,Bright Health MGG,Bright Health MGG,266.69,,,,,,,case rate,266.69,266.69,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Aetna,Aetna,259.48,,,,,,,per diem,259.48,259.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Aetna MGG,Aetna MGG,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,BCBS,BCBS,259.48,,,,,,,per diem,259.48,259.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,BCBS MGG,BCBS MGG,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Cigna,Cigna,259.48,,,,,,,per diem,259.48,259.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Cigna MGG,Cigna MGG,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Humana,Humana,259.48,,,,,,,per diem,259.48,259.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Humana MGG,Humana MGG,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Optum VA,Optum VA,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,UHC,UHC,259.48,,,,,,,per diem,259.48,259.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,UHC MGG,UHC MGG,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,VA,VA,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Wellcare MGG,Wellcare MGG,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Bright Health - commercial,Bright Health - commercial,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,259.48,259.48,Bright Health MGG,Bright Health MGG,259.48,,,,,,,case rate,259.48,259.48,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Aetna,Aetna,281.29,,,,,,,per diem,281.29,281.29,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Aetna MGG,Aetna MGG,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,BCBS,BCBS,281.29,,,,,,,per diem,281.29,281.29,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,BCBS MGG,BCBS MGG,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Cigna,Cigna,281.29,,,,,,,per diem,281.29,281.29,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Cigna MGG,Cigna MGG,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Humana,Humana,281.29,,,,,,,per diem,281.29,281.29,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Humana MGG,Humana MGG,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Optum VA,Optum VA,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,UHC,UHC,281.29,,,,,,,per diem,281.29,281.29,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,UHC MGG,UHC MGG,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,VA,VA,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Wellcare MGG,Wellcare MGG,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Bright Health - commercial,Bright Health - commercial,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,281.29,281.29,Bright Health MGG,Bright Health MGG,281.29,,,,,,,case rate,281.29,281.29,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Aetna,Aetna,326.21,,,,,,,per diem,326.21,326.21,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Aetna MGG,Aetna MGG,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,BCBS,BCBS,326.21,,,,,,,per diem,326.21,326.21,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,BCBS MGG,BCBS MGG,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Cigna,Cigna,326.21,,,,,,,per diem,326.21,326.21,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Cigna MGG,Cigna MGG,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Humana,Humana,326.21,,,,,,,per diem,326.21,326.21,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Humana MGG,Humana MGG,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Optum VA,Optum VA,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,UHC,UHC,326.21,,,,,,,per diem,326.21,326.21,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,UHC MGG,UHC MGG,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,VA,VA,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Wellcare MGG,Wellcare MGG,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Bright Health - commercial,Bright Health - commercial,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,326.21,326.21,Bright Health MGG,Bright Health MGG,326.21,,,,,,,case rate,326.21,326.21,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Aetna,Aetna,256.45,,,,,,,per diem,256.45,256.45,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Aetna MGG,Aetna MGG,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,BCBS,BCBS,256.45,,,,,,,per diem,256.45,256.45,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,BCBS MGG,BCBS MGG,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Cigna,Cigna,256.45,,,,,,,per diem,256.45,256.45,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Cigna MGG,Cigna MGG,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Humana,Humana,256.45,,,,,,,per diem,256.45,256.45,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Humana MGG,Humana MGG,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Optum VA,Optum VA,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,UHC,UHC,256.45,,,,,,,per diem,256.45,256.45,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,UHC MGG,UHC MGG,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,VA,VA,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Wellcare MGG,Wellcare MGG,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Bright Health - commercial,Bright Health - commercial,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,256.45,256.45,Bright Health MGG,Bright Health MGG,256.45,,,,,,,case rate,256.45,256.45,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Aetna,Aetna,252.04,,,,,,,per diem,252.04,252.04,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Aetna MGG,Aetna MGG,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,BCBS,BCBS,252.04,,,,,,,per diem,252.04,252.04,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,BCBS MGG,BCBS MGG,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Cigna,Cigna,252.04,,,,,,,per diem,252.04,252.04,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Cigna MGG,Cigna MGG,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Humana,Humana,252.04,,,,,,,per diem,252.04,252.04,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Humana MGG,Humana MGG,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Optum VA,Optum VA,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,UHC,UHC,252.04,,,,,,,per diem,252.04,252.04,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,UHC MGG,UHC MGG,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,VA,VA,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Wellcare MGG,Wellcare MGG,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Bright Health - commercial,Bright Health - commercial,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS RT              ,74010075,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,252.04,252.04,Bright Health MGG,Bright Health MGG,252.04,,,,,,,case rate,252.04,252.04,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Aetna,Aetna,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Aetna MGG,Aetna MGG,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,BCBS,BCBS,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,BCBS MGG,BCBS MGG,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Cigna,Cigna,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Cigna MGG,Cigna MGG,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Humana,Humana,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Humana MGG,Humana MGG,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Optum VA,Optum VA,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,UHC,UHC,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,UHC MGG,UHC MGG,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,VA,VA,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Wellcare MGG,Wellcare MGG,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Bright Health - commercial,Bright Health - commercial,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS LT              ,74010076,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,197.06,197.06,Bright Health MGG,Bright Health MGG,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Aetna,Aetna,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Aetna MGG,Aetna MGG,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,BCBS,BCBS,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,BCBS MGG,BCBS MGG,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Cigna,Cigna,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Cigna MGG,Cigna MGG,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Humana,Humana,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Humana MGG,Humana MGG,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Optum VA,Optum VA,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,UHC,UHC,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,UHC MGG,UHC MGG,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,VA,VA,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Wellcare MGG,Wellcare MGG,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Bright Health - commercial,Bright Health - commercial,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,229.82,229.82,Bright Health MGG,Bright Health MGG,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Aetna,Aetna,294.32,,,,,,,per diem,294.32,294.32,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Aetna MGG,Aetna MGG,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,BCBS,BCBS,294.32,,,,,,,per diem,294.32,294.32,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,BCBS MGG,BCBS MGG,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Cigna,Cigna,294.32,,,,,,,per diem,294.32,294.32,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Cigna MGG,Cigna MGG,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Humana,Humana,294.32,,,,,,,per diem,294.32,294.32,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Humana MGG,Humana MGG,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Optum VA,Optum VA,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,UHC,UHC,294.32,,,,,,,per diem,294.32,294.32,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,UHC MGG,UHC MGG,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,VA,VA,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Wellcare MGG,Wellcare MGG,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Bright Health - commercial,Bright Health - commercial,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,294.32,294.32,Bright Health MGG,Bright Health MGG,294.32,,,,,,,case rate,294.32,294.32,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Aetna,Aetna,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Aetna MGG,Aetna MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,BCBS,BCBS,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,BCBS MGG,BCBS MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Cigna,Cigna,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Cigna MGG,Cigna MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Humana,Humana,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Humana MGG,Humana MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Optum VA,Optum VA,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,UHC,UHC,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,UHC MGG,UHC MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,VA,VA,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Wellcare MGG,Wellcare MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Bright Health - commercial,Bright Health - commercial,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL RT        ,74010079,CDM,401,RC,77065,CPT,G0206,HCPCS,RTRT,Inpatient,,,259,259,Bright Health MGG,Bright Health MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Aetna,Aetna,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Aetna MGG,Aetna MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,BCBS,BCBS,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,BCBS MGG,BCBS MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Cigna,Cigna,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Cigna MGG,Cigna MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Humana,Humana,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Humana MGG,Humana MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Optum VA,Optum VA,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,UHC,UHC,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,UHC MGG,UHC MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,VA,VA,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Wellcare MGG,Wellcare MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Bright Health - commercial,Bright Health - commercial,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG UNIL LT        ,74010080,CDM,401,RC,77065,CPT,G0206,HCPCS,LTLT,Inpatient,,,259,259,Bright Health MGG,Bright Health MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Aetna,Aetna,322.5,,,,,,,per diem,322.5,322.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Aetna MGG,Aetna MGG,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,BCBS,BCBS,322.5,,,,,,,per diem,322.5,322.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,BCBS MGG,BCBS MGG,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Cigna,Cigna,322.5,,,,,,,per diem,322.5,322.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Cigna MGG,Cigna MGG,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Humana,Humana,322.5,,,,,,,per diem,322.5,322.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Humana MGG,Humana MGG,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Optum VA,Optum VA,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,UHC,UHC,322.5,,,,,,,per diem,322.5,322.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,UHC MGG,UHC MGG,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,VA,VA,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Wellcare MGG,Wellcare MGG,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Bright Health - commercial,Bright Health - commercial,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,322.5,322.5,Bright Health MGG,Bright Health MGG,322.5,,,,,,,case rate,322.5,322.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Aetna,Aetna,333,,,,,,,per diem,333,333,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Aetna MGG,Aetna MGG,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,BCBS,BCBS,333,,,,,,,per diem,333,333,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,BCBS MGG,BCBS MGG,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Cigna,Cigna,333,,,,,,,per diem,333,333,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Cigna MGG,Cigna MGG,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Humana,Humana,333,,,,,,,per diem,333,333,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Humana MGG,Humana MGG,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Optum VA,Optum VA,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,UHC,UHC,333,,,,,,,per diem,333,333,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,UHC MGG,UHC MGG,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,VA,VA,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Wellcare MGG,Wellcare MGG,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Bright Health - commercial,Bright Health - commercial,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,333,333,Bright Health MGG,Bright Health MGG,333,,,,,,,case rate,333,333,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Aetna,Aetna,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Aetna MGG,Aetna MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,BCBS,BCBS,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,BCBS MGG,BCBS MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Cigna,Cigna,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Cigna MGG,Cigna MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Humana,Humana,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Humana MGG,Humana MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Optum VA,Optum VA,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,UHC,UHC,27,,,,,,,per diem,27,27,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,UHC MGG,UHC MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,VA,VA,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Wellcare MGG,Wellcare MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Bright Health - commercial,Bright Health - commercial,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,27,27,Bright Health MGG,Bright Health MGG,27,,,,,,,case rate,27,27,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Aetna,Aetna,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Aetna MGG,Aetna MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,BCBS,BCBS,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,BCBS MGG,BCBS MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Cigna,Cigna,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Cigna MGG,Cigna MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Humana,Humana,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Humana MGG,Humana MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Optum VA,Optum VA,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,UHC,UHC,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,UHC MGG,UHC MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,VA,VA,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Wellcare MGG,Wellcare MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Bright Health - commercial,Bright Health - commercial,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SCAPULA LT                    ,74010091,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,283,283,Bright Health MGG,Bright Health MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Aetna,Aetna,336.5,,,,,,,per diem,336.5,336.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Aetna MGG,Aetna MGG,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,BCBS,BCBS,336.5,,,,,,,per diem,336.5,336.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,BCBS MGG,BCBS MGG,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Cigna,Cigna,336.5,,,,,,,per diem,336.5,336.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Cigna MGG,Cigna MGG,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Humana,Humana,336.5,,,,,,,per diem,336.5,336.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Humana MGG,Humana MGG,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Optum VA,Optum VA,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,UHC,UHC,336.5,,,,,,,per diem,336.5,336.5,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,UHC MGG,UHC MGG,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,VA,VA,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Wellcare MGG,Wellcare MGG,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Bright Health - commercial,Bright Health - commercial,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,336.5,336.5,Bright Health MGG,Bright Health MGG,336.5,,,,,,,case rate,336.5,336.5,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Aetna,Aetna,350.67,,,,,,,per diem,350.67,350.67,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Aetna MGG,Aetna MGG,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,BCBS,BCBS,350.67,,,,,,,per diem,350.67,350.67,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,BCBS MGG,BCBS MGG,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Cigna,Cigna,350.67,,,,,,,per diem,350.67,350.67,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Cigna MGG,Cigna MGG,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Humana,Humana,350.67,,,,,,,per diem,350.67,350.67,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Humana MGG,Humana MGG,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Optum VA,Optum VA,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,UHC,UHC,350.67,,,,,,,per diem,350.67,350.67,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,UHC MGG,UHC MGG,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,VA,VA,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Wellcare MGG,Wellcare MGG,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Bright Health - commercial,Bright Health - commercial,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,350.67,350.67,Bright Health MGG,Bright Health MGG,350.67,,,,,,,case rate,350.67,350.67,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Aetna,Aetna,277.34,,,,,,,per diem,277.34,277.34,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Aetna MGG,Aetna MGG,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,BCBS,BCBS,277.34,,,,,,,per diem,277.34,277.34,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,BCBS MGG,BCBS MGG,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Cigna,Cigna,277.34,,,,,,,per diem,277.34,277.34,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Cigna MGG,Cigna MGG,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Humana,Humana,277.34,,,,,,,per diem,277.34,277.34,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Humana MGG,Humana MGG,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Optum VA,Optum VA,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,UHC,UHC,277.34,,,,,,,per diem,277.34,277.34,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,UHC MGG,UHC MGG,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,VA,VA,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Wellcare MGG,Wellcare MGG,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Bright Health - commercial,Bright Health - commercial,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,277.34,277.34,Bright Health MGG,Bright Health MGG,277.34,,,,,,,case rate,277.34,277.34,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Aetna,Aetna,206,,,,,,,per diem,206,206,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Aetna MGG,Aetna MGG,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,BCBS,BCBS,206,,,,,,,per diem,206,206,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,BCBS MGG,BCBS MGG,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Cigna,Cigna,206,,,,,,,per diem,206,206,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Cigna MGG,Cigna MGG,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Humana,Humana,206,,,,,,,per diem,206,206,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Humana MGG,Humana MGG,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Optum VA,Optum VA,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,UHC,UHC,206,,,,,,,per diem,206,206,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,UHC MGG,UHC MGG,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,VA,VA,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Wellcare MGG,Wellcare MGG,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Bright Health - commercial,Bright Health - commercial,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,206,206,Bright Health MGG,Bright Health MGG,206,,,,,,,case rate,206,206,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Aetna,Aetna,270.33,,,,,,,per diem,270.33,270.33,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Aetna MGG,Aetna MGG,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,BCBS,BCBS,270.33,,,,,,,per diem,270.33,270.33,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,BCBS MGG,BCBS MGG,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Cigna,Cigna,270.33,,,,,,,per diem,270.33,270.33,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Cigna MGG,Cigna MGG,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Humana,Humana,270.33,,,,,,,per diem,270.33,270.33,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Humana MGG,Humana MGG,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Optum VA,Optum VA,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,UHC,UHC,270.33,,,,,,,per diem,270.33,270.33,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,UHC MGG,UHC MGG,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,VA,VA,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Wellcare MGG,Wellcare MGG,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Bright Health - commercial,Bright Health - commercial,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,270.33,270.33,Bright Health MGG,Bright Health MGG,270.33,,,,,,,case rate,270.33,270.33,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Aetna,Aetna,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Aetna MGG,Aetna MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,BCBS,BCBS,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,BCBS MGG,BCBS MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Cigna,Cigna,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Cigna MGG,Cigna MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Humana,Humana,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Humana MGG,Humana MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Optum VA,Optum VA,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,UHC,UHC,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,UHC MGG,UHC MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,VA,VA,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Wellcare MGG,Wellcare MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Bright Health - commercial,Bright Health - commercial,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,360,360,Bright Health MGG,Bright Health MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Aetna,Aetna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Aetna MGG,Aetna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,BCBS,BCBS,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,BCBS MGG,BCBS MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Cigna,Cigna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Cigna MGG,Cigna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Humana,Humana,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Humana MGG,Humana MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Optum VA,Optum VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,UHC,UHC,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,UHC MGG,UHC MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,VA,VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Wellcare MGG,Wellcare MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Bright Health - commercial,Bright Health - commercial,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,270,270,Bright Health MGG,Bright Health MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Aetna,Aetna,164.36,,,,,,,per diem,164.36,164.36,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Aetna MGG,Aetna MGG,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,BCBS,BCBS,164.36,,,,,,,per diem,164.36,164.36,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,BCBS MGG,BCBS MGG,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Cigna,Cigna,164.36,,,,,,,per diem,164.36,164.36,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Cigna MGG,Cigna MGG,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Humana,Humana,164.36,,,,,,,per diem,164.36,164.36,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Humana MGG,Humana MGG,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Optum VA,Optum VA,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,UHC,UHC,164.36,,,,,,,per diem,164.36,164.36,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,UHC MGG,UHC MGG,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,VA,VA,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Wellcare MGG,Wellcare MGG,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Bright Health - commercial,Bright Health - commercial,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,164.36,164.36,Bright Health MGG,Bright Health MGG,164.36,,,,,,,case rate,164.36,164.36,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Aetna,Aetna,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Aetna MGG,Aetna MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,BCBS,BCBS,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,BCBS MGG,BCBS MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Cigna,Cigna,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Cigna MGG,Cigna MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Humana,Humana,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Humana MGG,Humana MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Optum VA,Optum VA,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,UHC,UHC,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,UHC MGG,UHC MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,VA,VA,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Wellcare MGG,Wellcare MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Bright Health - commercial,Bright Health - commercial,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,279,279,Bright Health MGG,Bright Health MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Aetna,Aetna,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Aetna MGG,Aetna MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,BCBS,BCBS,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,BCBS MGG,BCBS MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Cigna,Cigna,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Cigna MGG,Cigna MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Humana,Humana,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Humana MGG,Humana MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Optum VA,Optum VA,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,UHC,UHC,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,UHC MGG,UHC MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,VA,VA,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Wellcare MGG,Wellcare MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Bright Health - commercial,Bright Health - commercial,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,228,228,Bright Health MGG,Bright Health MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Aetna,Aetna,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Aetna MGG,Aetna MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,BCBS,BCBS,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,BCBS MGG,BCBS MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Cigna,Cigna,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Cigna MGG,Cigna MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Humana,Humana,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Humana MGG,Humana MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Optum VA,Optum VA,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,UHC,UHC,228,,,,,,,per diem,228,228,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,UHC MGG,UHC MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,VA,VA,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Wellcare MGG,Wellcare MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Bright Health - commercial,Bright Health - commercial,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,228,228,Bright Health MGG,Bright Health MGG,228,,,,,,,case rate,228,228,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Aetna,Aetna,182,,,,,,,per diem,182,182,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Aetna MGG,Aetna MGG,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,BCBS,BCBS,182,,,,,,,per diem,182,182,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,BCBS MGG,BCBS MGG,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Cigna,Cigna,182,,,,,,,per diem,182,182,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Cigna MGG,Cigna MGG,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Humana,Humana,182,,,,,,,per diem,182,182,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Humana MGG,Humana MGG,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Optum VA,Optum VA,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,UHC,UHC,182,,,,,,,per diem,182,182,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,UHC MGG,UHC MGG,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,VA,VA,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Wellcare MGG,Wellcare MGG,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Bright Health - commercial,Bright Health - commercial,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,182,182,Bright Health MGG,Bright Health MGG,182,,,,,,,case rate,182,182,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Aetna,Aetna,258,,,,,,,per diem,258,258,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Aetna MGG,Aetna MGG,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,BCBS,BCBS,258,,,,,,,per diem,258,258,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,BCBS MGG,BCBS MGG,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Cigna,Cigna,258,,,,,,,per diem,258,258,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Cigna MGG,Cigna MGG,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Humana,Humana,258,,,,,,,per diem,258,258,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Humana MGG,Humana MGG,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Optum VA,Optum VA,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,UHC,UHC,258,,,,,,,per diem,258,258,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,UHC MGG,UHC MGG,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,VA,VA,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Wellcare MGG,Wellcare MGG,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Bright Health - commercial,Bright Health - commercial,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,258,258,Bright Health MGG,Bright Health MGG,258,,,,,,,case rate,258,258,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Aetna,Aetna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Aetna MGG,Aetna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,BCBS,BCBS,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,BCBS MGG,BCBS MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Cigna,Cigna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Cigna MGG,Cigna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Humana,Humana,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Humana MGG,Humana MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Optum VA,Optum VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,UHC,UHC,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,UHC MGG,UHC MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,VA,VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Wellcare MGG,Wellcare MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Bright Health - commercial,Bright Health - commercial,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,156,156,Bright Health MGG,Bright Health MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Aetna,Aetna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Aetna MGG,Aetna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,BCBS,BCBS,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,BCBS MGG,BCBS MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Cigna,Cigna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Cigna MGG,Cigna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Humana,Humana,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Humana MGG,Humana MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Optum VA,Optum VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,UHC,UHC,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,UHC MGG,UHC MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,VA,VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Wellcare MGG,Wellcare MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Bright Health - commercial,Bright Health - commercial,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,156,156,Bright Health MGG,Bright Health MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Aetna,Aetna,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Aetna MGG,Aetna MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,BCBS,BCBS,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,BCBS MGG,BCBS MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Cigna,Cigna,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Cigna MGG,Cigna MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Humana,Humana,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Humana MGG,Humana MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Optum VA,Optum VA,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,UHC,UHC,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,UHC MGG,UHC MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,VA,VA,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Wellcare MGG,Wellcare MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Bright Health - commercial,Bright Health - commercial,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Bright Health MGG,Bright Health MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Aetna,Aetna,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Aetna MGG,Aetna MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,BCBS,BCBS,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,BCBS MGG,BCBS MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Cigna,Cigna,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Cigna MGG,Cigna MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Humana,Humana,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Humana MGG,Humana MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Optum VA,Optum VA,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,UHC,UHC,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,UHC MGG,UHC MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,VA,VA,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Wellcare MGG,Wellcare MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Bright Health - commercial,Bright Health - commercial,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,375,375,Bright Health MGG,Bright Health MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Aetna,Aetna,611,,,,,,,per diem,611,611,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Aetna MGG,Aetna MGG,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,BCBS,BCBS,611,,,,,,,per diem,611,611,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,BCBS MGG,BCBS MGG,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Cigna,Cigna,611,,,,,,,per diem,611,611,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Cigna MGG,Cigna MGG,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Humana,Humana,611,,,,,,,per diem,611,611,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Humana MGG,Humana MGG,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Optum VA,Optum VA,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,UHC,UHC,611,,,,,,,per diem,611,611,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,UHC MGG,UHC MGG,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,VA,VA,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Wellcare MGG,Wellcare MGG,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Bright Health - commercial,Bright Health - commercial,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,611,611,Bright Health MGG,Bright Health MGG,611,,,,,,,case rate,611,611,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Aetna,Aetna,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Aetna MGG,Aetna MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,BCBS,BCBS,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,BCBS MGG,BCBS MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Cigna,Cigna,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Cigna MGG,Cigna MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Humana,Humana,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Humana MGG,Humana MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Optum VA,Optum VA,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,UHC,UHC,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,UHC MGG,UHC MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,VA,VA,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Wellcare MGG,Wellcare MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Bright Health - commercial,Bright Health - commercial,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Bright Health MGG,Bright Health MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Aetna,Aetna,369.51,,,,,,,per diem,369.51,369.51,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Aetna MGG,Aetna MGG,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,BCBS,BCBS,369.51,,,,,,,per diem,369.51,369.51,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,BCBS MGG,BCBS MGG,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Cigna,Cigna,369.51,,,,,,,per diem,369.51,369.51,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Cigna MGG,Cigna MGG,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Humana,Humana,369.51,,,,,,,per diem,369.51,369.51,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Humana MGG,Humana MGG,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Optum VA,Optum VA,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,UHC,UHC,369.51,,,,,,,per diem,369.51,369.51,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,UHC MGG,UHC MGG,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,VA,VA,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Wellcare MGG,Wellcare MGG,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Bright Health - commercial,Bright Health - commercial,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,369.51,369.51,Bright Health MGG,Bright Health MGG,369.51,,,,,,,case rate,369.51,369.51,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Aetna,Aetna,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Aetna MGG,Aetna MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,BCBS,BCBS,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,BCBS MGG,BCBS MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Cigna,Cigna,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Cigna MGG,Cigna MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Humana,Humana,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Humana MGG,Humana MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Optum VA,Optum VA,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,UHC,UHC,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,UHC MGG,UHC MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,VA,VA,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Wellcare MGG,Wellcare MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Bright Health - commercial,Bright Health - commercial,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM >400MG/ML IODINE/1ML     ,74020006,CDM,255,RC,Q9951,HCPCS,,,,Inpatient,1,EA,259,259,Bright Health MGG,Bright Health MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Aetna,Aetna,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Aetna MGG,Aetna MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,BCBS,BCBS,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,BCBS MGG,BCBS MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Cigna,Cigna,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Cigna MGG,Cigna MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Humana,Humana,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Humana MGG,Humana MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Optum VA,Optum VA,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,UHC,UHC,259,,,,,,,per diem,259,259,"Per diem rate, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,UHC MGG,UHC MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,VA,VA,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Wellcare MGG,Wellcare MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Bright Health - commercial,Bright Health - commercial,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 100-199MG/ML IODINE/1ML  ,74020007,CDM,255,RC,Q9965,HCPCS,,,,Inpatient,1,EA,259,259,Bright Health MGG,Bright Health MGG,259,,,,,,,case rate,259,259,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Aetna,Aetna,2.78,,,,,,,per diem,2.78,2.78,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Aetna MGG,Aetna MGG,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,BCBS,BCBS,2.78,,,,,,,per diem,2.78,2.78,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,BCBS MGG,BCBS MGG,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Cigna,Cigna,2.78,,,,,,,per diem,2.78,2.78,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Cigna MGG,Cigna MGG,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Humana,Humana,2.78,,,,,,,per diem,2.78,2.78,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Humana MGG,Humana MGG,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Optum VA,Optum VA,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,UHC,UHC,2.78,,,,,,,per diem,2.78,2.78,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,UHC MGG,UHC MGG,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,VA,VA,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Wellcare MGG,Wellcare MGG,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Bright Health - commercial,Bright Health - commercial,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.78,2.78,Bright Health MGG,Bright Health MGG,2.78,,,,,,,case rate,2.78,2.78,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Aetna,Aetna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Aetna MGG,Aetna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,BCBS,BCBS,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,BCBS MGG,BCBS MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Cigna,Cigna,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Cigna MGG,Cigna MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Humana,Humana,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Humana MGG,Humana MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Optum VA,Optum VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,UHC,UHC,75,,,,,,,per diem,75,75,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,UHC MGG,UHC MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,VA,VA,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Wellcare MGG,Wellcare MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Bright Health - commercial,Bright Health - commercial,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,75,75,Bright Health MGG,Bright Health MGG,75,,,,,,,case rate,75,75,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Aetna,Aetna,303.13,,,,,,,per diem,303.13,303.13,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Aetna MGG,Aetna MGG,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,BCBS,BCBS,303.13,,,,,,,per diem,303.13,303.13,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,BCBS MGG,BCBS MGG,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Cigna,Cigna,303.13,,,,,,,per diem,303.13,303.13,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Cigna MGG,Cigna MGG,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Humana,Humana,303.13,,,,,,,per diem,303.13,303.13,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Humana MGG,Humana MGG,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Optum VA,Optum VA,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,UHC,UHC,303.13,,,,,,,per diem,303.13,303.13,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,UHC MGG,UHC MGG,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,VA,VA,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Wellcare MGG,Wellcare MGG,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Bright Health - commercial,Bright Health - commercial,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,303.13,303.13,Bright Health MGG,Bright Health MGG,303.13,,,,,,,case rate,303.13,303.13,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Aetna,Aetna,66.14,,,,,,,per diem,66.14,66.14,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Aetna MGG,Aetna MGG,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,BCBS,BCBS,66.14,,,,,,,per diem,66.14,66.14,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,BCBS MGG,BCBS MGG,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Cigna,Cigna,66.14,,,,,,,per diem,66.14,66.14,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Cigna MGG,Cigna MGG,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Humana,Humana,66.14,,,,,,,per diem,66.14,66.14,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Humana MGG,Humana MGG,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Optum VA,Optum VA,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,UHC,UHC,66.14,,,,,,,per diem,66.14,66.14,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,UHC MGG,UHC MGG,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,VA,VA,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Wellcare MGG,Wellcare MGG,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Bright Health - commercial,Bright Health - commercial,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,66.14,66.14,Bright Health MGG,Bright Health MGG,66.14,,,,,,,case rate,66.14,66.14,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Aetna,Aetna,255.38,,,,,,,per diem,255.38,255.38,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Aetna MGG,Aetna MGG,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,BCBS,BCBS,255.38,,,,,,,per diem,255.38,255.38,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,BCBS MGG,BCBS MGG,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Cigna,Cigna,255.38,,,,,,,per diem,255.38,255.38,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Cigna MGG,Cigna MGG,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Humana,Humana,255.38,,,,,,,per diem,255.38,255.38,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Humana MGG,Humana MGG,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Optum VA,Optum VA,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,UHC,UHC,255.38,,,,,,,per diem,255.38,255.38,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,UHC MGG,UHC MGG,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,VA,VA,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Wellcare MGG,Wellcare MGG,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Bright Health - commercial,Bright Health - commercial,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,255.38,255.38,Bright Health MGG,Bright Health MGG,255.38,,,,,,,case rate,255.38,255.38,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Aetna,Aetna,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Aetna MGG,Aetna MGG,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,BCBS,BCBS,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,BCBS MGG,BCBS MGG,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Cigna,Cigna,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Cigna MGG,Cigna MGG,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Humana,Humana,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Humana MGG,Humana MGG,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Optum VA,Optum VA,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,UHC,UHC,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,UHC MGG,UHC MGG,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,VA,VA,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Wellcare MGG,Wellcare MGG,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Bright Health - commercial,Bright Health - commercial,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,207.47,207.47,Bright Health MGG,Bright Health MGG,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Aetna,Aetna,198.62,,,,,,,per diem,198.62,198.62,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Aetna MGG,Aetna MGG,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,BCBS,BCBS,198.62,,,,,,,per diem,198.62,198.62,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,BCBS MGG,BCBS MGG,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Cigna,Cigna,198.62,,,,,,,per diem,198.62,198.62,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Cigna MGG,Cigna MGG,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Humana,Humana,198.62,,,,,,,per diem,198.62,198.62,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Humana MGG,Humana MGG,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Optum VA,Optum VA,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,UHC,UHC,198.62,,,,,,,per diem,198.62,198.62,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,UHC MGG,UHC MGG,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,VA,VA,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Wellcare MGG,Wellcare MGG,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Bright Health - commercial,Bright Health - commercial,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,198.62,198.62,Bright Health MGG,Bright Health MGG,198.62,,,,,,,case rate,198.62,198.62,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Aetna,Aetna,174.78,,,,,,,per diem,174.78,174.78,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Aetna MGG,Aetna MGG,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,BCBS,BCBS,174.78,,,,,,,per diem,174.78,174.78,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,BCBS MGG,BCBS MGG,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Cigna,Cigna,174.78,,,,,,,per diem,174.78,174.78,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Cigna MGG,Cigna MGG,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Humana,Humana,174.78,,,,,,,per diem,174.78,174.78,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Humana MGG,Humana MGG,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Optum VA,Optum VA,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,UHC,UHC,174.78,,,,,,,per diem,174.78,174.78,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,UHC MGG,UHC MGG,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,VA,VA,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Wellcare MGG,Wellcare MGG,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Bright Health - commercial,Bright Health - commercial,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,174.78,174.78,Bright Health MGG,Bright Health MGG,174.78,,,,,,,case rate,174.78,174.78,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Aetna,Aetna,247.27,,,,,,,per diem,247.27,247.27,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Aetna MGG,Aetna MGG,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,BCBS,BCBS,247.27,,,,,,,per diem,247.27,247.27,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,BCBS MGG,BCBS MGG,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Cigna,Cigna,247.27,,,,,,,per diem,247.27,247.27,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Cigna MGG,Cigna MGG,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Humana,Humana,247.27,,,,,,,per diem,247.27,247.27,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Humana MGG,Humana MGG,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Optum VA,Optum VA,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,UHC,UHC,247.27,,,,,,,per diem,247.27,247.27,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,UHC MGG,UHC MGG,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,VA,VA,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Wellcare MGG,Wellcare MGG,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Bright Health - commercial,Bright Health - commercial,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,247.27,247.27,Bright Health MGG,Bright Health MGG,247.27,,,,,,,case rate,247.27,247.27,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Aetna,Aetna,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Aetna MGG,Aetna MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,BCBS,BCBS,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,BCBS MGG,BCBS MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Cigna,Cigna,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Cigna MGG,Cigna MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Humana,Humana,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Humana MGG,Humana MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Optum VA,Optum VA,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,UHC,UHC,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,UHC MGG,UHC MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,VA,VA,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Wellcare MGG,Wellcare MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Bright Health - commercial,Bright Health - commercial,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,1350,1350,Bright Health MGG,Bright Health MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Aetna,Aetna,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Aetna MGG,Aetna MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,BCBS,BCBS,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,BCBS MGG,BCBS MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Cigna,Cigna,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Cigna MGG,Cigna MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Humana,Humana,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Humana MGG,Humana MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Optum VA,Optum VA,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,UHC,UHC,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,UHC MGG,UHC MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,VA,VA,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Wellcare MGG,Wellcare MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Bright Health - commercial,Bright Health - commercial,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1326,1326,Bright Health MGG,Bright Health MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Aetna,Aetna,292.58,,,,,,,per diem,292.58,292.58,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Aetna MGG,Aetna MGG,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,BCBS,BCBS,292.58,,,,,,,per diem,292.58,292.58,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,BCBS MGG,BCBS MGG,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Cigna,Cigna,292.58,,,,,,,per diem,292.58,292.58,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Cigna MGG,Cigna MGG,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Humana,Humana,292.58,,,,,,,per diem,292.58,292.58,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Humana MGG,Humana MGG,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Optum VA,Optum VA,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,UHC,UHC,292.58,,,,,,,per diem,292.58,292.58,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,UHC MGG,UHC MGG,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,VA,VA,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Wellcare MGG,Wellcare MGG,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Bright Health - commercial,Bright Health - commercial,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,292.58,292.58,Bright Health MGG,Bright Health MGG,292.58,,,,,,,case rate,292.58,292.58,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Aetna,Aetna,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Aetna MGG,Aetna MGG,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,BCBS,BCBS,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,BCBS MGG,BCBS MGG,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Cigna,Cigna,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Cigna MGG,Cigna MGG,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Humana,Humana,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Humana MGG,Humana MGG,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Optum VA,Optum VA,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,UHC,UHC,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,UHC MGG,UHC MGG,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,VA,VA,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Wellcare MGG,Wellcare MGG,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Bright Health - commercial,Bright Health - commercial,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,168.3,168.3,Bright Health MGG,Bright Health MGG,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Aetna,Aetna,1862.98,,,,,,,per diem,1862.98,1862.98,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Aetna MGG,Aetna MGG,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,BCBS,BCBS,1862.98,,,,,,,per diem,1862.98,1862.98,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,BCBS MGG,BCBS MGG,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Cigna,Cigna,1862.98,,,,,,,per diem,1862.98,1862.98,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Cigna MGG,Cigna MGG,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Humana,Humana,1862.98,,,,,,,per diem,1862.98,1862.98,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Humana MGG,Humana MGG,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Optum VA,Optum VA,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,UHC,UHC,1862.98,,,,,,,per diem,1862.98,1862.98,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,UHC MGG,UHC MGG,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,VA,VA,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Wellcare MGG,Wellcare MGG,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Bright Health - commercial,Bright Health - commercial,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1862.98,1862.98,Bright Health MGG,Bright Health MGG,1862.98,,,,,,,case rate,1862.98,1862.98,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Aetna,Aetna,199.94,,,,,,,per diem,199.94,199.94,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Aetna MGG,Aetna MGG,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,BCBS,BCBS,199.94,,,,,,,per diem,199.94,199.94,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,BCBS MGG,BCBS MGG,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Cigna,Cigna,199.94,,,,,,,per diem,199.94,199.94,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Cigna MGG,Cigna MGG,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Humana,Humana,199.94,,,,,,,per diem,199.94,199.94,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Humana MGG,Humana MGG,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Optum VA,Optum VA,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,UHC,UHC,199.94,,,,,,,per diem,199.94,199.94,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,UHC MGG,UHC MGG,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,VA,VA,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Wellcare MGG,Wellcare MGG,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Bright Health - commercial,Bright Health - commercial,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,199.94,199.94,Bright Health MGG,Bright Health MGG,199.94,,,,,,,case rate,199.94,199.94,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Aetna,Aetna,210.55,,,,,,,per diem,210.55,210.55,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Aetna MGG,Aetna MGG,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,BCBS,BCBS,210.55,,,,,,,per diem,210.55,210.55,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,BCBS MGG,BCBS MGG,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Cigna,Cigna,210.55,,,,,,,per diem,210.55,210.55,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Cigna MGG,Cigna MGG,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Humana,Humana,210.55,,,,,,,per diem,210.55,210.55,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Humana MGG,Humana MGG,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Optum VA,Optum VA,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,UHC,UHC,210.55,,,,,,,per diem,210.55,210.55,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,UHC MGG,UHC MGG,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,VA,VA,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Wellcare MGG,Wellcare MGG,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Bright Health - commercial,Bright Health - commercial,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,210.55,210.55,Bright Health MGG,Bright Health MGG,210.55,,,,,,,case rate,210.55,210.55,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Aetna,Aetna,136.2,,,,,,,per diem,136.2,136.2,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Aetna MGG,Aetna MGG,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,BCBS,BCBS,136.2,,,,,,,per diem,136.2,136.2,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,BCBS MGG,BCBS MGG,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Cigna,Cigna,136.2,,,,,,,per diem,136.2,136.2,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Cigna MGG,Cigna MGG,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Humana,Humana,136.2,,,,,,,per diem,136.2,136.2,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Humana MGG,Humana MGG,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Optum VA,Optum VA,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,UHC,UHC,136.2,,,,,,,per diem,136.2,136.2,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,UHC MGG,UHC MGG,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,VA,VA,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Wellcare MGG,Wellcare MGG,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Bright Health - commercial,Bright Health - commercial,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,136.2,136.2,Bright Health MGG,Bright Health MGG,136.2,,,,,,,case rate,136.2,136.2,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Aetna,Aetna,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Aetna MGG,Aetna MGG,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,BCBS,BCBS,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,BCBS MGG,BCBS MGG,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Cigna,Cigna,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Cigna MGG,Cigna MGG,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Humana,Humana,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Humana MGG,Humana MGG,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Optum VA,Optum VA,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,UHC,UHC,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,UHC MGG,UHC MGG,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,VA,VA,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Wellcare MGG,Wellcare MGG,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Bright Health - commercial,Bright Health - commercial,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,87.6,87.6,Bright Health MGG,Bright Health MGG,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Aetna,Aetna,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Aetna MGG,Aetna MGG,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,BCBS,BCBS,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,BCBS MGG,BCBS MGG,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Cigna,Cigna,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Cigna MGG,Cigna MGG,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Humana,Humana,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Humana MGG,Humana MGG,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Optum VA,Optum VA,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,UHC,UHC,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,UHC MGG,UHC MGG,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,VA,VA,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Wellcare MGG,Wellcare MGG,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Bright Health - commercial,Bright Health - commercial,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,137.55,137.55,Bright Health MGG,Bright Health MGG,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Aetna,Aetna,335.94,,,,,,,per diem,335.94,335.94,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Aetna MGG,Aetna MGG,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,BCBS,BCBS,335.94,,,,,,,per diem,335.94,335.94,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,BCBS MGG,BCBS MGG,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Cigna,Cigna,335.94,,,,,,,per diem,335.94,335.94,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Cigna MGG,Cigna MGG,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Humana,Humana,335.94,,,,,,,per diem,335.94,335.94,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Humana MGG,Humana MGG,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Optum VA,Optum VA,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,UHC,UHC,335.94,,,,,,,per diem,335.94,335.94,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,UHC MGG,UHC MGG,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,VA,VA,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Wellcare MGG,Wellcare MGG,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Bright Health - commercial,Bright Health - commercial,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,335.94,335.94,Bright Health MGG,Bright Health MGG,335.94,,,,,,,case rate,335.94,335.94,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Aetna,Aetna,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Aetna MGG,Aetna MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,BCBS,BCBS,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,BCBS MGG,BCBS MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Cigna,Cigna,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Cigna MGG,Cigna MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Humana,Humana,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Humana MGG,Humana MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Optum VA,Optum VA,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,UHC,UHC,145,,,,,,,per diem,145,145,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,UHC MGG,UHC MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,VA,VA,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Wellcare MGG,Wellcare MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Bright Health - commercial,Bright Health - commercial,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,145,145,Bright Health MGG,Bright Health MGG,145,,,,,,,case rate,145,145,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Aetna,Aetna,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Aetna MGG,Aetna MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,BCBS,BCBS,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,BCBS MGG,BCBS MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Cigna,Cigna,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Cigna MGG,Cigna MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Humana,Humana,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Humana MGG,Humana MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Optum VA,Optum VA,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,UHC,UHC,322.14,,,,,,,per diem,322.14,322.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,UHC MGG,UHC MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,VA,VA,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Wellcare MGG,Wellcare MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Bright Health - commercial,Bright Health - commercial,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,322.14,322.14,Bright Health MGG,Bright Health MGG,322.14,,,,,,,case rate,322.14,322.14,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Aetna,Aetna,456.35,,,,,,,per diem,456.35,456.35,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Aetna MGG,Aetna MGG,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,BCBS,BCBS,456.35,,,,,,,per diem,456.35,456.35,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,BCBS MGG,BCBS MGG,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Cigna,Cigna,456.35,,,,,,,per diem,456.35,456.35,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Cigna MGG,Cigna MGG,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Humana,Humana,456.35,,,,,,,per diem,456.35,456.35,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Humana MGG,Humana MGG,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Optum VA,Optum VA,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,UHC,UHC,456.35,,,,,,,per diem,456.35,456.35,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,UHC MGG,UHC MGG,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,VA,VA,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Wellcare MGG,Wellcare MGG,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Bright Health - commercial,Bright Health - commercial,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,456.35,456.35,Bright Health MGG,Bright Health MGG,456.35,,,,,,,case rate,456.35,456.35,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Aetna,Aetna,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Aetna MGG,Aetna MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,BCBS,BCBS,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,BCBS MGG,BCBS MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Cigna,Cigna,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Cigna MGG,Cigna MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Humana,Humana,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Humana MGG,Humana MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Optum VA,Optum VA,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,UHC,UHC,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,UHC MGG,UHC MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,VA,VA,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Wellcare MGG,Wellcare MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Bright Health - commercial,Bright Health - commercial,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,295.8,295.8,Bright Health MGG,Bright Health MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Aetna,Aetna,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Aetna MGG,Aetna MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,BCBS,BCBS,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,BCBS MGG,BCBS MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Cigna,Cigna,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Cigna MGG,Cigna MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Humana,Humana,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Humana MGG,Humana MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Optum VA,Optum VA,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,UHC,UHC,295.8,,,,,,,per diem,295.8,295.8,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,UHC MGG,UHC MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,VA,VA,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Wellcare MGG,Wellcare MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Bright Health - commercial,Bright Health - commercial,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,295.8,295.8,Bright Health MGG,Bright Health MGG,295.8,,,,,,,case rate,295.8,295.8,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Aetna,Aetna,1097.98,,,,,,,per diem,1097.98,1097.98,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Aetna MGG,Aetna MGG,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,BCBS,BCBS,1097.98,,,,,,,per diem,1097.98,1097.98,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,BCBS MGG,BCBS MGG,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Cigna,Cigna,1097.98,,,,,,,per diem,1097.98,1097.98,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Cigna MGG,Cigna MGG,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Humana,Humana,1097.98,,,,,,,per diem,1097.98,1097.98,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Humana MGG,Humana MGG,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Optum VA,Optum VA,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,UHC,UHC,1097.98,,,,,,,per diem,1097.98,1097.98,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,UHC MGG,UHC MGG,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,VA,VA,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Wellcare MGG,Wellcare MGG,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Bright Health - commercial,Bright Health - commercial,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1097.98,1097.98,Bright Health MGG,Bright Health MGG,1097.98,,,,,,,case rate,1097.98,1097.98,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Aetna,Aetna,383.33,,,,,,,per diem,383.33,383.33,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Aetna MGG,Aetna MGG,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,BCBS,BCBS,383.33,,,,,,,per diem,383.33,383.33,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,BCBS MGG,BCBS MGG,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Cigna,Cigna,383.33,,,,,,,per diem,383.33,383.33,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Cigna MGG,Cigna MGG,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Humana,Humana,383.33,,,,,,,per diem,383.33,383.33,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Humana MGG,Humana MGG,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Optum VA,Optum VA,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,UHC,UHC,383.33,,,,,,,per diem,383.33,383.33,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,UHC MGG,UHC MGG,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,VA,VA,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Wellcare MGG,Wellcare MGG,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Bright Health - commercial,Bright Health - commercial,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,383.33,383.33,Bright Health MGG,Bright Health MGG,383.33,,,,,,,case rate,383.33,383.33,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Aetna,Aetna,198.25,,,,,,,per diem,198.25,198.25,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Aetna MGG,Aetna MGG,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,BCBS,BCBS,198.25,,,,,,,per diem,198.25,198.25,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,BCBS MGG,BCBS MGG,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Cigna,Cigna,198.25,,,,,,,per diem,198.25,198.25,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Cigna MGG,Cigna MGG,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Humana,Humana,198.25,,,,,,,per diem,198.25,198.25,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Humana MGG,Humana MGG,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Optum VA,Optum VA,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,UHC,UHC,198.25,,,,,,,per diem,198.25,198.25,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,UHC MGG,UHC MGG,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,VA,VA,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Wellcare MGG,Wellcare MGG,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Bright Health - commercial,Bright Health - commercial,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,198.25,198.25,Bright Health MGG,Bright Health MGG,198.25,,,,,,,case rate,198.25,198.25,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Aetna,Aetna,401.45,,,,,,,per diem,401.45,401.45,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Aetna MGG,Aetna MGG,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,BCBS,BCBS,401.45,,,,,,,per diem,401.45,401.45,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,BCBS MGG,BCBS MGG,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Cigna,Cigna,401.45,,,,,,,per diem,401.45,401.45,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Cigna MGG,Cigna MGG,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Humana,Humana,401.45,,,,,,,per diem,401.45,401.45,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Humana MGG,Humana MGG,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Optum VA,Optum VA,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,UHC,UHC,401.45,,,,,,,per diem,401.45,401.45,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,UHC MGG,UHC MGG,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,VA,VA,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Wellcare MGG,Wellcare MGG,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Bright Health - commercial,Bright Health - commercial,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,401.45,401.45,Bright Health MGG,Bright Health MGG,401.45,,,,,,,case rate,401.45,401.45,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Aetna,Aetna,309.43,,,,,,,per diem,309.43,309.43,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Aetna MGG,Aetna MGG,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,BCBS,BCBS,309.43,,,,,,,per diem,309.43,309.43,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,BCBS MGG,BCBS MGG,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Cigna,Cigna,309.43,,,,,,,per diem,309.43,309.43,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Cigna MGG,Cigna MGG,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Humana,Humana,309.43,,,,,,,per diem,309.43,309.43,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Humana MGG,Humana MGG,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Optum VA,Optum VA,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,UHC,UHC,309.43,,,,,,,per diem,309.43,309.43,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,UHC MGG,UHC MGG,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,VA,VA,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Wellcare MGG,Wellcare MGG,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Bright Health - commercial,Bright Health - commercial,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,309.43,309.43,Bright Health MGG,Bright Health MGG,309.43,,,,,,,case rate,309.43,309.43,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Aetna,Aetna,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Aetna MGG,Aetna MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,BCBS,BCBS,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,BCBS MGG,BCBS MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Cigna,Cigna,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Cigna MGG,Cigna MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Humana,Humana,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Humana MGG,Humana MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Optum VA,Optum VA,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,UHC,UHC,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,UHC MGG,UHC MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,VA,VA,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Wellcare MGG,Wellcare MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Bright Health - commercial,Bright Health - commercial,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,164,164,Bright Health MGG,Bright Health MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Aetna,Aetna,178.14,,,,,,,per diem,178.14,178.14,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Aetna MGG,Aetna MGG,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,BCBS,BCBS,178.14,,,,,,,per diem,178.14,178.14,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,BCBS MGG,BCBS MGG,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Cigna,Cigna,178.14,,,,,,,per diem,178.14,178.14,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Cigna MGG,Cigna MGG,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Humana,Humana,178.14,,,,,,,per diem,178.14,178.14,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Humana MGG,Humana MGG,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Optum VA,Optum VA,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,UHC,UHC,178.14,,,,,,,per diem,178.14,178.14,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,UHC MGG,UHC MGG,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,VA,VA,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Wellcare MGG,Wellcare MGG,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Bright Health - commercial,Bright Health - commercial,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,178.14,178.14,Bright Health MGG,Bright Health MGG,178.14,,,,,,,case rate,178.14,178.14,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Aetna,Aetna,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Aetna MGG,Aetna MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,BCBS,BCBS,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,BCBS MGG,BCBS MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Cigna,Cigna,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Cigna MGG,Cigna MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Humana,Humana,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Humana MGG,Humana MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Optum VA,Optum VA,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,UHC,UHC,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,UHC MGG,UHC MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,VA,VA,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Wellcare MGG,Wellcare MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Bright Health - commercial,Bright Health - commercial,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,903,903,Bright Health MGG,Bright Health MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Aetna,Aetna,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Aetna MGG,Aetna MGG,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,BCBS,BCBS,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,BCBS MGG,BCBS MGG,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Cigna,Cigna,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Cigna MGG,Cigna MGG,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Humana,Humana,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Humana MGG,Humana MGG,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Optum VA,Optum VA,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,UHC,UHC,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,UHC MGG,UHC MGG,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,VA,VA,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Wellcare MGG,Wellcare MGG,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Bright Health - commercial,Bright Health - commercial,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,358,358,Bright Health MGG,Bright Health MGG,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna,Aetna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna MGG,Aetna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS,BCBS,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS MGG,BCBS MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna,Cigna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna MGG,Cigna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana,Humana,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana MGG,Humana MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Optum VA,Optum VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC,UHC,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC MGG,UHC MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,VA,VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Wellcare MGG,Wellcare MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health - commercial,Bright Health - commercial,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health MGG,Bright Health MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Aetna,Aetna,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Aetna MGG,Aetna MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,BCBS,BCBS,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,BCBS MGG,BCBS MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Cigna,Cigna,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Cigna MGG,Cigna MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Humana,Humana,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Humana MGG,Humana MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Optum VA,Optum VA,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,UHC,UHC,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,UHC MGG,UHC MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,VA,VA,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Wellcare MGG,Wellcare MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Bright Health - commercial,Bright Health - commercial,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,164,164,Bright Health MGG,Bright Health MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna,Aetna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna MGG,Aetna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS,BCBS,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS MGG,BCBS MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna,Cigna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna MGG,Cigna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana,Humana,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana MGG,Humana MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Optum VA,Optum VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC,UHC,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC MGG,UHC MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,VA,VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Wellcare MGG,Wellcare MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health - commercial,Bright Health - commercial,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health MGG,Bright Health MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna,Aetna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna MGG,Aetna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS,BCBS,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS MGG,BCBS MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna,Cigna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna MGG,Cigna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana,Humana,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana MGG,Humana MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Optum VA,Optum VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC,UHC,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC MGG,UHC MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,VA,VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Wellcare MGG,Wellcare MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health - commercial,Bright Health - commercial,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health MGG,Bright Health MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna,Aetna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna MGG,Aetna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS,BCBS,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS MGG,BCBS MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna,Cigna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna MGG,Cigna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana,Humana,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana MGG,Humana MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Optum VA,Optum VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC,UHC,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC MGG,UHC MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,VA,VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Wellcare MGG,Wellcare MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health - commercial,Bright Health - commercial,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health MGG,Bright Health MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Aetna,Aetna,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Aetna MGG,Aetna MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,BCBS,BCBS,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,BCBS MGG,BCBS MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Cigna,Cigna,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Cigna MGG,Cigna MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Humana,Humana,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Humana MGG,Humana MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Optum VA,Optum VA,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,UHC,UHC,164,,,,,,,per diem,164,164,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,UHC MGG,UHC MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,VA,VA,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Wellcare MGG,Wellcare MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Bright Health - commercial,Bright Health - commercial,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,164,164,Bright Health MGG,Bright Health MGG,164,,,,,,,case rate,164,164,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Aetna,Aetna,306.5,,,,,,,per diem,306.5,306.5,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Aetna MGG,Aetna MGG,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,BCBS,BCBS,306.5,,,,,,,per diem,306.5,306.5,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,BCBS MGG,BCBS MGG,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Cigna,Cigna,306.5,,,,,,,per diem,306.5,306.5,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Cigna MGG,Cigna MGG,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Humana,Humana,306.5,,,,,,,per diem,306.5,306.5,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Humana MGG,Humana MGG,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Optum VA,Optum VA,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,UHC,UHC,306.5,,,,,,,per diem,306.5,306.5,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,UHC MGG,UHC MGG,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,VA,VA,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Wellcare MGG,Wellcare MGG,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Bright Health - commercial,Bright Health - commercial,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,306.5,306.5,Bright Health MGG,Bright Health MGG,306.5,,,,,,,case rate,306.5,306.5,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Aetna,Aetna,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Aetna MGG,Aetna MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,BCBS,BCBS,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,BCBS MGG,BCBS MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Cigna,Cigna,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Cigna MGG,Cigna MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Humana,Humana,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Humana MGG,Humana MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Optum VA,Optum VA,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,UHC,UHC,100,,,,,,,per diem,100,100,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,UHC MGG,UHC MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,VA,VA,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Wellcare MGG,Wellcare MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Bright Health - commercial,Bright Health - commercial,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,100,100,Bright Health MGG,Bright Health MGG,100,,,,,,,case rate,100,100,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Aetna,Aetna,232,,,,,,,per diem,232,232,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Aetna MGG,Aetna MGG,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,BCBS,BCBS,232,,,,,,,per diem,232,232,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,BCBS MGG,BCBS MGG,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Cigna,Cigna,232,,,,,,,per diem,232,232,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Cigna MGG,Cigna MGG,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Humana,Humana,232,,,,,,,per diem,232,232,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Humana MGG,Humana MGG,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Optum VA,Optum VA,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,UHC,UHC,232,,,,,,,per diem,232,232,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,UHC MGG,UHC MGG,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,VA,VA,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Wellcare MGG,Wellcare MGG,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Bright Health - commercial,Bright Health - commercial,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,232,232,Bright Health MGG,Bright Health MGG,232,,,,,,,case rate,232,232,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Aetna,Aetna,213,,,,,,,per diem,213,213,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Aetna MGG,Aetna MGG,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,BCBS,BCBS,213,,,,,,,per diem,213,213,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,BCBS MGG,BCBS MGG,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Cigna,Cigna,213,,,,,,,per diem,213,213,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Cigna MGG,Cigna MGG,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Humana,Humana,213,,,,,,,per diem,213,213,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Humana MGG,Humana MGG,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Optum VA,Optum VA,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,UHC,UHC,213,,,,,,,per diem,213,213,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,UHC MGG,UHC MGG,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,VA,VA,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Wellcare MGG,Wellcare MGG,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Bright Health - commercial,Bright Health - commercial,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,213,213,Bright Health MGG,Bright Health MGG,213,,,,,,,case rate,213,213,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Aetna,Aetna,271.5,,,,,,,per diem,271.5,271.5,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Aetna MGG,Aetna MGG,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,BCBS,BCBS,271.5,,,,,,,per diem,271.5,271.5,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,BCBS MGG,BCBS MGG,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Cigna,Cigna,271.5,,,,,,,per diem,271.5,271.5,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Cigna MGG,Cigna MGG,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Humana,Humana,271.5,,,,,,,per diem,271.5,271.5,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Humana MGG,Humana MGG,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Optum VA,Optum VA,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,UHC,UHC,271.5,,,,,,,per diem,271.5,271.5,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,UHC MGG,UHC MGG,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,VA,VA,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Wellcare MGG,Wellcare MGG,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Bright Health - commercial,Bright Health - commercial,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,271.5,271.5,Bright Health MGG,Bright Health MGG,271.5,,,,,,,case rate,271.5,271.5,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Aetna,Aetna,298.32,,,,,,,per diem,298.32,298.32,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Aetna MGG,Aetna MGG,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,BCBS,BCBS,298.32,,,,,,,per diem,298.32,298.32,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,BCBS MGG,BCBS MGG,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Cigna,Cigna,298.32,,,,,,,per diem,298.32,298.32,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Cigna MGG,Cigna MGG,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Humana,Humana,298.32,,,,,,,per diem,298.32,298.32,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Humana MGG,Humana MGG,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Optum VA,Optum VA,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,UHC,UHC,298.32,,,,,,,per diem,298.32,298.32,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,UHC MGG,UHC MGG,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,VA,VA,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Wellcare MGG,Wellcare MGG,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Bright Health - commercial,Bright Health - commercial,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,298.32,298.32,Bright Health MGG,Bright Health MGG,298.32,,,,,,,case rate,298.32,298.32,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Aetna,Aetna,114.97,,,,,,,per diem,114.97,114.97,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Aetna MGG,Aetna MGG,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,BCBS,BCBS,114.97,,,,,,,per diem,114.97,114.97,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,BCBS MGG,BCBS MGG,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Cigna,Cigna,114.97,,,,,,,per diem,114.97,114.97,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Cigna MGG,Cigna MGG,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Humana,Humana,114.97,,,,,,,per diem,114.97,114.97,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Humana MGG,Humana MGG,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Optum VA,Optum VA,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,UHC,UHC,114.97,,,,,,,per diem,114.97,114.97,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,UHC MGG,UHC MGG,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,VA,VA,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Wellcare MGG,Wellcare MGG,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Bright Health - commercial,Bright Health - commercial,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,114.97,114.97,Bright Health MGG,Bright Health MGG,114.97,,,,,,,case rate,114.97,114.97,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna,Aetna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Aetna MGG,Aetna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS,BCBS,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,BCBS MGG,BCBS MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna,Cigna,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Cigna MGG,Cigna MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana,Humana,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Humana MGG,Humana MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Optum VA,Optum VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC,UHC,171,,,,,,,per diem,171,171,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,UHC MGG,UHC MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,VA,VA,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Wellcare MGG,Wellcare MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health - commercial,Bright Health - commercial,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,171,171,Bright Health MGG,Bright Health MGG,171,,,,,,,case rate,171,171,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Aetna,Aetna,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Aetna MGG,Aetna MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,BCBS,BCBS,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,BCBS MGG,BCBS MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Cigna,Cigna,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Cigna MGG,Cigna MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Humana,Humana,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Humana MGG,Humana MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Optum VA,Optum VA,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,UHC,UHC,283,,,,,,,per diem,283,283,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,UHC MGG,UHC MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,VA,VA,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Wellcare MGG,Wellcare MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Bright Health - commercial,Bright Health - commercial,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,283,283,Bright Health MGG,Bright Health MGG,283,,,,,,,case rate,283,283,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Aetna,Aetna,292,,,,,,,per diem,292,292,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Aetna MGG,Aetna MGG,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,BCBS,BCBS,292,,,,,,,per diem,292,292,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,BCBS MGG,BCBS MGG,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Cigna,Cigna,292,,,,,,,per diem,292,292,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Cigna MGG,Cigna MGG,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Humana,Humana,292,,,,,,,per diem,292,292,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Humana MGG,Humana MGG,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Optum VA,Optum VA,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,UHC,UHC,292,,,,,,,per diem,292,292,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,UHC MGG,UHC MGG,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,VA,VA,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Wellcare MGG,Wellcare MGG,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Bright Health - commercial,Bright Health - commercial,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,292,292,Bright Health MGG,Bright Health MGG,292,,,,,,,case rate,292,292,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Aetna,Aetna,440,,,,,,,per diem,440,440,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Aetna MGG,Aetna MGG,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,BCBS,BCBS,440,,,,,,,per diem,440,440,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,BCBS MGG,BCBS MGG,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Cigna,Cigna,440,,,,,,,per diem,440,440,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Cigna MGG,Cigna MGG,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Humana,Humana,440,,,,,,,per diem,440,440,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Humana MGG,Humana MGG,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Optum VA,Optum VA,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,UHC,UHC,440,,,,,,,per diem,440,440,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,UHC MGG,UHC MGG,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,VA,VA,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Wellcare MGG,Wellcare MGG,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Bright Health - commercial,Bright Health - commercial,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,440,440,Bright Health MGG,Bright Health MGG,440,,,,,,,case rate,440,440,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Aetna,Aetna,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Aetna MGG,Aetna MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,BCBS,BCBS,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,BCBS MGG,BCBS MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Cigna,Cigna,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Cigna MGG,Cigna MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Humana,Humana,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Humana MGG,Humana MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Optum VA,Optum VA,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,UHC,UHC,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,UHC MGG,UHC MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,VA,VA,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Wellcare MGG,Wellcare MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Bright Health - commercial,Bright Health - commercial,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,405,405,Bright Health MGG,Bright Health MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Aetna,Aetna,352.17,,,,,,,per diem,352.17,352.17,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Aetna MGG,Aetna MGG,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,BCBS,BCBS,352.17,,,,,,,per diem,352.17,352.17,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,BCBS MGG,BCBS MGG,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Cigna,Cigna,352.17,,,,,,,per diem,352.17,352.17,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Cigna MGG,Cigna MGG,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Humana,Humana,352.17,,,,,,,per diem,352.17,352.17,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Humana MGG,Humana MGG,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Optum VA,Optum VA,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,UHC,UHC,352.17,,,,,,,per diem,352.17,352.17,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,UHC MGG,UHC MGG,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,VA,VA,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Wellcare MGG,Wellcare MGG,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Bright Health - commercial,Bright Health - commercial,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,352.17,352.17,Bright Health MGG,Bright Health MGG,352.17,,,,,,,case rate,352.17,352.17,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Aetna,Aetna,1170.55,,,,,,,per diem,1170.55,1170.55,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Aetna MGG,Aetna MGG,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,BCBS,BCBS,1170.55,,,,,,,per diem,1170.55,1170.55,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,BCBS MGG,BCBS MGG,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Cigna,Cigna,1170.55,,,,,,,per diem,1170.55,1170.55,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Cigna MGG,Cigna MGG,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Humana,Humana,1170.55,,,,,,,per diem,1170.55,1170.55,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Humana MGG,Humana MGG,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Optum VA,Optum VA,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,UHC,UHC,1170.55,,,,,,,per diem,1170.55,1170.55,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,UHC MGG,UHC MGG,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,VA,VA,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Wellcare MGG,Wellcare MGG,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Bright Health - commercial,Bright Health - commercial,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1170.55,1170.55,Bright Health MGG,Bright Health MGG,1170.55,,,,,,,case rate,1170.55,1170.55,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Aetna,Aetna,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Aetna MGG,Aetna MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,BCBS,BCBS,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,BCBS MGG,BCBS MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Cigna,Cigna,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Cigna MGG,Cigna MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Humana,Humana,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Humana MGG,Humana MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Optum VA,Optum VA,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,UHC,UHC,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,UHC MGG,UHC MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,VA,VA,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Wellcare MGG,Wellcare MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Bright Health - commercial,Bright Health - commercial,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,405,405,Bright Health MGG,Bright Health MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Aetna,Aetna,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Aetna MGG,Aetna MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,BCBS,BCBS,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,BCBS MGG,BCBS MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Cigna,Cigna,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Cigna MGG,Cigna MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Humana,Humana,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Humana MGG,Humana MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Optum VA,Optum VA,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,UHC,UHC,405,,,,,,,per diem,405,405,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,UHC MGG,UHC MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,VA,VA,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Wellcare MGG,Wellcare MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Bright Health - commercial,Bright Health - commercial,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,405,405,Bright Health MGG,Bright Health MGG,405,,,,,,,case rate,405,405,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Aetna,Aetna,3675.48,,,,,,,per diem,3675.48,3675.48,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Aetna MGG,Aetna MGG,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,BCBS,BCBS,3675.48,,,,,,,per diem,3675.48,3675.48,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,BCBS MGG,BCBS MGG,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Cigna,Cigna,3675.48,,,,,,,per diem,3675.48,3675.48,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Cigna MGG,Cigna MGG,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Humana,Humana,3675.48,,,,,,,per diem,3675.48,3675.48,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Humana MGG,Humana MGG,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Optum VA,Optum VA,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,UHC,UHC,3675.48,,,,,,,per diem,3675.48,3675.48,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,UHC MGG,UHC MGG,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,VA,VA,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Wellcare MGG,Wellcare MGG,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Bright Health - commercial,Bright Health - commercial,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3675.48,3675.48,Bright Health MGG,Bright Health MGG,3675.48,,,,,,,case rate,3675.48,3675.48,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Aetna,Aetna,2739,,,,,,,per diem,2739,2739,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Aetna MGG,Aetna MGG,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,BCBS,BCBS,2739,,,,,,,per diem,2739,2739,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,BCBS MGG,BCBS MGG,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Cigna,Cigna,2739,,,,,,,per diem,2739,2739,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Cigna MGG,Cigna MGG,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Humana,Humana,2739,,,,,,,per diem,2739,2739,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Humana MGG,Humana MGG,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Optum VA,Optum VA,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,UHC,UHC,2739,,,,,,,per diem,2739,2739,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,UHC MGG,UHC MGG,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,VA,VA,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Wellcare MGG,Wellcare MGG,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Bright Health - commercial,Bright Health - commercial,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2739,2739,Bright Health MGG,Bright Health MGG,2739,,,,,,,case rate,2739,2739,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Aetna,Aetna,669.5,,,,,,,per diem,669.5,669.5,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Aetna MGG,Aetna MGG,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,BCBS,BCBS,669.5,,,,,,,per diem,669.5,669.5,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,BCBS MGG,BCBS MGG,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Cigna,Cigna,669.5,,,,,,,per diem,669.5,669.5,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Cigna MGG,Cigna MGG,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Humana,Humana,669.5,,,,,,,per diem,669.5,669.5,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Humana MGG,Humana MGG,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Optum VA,Optum VA,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,UHC,UHC,669.5,,,,,,,per diem,669.5,669.5,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,UHC MGG,UHC MGG,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,VA,VA,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Wellcare MGG,Wellcare MGG,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Bright Health - commercial,Bright Health - commercial,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,669.5,669.5,Bright Health MGG,Bright Health MGG,669.5,,,,,,,case rate,669.5,669.5,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Aetna,Aetna,380.47,,,,,,,per diem,380.47,380.47,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Aetna MGG,Aetna MGG,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,BCBS,BCBS,380.47,,,,,,,per diem,380.47,380.47,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,BCBS MGG,BCBS MGG,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Cigna,Cigna,380.47,,,,,,,per diem,380.47,380.47,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Cigna MGG,Cigna MGG,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Humana,Humana,380.47,,,,,,,per diem,380.47,380.47,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Humana MGG,Humana MGG,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Optum VA,Optum VA,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,UHC,UHC,380.47,,,,,,,per diem,380.47,380.47,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,UHC MGG,UHC MGG,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,VA,VA,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Wellcare MGG,Wellcare MGG,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Bright Health - commercial,Bright Health - commercial,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,380.47,380.47,Bright Health MGG,Bright Health MGG,380.47,,,,,,,case rate,380.47,380.47,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Aetna,Aetna,334.75,,,,,,,per diem,334.75,334.75,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Aetna MGG,Aetna MGG,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,BCBS,BCBS,334.75,,,,,,,per diem,334.75,334.75,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,BCBS MGG,BCBS MGG,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Cigna,Cigna,334.75,,,,,,,per diem,334.75,334.75,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Cigna MGG,Cigna MGG,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Humana,Humana,334.75,,,,,,,per diem,334.75,334.75,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Humana MGG,Humana MGG,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Optum VA,Optum VA,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,UHC,UHC,334.75,,,,,,,per diem,334.75,334.75,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,UHC MGG,UHC MGG,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,VA,VA,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Wellcare MGG,Wellcare MGG,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Bright Health - commercial,Bright Health - commercial,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,334.75,334.75,Bright Health MGG,Bright Health MGG,334.75,,,,,,,case rate,334.75,334.75,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Aetna,Aetna,1141.92,,,,,,,per diem,1141.92,1141.92,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Aetna MGG,Aetna MGG,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,BCBS,BCBS,1141.92,,,,,,,per diem,1141.92,1141.92,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,BCBS MGG,BCBS MGG,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Cigna,Cigna,1141.92,,,,,,,per diem,1141.92,1141.92,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Cigna MGG,Cigna MGG,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Humana,Humana,1141.92,,,,,,,per diem,1141.92,1141.92,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Humana MGG,Humana MGG,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Optum VA,Optum VA,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,UHC,UHC,1141.92,,,,,,,per diem,1141.92,1141.92,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,UHC MGG,UHC MGG,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,VA,VA,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Wellcare MGG,Wellcare MGG,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Bright Health - commercial,Bright Health - commercial,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,1141.92,1141.92,Bright Health MGG,Bright Health MGG,1141.92,,,,,,,case rate,1141.92,1141.92,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Aetna,Aetna,199.67,,,,,,,per diem,199.67,199.67,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Aetna MGG,Aetna MGG,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,BCBS,BCBS,199.67,,,,,,,per diem,199.67,199.67,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,BCBS MGG,BCBS MGG,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Cigna,Cigna,199.67,,,,,,,per diem,199.67,199.67,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Cigna MGG,Cigna MGG,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Humana,Humana,199.67,,,,,,,per diem,199.67,199.67,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Humana MGG,Humana MGG,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Optum VA,Optum VA,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,UHC,UHC,199.67,,,,,,,per diem,199.67,199.67,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,UHC MGG,UHC MGG,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,VA,VA,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Wellcare MGG,Wellcare MGG,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Bright Health - commercial,Bright Health - commercial,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,199.67,199.67,Bright Health MGG,Bright Health MGG,199.67,,,,,,,case rate,199.67,199.67,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Aetna,Aetna,1680.11,,,,,,,per diem,1680.11,1680.11,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Aetna MGG,Aetna MGG,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,BCBS,BCBS,1680.11,,,,,,,per diem,1680.11,1680.11,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,BCBS MGG,BCBS MGG,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Cigna,Cigna,1680.11,,,,,,,per diem,1680.11,1680.11,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Cigna MGG,Cigna MGG,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Humana,Humana,1680.11,,,,,,,per diem,1680.11,1680.11,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Humana MGG,Humana MGG,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Optum VA,Optum VA,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,UHC,UHC,1680.11,,,,,,,per diem,1680.11,1680.11,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,UHC MGG,UHC MGG,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,VA,VA,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Wellcare MGG,Wellcare MGG,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Bright Health - commercial,Bright Health - commercial,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1680.11,1680.11,Bright Health MGG,Bright Health MGG,1680.11,,,,,,,case rate,1680.11,1680.11,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Aetna,Aetna,6823,,,,,,,per diem,6823,6823,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Aetna MGG,Aetna MGG,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,BCBS,BCBS,6823,,,,,,,per diem,6823,6823,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,BCBS MGG,BCBS MGG,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Cigna,Cigna,6823,,,,,,,per diem,6823,6823,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Cigna MGG,Cigna MGG,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Humana,Humana,6823,,,,,,,per diem,6823,6823,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Humana MGG,Humana MGG,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Optum VA,Optum VA,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,UHC,UHC,6823,,,,,,,per diem,6823,6823,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,UHC MGG,UHC MGG,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,VA,VA,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Wellcare MGG,Wellcare MGG,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Bright Health - commercial,Bright Health - commercial,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,6823,6823,Bright Health MGG,Bright Health MGG,6823,,,,,,,case rate,6823,6823,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Aetna,Aetna,995.51,,,,,,,per diem,995.51,995.51,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Aetna MGG,Aetna MGG,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,BCBS,BCBS,995.51,,,,,,,per diem,995.51,995.51,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,BCBS MGG,BCBS MGG,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Cigna,Cigna,995.51,,,,,,,per diem,995.51,995.51,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Cigna MGG,Cigna MGG,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Humana,Humana,995.51,,,,,,,per diem,995.51,995.51,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Humana MGG,Humana MGG,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Optum VA,Optum VA,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,UHC,UHC,995.51,,,,,,,per diem,995.51,995.51,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,UHC MGG,UHC MGG,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,VA,VA,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Wellcare MGG,Wellcare MGG,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Bright Health - commercial,Bright Health - commercial,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,995.51,995.51,Bright Health MGG,Bright Health MGG,995.51,,,,,,,case rate,995.51,995.51,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Aetna,Aetna,1727,,,,,,,per diem,1727,1727,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Aetna MGG,Aetna MGG,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,BCBS,BCBS,1727,,,,,,,per diem,1727,1727,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,BCBS MGG,BCBS MGG,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Cigna,Cigna,1727,,,,,,,per diem,1727,1727,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Cigna MGG,Cigna MGG,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Humana,Humana,1727,,,,,,,per diem,1727,1727,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Humana MGG,Humana MGG,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Optum VA,Optum VA,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,UHC,UHC,1727,,,,,,,per diem,1727,1727,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,UHC MGG,UHC MGG,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,VA,VA,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Wellcare MGG,Wellcare MGG,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Bright Health - commercial,Bright Health - commercial,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1727,1727,Bright Health MGG,Bright Health MGG,1727,,,,,,,case rate,1727,1727,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Aetna,Aetna,2000,,,,,,,per diem,2000,2000,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Aetna MGG,Aetna MGG,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,BCBS,BCBS,2000,,,,,,,per diem,2000,2000,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,BCBS MGG,BCBS MGG,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Cigna,Cigna,2000,,,,,,,per diem,2000,2000,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Cigna MGG,Cigna MGG,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Humana,Humana,2000,,,,,,,per diem,2000,2000,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Humana MGG,Humana MGG,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Optum VA,Optum VA,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,UHC,UHC,2000,,,,,,,per diem,2000,2000,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,UHC MGG,UHC MGG,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,VA,VA,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Wellcare MGG,Wellcare MGG,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Bright Health - commercial,Bright Health - commercial,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2000,2000,Bright Health MGG,Bright Health MGG,2000,,,,,,,case rate,2000,2000,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Aetna,Aetna,547,,,,,,,per diem,547,547,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Aetna MGG,Aetna MGG,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,BCBS,BCBS,547,,,,,,,per diem,547,547,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,BCBS MGG,BCBS MGG,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Cigna,Cigna,547,,,,,,,per diem,547,547,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Cigna MGG,Cigna MGG,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Humana,Humana,547,,,,,,,per diem,547,547,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Humana MGG,Humana MGG,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Optum VA,Optum VA,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,UHC,UHC,547,,,,,,,per diem,547,547,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,UHC MGG,UHC MGG,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,VA,VA,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Wellcare MGG,Wellcare MGG,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Bright Health - commercial,Bright Health - commercial,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,547,547,Bright Health MGG,Bright Health MGG,547,,,,,,,case rate,547,547,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Aetna,Aetna,387,,,,,,,per diem,387,387,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Aetna MGG,Aetna MGG,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,BCBS,BCBS,387,,,,,,,per diem,387,387,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,BCBS MGG,BCBS MGG,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Cigna,Cigna,387,,,,,,,per diem,387,387,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Cigna MGG,Cigna MGG,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Humana,Humana,387,,,,,,,per diem,387,387,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Humana MGG,Humana MGG,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Optum VA,Optum VA,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,UHC,UHC,387,,,,,,,per diem,387,387,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,UHC MGG,UHC MGG,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,VA,VA,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Wellcare MGG,Wellcare MGG,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Bright Health - commercial,Bright Health - commercial,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,387,387,Bright Health MGG,Bright Health MGG,387,,,,,,,case rate,387,387,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Aetna,Aetna,1215,,,,,,,per diem,1215,1215,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Aetna MGG,Aetna MGG,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,BCBS,BCBS,1215,,,,,,,per diem,1215,1215,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,BCBS MGG,BCBS MGG,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Cigna,Cigna,1215,,,,,,,per diem,1215,1215,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Cigna MGG,Cigna MGG,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Humana,Humana,1215,,,,,,,per diem,1215,1215,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Humana MGG,Humana MGG,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Optum VA,Optum VA,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,UHC,UHC,1215,,,,,,,per diem,1215,1215,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,UHC MGG,UHC MGG,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,VA,VA,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Wellcare MGG,Wellcare MGG,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Bright Health - commercial,Bright Health - commercial,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1215,1215,Bright Health MGG,Bright Health MGG,1215,,,,,,,case rate,1215,1215,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Aetna,Aetna,215.49,,,,,,,per diem,215.49,215.49,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Aetna MGG,Aetna MGG,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,BCBS,BCBS,215.49,,,,,,,per diem,215.49,215.49,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,BCBS MGG,BCBS MGG,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Cigna,Cigna,215.49,,,,,,,per diem,215.49,215.49,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Cigna MGG,Cigna MGG,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Humana,Humana,215.49,,,,,,,per diem,215.49,215.49,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Humana MGG,Humana MGG,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Optum VA,Optum VA,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,UHC,UHC,215.49,,,,,,,per diem,215.49,215.49,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,UHC MGG,UHC MGG,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,VA,VA,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Wellcare MGG,Wellcare MGG,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Bright Health - commercial,Bright Health - commercial,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,215.49,215.49,Bright Health MGG,Bright Health MGG,215.49,,,,,,,case rate,215.49,215.49,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Aetna,Aetna,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Aetna MGG,Aetna MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,BCBS,BCBS,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,BCBS MGG,BCBS MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Cigna,Cigna,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Cigna MGG,Cigna MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Humana,Humana,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Humana MGG,Humana MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Optum VA,Optum VA,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,UHC,UHC,297,,,,,,,per diem,297,297,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,UHC MGG,UHC MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,VA,VA,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Wellcare MGG,Wellcare MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Bright Health - commercial,Bright Health - commercial,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,297,297,Bright Health MGG,Bright Health MGG,297,,,,,,,case rate,297,297,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Aetna,Aetna,641.48,,,,,,,per diem,641.48,641.48,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Aetna MGG,Aetna MGG,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,BCBS,BCBS,641.48,,,,,,,per diem,641.48,641.48,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,BCBS MGG,BCBS MGG,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Cigna,Cigna,641.48,,,,,,,per diem,641.48,641.48,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Cigna MGG,Cigna MGG,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Humana,Humana,641.48,,,,,,,per diem,641.48,641.48,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Humana MGG,Humana MGG,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Optum VA,Optum VA,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,UHC,UHC,641.48,,,,,,,per diem,641.48,641.48,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,UHC MGG,UHC MGG,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,VA,VA,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Wellcare MGG,Wellcare MGG,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Bright Health - commercial,Bright Health - commercial,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,641.48,641.48,Bright Health MGG,Bright Health MGG,641.48,,,,,,,case rate,641.48,641.48,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Aetna,Aetna,1924.44,,,,,,,per diem,1924.44,1924.44,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Aetna MGG,Aetna MGG,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,BCBS,BCBS,1924.44,,,,,,,per diem,1924.44,1924.44,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,BCBS MGG,BCBS MGG,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Cigna,Cigna,1924.44,,,,,,,per diem,1924.44,1924.44,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Cigna MGG,Cigna MGG,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Humana,Humana,1924.44,,,,,,,per diem,1924.44,1924.44,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Humana MGG,Humana MGG,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Optum VA,Optum VA,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,UHC,UHC,1924.44,,,,,,,per diem,1924.44,1924.44,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,UHC MGG,UHC MGG,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,VA,VA,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Wellcare MGG,Wellcare MGG,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Bright Health - commercial,Bright Health - commercial,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,1924.44,1924.44,Bright Health MGG,Bright Health MGG,1924.44,,,,,,,case rate,1924.44,1924.44,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Aetna,Aetna,1347.23,,,,,,,per diem,1347.23,1347.23,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Aetna MGG,Aetna MGG,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,BCBS,BCBS,1347.23,,,,,,,per diem,1347.23,1347.23,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,BCBS MGG,BCBS MGG,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Cigna,Cigna,1347.23,,,,,,,per diem,1347.23,1347.23,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Cigna MGG,Cigna MGG,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Humana,Humana,1347.23,,,,,,,per diem,1347.23,1347.23,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Humana MGG,Humana MGG,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Optum VA,Optum VA,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,UHC,UHC,1347.23,,,,,,,per diem,1347.23,1347.23,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,UHC MGG,UHC MGG,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,VA,VA,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Wellcare MGG,Wellcare MGG,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Bright Health - commercial,Bright Health - commercial,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1347.23,1347.23,Bright Health MGG,Bright Health MGG,1347.23,,,,,,,case rate,1347.23,1347.23,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Aetna,Aetna,26970.62,,,,,,,per diem,26970.62,26970.62,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Aetna MGG,Aetna MGG,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,BCBS,BCBS,26970.62,,,,,,,per diem,26970.62,26970.62,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,BCBS MGG,BCBS MGG,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Cigna,Cigna,26970.62,,,,,,,per diem,26970.62,26970.62,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Cigna MGG,Cigna MGG,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Humana,Humana,26970.62,,,,,,,per diem,26970.62,26970.62,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Humana MGG,Humana MGG,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Optum VA,Optum VA,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,UHC,UHC,26970.62,,,,,,,per diem,26970.62,26970.62,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,UHC MGG,UHC MGG,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,VA,VA,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Wellcare MGG,Wellcare MGG,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Bright Health - commercial,Bright Health - commercial,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,26970.62,26970.62,Bright Health MGG,Bright Health MGG,26970.62,,,,,,,case rate,26970.62,26970.62,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Aetna,Aetna,34146.37,,,,,,,per diem,34146.37,34146.37,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Aetna MGG,Aetna MGG,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,BCBS,BCBS,34146.37,,,,,,,per diem,34146.37,34146.37,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,BCBS MGG,BCBS MGG,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Cigna,Cigna,34146.37,,,,,,,per diem,34146.37,34146.37,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Cigna MGG,Cigna MGG,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Humana,Humana,34146.37,,,,,,,per diem,34146.37,34146.37,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Humana MGG,Humana MGG,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Optum VA,Optum VA,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,UHC,UHC,34146.37,,,,,,,per diem,34146.37,34146.37,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,UHC MGG,UHC MGG,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,VA,VA,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Wellcare MGG,Wellcare MGG,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Bright Health - commercial,Bright Health - commercial,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,34146.37,34146.37,Bright Health MGG,Bright Health MGG,34146.37,,,,,,,case rate,34146.37,34146.37,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Aetna,Aetna,27654.17,,,,,,,per diem,27654.17,27654.17,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Aetna MGG,Aetna MGG,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,BCBS,BCBS,27654.17,,,,,,,per diem,27654.17,27654.17,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,BCBS MGG,BCBS MGG,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Cigna,Cigna,27654.17,,,,,,,per diem,27654.17,27654.17,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Cigna MGG,Cigna MGG,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Humana,Humana,27654.17,,,,,,,per diem,27654.17,27654.17,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Humana MGG,Humana MGG,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Optum VA,Optum VA,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,UHC,UHC,27654.17,,,,,,,per diem,27654.17,27654.17,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,UHC MGG,UHC MGG,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,VA,VA,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Wellcare MGG,Wellcare MGG,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Bright Health - commercial,Bright Health - commercial,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,27654.17,27654.17,Bright Health MGG,Bright Health MGG,27654.17,,,,,,,case rate,27654.17,27654.17,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Aetna,Aetna,21506.36,,,,,,,per diem,21506.36,21506.36,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Aetna MGG,Aetna MGG,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,BCBS,BCBS,21506.36,,,,,,,per diem,21506.36,21506.36,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,BCBS MGG,BCBS MGG,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Cigna,Cigna,21506.36,,,,,,,per diem,21506.36,21506.36,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Cigna MGG,Cigna MGG,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Humana,Humana,21506.36,,,,,,,per diem,21506.36,21506.36,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Humana MGG,Humana MGG,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Optum VA,Optum VA,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,UHC,UHC,21506.36,,,,,,,per diem,21506.36,21506.36,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,UHC MGG,UHC MGG,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,VA,VA,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Wellcare MGG,Wellcare MGG,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Bright Health - commercial,Bright Health - commercial,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,21506.36,21506.36,Bright Health MGG,Bright Health MGG,21506.36,,,,,,,case rate,21506.36,21506.36,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Aetna,Aetna,3019.28,,,,,,,per diem,3019.28,3019.28,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Aetna MGG,Aetna MGG,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,BCBS,BCBS,3019.28,,,,,,,per diem,3019.28,3019.28,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,BCBS MGG,BCBS MGG,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Cigna,Cigna,3019.28,,,,,,,per diem,3019.28,3019.28,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Cigna MGG,Cigna MGG,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Humana,Humana,3019.28,,,,,,,per diem,3019.28,3019.28,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Humana MGG,Humana MGG,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Optum VA,Optum VA,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,UHC,UHC,3019.28,,,,,,,per diem,3019.28,3019.28,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,UHC MGG,UHC MGG,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,VA,VA,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Wellcare MGG,Wellcare MGG,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Bright Health - commercial,Bright Health - commercial,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3019.28,3019.28,Bright Health MGG,Bright Health MGG,3019.28,,,,,,,case rate,3019.28,3019.28,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Aetna,Aetna,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Aetna MGG,Aetna MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,BCBS,BCBS,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,BCBS MGG,BCBS MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Cigna,Cigna,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Cigna MGG,Cigna MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Humana,Humana,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Humana MGG,Humana MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Optum VA,Optum VA,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,UHC,UHC,2213.44,,,,,,,per diem,2213.44,2213.44,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,UHC MGG,UHC MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,VA,VA,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Wellcare MGG,Wellcare MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Bright Health - commercial,Bright Health - commercial,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2213.44,2213.44,Bright Health MGG,Bright Health MGG,2213.44,,,,,,,case rate,2213.44,2213.44,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Aetna,Aetna,112.11,,,,,,,per diem,112.11,112.11,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Aetna MGG,Aetna MGG,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,BCBS,BCBS,112.11,,,,,,,per diem,112.11,112.11,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,BCBS MGG,BCBS MGG,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Cigna,Cigna,112.11,,,,,,,per diem,112.11,112.11,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Cigna MGG,Cigna MGG,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Humana,Humana,112.11,,,,,,,per diem,112.11,112.11,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Humana MGG,Humana MGG,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Optum VA,Optum VA,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,UHC,UHC,112.11,,,,,,,per diem,112.11,112.11,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,UHC MGG,UHC MGG,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,VA,VA,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Wellcare MGG,Wellcare MGG,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Bright Health - commercial,Bright Health - commercial,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,112.11,112.11,Bright Health MGG,Bright Health MGG,112.11,,,,,,,case rate,112.11,112.11,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Aetna,Aetna,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Aetna MGG,Aetna MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,BCBS,BCBS,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,BCBS MGG,BCBS MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Cigna,Cigna,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Cigna MGG,Cigna MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Humana,Humana,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Humana MGG,Humana MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Optum VA,Optum VA,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,UHC,UHC,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,UHC MGG,UHC MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,VA,VA,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Wellcare MGG,Wellcare MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Bright Health - commercial,Bright Health - commercial,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,95.76,95.76,Bright Health MGG,Bright Health MGG,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Aetna,Aetna,209.31,,,,,,,per diem,209.31,209.31,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Aetna MGG,Aetna MGG,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,BCBS,BCBS,209.31,,,,,,,per diem,209.31,209.31,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,BCBS MGG,BCBS MGG,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Cigna,Cigna,209.31,,,,,,,per diem,209.31,209.31,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Cigna MGG,Cigna MGG,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Humana,Humana,209.31,,,,,,,per diem,209.31,209.31,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Humana MGG,Humana MGG,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Optum VA,Optum VA,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,UHC,UHC,209.31,,,,,,,per diem,209.31,209.31,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,UHC MGG,UHC MGG,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,VA,VA,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Wellcare MGG,Wellcare MGG,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Bright Health - commercial,Bright Health - commercial,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,209.31,209.31,Bright Health MGG,Bright Health MGG,209.31,,,,,,,case rate,209.31,209.31,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Aetna,Aetna,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Aetna MGG,Aetna MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,BCBS,BCBS,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,BCBS MGG,BCBS MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Cigna,Cigna,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Cigna MGG,Cigna MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Humana,Humana,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Humana MGG,Humana MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Optum VA,Optum VA,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,UHC,UHC,1350,,,,,,,per diem,1350,1350,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,UHC MGG,UHC MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,VA,VA,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Wellcare MGG,Wellcare MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Bright Health - commercial,Bright Health - commercial,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,1350,1350,Bright Health MGG,Bright Health MGG,1350,,,,,,,case rate,1350,1350,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Aetna,Aetna,548.68,,,,,,,per diem,548.68,548.68,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Aetna MGG,Aetna MGG,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,BCBS,BCBS,548.68,,,,,,,per diem,548.68,548.68,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,BCBS MGG,BCBS MGG,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Cigna,Cigna,548.68,,,,,,,per diem,548.68,548.68,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Cigna MGG,Cigna MGG,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Humana,Humana,548.68,,,,,,,per diem,548.68,548.68,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Humana MGG,Humana MGG,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Optum VA,Optum VA,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,UHC,UHC,548.68,,,,,,,per diem,548.68,548.68,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,UHC MGG,UHC MGG,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,VA,VA,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Wellcare MGG,Wellcare MGG,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Bright Health - commercial,Bright Health - commercial,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,548.68,548.68,Bright Health MGG,Bright Health MGG,548.68,,,,,,,case rate,548.68,548.68,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Aetna,Aetna,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Aetna MGG,Aetna MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,BCBS,BCBS,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,BCBS MGG,BCBS MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Cigna,Cigna,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Cigna MGG,Cigna MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Humana,Humana,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Humana MGG,Humana MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Optum VA,Optum VA,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,UHC,UHC,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,UHC MGG,UHC MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,VA,VA,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Wellcare MGG,Wellcare MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Bright Health - commercial,Bright Health - commercial,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Bright Health MGG,Bright Health MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Aetna,Aetna,4896.5,,,,,,,per diem,4896.5,4896.5,"Per diem rate, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Aetna MGG,Aetna MGG,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,BCBS,BCBS,4896.5,,,,,,,per diem,4896.5,4896.5,"Per diem rate, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,BCBS MGG,BCBS MGG,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Cigna,Cigna,4896.5,,,,,,,per diem,4896.5,4896.5,"Per diem rate, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Cigna MGG,Cigna MGG,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Humana,Humana,4896.5,,,,,,,per diem,4896.5,4896.5,"Per diem rate, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Humana MGG,Humana MGG,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Optum VA,Optum VA,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,UHC,UHC,4896.5,,,,,,,per diem,4896.5,4896.5,"Per diem rate, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,UHC MGG,UHC MGG,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,VA,VA,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Wellcare MGG,Wellcare MGG,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Bright Health - commercial,Bright Health - commercial,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
PLACEMENT OF IVC FILTER       ,74075940,CDM,320,RC,37191,CPT,,,,Inpatient,,,4896.5,4896.5,Bright Health MGG,Bright Health MGG,4896.5,,,,,,,case rate,4896.5,4896.5,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Aetna,Aetna,3206.88,,,,,,,per diem,3206.88,3206.88,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Aetna MGG,Aetna MGG,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,BCBS,BCBS,3206.88,,,,,,,per diem,3206.88,3206.88,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,BCBS MGG,BCBS MGG,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Cigna,Cigna,3206.88,,,,,,,per diem,3206.88,3206.88,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Cigna MGG,Cigna MGG,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Humana,Humana,3206.88,,,,,,,per diem,3206.88,3206.88,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Humana MGG,Humana MGG,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Optum VA,Optum VA,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,UHC,UHC,3206.88,,,,,,,per diem,3206.88,3206.88,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,UHC MGG,UHC MGG,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,VA,VA,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Wellcare MGG,Wellcare MGG,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Bright Health - commercial,Bright Health - commercial,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3206.88,3206.88,Bright Health MGG,Bright Health MGG,3206.88,,,,,,,case rate,3206.88,3206.88,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Aetna,Aetna,571.77,,,,,,,per diem,571.77,571.77,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Aetna MGG,Aetna MGG,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,BCBS,BCBS,571.77,,,,,,,per diem,571.77,571.77,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,BCBS MGG,BCBS MGG,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Cigna,Cigna,571.77,,,,,,,per diem,571.77,571.77,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Cigna MGG,Cigna MGG,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Humana,Humana,571.77,,,,,,,per diem,571.77,571.77,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Humana MGG,Humana MGG,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Optum VA,Optum VA,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,UHC,UHC,571.77,,,,,,,per diem,571.77,571.77,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,UHC MGG,UHC MGG,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,VA,VA,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Wellcare MGG,Wellcare MGG,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Bright Health - commercial,Bright Health - commercial,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,571.77,571.77,Bright Health MGG,Bright Health MGG,571.77,,,,,,,case rate,571.77,571.77,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Aetna,Aetna,1196.46,,,,,,,per diem,1196.46,1196.46,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Aetna MGG,Aetna MGG,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,BCBS,BCBS,1196.46,,,,,,,per diem,1196.46,1196.46,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,BCBS MGG,BCBS MGG,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Cigna,Cigna,1196.46,,,,,,,per diem,1196.46,1196.46,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Cigna MGG,Cigna MGG,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Humana,Humana,1196.46,,,,,,,per diem,1196.46,1196.46,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Humana MGG,Humana MGG,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Optum VA,Optum VA,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,UHC,UHC,1196.46,,,,,,,per diem,1196.46,1196.46,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,UHC MGG,UHC MGG,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,VA,VA,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Wellcare MGG,Wellcare MGG,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Bright Health - commercial,Bright Health - commercial,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1196.46,1196.46,Bright Health MGG,Bright Health MGG,1196.46,,,,,,,case rate,1196.46,1196.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Aetna,Aetna,334.65,,,,,,,per diem,334.65,334.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Aetna MGG,Aetna MGG,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,BCBS,BCBS,334.65,,,,,,,per diem,334.65,334.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,BCBS MGG,BCBS MGG,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Cigna,Cigna,334.65,,,,,,,per diem,334.65,334.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Cigna MGG,Cigna MGG,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Humana,Humana,334.65,,,,,,,per diem,334.65,334.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Humana MGG,Humana MGG,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Optum VA,Optum VA,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,UHC,UHC,334.65,,,,,,,per diem,334.65,334.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,UHC MGG,UHC MGG,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,VA,VA,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Wellcare MGG,Wellcare MGG,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Bright Health - commercial,Bright Health - commercial,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,334.65,334.65,Bright Health MGG,Bright Health MGG,334.65,,,,,,,case rate,334.65,334.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Aetna,Aetna,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Aetna MGG,Aetna MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,BCBS,BCBS,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,BCBS MGG,BCBS MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Cigna,Cigna,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Cigna MGG,Cigna MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Humana,Humana,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Humana MGG,Humana MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Optum VA,Optum VA,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,UHC,UHC,903,,,,,,,per diem,903,903,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,UHC MGG,UHC MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,VA,VA,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Wellcare MGG,Wellcare MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Bright Health - commercial,Bright Health - commercial,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,903,903,Bright Health MGG,Bright Health MGG,903,,,,,,,case rate,903,903,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Aetna,Aetna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Aetna MGG,Aetna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,BCBS,BCBS,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,BCBS MGG,BCBS MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Cigna,Cigna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Cigna MGG,Cigna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Humana,Humana,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Humana MGG,Humana MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Optum VA,Optum VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,UHC,UHC,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,UHC MGG,UHC MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,VA,VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Wellcare MGG,Wellcare MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Bright Health - commercial,Bright Health - commercial,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,518.16,518.16,Bright Health MGG,Bright Health MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Aetna,Aetna,659.49,,,,,,,per diem,659.49,659.49,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Aetna MGG,Aetna MGG,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,BCBS,BCBS,659.49,,,,,,,per diem,659.49,659.49,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,BCBS MGG,BCBS MGG,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Cigna,Cigna,659.49,,,,,,,per diem,659.49,659.49,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Cigna MGG,Cigna MGG,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Humana,Humana,659.49,,,,,,,per diem,659.49,659.49,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Humana MGG,Humana MGG,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Optum VA,Optum VA,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,UHC,UHC,659.49,,,,,,,per diem,659.49,659.49,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,UHC MGG,UHC MGG,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,VA,VA,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Wellcare MGG,Wellcare MGG,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Bright Health - commercial,Bright Health - commercial,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,659.49,659.49,Bright Health MGG,Bright Health MGG,659.49,,,,,,,case rate,659.49,659.49,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Aetna,Aetna,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Aetna MGG,Aetna MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,BCBS,BCBS,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,BCBS MGG,BCBS MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Cigna,Cigna,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Cigna MGG,Cigna MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Humana,Humana,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Humana MGG,Humana MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Optum VA,Optum VA,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,UHC,UHC,1454.52,,,,,,,per diem,1454.52,1454.52,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,UHC MGG,UHC MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,VA,VA,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Wellcare MGG,Wellcare MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Bright Health - commercial,Bright Health - commercial,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,74300,CPT,,,,Inpatient,,,1454.52,1454.52,Bright Health MGG,Bright Health MGG,1454.52,,,,,,,case rate,1454.52,1454.52,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Aetna,Aetna,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Aetna MGG,Aetna MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,BCBS,BCBS,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,BCBS MGG,BCBS MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Cigna,Cigna,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Cigna MGG,Cigna MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Humana,Humana,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Humana MGG,Humana MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Optum VA,Optum VA,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,UHC,UHC,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,UHC MGG,UHC MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,VA,VA,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Wellcare MGG,Wellcare MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Bright Health - commercial,Bright Health - commercial,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,683.4,683.4,Bright Health MGG,Bright Health MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Aetna,Aetna,1211.76,,,,,,,per diem,1211.76,1211.76,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Aetna MGG,Aetna MGG,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,BCBS,BCBS,1211.76,,,,,,,per diem,1211.76,1211.76,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,BCBS MGG,BCBS MGG,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Cigna,Cigna,1211.76,,,,,,,per diem,1211.76,1211.76,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Cigna MGG,Cigna MGG,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Humana,Humana,1211.76,,,,,,,per diem,1211.76,1211.76,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Humana MGG,Humana MGG,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Optum VA,Optum VA,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,UHC,UHC,1211.76,,,,,,,per diem,1211.76,1211.76,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,UHC MGG,UHC MGG,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,VA,VA,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Wellcare MGG,Wellcare MGG,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Bright Health - commercial,Bright Health - commercial,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,76080,CPT,,,,Inpatient,,,1211.76,1211.76,Bright Health MGG,Bright Health MGG,1211.76,,,,,,,case rate,1211.76,1211.76,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Aetna,Aetna,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Aetna MGG,Aetna MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,BCBS,BCBS,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,BCBS MGG,BCBS MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Cigna,Cigna,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Cigna MGG,Cigna MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Humana,Humana,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Humana MGG,Humana MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Optum VA,Optum VA,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,UHC,UHC,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,UHC MGG,UHC MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,VA,VA,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Wellcare MGG,Wellcare MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Bright Health - commercial,Bright Health - commercial,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Bright Health MGG,Bright Health MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Aetna,Aetna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Aetna MGG,Aetna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,BCBS,BCBS,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,BCBS MGG,BCBS MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Cigna,Cigna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Cigna MGG,Cigna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Humana,Humana,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Humana MGG,Humana MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Optum VA,Optum VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,UHC,UHC,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,UHC MGG,UHC MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,VA,VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Wellcare MGG,Wellcare MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Bright Health - commercial,Bright Health - commercial,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,73580,CPT,,,LT,Inpatient,,,1001.64,1001.64,Bright Health MGG,Bright Health MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Aetna,Aetna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Aetna MGG,Aetna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,BCBS,BCBS,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,BCBS MGG,BCBS MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Cigna,Cigna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Cigna MGG,Cigna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Humana,Humana,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Humana MGG,Humana MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Optum VA,Optum VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,UHC,UHC,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,UHC MGG,UHC MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,VA,VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Wellcare MGG,Wellcare MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Bright Health - commercial,Bright Health - commercial,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,1001.64,1001.64,Bright Health MGG,Bright Health MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Aetna,Aetna,2667.3,,,,,,,per diem,2667.3,2667.3,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Aetna MGG,Aetna MGG,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,BCBS,BCBS,2667.3,,,,,,,per diem,2667.3,2667.3,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,BCBS MGG,BCBS MGG,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Cigna,Cigna,2667.3,,,,,,,per diem,2667.3,2667.3,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Cigna MGG,Cigna MGG,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Humana,Humana,2667.3,,,,,,,per diem,2667.3,2667.3,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Humana MGG,Humana MGG,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Optum VA,Optum VA,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,UHC,UHC,2667.3,,,,,,,per diem,2667.3,2667.3,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,UHC MGG,UHC MGG,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,VA,VA,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Wellcare MGG,Wellcare MGG,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Bright Health - commercial,Bright Health - commercial,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,72265,CPT,,,,Inpatient,,,2667.3,2667.3,Bright Health MGG,Bright Health MGG,2667.3,,,,,,,case rate,2667.3,2667.3,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Aetna,Aetna,1857.42,,,,,,,per diem,1857.42,1857.42,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Aetna MGG,Aetna MGG,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,BCBS,BCBS,1857.42,,,,,,,per diem,1857.42,1857.42,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,BCBS MGG,BCBS MGG,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Cigna,Cigna,1857.42,,,,,,,per diem,1857.42,1857.42,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Cigna MGG,Cigna MGG,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Humana,Humana,1857.42,,,,,,,per diem,1857.42,1857.42,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Humana MGG,Humana MGG,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Optum VA,Optum VA,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,UHC,UHC,1857.42,,,,,,,per diem,1857.42,1857.42,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,UHC MGG,UHC MGG,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,VA,VA,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Wellcare MGG,Wellcare MGG,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Bright Health - commercial,Bright Health - commercial,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,72255,CPT,,,,Inpatient,,,1857.42,1857.42,Bright Health MGG,Bright Health MGG,1857.42,,,,,,,case rate,1857.42,1857.42,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Aetna,Aetna,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Aetna MGG,Aetna MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,BCBS,BCBS,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,BCBS MGG,BCBS MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Cigna,Cigna,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Cigna MGG,Cigna MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Humana,Humana,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Humana MGG,Humana MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Optum VA,Optum VA,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,UHC,UHC,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,UHC MGG,UHC MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,VA,VA,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Wellcare MGG,Wellcare MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Bright Health - commercial,Bright Health - commercial,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,72240,CPT,,,,Inpatient,,,1900.26,1900.26,Bright Health MGG,Bright Health MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Aetna,Aetna,5699.76,,,,,,,per diem,5699.76,5699.76,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Aetna MGG,Aetna MGG,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,BCBS,BCBS,5699.76,,,,,,,per diem,5699.76,5699.76,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,BCBS MGG,BCBS MGG,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Cigna,Cigna,5699.76,,,,,,,per diem,5699.76,5699.76,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Cigna MGG,Cigna MGG,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Humana,Humana,5699.76,,,,,,,per diem,5699.76,5699.76,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Humana MGG,Humana MGG,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Optum VA,Optum VA,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,UHC,UHC,5699.76,,,,,,,per diem,5699.76,5699.76,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,UHC MGG,UHC MGG,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,VA,VA,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Wellcare MGG,Wellcare MGG,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Bright Health - commercial,Bright Health - commercial,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,75822,CPT,,,,Inpatient,,,5699.76,5699.76,Bright Health MGG,Bright Health MGG,5699.76,,,,,,,case rate,5699.76,5699.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Aetna,Aetna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Aetna MGG,Aetna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,BCBS,BCBS,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,BCBS MGG,BCBS MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Cigna,Cigna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Cigna MGG,Cigna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Humana,Humana,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Humana MGG,Humana MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Optum VA,Optum VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,UHC,UHC,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,UHC MGG,UHC MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,VA,VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Wellcare MGG,Wellcare MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Bright Health - commercial,Bright Health - commercial,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,73085,CPT,,,LT,Inpatient,,,1001.64,1001.64,Bright Health MGG,Bright Health MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Aetna,Aetna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Aetna MGG,Aetna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,BCBS,BCBS,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,BCBS MGG,BCBS MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Cigna,Cigna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Cigna MGG,Cigna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Humana,Humana,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Humana MGG,Humana MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Optum VA,Optum VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,UHC,UHC,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,UHC MGG,UHC MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,VA,VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Wellcare MGG,Wellcare MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Bright Health - commercial,Bright Health - commercial,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,1001.64,1001.64,Bright Health MGG,Bright Health MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Aetna,Aetna,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Aetna MGG,Aetna MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,BCBS,BCBS,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,BCBS MGG,BCBS MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Cigna,Cigna,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Cigna MGG,Cigna MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Humana,Humana,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Humana MGG,Humana MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Optum VA,Optum VA,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,UHC,UHC,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,UHC MGG,UHC MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,VA,VA,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Wellcare MGG,Wellcare MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Bright Health - commercial,Bright Health - commercial,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Bright Health MGG,Bright Health MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Aetna,Aetna,6878.88,,,,,,,per diem,6878.88,6878.88,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Aetna MGG,Aetna MGG,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,BCBS,BCBS,6878.88,,,,,,,per diem,6878.88,6878.88,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,BCBS MGG,BCBS MGG,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Cigna,Cigna,6878.88,,,,,,,per diem,6878.88,6878.88,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Cigna MGG,Cigna MGG,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Humana,Humana,6878.88,,,,,,,per diem,6878.88,6878.88,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Humana MGG,Humana MGG,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Optum VA,Optum VA,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,UHC,UHC,6878.88,,,,,,,per diem,6878.88,6878.88,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,UHC MGG,UHC MGG,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,VA,VA,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Wellcare MGG,Wellcare MGG,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Bright Health - commercial,Bright Health - commercial,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,75630,CPT,,,,Inpatient,,,6878.88,6878.88,Bright Health MGG,Bright Health MGG,6878.88,,,,,,,case rate,6878.88,6878.88,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Aetna,Aetna,1368.84,,,,,,,per diem,1368.84,1368.84,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Aetna MGG,Aetna MGG,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,BCBS,BCBS,1368.84,,,,,,,per diem,1368.84,1368.84,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,BCBS MGG,BCBS MGG,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Cigna,Cigna,1368.84,,,,,,,per diem,1368.84,1368.84,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Cigna MGG,Cigna MGG,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Humana,Humana,1368.84,,,,,,,per diem,1368.84,1368.84,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Humana MGG,Humana MGG,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Optum VA,Optum VA,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,UHC,UHC,1368.84,,,,,,,per diem,1368.84,1368.84,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,UHC MGG,UHC MGG,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,VA,VA,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Wellcare MGG,Wellcare MGG,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Bright Health - commercial,Bright Health - commercial,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,74425,CPT,,,RT,Inpatient,,,1368.84,1368.84,Bright Health MGG,Bright Health MGG,1368.84,,,,,,,case rate,1368.84,1368.84,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Aetna,Aetna,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Aetna MGG,Aetna MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,BCBS,BCBS,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,BCBS MGG,BCBS MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Cigna,Cigna,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Cigna MGG,Cigna MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Humana,Humana,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Humana MGG,Humana MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Optum VA,Optum VA,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,UHC,UHC,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,UHC MGG,UHC MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,VA,VA,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Wellcare MGG,Wellcare MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Bright Health - commercial,Bright Health - commercial,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,74450,CPT,,,,Inpatient,,,880.26,880.26,Bright Health MGG,Bright Health MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Aetna,Aetna,682.38,,,,,,,per diem,682.38,682.38,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Aetna MGG,Aetna MGG,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,BCBS,BCBS,682.38,,,,,,,per diem,682.38,682.38,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,BCBS MGG,BCBS MGG,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Cigna,Cigna,682.38,,,,,,,per diem,682.38,682.38,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Cigna MGG,Cigna MGG,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Humana,Humana,682.38,,,,,,,per diem,682.38,682.38,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Humana MGG,Humana MGG,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Optum VA,Optum VA,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,UHC,UHC,682.38,,,,,,,per diem,682.38,682.38,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,UHC MGG,UHC MGG,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,VA,VA,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Wellcare MGG,Wellcare MGG,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Bright Health - commercial,Bright Health - commercial,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,75791,CPT,,,,Inpatient,,,682.38,682.38,Bright Health MGG,Bright Health MGG,682.38,,,,,,,case rate,682.38,682.38,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Aetna,Aetna,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Aetna MGG,Aetna MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,BCBS,BCBS,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,BCBS MGG,BCBS MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Cigna,Cigna,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Cigna MGG,Cigna MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Humana,Humana,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Humana MGG,Humana MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Optum VA,Optum VA,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,UHC,UHC,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,UHC MGG,UHC MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,VA,VA,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Wellcare MGG,Wellcare MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Bright Health - commercial,Bright Health - commercial,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Bright Health MGG,Bright Health MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Aetna,Aetna,557.94,,,,,,,per diem,557.94,557.94,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Aetna MGG,Aetna MGG,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,BCBS,BCBS,557.94,,,,,,,per diem,557.94,557.94,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,BCBS MGG,BCBS MGG,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Cigna,Cigna,557.94,,,,,,,per diem,557.94,557.94,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Cigna MGG,Cigna MGG,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Humana,Humana,557.94,,,,,,,per diem,557.94,557.94,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Humana MGG,Humana MGG,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Optum VA,Optum VA,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,UHC,UHC,557.94,,,,,,,per diem,557.94,557.94,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,UHC MGG,UHC MGG,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,VA,VA,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Wellcare MGG,Wellcare MGG,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Bright Health - commercial,Bright Health - commercial,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,71010,CPT,,,,Inpatient,,,557.94,557.94,Bright Health MGG,Bright Health MGG,557.94,,,,,,,case rate,557.94,557.94,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Aetna,Aetna,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Aetna MGG,Aetna MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,BCBS,BCBS,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,BCBS MGG,BCBS MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Cigna,Cigna,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Cigna MGG,Cigna MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Humana,Humana,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Humana MGG,Humana MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Optum VA,Optum VA,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,UHC,UHC,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,UHC MGG,UHC MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,VA,VA,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Wellcare MGG,Wellcare MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Bright Health - commercial,Bright Health - commercial,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,75809,CPT,,,,Inpatient,,,416.16,416.16,Bright Health MGG,Bright Health MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Aetna,Aetna,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Aetna MGG,Aetna MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,BCBS,BCBS,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,BCBS MGG,BCBS MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Cigna,Cigna,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Cigna MGG,Cigna MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Humana,Humana,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Humana MGG,Humana MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Optum VA,Optum VA,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,UHC,UHC,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,UHC MGG,UHC MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,VA,VA,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Wellcare MGG,Wellcare MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Bright Health - commercial,Bright Health - commercial,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,77002,CPT,,,,Inpatient,,,432.48,432.48,Bright Health MGG,Bright Health MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Aetna,Aetna,1346.79,,,,,,,per diem,1346.79,1346.79,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Aetna MGG,Aetna MGG,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,BCBS,BCBS,1346.79,,,,,,,per diem,1346.79,1346.79,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,BCBS MGG,BCBS MGG,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Cigna,Cigna,1346.79,,,,,,,per diem,1346.79,1346.79,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Cigna MGG,Cigna MGG,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Humana,Humana,1346.79,,,,,,,per diem,1346.79,1346.79,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Humana MGG,Humana MGG,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Optum VA,Optum VA,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,UHC,UHC,1346.79,,,,,,,per diem,1346.79,1346.79,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,UHC MGG,UHC MGG,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,VA,VA,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Wellcare MGG,Wellcare MGG,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Bright Health - commercial,Bright Health - commercial,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,76942,CPT,,,,Inpatient,,,1346.79,1346.79,Bright Health MGG,Bright Health MGG,1346.79,,,,,,,case rate,1346.79,1346.79,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Aetna,Aetna,875.74,,,,,,,per diem,875.74,875.74,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Aetna MGG,Aetna MGG,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,BCBS,BCBS,875.74,,,,,,,per diem,875.74,875.74,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,BCBS MGG,BCBS MGG,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Cigna,Cigna,875.74,,,,,,,per diem,875.74,875.74,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Cigna MGG,Cigna MGG,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Humana,Humana,875.74,,,,,,,per diem,875.74,875.74,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Humana MGG,Humana MGG,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Optum VA,Optum VA,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,UHC,UHC,875.74,,,,,,,per diem,875.74,875.74,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,UHC MGG,UHC MGG,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,VA,VA,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Wellcare MGG,Wellcare MGG,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Bright Health - commercial,Bright Health - commercial,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,76937,CPT,,,,Inpatient,,,875.74,875.74,Bright Health MGG,Bright Health MGG,875.74,,,,,,,case rate,875.74,875.74,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Aetna,Aetna,3047.76,,,,,,,per diem,3047.76,3047.76,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Aetna MGG,Aetna MGG,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,BCBS,BCBS,3047.76,,,,,,,per diem,3047.76,3047.76,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,BCBS MGG,BCBS MGG,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Cigna,Cigna,3047.76,,,,,,,per diem,3047.76,3047.76,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Cigna MGG,Cigna MGG,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Humana,Humana,3047.76,,,,,,,per diem,3047.76,3047.76,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Humana MGG,Humana MGG,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Optum VA,Optum VA,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,UHC,UHC,3047.76,,,,,,,per diem,3047.76,3047.76,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,UHC MGG,UHC MGG,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,VA,VA,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Wellcare MGG,Wellcare MGG,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Bright Health - commercial,Bright Health - commercial,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,G0259,CPT,,,,Inpatient,,,3047.76,3047.76,Bright Health MGG,Bright Health MGG,3047.76,,,,,,,case rate,3047.76,3047.76,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Aetna,Aetna,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Aetna MGG,Aetna MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,BCBS,BCBS,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,BCBS MGG,BCBS MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Cigna,Cigna,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Cigna MGG,Cigna MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Humana,Humana,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Humana MGG,Humana MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Optum VA,Optum VA,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,UHC,UHC,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,UHC MGG,UHC MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,VA,VA,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Wellcare MGG,Wellcare MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Bright Health - commercial,Bright Health - commercial,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Bright Health MGG,Bright Health MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Aetna,Aetna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Aetna MGG,Aetna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,BCBS,BCBS,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,BCBS MGG,BCBS MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Cigna,Cigna,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Cigna MGG,Cigna MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Humana,Humana,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Humana MGG,Humana MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Optum VA,Optum VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,UHC,UHC,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,UHC MGG,UHC MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,VA,VA,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Wellcare MGG,Wellcare MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Bright Health - commercial,Bright Health - commercial,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,85.68,85.68,Bright Health MGG,Bright Health MGG,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Aetna,Aetna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Aetna MGG,Aetna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,BCBS,BCBS,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,BCBS MGG,BCBS MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Cigna,Cigna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Cigna MGG,Cigna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Humana,Humana,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Humana MGG,Humana MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Optum VA,Optum VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,UHC,UHC,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,UHC MGG,UHC MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,VA,VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Wellcare MGG,Wellcare MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Bright Health - commercial,Bright Health - commercial,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,96373,CPT,,,,Inpatient,,,644.64,644.64,Bright Health MGG,Bright Health MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Aetna,Aetna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Aetna MGG,Aetna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,BCBS,BCBS,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,BCBS MGG,BCBS MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Cigna,Cigna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Cigna MGG,Cigna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Humana,Humana,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Humana MGG,Humana MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Optum VA,Optum VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,UHC,UHC,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,UHC MGG,UHC MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,VA,VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Wellcare MGG,Wellcare MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Bright Health - commercial,Bright Health - commercial,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,96375,CPT,,,,Inpatient,,,644.64,644.64,Bright Health MGG,Bright Health MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Aetna,Aetna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Aetna MGG,Aetna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,BCBS,BCBS,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,BCBS MGG,BCBS MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Cigna,Cigna,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Cigna MGG,Cigna MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Humana,Humana,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Humana MGG,Humana MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Optum VA,Optum VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,UHC,UHC,644.64,,,,,,,per diem,644.64,644.64,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,UHC MGG,UHC MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,VA,VA,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Wellcare MGG,Wellcare MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Bright Health - commercial,Bright Health - commercial,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,96374,CPT,,,,Inpatient,,,644.64,644.64,Bright Health MGG,Bright Health MGG,644.64,,,,,,,case rate,644.64,644.64,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,75733,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,75731,CPT,,,LT,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,75731,CPT,,,RT,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,75658,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Aetna,Aetna,2863.14,,,,,,,per diem,2863.14,2863.14,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Aetna MGG,Aetna MGG,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,BCBS,BCBS,2863.14,,,,,,,per diem,2863.14,2863.14,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,BCBS MGG,BCBS MGG,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Cigna,Cigna,2863.14,,,,,,,per diem,2863.14,2863.14,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Cigna MGG,Cigna MGG,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Humana,Humana,2863.14,,,,,,,per diem,2863.14,2863.14,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Humana MGG,Humana MGG,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Optum VA,Optum VA,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,UHC,UHC,2863.14,,,,,,,per diem,2863.14,2863.14,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,UHC MGG,UHC MGG,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,VA,VA,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Wellcare MGG,Wellcare MGG,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Bright Health - commercial,Bright Health - commercial,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,75774,CPT,,,,Inpatient,,,2863.14,2863.14,Bright Health MGG,Bright Health MGG,2863.14,,,,,,,case rate,2863.14,2863.14,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Aetna,Aetna,3738.3,,,,,,,per diem,3738.3,3738.3,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Aetna MGG,Aetna MGG,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,BCBS,BCBS,3738.3,,,,,,,per diem,3738.3,3738.3,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,BCBS MGG,BCBS MGG,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Cigna,Cigna,3738.3,,,,,,,per diem,3738.3,3738.3,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Cigna MGG,Cigna MGG,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Humana,Humana,3738.3,,,,,,,per diem,3738.3,3738.3,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Humana MGG,Humana MGG,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Optum VA,Optum VA,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,UHC,UHC,3738.3,,,,,,,per diem,3738.3,3738.3,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,UHC MGG,UHC MGG,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,VA,VA,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Wellcare MGG,Wellcare MGG,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Bright Health - commercial,Bright Health - commercial,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,75756,CPT,,,,Inpatient,,,3738.3,3738.3,Bright Health MGG,Bright Health MGG,3738.3,,,,,,,case rate,3738.3,3738.3,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,75746,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,75741,CPT,,,LT,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,75741,CPT,,,RT,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Aetna,Aetna,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Aetna MGG,Aetna MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,BCBS,BCBS,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,BCBS MGG,BCBS MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Cigna,Cigna,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Cigna MGG,Cigna MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Humana,Humana,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Humana MGG,Humana MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Optum VA,Optum VA,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,UHC,UHC,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,UHC MGG,UHC MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,VA,VA,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Wellcare MGG,Wellcare MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Bright Health - commercial,Bright Health - commercial,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Bright Health MGG,Bright Health MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Aetna,Aetna,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Aetna MGG,Aetna MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,BCBS,BCBS,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,BCBS MGG,BCBS MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Cigna,Cigna,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Cigna MGG,Cigna MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Humana,Humana,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Humana MGG,Humana MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Optum VA,Optum VA,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,UHC,UHC,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,UHC MGG,UHC MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,VA,VA,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Wellcare MGG,Wellcare MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Bright Health - commercial,Bright Health - commercial,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,73525,CPT,,,,Inpatient,,,879.24,879.24,Bright Health MGG,Bright Health MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Aetna,Aetna,3964.74,,,,,,,per diem,3964.74,3964.74,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Aetna MGG,Aetna MGG,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,BCBS,BCBS,3964.74,,,,,,,per diem,3964.74,3964.74,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,BCBS MGG,BCBS MGG,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Cigna,Cigna,3964.74,,,,,,,per diem,3964.74,3964.74,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Cigna MGG,Cigna MGG,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Humana,Humana,3964.74,,,,,,,per diem,3964.74,3964.74,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Humana MGG,Humana MGG,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Optum VA,Optum VA,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,UHC,UHC,3964.74,,,,,,,per diem,3964.74,3964.74,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,UHC MGG,UHC MGG,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,VA,VA,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Wellcare MGG,Wellcare MGG,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Bright Health - commercial,Bright Health - commercial,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,74363,CPT,,,,Inpatient,,,3964.74,3964.74,Bright Health MGG,Bright Health MGG,3964.74,,,,,,,case rate,3964.74,3964.74,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Aetna,Aetna,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Aetna MGG,Aetna MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,BCBS,BCBS,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,BCBS MGG,BCBS MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Cigna,Cigna,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Cigna MGG,Cigna MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Humana,Humana,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Humana MGG,Humana MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Optum VA,Optum VA,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,UHC,UHC,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,UHC MGG,UHC MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,VA,VA,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Wellcare MGG,Wellcare MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Bright Health - commercial,Bright Health - commercial,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,77072,CPT,,,,Inpatient,,,293.76,293.76,Bright Health MGG,Bright Health MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Aetna,Aetna,397.8,,,,,,,per diem,397.8,397.8,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Aetna MGG,Aetna MGG,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,BCBS,BCBS,397.8,,,,,,,per diem,397.8,397.8,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,BCBS MGG,BCBS MGG,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Cigna,Cigna,397.8,,,,,,,per diem,397.8,397.8,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Cigna MGG,Cigna MGG,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Humana,Humana,397.8,,,,,,,per diem,397.8,397.8,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Humana MGG,Humana MGG,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Optum VA,Optum VA,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,UHC,UHC,397.8,,,,,,,per diem,397.8,397.8,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,UHC MGG,UHC MGG,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,VA,VA,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Wellcare MGG,Wellcare MGG,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Bright Health - commercial,Bright Health - commercial,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,77073,CPT,,,,Inpatient,,,397.8,397.8,Bright Health MGG,Bright Health MGG,397.8,,,,,,,case rate,397.8,397.8,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Aetna,Aetna,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Aetna MGG,Aetna MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,BCBS,BCBS,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,BCBS MGG,BCBS MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Cigna,Cigna,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Cigna MGG,Cigna MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Humana,Humana,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Humana MGG,Humana MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Optum VA,Optum VA,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,UHC,UHC,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,UHC MGG,UHC MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,VA,VA,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Wellcare MGG,Wellcare MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Bright Health - commercial,Bright Health - commercial,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Bright Health MGG,Bright Health MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,72285,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Aetna,Aetna,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Aetna MGG,Aetna MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,BCBS,BCBS,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,BCBS MGG,BCBS MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Cigna,Cigna,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Cigna MGG,Cigna MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Humana,Humana,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Humana MGG,Humana MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Optum VA,Optum VA,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,UHC,UHC,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,UHC MGG,UHC MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,VA,VA,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Wellcare MGG,Wellcare MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Bright Health - commercial,Bright Health - commercial,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Bright Health MGG,Bright Health MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Aetna,Aetna,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Aetna MGG,Aetna MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,BCBS,BCBS,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,BCBS MGG,BCBS MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Cigna,Cigna,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Cigna MGG,Cigna MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Humana,Humana,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Humana MGG,Humana MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Optum VA,Optum VA,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,UHC,UHC,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,UHC MGG,UHC MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,VA,VA,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Wellcare MGG,Wellcare MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Bright Health - commercial,Bright Health - commercial,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,74742,CPT,,,,Inpatient,,,798.66,798.66,Bright Health MGG,Bright Health MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Aetna,Aetna,1667.7,,,,,,,per diem,1667.7,1667.7,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Aetna MGG,Aetna MGG,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,BCBS,BCBS,1667.7,,,,,,,per diem,1667.7,1667.7,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,BCBS MGG,BCBS MGG,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Cigna,Cigna,1667.7,,,,,,,per diem,1667.7,1667.7,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Cigna MGG,Cigna MGG,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Humana,Humana,1667.7,,,,,,,per diem,1667.7,1667.7,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Humana MGG,Humana MGG,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Optum VA,Optum VA,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,UHC,UHC,1667.7,,,,,,,per diem,1667.7,1667.7,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,UHC MGG,UHC MGG,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,VA,VA,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Wellcare MGG,Wellcare MGG,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Bright Health - commercial,Bright Health - commercial,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,74360,CPT,,,,Inpatient,,,1667.7,1667.7,Bright Health MGG,Bright Health MGG,1667.7,,,,,,,case rate,1667.7,1667.7,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Aetna,Aetna,1538.16,,,,,,,per diem,1538.16,1538.16,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Aetna MGG,Aetna MGG,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,BCBS,BCBS,1538.16,,,,,,,per diem,1538.16,1538.16,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,BCBS MGG,BCBS MGG,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Cigna,Cigna,1538.16,,,,,,,per diem,1538.16,1538.16,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Cigna MGG,Cigna MGG,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Humana,Humana,1538.16,,,,,,,per diem,1538.16,1538.16,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Humana MGG,Humana MGG,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Optum VA,Optum VA,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,UHC,UHC,1538.16,,,,,,,per diem,1538.16,1538.16,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,UHC MGG,UHC MGG,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,VA,VA,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Wellcare MGG,Wellcare MGG,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Bright Health - commercial,Bright Health - commercial,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,74485,CPT,,,,Inpatient,,,1538.16,1538.16,Bright Health MGG,Bright Health MGG,1538.16,,,,,,,case rate,1538.16,1538.16,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Aetna,Aetna,677.28,,,,,,,per diem,677.28,677.28,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Aetna MGG,Aetna MGG,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,BCBS,BCBS,677.28,,,,,,,per diem,677.28,677.28,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,BCBS MGG,BCBS MGG,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Cigna,Cigna,677.28,,,,,,,per diem,677.28,677.28,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Cigna MGG,Cigna MGG,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Humana,Humana,677.28,,,,,,,per diem,677.28,677.28,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Humana MGG,Humana MGG,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Optum VA,Optum VA,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,UHC,UHC,677.28,,,,,,,per diem,677.28,677.28,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,UHC MGG,UHC MGG,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,VA,VA,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Wellcare MGG,Wellcare MGG,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Bright Health - commercial,Bright Health - commercial,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,74190,CPT,,,,Inpatient,,,677.28,677.28,Bright Health MGG,Bright Health MGG,677.28,,,,,,,case rate,677.28,677.28,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,75885,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Aetna,Aetna,7763.22,,,,,,,per diem,7763.22,7763.22,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Aetna MGG,Aetna MGG,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,BCBS,BCBS,7763.22,,,,,,,per diem,7763.22,7763.22,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,BCBS MGG,BCBS MGG,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Cigna,Cigna,7763.22,,,,,,,per diem,7763.22,7763.22,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Cigna MGG,Cigna MGG,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Humana,Humana,7763.22,,,,,,,per diem,7763.22,7763.22,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Humana MGG,Humana MGG,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Optum VA,Optum VA,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,UHC,UHC,7763.22,,,,,,,per diem,7763.22,7763.22,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,UHC MGG,UHC MGG,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,VA,VA,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Wellcare MGG,Wellcare MGG,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Bright Health - commercial,Bright Health - commercial,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,75887,CPT,,,,Inpatient,,,7763.22,7763.22,Bright Health MGG,Bright Health MGG,7763.22,,,,,,,case rate,7763.22,7763.22,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Aetna,Aetna,3334.38,,,,,,,per diem,3334.38,3334.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Aetna MGG,Aetna MGG,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,BCBS,BCBS,3334.38,,,,,,,per diem,3334.38,3334.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,BCBS MGG,BCBS MGG,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Cigna,Cigna,3334.38,,,,,,,per diem,3334.38,3334.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Cigna MGG,Cigna MGG,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Humana,Humana,3334.38,,,,,,,per diem,3334.38,3334.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Humana MGG,Humana MGG,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Optum VA,Optum VA,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,UHC,UHC,3334.38,,,,,,,per diem,3334.38,3334.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,UHC MGG,UHC MGG,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,VA,VA,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Wellcare MGG,Wellcare MGG,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Bright Health - commercial,Bright Health - commercial,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,75964,CPT,,,,Inpatient,,,3334.38,3334.38,Bright Health MGG,Bright Health MGG,3334.38,,,,,,,case rate,3334.38,3334.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Aetna,Aetna,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Aetna MGG,Aetna MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,BCBS,BCBS,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,BCBS MGG,BCBS MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Cigna,Cigna,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Cigna MGG,Cigna MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Humana,Humana,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Humana MGG,Humana MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Optum VA,Optum VA,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,UHC,UHC,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,UHC MGG,UHC MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,VA,VA,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Wellcare MGG,Wellcare MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Bright Health - commercial,Bright Health - commercial,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Bright Health MGG,Bright Health MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Aetna,Aetna,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Aetna MGG,Aetna MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,BCBS,BCBS,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,BCBS MGG,BCBS MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Cigna,Cigna,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Cigna MGG,Cigna MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Humana,Humana,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Humana MGG,Humana MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Optum VA,Optum VA,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,UHC,UHC,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,UHC MGG,UHC MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,VA,VA,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Wellcare MGG,Wellcare MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Bright Health - commercial,Bright Health - commercial,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,75968,CPT,,,,Inpatient,,,2695.86,2695.86,Bright Health MGG,Bright Health MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Aetna,Aetna,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Aetna MGG,Aetna MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,BCBS,BCBS,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,BCBS MGG,BCBS MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Cigna,Cigna,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Cigna MGG,Cigna MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Humana,Humana,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Humana MGG,Humana MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Optum VA,Optum VA,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,UHC,UHC,2695.86,,,,,,,per diem,2695.86,2695.86,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,UHC MGG,UHC MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,VA,VA,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Wellcare MGG,Wellcare MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Bright Health - commercial,Bright Health - commercial,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,75966,CPT,,,,Inpatient,,,2695.86,2695.86,Bright Health MGG,Bright Health MGG,2695.86,,,,,,,case rate,2695.86,2695.86,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Aetna,Aetna,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Aetna MGG,Aetna MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,BCBS,BCBS,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,BCBS MGG,BCBS MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Cigna,Cigna,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Cigna MGG,Cigna MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Humana,Humana,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Humana MGG,Humana MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Optum VA,Optum VA,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,UHC,UHC,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,UHC MGG,UHC MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,VA,VA,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Wellcare MGG,Wellcare MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Bright Health - commercial,Bright Health - commercial,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Bright Health MGG,Bright Health MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Aetna,Aetna,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Aetna MGG,Aetna MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,BCBS,BCBS,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,BCBS MGG,BCBS MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Cigna,Cigna,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Cigna MGG,Cigna MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Humana,Humana,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Humana MGG,Humana MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Optum VA,Optum VA,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,UHC,UHC,808.86,,,,,,,per diem,808.86,808.86,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,UHC MGG,UHC MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,VA,VA,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Wellcare MGG,Wellcare MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Bright Health - commercial,Bright Health - commercial,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,75902,CPT,,,,Inpatient,,,808.86,808.86,Bright Health MGG,Bright Health MGG,808.86,,,,,,,case rate,808.86,808.86,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Aetna,Aetna,813.96,,,,,,,per diem,813.96,813.96,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Aetna MGG,Aetna MGG,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,BCBS,BCBS,813.96,,,,,,,per diem,813.96,813.96,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,BCBS MGG,BCBS MGG,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Cigna,Cigna,813.96,,,,,,,per diem,813.96,813.96,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Cigna MGG,Cigna MGG,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Humana,Humana,813.96,,,,,,,per diem,813.96,813.96,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Humana MGG,Humana MGG,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Optum VA,Optum VA,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,UHC,UHC,813.96,,,,,,,per diem,813.96,813.96,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,UHC MGG,UHC MGG,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,VA,VA,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Wellcare MGG,Wellcare MGG,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Bright Health - commercial,Bright Health - commercial,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,70390,CPT,,,,Inpatient,,,813.96,813.96,Bright Health MGG,Bright Health MGG,813.96,,,,,,,case rate,813.96,813.96,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,75810,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Aetna,Aetna,4809.3,,,,,,,per diem,4809.3,4809.3,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Aetna MGG,Aetna MGG,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,BCBS,BCBS,4809.3,,,,,,,per diem,4809.3,4809.3,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,BCBS MGG,BCBS MGG,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Cigna,Cigna,4809.3,,,,,,,per diem,4809.3,4809.3,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Cigna MGG,Cigna MGG,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Humana,Humana,4809.3,,,,,,,per diem,4809.3,4809.3,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Humana MGG,Humana MGG,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Optum VA,Optum VA,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,UHC,UHC,4809.3,,,,,,,per diem,4809.3,4809.3,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,UHC MGG,UHC MGG,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,VA,VA,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Wellcare MGG,Wellcare MGG,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Bright Health - commercial,Bright Health - commercial,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,75894,CPT,,,,Inpatient,,,4809.3,4809.3,Bright Health MGG,Bright Health MGG,4809.3,,,,,,,case rate,4809.3,4809.3,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Aetna,Aetna,1124.04,,,,,,,per diem,1124.04,1124.04,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Aetna MGG,Aetna MGG,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,BCBS,BCBS,1124.04,,,,,,,per diem,1124.04,1124.04,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,BCBS MGG,BCBS MGG,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Cigna,Cigna,1124.04,,,,,,,per diem,1124.04,1124.04,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Cigna MGG,Cigna MGG,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Humana,Humana,1124.04,,,,,,,per diem,1124.04,1124.04,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Humana MGG,Humana MGG,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Optum VA,Optum VA,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,UHC,UHC,1124.04,,,,,,,per diem,1124.04,1124.04,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,UHC MGG,UHC MGG,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,VA,VA,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Wellcare MGG,Wellcare MGG,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Bright Health - commercial,Bright Health - commercial,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,75898,CPT,,,,Inpatient,,,1124.04,1124.04,Bright Health MGG,Bright Health MGG,1124.04,,,,,,,case rate,1124.04,1124.04,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Aetna,Aetna,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Aetna MGG,Aetna MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,BCBS,BCBS,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,BCBS MGG,BCBS MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Cigna,Cigna,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Cigna MGG,Cigna MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Humana,Humana,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Humana MGG,Humana MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Optum VA,Optum VA,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,UHC,UHC,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,UHC MGG,UHC MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,VA,VA,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Wellcare MGG,Wellcare MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Bright Health - commercial,Bright Health - commercial,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,75842,CPT,,,,Inpatient,,,2971.26,2971.26,Bright Health MGG,Bright Health MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Aetna,Aetna,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Aetna MGG,Aetna MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,BCBS,BCBS,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,BCBS MGG,BCBS MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Cigna,Cigna,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Cigna MGG,Cigna MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Humana,Humana,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Humana MGG,Humana MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Optum VA,Optum VA,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,UHC,UHC,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,UHC MGG,UHC MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,VA,VA,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Wellcare MGG,Wellcare MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Bright Health - commercial,Bright Health - commercial,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,75840,CPT,,,LT,Inpatient,,,2971.26,2971.26,Bright Health MGG,Bright Health MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Aetna,Aetna,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Aetna MGG,Aetna MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,BCBS,BCBS,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,BCBS MGG,BCBS MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Cigna,Cigna,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Cigna MGG,Cigna MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Humana,Humana,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Humana MGG,Humana MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Optum VA,Optum VA,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,UHC,UHC,2971.26,,,,,,,per diem,2971.26,2971.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,UHC MGG,UHC MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,VA,VA,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Wellcare MGG,Wellcare MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Bright Health - commercial,Bright Health - commercial,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,75840,CPT,,,RT,Inpatient,,,2971.26,2971.26,Bright Health MGG,Bright Health MGG,2971.26,,,,,,,case rate,2971.26,2971.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Aetna,Aetna,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Aetna MGG,Aetna MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,BCBS,BCBS,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,BCBS MGG,BCBS MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Cigna,Cigna,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Cigna MGG,Cigna MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Humana,Humana,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Humana MGG,Humana MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Optum VA,Optum VA,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,UHC,UHC,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,UHC MGG,UHC MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,VA,VA,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Wellcare MGG,Wellcare MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Bright Health - commercial,Bright Health - commercial,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,75872,CPT,,,,Inpatient,,,3045.72,3045.72,Bright Health MGG,Bright Health MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Aetna,Aetna,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Aetna MGG,Aetna MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,BCBS,BCBS,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,BCBS MGG,BCBS MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Cigna,Cigna,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Cigna MGG,Cigna MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Humana,Humana,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Humana MGG,Humana MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Optum VA,Optum VA,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,UHC,UHC,3045.72,,,,,,,per diem,3045.72,3045.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,UHC MGG,UHC MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,VA,VA,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Wellcare MGG,Wellcare MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Bright Health - commercial,Bright Health - commercial,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,75880,CPT,,,,Inpatient,,,3045.72,3045.72,Bright Health MGG,Bright Health MGG,3045.72,,,,,,,case rate,3045.72,3045.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,75833,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,75831,CPT,,,RT,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,75831,CPT,,,LT,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Aetna,Aetna,3199.74,,,,,,,per diem,3199.74,3199.74,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Aetna MGG,Aetna MGG,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,BCBS,BCBS,3199.74,,,,,,,per diem,3199.74,3199.74,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,BCBS MGG,BCBS MGG,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Cigna,Cigna,3199.74,,,,,,,per diem,3199.74,3199.74,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Cigna MGG,Cigna MGG,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Humana,Humana,3199.74,,,,,,,per diem,3199.74,3199.74,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Humana MGG,Humana MGG,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Optum VA,Optum VA,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,UHC,UHC,3199.74,,,,,,,per diem,3199.74,3199.74,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,UHC MGG,UHC MGG,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,VA,VA,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Wellcare MGG,Wellcare MGG,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Bright Health - commercial,Bright Health - commercial,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,75860,CPT,,,,Inpatient,,,3199.74,3199.74,Bright Health MGG,Bright Health MGG,3199.74,,,,,,,case rate,3199.74,3199.74,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Aetna,Aetna,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Aetna MGG,Aetna MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,BCBS,BCBS,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,BCBS MGG,BCBS MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Cigna,Cigna,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Cigna MGG,Cigna MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Humana,Humana,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Humana MGG,Humana MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Optum VA,Optum VA,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,UHC,UHC,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,UHC MGG,UHC MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,VA,VA,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Wellcare MGG,Wellcare MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Bright Health - commercial,Bright Health - commercial,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Bright Health MGG,Bright Health MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Aetna,Aetna,3432.3,,,,,,,per diem,3432.3,3432.3,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Aetna MGG,Aetna MGG,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,BCBS,BCBS,3432.3,,,,,,,per diem,3432.3,3432.3,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,BCBS MGG,BCBS MGG,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Cigna,Cigna,3432.3,,,,,,,per diem,3432.3,3432.3,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Cigna MGG,Cigna MGG,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Humana,Humana,3432.3,,,,,,,per diem,3432.3,3432.3,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Humana MGG,Humana MGG,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Optum VA,Optum VA,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,UHC,UHC,3432.3,,,,,,,per diem,3432.3,3432.3,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,UHC MGG,UHC MGG,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,VA,VA,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Wellcare MGG,Wellcare MGG,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Bright Health - commercial,Bright Health - commercial,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,75889,CPT,,,,Inpatient,,,3432.3,3432.3,Bright Health MGG,Bright Health MGG,3432.3,,,,,,,case rate,3432.3,3432.3,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,75891,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna,Aetna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Aetna MGG,Aetna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS,BCBS,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,BCBS MGG,BCBS MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna,Cigna,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Cigna MGG,Cigna MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Humana,Humana,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Humana MGG,Humana MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Optum VA,Optum VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,UHC,UHC,2774.4,,,,,,,per diem,2774.4,2774.4,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,UHC MGG,UHC MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,VA,VA,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Wellcare MGG,Wellcare MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health - commercial,Bright Health - commercial,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,75893,CPT,,,,Inpatient,,,2774.4,2774.4,Bright Health MGG,Bright Health MGG,2774.4,,,,,,,case rate,2774.4,2774.4,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Aetna,Aetna,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Aetna MGG,Aetna MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,BCBS,BCBS,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,BCBS MGG,BCBS MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Cigna,Cigna,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Cigna MGG,Cigna MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Humana,Humana,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Humana MGG,Humana MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Optum VA,Optum VA,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,UHC,UHC,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,UHC MGG,UHC MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,VA,VA,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Wellcare MGG,Wellcare MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Bright Health - commercial,Bright Health - commercial,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,77054,CPT,,,RT,Inpatient,,,1695.24,1695.24,Bright Health MGG,Bright Health MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Aetna,Aetna,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Aetna MGG,Aetna MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,BCBS,BCBS,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,BCBS MGG,BCBS MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Cigna,Cigna,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Cigna MGG,Cigna MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Humana,Humana,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Humana MGG,Humana MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Optum VA,Optum VA,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,UHC,UHC,1695.24,,,,,,,per diem,1695.24,1695.24,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,UHC MGG,UHC MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,VA,VA,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Wellcare MGG,Wellcare MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Bright Health - commercial,Bright Health - commercial,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,77054,CPT,,,LT,Inpatient,,,1695.24,1695.24,Bright Health MGG,Bright Health MGG,1695.24,,,,,,,case rate,1695.24,1695.24,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna,Aetna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna MGG,Aetna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS,BCBS,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS MGG,BCBS MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna,Cigna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna MGG,Cigna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana,Humana,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana MGG,Humana MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Optum VA,Optum VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC,UHC,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC MGG,UHC MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,VA,VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Wellcare MGG,Wellcare MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health - commercial,Bright Health - commercial,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health MGG,Bright Health MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna,Aetna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna MGG,Aetna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS,BCBS,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS MGG,BCBS MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna,Cigna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna MGG,Cigna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana,Humana,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana MGG,Humana MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Optum VA,Optum VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC,UHC,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC MGG,UHC MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,VA,VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Wellcare MGG,Wellcare MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health - commercial,Bright Health - commercial,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health MGG,Bright Health MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna,Aetna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna MGG,Aetna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS,BCBS,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS MGG,BCBS MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna,Cigna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna MGG,Cigna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana,Humana,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana MGG,Humana MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Optum VA,Optum VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC,UHC,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC MGG,UHC MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,VA,VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Wellcare MGG,Wellcare MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health - commercial,Bright Health - commercial,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health MGG,Bright Health MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna,Aetna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna MGG,Aetna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS,BCBS,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS MGG,BCBS MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna,Cigna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna MGG,Cigna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana,Humana,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana MGG,Humana MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Optum VA,Optum VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC,UHC,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC MGG,UHC MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,VA,VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Wellcare MGG,Wellcare MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health - commercial,Bright Health - commercial,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health MGG,Bright Health MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna,Aetna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna MGG,Aetna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS,BCBS,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS MGG,BCBS MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna,Cigna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna MGG,Cigna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana,Humana,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana MGG,Humana MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Optum VA,Optum VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC,UHC,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC MGG,UHC MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,VA,VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Wellcare MGG,Wellcare MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health - commercial,Bright Health - commercial,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health MGG,Bright Health MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Aetna,Aetna,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Aetna MGG,Aetna MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,BCBS,BCBS,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,BCBS MGG,BCBS MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Cigna,Cigna,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Cigna MGG,Cigna MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Humana,Humana,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Humana MGG,Humana MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Optum VA,Optum VA,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,UHC,UHC,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,UHC MGG,UHC MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,VA,VA,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Wellcare MGG,Wellcare MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Bright Health - commercial,Bright Health - commercial,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,G0269,CPT,,,,Inpatient,,,257.04,257.04,Bright Health MGG,Bright Health MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Aetna,Aetna,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Aetna MGG,Aetna MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,BCBS,BCBS,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,BCBS MGG,BCBS MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Cigna,Cigna,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Cigna MGG,Cigna MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Humana,Humana,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Humana MGG,Humana MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Optum VA,Optum VA,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,UHC,UHC,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,UHC MGG,UHC MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,VA,VA,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Wellcare MGG,Wellcare MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Bright Health - commercial,Bright Health - commercial,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Bright Health MGG,Bright Health MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Aetna,Aetna,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Aetna MGG,Aetna MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,BCBS,BCBS,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,BCBS MGG,BCBS MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Cigna,Cigna,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Cigna MGG,Cigna MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Humana,Humana,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Humana MGG,Humana MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Optum VA,Optum VA,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,UHC,UHC,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,UHC MGG,UHC MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,VA,VA,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Wellcare MGG,Wellcare MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Bright Health - commercial,Bright Health - commercial,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Bright Health MGG,Bright Health MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Aetna,Aetna,831.3,,,,,,,per diem,831.3,831.3,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Aetna MGG,Aetna MGG,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,BCBS,BCBS,831.3,,,,,,,per diem,831.3,831.3,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,BCBS MGG,BCBS MGG,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Cigna,Cigna,831.3,,,,,,,per diem,831.3,831.3,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Cigna MGG,Cigna MGG,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Humana,Humana,831.3,,,,,,,per diem,831.3,831.3,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Humana MGG,Humana MGG,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Optum VA,Optum VA,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,UHC,UHC,831.3,,,,,,,per diem,831.3,831.3,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,UHC MGG,UHC MGG,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,VA,VA,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Wellcare MGG,Wellcare MGG,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Bright Health - commercial,Bright Health - commercial,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,36593,CPT,,,,Inpatient,,,831.3,831.3,Bright Health MGG,Bright Health MGG,831.3,,,,,,,case rate,831.3,831.3,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Aetna,Aetna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Aetna MGG,Aetna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,BCBS,BCBS,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,BCBS MGG,BCBS MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Cigna,Cigna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Cigna MGG,Cigna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Humana,Humana,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Humana MGG,Humana MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Optum VA,Optum VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,UHC,UHC,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,UHC MGG,UHC MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,VA,VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Wellcare MGG,Wellcare MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Bright Health - commercial,Bright Health - commercial,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Bright Health MGG,Bright Health MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Aetna,Aetna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Aetna MGG,Aetna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,BCBS,BCBS,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,BCBS MGG,BCBS MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Cigna,Cigna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Cigna MGG,Cigna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Humana,Humana,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Humana MGG,Humana MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Optum VA,Optum VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,UHC,UHC,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,UHC MGG,UHC MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,VA,VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Wellcare MGG,Wellcare MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Bright Health - commercial,Bright Health - commercial,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Bright Health MGG,Bright Health MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Aetna,Aetna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Aetna MGG,Aetna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,BCBS,BCBS,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,BCBS MGG,BCBS MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Cigna,Cigna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Cigna MGG,Cigna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Humana,Humana,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Humana MGG,Humana MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Optum VA,Optum VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,UHC,UHC,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,UHC MGG,UHC MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,VA,VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Wellcare MGG,Wellcare MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Bright Health - commercial,Bright Health - commercial,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,1001.64,1001.64,Bright Health MGG,Bright Health MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Aetna,Aetna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Aetna MGG,Aetna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,BCBS,BCBS,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,BCBS MGG,BCBS MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Cigna,Cigna,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Cigna MGG,Cigna MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Humana,Humana,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Humana MGG,Humana MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Optum VA,Optum VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,UHC,UHC,1001.64,,,,,,,per diem,1001.64,1001.64,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,UHC MGG,UHC MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,VA,VA,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Wellcare MGG,Wellcare MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Bright Health - commercial,Bright Health - commercial,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,1001.64,1001.64,Bright Health MGG,Bright Health MGG,1001.64,,,,,,,case rate,1001.64,1001.64,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Aetna,Aetna,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Aetna MGG,Aetna MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,BCBS,BCBS,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,BCBS MGG,BCBS MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Cigna,Cigna,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Cigna MGG,Cigna MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Humana,Humana,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Humana MGG,Humana MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Optum VA,Optum VA,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,UHC,UHC,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,UHC MGG,UHC MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,VA,VA,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Wellcare MGG,Wellcare MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Bright Health - commercial,Bright Health - commercial,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Bright Health MGG,Bright Health MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Aetna,Aetna,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Aetna MGG,Aetna MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,BCBS,BCBS,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,BCBS MGG,BCBS MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Cigna,Cigna,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Cigna MGG,Cigna MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Humana,Humana,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Humana MGG,Humana MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Optum VA,Optum VA,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,UHC,UHC,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,UHC MGG,UHC MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,VA,VA,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Wellcare MGG,Wellcare MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Bright Health - commercial,Bright Health - commercial,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Bright Health MGG,Bright Health MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Aetna,Aetna,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Aetna MGG,Aetna MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,BCBS,BCBS,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,BCBS MGG,BCBS MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Cigna,Cigna,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Cigna MGG,Cigna MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Humana,Humana,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Humana MGG,Humana MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Optum VA,Optum VA,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,UHC,UHC,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,UHC MGG,UHC MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,VA,VA,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Wellcare MGG,Wellcare MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Bright Health - commercial,Bright Health - commercial,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Bright Health MGG,Bright Health MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Aetna,Aetna,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Aetna MGG,Aetna MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,BCBS,BCBS,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,BCBS MGG,BCBS MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Cigna,Cigna,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Cigna MGG,Cigna MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Humana,Humana,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Humana MGG,Humana MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Optum VA,Optum VA,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,UHC,UHC,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,UHC MGG,UHC MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,VA,VA,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Wellcare MGG,Wellcare MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Bright Health - commercial,Bright Health - commercial,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Bright Health MGG,Bright Health MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Aetna,Aetna,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Aetna MGG,Aetna MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,BCBS,BCBS,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,BCBS MGG,BCBS MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Cigna,Cigna,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Cigna MGG,Cigna MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Humana,Humana,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Humana MGG,Humana MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Optum VA,Optum VA,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,UHC,UHC,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,UHC MGG,UHC MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,VA,VA,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Wellcare MGG,Wellcare MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Bright Health - commercial,Bright Health - commercial,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Bright Health MGG,Bright Health MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Aetna,Aetna,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Aetna MGG,Aetna MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,BCBS,BCBS,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,BCBS MGG,BCBS MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Cigna,Cigna,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Cigna MGG,Cigna MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Humana,Humana,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Humana MGG,Humana MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Optum VA,Optum VA,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,UHC,UHC,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,UHC MGG,UHC MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,VA,VA,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Wellcare MGG,Wellcare MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Bright Health - commercial,Bright Health - commercial,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Bright Health MGG,Bright Health MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Aetna,Aetna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Aetna MGG,Aetna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,BCBS,BCBS,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,BCBS MGG,BCBS MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Cigna,Cigna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Cigna MGG,Cigna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Humana,Humana,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Humana MGG,Humana MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Optum VA,Optum VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,UHC,UHC,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,UHC MGG,UHC MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,VA,VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Wellcare MGG,Wellcare MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Bright Health - commercial,Bright Health - commercial,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Bright Health MGG,Bright Health MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Aetna,Aetna,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Aetna MGG,Aetna MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,BCBS,BCBS,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,BCBS MGG,BCBS MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Cigna,Cigna,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Cigna MGG,Cigna MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Humana,Humana,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Humana MGG,Humana MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Optum VA,Optum VA,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,UHC,UHC,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,UHC MGG,UHC MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,VA,VA,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Wellcare MGG,Wellcare MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Bright Health - commercial,Bright Health - commercial,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Bright Health MGG,Bright Health MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Aetna,Aetna,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Aetna MGG,Aetna MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,BCBS,BCBS,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,BCBS MGG,BCBS MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Cigna,Cigna,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Cigna MGG,Cigna MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Humana,Humana,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Humana MGG,Humana MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Optum VA,Optum VA,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,UHC,UHC,416.16,,,,,,,per diem,416.16,416.16,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,UHC MGG,UHC MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,VA,VA,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Wellcare MGG,Wellcare MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Bright Health - commercial,Bright Health - commercial,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,416.16,416.16,Bright Health MGG,Bright Health MGG,416.16,,,,,,,case rate,416.16,416.16,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Aetna,Aetna,1422.9,,,,,,,per diem,1422.9,1422.9,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Aetna MGG,Aetna MGG,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,BCBS,BCBS,1422.9,,,,,,,per diem,1422.9,1422.9,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,BCBS MGG,BCBS MGG,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Cigna,Cigna,1422.9,,,,,,,per diem,1422.9,1422.9,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Cigna MGG,Cigna MGG,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Humana,Humana,1422.9,,,,,,,per diem,1422.9,1422.9,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Humana MGG,Humana MGG,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Optum VA,Optum VA,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,UHC,UHC,1422.9,,,,,,,per diem,1422.9,1422.9,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,UHC MGG,UHC MGG,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,VA,VA,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Wellcare MGG,Wellcare MGG,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Bright Health - commercial,Bright Health - commercial,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,79445,CPT,,,,Inpatient,,,1422.9,1422.9,Bright Health MGG,Bright Health MGG,1422.9,,,,,,,case rate,1422.9,1422.9,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Aetna,Aetna,394.16,,,,,,,per diem,394.16,394.16,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Aetna MGG,Aetna MGG,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,BCBS,BCBS,394.16,,,,,,,per diem,394.16,394.16,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,BCBS MGG,BCBS MGG,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Cigna,Cigna,394.16,,,,,,,per diem,394.16,394.16,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Cigna MGG,Cigna MGG,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Humana,Humana,394.16,,,,,,,per diem,394.16,394.16,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Humana MGG,Humana MGG,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Optum VA,Optum VA,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,UHC,UHC,394.16,,,,,,,per diem,394.16,394.16,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,UHC MGG,UHC MGG,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,VA,VA,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Wellcare MGG,Wellcare MGG,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Bright Health - commercial,Bright Health - commercial,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,99211,CPT,,,,Inpatient,,,394.16,394.16,Bright Health MGG,Bright Health MGG,394.16,,,,,,,case rate,394.16,394.16,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Aetna,Aetna,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Aetna MGG,Aetna MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,BCBS,BCBS,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,BCBS MGG,BCBS MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Cigna,Cigna,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Cigna MGG,Cigna MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Humana,Humana,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Humana MGG,Humana MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Optum VA,Optum VA,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,UHC,UHC,1380.06,,,,,,,per diem,1380.06,1380.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,UHC MGG,UHC MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,VA,VA,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Wellcare MGG,Wellcare MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Bright Health - commercial,Bright Health - commercial,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,76000,CPT,,,,Inpatient,,,1380.06,1380.06,Bright Health MGG,Bright Health MGG,1380.06,,,,,,,case rate,1380.06,1380.06,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Aetna,Aetna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Aetna MGG,Aetna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,BCBS,BCBS,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,BCBS MGG,BCBS MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Cigna,Cigna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Cigna MGG,Cigna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Humana,Humana,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Humana MGG,Humana MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Optum VA,Optum VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,UHC,UHC,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,UHC MGG,UHC MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,VA,VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Wellcare MGG,Wellcare MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Bright Health - commercial,Bright Health - commercial,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,73580,CPT,,,RT,Inpatient,,,894.54,894.54,Bright Health MGG,Bright Health MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Aetna,Aetna,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Aetna MGG,Aetna MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,BCBS,BCBS,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,BCBS MGG,BCBS MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Cigna,Cigna,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Cigna MGG,Cigna MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Humana,Humana,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Humana MGG,Humana MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Optum VA,Optum VA,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,UHC,UHC,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,UHC MGG,UHC MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,VA,VA,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Wellcare MGG,Wellcare MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Bright Health - commercial,Bright Health - commercial,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,77056,CPT,,,,Inpatient,,,466.14,466.14,Bright Health MGG,Bright Health MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Aetna,Aetna,423.3,,,,,,,per diem,423.3,423.3,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Aetna MGG,Aetna MGG,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,BCBS,BCBS,423.3,,,,,,,per diem,423.3,423.3,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,BCBS MGG,BCBS MGG,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Cigna,Cigna,423.3,,,,,,,per diem,423.3,423.3,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Cigna MGG,Cigna MGG,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Humana,Humana,423.3,,,,,,,per diem,423.3,423.3,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Humana MGG,Humana MGG,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Optum VA,Optum VA,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,UHC,UHC,423.3,,,,,,,per diem,423.3,423.3,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,UHC MGG,UHC MGG,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,VA,VA,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Wellcare MGG,Wellcare MGG,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Bright Health - commercial,Bright Health - commercial,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,77057,CPT,,,,Inpatient,,,423.3,423.3,Bright Health MGG,Bright Health MGG,423.3,,,,,,,case rate,423.3,423.3,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Aetna,Aetna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Aetna MGG,Aetna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,BCBS,BCBS,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,BCBS MGG,BCBS MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Cigna,Cigna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Cigna MGG,Cigna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Humana,Humana,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Humana MGG,Humana MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Optum VA,Optum VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,UHC,UHC,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,UHC MGG,UHC MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,VA,VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Wellcare MGG,Wellcare MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Bright Health - commercial,Bright Health - commercial,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,77057,CPT,,,RT52,Inpatient,,,200.94,200.94,Bright Health MGG,Bright Health MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Aetna,Aetna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Aetna MGG,Aetna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,BCBS,BCBS,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,BCBS MGG,BCBS MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Cigna,Cigna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Cigna MGG,Cigna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Humana,Humana,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Humana MGG,Humana MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Optum VA,Optum VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,UHC,UHC,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,UHC MGG,UHC MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,VA,VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Wellcare MGG,Wellcare MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Bright Health - commercial,Bright Health - commercial,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,73085,CPT,,,RT,Inpatient,,,894.54,894.54,Bright Health MGG,Bright Health MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Aetna,Aetna,953.06,,,,,,,per diem,953.06,953.06,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Aetna MGG,Aetna MGG,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,BCBS,BCBS,953.06,,,,,,,per diem,953.06,953.06,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,BCBS MGG,BCBS MGG,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Cigna,Cigna,953.06,,,,,,,per diem,953.06,953.06,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Cigna MGG,Cigna MGG,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Humana,Humana,953.06,,,,,,,per diem,953.06,953.06,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Humana MGG,Humana MGG,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Optum VA,Optum VA,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,UHC,UHC,953.06,,,,,,,per diem,953.06,953.06,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,UHC MGG,UHC MGG,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,VA,VA,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Wellcare MGG,Wellcare MGG,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Bright Health - commercial,Bright Health - commercial,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,74425,CPT,,,,Inpatient,,,953.06,953.06,Bright Health MGG,Bright Health MGG,953.06,,,,,,,case rate,953.06,953.06,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Aetna,Aetna,249.26,,,,,,,per diem,249.26,249.26,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Aetna MGG,Aetna MGG,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,BCBS,BCBS,249.26,,,,,,,per diem,249.26,249.26,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,BCBS MGG,BCBS MGG,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Cigna,Cigna,249.26,,,,,,,per diem,249.26,249.26,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Cigna MGG,Cigna MGG,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Humana,Humana,249.26,,,,,,,per diem,249.26,249.26,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Humana MGG,Humana MGG,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Optum VA,Optum VA,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,UHC,UHC,249.26,,,,,,,per diem,249.26,249.26,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,UHC MGG,UHC MGG,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,VA,VA,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Wellcare MGG,Wellcare MGG,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Bright Health - commercial,Bright Health - commercial,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,249.26,249.26,Bright Health MGG,Bright Health MGG,249.26,,,,,,,case rate,249.26,249.26,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Aetna,Aetna,261.95,,,,,,,per diem,261.95,261.95,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Aetna MGG,Aetna MGG,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,BCBS,BCBS,261.95,,,,,,,per diem,261.95,261.95,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,BCBS MGG,BCBS MGG,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Cigna,Cigna,261.95,,,,,,,per diem,261.95,261.95,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Cigna MGG,Cigna MGG,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Humana,Humana,261.95,,,,,,,per diem,261.95,261.95,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Humana MGG,Humana MGG,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Optum VA,Optum VA,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,UHC,UHC,261.95,,,,,,,per diem,261.95,261.95,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,UHC MGG,UHC MGG,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,VA,VA,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Wellcare MGG,Wellcare MGG,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Bright Health - commercial,Bright Health - commercial,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,72020,CPT,,,,Inpatient,,,261.95,261.95,Bright Health MGG,Bright Health MGG,261.95,,,,,,,case rate,261.95,261.95,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Aetna,Aetna,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Aetna MGG,Aetna MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,BCBS,BCBS,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,BCBS MGG,BCBS MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Cigna,Cigna,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Cigna MGG,Cigna MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Humana,Humana,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Humana MGG,Humana MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Optum VA,Optum VA,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,UHC,UHC,521.22,,,,,,,per diem,521.22,521.22,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,UHC MGG,UHC MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,VA,VA,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Wellcare MGG,Wellcare MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Bright Health - commercial,Bright Health - commercial,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,96450,CPT,,,,Inpatient,,,521.22,521.22,Bright Health MGG,Bright Health MGG,521.22,,,,,,,case rate,521.22,521.22,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Aetna,Aetna,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Aetna MGG,Aetna MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,BCBS,BCBS,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,BCBS MGG,BCBS MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Cigna,Cigna,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Cigna MGG,Cigna MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Humana,Humana,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Humana MGG,Humana MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Optum VA,Optum VA,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,UHC,UHC,83.64,,,,,,,per diem,83.64,83.64,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,UHC MGG,UHC MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,VA,VA,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Wellcare MGG,Wellcare MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Bright Health - commercial,Bright Health - commercial,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,83.64,83.64,Bright Health MGG,Bright Health MGG,83.64,,,,,,,case rate,83.64,83.64,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Aetna,Aetna,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Aetna MGG,Aetna MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,BCBS,BCBS,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,BCBS MGG,BCBS MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Cigna,Cigna,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Cigna MGG,Cigna MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Humana,Humana,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Humana MGG,Humana MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Optum VA,Optum VA,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,UHC,UHC,1487.16,,,,,,,per diem,1487.16,1487.16,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,UHC MGG,UHC MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,VA,VA,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Wellcare MGG,Wellcare MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Bright Health - commercial,Bright Health - commercial,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,72270,CPT,,,,Inpatient,,,1487.16,1487.16,Bright Health MGG,Bright Health MGG,1487.16,,,,,,,case rate,1487.16,1487.16,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Aetna,Aetna,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Aetna MGG,Aetna MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,BCBS,BCBS,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,BCBS MGG,BCBS MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Cigna,Cigna,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Cigna MGG,Cigna MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Humana,Humana,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Humana MGG,Humana MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Optum VA,Optum VA,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,UHC,UHC,309.06,,,,,,,per diem,309.06,309.06,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,UHC MGG,UHC MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,VA,VA,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Wellcare MGG,Wellcare MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Bright Health - commercial,Bright Health - commercial,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,Q9966,CPT,,,,Inpatient,1,EA,309.06,309.06,Bright Health MGG,Bright Health MGG,309.06,,,,,,,case rate,309.06,309.06,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Aetna,Aetna,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Aetna MGG,Aetna MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,BCBS,BCBS,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,BCBS MGG,BCBS MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Cigna,Cigna,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Cigna MGG,Cigna MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Humana,Humana,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Humana MGG,Humana MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Optum VA,Optum VA,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,UHC,UHC,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,UHC MGG,UHC MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,VA,VA,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Wellcare MGG,Wellcare MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Bright Health - commercial,Bright Health - commercial,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,132.6,132.6,Bright Health MGG,Bright Health MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Aetna,Aetna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Aetna MGG,Aetna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,BCBS,BCBS,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,BCBS MGG,BCBS MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Cigna,Cigna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Cigna MGG,Cigna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Humana,Humana,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Humana MGG,Humana MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Optum VA,Optum VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,UHC,UHC,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,UHC MGG,UHC MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,VA,VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Wellcare MGG,Wellcare MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Bright Health - commercial,Bright Health - commercial,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,128.52,128.52,Bright Health MGG,Bright Health MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Aetna,Aetna,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Aetna MGG,Aetna MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,BCBS,BCBS,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,BCBS MGG,BCBS MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Cigna,Cigna,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Cigna MGG,Cigna MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Humana,Humana,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Humana MGG,Humana MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Optum VA,Optum VA,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,UHC,UHC,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,UHC MGG,UHC MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,VA,VA,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Wellcare MGG,Wellcare MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Bright Health - commercial,Bright Health - commercial,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Bright Health MGG,Bright Health MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Aetna,Aetna,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Aetna MGG,Aetna MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,BCBS,BCBS,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,BCBS MGG,BCBS MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Cigna,Cigna,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Cigna MGG,Cigna MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Humana,Humana,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Humana MGG,Humana MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Optum VA,Optum VA,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,UHC,UHC,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,UHC MGG,UHC MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,VA,VA,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Wellcare MGG,Wellcare MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Bright Health - commercial,Bright Health - commercial,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,77051,CPT,,,,Inpatient,,,169.32,169.32,Bright Health MGG,Bright Health MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Aetna,Aetna,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Aetna MGG,Aetna MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,BCBS,BCBS,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,BCBS MGG,BCBS MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Cigna,Cigna,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Cigna MGG,Cigna MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Humana,Humana,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Humana MGG,Humana MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Optum VA,Optum VA,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,UHC,UHC,169.32,,,,,,,per diem,169.32,169.32,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,UHC MGG,UHC MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,VA,VA,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Wellcare MGG,Wellcare MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Bright Health - commercial,Bright Health - commercial,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,77052,CPT,,,,Inpatient,,,169.32,169.32,Bright Health MGG,Bright Health MGG,169.32,,,,,,,case rate,169.32,169.32,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Aetna,Aetna,657.9,,,,,,,per diem,657.9,657.9,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Aetna MGG,Aetna MGG,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,BCBS,BCBS,657.9,,,,,,,per diem,657.9,657.9,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,BCBS MGG,BCBS MGG,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Cigna,Cigna,657.9,,,,,,,per diem,657.9,657.9,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Cigna MGG,Cigna MGG,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Humana,Humana,657.9,,,,,,,per diem,657.9,657.9,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Humana MGG,Humana MGG,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Optum VA,Optum VA,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,UHC,UHC,657.9,,,,,,,per diem,657.9,657.9,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,UHC MGG,UHC MGG,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,VA,VA,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Wellcare MGG,Wellcare MGG,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Bright Health - commercial,Bright Health - commercial,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,G0204,CPT,,,,Inpatient,,,657.9,657.9,Bright Health MGG,Bright Health MGG,657.9,,,,,,,case rate,657.9,657.9,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Aetna,Aetna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Aetna MGG,Aetna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,BCBS,BCBS,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,BCBS MGG,BCBS MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Cigna,Cigna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Cigna MGG,Cigna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Humana,Humana,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Humana MGG,Humana MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Optum VA,Optum VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,UHC,UHC,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,UHC MGG,UHC MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,VA,VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Wellcare MGG,Wellcare MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Bright Health - commercial,Bright Health - commercial,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,G0206,CPT,,,,Inpatient,,,518.16,518.16,Bright Health MGG,Bright Health MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Aetna,Aetna,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Aetna MGG,Aetna MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,BCBS,BCBS,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,BCBS MGG,BCBS MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Cigna,Cigna,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Cigna MGG,Cigna MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Humana,Humana,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Humana MGG,Humana MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Optum VA,Optum VA,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,UHC,UHC,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,UHC MGG,UHC MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,VA,VA,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Wellcare MGG,Wellcare MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Bright Health - commercial,Bright Health - commercial,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,77055,CPT,,,LT,Inpatient,,,358.02,358.02,Bright Health MGG,Bright Health MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Aetna,Aetna,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Aetna MGG,Aetna MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,BCBS,BCBS,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,BCBS MGG,BCBS MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Cigna,Cigna,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Cigna MGG,Cigna MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Humana,Humana,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Humana MGG,Humana MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Optum VA,Optum VA,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,UHC,UHC,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,UHC MGG,UHC MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,VA,VA,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Wellcare MGG,Wellcare MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Bright Health - commercial,Bright Health - commercial,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,77055,CPT,,,RT,Inpatient,,,358.02,358.02,Bright Health MGG,Bright Health MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Aetna,Aetna,693.6,,,,,,,per diem,693.6,693.6,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Aetna MGG,Aetna MGG,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,BCBS,BCBS,693.6,,,,,,,per diem,693.6,693.6,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,BCBS MGG,BCBS MGG,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Cigna,Cigna,693.6,,,,,,,per diem,693.6,693.6,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Cigna MGG,Cigna MGG,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Humana,Humana,693.6,,,,,,,per diem,693.6,693.6,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Humana MGG,Humana MGG,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Optum VA,Optum VA,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,UHC,UHC,693.6,,,,,,,per diem,693.6,693.6,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,UHC MGG,UHC MGG,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,VA,VA,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Wellcare MGG,Wellcare MGG,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Bright Health - commercial,Bright Health - commercial,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,G0202,CPT,,,,Inpatient,,,693.6,693.6,Bright Health MGG,Bright Health MGG,693.6,,,,,,,case rate,693.6,693.6,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Aetna,Aetna,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Aetna MGG,Aetna MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,BCBS,BCBS,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,BCBS MGG,BCBS MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Cigna,Cigna,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Cigna MGG,Cigna MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Humana,Humana,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Humana MGG,Humana MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Optum VA,Optum VA,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,UHC,UHC,1770.72,,,,,,,per diem,1770.72,1770.72,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,UHC MGG,UHC MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,VA,VA,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Wellcare MGG,Wellcare MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Bright Health - commercial,Bright Health - commercial,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,93660,CPT,,,,Inpatient,,,1770.72,1770.72,Bright Health MGG,Bright Health MGG,1770.72,,,,,,,case rate,1770.72,1770.72,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Aetna,Aetna,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Aetna MGG,Aetna MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,BCBS,BCBS,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,BCBS MGG,BCBS MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Cigna,Cigna,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Cigna MGG,Cigna MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Humana,Humana,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Humana MGG,Humana MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Optum VA,Optum VA,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,UHC,UHC,1138.32,,,,,,,per diem,1138.32,1138.32,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,UHC MGG,UHC MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,VA,VA,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Wellcare MGG,Wellcare MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Bright Health - commercial,Bright Health - commercial,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,76936,CPT,,,,Inpatient,,,1138.32,1138.32,Bright Health MGG,Bright Health MGG,1138.32,,,,,,,case rate,1138.32,1138.32,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Aetna,Aetna,1136.28,,,,,,,per diem,1136.28,1136.28,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Aetna MGG,Aetna MGG,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,BCBS,BCBS,1136.28,,,,,,,per diem,1136.28,1136.28,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,BCBS MGG,BCBS MGG,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Cigna,Cigna,1136.28,,,,,,,per diem,1136.28,1136.28,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Cigna MGG,Cigna MGG,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Humana,Humana,1136.28,,,,,,,per diem,1136.28,1136.28,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Humana MGG,Humana MGG,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Optum VA,Optum VA,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,UHC,UHC,1136.28,,,,,,,per diem,1136.28,1136.28,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,UHC MGG,UHC MGG,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,VA,VA,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Wellcare MGG,Wellcare MGG,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Bright Health - commercial,Bright Health - commercial,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,73600,CPT,,,,Inpatient,,,1136.28,1136.28,Bright Health MGG,Bright Health MGG,1136.28,,,,,,,case rate,1136.28,1136.28,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Aetna,Aetna,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Aetna MGG,Aetna MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,BCBS,BCBS,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,BCBS MGG,BCBS MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Cigna,Cigna,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Cigna MGG,Cigna MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Humana,Humana,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Humana MGG,Humana MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Optum VA,Optum VA,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,UHC,UHC,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,UHC MGG,UHC MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,VA,VA,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Wellcare MGG,Wellcare MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Bright Health - commercial,Bright Health - commercial,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,73610,CPT,,,50,Inpatient,,,1320.9,1320.9,Bright Health MGG,Bright Health MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Aetna,Aetna,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Aetna MGG,Aetna MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,BCBS,BCBS,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,BCBS MGG,BCBS MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Cigna,Cigna,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Cigna MGG,Cigna MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Humana,Humana,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Humana MGG,Humana MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Optum VA,Optum VA,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,UHC,UHC,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,UHC MGG,UHC MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,VA,VA,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Wellcare MGG,Wellcare MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Bright Health - commercial,Bright Health - commercial,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,1320.9,1320.9,Bright Health MGG,Bright Health MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Aetna,Aetna,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Aetna MGG,Aetna MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,BCBS,BCBS,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,BCBS MGG,BCBS MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Cigna,Cigna,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Cigna MGG,Cigna MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Humana,Humana,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Humana MGG,Humana MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Optum VA,Optum VA,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,UHC,UHC,1320.9,,,,,,,per diem,1320.9,1320.9,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,UHC MGG,UHC MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,VA,VA,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Wellcare MGG,Wellcare MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Bright Health - commercial,Bright Health - commercial,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,1320.9,1320.9,Bright Health MGG,Bright Health MGG,1320.9,,,,,,,case rate,1320.9,1320.9,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Aetna,Aetna,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Aetna MGG,Aetna MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,BCBS,BCBS,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,BCBS MGG,BCBS MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Cigna,Cigna,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Cigna MGG,Cigna MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Humana,Humana,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Humana MGG,Humana MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Optum VA,Optum VA,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,UHC,UHC,5547.78,,,,,,,per diem,5547.78,5547.78,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,UHC MGG,UHC MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,VA,VA,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Wellcare MGG,Wellcare MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Bright Health - commercial,Bright Health - commercial,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,75625,CPT,,,,Inpatient,,,5547.78,5547.78,Bright Health MGG,Bright Health MGG,5547.78,,,,,,,case rate,5547.78,5547.78,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Aetna,Aetna,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Aetna MGG,Aetna MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,BCBS,BCBS,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,BCBS MGG,BCBS MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Cigna,Cigna,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Cigna MGG,Cigna MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Humana,Humana,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Humana MGG,Humana MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Optum VA,Optum VA,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,UHC,UHC,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,UHC MGG,UHC MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,VA,VA,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Wellcare MGG,Wellcare MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Bright Health - commercial,Bright Health - commercial,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,73615,CPT,,,LT,Inpatient,,,836.4,836.4,Bright Health MGG,Bright Health MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Aetna,Aetna,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Aetna MGG,Aetna MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,BCBS,BCBS,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,BCBS MGG,BCBS MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Cigna,Cigna,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Cigna MGG,Cigna MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Humana,Humana,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Humana MGG,Humana MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Optum VA,Optum VA,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,UHC,UHC,836.4,,,,,,,per diem,836.4,836.4,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,UHC MGG,UHC MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,VA,VA,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Wellcare MGG,Wellcare MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Bright Health - commercial,Bright Health - commercial,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,73615,CPT,,,RT,Inpatient,,,836.4,836.4,Bright Health MGG,Bright Health MGG,836.4,,,,,,,case rate,836.4,836.4,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Aetna,Aetna,910.16,,,,,,,per diem,910.16,910.16,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Aetna MGG,Aetna MGG,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,BCBS,BCBS,910.16,,,,,,,per diem,910.16,910.16,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,BCBS MGG,BCBS MGG,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Cigna,Cigna,910.16,,,,,,,per diem,910.16,910.16,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Cigna MGG,Cigna MGG,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Humana,Humana,910.16,,,,,,,per diem,910.16,910.16,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Humana MGG,Humana MGG,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Optum VA,Optum VA,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,UHC,UHC,910.16,,,,,,,per diem,910.16,910.16,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,UHC MGG,UHC MGG,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,VA,VA,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Wellcare MGG,Wellcare MGG,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Bright Health - commercial,Bright Health - commercial,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,73525,CPT,,,LT,Inpatient,,,910.16,910.16,Bright Health MGG,Bright Health MGG,910.16,,,,,,,case rate,910.16,910.16,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Aetna,Aetna,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Aetna MGG,Aetna MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,BCBS,BCBS,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,BCBS MGG,BCBS MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Cigna,Cigna,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Cigna MGG,Cigna MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Humana,Humana,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Humana MGG,Humana MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Optum VA,Optum VA,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,UHC,UHC,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,UHC MGG,UHC MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,VA,VA,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Wellcare MGG,Wellcare MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Bright Health - commercial,Bright Health - commercial,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,73525,CPT,,,RT,Inpatient,,,879.24,879.24,Bright Health MGG,Bright Health MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Aetna,Aetna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Aetna MGG,Aetna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,BCBS,BCBS,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,BCBS MGG,BCBS MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Cigna,Cigna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Cigna MGG,Cigna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Humana,Humana,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Humana MGG,Humana MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Optum VA,Optum VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,UHC,UHC,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,UHC MGG,UHC MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,VA,VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Wellcare MGG,Wellcare MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Bright Health - commercial,Bright Health - commercial,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,73040,CPT,,,LT,Inpatient,,,915.96,915.96,Bright Health MGG,Bright Health MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Aetna,Aetna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Aetna MGG,Aetna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,BCBS,BCBS,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,BCBS MGG,BCBS MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Cigna,Cigna,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Cigna MGG,Cigna MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Humana,Humana,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Humana MGG,Humana MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Optum VA,Optum VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,UHC,UHC,915.96,,,,,,,per diem,915.96,915.96,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,UHC MGG,UHC MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,VA,VA,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Wellcare MGG,Wellcare MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Bright Health - commercial,Bright Health - commercial,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,915.96,915.96,Bright Health MGG,Bright Health MGG,915.96,,,,,,,case rate,915.96,915.96,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Aetna,Aetna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Aetna MGG,Aetna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,BCBS,BCBS,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,BCBS MGG,BCBS MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Cigna,Cigna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Cigna MGG,Cigna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Humana,Humana,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Humana MGG,Humana MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Optum VA,Optum VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,UHC,UHC,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,UHC MGG,UHC MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,VA,VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Wellcare MGG,Wellcare MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Bright Health - commercial,Bright Health - commercial,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,73115,CPT,,,LT,Inpatient,,,894.54,894.54,Bright Health MGG,Bright Health MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Aetna,Aetna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Aetna MGG,Aetna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,BCBS,BCBS,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,BCBS MGG,BCBS MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Cigna,Cigna,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Cigna MGG,Cigna MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Humana,Humana,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Humana MGG,Humana MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Optum VA,Optum VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,UHC,UHC,894.54,,,,,,,per diem,894.54,894.54,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,UHC MGG,UHC MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,VA,VA,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Wellcare MGG,Wellcare MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Bright Health - commercial,Bright Health - commercial,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,73115,CPT,,,RT,Inpatient,,,894.54,894.54,Bright Health MGG,Bright Health MGG,894.54,,,,,,,case rate,894.54,894.54,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Aetna,Aetna,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Aetna MGG,Aetna MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,BCBS,BCBS,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,BCBS MGG,BCBS MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Cigna,Cigna,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Cigna MGG,Cigna MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Humana,Humana,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Humana MGG,Humana MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Optum VA,Optum VA,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,UHC,UHC,358.02,,,,,,,per diem,358.02,358.02,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,UHC MGG,UHC MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,VA,VA,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Wellcare MGG,Wellcare MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Bright Health - commercial,Bright Health - commercial,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,77072,CPT,,,,Inpatient,,,358.02,358.02,Bright Health MGG,Bright Health MGG,358.02,,,,,,,case rate,358.02,358.02,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Aetna,Aetna,405.96,,,,,,,per diem,405.96,405.96,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Aetna MGG,Aetna MGG,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,BCBS,BCBS,405.96,,,,,,,per diem,405.96,405.96,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,BCBS MGG,BCBS MGG,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Cigna,Cigna,405.96,,,,,,,per diem,405.96,405.96,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Cigna MGG,Cigna MGG,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Humana,Humana,405.96,,,,,,,per diem,405.96,405.96,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Humana MGG,Humana MGG,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Optum VA,Optum VA,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,UHC,UHC,405.96,,,,,,,per diem,405.96,405.96,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,UHC MGG,UHC MGG,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,VA,VA,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Wellcare MGG,Wellcare MGG,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Bright Health - commercial,Bright Health - commercial,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,77073,CPT,,,,Inpatient,,,405.96,405.96,Bright Health MGG,Bright Health MGG,405.96,,,,,,,case rate,405.96,405.96,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Aetna,Aetna,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Aetna MGG,Aetna MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,BCBS,BCBS,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,BCBS MGG,BCBS MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Cigna,Cigna,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Cigna MGG,Cigna MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Humana,Humana,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Humana MGG,Humana MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Optum VA,Optum VA,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,UHC,UHC,459,,,,,,,per diem,459,459,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,UHC MGG,UHC MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,VA,VA,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Wellcare MGG,Wellcare MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Bright Health - commercial,Bright Health - commercial,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,77074,CPT,,,,Inpatient,,,459,459,Bright Health MGG,Bright Health MGG,459,,,,,,,case rate,459,459,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Aetna,Aetna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Aetna MGG,Aetna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,BCBS,BCBS,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,BCBS MGG,BCBS MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Cigna,Cigna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Cigna MGG,Cigna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Humana,Humana,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Humana MGG,Humana MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Optum VA,Optum VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,UHC,UHC,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,UHC MGG,UHC MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,VA,VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Wellcare MGG,Wellcare MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Bright Health - commercial,Bright Health - commercial,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,73650,CPT,,,50,Inpatient,,,717.06,717.06,Bright Health MGG,Bright Health MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Aetna,Aetna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Aetna MGG,Aetna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,BCBS,BCBS,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,BCBS MGG,BCBS MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Cigna,Cigna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Cigna MGG,Cigna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Humana,Humana,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Humana MGG,Humana MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Optum VA,Optum VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,UHC,UHC,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,UHC MGG,UHC MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,VA,VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Wellcare MGG,Wellcare MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Bright Health - commercial,Bright Health - commercial,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,717.06,717.06,Bright Health MGG,Bright Health MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Aetna,Aetna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Aetna MGG,Aetna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,BCBS,BCBS,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,BCBS MGG,BCBS MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Cigna,Cigna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Cigna MGG,Cigna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Humana,Humana,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Humana MGG,Humana MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Optum VA,Optum VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,UHC,UHC,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,UHC MGG,UHC MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,VA,VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Wellcare MGG,Wellcare MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Bright Health - commercial,Bright Health - commercial,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,717.06,717.06,Bright Health MGG,Bright Health MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Aetna,Aetna,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Aetna MGG,Aetna MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,BCBS,BCBS,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,BCBS MGG,BCBS MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Cigna,Cigna,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Cigna MGG,Cigna MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Humana,Humana,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Humana MGG,Humana MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Optum VA,Optum VA,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,UHC,UHC,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,UHC MGG,UHC MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,VA,VA,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Wellcare MGG,Wellcare MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Bright Health - commercial,Bright Health - commercial,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,73000,CPT,,,50,Inpatient,,,791.52,791.52,Bright Health MGG,Bright Health MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Aetna,Aetna,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Aetna MGG,Aetna MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,BCBS,BCBS,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,BCBS MGG,BCBS MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Cigna,Cigna,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Cigna MGG,Cigna MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Humana,Humana,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Humana MGG,Humana MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Optum VA,Optum VA,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,UHC,UHC,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,UHC MGG,UHC MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,VA,VA,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Wellcare MGG,Wellcare MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Bright Health - commercial,Bright Health - commercial,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,73000,CPT,,,LT,Inpatient,,,791.52,791.52,Bright Health MGG,Bright Health MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Aetna,Aetna,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Aetna MGG,Aetna MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,BCBS,BCBS,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,BCBS MGG,BCBS MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Cigna,Cigna,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Cigna MGG,Cigna MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Humana,Humana,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Humana MGG,Humana MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Optum VA,Optum VA,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,UHC,UHC,791.52,,,,,,,per diem,791.52,791.52,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,UHC MGG,UHC MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,VA,VA,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Wellcare MGG,Wellcare MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Bright Health - commercial,Bright Health - commercial,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,791.52,791.52,Bright Health MGG,Bright Health MGG,791.52,,,,,,,case rate,791.52,791.52,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Aetna,Aetna,561,,,,,,,per diem,561,561,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Aetna MGG,Aetna MGG,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,BCBS,BCBS,561,,,,,,,per diem,561,561,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,BCBS MGG,BCBS MGG,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Cigna,Cigna,561,,,,,,,per diem,561,561,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Cigna MGG,Cigna MGG,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Humana,Humana,561,,,,,,,per diem,561,561,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Humana MGG,Humana MGG,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Optum VA,Optum VA,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,UHC,UHC,561,,,,,,,per diem,561,561,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,UHC MGG,UHC MGG,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,VA,VA,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Wellcare MGG,Wellcare MGG,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Bright Health - commercial,Bright Health - commercial,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,74283,CPT,,,,Inpatient,,,561,561,Bright Health MGG,Bright Health MGG,561,,,,,,,case rate,561,561,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Aetna,Aetna,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Aetna MGG,Aetna MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,BCBS,BCBS,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,BCBS MGG,BCBS MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Cigna,Cigna,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Cigna MGG,Cigna MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Humana,Humana,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Humana MGG,Humana MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Optum VA,Optum VA,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,UHC,UHC,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,UHC MGG,UHC MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,VA,VA,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Wellcare MGG,Wellcare MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Bright Health - commercial,Bright Health - commercial,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,798.66,798.66,Bright Health MGG,Bright Health MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Aetna,Aetna,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Aetna MGG,Aetna MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,BCBS,BCBS,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,BCBS MGG,BCBS MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Cigna,Cigna,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Cigna MGG,Cigna MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Humana,Humana,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Humana MGG,Humana MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Optum VA,Optum VA,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,UHC,UHC,798.66,,,,,,,per diem,798.66,798.66,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,UHC MGG,UHC MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,VA,VA,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Wellcare MGG,Wellcare MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Bright Health - commercial,Bright Health - commercial,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,798.66,798.66,Bright Health MGG,Bright Health MGG,798.66,,,,,,,case rate,798.66,798.66,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Aetna,Aetna,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Aetna MGG,Aetna MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,BCBS,BCBS,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,BCBS MGG,BCBS MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Cigna,Cigna,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Cigna MGG,Cigna MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Humana,Humana,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Humana MGG,Humana MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Optum VA,Optum VA,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,UHC,UHC,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,UHC MGG,UHC MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,VA,VA,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Wellcare MGG,Wellcare MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Bright Health - commercial,Bright Health - commercial,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,73080,CPT,,,50,Inpatient,,,907.8,907.8,Bright Health MGG,Bright Health MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Aetna,Aetna,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Aetna MGG,Aetna MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,BCBS,BCBS,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,BCBS MGG,BCBS MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Cigna,Cigna,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Cigna MGG,Cigna MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Humana,Humana,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Humana MGG,Humana MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Optum VA,Optum VA,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,UHC,UHC,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,UHC MGG,UHC MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,VA,VA,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Wellcare MGG,Wellcare MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Bright Health - commercial,Bright Health - commercial,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,907.8,907.8,Bright Health MGG,Bright Health MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Aetna,Aetna,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Aetna MGG,Aetna MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,BCBS,BCBS,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,BCBS MGG,BCBS MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Cigna,Cigna,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Cigna MGG,Cigna MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Humana,Humana,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Humana MGG,Humana MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Optum VA,Optum VA,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,UHC,UHC,907.8,,,,,,,per diem,907.8,907.8,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,UHC MGG,UHC MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,VA,VA,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Wellcare MGG,Wellcare MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Bright Health - commercial,Bright Health - commercial,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,907.8,907.8,Bright Health MGG,Bright Health MGG,907.8,,,,,,,case rate,907.8,907.8,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Aetna,Aetna,1641.18,,,,,,,per diem,1641.18,1641.18,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Aetna MGG,Aetna MGG,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,BCBS,BCBS,1641.18,,,,,,,per diem,1641.18,1641.18,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,BCBS MGG,BCBS MGG,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Cigna,Cigna,1641.18,,,,,,,per diem,1641.18,1641.18,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Cigna MGG,Cigna MGG,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Humana,Humana,1641.18,,,,,,,per diem,1641.18,1641.18,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Humana MGG,Humana MGG,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Optum VA,Optum VA,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,UHC,UHC,1641.18,,,,,,,per diem,1641.18,1641.18,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,UHC MGG,UHC MGG,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,VA,VA,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Wellcare MGG,Wellcare MGG,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Bright Health - commercial,Bright Health - commercial,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,74330,CPT,,,,Inpatient,,,1641.18,1641.18,Bright Health MGG,Bright Health MGG,1641.18,,,,,,,case rate,1641.18,1641.18,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Aetna,Aetna,1342.32,,,,,,,per diem,1342.32,1342.32,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Aetna MGG,Aetna MGG,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,BCBS,BCBS,1342.32,,,,,,,per diem,1342.32,1342.32,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,BCBS MGG,BCBS MGG,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Cigna,Cigna,1342.32,,,,,,,per diem,1342.32,1342.32,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Cigna MGG,Cigna MGG,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Humana,Humana,1342.32,,,,,,,per diem,1342.32,1342.32,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Humana MGG,Humana MGG,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Optum VA,Optum VA,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,UHC,UHC,1342.32,,,,,,,per diem,1342.32,1342.32,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,UHC MGG,UHC MGG,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,VA,VA,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Wellcare MGG,Wellcare MGG,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Bright Health - commercial,Bright Health - commercial,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,74329,CPT,,,,Inpatient,,,1342.32,1342.32,Bright Health MGG,Bright Health MGG,1342.32,,,,,,,case rate,1342.32,1342.32,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Aetna,Aetna,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Aetna MGG,Aetna MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,BCBS,BCBS,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,BCBS MGG,BCBS MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Cigna,Cigna,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Cigna MGG,Cigna MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Humana,Humana,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Humana MGG,Humana MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Optum VA,Optum VA,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,UHC,UHC,550.8,,,,,,,per diem,550.8,550.8,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,UHC MGG,UHC MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,VA,VA,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Wellcare MGG,Wellcare MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Bright Health - commercial,Bright Health - commercial,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,75952,CPT,,,,Inpatient,,,550.8,550.8,Bright Health MGG,Bright Health MGG,550.8,,,,,,,case rate,550.8,550.8,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Aetna,Aetna,494.7,,,,,,,per diem,494.7,494.7,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Aetna MGG,Aetna MGG,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,BCBS,BCBS,494.7,,,,,,,per diem,494.7,494.7,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,BCBS MGG,BCBS MGG,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Cigna,Cigna,494.7,,,,,,,per diem,494.7,494.7,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Cigna MGG,Cigna MGG,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Humana,Humana,494.7,,,,,,,per diem,494.7,494.7,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Humana MGG,Humana MGG,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Optum VA,Optum VA,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,UHC,UHC,494.7,,,,,,,per diem,494.7,494.7,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,UHC MGG,UHC MGG,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,VA,VA,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Wellcare MGG,Wellcare MGG,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Bright Health - commercial,Bright Health - commercial,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,76010,CPT,,,,Inpatient,,,494.7,494.7,Bright Health MGG,Bright Health MGG,494.7,,,,,,,case rate,494.7,494.7,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Aetna,Aetna,757.86,,,,,,,per diem,757.86,757.86,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Aetna MGG,Aetna MGG,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,BCBS,BCBS,757.86,,,,,,,per diem,757.86,757.86,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,BCBS MGG,BCBS MGG,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Cigna,Cigna,757.86,,,,,,,per diem,757.86,757.86,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Cigna MGG,Cigna MGG,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Humana,Humana,757.86,,,,,,,per diem,757.86,757.86,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Humana MGG,Humana MGG,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Optum VA,Optum VA,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,UHC,UHC,757.86,,,,,,,per diem,757.86,757.86,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,UHC MGG,UHC MGG,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,VA,VA,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Wellcare MGG,Wellcare MGG,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Bright Health - commercial,Bright Health - commercial,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,73140,CPT,,,50,Inpatient,,,757.86,757.86,Bright Health MGG,Bright Health MGG,757.86,,,,,,,case rate,757.86,757.86,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Aetna,Aetna,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Aetna MGG,Aetna MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,BCBS,BCBS,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,BCBS MGG,BCBS MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Cigna,Cigna,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Cigna MGG,Cigna MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Humana,Humana,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Humana MGG,Humana MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Optum VA,Optum VA,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,UHC,UHC,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,UHC MGG,UHC MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,VA,VA,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Wellcare MGG,Wellcare MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Bright Health - commercial,Bright Health - commercial,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,752.91,752.91,Bright Health MGG,Bright Health MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Aetna,Aetna,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Aetna MGG,Aetna MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,BCBS,BCBS,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,BCBS MGG,BCBS MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Cigna,Cigna,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Cigna MGG,Cigna MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Humana,Humana,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Humana MGG,Humana MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Optum VA,Optum VA,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,UHC,UHC,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,UHC MGG,UHC MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,VA,VA,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Wellcare MGG,Wellcare MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Bright Health - commercial,Bright Health - commercial,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,73140,CPT,,,RT,Inpatient,,,752.91,752.91,Bright Health MGG,Bright Health MGG,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Aetna,Aetna,1097.53,,,,,,,per diem,1097.53,1097.53,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Aetna MGG,Aetna MGG,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,BCBS,BCBS,1097.53,,,,,,,per diem,1097.53,1097.53,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,BCBS MGG,BCBS MGG,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Cigna,Cigna,1097.53,,,,,,,per diem,1097.53,1097.53,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Cigna MGG,Cigna MGG,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Humana,Humana,1097.53,,,,,,,per diem,1097.53,1097.53,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Humana MGG,Humana MGG,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Optum VA,Optum VA,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,UHC,UHC,1097.53,,,,,,,per diem,1097.53,1097.53,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,UHC MGG,UHC MGG,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,VA,VA,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Wellcare MGG,Wellcare MGG,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Bright Health - commercial,Bright Health - commercial,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,73620,CPT,,,50,Inpatient,,,1097.53,1097.53,Bright Health MGG,Bright Health MGG,1097.53,,,,,,,case rate,1097.53,1097.53,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Aetna,Aetna,1151.58,,,,,,,per diem,1151.58,1151.58,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Aetna MGG,Aetna MGG,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,BCBS,BCBS,1151.58,,,,,,,per diem,1151.58,1151.58,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,BCBS MGG,BCBS MGG,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Cigna,Cigna,1151.58,,,,,,,per diem,1151.58,1151.58,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Cigna MGG,Cigna MGG,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Humana,Humana,1151.58,,,,,,,per diem,1151.58,1151.58,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Humana MGG,Humana MGG,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Optum VA,Optum VA,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,UHC,UHC,1151.58,,,,,,,per diem,1151.58,1151.58,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,UHC MGG,UHC MGG,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,VA,VA,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Wellcare MGG,Wellcare MGG,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Bright Health - commercial,Bright Health - commercial,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,1151.58,1151.58,Bright Health MGG,Bright Health MGG,1151.58,,,,,,,case rate,1151.58,1151.58,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Aetna,Aetna,867.72,,,,,,,per diem,867.72,867.72,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Aetna MGG,Aetna MGG,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,BCBS,BCBS,867.72,,,,,,,per diem,867.72,867.72,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,BCBS MGG,BCBS MGG,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Cigna,Cigna,867.72,,,,,,,per diem,867.72,867.72,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Cigna MGG,Cigna MGG,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Humana,Humana,867.72,,,,,,,per diem,867.72,867.72,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Humana MGG,Humana MGG,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Optum VA,Optum VA,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,UHC,UHC,867.72,,,,,,,per diem,867.72,867.72,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,UHC MGG,UHC MGG,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,VA,VA,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Wellcare MGG,Wellcare MGG,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Bright Health - commercial,Bright Health - commercial,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,867.72,867.72,Bright Health MGG,Bright Health MGG,867.72,,,,,,,case rate,867.72,867.72,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Aetna,Aetna,1596.3,,,,,,,per diem,1596.3,1596.3,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Aetna MGG,Aetna MGG,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,BCBS,BCBS,1596.3,,,,,,,per diem,1596.3,1596.3,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,BCBS MGG,BCBS MGG,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Cigna,Cigna,1596.3,,,,,,,per diem,1596.3,1596.3,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Cigna MGG,Cigna MGG,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Humana,Humana,1596.3,,,,,,,per diem,1596.3,1596.3,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Humana MGG,Humana MGG,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Optum VA,Optum VA,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,UHC,UHC,1596.3,,,,,,,per diem,1596.3,1596.3,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,UHC MGG,UHC MGG,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,VA,VA,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Wellcare MGG,Wellcare MGG,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Bright Health - commercial,Bright Health - commercial,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,73630,CPT,,,50,Inpatient,,,1596.3,1596.3,Bright Health MGG,Bright Health MGG,1596.3,,,,,,,case rate,1596.3,1596.3,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Aetna,Aetna,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Aetna MGG,Aetna MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,BCBS,BCBS,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,BCBS MGG,BCBS MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Cigna,Cigna,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Cigna MGG,Cigna MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Humana,Humana,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Humana MGG,Humana MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Optum VA,Optum VA,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,UHC,UHC,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,UHC MGG,UHC MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,VA,VA,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Wellcare MGG,Wellcare MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Bright Health - commercial,Bright Health - commercial,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,1308.66,1308.66,Bright Health MGG,Bright Health MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Aetna,Aetna,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Aetna MGG,Aetna MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,BCBS,BCBS,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,BCBS MGG,BCBS MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Cigna,Cigna,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Cigna MGG,Cigna MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Humana,Humana,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Humana MGG,Humana MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Optum VA,Optum VA,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,UHC,UHC,1308.66,,,,,,,per diem,1308.66,1308.66,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,UHC MGG,UHC MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,VA,VA,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Wellcare MGG,Wellcare MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Bright Health - commercial,Bright Health - commercial,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,1308.66,1308.66,Bright Health MGG,Bright Health MGG,1308.66,,,,,,,case rate,1308.66,1308.66,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Aetna,Aetna,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Aetna MGG,Aetna MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,BCBS,BCBS,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,BCBS MGG,BCBS MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Cigna,Cigna,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Cigna MGG,Cigna MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Humana,Humana,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Humana MGG,Humana MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Optum VA,Optum VA,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,UHC,UHC,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,UHC MGG,UHC MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,VA,VA,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Wellcare MGG,Wellcare MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Bright Health - commercial,Bright Health - commercial,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,73090,CPT,,,50,Inpatient,,,902.7,902.7,Bright Health MGG,Bright Health MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Aetna,Aetna,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Aetna MGG,Aetna MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,BCBS,BCBS,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,BCBS MGG,BCBS MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Cigna,Cigna,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Cigna MGG,Cigna MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Humana,Humana,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Humana MGG,Humana MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Optum VA,Optum VA,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,UHC,UHC,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,UHC MGG,UHC MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,VA,VA,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Wellcare MGG,Wellcare MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Bright Health - commercial,Bright Health - commercial,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,902.7,902.7,Bright Health MGG,Bright Health MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Aetna,Aetna,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Aetna MGG,Aetna MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,BCBS,BCBS,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,BCBS MGG,BCBS MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Cigna,Cigna,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Cigna MGG,Cigna MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Humana,Humana,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Humana MGG,Humana MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Optum VA,Optum VA,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,UHC,UHC,902.7,,,,,,,per diem,902.7,902.7,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,UHC MGG,UHC MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,VA,VA,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Wellcare MGG,Wellcare MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Bright Health - commercial,Bright Health - commercial,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,902.7,902.7,Bright Health MGG,Bright Health MGG,902.7,,,,,,,case rate,902.7,902.7,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Aetna,Aetna,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Aetna MGG,Aetna MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,BCBS,BCBS,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,BCBS MGG,BCBS MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Cigna,Cigna,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Cigna MGG,Cigna MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Humana,Humana,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Humana MGG,Humana MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Optum VA,Optum VA,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,UHC,UHC,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,UHC MGG,UHC MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,VA,VA,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Wellcare MGG,Wellcare MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Bright Health - commercial,Bright Health - commercial,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,73120,CPT,,,50,Inpatient,,,1119.96,1119.96,Bright Health MGG,Bright Health MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Aetna,Aetna,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Aetna MGG,Aetna MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,BCBS,BCBS,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,BCBS MGG,BCBS MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Cigna,Cigna,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Cigna MGG,Cigna MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Humana,Humana,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Humana MGG,Humana MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Optum VA,Optum VA,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,UHC,UHC,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,UHC MGG,UHC MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,VA,VA,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Wellcare MGG,Wellcare MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Bright Health - commercial,Bright Health - commercial,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,1119.96,1119.96,Bright Health MGG,Bright Health MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Aetna,Aetna,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Aetna MGG,Aetna MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,BCBS,BCBS,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,BCBS MGG,BCBS MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Cigna,Cigna,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Cigna MGG,Cigna MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Humana,Humana,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Humana MGG,Humana MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Optum VA,Optum VA,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,UHC,UHC,1119.96,,,,,,,per diem,1119.96,1119.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,UHC MGG,UHC MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,VA,VA,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Wellcare MGG,Wellcare MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Bright Health - commercial,Bright Health - commercial,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,1119.96,1119.96,Bright Health MGG,Bright Health MGG,1119.96,,,,,,,case rate,1119.96,1119.96,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Aetna,Aetna,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Aetna MGG,Aetna MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,BCBS,BCBS,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,BCBS MGG,BCBS MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Cigna,Cigna,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Cigna MGG,Cigna MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Humana,Humana,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Humana MGG,Humana MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Optum VA,Optum VA,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,UHC,UHC,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,UHC MGG,UHC MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,VA,VA,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Wellcare MGG,Wellcare MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Bright Health - commercial,Bright Health - commercial,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,73130,CPT,,,50,Inpatient,,,1302.54,1302.54,Bright Health MGG,Bright Health MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Aetna,Aetna,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Aetna MGG,Aetna MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,BCBS,BCBS,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,BCBS MGG,BCBS MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Cigna,Cigna,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Cigna MGG,Cigna MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Humana,Humana,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Humana MGG,Humana MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Optum VA,Optum VA,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,UHC,UHC,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,UHC MGG,UHC MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,VA,VA,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Wellcare MGG,Wellcare MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Bright Health - commercial,Bright Health - commercial,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,1302.54,1302.54,Bright Health MGG,Bright Health MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Aetna,Aetna,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Aetna MGG,Aetna MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,BCBS,BCBS,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,BCBS MGG,BCBS MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Cigna,Cigna,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Cigna MGG,Cigna MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Humana,Humana,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Humana MGG,Humana MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Optum VA,Optum VA,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,UHC,UHC,1302.54,,,,,,,per diem,1302.54,1302.54,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,UHC MGG,UHC MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,VA,VA,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Wellcare MGG,Wellcare MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Bright Health - commercial,Bright Health - commercial,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,1302.54,1302.54,Bright Health MGG,Bright Health MGG,1302.54,,,,,,,case rate,1302.54,1302.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Aetna,Aetna,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Aetna MGG,Aetna MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,BCBS,BCBS,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,BCBS MGG,BCBS MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Cigna,Cigna,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Cigna MGG,Cigna MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Humana,Humana,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Humana MGG,Humana MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Optum VA,Optum VA,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,UHC,UHC,1391.28,,,,,,,per diem,1391.28,1391.28,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,UHC MGG,UHC MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,VA,VA,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Wellcare MGG,Wellcare MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Bright Health - commercial,Bright Health - commercial,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,73060,CPT,,,50,Inpatient,,,1391.28,1391.28,Bright Health MGG,Bright Health MGG,1391.28,,,,,,,case rate,1391.28,1391.28,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Aetna,Aetna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Aetna MGG,Aetna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,BCBS,BCBS,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,BCBS MGG,BCBS MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Cigna,Cigna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Cigna MGG,Cigna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Humana,Humana,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Humana MGG,Humana MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Optum VA,Optum VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,UHC,UHC,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,UHC MGG,UHC MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,VA,VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Wellcare MGG,Wellcare MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Bright Health - commercial,Bright Health - commercial,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,927.18,927.18,Bright Health MGG,Bright Health MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Aetna,Aetna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Aetna MGG,Aetna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,BCBS,BCBS,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,BCBS MGG,BCBS MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Cigna,Cigna,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Cigna MGG,Cigna MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Humana,Humana,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Humana MGG,Humana MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Optum VA,Optum VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,UHC,UHC,927.18,,,,,,,per diem,927.18,927.18,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,UHC MGG,UHC MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,VA,VA,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Wellcare MGG,Wellcare MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Bright Health - commercial,Bright Health - commercial,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,927.18,927.18,Bright Health MGG,Bright Health MGG,927.18,,,,,,,case rate,927.18,927.18,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Aetna,Aetna,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Aetna MGG,Aetna MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,BCBS,BCBS,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,BCBS MGG,BCBS MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Cigna,Cigna,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Cigna MGG,Cigna MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Humana,Humana,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Humana MGG,Humana MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Optum VA,Optum VA,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,UHC,UHC,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,UHC MGG,UHC MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,VA,VA,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Wellcare MGG,Wellcare MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Bright Health - commercial,Bright Health - commercial,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,73560,CPT,,,50,Inpatient,,,1102.62,1102.62,Bright Health MGG,Bright Health MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Aetna,Aetna,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Aetna MGG,Aetna MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,BCBS,BCBS,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,BCBS MGG,BCBS MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Cigna,Cigna,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Cigna MGG,Cigna MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Humana,Humana,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Humana MGG,Humana MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Optum VA,Optum VA,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,UHC,UHC,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,UHC MGG,UHC MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,VA,VA,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Wellcare MGG,Wellcare MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Bright Health - commercial,Bright Health - commercial,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,1102.62,1102.62,Bright Health MGG,Bright Health MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Aetna,Aetna,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Aetna MGG,Aetna MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,BCBS,BCBS,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,BCBS MGG,BCBS MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Cigna,Cigna,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Cigna MGG,Cigna MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Humana,Humana,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Humana MGG,Humana MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Optum VA,Optum VA,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,UHC,UHC,1102.62,,,,,,,per diem,1102.62,1102.62,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,UHC MGG,UHC MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,VA,VA,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Wellcare MGG,Wellcare MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Bright Health - commercial,Bright Health - commercial,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,1102.62,1102.62,Bright Health MGG,Bright Health MGG,1102.62,,,,,,,case rate,1102.62,1102.62,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Aetna,Aetna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Aetna MGG,Aetna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,BCBS,BCBS,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,BCBS MGG,BCBS MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Cigna,Cigna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Cigna MGG,Cigna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Humana,Humana,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Humana MGG,Humana MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Optum VA,Optum VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,UHC,UHC,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,UHC MGG,UHC MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,VA,VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Wellcare MGG,Wellcare MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Bright Health - commercial,Bright Health - commercial,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,73562,CPT,,,50,Inpatient,,,1297.44,1297.44,Bright Health MGG,Bright Health MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Aetna,Aetna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Aetna MGG,Aetna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,BCBS,BCBS,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,BCBS MGG,BCBS MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Cigna,Cigna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Cigna MGG,Cigna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Humana,Humana,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Humana MGG,Humana MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Optum VA,Optum VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,UHC,UHC,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,UHC MGG,UHC MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,VA,VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Wellcare MGG,Wellcare MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Bright Health - commercial,Bright Health - commercial,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,1297.44,1297.44,Bright Health MGG,Bright Health MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Aetna,Aetna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Aetna MGG,Aetna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,BCBS,BCBS,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,BCBS MGG,BCBS MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Cigna,Cigna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Cigna MGG,Cigna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Humana,Humana,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Humana MGG,Humana MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Optum VA,Optum VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,UHC,UHC,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,UHC MGG,UHC MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,VA,VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Wellcare MGG,Wellcare MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Bright Health - commercial,Bright Health - commercial,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,1297.44,1297.44,Bright Health MGG,Bright Health MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Aetna,Aetna,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Aetna MGG,Aetna MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,BCBS,BCBS,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,BCBS MGG,BCBS MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Cigna,Cigna,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Cigna MGG,Cigna MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Humana,Humana,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Humana MGG,Humana MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Optum VA,Optum VA,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,UHC,UHC,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,UHC MGG,UHC MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,VA,VA,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Wellcare MGG,Wellcare MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Bright Health - commercial,Bright Health - commercial,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,73564,CPT,,,50,Inpatient,,,1492.26,1492.26,Bright Health MGG,Bright Health MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Aetna,Aetna,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Aetna MGG,Aetna MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,BCBS,BCBS,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,BCBS MGG,BCBS MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Cigna,Cigna,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Cigna MGG,Cigna MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Humana,Humana,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Humana MGG,Humana MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Optum VA,Optum VA,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,UHC,UHC,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,UHC MGG,UHC MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,VA,VA,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Wellcare MGG,Wellcare MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Bright Health - commercial,Bright Health - commercial,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,73564,CPT,,,LT,Inpatient,,,1492.26,1492.26,Bright Health MGG,Bright Health MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Aetna,Aetna,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Aetna MGG,Aetna MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,BCBS,BCBS,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,BCBS MGG,BCBS MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Cigna,Cigna,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Cigna MGG,Cigna MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Humana,Humana,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Humana MGG,Humana MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Optum VA,Optum VA,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,UHC,UHC,1492.26,,,,,,,per diem,1492.26,1492.26,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,UHC MGG,UHC MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,VA,VA,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Wellcare MGG,Wellcare MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Bright Health - commercial,Bright Health - commercial,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,73564,CPT,,,RT,Inpatient,,,1492.26,1492.26,Bright Health MGG,Bright Health MGG,1492.26,,,,,,,case rate,1492.26,1492.26,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Aetna,Aetna,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Aetna MGG,Aetna MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,BCBS,BCBS,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,BCBS MGG,BCBS MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Cigna,Cigna,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Cigna MGG,Cigna MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Humana,Humana,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Humana MGG,Humana MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Optum VA,Optum VA,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,UHC,UHC,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,UHC MGG,UHC MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,VA,VA,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Wellcare MGG,Wellcare MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Bright Health - commercial,Bright Health - commercial,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,70130,CPT,,,,Inpatient,,,659.94,659.94,Bright Health MGG,Bright Health MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Aetna,Aetna,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Aetna MGG,Aetna MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,BCBS,BCBS,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,BCBS MGG,BCBS MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Cigna,Cigna,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Cigna MGG,Cigna MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Humana,Humana,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Humana MGG,Humana MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Optum VA,Optum VA,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,UHC,UHC,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,UHC MGG,UHC MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,VA,VA,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Wellcare MGG,Wellcare MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Bright Health - commercial,Bright Health - commercial,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,74210,CPT,,,,Inpatient,,,291.72,291.72,Bright Health MGG,Bright Health MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Aetna,Aetna,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Aetna MGG,Aetna MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,BCBS,BCBS,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,BCBS MGG,BCBS MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Cigna,Cigna,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Cigna MGG,Cigna MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Humana,Humana,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Humana MGG,Humana MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Optum VA,Optum VA,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,UHC,UHC,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,UHC MGG,UHC MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,VA,VA,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Wellcare MGG,Wellcare MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Bright Health - commercial,Bright Health - commercial,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Bright Health MGG,Bright Health MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Aetna,Aetna,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Aetna MGG,Aetna MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,BCBS,BCBS,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,BCBS MGG,BCBS MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Cigna,Cigna,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Cigna MGG,Cigna MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Humana,Humana,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Humana MGG,Humana MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Optum VA,Optum VA,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,UHC,UHC,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,UHC MGG,UHC MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,VA,VA,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Wellcare MGG,Wellcare MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Bright Health - commercial,Bright Health - commercial,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,958.8,958.8,Bright Health MGG,Bright Health MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Aetna,Aetna,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Aetna MGG,Aetna MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,BCBS,BCBS,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,BCBS MGG,BCBS MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Cigna,Cigna,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Cigna MGG,Cigna MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Humana,Humana,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Humana MGG,Humana MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Optum VA,Optum VA,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,UHC,UHC,958.8,,,,,,,per diem,958.8,958.8,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,UHC MGG,UHC MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,VA,VA,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Wellcare MGG,Wellcare MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Bright Health - commercial,Bright Health - commercial,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,958.8,958.8,Bright Health MGG,Bright Health MGG,958.8,,,,,,,case rate,958.8,958.8,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Aetna,Aetna,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Aetna MGG,Aetna MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,BCBS,BCBS,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,BCBS MGG,BCBS MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Cigna,Cigna,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Cigna MGG,Cigna MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Humana,Humana,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Humana MGG,Humana MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Optum VA,Optum VA,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,UHC,UHC,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,UHC MGG,UHC MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,VA,VA,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Wellcare MGG,Wellcare MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Bright Health - commercial,Bright Health - commercial,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,1141.38,1141.38,Bright Health MGG,Bright Health MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Aetna,Aetna,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Aetna MGG,Aetna MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,BCBS,BCBS,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,BCBS MGG,BCBS MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Cigna,Cigna,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Cigna MGG,Cigna MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Humana,Humana,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Humana MGG,Humana MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Optum VA,Optum VA,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,UHC,UHC,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,UHC MGG,UHC MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,VA,VA,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Wellcare MGG,Wellcare MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Bright Health - commercial,Bright Health - commercial,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,1141.38,1141.38,Bright Health MGG,Bright Health MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Aetna,Aetna,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Aetna MGG,Aetna MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,BCBS,BCBS,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,BCBS MGG,BCBS MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Cigna,Cigna,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Cigna MGG,Cigna MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Humana,Humana,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Humana MGG,Humana MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Optum VA,Optum VA,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,UHC,UHC,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,UHC MGG,UHC MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,VA,VA,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Wellcare MGG,Wellcare MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Bright Health - commercial,Bright Health - commercial,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,73010,CPT,,,LT,Inpatient,,,923.1,923.1,Bright Health MGG,Bright Health MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Aetna,Aetna,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Aetna MGG,Aetna MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,BCBS,BCBS,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,BCBS MGG,BCBS MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Cigna,Cigna,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Cigna MGG,Cigna MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Humana,Humana,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Humana MGG,Humana MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Optum VA,Optum VA,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,UHC,UHC,923.1,,,,,,,per diem,923.1,923.1,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,UHC MGG,UHC MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,VA,VA,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Wellcare MGG,Wellcare MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Bright Health - commercial,Bright Health - commercial,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,923.1,923.1,Bright Health MGG,Bright Health MGG,923.1,,,,,,,case rate,923.1,923.1,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Aetna,Aetna,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Aetna MGG,Aetna MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,BCBS,BCBS,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,BCBS MGG,BCBS MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Cigna,Cigna,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Cigna MGG,Cigna MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Humana,Humana,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Humana MGG,Humana MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Optum VA,Optum VA,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,UHC,UHC,879.24,,,,,,,per diem,879.24,879.24,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,UHC MGG,UHC MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,VA,VA,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Wellcare MGG,Wellcare MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Bright Health - commercial,Bright Health - commercial,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,879.24,879.24,Bright Health MGG,Bright Health MGG,879.24,,,,,,,case rate,879.24,879.24,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Aetna,Aetna,686.16,,,,,,,per diem,686.16,686.16,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Aetna MGG,Aetna MGG,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,BCBS,BCBS,686.16,,,,,,,per diem,686.16,686.16,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,BCBS MGG,BCBS MGG,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Cigna,Cigna,686.16,,,,,,,per diem,686.16,686.16,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Cigna MGG,Cigna MGG,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Humana,Humana,686.16,,,,,,,per diem,686.16,686.16,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Humana MGG,Humana MGG,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Optum VA,Optum VA,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,UHC,UHC,686.16,,,,,,,per diem,686.16,686.16,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,UHC MGG,UHC MGG,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,VA,VA,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Wellcare MGG,Wellcare MGG,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Bright Health - commercial,Bright Health - commercial,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,686.16,686.16,Bright Health MGG,Bright Health MGG,686.16,,,,,,,case rate,686.16,686.16,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Aetna,Aetna,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Aetna MGG,Aetna MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,BCBS,BCBS,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,BCBS MGG,BCBS MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Cigna,Cigna,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Cigna MGG,Cigna MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Humana,Humana,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Humana MGG,Humana MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Optum VA,Optum VA,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,UHC,UHC,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,UHC MGG,UHC MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,VA,VA,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Wellcare MGG,Wellcare MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Bright Health - commercial,Bright Health - commercial,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,73030,CPT,,,50,Inpatient,,,1099.56,1099.56,Bright Health MGG,Bright Health MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Aetna,Aetna,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Aetna MGG,Aetna MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,BCBS,BCBS,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,BCBS MGG,BCBS MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Cigna,Cigna,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Cigna MGG,Cigna MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Humana,Humana,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Humana MGG,Humana MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Optum VA,Optum VA,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,UHC,UHC,1099.56,,,,,,,per diem,1099.56,1099.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,UHC MGG,UHC MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,VA,VA,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Wellcare MGG,Wellcare MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Bright Health - commercial,Bright Health - commercial,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,1099.56,1099.56,Bright Health MGG,Bright Health MGG,1099.56,,,,,,,case rate,1099.56,1099.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Aetna,Aetna,762.56,,,,,,,per diem,762.56,762.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Aetna MGG,Aetna MGG,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,BCBS,BCBS,762.56,,,,,,,per diem,762.56,762.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,BCBS MGG,BCBS MGG,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Cigna,Cigna,762.56,,,,,,,per diem,762.56,762.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Cigna MGG,Cigna MGG,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Humana,Humana,762.56,,,,,,,per diem,762.56,762.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Humana MGG,Humana MGG,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Optum VA,Optum VA,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,UHC,UHC,762.56,,,,,,,per diem,762.56,762.56,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,UHC MGG,UHC MGG,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,VA,VA,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Wellcare MGG,Wellcare MGG,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Bright Health - commercial,Bright Health - commercial,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,762.56,762.56,Bright Health MGG,Bright Health MGG,762.56,,,,,,,case rate,762.56,762.56,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Aetna,Aetna,656.88,,,,,,,per diem,656.88,656.88,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Aetna MGG,Aetna MGG,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,BCBS,BCBS,656.88,,,,,,,per diem,656.88,656.88,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,BCBS MGG,BCBS MGG,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Cigna,Cigna,656.88,,,,,,,per diem,656.88,656.88,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Cigna MGG,Cigna MGG,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Humana,Humana,656.88,,,,,,,per diem,656.88,656.88,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Humana MGG,Humana MGG,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Optum VA,Optum VA,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,UHC,UHC,656.88,,,,,,,per diem,656.88,656.88,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,UHC MGG,UHC MGG,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,VA,VA,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Wellcare MGG,Wellcare MGG,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Bright Health - commercial,Bright Health - commercial,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,70390,CPT,,,,Inpatient,,,656.88,656.88,Bright Health MGG,Bright Health MGG,656.88,,,,,,,case rate,656.88,656.88,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Aetna,Aetna,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Aetna MGG,Aetna MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,BCBS,BCBS,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,BCBS MGG,BCBS MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Cigna,Cigna,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Cigna MGG,Cigna MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Humana,Humana,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Humana MGG,Humana MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Optum VA,Optum VA,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,UHC,UHC,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,UHC MGG,UHC MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,VA,VA,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Wellcare MGG,Wellcare MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Bright Health - commercial,Bright Health - commercial,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,73600,CPT,,,0000,Inpatient,,,826.2,826.2,Bright Health MGG,Bright Health MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Aetna,Aetna,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Aetna MGG,Aetna MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,BCBS,BCBS,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,BCBS MGG,BCBS MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Cigna,Cigna,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Cigna MGG,Cigna MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Humana,Humana,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Humana MGG,Humana MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Optum VA,Optum VA,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,UHC,UHC,826.2,,,,,,,per diem,826.2,826.2,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,UHC MGG,UHC MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,VA,VA,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Wellcare MGG,Wellcare MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Bright Health - commercial,Bright Health - commercial,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,826.2,826.2,Bright Health MGG,Bright Health MGG,826.2,,,,,,,case rate,826.2,826.2,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Aetna,Aetna,659.28,,,,,,,per diem,659.28,659.28,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Aetna MGG,Aetna MGG,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,BCBS,BCBS,659.28,,,,,,,per diem,659.28,659.28,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,BCBS MGG,BCBS MGG,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Cigna,Cigna,659.28,,,,,,,per diem,659.28,659.28,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Cigna MGG,Cigna MGG,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Humana,Humana,659.28,,,,,,,per diem,659.28,659.28,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Humana MGG,Humana MGG,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Optum VA,Optum VA,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,UHC,UHC,659.28,,,,,,,per diem,659.28,659.28,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,UHC MGG,UHC MGG,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,VA,VA,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Wellcare MGG,Wellcare MGG,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Bright Health - commercial,Bright Health - commercial,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,659.28,659.28,Bright Health MGG,Bright Health MGG,659.28,,,,,,,case rate,659.28,659.28,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Aetna,Aetna,440.21,,,,,,,per diem,440.21,440.21,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Aetna MGG,Aetna MGG,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,BCBS,BCBS,440.21,,,,,,,per diem,440.21,440.21,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,BCBS MGG,BCBS MGG,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Cigna,Cigna,440.21,,,,,,,per diem,440.21,440.21,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Cigna MGG,Cigna MGG,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Humana,Humana,440.21,,,,,,,per diem,440.21,440.21,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Humana MGG,Humana MGG,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Optum VA,Optum VA,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,UHC,UHC,440.21,,,,,,,per diem,440.21,440.21,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,UHC MGG,UHC MGG,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,VA,VA,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Wellcare MGG,Wellcare MGG,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Bright Health - commercial,Bright Health - commercial,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,440.21,440.21,Bright Health MGG,Bright Health MGG,440.21,,,,,,,case rate,440.21,440.21,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Aetna,Aetna,589.76,,,,,,,per diem,589.76,589.76,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Aetna MGG,Aetna MGG,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,BCBS,BCBS,589.76,,,,,,,per diem,589.76,589.76,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,BCBS MGG,BCBS MGG,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Cigna,Cigna,589.76,,,,,,,per diem,589.76,589.76,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Cigna MGG,Cigna MGG,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Humana,Humana,589.76,,,,,,,per diem,589.76,589.76,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Humana MGG,Humana MGG,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Optum VA,Optum VA,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,UHC,UHC,589.76,,,,,,,per diem,589.76,589.76,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,UHC MGG,UHC MGG,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,VA,VA,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Wellcare MGG,Wellcare MGG,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Bright Health - commercial,Bright Health - commercial,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,589.76,589.76,Bright Health MGG,Bright Health MGG,589.76,,,,,,,case rate,589.76,589.76,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Aetna,Aetna,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Aetna MGG,Aetna MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,BCBS,BCBS,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,BCBS MGG,BCBS MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Cigna,Cigna,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Cigna MGG,Cigna MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Humana,Humana,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Humana MGG,Humana MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Optum VA,Optum VA,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,UHC,UHC,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,UHC MGG,UHC MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,VA,VA,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Wellcare MGG,Wellcare MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Bright Health - commercial,Bright Health - commercial,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,4830.72,4830.72,Bright Health MGG,Bright Health MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Aetna,Aetna,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Aetna MGG,Aetna MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,BCBS,BCBS,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,BCBS MGG,BCBS MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Cigna,Cigna,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Cigna MGG,Cigna MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Humana,Humana,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Humana MGG,Humana MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Optum VA,Optum VA,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,UHC,UHC,4830.72,,,,,,,per diem,4830.72,4830.72,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,UHC MGG,UHC MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,VA,VA,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Wellcare MGG,Wellcare MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Bright Health - commercial,Bright Health - commercial,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,75820,CPT,,,RT,Inpatient,,,4830.72,4830.72,Bright Health MGG,Bright Health MGG,4830.72,,,,,,,case rate,4830.72,4830.72,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Aetna,Aetna,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Aetna MGG,Aetna MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,BCBS,BCBS,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,BCBS MGG,BCBS MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Cigna,Cigna,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Cigna MGG,Cigna MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Humana,Humana,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Humana MGG,Humana MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Optum VA,Optum VA,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,UHC,UHC,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,UHC MGG,UHC MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,VA,VA,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Wellcare MGG,Wellcare MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Bright Health - commercial,Bright Health - commercial,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,949.62,949.62,Bright Health MGG,Bright Health MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Aetna,Aetna,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Aetna MGG,Aetna MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,BCBS,BCBS,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,BCBS MGG,BCBS MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Cigna,Cigna,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Cigna MGG,Cigna MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Humana,Humana,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Humana MGG,Humana MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Optum VA,Optum VA,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,UHC,UHC,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,UHC MGG,UHC MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,VA,VA,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Wellcare MGG,Wellcare MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Bright Health - commercial,Bright Health - commercial,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,949.62,949.62,Bright Health MGG,Bright Health MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Aetna,Aetna,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Aetna MGG,Aetna MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,BCBS,BCBS,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,BCBS MGG,BCBS MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Cigna,Cigna,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Cigna MGG,Cigna MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Humana,Humana,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Humana MGG,Humana MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Optum VA,Optum VA,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,UHC,UHC,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,UHC MGG,UHC MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,VA,VA,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Wellcare MGG,Wellcare MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Bright Health - commercial,Bright Health - commercial,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,73110,CPT,,,50,Inpatient,,,1144.44,1144.44,Bright Health MGG,Bright Health MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Aetna,Aetna,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Aetna MGG,Aetna MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,BCBS,BCBS,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,BCBS MGG,BCBS MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Cigna,Cigna,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Cigna MGG,Cigna MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Humana,Humana,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Humana MGG,Humana MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Optum VA,Optum VA,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,UHC,UHC,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,UHC MGG,UHC MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,VA,VA,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Wellcare MGG,Wellcare MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Bright Health - commercial,Bright Health - commercial,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,1144.44,1144.44,Bright Health MGG,Bright Health MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Aetna,Aetna,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Aetna MGG,Aetna MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,BCBS,BCBS,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,BCBS MGG,BCBS MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Cigna,Cigna,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Cigna MGG,Cigna MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Humana,Humana,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Humana MGG,Humana MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Optum VA,Optum VA,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,UHC,UHC,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,UHC MGG,UHC MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,VA,VA,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Wellcare MGG,Wellcare MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Bright Health - commercial,Bright Health - commercial,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,1144.44,1144.44,Bright Health MGG,Bright Health MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Aetna,Aetna,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Aetna MGG,Aetna MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,BCBS,BCBS,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,BCBS MGG,BCBS MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Cigna,Cigna,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Cigna MGG,Cigna MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Humana,Humana,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Humana MGG,Humana MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Optum VA,Optum VA,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,UHC,UHC,5376.42,,,,,,,per diem,5376.42,5376.42,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,UHC MGG,UHC MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,VA,VA,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Wellcare MGG,Wellcare MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Bright Health - commercial,Bright Health - commercial,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,75978,CPT,,,,Inpatient,,,5376.42,5376.42,Bright Health MGG,Bright Health MGG,5376.42,,,,,,,case rate,5376.42,5376.42,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Aetna,Aetna,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Aetna MGG,Aetna MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,BCBS,BCBS,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,BCBS MGG,BCBS MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Cigna,Cigna,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Cigna MGG,Cigna MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Humana,Humana,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Humana MGG,Humana MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Optum VA,Optum VA,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,UHC,UHC,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,UHC MGG,UHC MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,VA,VA,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Wellcare MGG,Wellcare MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Bright Health - commercial,Bright Health - commercial,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Bright Health MGG,Bright Health MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Aetna,Aetna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Aetna MGG,Aetna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,BCBS,BCBS,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,BCBS MGG,BCBS MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Cigna,Cigna,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Cigna MGG,Cigna MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Humana,Humana,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Humana MGG,Humana MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Optum VA,Optum VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,UHC,UHC,138.72,,,,,,,per diem,138.72,138.72,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,UHC MGG,UHC MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,VA,VA,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Wellcare MGG,Wellcare MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Bright Health - commercial,Bright Health - commercial,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,138.72,138.72,Bright Health MGG,Bright Health MGG,138.72,,,,,,,case rate,138.72,138.72,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Aetna,Aetna,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Aetna MGG,Aetna MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,BCBS,BCBS,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,BCBS MGG,BCBS MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Cigna,Cigna,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Cigna MGG,Cigna MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Humana,Humana,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Humana MGG,Humana MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Optum VA,Optum VA,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,UHC,UHC,277.44,,,,,,,per diem,277.44,277.44,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,UHC MGG,UHC MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,VA,VA,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Wellcare MGG,Wellcare MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Bright Health - commercial,Bright Health - commercial,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,Q9967,CPT,,,,Inpatient,1,EA,277.44,277.44,Bright Health MGG,Bright Health MGG,277.44,,,,,,,case rate,277.44,277.44,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Aetna,Aetna,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Aetna MGG,Aetna MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,BCBS,BCBS,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,BCBS MGG,BCBS MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Cigna,Cigna,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Cigna MGG,Cigna MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Humana,Humana,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Humana MGG,Humana MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Optum VA,Optum VA,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,UHC,UHC,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,UHC MGG,UHC MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,VA,VA,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Wellcare MGG,Wellcare MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Bright Health - commercial,Bright Health - commercial,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,75710,CPT,,,LT,Inpatient,,,4871.52,4871.52,Bright Health MGG,Bright Health MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Aetna,Aetna,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Aetna MGG,Aetna MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,BCBS,BCBS,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,BCBS MGG,BCBS MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Cigna,Cigna,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Cigna MGG,Cigna MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Humana,Humana,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Humana MGG,Humana MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Optum VA,Optum VA,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,UHC,UHC,4871.52,,,,,,,per diem,4871.52,4871.52,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,UHC MGG,UHC MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,VA,VA,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Wellcare MGG,Wellcare MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Bright Health - commercial,Bright Health - commercial,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,75710,CPT,,,RT,Inpatient,,,4871.52,4871.52,Bright Health MGG,Bright Health MGG,4871.52,,,,,,,case rate,4871.52,4871.52,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Aetna,Aetna,254.33,,,,,,,per diem,254.33,254.33,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Aetna MGG,Aetna MGG,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,BCBS,BCBS,254.33,,,,,,,per diem,254.33,254.33,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,BCBS MGG,BCBS MGG,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Cigna,Cigna,254.33,,,,,,,per diem,254.33,254.33,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Cigna MGG,Cigna MGG,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Humana,Humana,254.33,,,,,,,per diem,254.33,254.33,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Humana MGG,Humana MGG,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Optum VA,Optum VA,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,UHC,UHC,254.33,,,,,,,per diem,254.33,254.33,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,UHC MGG,UHC MGG,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,VA,VA,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Wellcare MGG,Wellcare MGG,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Bright Health - commercial,Bright Health - commercial,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,77086,CPT,,,,Inpatient,,,254.33,254.33,Bright Health MGG,Bright Health MGG,254.33,,,,,,,case rate,254.33,254.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Aetna,Aetna,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Aetna MGG,Aetna MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,BCBS,BCBS,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,BCBS MGG,BCBS MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Cigna,Cigna,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Cigna MGG,Cigna MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Humana,Humana,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Humana MGG,Humana MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Optum VA,Optum VA,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,UHC,UHC,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,UHC MGG,UHC MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,VA,VA,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Wellcare MGG,Wellcare MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Bright Health - commercial,Bright Health - commercial,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,77085,CPT,,,,Inpatient,,,655.86,655.86,Bright Health MGG,Bright Health MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Aetna,Aetna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Aetna MGG,Aetna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,BCBS,BCBS,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,BCBS MGG,BCBS MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Cigna,Cigna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Cigna MGG,Cigna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Humana,Humana,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Humana MGG,Humana MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Optum VA,Optum VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,UHC,UHC,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,UHC MGG,UHC MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,VA,VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Wellcare MGG,Wellcare MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Bright Health - commercial,Bright Health - commercial,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,G0202,CPT,,,52RT,Inpatient,,,200.94,200.94,Bright Health MGG,Bright Health MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Aetna,Aetna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Aetna MGG,Aetna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,BCBS,BCBS,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,BCBS MGG,BCBS MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Cigna,Cigna,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Cigna MGG,Cigna MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Humana,Humana,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Humana MGG,Humana MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Optum VA,Optum VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,UHC,UHC,200.94,,,,,,,per diem,200.94,200.94,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,UHC MGG,UHC MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,VA,VA,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Wellcare MGG,Wellcare MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Bright Health - commercial,Bright Health - commercial,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,G0202,CPT,,,52LT,Inpatient,,,200.94,200.94,Bright Health MGG,Bright Health MGG,200.94,,,,,,,case rate,200.94,200.94,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Aetna,Aetna,261.81,,,,,,,per diem,261.81,261.81,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Aetna MGG,Aetna MGG,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,BCBS,BCBS,261.81,,,,,,,per diem,261.81,261.81,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,BCBS MGG,BCBS MGG,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Cigna,Cigna,261.81,,,,,,,per diem,261.81,261.81,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Cigna MGG,Cigna MGG,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Humana,Humana,261.81,,,,,,,per diem,261.81,261.81,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Humana MGG,Humana MGG,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Optum VA,Optum VA,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,UHC,UHC,261.81,,,,,,,per diem,261.81,261.81,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,UHC MGG,UHC MGG,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,VA,VA,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Wellcare MGG,Wellcare MGG,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Bright Health - commercial,Bright Health - commercial,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,73060,CPT,,,52LT,Inpatient,,,261.81,261.81,Bright Health MGG,Bright Health MGG,261.81,,,,,,,case rate,261.81,261.81,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Aetna,Aetna,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Aetna MGG,Aetna MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,BCBS,BCBS,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,BCBS MGG,BCBS MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Cigna,Cigna,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Cigna MGG,Cigna MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Humana,Humana,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Humana MGG,Humana MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Optum VA,Optum VA,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,UHC,UHC,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,UHC MGG,UHC MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,VA,VA,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Wellcare MGG,Wellcare MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Bright Health - commercial,Bright Health - commercial,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,73070,CPT,,,52LT,Inpatient,,,344.84,344.84,Bright Health MGG,Bright Health MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Aetna,Aetna,328.48,,,,,,,per diem,328.48,328.48,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Aetna MGG,Aetna MGG,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,BCBS,BCBS,328.48,,,,,,,per diem,328.48,328.48,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,BCBS MGG,BCBS MGG,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Cigna,Cigna,328.48,,,,,,,per diem,328.48,328.48,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Cigna MGG,Cigna MGG,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Humana,Humana,328.48,,,,,,,per diem,328.48,328.48,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Humana MGG,Humana MGG,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Optum VA,Optum VA,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,UHC,UHC,328.48,,,,,,,per diem,328.48,328.48,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,UHC MGG,UHC MGG,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,VA,VA,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Wellcare MGG,Wellcare MGG,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Bright Health - commercial,Bright Health - commercial,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,73090,CPT,,,52LT,Inpatient,,,328.48,328.48,Bright Health MGG,Bright Health MGG,328.48,,,,,,,case rate,328.48,328.48,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Aetna,Aetna,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Aetna MGG,Aetna MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,BCBS,BCBS,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,BCBS MGG,BCBS MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Cigna,Cigna,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Cigna MGG,Cigna MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Humana,Humana,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Humana MGG,Humana MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Optum VA,Optum VA,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,UHC,UHC,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,UHC MGG,UHC MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,VA,VA,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Wellcare MGG,Wellcare MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Bright Health - commercial,Bright Health - commercial,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,73600,CPT,,,52LT,Inpatient,,,554.88,554.88,Bright Health MGG,Bright Health MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Aetna,Aetna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Aetna MGG,Aetna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,BCBS,BCBS,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,BCBS MGG,BCBS MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Cigna,Cigna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Cigna MGG,Cigna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Humana,Humana,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Humana MGG,Humana MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Optum VA,Optum VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,UHC,UHC,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,UHC MGG,UHC MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,VA,VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Wellcare MGG,Wellcare MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Bright Health - commercial,Bright Health - commercial,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,73100,CPT,,,52LT,Inpatient,,,343.74,343.74,Bright Health MGG,Bright Health MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Aetna,Aetna,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Aetna MGG,Aetna MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,BCBS,BCBS,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,BCBS MGG,BCBS MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Cigna,Cigna,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Cigna MGG,Cigna MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Humana,Humana,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Humana MGG,Humana MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Optum VA,Optum VA,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,UHC,UHC,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,UHC MGG,UHC MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,VA,VA,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Wellcare MGG,Wellcare MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Bright Health - commercial,Bright Health - commercial,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,73590,CPT,,,52LT,Inpatient,,,346.8,346.8,Bright Health MGG,Bright Health MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Aetna,Aetna,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Aetna MGG,Aetna MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,BCBS,BCBS,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,BCBS MGG,BCBS MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Cigna,Cigna,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Cigna MGG,Cigna MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Humana,Humana,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Humana MGG,Humana MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Optum VA,Optum VA,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,UHC,UHC,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,UHC MGG,UHC MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,VA,VA,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Wellcare MGG,Wellcare MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Bright Health - commercial,Bright Health - commercial,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,73060,CPT,,,52RT,Inpatient,,,342.72,342.72,Bright Health MGG,Bright Health MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Aetna,Aetna,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Aetna MGG,Aetna MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,BCBS,BCBS,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,BCBS MGG,BCBS MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Cigna,Cigna,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Cigna MGG,Cigna MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Humana,Humana,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Humana MGG,Humana MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Optum VA,Optum VA,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,UHC,UHC,344.84,,,,,,,per diem,344.84,344.84,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,UHC MGG,UHC MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,VA,VA,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Wellcare MGG,Wellcare MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Bright Health - commercial,Bright Health - commercial,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,73070,CPT,,,52RT,Inpatient,,,344.84,344.84,Bright Health MGG,Bright Health MGG,344.84,,,,,,,case rate,344.84,344.84,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Aetna,Aetna,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Aetna MGG,Aetna MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,BCBS,BCBS,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,BCBS MGG,BCBS MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Cigna,Cigna,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Cigna MGG,Cigna MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Humana,Humana,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Humana MGG,Humana MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Optum VA,Optum VA,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,UHC,UHC,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,UHC MGG,UHC MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,VA,VA,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Wellcare MGG,Wellcare MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Bright Health - commercial,Bright Health - commercial,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,73090,CPT,,,52RT,Inpatient,,,342.72,342.72,Bright Health MGG,Bright Health MGG,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Aetna,Aetna,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Aetna MGG,Aetna MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,BCBS,BCBS,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,BCBS MGG,BCBS MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Cigna,Cigna,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Cigna MGG,Cigna MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Humana,Humana,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Humana MGG,Humana MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Optum VA,Optum VA,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,UHC,UHC,554.88,,,,,,,per diem,554.88,554.88,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,UHC MGG,UHC MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,VA,VA,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Wellcare MGG,Wellcare MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Bright Health - commercial,Bright Health - commercial,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,73600,CPT,,,52RT,Inpatient,,,554.88,554.88,Bright Health MGG,Bright Health MGG,554.88,,,,,,,case rate,554.88,554.88,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Aetna,Aetna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Aetna MGG,Aetna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,BCBS,BCBS,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,BCBS MGG,BCBS MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Cigna,Cigna,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Cigna MGG,Cigna MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Humana,Humana,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Humana MGG,Humana MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Optum VA,Optum VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,UHC,UHC,343.74,,,,,,,per diem,343.74,343.74,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,UHC MGG,UHC MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,VA,VA,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Wellcare MGG,Wellcare MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Bright Health - commercial,Bright Health - commercial,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,73100,CPT,,,52RT,Inpatient,,,343.74,343.74,Bright Health MGG,Bright Health MGG,343.74,,,,,,,case rate,343.74,343.74,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Aetna,Aetna,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Aetna MGG,Aetna MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,BCBS,BCBS,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,BCBS MGG,BCBS MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Cigna,Cigna,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Cigna MGG,Cigna MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Humana,Humana,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Humana MGG,Humana MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Optum VA,Optum VA,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,UHC,UHC,346.8,,,,,,,per diem,346.8,346.8,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,UHC MGG,UHC MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,VA,VA,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Wellcare MGG,Wellcare MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Bright Health - commercial,Bright Health - commercial,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,73590,CPT,,,52RT,Inpatient,,,346.8,346.8,Bright Health MGG,Bright Health MGG,346.8,,,,,,,case rate,346.8,346.8,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Aetna,Aetna,457.98,,,,,,,per diem,457.98,457.98,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Aetna MGG,Aetna MGG,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,BCBS,BCBS,457.98,,,,,,,per diem,457.98,457.98,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,BCBS MGG,BCBS MGG,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Cigna,Cigna,457.98,,,,,,,per diem,457.98,457.98,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Cigna MGG,Cigna MGG,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Humana,Humana,457.98,,,,,,,per diem,457.98,457.98,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Humana MGG,Humana MGG,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Optum VA,Optum VA,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,UHC,UHC,457.98,,,,,,,per diem,457.98,457.98,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,UHC MGG,UHC MGG,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,VA,VA,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Wellcare MGG,Wellcare MGG,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Bright Health - commercial,Bright Health - commercial,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,73620,CPT,,,52LT,Inpatient,,,457.98,457.98,Bright Health MGG,Bright Health MGG,457.98,,,,,,,case rate,457.98,457.98,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Aetna,Aetna,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Aetna MGG,Aetna MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,BCBS,BCBS,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,BCBS MGG,BCBS MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Cigna,Cigna,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Cigna MGG,Cigna MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Humana,Humana,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Humana MGG,Humana MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Optum VA,Optum VA,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,UHC,UHC,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,UHC MGG,UHC MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,VA,VA,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Wellcare MGG,Wellcare MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Bright Health - commercial,Bright Health - commercial,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,73620,CPT,,,52RT,Inpatient,,,338.65,338.65,Bright Health MGG,Bright Health MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Aetna,Aetna,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Aetna MGG,Aetna MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,BCBS,BCBS,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,BCBS MGG,BCBS MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Cigna,Cigna,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Cigna MGG,Cigna MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Humana,Humana,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Humana MGG,Humana MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Optum VA,Optum VA,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,UHC,UHC,5378.46,,,,,,,per diem,5378.46,5378.46,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,UHC MGG,UHC MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,VA,VA,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Wellcare MGG,Wellcare MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Bright Health - commercial,Bright Health - commercial,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,75962,CPT,,,,Inpatient,,,5378.46,5378.46,Bright Health MGG,Bright Health MGG,5378.46,,,,,,,case rate,5378.46,5378.46,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Aetna,Aetna,693.97,,,,,,,per diem,693.97,693.97,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Aetna MGG,Aetna MGG,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,BCBS,BCBS,693.97,,,,,,,per diem,693.97,693.97,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,BCBS MGG,BCBS MGG,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Cigna,Cigna,693.97,,,,,,,per diem,693.97,693.97,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Cigna MGG,Cigna MGG,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Humana,Humana,693.97,,,,,,,per diem,693.97,693.97,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Humana MGG,Humana MGG,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Optum VA,Optum VA,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,UHC,UHC,693.97,,,,,,,per diem,693.97,693.97,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,UHC MGG,UHC MGG,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,VA,VA,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Wellcare MGG,Wellcare MGG,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Bright Health - commercial,Bright Health - commercial,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,72081,CPT,,,,Inpatient,,,693.97,693.97,Bright Health MGG,Bright Health MGG,693.97,,,,,,,case rate,693.97,693.97,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Aetna,Aetna,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Aetna MGG,Aetna MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,BCBS,BCBS,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,BCBS MGG,BCBS MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Cigna,Cigna,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Cigna MGG,Cigna MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Humana,Humana,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Humana MGG,Humana MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Optum VA,Optum VA,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,UHC,UHC,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,UHC MGG,UHC MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,VA,VA,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Wellcare MGG,Wellcare MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Bright Health - commercial,Bright Health - commercial,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,72082,CPT,,,,Inpatient,,,932.28,932.28,Bright Health MGG,Bright Health MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Aetna,Aetna,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Aetna MGG,Aetna MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,BCBS,BCBS,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,BCBS MGG,BCBS MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Cigna,Cigna,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Cigna MGG,Cigna MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Humana,Humana,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Humana MGG,Humana MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Optum VA,Optum VA,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,UHC,UHC,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,UHC MGG,UHC MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,VA,VA,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Wellcare MGG,Wellcare MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Bright Health - commercial,Bright Health - commercial,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,72083,CPT,,,,Inpatient,,,932.28,932.28,Bright Health MGG,Bright Health MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Aetna,Aetna,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Aetna MGG,Aetna MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,BCBS,BCBS,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,BCBS MGG,BCBS MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Cigna,Cigna,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Cigna MGG,Cigna MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Humana,Humana,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Humana MGG,Humana MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Optum VA,Optum VA,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,UHC,UHC,932.28,,,,,,,per diem,932.28,932.28,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,UHC MGG,UHC MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,VA,VA,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Wellcare MGG,Wellcare MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Bright Health - commercial,Bright Health - commercial,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,72084,CPT,,,,Inpatient,,,932.28,932.28,Bright Health MGG,Bright Health MGG,932.28,,,,,,,case rate,932.28,932.28,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,73501,CPT,,,LT,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,73501,CPT,,,RT,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,73503,CPT,,,LT,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Aetna,Aetna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Aetna MGG,Aetna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,BCBS,BCBS,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,BCBS MGG,BCBS MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Cigna,Cigna,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Cigna MGG,Cigna MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Humana,Humana,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Humana MGG,Humana MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Optum VA,Optum VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,UHC,UHC,752.76,,,,,,,per diem,752.76,752.76,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,UHC MGG,UHC MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,VA,VA,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Wellcare MGG,Wellcare MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Bright Health - commercial,Bright Health - commercial,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,73503,CPT,,,RT,Inpatient,,,752.76,752.76,Bright Health MGG,Bright Health MGG,752.76,,,,,,,case rate,752.76,752.76,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Aetna,Aetna,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Aetna MGG,Aetna MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,BCBS,BCBS,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,BCBS MGG,BCBS MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Cigna,Cigna,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Cigna MGG,Cigna MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Humana,Humana,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Humana MGG,Humana MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Optum VA,Optum VA,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,UHC,UHC,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,UHC MGG,UHC MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,VA,VA,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Wellcare MGG,Wellcare MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Bright Health - commercial,Bright Health - commercial,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,73521,CPT,,,,Inpatient,,,532.44,532.44,Bright Health MGG,Bright Health MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Aetna,Aetna,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Aetna MGG,Aetna MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,BCBS,BCBS,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,BCBS MGG,BCBS MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Cigna,Cigna,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Cigna MGG,Cigna MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Humana,Humana,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Humana MGG,Humana MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Optum VA,Optum VA,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,UHC,UHC,532.44,,,,,,,per diem,532.44,532.44,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,UHC MGG,UHC MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,VA,VA,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Wellcare MGG,Wellcare MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Bright Health - commercial,Bright Health - commercial,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,73522,CPT,,,,Inpatient,,,532.44,532.44,Bright Health MGG,Bright Health MGG,532.44,,,,,,,case rate,532.44,532.44,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Aetna,Aetna,614.73,,,,,,,per diem,614.73,614.73,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Aetna MGG,Aetna MGG,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,BCBS,BCBS,614.73,,,,,,,per diem,614.73,614.73,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,BCBS MGG,BCBS MGG,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Cigna,Cigna,614.73,,,,,,,per diem,614.73,614.73,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Cigna MGG,Cigna MGG,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Humana,Humana,614.73,,,,,,,per diem,614.73,614.73,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Humana MGG,Humana MGG,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Optum VA,Optum VA,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,UHC,UHC,614.73,,,,,,,per diem,614.73,614.73,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,UHC MGG,UHC MGG,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,VA,VA,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Wellcare MGG,Wellcare MGG,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Bright Health - commercial,Bright Health - commercial,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,73523,CPT,,,,Inpatient,,,614.73,614.73,Bright Health MGG,Bright Health MGG,614.73,,,,,,,case rate,614.73,614.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Aetna,Aetna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Aetna MGG,Aetna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,BCBS,BCBS,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,BCBS MGG,BCBS MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Cigna,Cigna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Cigna MGG,Cigna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Humana,Humana,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Humana MGG,Humana MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Optum VA,Optum VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,UHC,UHC,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,UHC MGG,UHC MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,VA,VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Wellcare MGG,Wellcare MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Bright Health - commercial,Bright Health - commercial,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,73551,CPT,,,LT,Inpatient,,,470.22,470.22,Bright Health MGG,Bright Health MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Aetna,Aetna,413.48,,,,,,,per diem,413.48,413.48,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Aetna MGG,Aetna MGG,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,BCBS,BCBS,413.48,,,,,,,per diem,413.48,413.48,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,BCBS MGG,BCBS MGG,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Cigna,Cigna,413.48,,,,,,,per diem,413.48,413.48,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Cigna MGG,Cigna MGG,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Humana,Humana,413.48,,,,,,,per diem,413.48,413.48,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Humana MGG,Humana MGG,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Optum VA,Optum VA,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,UHC,UHC,413.48,,,,,,,per diem,413.48,413.48,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,UHC MGG,UHC MGG,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,VA,VA,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Wellcare MGG,Wellcare MGG,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Bright Health - commercial,Bright Health - commercial,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,73551,CPT,,,RT,Inpatient,,,413.48,413.48,Bright Health MGG,Bright Health MGG,413.48,,,,,,,case rate,413.48,413.48,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Aetna,Aetna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Aetna MGG,Aetna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,BCBS,BCBS,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,BCBS MGG,BCBS MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Cigna,Cigna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Cigna MGG,Cigna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Humana,Humana,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Humana MGG,Humana MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Optum VA,Optum VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,UHC,UHC,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,UHC MGG,UHC MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,VA,VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Wellcare MGG,Wellcare MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Bright Health - commercial,Bright Health - commercial,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,73552,CPT,,,LT,Inpatient,,,470.22,470.22,Bright Health MGG,Bright Health MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Aetna,Aetna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Aetna MGG,Aetna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,BCBS,BCBS,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,BCBS MGG,BCBS MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Cigna,Cigna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Cigna MGG,Cigna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Humana,Humana,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Humana MGG,Humana MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Optum VA,Optum VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,UHC,UHC,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,UHC MGG,UHC MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,VA,VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Wellcare MGG,Wellcare MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Bright Health - commercial,Bright Health - commercial,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,73552,CPT,,,RT,Inpatient,,,470.22,470.22,Bright Health MGG,Bright Health MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Aetna,Aetna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Aetna MGG,Aetna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,BCBS,BCBS,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,BCBS MGG,BCBS MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Cigna,Cigna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Cigna MGG,Cigna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Humana,Humana,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Humana MGG,Humana MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Optum VA,Optum VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,UHC,UHC,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,UHC MGG,UHC MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,VA,VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Wellcare MGG,Wellcare MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Bright Health - commercial,Bright Health - commercial,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,73552,CPT,,,50,Inpatient,,,470.22,470.22,Bright Health MGG,Bright Health MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Aetna,Aetna,2469.42,,,,,,,per diem,2469.42,2469.42,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Aetna MGG,Aetna MGG,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,BCBS,BCBS,2469.42,,,,,,,per diem,2469.42,2469.42,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,BCBS MGG,BCBS MGG,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Cigna,Cigna,2469.42,,,,,,,per diem,2469.42,2469.42,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Cigna MGG,Cigna MGG,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Humana,Humana,2469.42,,,,,,,per diem,2469.42,2469.42,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Humana MGG,Humana MGG,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Optum VA,Optum VA,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,UHC,UHC,2469.42,,,,,,,per diem,2469.42,2469.42,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,UHC MGG,UHC MGG,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,VA,VA,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Wellcare MGG,Wellcare MGG,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Bright Health - commercial,Bright Health - commercial,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,75774,CPT,,,,Inpatient,,,2469.42,2469.42,Bright Health MGG,Bright Health MGG,2469.42,,,,,,,case rate,2469.42,2469.42,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Aetna,Aetna,2790.72,,,,,,,per diem,2790.72,2790.72,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Aetna MGG,Aetna MGG,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,BCBS,BCBS,2790.72,,,,,,,per diem,2790.72,2790.72,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,BCBS MGG,BCBS MGG,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Cigna,Cigna,2790.72,,,,,,,per diem,2790.72,2790.72,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Cigna MGG,Cigna MGG,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Humana,Humana,2790.72,,,,,,,per diem,2790.72,2790.72,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Humana MGG,Humana MGG,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Optum VA,Optum VA,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,UHC,UHC,2790.72,,,,,,,per diem,2790.72,2790.72,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,UHC MGG,UHC MGG,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,VA,VA,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Wellcare MGG,Wellcare MGG,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Bright Health - commercial,Bright Health - commercial,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,75966,CPT,,,,Inpatient,,,2790.72,2790.72,Bright Health MGG,Bright Health MGG,2790.72,,,,,,,case rate,2790.72,2790.72,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Aetna,Aetna,841.5,,,,,,,per diem,841.5,841.5,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Aetna MGG,Aetna MGG,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,BCBS,BCBS,841.5,,,,,,,per diem,841.5,841.5,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,BCBS MGG,BCBS MGG,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Cigna,Cigna,841.5,,,,,,,per diem,841.5,841.5,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Cigna MGG,Cigna MGG,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Humana,Humana,841.5,,,,,,,per diem,841.5,841.5,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Humana MGG,Humana MGG,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Optum VA,Optum VA,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,UHC,UHC,841.5,,,,,,,per diem,841.5,841.5,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,UHC MGG,UHC MGG,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,VA,VA,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Wellcare MGG,Wellcare MGG,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Bright Health - commercial,Bright Health - commercial,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,73092,CPT,,,50,Inpatient,,,841.5,841.5,Bright Health MGG,Bright Health MGG,841.5,,,,,,,case rate,841.5,841.5,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Aetna,Aetna,45988.74,,,,,,,per diem,45988.74,45988.74,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Aetna MGG,Aetna MGG,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,BCBS,BCBS,45988.74,,,,,,,per diem,45988.74,45988.74,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,BCBS MGG,BCBS MGG,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Cigna,Cigna,45988.74,,,,,,,per diem,45988.74,45988.74,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Cigna MGG,Cigna MGG,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Humana,Humana,45988.74,,,,,,,per diem,45988.74,45988.74,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Humana MGG,Humana MGG,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Optum VA,Optum VA,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,UHC,UHC,45988.74,,,,,,,per diem,45988.74,45988.74,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,UHC MGG,UHC MGG,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,VA,VA,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Wellcare MGG,Wellcare MGG,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Bright Health - commercial,Bright Health - commercial,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,37182,CPT,,,,Inpatient,,,45988.74,45988.74,Bright Health MGG,Bright Health MGG,45988.74,,,,,,,case rate,45988.74,45988.74,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Aetna,Aetna,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Aetna MGG,Aetna MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,BCBS,BCBS,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,BCBS MGG,BCBS MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Cigna,Cigna,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Cigna MGG,Cigna MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Humana,Humana,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Humana MGG,Humana MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Optum VA,Optum VA,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,UHC,UHC,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,UHC MGG,UHC MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,VA,VA,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Wellcare MGG,Wellcare MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Bright Health - commercial,Bright Health - commercial,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,61624,CPT,,,,Inpatient,,,325.38,325.38,Bright Health MGG,Bright Health MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Aetna,Aetna,3455.76,,,,,,,per diem,3455.76,3455.76,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Aetna MGG,Aetna MGG,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,BCBS,BCBS,3455.76,,,,,,,per diem,3455.76,3455.76,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,BCBS MGG,BCBS MGG,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Cigna,Cigna,3455.76,,,,,,,per diem,3455.76,3455.76,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Cigna MGG,Cigna MGG,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Humana,Humana,3455.76,,,,,,,per diem,3455.76,3455.76,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Humana MGG,Humana MGG,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Optum VA,Optum VA,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,UHC,UHC,3455.76,,,,,,,per diem,3455.76,3455.76,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,UHC MGG,UHC MGG,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,VA,VA,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Wellcare MGG,Wellcare MGG,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Bright Health - commercial,Bright Health - commercial,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,38792,CPT,,,,Inpatient,,,3455.76,3455.76,Bright Health MGG,Bright Health MGG,3455.76,,,,,,,case rate,3455.76,3455.76,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Aetna,Aetna,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Aetna MGG,Aetna MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,BCBS,BCBS,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,BCBS MGG,BCBS MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Cigna,Cigna,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Cigna MGG,Cigna MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Humana,Humana,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Humana MGG,Humana MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Optum VA,Optum VA,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,UHC,UHC,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,UHC MGG,UHC MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,VA,VA,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Wellcare MGG,Wellcare MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Bright Health - commercial,Bright Health - commercial,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,34841,CPT,,,,Inpatient,,,15582.54,15582.54,Bright Health MGG,Bright Health MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Aetna,Aetna,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Aetna MGG,Aetna MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,BCBS,BCBS,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,BCBS MGG,BCBS MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Cigna,Cigna,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Cigna MGG,Cigna MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Humana,Humana,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Humana MGG,Humana MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Optum VA,Optum VA,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,UHC,UHC,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,UHC MGG,UHC MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,VA,VA,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Wellcare MGG,Wellcare MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Bright Health - commercial,Bright Health - commercial,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,34842,CPT,,,,Inpatient,,,15582.54,15582.54,Bright Health MGG,Bright Health MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Aetna,Aetna,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Aetna MGG,Aetna MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,BCBS,BCBS,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,BCBS MGG,BCBS MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Cigna,Cigna,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Cigna MGG,Cigna MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Humana,Humana,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Humana MGG,Humana MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Optum VA,Optum VA,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,UHC,UHC,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,UHC MGG,UHC MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,VA,VA,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Wellcare MGG,Wellcare MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Bright Health - commercial,Bright Health - commercial,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,34843,CPT,,,,Inpatient,,,15582.54,15582.54,Bright Health MGG,Bright Health MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Aetna,Aetna,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Aetna MGG,Aetna MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,BCBS,BCBS,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,BCBS MGG,BCBS MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Cigna,Cigna,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Cigna MGG,Cigna MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Humana,Humana,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Humana MGG,Humana MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Optum VA,Optum VA,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,UHC,UHC,15582.54,,,,,,,per diem,15582.54,15582.54,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,UHC MGG,UHC MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,VA,VA,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Wellcare MGG,Wellcare MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Bright Health - commercial,Bright Health - commercial,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,34844,CPT,,,,Inpatient,,,15582.54,15582.54,Bright Health MGG,Bright Health MGG,15582.54,,,,,,,case rate,15582.54,15582.54,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Aetna,Aetna,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Aetna MGG,Aetna MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,BCBS,BCBS,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,BCBS MGG,BCBS MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Cigna,Cigna,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Cigna MGG,Cigna MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Humana,Humana,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Humana MGG,Humana MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Optum VA,Optum VA,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,UHC,UHC,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,UHC MGG,UHC MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,VA,VA,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Wellcare MGG,Wellcare MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Bright Health - commercial,Bright Health - commercial,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,34845,CPT,,,,Inpatient,,,2653.02,2653.02,Bright Health MGG,Bright Health MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Aetna,Aetna,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Aetna MGG,Aetna MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,BCBS,BCBS,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,BCBS MGG,BCBS MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Cigna,Cigna,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Cigna MGG,Cigna MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Humana,Humana,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Humana MGG,Humana MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Optum VA,Optum VA,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,UHC,UHC,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,UHC MGG,UHC MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,VA,VA,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Wellcare MGG,Wellcare MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Bright Health - commercial,Bright Health - commercial,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,34846,CPT,,,,Inpatient,,,2653.02,2653.02,Bright Health MGG,Bright Health MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Aetna,Aetna,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Aetna MGG,Aetna MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,BCBS,BCBS,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,BCBS MGG,BCBS MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Cigna,Cigna,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Cigna MGG,Cigna MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Humana,Humana,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Humana MGG,Humana MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Optum VA,Optum VA,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,UHC,UHC,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,UHC MGG,UHC MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,VA,VA,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Wellcare MGG,Wellcare MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Bright Health - commercial,Bright Health - commercial,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,34847,CPT,,,,Inpatient,,,2653.02,2653.02,Bright Health MGG,Bright Health MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Aetna,Aetna,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Aetna MGG,Aetna MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,BCBS,BCBS,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,BCBS MGG,BCBS MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Cigna,Cigna,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Cigna MGG,Cigna MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Humana,Humana,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Humana MGG,Humana MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Optum VA,Optum VA,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,UHC,UHC,2653.02,,,,,,,per diem,2653.02,2653.02,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,UHC MGG,UHC MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,VA,VA,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Wellcare MGG,Wellcare MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Bright Health - commercial,Bright Health - commercial,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,34848,CPT,,,,Inpatient,,,2653.02,2653.02,Bright Health MGG,Bright Health MGG,2653.02,,,,,,,case rate,2653.02,2653.02,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Aetna,Aetna,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Aetna MGG,Aetna MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,BCBS,BCBS,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,BCBS MGG,BCBS MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Cigna,Cigna,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Cigna MGG,Cigna MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Humana,Humana,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Humana MGG,Humana MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Optum VA,Optum VA,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,UHC,UHC,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,UHC MGG,UHC MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,VA,VA,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Wellcare MGG,Wellcare MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Bright Health - commercial,Bright Health - commercial,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,49424,CPT,,,,Inpatient,,,2479.62,2479.62,Bright Health MGG,Bright Health MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Aetna,Aetna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Aetna MGG,Aetna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,BCBS,BCBS,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,BCBS MGG,BCBS MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Cigna,Cigna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Cigna MGG,Cigna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Humana,Humana,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Humana MGG,Humana MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Optum VA,Optum VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,UHC,UHC,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,UHC MGG,UHC MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,VA,VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Wellcare MGG,Wellcare MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Bright Health - commercial,Bright Health - commercial,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,51080,CPT,,,,Inpatient,,,961.86,961.86,Bright Health MGG,Bright Health MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Aetna,Aetna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Aetna MGG,Aetna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,BCBS,BCBS,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,BCBS MGG,BCBS MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Cigna,Cigna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Cigna MGG,Cigna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Humana,Humana,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Humana MGG,Humana MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Optum VA,Optum VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,UHC,UHC,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,UHC MGG,UHC MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,VA,VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Wellcare MGG,Wellcare MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Bright Health - commercial,Bright Health - commercial,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,61710,CPT,,,,Inpatient,,,797.64,797.64,Bright Health MGG,Bright Health MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Aetna,Aetna,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Aetna MGG,Aetna MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,BCBS,BCBS,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,BCBS MGG,BCBS MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Cigna,Cigna,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Cigna MGG,Cigna MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Humana,Humana,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Humana MGG,Humana MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Optum VA,Optum VA,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,UHC,UHC,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,UHC MGG,UHC MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,VA,VA,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Wellcare MGG,Wellcare MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Bright Health - commercial,Bright Health - commercial,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,37186,CPT,,,,Inpatient,,,5280.54,5280.54,Bright Health MGG,Bright Health MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Aetna,Aetna,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Aetna MGG,Aetna MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,BCBS,BCBS,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,BCBS MGG,BCBS MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Cigna,Cigna,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Cigna MGG,Cigna MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Humana,Humana,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Humana MGG,Humana MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Optum VA,Optum VA,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,UHC,UHC,5280.54,,,,,,,per diem,5280.54,5280.54,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,UHC MGG,UHC MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,VA,VA,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Wellcare MGG,Wellcare MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Bright Health - commercial,Bright Health - commercial,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,37185,CPT,,,,Inpatient,,,5280.54,5280.54,Bright Health MGG,Bright Health MGG,5280.54,,,,,,,case rate,5280.54,5280.54,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Aetna,Aetna,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Aetna MGG,Aetna MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,BCBS,BCBS,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,BCBS MGG,BCBS MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Cigna,Cigna,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Cigna MGG,Cigna MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Humana,Humana,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Humana MGG,Humana MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Optum VA,Optum VA,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,UHC,UHC,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,UHC MGG,UHC MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,VA,VA,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Wellcare MGG,Wellcare MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Bright Health - commercial,Bright Health - commercial,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,37184,CPT,,,,Inpatient,,,12880.56,12880.56,Bright Health MGG,Bright Health MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Aetna,Aetna,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Aetna MGG,Aetna MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,BCBS,BCBS,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,BCBS MGG,BCBS MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Cigna,Cigna,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Cigna MGG,Cigna MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Humana,Humana,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Humana MGG,Humana MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Optum VA,Optum VA,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,UHC,UHC,338.65,,,,,,,per diem,338.65,338.65,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,UHC MGG,UHC MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,VA,VA,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Wellcare MGG,Wellcare MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Bright Health - commercial,Bright Health - commercial,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,36620,CPT,,,,Inpatient,,,338.65,338.65,Bright Health MGG,Bright Health MGG,338.65,,,,,,,case rate,338.65,338.65,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Aetna,Aetna,1261.74,,,,,,,per diem,1261.74,1261.74,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Aetna MGG,Aetna MGG,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,BCBS,BCBS,1261.74,,,,,,,per diem,1261.74,1261.74,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,BCBS MGG,BCBS MGG,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Cigna,Cigna,1261.74,,,,,,,per diem,1261.74,1261.74,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Cigna MGG,Cigna MGG,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Humana,Humana,1261.74,,,,,,,per diem,1261.74,1261.74,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Humana MGG,Humana MGG,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Optum VA,Optum VA,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,UHC,UHC,1261.74,,,,,,,per diem,1261.74,1261.74,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,UHC MGG,UHC MGG,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,VA,VA,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Wellcare MGG,Wellcare MGG,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Bright Health - commercial,Bright Health - commercial,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,20605,CPT,,,,Inpatient,,,1261.74,1261.74,Bright Health MGG,Bright Health MGG,1261.74,,,,,,,case rate,1261.74,1261.74,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Aetna,Aetna,1502.46,,,,,,,per diem,1502.46,1502.46,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Aetna MGG,Aetna MGG,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,BCBS,BCBS,1502.46,,,,,,,per diem,1502.46,1502.46,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,BCBS MGG,BCBS MGG,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Cigna,Cigna,1502.46,,,,,,,per diem,1502.46,1502.46,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Cigna MGG,Cigna MGG,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Humana,Humana,1502.46,,,,,,,per diem,1502.46,1502.46,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Humana MGG,Humana MGG,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Optum VA,Optum VA,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,UHC,UHC,1502.46,,,,,,,per diem,1502.46,1502.46,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,UHC MGG,UHC MGG,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,VA,VA,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Wellcare MGG,Wellcare MGG,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Bright Health - commercial,Bright Health - commercial,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,20610,CPT,,,,Inpatient,,,1502.46,1502.46,Bright Health MGG,Bright Health MGG,1502.46,,,,,,,case rate,1502.46,1502.46,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Aetna,Aetna,270.3,,,,,,,per diem,270.3,270.3,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Aetna MGG,Aetna MGG,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,BCBS,BCBS,270.3,,,,,,,per diem,270.3,270.3,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,BCBS MGG,BCBS MGG,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Cigna,Cigna,270.3,,,,,,,per diem,270.3,270.3,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Cigna MGG,Cigna MGG,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Humana,Humana,270.3,,,,,,,per diem,270.3,270.3,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Humana MGG,Humana MGG,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Optum VA,Optum VA,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,UHC,UHC,270.3,,,,,,,per diem,270.3,270.3,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,UHC MGG,UHC MGG,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,VA,VA,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Wellcare MGG,Wellcare MGG,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Bright Health - commercial,Bright Health - commercial,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,20600,CPT,,,,Inpatient,,,270.3,270.3,Bright Health MGG,Bright Health MGG,270.3,,,,,,,case rate,270.3,270.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Aetna,Aetna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Aetna MGG,Aetna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,BCBS,BCBS,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,BCBS MGG,BCBS MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Cigna,Cigna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Cigna MGG,Cigna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Humana,Humana,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Humana MGG,Humana MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Optum VA,Optum VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,UHC,UHC,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,UHC MGG,UHC MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,VA,VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Wellcare MGG,Wellcare MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Bright Health - commercial,Bright Health - commercial,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,24220,CPT,,,,Inpatient,,,233.58,233.58,Bright Health MGG,Bright Health MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Aetna,Aetna,349.86,,,,,,,per diem,349.86,349.86,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Aetna MGG,Aetna MGG,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,BCBS,BCBS,349.86,,,,,,,per diem,349.86,349.86,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,BCBS MGG,BCBS MGG,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Cigna,Cigna,349.86,,,,,,,per diem,349.86,349.86,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Cigna MGG,Cigna MGG,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Humana,Humana,349.86,,,,,,,per diem,349.86,349.86,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Humana MGG,Humana MGG,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Optum VA,Optum VA,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,UHC,UHC,349.86,,,,,,,per diem,349.86,349.86,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,UHC MGG,UHC MGG,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,VA,VA,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Wellcare MGG,Wellcare MGG,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Bright Health - commercial,Bright Health - commercial,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,27370,CPT,,,,Inpatient,,,349.86,349.86,Bright Health MGG,Bright Health MGG,349.86,,,,,,,case rate,349.86,349.86,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Aetna,Aetna,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Aetna MGG,Aetna MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,BCBS,BCBS,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,BCBS MGG,BCBS MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Cigna,Cigna,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Cigna MGG,Cigna MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Humana,Humana,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Humana MGG,Humana MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Optum VA,Optum VA,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,UHC,UHC,210.12,,,,,,,per diem,210.12,210.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,UHC MGG,UHC MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,VA,VA,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Wellcare MGG,Wellcare MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Bright Health - commercial,Bright Health - commercial,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,23350,CPT,,,,Inpatient,,,210.12,210.12,Bright Health MGG,Bright Health MGG,210.12,,,,,,,case rate,210.12,210.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Aetna,Aetna,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Aetna MGG,Aetna MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,BCBS,BCBS,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,BCBS MGG,BCBS MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Cigna,Cigna,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Cigna MGG,Cigna MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Humana,Humana,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Humana MGG,Humana MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Optum VA,Optum VA,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,UHC,UHC,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,UHC MGG,UHC MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,VA,VA,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Wellcare MGG,Wellcare MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Bright Health - commercial,Bright Health - commercial,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,25246,CPT,,,,Inpatient,,,303.96,303.96,Bright Health MGG,Bright Health MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Aetna,Aetna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Aetna MGG,Aetna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,BCBS,BCBS,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,BCBS MGG,BCBS MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Cigna,Cigna,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Cigna MGG,Cigna MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Humana,Humana,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Humana MGG,Humana MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Optum VA,Optum VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,UHC,UHC,233.58,,,,,,,per diem,233.58,233.58,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,UHC MGG,UHC MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,VA,VA,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Wellcare MGG,Wellcare MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Bright Health - commercial,Bright Health - commercial,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,27093,CPT,,,,Inpatient,,,233.58,233.58,Bright Health MGG,Bright Health MGG,233.58,,,,,,,case rate,233.58,233.58,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Aetna,Aetna,511.02,,,,,,,per diem,511.02,511.02,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Aetna MGG,Aetna MGG,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,BCBS,BCBS,511.02,,,,,,,per diem,511.02,511.02,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,BCBS MGG,BCBS MGG,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Cigna,Cigna,511.02,,,,,,,per diem,511.02,511.02,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Cigna MGG,Cigna MGG,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Humana,Humana,511.02,,,,,,,per diem,511.02,511.02,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Humana MGG,Humana MGG,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Optum VA,Optum VA,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,UHC,UHC,511.02,,,,,,,per diem,511.02,511.02,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,UHC MGG,UHC MGG,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,VA,VA,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Wellcare MGG,Wellcare MGG,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Bright Health - commercial,Bright Health - commercial,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,10160,CPT,,,,Inpatient,,,511.02,511.02,Bright Health MGG,Bright Health MGG,511.02,,,,,,,case rate,511.02,511.02,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Aetna,Aetna,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Aetna MGG,Aetna MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,BCBS,BCBS,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,BCBS MGG,BCBS MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Cigna,Cigna,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Cigna MGG,Cigna MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Humana,Humana,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Humana MGG,Humana MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Optum VA,Optum VA,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,UHC,UHC,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,UHC MGG,UHC MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,VA,VA,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Wellcare MGG,Wellcare MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Bright Health - commercial,Bright Health - commercial,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Bright Health MGG,Bright Health MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Aetna,Aetna,604.86,,,,,,,per diem,604.86,604.86,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Aetna MGG,Aetna MGG,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,BCBS,BCBS,604.86,,,,,,,per diem,604.86,604.86,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,BCBS MGG,BCBS MGG,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Cigna,Cigna,604.86,,,,,,,per diem,604.86,604.86,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Cigna MGG,Cigna MGG,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Humana,Humana,604.86,,,,,,,per diem,604.86,604.86,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Humana MGG,Humana MGG,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Optum VA,Optum VA,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,UHC,UHC,604.86,,,,,,,per diem,604.86,604.86,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,UHC MGG,UHC MGG,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,VA,VA,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Wellcare MGG,Wellcare MGG,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Bright Health - commercial,Bright Health - commercial,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,10021,CPT,,,,Inpatient,,,604.86,604.86,Bright Health MGG,Bright Health MGG,604.86,,,,,,,case rate,604.86,604.86,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Aetna,Aetna,8960.7,,,,,,,per diem,8960.7,8960.7,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Aetna MGG,Aetna MGG,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,BCBS,BCBS,8960.7,,,,,,,per diem,8960.7,8960.7,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,BCBS MGG,BCBS MGG,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Cigna,Cigna,8960.7,,,,,,,per diem,8960.7,8960.7,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Cigna MGG,Cigna MGG,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Humana,Humana,8960.7,,,,,,,per diem,8960.7,8960.7,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Humana MGG,Humana MGG,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Optum VA,Optum VA,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,UHC,UHC,8960.7,,,,,,,per diem,8960.7,8960.7,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,UHC MGG,UHC MGG,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,VA,VA,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Wellcare MGG,Wellcare MGG,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Bright Health - commercial,Bright Health - commercial,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,37607,CPT,,,,Inpatient,,,8960.7,8960.7,Bright Health MGG,Bright Health MGG,8960.7,,,,,,,case rate,8960.7,8960.7,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Aetna,Aetna,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Aetna MGG,Aetna MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,BCBS,BCBS,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,BCBS MGG,BCBS MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Cigna,Cigna,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Cigna MGG,Cigna MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Humana,Humana,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Humana MGG,Humana MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Optum VA,Optum VA,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,UHC,UHC,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,UHC MGG,UHC MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,VA,VA,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Wellcare MGG,Wellcare MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Bright Health - commercial,Bright Health - commercial,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,47553,CPT,,,,Inpatient,,,7299.12,7299.12,Bright Health MGG,Bright Health MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Aetna,Aetna,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Aetna MGG,Aetna MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,BCBS,BCBS,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,BCBS MGG,BCBS MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Cigna,Cigna,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Cigna MGG,Cigna MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Humana,Humana,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Humana MGG,Humana MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Optum VA,Optum VA,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,UHC,UHC,7299.12,,,,,,,per diem,7299.12,7299.12,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,UHC MGG,UHC MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,VA,VA,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Wellcare MGG,Wellcare MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Bright Health - commercial,Bright Health - commercial,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,47552,CPT,,,,Inpatient,,,7299.12,7299.12,Bright Health MGG,Bright Health MGG,7299.12,,,,,,,case rate,7299.12,7299.12,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Aetna,Aetna,3493.5,,,,,,,per diem,3493.5,3493.5,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Aetna MGG,Aetna MGG,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,BCBS,BCBS,3493.5,,,,,,,per diem,3493.5,3493.5,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,BCBS MGG,BCBS MGG,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Cigna,Cigna,3493.5,,,,,,,per diem,3493.5,3493.5,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Cigna MGG,Cigna MGG,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Humana,Humana,3493.5,,,,,,,per diem,3493.5,3493.5,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Humana MGG,Humana MGG,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Optum VA,Optum VA,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,UHC,UHC,3493.5,,,,,,,per diem,3493.5,3493.5,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,UHC MGG,UHC MGG,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,VA,VA,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Wellcare MGG,Wellcare MGG,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Bright Health - commercial,Bright Health - commercial,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,32405,CPT,,,,Inpatient,,,3493.5,3493.5,Bright Health MGG,Bright Health MGG,3493.5,,,,,,,case rate,3493.5,3493.5,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Aetna,Aetna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Aetna MGG,Aetna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,BCBS,BCBS,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,BCBS MGG,BCBS MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Cigna,Cigna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Cigna MGG,Cigna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Humana,Humana,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Humana MGG,Humana MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Optum VA,Optum VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,UHC,UHC,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,UHC MGG,UHC MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,VA,VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Wellcare MGG,Wellcare MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Bright Health - commercial,Bright Health - commercial,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Bright Health MGG,Bright Health MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Aetna,Aetna,6694.26,,,,,,,per diem,6694.26,6694.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Aetna MGG,Aetna MGG,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,BCBS,BCBS,6694.26,,,,,,,per diem,6694.26,6694.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,BCBS MGG,BCBS MGG,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Cigna,Cigna,6694.26,,,,,,,per diem,6694.26,6694.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Cigna MGG,Cigna MGG,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Humana,Humana,6694.26,,,,,,,per diem,6694.26,6694.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Humana MGG,Humana MGG,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Optum VA,Optum VA,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,UHC,UHC,6694.26,,,,,,,per diem,6694.26,6694.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,UHC MGG,UHC MGG,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,VA,VA,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Wellcare MGG,Wellcare MGG,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Bright Health - commercial,Bright Health - commercial,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,51102,CPT,,,,Inpatient,,,6694.26,6694.26,Bright Health MGG,Bright Health MGG,6694.26,,,,,,,case rate,6694.26,6694.26,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Aetna,Aetna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Aetna MGG,Aetna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,BCBS,BCBS,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,BCBS MGG,BCBS MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Cigna,Cigna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Cigna MGG,Cigna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Humana,Humana,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Humana MGG,Humana MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Optum VA,Optum VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,UHC,UHC,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,UHC MGG,UHC MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,VA,VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Wellcare MGG,Wellcare MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Bright Health - commercial,Bright Health - commercial,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,38220,CPT,,,,Inpatient,,,961.86,961.86,Bright Health MGG,Bright Health MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Aetna,Aetna,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Aetna MGG,Aetna MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,BCBS,BCBS,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,BCBS MGG,BCBS MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Cigna,Cigna,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Cigna MGG,Cigna MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Humana,Humana,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Humana MGG,Humana MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Optum VA,Optum VA,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,UHC,UHC,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,UHC MGG,UHC MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,VA,VA,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Wellcare MGG,Wellcare MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Bright Health - commercial,Bright Health - commercial,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,19001,CPT,,,,Inpatient,,,216.24,216.24,Bright Health MGG,Bright Health MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Aetna,Aetna,2491.79,,,,,,,per diem,2491.79,2491.79,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Aetna MGG,Aetna MGG,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,BCBS,BCBS,2491.79,,,,,,,per diem,2491.79,2491.79,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,BCBS MGG,BCBS MGG,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Cigna,Cigna,2491.79,,,,,,,per diem,2491.79,2491.79,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Cigna MGG,Cigna MGG,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Humana,Humana,2491.79,,,,,,,per diem,2491.79,2491.79,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Humana MGG,Humana MGG,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Optum VA,Optum VA,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,UHC,UHC,2491.79,,,,,,,per diem,2491.79,2491.79,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,UHC MGG,UHC MGG,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,VA,VA,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Wellcare MGG,Wellcare MGG,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Bright Health - commercial,Bright Health - commercial,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,49180,CPT,,,,Inpatient,,,2491.79,2491.79,Bright Health MGG,Bright Health MGG,2491.79,,,,,,,case rate,2491.79,2491.79,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Aetna,Aetna,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Aetna MGG,Aetna MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,BCBS,BCBS,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,BCBS MGG,BCBS MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Cigna,Cigna,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Cigna MGG,Cigna MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Humana,Humana,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Humana MGG,Humana MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Optum VA,Optum VA,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,UHC,UHC,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,UHC MGG,UHC MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,VA,VA,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Wellcare MGG,Wellcare MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Bright Health - commercial,Bright Health - commercial,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,20225,CPT,,,,Inpatient,,,2567.34,2567.34,Bright Health MGG,Bright Health MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Aetna,Aetna,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Aetna MGG,Aetna MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,BCBS,BCBS,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,BCBS MGG,BCBS MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Cigna,Cigna,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Cigna MGG,Cigna MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Humana,Humana,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Humana MGG,Humana MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Optum VA,Optum VA,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,UHC,UHC,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,UHC MGG,UHC MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,VA,VA,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Wellcare MGG,Wellcare MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Bright Health - commercial,Bright Health - commercial,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,47001,CPT,,,,Inpatient,,,1238.28,1238.28,Bright Health MGG,Bright Health MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Aetna,Aetna,4306.44,,,,,,,per diem,4306.44,4306.44,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Aetna MGG,Aetna MGG,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,BCBS,BCBS,4306.44,,,,,,,per diem,4306.44,4306.44,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,BCBS MGG,BCBS MGG,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Cigna,Cigna,4306.44,,,,,,,per diem,4306.44,4306.44,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Cigna MGG,Cigna MGG,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Humana,Humana,4306.44,,,,,,,per diem,4306.44,4306.44,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Humana MGG,Humana MGG,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Optum VA,Optum VA,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,UHC,UHC,4306.44,,,,,,,per diem,4306.44,4306.44,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,UHC MGG,UHC MGG,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,VA,VA,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Wellcare MGG,Wellcare MGG,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Bright Health - commercial,Bright Health - commercial,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,47000,CPT,,,,Inpatient,,,4306.44,4306.44,Bright Health MGG,Bright Health MGG,4306.44,,,,,,,case rate,4306.44,4306.44,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Aetna,Aetna,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Aetna MGG,Aetna MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,BCBS,BCBS,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,BCBS MGG,BCBS MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Cigna,Cigna,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Cigna MGG,Cigna MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Humana,Humana,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Humana MGG,Humana MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Optum VA,Optum VA,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,UHC,UHC,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,UHC MGG,UHC MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,VA,VA,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Wellcare MGG,Wellcare MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Bright Health - commercial,Bright Health - commercial,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,20206,CPT,,,,Inpatient,,,2307.24,2307.24,Bright Health MGG,Bright Health MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Aetna,Aetna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Aetna MGG,Aetna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,BCBS,BCBS,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,BCBS MGG,BCBS MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Cigna,Cigna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Cigna MGG,Cigna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Humana,Humana,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Humana MGG,Humana MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Optum VA,Optum VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,UHC,UHC,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,UHC MGG,UHC MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,VA,VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Wellcare MGG,Wellcare MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Bright Health - commercial,Bright Health - commercial,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Bright Health MGG,Bright Health MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Aetna,Aetna,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Aetna MGG,Aetna MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,BCBS,BCBS,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,BCBS MGG,BCBS MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Cigna,Cigna,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Cigna MGG,Cigna MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Humana,Humana,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Humana MGG,Humana MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Optum VA,Optum VA,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,UHC,UHC,1238.28,,,,,,,per diem,1238.28,1238.28,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,UHC MGG,UHC MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,VA,VA,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Wellcare MGG,Wellcare MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Bright Health - commercial,Bright Health - commercial,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,42400,CPT,,,,Inpatient,,,1238.28,1238.28,Bright Health MGG,Bright Health MGG,1238.28,,,,,,,case rate,1238.28,1238.28,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Aetna,Aetna,7986.6,,,,,,,per diem,7986.6,7986.6,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Aetna MGG,Aetna MGG,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,BCBS,BCBS,7986.6,,,,,,,per diem,7986.6,7986.6,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,BCBS MGG,BCBS MGG,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Cigna,Cigna,7986.6,,,,,,,per diem,7986.6,7986.6,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Cigna MGG,Cigna MGG,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Humana,Humana,7986.6,,,,,,,per diem,7986.6,7986.6,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Humana MGG,Humana MGG,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Optum VA,Optum VA,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,UHC,UHC,7986.6,,,,,,,per diem,7986.6,7986.6,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,UHC MGG,UHC MGG,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,VA,VA,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Wellcare MGG,Wellcare MGG,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Bright Health - commercial,Bright Health - commercial,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,24065,CPT,,,,Inpatient,,,7986.6,7986.6,Bright Health MGG,Bright Health MGG,7986.6,,,,,,,case rate,7986.6,7986.6,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Aetna,Aetna,1490.22,,,,,,,per diem,1490.22,1490.22,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Aetna MGG,Aetna MGG,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,BCBS,BCBS,1490.22,,,,,,,per diem,1490.22,1490.22,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,BCBS MGG,BCBS MGG,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Cigna,Cigna,1490.22,,,,,,,per diem,1490.22,1490.22,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Cigna MGG,Cigna MGG,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Humana,Humana,1490.22,,,,,,,per diem,1490.22,1490.22,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Humana MGG,Humana MGG,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Optum VA,Optum VA,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,UHC,UHC,1490.22,,,,,,,per diem,1490.22,1490.22,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,UHC MGG,UHC MGG,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,VA,VA,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Wellcare MGG,Wellcare MGG,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Bright Health - commercial,Bright Health - commercial,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,38505,CPT,,,,Inpatient,,,1490.22,1490.22,Bright Health MGG,Bright Health MGG,1490.22,,,,,,,case rate,1490.22,1490.22,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Aetna,Aetna,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Aetna MGG,Aetna MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,BCBS,BCBS,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,BCBS MGG,BCBS MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Cigna,Cigna,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Cigna MGG,Cigna MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Humana,Humana,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Humana MGG,Humana MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Optum VA,Optum VA,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,UHC,UHC,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,UHC MGG,UHC MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,VA,VA,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Wellcare MGG,Wellcare MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Bright Health - commercial,Bright Health - commercial,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Bright Health MGG,Bright Health MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Aetna,Aetna,3276.24,,,,,,,per diem,3276.24,3276.24,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Aetna MGG,Aetna MGG,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,BCBS,BCBS,3276.24,,,,,,,per diem,3276.24,3276.24,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,BCBS MGG,BCBS MGG,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Cigna,Cigna,3276.24,,,,,,,per diem,3276.24,3276.24,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Cigna MGG,Cigna MGG,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Humana,Humana,3276.24,,,,,,,per diem,3276.24,3276.24,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Humana MGG,Humana MGG,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Optum VA,Optum VA,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,UHC,UHC,3276.24,,,,,,,per diem,3276.24,3276.24,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,UHC MGG,UHC MGG,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,VA,VA,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Wellcare MGG,Wellcare MGG,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Bright Health - commercial,Bright Health - commercial,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,36015,CPT,,,,Inpatient,,,3276.24,3276.24,Bright Health MGG,Bright Health MGG,3276.24,,,,,,,case rate,3276.24,3276.24,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Aetna,Aetna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Aetna MGG,Aetna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,BCBS,BCBS,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,BCBS MGG,BCBS MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Cigna,Cigna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Cigna MGG,Cigna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Humana,Humana,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Humana MGG,Humana MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Optum VA,Optum VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,UHC,UHC,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,UHC MGG,UHC MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,VA,VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Wellcare MGG,Wellcare MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Bright Health - commercial,Bright Health - commercial,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,36013,CPT,,,,Inpatient,,,797.64,797.64,Bright Health MGG,Bright Health MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Aetna,Aetna,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Aetna MGG,Aetna MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,BCBS,BCBS,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,BCBS MGG,BCBS MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Cigna,Cigna,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Cigna MGG,Cigna MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Humana,Humana,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Humana MGG,Humana MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Optum VA,Optum VA,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,UHC,UHC,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,UHC MGG,UHC MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,VA,VA,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Wellcare MGG,Wellcare MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Bright Health - commercial,Bright Health - commercial,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,36011,CPT,,,,Inpatient,,,2772.36,2772.36,Bright Health MGG,Bright Health MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Aetna,Aetna,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Aetna MGG,Aetna MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,BCBS,BCBS,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,BCBS MGG,BCBS MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Cigna,Cigna,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Cigna MGG,Cigna MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Humana,Humana,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Humana MGG,Humana MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Optum VA,Optum VA,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,UHC,UHC,2772.36,,,,,,,per diem,2772.36,2772.36,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,UHC MGG,UHC MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,VA,VA,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Wellcare MGG,Wellcare MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Bright Health - commercial,Bright Health - commercial,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,36012,CPT,,,,Inpatient,,,2772.36,2772.36,Bright Health MGG,Bright Health MGG,2772.36,,,,,,,case rate,2772.36,2772.36,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Aetna,Aetna,3917.82,,,,,,,per diem,3917.82,3917.82,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Aetna MGG,Aetna MGG,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,BCBS,BCBS,3917.82,,,,,,,per diem,3917.82,3917.82,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,BCBS MGG,BCBS MGG,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Cigna,Cigna,3917.82,,,,,,,per diem,3917.82,3917.82,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Cigna MGG,Cigna MGG,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Humana,Humana,3917.82,,,,,,,per diem,3917.82,3917.82,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Humana MGG,Humana MGG,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Optum VA,Optum VA,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,UHC,UHC,3917.82,,,,,,,per diem,3917.82,3917.82,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,UHC MGG,UHC MGG,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,VA,VA,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Wellcare MGG,Wellcare MGG,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Bright Health - commercial,Bright Health - commercial,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,36014,CPT,,,,Inpatient,,,3917.82,3917.82,Bright Health MGG,Bright Health MGG,3917.82,,,,,,,case rate,3917.82,3917.82,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Aetna,Aetna,2309.28,,,,,,,per diem,2309.28,2309.28,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Aetna MGG,Aetna MGG,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,BCBS,BCBS,2309.28,,,,,,,per diem,2309.28,2309.28,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,BCBS MGG,BCBS MGG,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Cigna,Cigna,2309.28,,,,,,,per diem,2309.28,2309.28,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Cigna MGG,Cigna MGG,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Humana,Humana,2309.28,,,,,,,per diem,2309.28,2309.28,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Humana MGG,Humana MGG,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Optum VA,Optum VA,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,UHC,UHC,2309.28,,,,,,,per diem,2309.28,2309.28,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,UHC MGG,UHC MGG,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,VA,VA,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Wellcare MGG,Wellcare MGG,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Bright Health - commercial,Bright Health - commercial,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,36140,CPT,,,,Inpatient,,,2309.28,2309.28,Bright Health MGG,Bright Health MGG,2309.28,,,,,,,case rate,2309.28,2309.28,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Aetna,Aetna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Aetna MGG,Aetna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,BCBS,BCBS,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,BCBS MGG,BCBS MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Cigna,Cigna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Cigna MGG,Cigna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Humana,Humana,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Humana MGG,Humana MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Optum VA,Optum VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,UHC,UHC,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,UHC MGG,UHC MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,VA,VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Wellcare MGG,Wellcare MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Bright Health - commercial,Bright Health - commercial,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,36160,CPT,,,,Inpatient,,,797.64,797.64,Bright Health MGG,Bright Health MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Aetna,Aetna,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Aetna MGG,Aetna MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,BCBS,BCBS,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,BCBS MGG,BCBS MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Cigna,Cigna,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Cigna MGG,Cigna MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Humana,Humana,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Humana MGG,Humana MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Optum VA,Optum VA,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,UHC,UHC,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,UHC MGG,UHC MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,VA,VA,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Wellcare MGG,Wellcare MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Bright Health - commercial,Bright Health - commercial,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,36148,CPT,,,,Inpatient,,,2250.12,2250.12,Bright Health MGG,Bright Health MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Aetna,Aetna,3242.58,,,,,,,per diem,3242.58,3242.58,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Aetna MGG,Aetna MGG,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,BCBS,BCBS,3242.58,,,,,,,per diem,3242.58,3242.58,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,BCBS MGG,BCBS MGG,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Cigna,Cigna,3242.58,,,,,,,per diem,3242.58,3242.58,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Cigna MGG,Cigna MGG,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Humana,Humana,3242.58,,,,,,,per diem,3242.58,3242.58,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Humana MGG,Humana MGG,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Optum VA,Optum VA,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,UHC,UHC,3242.58,,,,,,,per diem,3242.58,3242.58,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,UHC MGG,UHC MGG,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,VA,VA,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Wellcare MGG,Wellcare MGG,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Bright Health - commercial,Bright Health - commercial,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,36147,CPT,,,,Inpatient,,,3242.58,3242.58,Bright Health MGG,Bright Health MGG,3242.58,,,,,,,case rate,3242.58,3242.58,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Aetna,Aetna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Aetna MGG,Aetna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,BCBS,BCBS,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,BCBS MGG,BCBS MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Cigna,Cigna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Cigna MGG,Cigna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Humana,Humana,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Humana MGG,Humana MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Optum VA,Optum VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,UHC,UHC,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,UHC MGG,UHC MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,VA,VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Wellcare MGG,Wellcare MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Bright Health - commercial,Bright Health - commercial,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,36100,CPT,,,,Inpatient,,,797.64,797.64,Bright Health MGG,Bright Health MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Aetna,Aetna,2311.32,,,,,,,per diem,2311.32,2311.32,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Aetna MGG,Aetna MGG,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,BCBS,BCBS,2311.32,,,,,,,per diem,2311.32,2311.32,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,BCBS MGG,BCBS MGG,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Cigna,Cigna,2311.32,,,,,,,per diem,2311.32,2311.32,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Cigna MGG,Cigna MGG,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Humana,Humana,2311.32,,,,,,,per diem,2311.32,2311.32,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Humana MGG,Humana MGG,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Optum VA,Optum VA,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,UHC,UHC,2311.32,,,,,,,per diem,2311.32,2311.32,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,UHC MGG,UHC MGG,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,VA,VA,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Wellcare MGG,Wellcare MGG,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Bright Health - commercial,Bright Health - commercial,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,36120,CPT,,,,Inpatient,,,2311.32,2311.32,Bright Health MGG,Bright Health MGG,2311.32,,,,,,,case rate,2311.32,2311.32,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Aetna,Aetna,391.68,,,,,,,per diem,391.68,391.68,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Aetna MGG,Aetna MGG,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,BCBS,BCBS,391.68,,,,,,,per diem,391.68,391.68,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,BCBS MGG,BCBS MGG,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Cigna,Cigna,391.68,,,,,,,per diem,391.68,391.68,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Cigna MGG,Cigna MGG,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Humana,Humana,391.68,,,,,,,per diem,391.68,391.68,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Humana MGG,Humana MGG,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Optum VA,Optum VA,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,UHC,UHC,391.68,,,,,,,per diem,391.68,391.68,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,UHC MGG,UHC MGG,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,VA,VA,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Wellcare MGG,Wellcare MGG,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Bright Health - commercial,Bright Health - commercial,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,17250,CPT,,,,Inpatient,,,391.68,391.68,Bright Health MGG,Bright Health MGG,391.68,,,,,,,case rate,391.68,391.68,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Aetna,Aetna,2920.26,,,,,,,per diem,2920.26,2920.26,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Aetna MGG,Aetna MGG,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,BCBS,BCBS,2920.26,,,,,,,per diem,2920.26,2920.26,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,BCBS MGG,BCBS MGG,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Cigna,Cigna,2920.26,,,,,,,per diem,2920.26,2920.26,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Cigna MGG,Cigna MGG,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Humana,Humana,2920.26,,,,,,,per diem,2920.26,2920.26,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Humana MGG,Humana MGG,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Optum VA,Optum VA,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,UHC,UHC,2920.26,,,,,,,per diem,2920.26,2920.26,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,UHC MGG,UHC MGG,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,VA,VA,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Wellcare MGG,Wellcare MGG,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Bright Health - commercial,Bright Health - commercial,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,47490,CPT,,,,Inpatient,,,2920.26,2920.26,Bright Health MGG,Bright Health MGG,2920.26,,,,,,,case rate,2920.26,2920.26,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Aetna,Aetna,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Aetna MGG,Aetna MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,BCBS,BCBS,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,BCBS MGG,BCBS MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Cigna,Cigna,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Cigna MGG,Cigna MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Humana,Humana,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Humana MGG,Humana MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Optum VA,Optum VA,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,UHC,UHC,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,UHC MGG,UHC MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,VA,VA,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Wellcare MGG,Wellcare MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Bright Health - commercial,Bright Health - commercial,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,47801,CPT,,,,Inpatient,,,909.84,909.84,Bright Health MGG,Bright Health MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna,Aetna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna MGG,Aetna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS,BCBS,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS MGG,BCBS MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna,Cigna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna MGG,Cigna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Humana,Humana,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Humana MGG,Humana MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Optum VA,Optum VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,UHC,UHC,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,UHC MGG,UHC MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,VA,VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Wellcare MGG,Wellcare MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health - commercial,Bright Health - commercial,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health MGG,Bright Health MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna,Aetna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna MGG,Aetna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS,BCBS,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS MGG,BCBS MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna,Cigna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna MGG,Cigna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Humana,Humana,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Humana MGG,Humana MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Optum VA,Optum VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,UHC,UHC,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,UHC MGG,UHC MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,VA,VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Wellcare MGG,Wellcare MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health - commercial,Bright Health - commercial,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health MGG,Bright Health MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna,Aetna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna MGG,Aetna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS,BCBS,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS MGG,BCBS MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna,Cigna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna MGG,Cigna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Humana,Humana,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Humana MGG,Humana MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Optum VA,Optum VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,UHC,UHC,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,UHC MGG,UHC MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,VA,VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Wellcare MGG,Wellcare MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health - commercial,Bright Health - commercial,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health MGG,Bright Health MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Aetna,Aetna,4951.08,,,,,,,per diem,4951.08,4951.08,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Aetna MGG,Aetna MGG,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,BCBS,BCBS,4951.08,,,,,,,per diem,4951.08,4951.08,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,BCBS MGG,BCBS MGG,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Cigna,Cigna,4951.08,,,,,,,per diem,4951.08,4951.08,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Cigna MGG,Cigna MGG,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Humana,Humana,4951.08,,,,,,,per diem,4951.08,4951.08,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Humana MGG,Humana MGG,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Optum VA,Optum VA,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,UHC,UHC,4951.08,,,,,,,per diem,4951.08,4951.08,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,UHC MGG,UHC MGG,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,VA,VA,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Wellcare MGG,Wellcare MGG,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Bright Health - commercial,Bright Health - commercial,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,36246,CPT,,,,Inpatient,,,4951.08,4951.08,Bright Health MGG,Bright Health MGG,4951.08,,,,,,,case rate,4951.08,4951.08,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Aetna,Aetna,5893.56,,,,,,,per diem,5893.56,5893.56,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Aetna MGG,Aetna MGG,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,BCBS,BCBS,5893.56,,,,,,,per diem,5893.56,5893.56,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,BCBS MGG,BCBS MGG,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Cigna,Cigna,5893.56,,,,,,,per diem,5893.56,5893.56,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Cigna MGG,Cigna MGG,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Humana,Humana,5893.56,,,,,,,per diem,5893.56,5893.56,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Humana MGG,Humana MGG,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Optum VA,Optum VA,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,UHC,UHC,5893.56,,,,,,,per diem,5893.56,5893.56,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,UHC MGG,UHC MGG,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,VA,VA,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Wellcare MGG,Wellcare MGG,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Bright Health - commercial,Bright Health - commercial,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,36247,CPT,,,,Inpatient,,,5893.56,5893.56,Bright Health MGG,Bright Health MGG,5893.56,,,,,,,case rate,5893.56,5893.56,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Aetna,Aetna,3192.6,,,,,,,per diem,3192.6,3192.6,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Aetna MGG,Aetna MGG,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,BCBS,BCBS,3192.6,,,,,,,per diem,3192.6,3192.6,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,BCBS MGG,BCBS MGG,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Cigna,Cigna,3192.6,,,,,,,per diem,3192.6,3192.6,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Cigna MGG,Cigna MGG,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Humana,Humana,3192.6,,,,,,,per diem,3192.6,3192.6,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Humana MGG,Humana MGG,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Optum VA,Optum VA,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,UHC,UHC,3192.6,,,,,,,per diem,3192.6,3192.6,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,UHC MGG,UHC MGG,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,VA,VA,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Wellcare MGG,Wellcare MGG,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Bright Health - commercial,Bright Health - commercial,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,36245,CPT,,,,Inpatient,,,3192.6,3192.6,Bright Health MGG,Bright Health MGG,3192.6,,,,,,,case rate,3192.6,3192.6,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Aetna,Aetna,4478.82,,,,,,,per diem,4478.82,4478.82,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Aetna MGG,Aetna MGG,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,BCBS,BCBS,4478.82,,,,,,,per diem,4478.82,4478.82,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,BCBS MGG,BCBS MGG,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Cigna,Cigna,4478.82,,,,,,,per diem,4478.82,4478.82,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Cigna MGG,Cigna MGG,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Humana,Humana,4478.82,,,,,,,per diem,4478.82,4478.82,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Humana MGG,Humana MGG,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Optum VA,Optum VA,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,UHC,UHC,4478.82,,,,,,,per diem,4478.82,4478.82,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,UHC MGG,UHC MGG,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,VA,VA,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Wellcare MGG,Wellcare MGG,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Bright Health - commercial,Bright Health - commercial,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4478.82,4478.82,Bright Health MGG,Bright Health MGG,4478.82,,,,,,,case rate,4478.82,4478.82,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna,Aetna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna MGG,Aetna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS,BCBS,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS MGG,BCBS MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna,Cigna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna MGG,Cigna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Humana,Humana,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Humana MGG,Humana MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Optum VA,Optum VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,UHC,UHC,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,UHC MGG,UHC MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,VA,VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Wellcare MGG,Wellcare MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health - commercial,Bright Health - commercial,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,36222,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health MGG,Bright Health MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna,Aetna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna MGG,Aetna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS,BCBS,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS MGG,BCBS MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna,Cigna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna MGG,Cigna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Humana,Humana,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Humana MGG,Humana MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Optum VA,Optum VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,UHC,UHC,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,UHC MGG,UHC MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,VA,VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Wellcare MGG,Wellcare MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health - commercial,Bright Health - commercial,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,36223,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health MGG,Bright Health MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna,Aetna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna MGG,Aetna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS,BCBS,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS MGG,BCBS MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna,Cigna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna MGG,Cigna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Humana,Humana,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Humana MGG,Humana MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Optum VA,Optum VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,UHC,UHC,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,UHC MGG,UHC MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,VA,VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Wellcare MGG,Wellcare MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health - commercial,Bright Health - commercial,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,36227,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health MGG,Bright Health MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna,Aetna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna MGG,Aetna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS,BCBS,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS MGG,BCBS MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna,Cigna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna MGG,Cigna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Humana,Humana,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Humana MGG,Humana MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Optum VA,Optum VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,UHC,UHC,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,UHC MGG,UHC MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,VA,VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Wellcare MGG,Wellcare MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health - commercial,Bright Health - commercial,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health MGG,Bright Health MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna,Aetna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna MGG,Aetna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS,BCBS,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS MGG,BCBS MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna,Cigna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna MGG,Cigna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Humana,Humana,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Humana MGG,Humana MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Optum VA,Optum VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,UHC,UHC,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,UHC MGG,UHC MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,VA,VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Wellcare MGG,Wellcare MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health - commercial,Bright Health - commercial,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,36224,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health MGG,Bright Health MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Aetna,Aetna,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Aetna MGG,Aetna MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,BCBS,BCBS,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,BCBS MGG,BCBS MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Cigna,Cigna,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Cigna MGG,Cigna MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Humana,Humana,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Humana MGG,Humana MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Optum VA,Optum VA,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,UHC,UHC,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,UHC MGG,UHC MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,VA,VA,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Wellcare MGG,Wellcare MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Bright Health - commercial,Bright Health - commercial,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,36252,CPT,,,,Inpatient,,,9146.34,9146.34,Bright Health MGG,Bright Health MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Aetna,Aetna,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Aetna MGG,Aetna MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,BCBS,BCBS,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,BCBS MGG,BCBS MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Cigna,Cigna,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Cigna MGG,Cigna MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Humana,Humana,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Humana MGG,Humana MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Optum VA,Optum VA,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,UHC,UHC,9146.34,,,,,,,per diem,9146.34,9146.34,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,UHC MGG,UHC MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,VA,VA,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Wellcare MGG,Wellcare MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Bright Health - commercial,Bright Health - commercial,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,36254,CPT,,,,Inpatient,,,9146.34,9146.34,Bright Health MGG,Bright Health MGG,9146.34,,,,,,,case rate,9146.34,9146.34,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna,Aetna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna MGG,Aetna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS,BCBS,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS MGG,BCBS MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna,Cigna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna MGG,Cigna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Humana,Humana,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Humana MGG,Humana MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Optum VA,Optum VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,UHC,UHC,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,UHC MGG,UHC MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,VA,VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Wellcare MGG,Wellcare MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health - commercial,Bright Health - commercial,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,36225,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health MGG,Bright Health MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna,Aetna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna MGG,Aetna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS,BCBS,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS MGG,BCBS MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna,Cigna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna MGG,Cigna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Humana,Humana,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Humana MGG,Humana MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Optum VA,Optum VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,UHC,UHC,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,UHC MGG,UHC MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,VA,VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Wellcare MGG,Wellcare MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health - commercial,Bright Health - commercial,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,36221,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health MGG,Bright Health MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Aetna,Aetna,3798.48,,,,,,,per diem,3798.48,3798.48,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Aetna MGG,Aetna MGG,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,BCBS,BCBS,3798.48,,,,,,,per diem,3798.48,3798.48,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,BCBS MGG,BCBS MGG,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Cigna,Cigna,3798.48,,,,,,,per diem,3798.48,3798.48,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Cigna MGG,Cigna MGG,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Humana,Humana,3798.48,,,,,,,per diem,3798.48,3798.48,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Humana MGG,Humana MGG,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Optum VA,Optum VA,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,UHC,UHC,3798.48,,,,,,,per diem,3798.48,3798.48,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,UHC MGG,UHC MGG,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,VA,VA,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Wellcare MGG,Wellcare MGG,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Bright Health - commercial,Bright Health - commercial,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,36215,CPT,,,,Inpatient,,,3798.48,3798.48,Bright Health MGG,Bright Health MGG,3798.48,,,,,,,case rate,3798.48,3798.48,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Aetna,Aetna,4030.02,,,,,,,per diem,4030.02,4030.02,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Aetna MGG,Aetna MGG,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,BCBS,BCBS,4030.02,,,,,,,per diem,4030.02,4030.02,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,BCBS MGG,BCBS MGG,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Cigna,Cigna,4030.02,,,,,,,per diem,4030.02,4030.02,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Cigna MGG,Cigna MGG,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Humana,Humana,4030.02,,,,,,,per diem,4030.02,4030.02,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Humana MGG,Humana MGG,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Optum VA,Optum VA,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,UHC,UHC,4030.02,,,,,,,per diem,4030.02,4030.02,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,UHC MGG,UHC MGG,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,VA,VA,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Wellcare MGG,Wellcare MGG,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Bright Health - commercial,Bright Health - commercial,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,36216,CPT,,,,Inpatient,,,4030.02,4030.02,Bright Health MGG,Bright Health MGG,4030.02,,,,,,,case rate,4030.02,4030.02,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Aetna,Aetna,5166.3,,,,,,,per diem,5166.3,5166.3,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Aetna MGG,Aetna MGG,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,BCBS,BCBS,5166.3,,,,,,,per diem,5166.3,5166.3,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,BCBS MGG,BCBS MGG,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Cigna,Cigna,5166.3,,,,,,,per diem,5166.3,5166.3,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Cigna MGG,Cigna MGG,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Humana,Humana,5166.3,,,,,,,per diem,5166.3,5166.3,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Humana MGG,Humana MGG,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Optum VA,Optum VA,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,UHC,UHC,5166.3,,,,,,,per diem,5166.3,5166.3,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,UHC MGG,UHC MGG,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,VA,VA,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Wellcare MGG,Wellcare MGG,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Bright Health - commercial,Bright Health - commercial,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,36217,CPT,,,,Inpatient,,,5166.3,5166.3,Bright Health MGG,Bright Health MGG,5166.3,,,,,,,case rate,5166.3,5166.3,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Aetna,Aetna,3254.82,,,,,,,per diem,3254.82,3254.82,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Aetna MGG,Aetna MGG,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,BCBS,BCBS,3254.82,,,,,,,per diem,3254.82,3254.82,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,BCBS MGG,BCBS MGG,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Cigna,Cigna,3254.82,,,,,,,per diem,3254.82,3254.82,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Cigna MGG,Cigna MGG,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Humana,Humana,3254.82,,,,,,,per diem,3254.82,3254.82,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Humana MGG,Humana MGG,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Optum VA,Optum VA,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,UHC,UHC,3254.82,,,,,,,per diem,3254.82,3254.82,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,UHC MGG,UHC MGG,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,VA,VA,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Wellcare MGG,Wellcare MGG,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Bright Health - commercial,Bright Health - commercial,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,36218,CPT,,,,Inpatient,,,3254.82,3254.82,Bright Health MGG,Bright Health MGG,3254.82,,,,,,,case rate,3254.82,3254.82,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna,Aetna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna MGG,Aetna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS,BCBS,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS MGG,BCBS MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna,Cigna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna MGG,Cigna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Humana,Humana,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Humana MGG,Humana MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Optum VA,Optum VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,UHC,UHC,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,UHC MGG,UHC MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,VA,VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Wellcare MGG,Wellcare MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health - commercial,Bright Health - commercial,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health MGG,Bright Health MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna,Aetna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Aetna MGG,Aetna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS,BCBS,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,BCBS MGG,BCBS MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna,Cigna,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Cigna MGG,Cigna MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Humana,Humana,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Humana MGG,Humana MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Optum VA,Optum VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,UHC,UHC,9198.36,,,,,,,per diem,9198.36,9198.36,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,UHC MGG,UHC MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,VA,VA,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Wellcare MGG,Wellcare MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health - commercial,Bright Health - commercial,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,36226,CPT,,,,Inpatient,,,9198.36,9198.36,Bright Health MGG,Bright Health MGG,9198.36,,,,,,,case rate,9198.36,9198.36,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Aetna,Aetna,3457.8,,,,,,,per diem,3457.8,3457.8,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Aetna MGG,Aetna MGG,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,BCBS,BCBS,3457.8,,,,,,,per diem,3457.8,3457.8,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,BCBS MGG,BCBS MGG,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Cigna,Cigna,3457.8,,,,,,,per diem,3457.8,3457.8,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Cigna MGG,Cigna MGG,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Humana,Humana,3457.8,,,,,,,per diem,3457.8,3457.8,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Humana MGG,Humana MGG,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Optum VA,Optum VA,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,UHC,UHC,3457.8,,,,,,,per diem,3457.8,3457.8,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,UHC MGG,UHC MGG,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,VA,VA,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Wellcare MGG,Wellcare MGG,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Bright Health - commercial,Bright Health - commercial,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,51710,CPT,,,,Inpatient,,,3457.8,3457.8,Bright Health MGG,Bright Health MGG,3457.8,,,,,,,case rate,3457.8,3457.8,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Aetna,Aetna,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Aetna MGG,Aetna MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,BCBS,BCBS,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,BCBS MGG,BCBS MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Cigna,Cigna,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Cigna MGG,Cigna MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Humana,Humana,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Humana MGG,Humana MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Optum VA,Optum VA,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,UHC,UHC,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,UHC MGG,UHC MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,VA,VA,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Wellcare MGG,Wellcare MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Bright Health - commercial,Bright Health - commercial,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,51705,CPT,,,,Inpatient,,,454.92,454.92,Bright Health MGG,Bright Health MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Aetna,Aetna,956.76,,,,,,,per diem,956.76,956.76,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Aetna MGG,Aetna MGG,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,BCBS,BCBS,956.76,,,,,,,per diem,956.76,956.76,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,BCBS MGG,BCBS MGG,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Cigna,Cigna,956.76,,,,,,,per diem,956.76,956.76,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Cigna MGG,Cigna MGG,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Humana,Humana,956.76,,,,,,,per diem,956.76,956.76,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Humana MGG,Humana MGG,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Optum VA,Optum VA,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,UHC,UHC,956.76,,,,,,,per diem,956.76,956.76,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,UHC MGG,UHC MGG,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,VA,VA,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Wellcare MGG,Wellcare MGG,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Bright Health - commercial,Bright Health - commercial,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,51600,CPT,,,,Inpatient,,,956.76,956.76,Bright Health MGG,Bright Health MGG,956.76,,,,,,,case rate,956.76,956.76,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Aetna,Aetna,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Aetna MGG,Aetna MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,BCBS,BCBS,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,BCBS MGG,BCBS MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Cigna,Cigna,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Cigna MGG,Cigna MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Humana,Humana,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Humana MGG,Humana MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Optum VA,Optum VA,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,UHC,UHC,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,UHC MGG,UHC MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,VA,VA,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Wellcare MGG,Wellcare MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Bright Health - commercial,Bright Health - commercial,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,36861,CPT,,,,Inpatient,,,987.36,987.36,Bright Health MGG,Bright Health MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Aetna,Aetna,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Aetna MGG,Aetna MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,BCBS,BCBS,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,BCBS MGG,BCBS MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Cigna,Cigna,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Cigna MGG,Cigna MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Humana,Humana,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Humana MGG,Humana MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Optum VA,Optum VA,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,UHC,UHC,987.36,,,,,,,per diem,987.36,987.36,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,UHC MGG,UHC MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,VA,VA,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Wellcare MGG,Wellcare MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Bright Health - commercial,Bright Health - commercial,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,36860,CPT,,,,Inpatient,,,987.36,987.36,Bright Health MGG,Bright Health MGG,987.36,,,,,,,case rate,987.36,987.36,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Aetna,Aetna,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Aetna MGG,Aetna MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,BCBS,BCBS,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,BCBS MGG,BCBS MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Cigna,Cigna,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Cigna MGG,Cigna MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Humana,Humana,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Humana MGG,Humana MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Optum VA,Optum VA,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,UHC,UHC,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,UHC MGG,UHC MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,VA,VA,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Wellcare MGG,Wellcare MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Bright Health - commercial,Bright Health - commercial,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,47556,CPT,,,,Inpatient,,,6370.92,6370.92,Bright Health MGG,Bright Health MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Aetna,Aetna,2222.58,,,,,,,per diem,2222.58,2222.58,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Aetna MGG,Aetna MGG,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,BCBS,BCBS,2222.58,,,,,,,per diem,2222.58,2222.58,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,BCBS MGG,BCBS MGG,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Cigna,Cigna,2222.58,,,,,,,per diem,2222.58,2222.58,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Cigna MGG,Cigna MGG,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Humana,Humana,2222.58,,,,,,,per diem,2222.58,2222.58,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Humana MGG,Humana MGG,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Optum VA,Optum VA,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,UHC,UHC,2222.58,,,,,,,per diem,2222.58,2222.58,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,UHC MGG,UHC MGG,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,VA,VA,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Wellcare MGG,Wellcare MGG,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Bright Health - commercial,Bright Health - commercial,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,47555,CPT,,,,Inpatient,,,2222.58,2222.58,Bright Health MGG,Bright Health MGG,2222.58,,,,,,,case rate,2222.58,2222.58,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Aetna,Aetna,2708.1,,,,,,,per diem,2708.1,2708.1,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Aetna MGG,Aetna MGG,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,BCBS,BCBS,2708.1,,,,,,,per diem,2708.1,2708.1,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,BCBS MGG,BCBS MGG,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Cigna,Cigna,2708.1,,,,,,,per diem,2708.1,2708.1,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Cigna MGG,Cigna MGG,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Humana,Humana,2708.1,,,,,,,per diem,2708.1,2708.1,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Humana MGG,Humana MGG,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Optum VA,Optum VA,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,UHC,UHC,2708.1,,,,,,,per diem,2708.1,2708.1,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,UHC MGG,UHC MGG,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,VA,VA,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Wellcare MGG,Wellcare MGG,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Bright Health - commercial,Bright Health - commercial,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,43453,CPT,,,,Inpatient,,,2708.1,2708.1,Bright Health MGG,Bright Health MGG,2708.1,,,,,,,case rate,2708.1,2708.1,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Aetna,Aetna,547.74,,,,,,,per diem,547.74,547.74,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Aetna MGG,Aetna MGG,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,BCBS,BCBS,547.74,,,,,,,per diem,547.74,547.74,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,BCBS MGG,BCBS MGG,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Cigna,Cigna,547.74,,,,,,,per diem,547.74,547.74,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Cigna MGG,Cigna MGG,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Humana,Humana,547.74,,,,,,,per diem,547.74,547.74,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Humana MGG,Humana MGG,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Optum VA,Optum VA,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,UHC,UHC,547.74,,,,,,,per diem,547.74,547.74,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,UHC MGG,UHC MGG,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,VA,VA,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Wellcare MGG,Wellcare MGG,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Bright Health - commercial,Bright Health - commercial,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,62291,CPT,,,,Inpatient,,,547.74,547.74,Bright Health MGG,Bright Health MGG,547.74,,,,,,,case rate,547.74,547.74,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Aetna,Aetna,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Aetna MGG,Aetna MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,BCBS,BCBS,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,BCBS MGG,BCBS MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Cigna,Cigna,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Cigna MGG,Cigna MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Humana,Humana,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Humana MGG,Humana MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Optum VA,Optum VA,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,UHC,UHC,655.86,,,,,,,per diem,655.86,655.86,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,UHC MGG,UHC MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,VA,VA,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Wellcare MGG,Wellcare MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Bright Health - commercial,Bright Health - commercial,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,62290,CPT,,,,Inpatient,,,655.86,655.86,Bright Health MGG,Bright Health MGG,655.86,,,,,,,case rate,655.86,655.86,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Aetna,Aetna,4076.94,,,,,,,per diem,4076.94,4076.94,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Aetna MGG,Aetna MGG,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,BCBS,BCBS,4076.94,,,,,,,per diem,4076.94,4076.94,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,BCBS MGG,BCBS MGG,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Cigna,Cigna,4076.94,,,,,,,per diem,4076.94,4076.94,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Cigna MGG,Cigna MGG,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Humana,Humana,4076.94,,,,,,,per diem,4076.94,4076.94,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Humana MGG,Humana MGG,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Optum VA,Optum VA,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,UHC,UHC,4076.94,,,,,,,per diem,4076.94,4076.94,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,UHC MGG,UHC MGG,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,VA,VA,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Wellcare MGG,Wellcare MGG,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Bright Health - commercial,Bright Health - commercial,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,49441,CPT,,,,Inpatient,,,4076.94,4076.94,Bright Health MGG,Bright Health MGG,4076.94,,,,,,,case rate,4076.94,4076.94,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Aetna,Aetna,1464.72,,,,,,,per diem,1464.72,1464.72,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Aetna MGG,Aetna MGG,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,BCBS,BCBS,1464.72,,,,,,,per diem,1464.72,1464.72,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,BCBS MGG,BCBS MGG,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Cigna,Cigna,1464.72,,,,,,,per diem,1464.72,1464.72,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Cigna MGG,Cigna MGG,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Humana,Humana,1464.72,,,,,,,per diem,1464.72,1464.72,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Humana MGG,Humana MGG,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Optum VA,Optum VA,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,UHC,UHC,1464.72,,,,,,,per diem,1464.72,1464.72,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,UHC MGG,UHC MGG,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,VA,VA,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Wellcare MGG,Wellcare MGG,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Bright Health - commercial,Bright Health - commercial,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,49451,CPT,,,,Inpatient,,,1464.72,1464.72,Bright Health MGG,Bright Health MGG,1464.72,,,,,,,case rate,1464.72,1464.72,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Aetna,Aetna,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Aetna MGG,Aetna MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,BCBS,BCBS,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,BCBS MGG,BCBS MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Cigna,Cigna,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Cigna MGG,Cigna MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Humana,Humana,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Humana MGG,Humana MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Optum VA,Optum VA,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,UHC,UHC,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,UHC MGG,UHC MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,VA,VA,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Wellcare MGG,Wellcare MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Bright Health - commercial,Bright Health - commercial,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,43246,CPT,,,,Inpatient,,,1110.78,1110.78,Bright Health MGG,Bright Health MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Aetna,Aetna,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Aetna MGG,Aetna MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,BCBS,BCBS,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,BCBS MGG,BCBS MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Cigna,Cigna,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Cigna MGG,Cigna MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Humana,Humana,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Humana MGG,Humana MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Optum VA,Optum VA,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,UHC,UHC,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,UHC MGG,UHC MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,VA,VA,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Wellcare MGG,Wellcare MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Bright Health - commercial,Bright Health - commercial,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,34826,CPT,,,,Inpatient,,,942.48,942.48,Bright Health MGG,Bright Health MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Aetna,Aetna,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Aetna MGG,Aetna MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,BCBS,BCBS,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,BCBS MGG,BCBS MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Cigna,Cigna,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Cigna MGG,Cigna MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Humana,Humana,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Humana MGG,Humana MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Optum VA,Optum VA,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,UHC,UHC,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,UHC MGG,UHC MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,VA,VA,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Wellcare MGG,Wellcare MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Bright Health - commercial,Bright Health - commercial,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,34825,CPT,,,,Inpatient,,,942.48,942.48,Bright Health MGG,Bright Health MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Aetna,Aetna,7407.24,,,,,,,per diem,7407.24,7407.24,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Aetna MGG,Aetna MGG,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,BCBS,BCBS,7407.24,,,,,,,per diem,7407.24,7407.24,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,BCBS MGG,BCBS MGG,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Cigna,Cigna,7407.24,,,,,,,per diem,7407.24,7407.24,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Cigna MGG,Cigna MGG,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Humana,Humana,7407.24,,,,,,,per diem,7407.24,7407.24,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Humana MGG,Humana MGG,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Optum VA,Optum VA,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,UHC,UHC,7407.24,,,,,,,per diem,7407.24,7407.24,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,UHC MGG,UHC MGG,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,VA,VA,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Wellcare MGG,Wellcare MGG,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Bright Health - commercial,Bright Health - commercial,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,34802,CPT,,,,Inpatient,,,7407.24,7407.24,Bright Health MGG,Bright Health MGG,7407.24,,,,,,,case rate,7407.24,7407.24,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Aetna,Aetna,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Aetna MGG,Aetna MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,BCBS,BCBS,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,BCBS MGG,BCBS MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Cigna,Cigna,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Cigna MGG,Cigna MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Humana,Humana,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Humana MGG,Humana MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Optum VA,Optum VA,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,UHC,UHC,942.48,,,,,,,per diem,942.48,942.48,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,UHC MGG,UHC MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,VA,VA,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Wellcare MGG,Wellcare MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Bright Health - commercial,Bright Health - commercial,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,34804,CPT,,,,Inpatient,,,942.48,942.48,Bright Health MGG,Bright Health MGG,942.48,,,,,,,case rate,942.48,942.48,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Aetna,Aetna,9925.62,,,,,,,per diem,9925.62,9925.62,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Aetna MGG,Aetna MGG,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,BCBS,BCBS,9925.62,,,,,,,per diem,9925.62,9925.62,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,BCBS MGG,BCBS MGG,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Cigna,Cigna,9925.62,,,,,,,per diem,9925.62,9925.62,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Cigna MGG,Cigna MGG,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Humana,Humana,9925.62,,,,,,,per diem,9925.62,9925.62,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Humana MGG,Humana MGG,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Optum VA,Optum VA,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,UHC,UHC,9925.62,,,,,,,per diem,9925.62,9925.62,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,UHC MGG,UHC MGG,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,VA,VA,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Wellcare MGG,Wellcare MGG,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Bright Health - commercial,Bright Health - commercial,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,44300,CPT,,,,Inpatient,,,9925.62,9925.62,Bright Health MGG,Bright Health MGG,9925.62,,,,,,,case rate,9925.62,9925.62,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Aetna,Aetna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Aetna MGG,Aetna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,BCBS,BCBS,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,BCBS MGG,BCBS MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Cigna,Cigna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Cigna MGG,Cigna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Humana,Humana,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Humana MGG,Humana MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Optum VA,Optum VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,UHC,UHC,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,UHC MGG,UHC MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,VA,VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Wellcare MGG,Wellcare MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Bright Health - commercial,Bright Health - commercial,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Bright Health MGG,Bright Health MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Aetna,Aetna,2170.56,,,,,,,per diem,2170.56,2170.56,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Aetna MGG,Aetna MGG,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,BCBS,BCBS,2170.56,,,,,,,per diem,2170.56,2170.56,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,BCBS MGG,BCBS MGG,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Cigna,Cigna,2170.56,,,,,,,per diem,2170.56,2170.56,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Cigna MGG,Cigna MGG,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Humana,Humana,2170.56,,,,,,,per diem,2170.56,2170.56,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Humana MGG,Humana MGG,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Optum VA,Optum VA,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,UHC,UHC,2170.56,,,,,,,per diem,2170.56,2170.56,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,UHC MGG,UHC MGG,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,VA,VA,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Wellcare MGG,Wellcare MGG,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Bright Health - commercial,Bright Health - commercial,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,62311,CPT,,,,Inpatient,,,2170.56,2170.56,Bright Health MGG,Bright Health MGG,2170.56,,,,,,,case rate,2170.56,2170.56,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Aetna,Aetna,1501.08,,,,,,,per diem,1501.08,1501.08,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Aetna MGG,Aetna MGG,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,BCBS,BCBS,1501.08,,,,,,,per diem,1501.08,1501.08,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,BCBS MGG,BCBS MGG,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Cigna,Cigna,1501.08,,,,,,,per diem,1501.08,1501.08,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Cigna MGG,Cigna MGG,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Humana,Humana,1501.08,,,,,,,per diem,1501.08,1501.08,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Humana MGG,Humana MGG,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Optum VA,Optum VA,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,UHC,UHC,1501.08,,,,,,,per diem,1501.08,1501.08,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,UHC MGG,UHC MGG,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,VA,VA,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Wellcare MGG,Wellcare MGG,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Bright Health - commercial,Bright Health - commercial,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,62273,CPT,,,,Inpatient,,,1501.08,1501.08,Bright Health MGG,Bright Health MGG,1501.08,,,,,,,case rate,1501.08,1501.08,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Aetna,Aetna,3368.04,,,,,,,per diem,3368.04,3368.04,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Aetna MGG,Aetna MGG,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,BCBS,BCBS,3368.04,,,,,,,per diem,3368.04,3368.04,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,BCBS MGG,BCBS MGG,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Cigna,Cigna,3368.04,,,,,,,per diem,3368.04,3368.04,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Cigna MGG,Cigna MGG,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Humana,Humana,3368.04,,,,,,,per diem,3368.04,3368.04,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Humana MGG,Humana MGG,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Optum VA,Optum VA,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,UHC,UHC,3368.04,,,,,,,per diem,3368.04,3368.04,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,UHC MGG,UHC MGG,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,VA,VA,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Wellcare MGG,Wellcare MGG,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Bright Health - commercial,Bright Health - commercial,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,43220,CPT,,,,Inpatient,,,3368.04,3368.04,Bright Health MGG,Bright Health MGG,3368.04,,,,,,,case rate,3368.04,3368.04,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Aetna,Aetna,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Aetna MGG,Aetna MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,BCBS,BCBS,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,BCBS MGG,BCBS MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Cigna,Cigna,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Cigna MGG,Cigna MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Humana,Humana,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Humana MGG,Humana MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Optum VA,Optum VA,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,UHC,UHC,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,UHC MGG,UHC MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,VA,VA,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Wellcare MGG,Wellcare MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Bright Health - commercial,Bright Health - commercial,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Bright Health MGG,Bright Health MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Aetna,Aetna,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Aetna MGG,Aetna MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,BCBS,BCBS,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,BCBS MGG,BCBS MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Cigna,Cigna,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Cigna MGG,Cigna MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Humana,Humana,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Humana MGG,Humana MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Optum VA,Optum VA,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,UHC,UHC,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,UHC MGG,UHC MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,VA,VA,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Wellcare MGG,Wellcare MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Bright Health - commercial,Bright Health - commercial,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Bright Health MGG,Bright Health MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Aetna,Aetna,20440.8,,,,,,,per diem,20440.8,20440.8,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Aetna MGG,Aetna MGG,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,BCBS,BCBS,20440.8,,,,,,,per diem,20440.8,20440.8,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,BCBS MGG,BCBS MGG,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Cigna,Cigna,20440.8,,,,,,,per diem,20440.8,20440.8,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Cigna MGG,Cigna MGG,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Humana,Humana,20440.8,,,,,,,per diem,20440.8,20440.8,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Humana MGG,Humana MGG,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Optum VA,Optum VA,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,UHC,UHC,20440.8,,,,,,,per diem,20440.8,20440.8,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,UHC MGG,UHC MGG,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,VA,VA,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Wellcare MGG,Wellcare MGG,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Bright Health - commercial,Bright Health - commercial,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,36475,CPT,,,,Inpatient,,,20440.8,20440.8,Bright Health MGG,Bright Health MGG,20440.8,,,,,,,case rate,20440.8,20440.8,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Aetna,Aetna,12065.58,,,,,,,per diem,12065.58,12065.58,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Aetna MGG,Aetna MGG,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,BCBS,BCBS,12065.58,,,,,,,per diem,12065.58,12065.58,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,BCBS MGG,BCBS MGG,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Cigna,Cigna,12065.58,,,,,,,per diem,12065.58,12065.58,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Cigna MGG,Cigna MGG,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Humana,Humana,12065.58,,,,,,,per diem,12065.58,12065.58,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Humana MGG,Humana MGG,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Optum VA,Optum VA,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,UHC,UHC,12065.58,,,,,,,per diem,12065.58,12065.58,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,UHC MGG,UHC MGG,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,VA,VA,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Wellcare MGG,Wellcare MGG,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Bright Health - commercial,Bright Health - commercial,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,36476,CPT,,,,Inpatient,,,12065.58,12065.58,Bright Health MGG,Bright Health MGG,12065.58,,,,,,,case rate,12065.58,12065.58,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Aetna,Aetna,840.48,,,,,,,per diem,840.48,840.48,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Aetna MGG,Aetna MGG,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,BCBS,BCBS,840.48,,,,,,,per diem,840.48,840.48,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,BCBS MGG,BCBS MGG,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Cigna,Cigna,840.48,,,,,,,per diem,840.48,840.48,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Cigna MGG,Cigna MGG,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Humana,Humana,840.48,,,,,,,per diem,840.48,840.48,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Humana MGG,Humana MGG,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Optum VA,Optum VA,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,UHC,UHC,840.48,,,,,,,per diem,840.48,840.48,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,UHC MGG,UHC MGG,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,VA,VA,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Wellcare MGG,Wellcare MGG,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Bright Health - commercial,Bright Health - commercial,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,64493,CPT,,,,Inpatient,,,840.48,840.48,Bright Health MGG,Bright Health MGG,840.48,,,,,,,case rate,840.48,840.48,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Aetna,Aetna,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Aetna MGG,Aetna MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,BCBS,BCBS,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,BCBS MGG,BCBS MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Cigna,Cigna,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Cigna MGG,Cigna MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Humana,Humana,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Humana MGG,Humana MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Optum VA,Optum VA,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,UHC,UHC,1900.26,,,,,,,per diem,1900.26,1900.26,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,UHC MGG,UHC MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,VA,VA,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Wellcare MGG,Wellcare MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Bright Health - commercial,Bright Health - commercial,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,58345,CPT,,,,Inpatient,,,1900.26,1900.26,Bright Health MGG,Bright Health MGG,1900.26,,,,,,,case rate,1900.26,1900.26,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Aetna,Aetna,2348.04,,,,,,,per diem,2348.04,2348.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Aetna MGG,Aetna MGG,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,BCBS,BCBS,2348.04,,,,,,,per diem,2348.04,2348.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,BCBS MGG,BCBS MGG,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Cigna,Cigna,2348.04,,,,,,,per diem,2348.04,2348.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Cigna MGG,Cigna MGG,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Humana,Humana,2348.04,,,,,,,per diem,2348.04,2348.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Humana MGG,Humana MGG,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Optum VA,Optum VA,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,UHC,UHC,2348.04,,,,,,,per diem,2348.04,2348.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,UHC MGG,UHC MGG,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,VA,VA,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Wellcare MGG,Wellcare MGG,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Bright Health - commercial,Bright Health - commercial,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,43760,CPT,,,,Inpatient,,,2348.04,2348.04,Bright Health MGG,Bright Health MGG,2348.04,,,,,,,case rate,2348.04,2348.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Aetna,Aetna,2297.04,,,,,,,per diem,2297.04,2297.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Aetna MGG,Aetna MGG,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,BCBS,BCBS,2297.04,,,,,,,per diem,2297.04,2297.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,BCBS MGG,BCBS MGG,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Cigna,Cigna,2297.04,,,,,,,per diem,2297.04,2297.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Cigna MGG,Cigna MGG,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Humana,Humana,2297.04,,,,,,,per diem,2297.04,2297.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Humana MGG,Humana MGG,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Optum VA,Optum VA,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,UHC,UHC,2297.04,,,,,,,per diem,2297.04,2297.04,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,UHC MGG,UHC MGG,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,VA,VA,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Wellcare MGG,Wellcare MGG,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Bright Health - commercial,Bright Health - commercial,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,49450,CPT,,,,Inpatient,,,2297.04,2297.04,Bright Health MGG,Bright Health MGG,2297.04,,,,,,,case rate,2297.04,2297.04,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Aetna,Aetna,2871.3,,,,,,,per diem,2871.3,2871.3,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Aetna MGG,Aetna MGG,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,BCBS,BCBS,2871.3,,,,,,,per diem,2871.3,2871.3,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,BCBS MGG,BCBS MGG,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Cigna,Cigna,2871.3,,,,,,,per diem,2871.3,2871.3,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Cigna MGG,Cigna MGG,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Humana,Humana,2871.3,,,,,,,per diem,2871.3,2871.3,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Humana MGG,Humana MGG,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Optum VA,Optum VA,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,UHC,UHC,2871.3,,,,,,,per diem,2871.3,2871.3,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,UHC MGG,UHC MGG,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,VA,VA,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Wellcare MGG,Wellcare MGG,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Bright Health - commercial,Bright Health - commercial,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,49440,CPT,,,,Inpatient,,,2871.3,2871.3,Bright Health MGG,Bright Health MGG,2871.3,,,,,,,case rate,2871.3,2871.3,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Aetna,Aetna,857.82,,,,,,,per diem,857.82,857.82,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Aetna MGG,Aetna MGG,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,BCBS,BCBS,857.82,,,,,,,per diem,857.82,857.82,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,BCBS MGG,BCBS MGG,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Cigna,Cigna,857.82,,,,,,,per diem,857.82,857.82,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Cigna MGG,Cigna MGG,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Humana,Humana,857.82,,,,,,,per diem,857.82,857.82,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Humana MGG,Humana MGG,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Optum VA,Optum VA,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,UHC,UHC,857.82,,,,,,,per diem,857.82,857.82,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,UHC MGG,UHC MGG,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,VA,VA,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Wellcare MGG,Wellcare MGG,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Bright Health - commercial,Bright Health - commercial,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,857.82,857.82,Bright Health MGG,Bright Health MGG,857.82,,,,,,,case rate,857.82,857.82,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Aetna,Aetna,1251.54,,,,,,,per diem,1251.54,1251.54,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Aetna MGG,Aetna MGG,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,BCBS,BCBS,1251.54,,,,,,,per diem,1251.54,1251.54,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,BCBS MGG,BCBS MGG,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Cigna,Cigna,1251.54,,,,,,,per diem,1251.54,1251.54,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Cigna MGG,Cigna MGG,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Humana,Humana,1251.54,,,,,,,per diem,1251.54,1251.54,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Humana MGG,Humana MGG,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Optum VA,Optum VA,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,UHC,UHC,1251.54,,,,,,,per diem,1251.54,1251.54,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,UHC MGG,UHC MGG,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,VA,VA,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Wellcare MGG,Wellcare MGG,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Bright Health - commercial,Bright Health - commercial,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,44500,CPT,,,,Inpatient,,,1251.54,1251.54,Bright Health MGG,Bright Health MGG,1251.54,,,,,,,case rate,1251.54,1251.54,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Aetna,Aetna,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Aetna MGG,Aetna MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,BCBS,BCBS,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,BCBS MGG,BCBS MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Cigna,Cigna,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Cigna MGG,Cigna MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Humana,Humana,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Humana MGG,Humana MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Optum VA,Optum VA,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,UHC,UHC,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,UHC MGG,UHC MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,VA,VA,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Wellcare MGG,Wellcare MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Bright Health - commercial,Bright Health - commercial,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Bright Health MGG,Bright Health MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Aetna,Aetna,18524.22,,,,,,,per diem,18524.22,18524.22,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Aetna MGG,Aetna MGG,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,BCBS,BCBS,18524.22,,,,,,,per diem,18524.22,18524.22,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,BCBS MGG,BCBS MGG,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Cigna,Cigna,18524.22,,,,,,,per diem,18524.22,18524.22,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Cigna MGG,Cigna MGG,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Humana,Humana,18524.22,,,,,,,per diem,18524.22,18524.22,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Humana MGG,Humana MGG,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Optum VA,Optum VA,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,UHC,UHC,18524.22,,,,,,,per diem,18524.22,18524.22,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,UHC MGG,UHC MGG,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,VA,VA,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Wellcare MGG,Wellcare MGG,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Bright Health - commercial,Bright Health - commercial,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,36838,CPT,,,,Inpatient,,,18524.22,18524.22,Bright Health MGG,Bright Health MGG,18524.22,,,,,,,case rate,18524.22,18524.22,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Aetna,Aetna,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Aetna MGG,Aetna MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,BCBS,BCBS,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,BCBS MGG,BCBS MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Cigna,Cigna,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Cigna MGG,Cigna MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Humana,Humana,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Humana MGG,Humana MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Optum VA,Optum VA,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,UHC,UHC,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,UHC MGG,UHC MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,VA,VA,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Wellcare MGG,Wellcare MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Bright Health - commercial,Bright Health - commercial,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,58340,CPT,,,,Inpatient,,,659.94,659.94,Bright Health MGG,Bright Health MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Aetna,Aetna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Aetna MGG,Aetna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,BCBS,BCBS,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,BCBS MGG,BCBS MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Cigna,Cigna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Cigna MGG,Cigna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Humana,Humana,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Humana MGG,Humana MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Optum VA,Optum VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,UHC,UHC,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,UHC MGG,UHC MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,VA,VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Wellcare MGG,Wellcare MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Bright Health - commercial,Bright Health - commercial,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,50690,CPT,,,,Inpatient,,,797.64,797.64,Bright Health MGG,Bright Health MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Aetna,Aetna,1237.26,,,,,,,per diem,1237.26,1237.26,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Aetna MGG,Aetna MGG,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,BCBS,BCBS,1237.26,,,,,,,per diem,1237.26,1237.26,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,BCBS MGG,BCBS MGG,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Cigna,Cigna,1237.26,,,,,,,per diem,1237.26,1237.26,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Cigna MGG,Cigna MGG,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Humana,Humana,1237.26,,,,,,,per diem,1237.26,1237.26,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Humana MGG,Humana MGG,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Optum VA,Optum VA,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,UHC,UHC,1237.26,,,,,,,per diem,1237.26,1237.26,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,UHC MGG,UHC MGG,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,VA,VA,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Wellcare MGG,Wellcare MGG,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Bright Health - commercial,Bright Health - commercial,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,20552,CPT,,,,Inpatient,,,1237.26,1237.26,Bright Health MGG,Bright Health MGG,1237.26,,,,,,,case rate,1237.26,1237.26,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Aetna,Aetna,3700.56,,,,,,,per diem,3700.56,3700.56,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Aetna MGG,Aetna MGG,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,BCBS,BCBS,3700.56,,,,,,,per diem,3700.56,3700.56,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,BCBS MGG,BCBS MGG,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Cigna,Cigna,3700.56,,,,,,,per diem,3700.56,3700.56,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Cigna MGG,Cigna MGG,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Humana,Humana,3700.56,,,,,,,per diem,3700.56,3700.56,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Humana MGG,Humana MGG,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Optum VA,Optum VA,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,UHC,UHC,3700.56,,,,,,,per diem,3700.56,3700.56,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,UHC MGG,UHC MGG,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,VA,VA,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Wellcare MGG,Wellcare MGG,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Bright Health - commercial,Bright Health - commercial,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,36571,CPT,,,,Inpatient,,,3700.56,3700.56,Bright Health MGG,Bright Health MGG,3700.56,,,,,,,case rate,3700.56,3700.56,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Aetna,Aetna,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Aetna MGG,Aetna MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,BCBS,BCBS,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,BCBS MGG,BCBS MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Cigna,Cigna,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Cigna MGG,Cigna MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Humana,Humana,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Humana MGG,Humana MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Optum VA,Optum VA,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,UHC,UHC,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,UHC MGG,UHC MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,VA,VA,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Wellcare MGG,Wellcare MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Bright Health - commercial,Bright Health - commercial,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,36570,CPT,,,,Inpatient,,,2401.08,2401.08,Bright Health MGG,Bright Health MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Aetna,Aetna,13694.52,,,,,,,per diem,13694.52,13694.52,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Aetna MGG,Aetna MGG,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,BCBS,BCBS,13694.52,,,,,,,per diem,13694.52,13694.52,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,BCBS MGG,BCBS MGG,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Cigna,Cigna,13694.52,,,,,,,per diem,13694.52,13694.52,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Cigna MGG,Cigna MGG,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Humana,Humana,13694.52,,,,,,,per diem,13694.52,13694.52,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Humana MGG,Humana MGG,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Optum VA,Optum VA,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,UHC,UHC,13694.52,,,,,,,per diem,13694.52,13694.52,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,UHC MGG,UHC MGG,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,VA,VA,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Wellcare MGG,Wellcare MGG,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Bright Health - commercial,Bright Health - commercial,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,49418,CPT,,,,Inpatient,,,13694.52,13694.52,Bright Health MGG,Bright Health MGG,13694.52,,,,,,,case rate,13694.52,13694.52,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Aetna,Aetna,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Aetna MGG,Aetna MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,BCBS,BCBS,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,BCBS MGG,BCBS MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Cigna,Cigna,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Cigna MGG,Cigna MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Humana,Humana,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Humana MGG,Humana MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Optum VA,Optum VA,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,UHC,UHC,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,UHC MGG,UHC MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,VA,VA,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Wellcare MGG,Wellcare MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Bright Health - commercial,Bright Health - commercial,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,37191,CPT,,,,Inpatient,,,4733.82,4733.82,Bright Health MGG,Bright Health MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Aetna,Aetna,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Aetna MGG,Aetna MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,BCBS,BCBS,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,BCBS MGG,BCBS MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Cigna,Cigna,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Cigna MGG,Cigna MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Humana,Humana,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Humana MGG,Humana MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Optum VA,Optum VA,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,UHC,UHC,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,UHC MGG,UHC MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,VA,VA,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Wellcare MGG,Wellcare MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Bright Health - commercial,Bright Health - commercial,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,36568,CPT,,,,Inpatient,,,1188.3,1188.3,Bright Health MGG,Bright Health MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Aetna,Aetna,1337.87,,,,,,,per diem,1337.87,1337.87,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Aetna MGG,Aetna MGG,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,BCBS,BCBS,1337.87,,,,,,,per diem,1337.87,1337.87,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,BCBS MGG,BCBS MGG,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Cigna,Cigna,1337.87,,,,,,,per diem,1337.87,1337.87,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Cigna MGG,Cigna MGG,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Humana,Humana,1337.87,,,,,,,per diem,1337.87,1337.87,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Humana MGG,Humana MGG,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Optum VA,Optum VA,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,UHC,UHC,1337.87,,,,,,,per diem,1337.87,1337.87,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,UHC MGG,UHC MGG,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,VA,VA,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Wellcare MGG,Wellcare MGG,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Bright Health - commercial,Bright Health - commercial,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,36569,CPT,,,,Inpatient,,,1337.87,1337.87,Bright Health MGG,Bright Health MGG,1337.87,,,,,,,case rate,1337.87,1337.87,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Aetna,Aetna,2726.46,,,,,,,per diem,2726.46,2726.46,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Aetna MGG,Aetna MGG,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,BCBS,BCBS,2726.46,,,,,,,per diem,2726.46,2726.46,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,BCBS MGG,BCBS MGG,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Cigna,Cigna,2726.46,,,,,,,per diem,2726.46,2726.46,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Cigna MGG,Cigna MGG,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Humana,Humana,2726.46,,,,,,,per diem,2726.46,2726.46,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Humana MGG,Humana MGG,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Optum VA,Optum VA,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,UHC,UHC,2726.46,,,,,,,per diem,2726.46,2726.46,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,UHC MGG,UHC MGG,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,VA,VA,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Wellcare MGG,Wellcare MGG,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Bright Health - commercial,Bright Health - commercial,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,32550,CPT,,,,Inpatient,,,2726.46,2726.46,Bright Health MGG,Bright Health MGG,2726.46,,,,,,,case rate,2726.46,2726.46,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Aetna,Aetna,2095.08,,,,,,,per diem,2095.08,2095.08,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Aetna MGG,Aetna MGG,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,BCBS,BCBS,2095.08,,,,,,,per diem,2095.08,2095.08,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,BCBS MGG,BCBS MGG,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Cigna,Cigna,2095.08,,,,,,,per diem,2095.08,2095.08,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Cigna MGG,Cigna MGG,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Humana,Humana,2095.08,,,,,,,per diem,2095.08,2095.08,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Humana MGG,Humana MGG,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Optum VA,Optum VA,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,UHC,UHC,2095.08,,,,,,,per diem,2095.08,2095.08,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,UHC MGG,UHC MGG,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,VA,VA,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Wellcare MGG,Wellcare MGG,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Bright Health - commercial,Bright Health - commercial,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,36557,CPT,,,,Inpatient,,,2095.08,2095.08,Bright Health MGG,Bright Health MGG,2095.08,,,,,,,case rate,2095.08,2095.08,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Aetna,Aetna,2586.72,,,,,,,per diem,2586.72,2586.72,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Aetna MGG,Aetna MGG,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,BCBS,BCBS,2586.72,,,,,,,per diem,2586.72,2586.72,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,BCBS MGG,BCBS MGG,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Cigna,Cigna,2586.72,,,,,,,per diem,2586.72,2586.72,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Cigna MGG,Cigna MGG,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Humana,Humana,2586.72,,,,,,,per diem,2586.72,2586.72,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Humana MGG,Humana MGG,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Optum VA,Optum VA,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,UHC,UHC,2586.72,,,,,,,per diem,2586.72,2586.72,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,UHC MGG,UHC MGG,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,VA,VA,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Wellcare MGG,Wellcare MGG,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Bright Health - commercial,Bright Health - commercial,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,36558,CPT,,,,Inpatient,,,2586.72,2586.72,Bright Health MGG,Bright Health MGG,2586.72,,,,,,,case rate,2586.72,2586.72,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Aetna,Aetna,2676.48,,,,,,,per diem,2676.48,2676.48,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Aetna MGG,Aetna MGG,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,BCBS,BCBS,2676.48,,,,,,,per diem,2676.48,2676.48,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,BCBS MGG,BCBS MGG,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Cigna,Cigna,2676.48,,,,,,,per diem,2676.48,2676.48,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Cigna MGG,Cigna MGG,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Humana,Humana,2676.48,,,,,,,per diem,2676.48,2676.48,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Humana MGG,Humana MGG,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Optum VA,Optum VA,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,UHC,UHC,2676.48,,,,,,,per diem,2676.48,2676.48,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,UHC MGG,UHC MGG,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,VA,VA,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Wellcare MGG,Wellcare MGG,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Bright Health - commercial,Bright Health - commercial,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,36566,CPT,,,,Inpatient,,,2676.48,2676.48,Bright Health MGG,Bright Health MGG,2676.48,,,,,,,case rate,2676.48,2676.48,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Aetna,Aetna,3915.78,,,,,,,per diem,3915.78,3915.78,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Aetna MGG,Aetna MGG,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,BCBS,BCBS,3915.78,,,,,,,per diem,3915.78,3915.78,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,BCBS MGG,BCBS MGG,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Cigna,Cigna,3915.78,,,,,,,per diem,3915.78,3915.78,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Cigna MGG,Cigna MGG,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Humana,Humana,3915.78,,,,,,,per diem,3915.78,3915.78,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Humana MGG,Humana MGG,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Optum VA,Optum VA,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,UHC,UHC,3915.78,,,,,,,per diem,3915.78,3915.78,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,UHC MGG,UHC MGG,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,VA,VA,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Wellcare MGG,Wellcare MGG,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Bright Health - commercial,Bright Health - commercial,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,36565,CPT,,,,Inpatient,,,3915.78,3915.78,Bright Health MGG,Bright Health MGG,3915.78,,,,,,,case rate,3915.78,3915.78,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Aetna,Aetna,2596.83,,,,,,,per diem,2596.83,2596.83,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Aetna MGG,Aetna MGG,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,BCBS,BCBS,2596.83,,,,,,,per diem,2596.83,2596.83,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,BCBS MGG,BCBS MGG,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Cigna,Cigna,2596.83,,,,,,,per diem,2596.83,2596.83,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Cigna MGG,Cigna MGG,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Humana,Humana,2596.83,,,,,,,per diem,2596.83,2596.83,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Humana MGG,Humana MGG,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Optum VA,Optum VA,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,UHC,UHC,2596.83,,,,,,,per diem,2596.83,2596.83,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,UHC MGG,UHC MGG,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,VA,VA,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Wellcare MGG,Wellcare MGG,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Bright Health - commercial,Bright Health - commercial,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,36560,CPT,,,,Inpatient,,,2596.83,2596.83,Bright Health MGG,Bright Health MGG,2596.83,,,,,,,case rate,2596.83,2596.83,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Aetna,Aetna,5029.73,,,,,,,per diem,5029.73,5029.73,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Aetna MGG,Aetna MGG,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,BCBS,BCBS,5029.73,,,,,,,per diem,5029.73,5029.73,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,BCBS MGG,BCBS MGG,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Cigna,Cigna,5029.73,,,,,,,per diem,5029.73,5029.73,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Cigna MGG,Cigna MGG,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Humana,Humana,5029.73,,,,,,,per diem,5029.73,5029.73,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Humana MGG,Humana MGG,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Optum VA,Optum VA,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,UHC,UHC,5029.73,,,,,,,per diem,5029.73,5029.73,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,UHC MGG,UHC MGG,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,VA,VA,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Wellcare MGG,Wellcare MGG,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Bright Health - commercial,Bright Health - commercial,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,36561,CPT,,,,Inpatient,,,5029.73,5029.73,Bright Health MGG,Bright Health MGG,5029.73,,,,,,,case rate,5029.73,5029.73,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Aetna,Aetna,3851.52,,,,,,,per diem,3851.52,3851.52,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Aetna MGG,Aetna MGG,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,BCBS,BCBS,3851.52,,,,,,,per diem,3851.52,3851.52,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,BCBS MGG,BCBS MGG,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Cigna,Cigna,3851.52,,,,,,,per diem,3851.52,3851.52,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Cigna MGG,Cigna MGG,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Humana,Humana,3851.52,,,,,,,per diem,3851.52,3851.52,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Humana MGG,Humana MGG,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Optum VA,Optum VA,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,UHC,UHC,3851.52,,,,,,,per diem,3851.52,3851.52,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,UHC MGG,UHC MGG,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,VA,VA,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Wellcare MGG,Wellcare MGG,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Bright Health - commercial,Bright Health - commercial,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,36563,CPT,,,,Inpatient,,,3851.52,3851.52,Bright Health MGG,Bright Health MGG,3851.52,,,,,,,case rate,3851.52,3851.52,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Aetna,Aetna,1599.36,,,,,,,per diem,1599.36,1599.36,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Aetna MGG,Aetna MGG,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,BCBS,BCBS,1599.36,,,,,,,per diem,1599.36,1599.36,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,BCBS MGG,BCBS MGG,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Cigna,Cigna,1599.36,,,,,,,per diem,1599.36,1599.36,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Cigna MGG,Cigna MGG,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Humana,Humana,1599.36,,,,,,,per diem,1599.36,1599.36,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Humana MGG,Humana MGG,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Optum VA,Optum VA,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,UHC,UHC,1599.36,,,,,,,per diem,1599.36,1599.36,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,UHC MGG,UHC MGG,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,VA,VA,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Wellcare MGG,Wellcare MGG,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Bright Health - commercial,Bright Health - commercial,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,36555,CPT,,,,Inpatient,,,1599.36,1599.36,Bright Health MGG,Bright Health MGG,1599.36,,,,,,,case rate,1599.36,1599.36,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Aetna,Aetna,1950.24,,,,,,,per diem,1950.24,1950.24,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Aetna MGG,Aetna MGG,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,BCBS,BCBS,1950.24,,,,,,,per diem,1950.24,1950.24,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,BCBS MGG,BCBS MGG,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Cigna,Cigna,1950.24,,,,,,,per diem,1950.24,1950.24,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Cigna MGG,Cigna MGG,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Humana,Humana,1950.24,,,,,,,per diem,1950.24,1950.24,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Humana MGG,Humana MGG,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Optum VA,Optum VA,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,UHC,UHC,1950.24,,,,,,,per diem,1950.24,1950.24,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,UHC MGG,UHC MGG,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,VA,VA,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Wellcare MGG,Wellcare MGG,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Bright Health - commercial,Bright Health - commercial,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,36556,CPT,,,,Inpatient,,,1950.24,1950.24,Bright Health MGG,Bright Health MGG,1950.24,,,,,,,case rate,1950.24,1950.24,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Aetna,Aetna,2669.34,,,,,,,per diem,2669.34,2669.34,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Aetna MGG,Aetna MGG,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,BCBS,BCBS,2669.34,,,,,,,per diem,2669.34,2669.34,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,BCBS MGG,BCBS MGG,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Cigna,Cigna,2669.34,,,,,,,per diem,2669.34,2669.34,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Cigna MGG,Cigna MGG,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Humana,Humana,2669.34,,,,,,,per diem,2669.34,2669.34,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Humana MGG,Humana MGG,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Optum VA,Optum VA,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,UHC,UHC,2669.34,,,,,,,per diem,2669.34,2669.34,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,UHC MGG,UHC MGG,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,VA,VA,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Wellcare MGG,Wellcare MGG,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Bright Health - commercial,Bright Health - commercial,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,36000,CPT,,,,Inpatient,,,2669.34,2669.34,Bright Health MGG,Bright Health MGG,2669.34,,,,,,,case rate,2669.34,2669.34,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Aetna,Aetna,619.14,,,,,,,per diem,619.14,619.14,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Aetna MGG,Aetna MGG,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,BCBS,BCBS,619.14,,,,,,,per diem,619.14,619.14,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,BCBS MGG,BCBS MGG,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Cigna,Cigna,619.14,,,,,,,per diem,619.14,619.14,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Cigna MGG,Cigna MGG,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Humana,Humana,619.14,,,,,,,per diem,619.14,619.14,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Humana MGG,Humana MGG,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Optum VA,Optum VA,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,UHC,UHC,619.14,,,,,,,per diem,619.14,619.14,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,UHC MGG,UHC MGG,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,VA,VA,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Wellcare MGG,Wellcare MGG,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Bright Health - commercial,Bright Health - commercial,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,44015,CPT,,,,Inpatient,,,619.14,619.14,Bright Health MGG,Bright Health MGG,619.14,,,,,,,case rate,619.14,619.14,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Aetna,Aetna,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Aetna MGG,Aetna MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,BCBS,BCBS,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,BCBS MGG,BCBS MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Cigna,Cigna,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Cigna MGG,Cigna MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Humana,Humana,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Humana MGG,Humana MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Optum VA,Optum VA,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,UHC,UHC,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,UHC MGG,UHC MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,VA,VA,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Wellcare MGG,Wellcare MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Bright Health - commercial,Bright Health - commercial,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,49452,CPT,,,,Inpatient,,,2121.6,2121.6,Bright Health MGG,Bright Health MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Aetna,Aetna,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Aetna MGG,Aetna MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,BCBS,BCBS,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,BCBS MGG,BCBS MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Cigna,Cigna,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Cigna MGG,Cigna MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Humana,Humana,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Humana MGG,Humana MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Optum VA,Optum VA,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,UHC,UHC,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,UHC MGG,UHC MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,VA,VA,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Wellcare MGG,Wellcare MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Bright Health - commercial,Bright Health - commercial,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,17003,CPT,,,,Inpatient,,,303.96,303.96,Bright Health MGG,Bright Health MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Aetna,Aetna,971.04,,,,,,,per diem,971.04,971.04,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Aetna MGG,Aetna MGG,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,BCBS,BCBS,971.04,,,,,,,per diem,971.04,971.04,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,BCBS MGG,BCBS MGG,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Cigna,Cigna,971.04,,,,,,,per diem,971.04,971.04,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Cigna MGG,Cigna MGG,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Humana,Humana,971.04,,,,,,,per diem,971.04,971.04,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Humana MGG,Humana MGG,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Optum VA,Optum VA,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,UHC,UHC,971.04,,,,,,,per diem,971.04,971.04,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,UHC MGG,UHC MGG,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,VA,VA,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Wellcare MGG,Wellcare MGG,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Bright Health - commercial,Bright Health - commercial,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,17004,CPT,,,,Inpatient,,,971.04,971.04,Bright Health MGG,Bright Health MGG,971.04,,,,,,,case rate,971.04,971.04,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Aetna,Aetna,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Aetna MGG,Aetna MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,BCBS,BCBS,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,BCBS MGG,BCBS MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Cigna,Cigna,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Cigna MGG,Cigna MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Humana,Humana,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Humana MGG,Humana MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Optum VA,Optum VA,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,UHC,UHC,303.96,,,,,,,per diem,303.96,303.96,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,UHC MGG,UHC MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,VA,VA,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Wellcare MGG,Wellcare MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Bright Health - commercial,Bright Health - commercial,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,17000,CPT,,,,Inpatient,,,303.96,303.96,Bright Health MGG,Bright Health MGG,303.96,,,,,,,case rate,303.96,303.96,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Aetna,Aetna,11201.64,,,,,,,per diem,11201.64,11201.64,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Aetna MGG,Aetna MGG,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,BCBS,BCBS,11201.64,,,,,,,per diem,11201.64,11201.64,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,BCBS MGG,BCBS MGG,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Cigna,Cigna,11201.64,,,,,,,per diem,11201.64,11201.64,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Cigna MGG,Cigna MGG,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Humana,Humana,11201.64,,,,,,,per diem,11201.64,11201.64,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Humana MGG,Humana MGG,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Optum VA,Optum VA,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,UHC,UHC,11201.64,,,,,,,per diem,11201.64,11201.64,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,UHC MGG,UHC MGG,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,VA,VA,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Wellcare MGG,Wellcare MGG,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Bright Health - commercial,Bright Health - commercial,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,37735,CPT,,,,Inpatient,,,11201.64,11201.64,Bright Health MGG,Bright Health MGG,11201.64,,,,,,,case rate,11201.64,11201.64,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Aetna,Aetna,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Aetna MGG,Aetna MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,BCBS,BCBS,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,BCBS MGG,BCBS MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Cigna,Cigna,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Cigna MGG,Cigna MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Humana,Humana,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Humana MGG,Humana MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Optum VA,Optum VA,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,UHC,UHC,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,UHC MGG,UHC MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,VA,VA,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Wellcare MGG,Wellcare MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Bright Health - commercial,Bright Health - commercial,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,37785,CPT,,,,Inpatient,,,12710.22,12710.22,Bright Health MGG,Bright Health MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Aetna,Aetna,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Aetna MGG,Aetna MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,BCBS,BCBS,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,BCBS MGG,BCBS MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Cigna,Cigna,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Cigna MGG,Cigna MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Humana,Humana,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Humana MGG,Humana MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Optum VA,Optum VA,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,UHC,UHC,12710.22,,,,,,,per diem,12710.22,12710.22,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,UHC MGG,UHC MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,VA,VA,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Wellcare MGG,Wellcare MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Bright Health - commercial,Bright Health - commercial,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,37718,CPT,,,,Inpatient,,,12710.22,12710.22,Bright Health MGG,Bright Health MGG,12710.22,,,,,,,case rate,12710.22,12710.22,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Aetna,Aetna,7942.74,,,,,,,per diem,7942.74,7942.74,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Aetna MGG,Aetna MGG,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,BCBS,BCBS,7942.74,,,,,,,per diem,7942.74,7942.74,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,BCBS MGG,BCBS MGG,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Cigna,Cigna,7942.74,,,,,,,per diem,7942.74,7942.74,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Cigna MGG,Cigna MGG,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Humana,Humana,7942.74,,,,,,,per diem,7942.74,7942.74,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Humana MGG,Humana MGG,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Optum VA,Optum VA,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,UHC,UHC,7942.74,,,,,,,per diem,7942.74,7942.74,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,UHC MGG,UHC MGG,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,VA,VA,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Wellcare MGG,Wellcare MGG,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Bright Health - commercial,Bright Health - commercial,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,37619,CPT,,,,Inpatient,,,7942.74,7942.74,Bright Health MGG,Bright Health MGG,7942.74,,,,,,,case rate,7942.74,7942.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Aetna,Aetna,1911.48,,,,,,,per diem,1911.48,1911.48,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Aetna MGG,Aetna MGG,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,BCBS,BCBS,1911.48,,,,,,,per diem,1911.48,1911.48,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,BCBS MGG,BCBS MGG,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Cigna,Cigna,1911.48,,,,,,,per diem,1911.48,1911.48,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Cigna MGG,Cigna MGG,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Humana,Humana,1911.48,,,,,,,per diem,1911.48,1911.48,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Humana MGG,Humana MGG,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Optum VA,Optum VA,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,UHC,UHC,1911.48,,,,,,,per diem,1911.48,1911.48,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,UHC MGG,UHC MGG,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,VA,VA,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Wellcare MGG,Wellcare MGG,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Bright Health - commercial,Bright Health - commercial,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,62270,CPT,,,,Inpatient,,,1911.48,1911.48,Bright Health MGG,Bright Health MGG,1911.48,,,,,,,case rate,1911.48,1911.48,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Aetna,Aetna,740.52,,,,,,,per diem,740.52,740.52,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Aetna MGG,Aetna MGG,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,BCBS,BCBS,740.52,,,,,,,per diem,740.52,740.52,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,BCBS MGG,BCBS MGG,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Cigna,Cigna,740.52,,,,,,,per diem,740.52,740.52,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Cigna MGG,Cigna MGG,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Humana,Humana,740.52,,,,,,,per diem,740.52,740.52,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Humana MGG,Humana MGG,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Optum VA,Optum VA,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,UHC,UHC,740.52,,,,,,,per diem,740.52,740.52,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,UHC MGG,UHC MGG,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,VA,VA,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Wellcare MGG,Wellcare MGG,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Bright Health - commercial,Bright Health - commercial,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,62272,CPT,,,,Inpatient,,,740.52,740.52,Bright Health MGG,Bright Health MGG,740.52,,,,,,,case rate,740.52,740.52,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Aetna,Aetna,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Aetna MGG,Aetna MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,BCBS,BCBS,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,BCBS MGG,BCBS MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Cigna,Cigna,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Cigna MGG,Cigna MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Humana,Humana,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Humana MGG,Humana MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Optum VA,Optum VA,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,UHC,UHC,216.24,,,,,,,per diem,216.24,216.24,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,UHC MGG,UHC MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,VA,VA,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Wellcare MGG,Wellcare MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Bright Health - commercial,Bright Health - commercial,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,19030,CPT,,,,Inpatient,,,216.24,216.24,Bright Health MGG,Bright Health MGG,216.24,,,,,,,case rate,216.24,216.24,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Aetna,Aetna,2638.74,,,,,,,per diem,2638.74,2638.74,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Aetna MGG,Aetna MGG,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,BCBS,BCBS,2638.74,,,,,,,per diem,2638.74,2638.74,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,BCBS MGG,BCBS MGG,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Cigna,Cigna,2638.74,,,,,,,per diem,2638.74,2638.74,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Cigna MGG,Cigna MGG,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Humana,Humana,2638.74,,,,,,,per diem,2638.74,2638.74,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Humana MGG,Humana MGG,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Optum VA,Optum VA,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,UHC,UHC,2638.74,,,,,,,per diem,2638.74,2638.74,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,UHC MGG,UHC MGG,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,VA,VA,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Wellcare MGG,Wellcare MGG,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Bright Health - commercial,Bright Health - commercial,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,50389,CPT,,,,Inpatient,,,2638.74,2638.74,Bright Health MGG,Bright Health MGG,2638.74,,,,,,,case rate,2638.74,2638.74,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Aetna,Aetna,2795.82,,,,,,,per diem,2795.82,2795.82,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Aetna MGG,Aetna MGG,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,BCBS,BCBS,2795.82,,,,,,,per diem,2795.82,2795.82,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,BCBS MGG,BCBS MGG,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Cigna,Cigna,2795.82,,,,,,,per diem,2795.82,2795.82,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Cigna MGG,Cigna MGG,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Humana,Humana,2795.82,,,,,,,per diem,2795.82,2795.82,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Humana MGG,Humana MGG,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Optum VA,Optum VA,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,UHC,UHC,2795.82,,,,,,,per diem,2795.82,2795.82,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,UHC MGG,UHC MGG,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,VA,VA,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Wellcare MGG,Wellcare MGG,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Bright Health - commercial,Bright Health - commercial,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,50395,CPT,,,,Inpatient,,,2795.82,2795.82,Bright Health MGG,Bright Health MGG,2795.82,,,,,,,case rate,2795.82,2795.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Aetna,Aetna,22175.82,,,,,,,per diem,22175.82,22175.82,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Aetna MGG,Aetna MGG,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,BCBS,BCBS,22175.82,,,,,,,per diem,22175.82,22175.82,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,BCBS MGG,BCBS MGG,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Cigna,Cigna,22175.82,,,,,,,per diem,22175.82,22175.82,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Cigna MGG,Cigna MGG,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Humana,Humana,22175.82,,,,,,,per diem,22175.82,22175.82,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Humana MGG,Humana MGG,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Optum VA,Optum VA,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,UHC,UHC,22175.82,,,,,,,per diem,22175.82,22175.82,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,UHC MGG,UHC MGG,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,VA,VA,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Wellcare MGG,Wellcare MGG,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Bright Health - commercial,Bright Health - commercial,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,50080,CPT,,,,Inpatient,,,22175.82,22175.82,Bright Health MGG,Bright Health MGG,22175.82,,,,,,,case rate,22175.82,22175.82,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Aetna,Aetna,15054.18,,,,,,,per diem,15054.18,15054.18,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Aetna MGG,Aetna MGG,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,BCBS,BCBS,15054.18,,,,,,,per diem,15054.18,15054.18,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,BCBS MGG,BCBS MGG,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Cigna,Cigna,15054.18,,,,,,,per diem,15054.18,15054.18,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Cigna MGG,Cigna MGG,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Humana,Humana,15054.18,,,,,,,per diem,15054.18,15054.18,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Humana MGG,Humana MGG,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Optum VA,Optum VA,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,UHC,UHC,15054.18,,,,,,,per diem,15054.18,15054.18,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,UHC MGG,UHC MGG,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,VA,VA,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Wellcare MGG,Wellcare MGG,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Bright Health - commercial,Bright Health - commercial,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,50081,CPT,,,,Inpatient,,,15054.18,15054.18,Bright Health MGG,Bright Health MGG,15054.18,,,,,,,case rate,15054.18,15054.18,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Aetna,Aetna,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Aetna MGG,Aetna MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,BCBS,BCBS,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,BCBS MGG,BCBS MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Cigna,Cigna,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Cigna MGG,Cigna MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Humana,Humana,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Humana MGG,Humana MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Optum VA,Optum VA,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,UHC,UHC,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,UHC MGG,UHC MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,VA,VA,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Wellcare MGG,Wellcare MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Bright Health - commercial,Bright Health - commercial,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,61626,CPT,,,,Inpatient,,,325.38,325.38,Bright Health MGG,Bright Health MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Aetna,Aetna,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Aetna MGG,Aetna MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,BCBS,BCBS,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,BCBS MGG,BCBS MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Cigna,Cigna,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Cigna MGG,Cigna MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Humana,Humana,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Humana MGG,Humana MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Optum VA,Optum VA,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,UHC,UHC,880.26,,,,,,,per diem,880.26,880.26,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,UHC MGG,UHC MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,VA,VA,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Wellcare MGG,Wellcare MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Bright Health - commercial,Bright Health - commercial,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,48400,CPT,,,,Inpatient,,,880.26,880.26,Bright Health MGG,Bright Health MGG,880.26,,,,,,,case rate,880.26,880.26,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Aetna,Aetna,1221.96,,,,,,,per diem,1221.96,1221.96,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Aetna MGG,Aetna MGG,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,BCBS,BCBS,1221.96,,,,,,,per diem,1221.96,1221.96,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,BCBS MGG,BCBS MGG,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Cigna,Cigna,1221.96,,,,,,,per diem,1221.96,1221.96,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Cigna MGG,Cigna MGG,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Humana,Humana,1221.96,,,,,,,per diem,1221.96,1221.96,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Humana MGG,Humana MGG,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Optum VA,Optum VA,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,UHC,UHC,1221.96,,,,,,,per diem,1221.96,1221.96,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,UHC MGG,UHC MGG,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,VA,VA,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Wellcare MGG,Wellcare MGG,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Bright Health - commercial,Bright Health - commercial,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,49082,CPT,,,,Inpatient,,,1221.96,1221.96,Bright Health MGG,Bright Health MGG,1221.96,,,,,,,case rate,1221.96,1221.96,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Aetna,Aetna,2670,,,,,,,per diem,2670,2670,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Aetna MGG,Aetna MGG,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,BCBS,BCBS,2670,,,,,,,per diem,2670,2670,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,BCBS MGG,BCBS MGG,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Cigna,Cigna,2670,,,,,,,per diem,2670,2670,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Cigna MGG,Cigna MGG,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Humana,Humana,2670,,,,,,,per diem,2670,2670,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Humana MGG,Humana MGG,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Optum VA,Optum VA,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,UHC,UHC,2670,,,,,,,per diem,2670,2670,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,UHC MGG,UHC MGG,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,VA,VA,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Wellcare MGG,Wellcare MGG,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Bright Health - commercial,Bright Health - commercial,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,49083,CPT,,,,Inpatient,,,2670,2670,Bright Health MGG,Bright Health MGG,2670,,,,,,,case rate,2670,2670,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Aetna,Aetna,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Aetna MGG,Aetna MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,BCBS,BCBS,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,BCBS MGG,BCBS MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Cigna,Cigna,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Cigna MGG,Cigna MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Humana,Humana,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Humana MGG,Humana MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Optum VA,Optum VA,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,UHC,UHC,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,UHC MGG,UHC MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,VA,VA,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Wellcare MGG,Wellcare MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Bright Health - commercial,Bright Health - commercial,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,45000,CPT,,,,Inpatient,,,1696.26,1696.26,Bright Health MGG,Bright Health MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Aetna,Aetna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Aetna MGG,Aetna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,BCBS,BCBS,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,BCBS MGG,BCBS MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Cigna,Cigna,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Cigna MGG,Cigna MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Humana,Humana,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Humana MGG,Humana MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Optum VA,Optum VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,UHC,UHC,797.64,,,,,,,per diem,797.64,797.64,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,UHC MGG,UHC MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,VA,VA,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Wellcare MGG,Wellcare MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Bright Health - commercial,Bright Health - commercial,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,33011,CPT,,,,Inpatient,,,797.64,797.64,Bright Health MGG,Bright Health MGG,797.64,,,,,,,case rate,797.64,797.64,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Aetna,Aetna,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Aetna MGG,Aetna MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,BCBS,BCBS,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,BCBS MGG,BCBS MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Cigna,Cigna,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Cigna MGG,Cigna MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Humana,Humana,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Humana MGG,Humana MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Optum VA,Optum VA,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,UHC,UHC,972.06,,,,,,,per diem,972.06,972.06,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,UHC MGG,UHC MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,VA,VA,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Wellcare MGG,Wellcare MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Bright Health - commercial,Bright Health - commercial,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,33010,CPT,,,,Inpatient,,,972.06,972.06,Bright Health MGG,Bright Health MGG,972.06,,,,,,,case rate,972.06,972.06,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Aetna,Aetna,13828.14,,,,,,,per diem,13828.14,13828.14,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Aetna MGG,Aetna MGG,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,BCBS,BCBS,13828.14,,,,,,,per diem,13828.14,13828.14,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,BCBS MGG,BCBS MGG,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Cigna,Cigna,13828.14,,,,,,,per diem,13828.14,13828.14,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Cigna MGG,Cigna MGG,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Humana,Humana,13828.14,,,,,,,per diem,13828.14,13828.14,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Humana MGG,Humana MGG,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Optum VA,Optum VA,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,UHC,UHC,13828.14,,,,,,,per diem,13828.14,13828.14,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,UHC MGG,UHC MGG,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,VA,VA,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Wellcare MGG,Wellcare MGG,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Bright Health - commercial,Bright Health - commercial,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,49421,CPT,,,,Inpatient,,,13828.14,13828.14,Bright Health MGG,Bright Health MGG,13828.14,,,,,,,case rate,13828.14,13828.14,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Aetna,Aetna,10708.98,,,,,,,per diem,10708.98,10708.98,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Aetna MGG,Aetna MGG,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,BCBS,BCBS,10708.98,,,,,,,per diem,10708.98,10708.98,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,BCBS MGG,BCBS MGG,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Cigna,Cigna,10708.98,,,,,,,per diem,10708.98,10708.98,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Cigna MGG,Cigna MGG,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Humana,Humana,10708.98,,,,,,,per diem,10708.98,10708.98,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Humana MGG,Humana MGG,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Optum VA,Optum VA,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,UHC,UHC,10708.98,,,,,,,per diem,10708.98,10708.98,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,UHC MGG,UHC MGG,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,VA,VA,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Wellcare MGG,Wellcare MGG,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Bright Health - commercial,Bright Health - commercial,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,49419,CPT,,,,Inpatient,,,10708.98,10708.98,Bright Health MGG,Bright Health MGG,10708.98,,,,,,,case rate,10708.98,10708.98,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Aetna,Aetna,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Aetna MGG,Aetna MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,BCBS,BCBS,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,BCBS MGG,BCBS MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Cigna,Cigna,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Cigna MGG,Cigna MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Humana,Humana,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Humana MGG,Humana MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Optum VA,Optum VA,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,UHC,UHC,2479.62,,,,,,,per diem,2479.62,2479.62,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,UHC MGG,UHC MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,VA,VA,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Wellcare MGG,Wellcare MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Bright Health - commercial,Bright Health - commercial,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,49427,CPT,,,,Inpatient,,,2479.62,2479.62,Bright Health MGG,Bright Health MGG,2479.62,,,,,,,case rate,2479.62,2479.62,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Aetna,Aetna,1024.77,,,,,,,per diem,1024.77,1024.77,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Aetna MGG,Aetna MGG,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,BCBS,BCBS,1024.77,,,,,,,per diem,1024.77,1024.77,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,BCBS MGG,BCBS MGG,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Cigna,Cigna,1024.77,,,,,,,per diem,1024.77,1024.77,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Cigna MGG,Cigna MGG,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Humana,Humana,1024.77,,,,,,,per diem,1024.77,1024.77,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Humana MGG,Humana MGG,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Optum VA,Optum VA,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,UHC,UHC,1024.77,,,,,,,per diem,1024.77,1024.77,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,UHC MGG,UHC MGG,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,VA,VA,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Wellcare MGG,Wellcare MGG,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Bright Health - commercial,Bright Health - commercial,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,49084,CPT,,,,Inpatient,,,1024.77,1024.77,Bright Health MGG,Bright Health MGG,1024.77,,,,,,,case rate,1024.77,1024.77,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Aetna,Aetna,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Aetna MGG,Aetna MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,BCBS,BCBS,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,BCBS MGG,BCBS MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Cigna,Cigna,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Cigna MGG,Cigna MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Humana,Humana,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Humana MGG,Humana MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Optum VA,Optum VA,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,UHC,UHC,454.92,,,,,,,per diem,454.92,454.92,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,UHC MGG,UHC MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,VA,VA,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Wellcare MGG,Wellcare MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Bright Health - commercial,Bright Health - commercial,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,49400,CPT,,,,Inpatient,,,454.92,454.92,Bright Health MGG,Bright Health MGG,454.92,,,,,,,case rate,454.92,454.92,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Aetna,Aetna,10422.36,,,,,,,per diem,10422.36,10422.36,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Aetna MGG,Aetna MGG,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,BCBS,BCBS,10422.36,,,,,,,per diem,10422.36,10422.36,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,BCBS MGG,BCBS MGG,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Cigna,Cigna,10422.36,,,,,,,per diem,10422.36,10422.36,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Cigna MGG,Cigna MGG,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Humana,Humana,10422.36,,,,,,,per diem,10422.36,10422.36,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Humana MGG,Humana MGG,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Optum VA,Optum VA,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,UHC,UHC,10422.36,,,,,,,per diem,10422.36,10422.36,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,UHC MGG,UHC MGG,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,VA,VA,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Wellcare MGG,Wellcare MGG,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Bright Health - commercial,Bright Health - commercial,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,34800,CPT,,,,Inpatient,,,10422.36,10422.36,Bright Health MGG,Bright Health MGG,10422.36,,,,,,,case rate,10422.36,10422.36,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Aetna,Aetna,2956.98,,,,,,,per diem,2956.98,2956.98,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Aetna MGG,Aetna MGG,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,BCBS,BCBS,2956.98,,,,,,,per diem,2956.98,2956.98,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,BCBS MGG,BCBS MGG,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Cigna,Cigna,2956.98,,,,,,,per diem,2956.98,2956.98,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Cigna MGG,Cigna MGG,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Humana,Humana,2956.98,,,,,,,per diem,2956.98,2956.98,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Humana MGG,Humana MGG,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Optum VA,Optum VA,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,UHC,UHC,2956.98,,,,,,,per diem,2956.98,2956.98,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,UHC MGG,UHC MGG,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,VA,VA,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Wellcare MGG,Wellcare MGG,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Bright Health - commercial,Bright Health - commercial,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,43752,CPT,,,,Inpatient,,,2956.98,2956.98,Bright Health MGG,Bright Health MGG,2956.98,,,,,,,case rate,2956.98,2956.98,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Aetna,Aetna,5617.14,,,,,,,per diem,5617.14,5617.14,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Aetna MGG,Aetna MGG,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,BCBS,BCBS,5617.14,,,,,,,per diem,5617.14,5617.14,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,BCBS MGG,BCBS MGG,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Cigna,Cigna,5617.14,,,,,,,per diem,5617.14,5617.14,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Cigna MGG,Cigna MGG,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Humana,Humana,5617.14,,,,,,,per diem,5617.14,5617.14,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Humana MGG,Humana MGG,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Optum VA,Optum VA,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,UHC,UHC,5617.14,,,,,,,per diem,5617.14,5617.14,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,UHC MGG,UHC MGG,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,VA,VA,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Wellcare MGG,Wellcare MGG,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Bright Health - commercial,Bright Health - commercial,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,32553,CPT,,,,Inpatient,,,5617.14,5617.14,Bright Health MGG,Bright Health MGG,5617.14,,,,,,,case rate,5617.14,5617.14,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Aetna,Aetna,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Aetna MGG,Aetna MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,BCBS,BCBS,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,BCBS MGG,BCBS MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Cigna,Cigna,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Cigna MGG,Cigna MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Humana,Humana,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Humana MGG,Humana MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Optum VA,Optum VA,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,UHC,UHC,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,UHC MGG,UHC MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,VA,VA,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Wellcare MGG,Wellcare MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Bright Health - commercial,Bright Health - commercial,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Bright Health MGG,Bright Health MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Aetna,Aetna,768.06,,,,,,,per diem,768.06,768.06,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Aetna MGG,Aetna MGG,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,BCBS,BCBS,768.06,,,,,,,per diem,768.06,768.06,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,BCBS MGG,BCBS MGG,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Cigna,Cigna,768.06,,,,,,,per diem,768.06,768.06,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Cigna MGG,Cigna MGG,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Humana,Humana,768.06,,,,,,,per diem,768.06,768.06,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Humana MGG,Humana MGG,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Optum VA,Optum VA,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,UHC,UHC,768.06,,,,,,,per diem,768.06,768.06,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,UHC MGG,UHC MGG,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,VA,VA,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Wellcare MGG,Wellcare MGG,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Bright Health - commercial,Bright Health - commercial,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,36481,CPT,,,,Inpatient,,,768.06,768.06,Bright Health MGG,Bright Health MGG,768.06,,,,,,,case rate,768.06,768.06,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Aetna,Aetna,1015.92,,,,,,,per diem,1015.92,1015.92,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Aetna MGG,Aetna MGG,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,BCBS,BCBS,1015.92,,,,,,,per diem,1015.92,1015.92,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,BCBS MGG,BCBS MGG,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Cigna,Cigna,1015.92,,,,,,,per diem,1015.92,1015.92,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Cigna MGG,Cigna MGG,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Humana,Humana,1015.92,,,,,,,per diem,1015.92,1015.92,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Humana MGG,Humana MGG,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Optum VA,Optum VA,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,UHC,UHC,1015.92,,,,,,,per diem,1015.92,1015.92,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,UHC MGG,UHC MGG,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,VA,VA,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Wellcare MGG,Wellcare MGG,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Bright Health - commercial,Bright Health - commercial,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,36002,CPT,,,,Inpatient,,,1015.92,1015.92,Bright Health MGG,Bright Health MGG,1015.92,,,,,,,case rate,1015.92,1015.92,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Aetna,Aetna,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Aetna MGG,Aetna MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,BCBS,BCBS,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,BCBS MGG,BCBS MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Cigna,Cigna,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Cigna MGG,Cigna MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Humana,Humana,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Humana MGG,Humana MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Optum VA,Optum VA,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,UHC,UHC,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,UHC MGG,UHC MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,VA,VA,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Wellcare MGG,Wellcare MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Bright Health - commercial,Bright Health - commercial,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,35472,CPT,,,,Inpatient,,,820.08,820.08,Bright Health MGG,Bright Health MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Aetna,Aetna,13669.02,,,,,,,per diem,13669.02,13669.02,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Aetna MGG,Aetna MGG,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,BCBS,BCBS,13669.02,,,,,,,per diem,13669.02,13669.02,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,BCBS MGG,BCBS MGG,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Cigna,Cigna,13669.02,,,,,,,per diem,13669.02,13669.02,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Cigna MGG,Cigna MGG,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Humana,Humana,13669.02,,,,,,,per diem,13669.02,13669.02,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Humana MGG,Humana MGG,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Optum VA,Optum VA,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,UHC,UHC,13669.02,,,,,,,per diem,13669.02,13669.02,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,UHC MGG,UHC MGG,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,VA,VA,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Wellcare MGG,Wellcare MGG,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Bright Health - commercial,Bright Health - commercial,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,35475,CPT,,,,Inpatient,,,13669.02,13669.02,Bright Health MGG,Bright Health MGG,13669.02,,,,,,,case rate,13669.02,13669.02,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Aetna,Aetna,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Aetna MGG,Aetna MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,BCBS,BCBS,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,BCBS MGG,BCBS MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Cigna,Cigna,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Cigna MGG,Cigna MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Humana,Humana,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Humana MGG,Humana MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Optum VA,Optum VA,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,UHC,UHC,683.4,,,,,,,per diem,683.4,683.4,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,UHC MGG,UHC MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,VA,VA,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Wellcare MGG,Wellcare MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Bright Health - commercial,Bright Health - commercial,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,35471,CPT,,,,Inpatient,,,683.4,683.4,Bright Health MGG,Bright Health MGG,683.4,,,,,,,case rate,683.4,683.4,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Aetna,Aetna,7048.2,,,,,,,per diem,7048.2,7048.2,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Aetna MGG,Aetna MGG,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,BCBS,BCBS,7048.2,,,,,,,per diem,7048.2,7048.2,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,BCBS MGG,BCBS MGG,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Cigna,Cigna,7048.2,,,,,,,per diem,7048.2,7048.2,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Cigna MGG,Cigna MGG,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Humana,Humana,7048.2,,,,,,,per diem,7048.2,7048.2,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Humana MGG,Humana MGG,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Optum VA,Optum VA,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,UHC,UHC,7048.2,,,,,,,per diem,7048.2,7048.2,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,UHC MGG,UHC MGG,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,VA,VA,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Wellcare MGG,Wellcare MGG,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Bright Health - commercial,Bright Health - commercial,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,35476,CPT,,,,Inpatient,,,7048.2,7048.2,Bright Health MGG,Bright Health MGG,7048.2,,,,,,,case rate,7048.2,7048.2,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Aetna,Aetna,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Aetna MGG,Aetna MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,BCBS,BCBS,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,BCBS MGG,BCBS MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Cigna,Cigna,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Cigna MGG,Cigna MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Humana,Humana,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Humana MGG,Humana MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Optum VA,Optum VA,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,UHC,UHC,1696.26,,,,,,,per diem,1696.26,1696.26,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,UHC MGG,UHC MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,VA,VA,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Wellcare MGG,Wellcare MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Bright Health - commercial,Bright Health - commercial,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,45020,CPT,,,,Inpatient,,,1696.26,1696.26,Bright Health MGG,Bright Health MGG,1696.26,,,,,,,case rate,1696.26,1696.26,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Aetna,Aetna,9847.08,,,,,,,per diem,9847.08,9847.08,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Aetna MGG,Aetna MGG,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,BCBS,BCBS,9847.08,,,,,,,per diem,9847.08,9847.08,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,BCBS MGG,BCBS MGG,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Cigna,Cigna,9847.08,,,,,,,per diem,9847.08,9847.08,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Cigna MGG,Cigna MGG,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Humana,Humana,9847.08,,,,,,,per diem,9847.08,9847.08,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Humana MGG,Humana MGG,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Optum VA,Optum VA,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,UHC,UHC,9847.08,,,,,,,per diem,9847.08,9847.08,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,UHC MGG,UHC MGG,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,VA,VA,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Wellcare MGG,Wellcare MGG,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Bright Health - commercial,Bright Health - commercial,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,23333,CPT,,,,Inpatient,,,9847.08,9847.08,Bright Health MGG,Bright Health MGG,9847.08,,,,,,,case rate,9847.08,9847.08,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Aetna,Aetna,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Aetna MGG,Aetna MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,BCBS,BCBS,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,BCBS MGG,BCBS MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Cigna,Cigna,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Cigna MGG,Cigna MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Humana,Humana,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Humana MGG,Humana MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Optum VA,Optum VA,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,UHC,UHC,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,UHC MGG,UHC MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,VA,VA,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Wellcare MGG,Wellcare MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Bright Health - commercial,Bright Health - commercial,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,36596,CPT,,,,Inpatient,,,11418.9,11418.9,Bright Health MGG,Bright Health MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Aetna,Aetna,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Aetna MGG,Aetna MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,BCBS,BCBS,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,BCBS MGG,BCBS MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Cigna,Cigna,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Cigna MGG,Cigna MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Humana,Humana,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Humana MGG,Humana MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Optum VA,Optum VA,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,UHC,UHC,11418.9,,,,,,,per diem,11418.9,11418.9,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,UHC MGG,UHC MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,VA,VA,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Wellcare MGG,Wellcare MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Bright Health - commercial,Bright Health - commercial,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,36595,CPT,,,,Inpatient,,,11418.9,11418.9,Bright Health MGG,Bright Health MGG,11418.9,,,,,,,case rate,11418.9,11418.9,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Aetna,Aetna,9382.98,,,,,,,per diem,9382.98,9382.98,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Aetna MGG,Aetna MGG,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,BCBS,BCBS,9382.98,,,,,,,per diem,9382.98,9382.98,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,BCBS MGG,BCBS MGG,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Cigna,Cigna,9382.98,,,,,,,per diem,9382.98,9382.98,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Cigna MGG,Cigna MGG,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Humana,Humana,9382.98,,,,,,,per diem,9382.98,9382.98,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Humana MGG,Humana MGG,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Optum VA,Optum VA,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,UHC,UHC,9382.98,,,,,,,per diem,9382.98,9382.98,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,UHC MGG,UHC MGG,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,VA,VA,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Wellcare MGG,Wellcare MGG,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Bright Health - commercial,Bright Health - commercial,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,49422,CPT,,,,Inpatient,,,9382.98,9382.98,Bright Health MGG,Bright Health MGG,9382.98,,,,,,,case rate,9382.98,9382.98,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Aetna,Aetna,1737.41,,,,,,,per diem,1737.41,1737.41,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Aetna MGG,Aetna MGG,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,BCBS,BCBS,1737.41,,,,,,,per diem,1737.41,1737.41,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,BCBS MGG,BCBS MGG,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Cigna,Cigna,1737.41,,,,,,,per diem,1737.41,1737.41,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Cigna MGG,Cigna MGG,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Humana,Humana,1737.41,,,,,,,per diem,1737.41,1737.41,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Humana MGG,Humana MGG,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Optum VA,Optum VA,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,UHC,UHC,1737.41,,,,,,,per diem,1737.41,1737.41,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,UHC MGG,UHC MGG,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,VA,VA,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Wellcare MGG,Wellcare MGG,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Bright Health - commercial,Bright Health - commercial,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,36589,CPT,,,,Inpatient,,,1737.41,1737.41,Bright Health MGG,Bright Health MGG,1737.41,,,,,,,case rate,1737.41,1737.41,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Aetna,Aetna,1510.62,,,,,,,per diem,1510.62,1510.62,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Aetna MGG,Aetna MGG,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,BCBS,BCBS,1510.62,,,,,,,per diem,1510.62,1510.62,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,BCBS MGG,BCBS MGG,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Cigna,Cigna,1510.62,,,,,,,per diem,1510.62,1510.62,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Cigna MGG,Cigna MGG,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Humana,Humana,1510.62,,,,,,,per diem,1510.62,1510.62,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Humana MGG,Humana MGG,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Optum VA,Optum VA,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,UHC,UHC,1510.62,,,,,,,per diem,1510.62,1510.62,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,UHC MGG,UHC MGG,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,VA,VA,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Wellcare MGG,Wellcare MGG,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Bright Health - commercial,Bright Health - commercial,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,36590,CPT,,,,Inpatient,,,1510.62,1510.62,Bright Health MGG,Bright Health MGG,1510.62,,,,,,,case rate,1510.62,1510.62,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Aetna,Aetna,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Aetna MGG,Aetna MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,BCBS,BCBS,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,BCBS MGG,BCBS MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Cigna,Cigna,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Cigna MGG,Cigna MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Humana,Humana,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Humana MGG,Humana MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Optum VA,Optum VA,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,UHC,UHC,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,UHC MGG,UHC MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,VA,VA,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Wellcare MGG,Wellcare MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Bright Health - commercial,Bright Health - commercial,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,32552,CPT,,,,Inpatient,,,590.58,590.58,Bright Health MGG,Bright Health MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Aetna,Aetna,1520.23,,,,,,,per diem,1520.23,1520.23,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Aetna MGG,Aetna MGG,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,BCBS,BCBS,1520.23,,,,,,,per diem,1520.23,1520.23,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,BCBS MGG,BCBS MGG,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Cigna,Cigna,1520.23,,,,,,,per diem,1520.23,1520.23,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Cigna MGG,Cigna MGG,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Humana,Humana,1520.23,,,,,,,per diem,1520.23,1520.23,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Humana MGG,Humana MGG,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Optum VA,Optum VA,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,UHC,UHC,1520.23,,,,,,,per diem,1520.23,1520.23,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,UHC MGG,UHC MGG,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,VA,VA,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Wellcare MGG,Wellcare MGG,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Bright Health - commercial,Bright Health - commercial,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,50390,CPT,,,,Inpatient,,,1520.23,1520.23,Bright Health MGG,Bright Health MGG,1520.23,,,,,,,case rate,1520.23,1520.23,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Aetna,Aetna,2547.58,,,,,,,per diem,2547.58,2547.58,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Aetna MGG,Aetna MGG,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,BCBS,BCBS,2547.58,,,,,,,per diem,2547.58,2547.58,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,BCBS MGG,BCBS MGG,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Cigna,Cigna,2547.58,,,,,,,per diem,2547.58,2547.58,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Cigna MGG,Cigna MGG,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Humana,Humana,2547.58,,,,,,,per diem,2547.58,2547.58,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Humana MGG,Humana MGG,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Optum VA,Optum VA,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,UHC,UHC,2547.58,,,,,,,per diem,2547.58,2547.58,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,UHC MGG,UHC MGG,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,VA,VA,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Wellcare MGG,Wellcare MGG,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Bright Health - commercial,Bright Health - commercial,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,50553,CPT,,,,Inpatient,,,2547.58,2547.58,Bright Health MGG,Bright Health MGG,2547.58,,,,,,,case rate,2547.58,2547.58,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Aetna,Aetna,596.11,,,,,,,per diem,596.11,596.11,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Aetna MGG,Aetna MGG,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,BCBS,BCBS,596.11,,,,,,,per diem,596.11,596.11,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,BCBS MGG,BCBS MGG,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Cigna,Cigna,596.11,,,,,,,per diem,596.11,596.11,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Cigna MGG,Cigna MGG,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Humana,Humana,596.11,,,,,,,per diem,596.11,596.11,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Humana MGG,Humana MGG,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Optum VA,Optum VA,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,UHC,UHC,596.11,,,,,,,per diem,596.11,596.11,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,UHC MGG,UHC MGG,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,VA,VA,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Wellcare MGG,Wellcare MGG,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Bright Health - commercial,Bright Health - commercial,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,50391,CPT,,,,Inpatient,,,596.11,596.11,Bright Health MGG,Bright Health MGG,596.11,,,,,,,case rate,596.11,596.11,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Aetna,Aetna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Aetna MGG,Aetna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,BCBS,BCBS,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,BCBS MGG,BCBS MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Cigna,Cigna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Cigna MGG,Cigna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Humana,Humana,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Humana MGG,Humana MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Optum VA,Optum VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,UHC,UHC,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,UHC MGG,UHC MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,VA,VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Wellcare MGG,Wellcare MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Bright Health - commercial,Bright Health - commercial,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,36575,CPT,,,,Inpatient,,,493.68,493.68,Bright Health MGG,Bright Health MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Aetna,Aetna,1024.08,,,,,,,per diem,1024.08,1024.08,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Aetna MGG,Aetna MGG,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,BCBS,BCBS,1024.08,,,,,,,per diem,1024.08,1024.08,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,BCBS MGG,BCBS MGG,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Cigna,Cigna,1024.08,,,,,,,per diem,1024.08,1024.08,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Cigna MGG,Cigna MGG,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Humana,Humana,1024.08,,,,,,,per diem,1024.08,1024.08,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Humana MGG,Humana MGG,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Optum VA,Optum VA,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,UHC,UHC,1024.08,,,,,,,per diem,1024.08,1024.08,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,UHC MGG,UHC MGG,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,VA,VA,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Wellcare MGG,Wellcare MGG,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Bright Health - commercial,Bright Health - commercial,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,36576,CPT,,,,Inpatient,,,1024.08,1024.08,Bright Health MGG,Bright Health MGG,1024.08,,,,,,,case rate,1024.08,1024.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Aetna,Aetna,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Aetna MGG,Aetna MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,BCBS,BCBS,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,BCBS MGG,BCBS MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Cigna,Cigna,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Cigna MGG,Cigna MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Humana,Humana,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Humana MGG,Humana MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Optum VA,Optum VA,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,UHC,UHC,2401.08,,,,,,,per diem,2401.08,2401.08,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,UHC MGG,UHC MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,VA,VA,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Wellcare MGG,Wellcare MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Bright Health - commercial,Bright Health - commercial,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,36585,CPT,,,,Inpatient,,,2401.08,2401.08,Bright Health MGG,Bright Health MGG,2401.08,,,,,,,case rate,2401.08,2401.08,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,36580,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Aetna,Aetna,881.28,,,,,,,per diem,881.28,881.28,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Aetna MGG,Aetna MGG,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,BCBS,BCBS,881.28,,,,,,,per diem,881.28,881.28,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,BCBS MGG,BCBS MGG,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Cigna,Cigna,881.28,,,,,,,per diem,881.28,881.28,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Cigna MGG,Cigna MGG,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Humana,Humana,881.28,,,,,,,per diem,881.28,881.28,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Humana MGG,Humana MGG,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Optum VA,Optum VA,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,UHC,UHC,881.28,,,,,,,per diem,881.28,881.28,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,UHC MGG,UHC MGG,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,VA,VA,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Wellcare MGG,Wellcare MGG,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Bright Health - commercial,Bright Health - commercial,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,36584,CPT,,,,Inpatient,,,881.28,881.28,Bright Health MGG,Bright Health MGG,881.28,,,,,,,case rate,881.28,881.28,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Aetna,Aetna,4772.16,,,,,,,per diem,4772.16,4772.16,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Aetna MGG,Aetna MGG,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,BCBS,BCBS,4772.16,,,,,,,per diem,4772.16,4772.16,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,BCBS MGG,BCBS MGG,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Cigna,Cigna,4772.16,,,,,,,per diem,4772.16,4772.16,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Cigna MGG,Cigna MGG,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Humana,Humana,4772.16,,,,,,,per diem,4772.16,4772.16,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Humana MGG,Humana MGG,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Optum VA,Optum VA,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,UHC,UHC,4772.16,,,,,,,per diem,4772.16,4772.16,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,UHC MGG,UHC MGG,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,VA,VA,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Wellcare MGG,Wellcare MGG,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Bright Health - commercial,Bright Health - commercial,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,36581,CPT,,,,Inpatient,,,4772.16,4772.16,Bright Health MGG,Bright Health MGG,4772.16,,,,,,,case rate,4772.16,4772.16,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Aetna,Aetna,2882.52,,,,,,,per diem,2882.52,2882.52,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Aetna MGG,Aetna MGG,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,BCBS,BCBS,2882.52,,,,,,,per diem,2882.52,2882.52,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,BCBS MGG,BCBS MGG,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Cigna,Cigna,2882.52,,,,,,,per diem,2882.52,2882.52,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Cigna MGG,Cigna MGG,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Humana,Humana,2882.52,,,,,,,per diem,2882.52,2882.52,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Humana MGG,Humana MGG,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Optum VA,Optum VA,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,UHC,UHC,2882.52,,,,,,,per diem,2882.52,2882.52,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,UHC MGG,UHC MGG,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,VA,VA,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Wellcare MGG,Wellcare MGG,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Bright Health - commercial,Bright Health - commercial,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,36582,CPT,,,,Inpatient,,,2882.52,2882.52,Bright Health MGG,Bright Health MGG,2882.52,,,,,,,case rate,2882.52,2882.52,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Aetna,Aetna,2404.14,,,,,,,per diem,2404.14,2404.14,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Aetna MGG,Aetna MGG,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,BCBS,BCBS,2404.14,,,,,,,per diem,2404.14,2404.14,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,BCBS MGG,BCBS MGG,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Cigna,Cigna,2404.14,,,,,,,per diem,2404.14,2404.14,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Cigna MGG,Cigna MGG,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Humana,Humana,2404.14,,,,,,,per diem,2404.14,2404.14,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Humana MGG,Humana MGG,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Optum VA,Optum VA,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,UHC,UHC,2404.14,,,,,,,per diem,2404.14,2404.14,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,UHC MGG,UHC MGG,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,VA,VA,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Wellcare MGG,Wellcare MGG,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Bright Health - commercial,Bright Health - commercial,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,36583,CPT,,,,Inpatient,,,2404.14,2404.14,Bright Health MGG,Bright Health MGG,2404.14,,,,,,,case rate,2404.14,2404.14,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Aetna,Aetna,1303.56,,,,,,,per diem,1303.56,1303.56,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Aetna MGG,Aetna MGG,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,BCBS,BCBS,1303.56,,,,,,,per diem,1303.56,1303.56,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,BCBS MGG,BCBS MGG,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Cigna,Cigna,1303.56,,,,,,,per diem,1303.56,1303.56,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Cigna MGG,Cigna MGG,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Humana,Humana,1303.56,,,,,,,per diem,1303.56,1303.56,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Humana MGG,Humana MGG,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Optum VA,Optum VA,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,UHC,UHC,1303.56,,,,,,,per diem,1303.56,1303.56,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,UHC MGG,UHC MGG,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,VA,VA,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Wellcare MGG,Wellcare MGG,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Bright Health - commercial,Bright Health - commercial,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,36578,CPT,,,,Inpatient,,,1303.56,1303.56,Bright Health MGG,Bright Health MGG,1303.56,,,,,,,case rate,1303.56,1303.56,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Aetna,Aetna,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Aetna MGG,Aetna MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,BCBS,BCBS,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,BCBS MGG,BCBS MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Cigna,Cigna,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Cigna MGG,Cigna MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Humana,Humana,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Humana MGG,Humana MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Optum VA,Optum VA,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,UHC,UHC,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,UHC MGG,UHC MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,VA,VA,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Wellcare MGG,Wellcare MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Bright Health - commercial,Bright Health - commercial,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,37192,CPT,,,,Inpatient,,,3872.94,3872.94,Bright Health MGG,Bright Health MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Aetna,Aetna,978.18,,,,,,,per diem,978.18,978.18,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Aetna MGG,Aetna MGG,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,BCBS,BCBS,978.18,,,,,,,per diem,978.18,978.18,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,BCBS MGG,BCBS MGG,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Cigna,Cigna,978.18,,,,,,,per diem,978.18,978.18,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Cigna MGG,Cigna MGG,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Humana,Humana,978.18,,,,,,,per diem,978.18,978.18,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Humana MGG,Humana MGG,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Optum VA,Optum VA,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,UHC,UHC,978.18,,,,,,,per diem,978.18,978.18,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,UHC MGG,UHC MGG,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,VA,VA,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Wellcare MGG,Wellcare MGG,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Bright Health - commercial,Bright Health - commercial,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,36597,CPT,,,,Inpatient,,,978.18,978.18,Bright Health MGG,Bright Health MGG,978.18,,,,,,,case rate,978.18,978.18,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Aetna,Aetna,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Aetna MGG,Aetna MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,BCBS,BCBS,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,BCBS MGG,BCBS MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Cigna,Cigna,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Cigna MGG,Cigna MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Humana,Humana,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Humana MGG,Humana MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Optum VA,Optum VA,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,UHC,UHC,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,UHC MGG,UHC MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,VA,VA,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Wellcare MGG,Wellcare MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Bright Health - commercial,Bright Health - commercial,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,37193,CPT,,,,Inpatient,,,4733.82,4733.82,Bright Health MGG,Bright Health MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Aetna,Aetna,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Aetna MGG,Aetna MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,BCBS,BCBS,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,BCBS MGG,BCBS MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Cigna,Cigna,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Cigna MGG,Cigna MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Humana,Humana,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Humana MGG,Humana MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Optum VA,Optum VA,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,UHC,UHC,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,UHC MGG,UHC MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,VA,VA,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Wellcare MGG,Wellcare MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Bright Health - commercial,Bright Health - commercial,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,37225,CPT,,,,Inpatient,,,24671.76,24671.76,Bright Health MGG,Bright Health MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Aetna,Aetna,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Aetna MGG,Aetna MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,BCBS,BCBS,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,BCBS MGG,BCBS MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Cigna,Cigna,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Cigna MGG,Cigna MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Humana,Humana,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Humana MGG,Humana MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Optum VA,Optum VA,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,UHC,UHC,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,UHC MGG,UHC MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,VA,VA,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Wellcare MGG,Wellcare MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Bright Health - commercial,Bright Health - commercial,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,37227,CPT,,,,Inpatient,,,24671.76,24671.76,Bright Health MGG,Bright Health MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Aetna,Aetna,10261.2,,,,,,,per diem,10261.2,10261.2,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Aetna MGG,Aetna MGG,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,BCBS,BCBS,10261.2,,,,,,,per diem,10261.2,10261.2,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,BCBS MGG,BCBS MGG,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Cigna,Cigna,10261.2,,,,,,,per diem,10261.2,10261.2,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Cigna MGG,Cigna MGG,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Humana,Humana,10261.2,,,,,,,per diem,10261.2,10261.2,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Humana MGG,Humana MGG,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Optum VA,Optum VA,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,UHC,UHC,10261.2,,,,,,,per diem,10261.2,10261.2,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,UHC MGG,UHC MGG,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,VA,VA,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Wellcare MGG,Wellcare MGG,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Bright Health - commercial,Bright Health - commercial,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10261.2,10261.2,Bright Health MGG,Bright Health MGG,10261.2,,,,,,,case rate,10261.2,10261.2,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Aetna,Aetna,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Aetna MGG,Aetna MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,BCBS,BCBS,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,BCBS MGG,BCBS MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Cigna,Cigna,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Cigna MGG,Cigna MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Humana,Humana,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Humana MGG,Humana MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Optum VA,Optum VA,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,UHC,UHC,24671.76,,,,,,,per diem,24671.76,24671.76,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,UHC MGG,UHC MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,VA,VA,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Wellcare MGG,Wellcare MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Bright Health - commercial,Bright Health - commercial,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,37226,CPT,,,,Inpatient,,,24671.76,24671.76,Bright Health MGG,Bright Health MGG,24671.76,,,,,,,case rate,24671.76,24671.76,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna,Aetna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna MGG,Aetna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS,BCBS,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS MGG,BCBS MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna,Cigna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna MGG,Cigna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Humana,Humana,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Humana MGG,Humana MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Optum VA,Optum VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,UHC,UHC,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,UHC MGG,UHC MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,VA,VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Wellcare MGG,Wellcare MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health - commercial,Bright Health - commercial,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,37221,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health MGG,Bright Health MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna,Aetna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna MGG,Aetna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS,BCBS,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS MGG,BCBS MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna,Cigna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna MGG,Cigna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Humana,Humana,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Humana MGG,Humana MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Optum VA,Optum VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,UHC,UHC,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,UHC MGG,UHC MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,VA,VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Wellcare MGG,Wellcare MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health - commercial,Bright Health - commercial,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,37220,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health MGG,Bright Health MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna,Aetna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna MGG,Aetna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS,BCBS,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS MGG,BCBS MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna,Cigna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna MGG,Cigna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Humana,Humana,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Humana MGG,Humana MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Optum VA,Optum VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,UHC,UHC,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,UHC MGG,UHC MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,VA,VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Wellcare MGG,Wellcare MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health - commercial,Bright Health - commercial,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,37222,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health MGG,Bright Health MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna,Aetna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna MGG,Aetna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS,BCBS,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS MGG,BCBS MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna,Cigna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna MGG,Cigna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Humana,Humana,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Humana MGG,Humana MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Optum VA,Optum VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,UHC,UHC,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,UHC MGG,UHC MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,VA,VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Wellcare MGG,Wellcare MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health - commercial,Bright Health - commercial,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,37223,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health MGG,Bright Health MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna,Aetna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna MGG,Aetna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS,BCBS,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS MGG,BCBS MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna,Cigna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna MGG,Cigna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Humana,Humana,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Humana MGG,Humana MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Optum VA,Optum VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,UHC,UHC,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,UHC MGG,UHC MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,VA,VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Wellcare MGG,Wellcare MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health - commercial,Bright Health - commercial,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,37232,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health MGG,Bright Health MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Aetna,Aetna,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Aetna MGG,Aetna MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,BCBS,BCBS,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,BCBS MGG,BCBS MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Cigna,Cigna,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Cigna MGG,Cigna MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Humana,Humana,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Humana MGG,Humana MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Optum VA,Optum VA,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,UHC,UHC,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,UHC MGG,UHC MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,VA,VA,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Wellcare MGG,Wellcare MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Bright Health - commercial,Bright Health - commercial,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,37233,CPT,,,,Inpatient,,,24764.58,24764.58,Bright Health MGG,Bright Health MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Aetna,Aetna,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Aetna MGG,Aetna MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,BCBS,BCBS,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,BCBS MGG,BCBS MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Cigna,Cigna,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Cigna MGG,Cigna MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Humana,Humana,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Humana MGG,Humana MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Optum VA,Optum VA,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,UHC,UHC,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,UHC MGG,UHC MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,VA,VA,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Wellcare MGG,Wellcare MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Bright Health - commercial,Bright Health - commercial,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,37229,CPT,,,,Inpatient,,,24764.58,24764.58,Bright Health MGG,Bright Health MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Aetna,Aetna,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Aetna MGG,Aetna MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,BCBS,BCBS,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,BCBS MGG,BCBS MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Cigna,Cigna,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Cigna MGG,Cigna MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Humana,Humana,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Humana MGG,Humana MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Optum VA,Optum VA,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,UHC,UHC,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,UHC MGG,UHC MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,VA,VA,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Wellcare MGG,Wellcare MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Bright Health - commercial,Bright Health - commercial,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,37230,CPT,,,,Inpatient,,,24764.58,24764.58,Bright Health MGG,Bright Health MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna,Aetna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna MGG,Aetna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS,BCBS,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS MGG,BCBS MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna,Cigna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna MGG,Cigna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Humana,Humana,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Humana MGG,Humana MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Optum VA,Optum VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,UHC,UHC,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,UHC MGG,UHC MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,VA,VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Wellcare MGG,Wellcare MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health - commercial,Bright Health - commercial,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,37235,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health MGG,Bright Health MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Aetna,Aetna,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Aetna MGG,Aetna MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,BCBS,BCBS,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,BCBS MGG,BCBS MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Cigna,Cigna,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Cigna MGG,Cigna MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Humana,Humana,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Humana MGG,Humana MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Optum VA,Optum VA,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,UHC,UHC,24764.58,,,,,,,per diem,24764.58,24764.58,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,UHC MGG,UHC MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,VA,VA,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Wellcare MGG,Wellcare MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Bright Health - commercial,Bright Health - commercial,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,37231,CPT,,,,Inpatient,,,24764.58,24764.58,Bright Health MGG,Bright Health MGG,24764.58,,,,,,,case rate,24764.58,24764.58,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna,Aetna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Aetna MGG,Aetna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS,BCBS,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,BCBS MGG,BCBS MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna,Cigna,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Cigna MGG,Cigna MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Humana,Humana,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Humana MGG,Humana MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Optum VA,Optum VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,UHC,UHC,10287.72,,,,,,,per diem,10287.72,10287.72,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,UHC MGG,UHC MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,VA,VA,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Wellcare MGG,Wellcare MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health - commercial,Bright Health - commercial,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,37228,CPT,,,,Inpatient,,,10287.72,10287.72,Bright Health MGG,Bright Health MGG,10287.72,,,,,,,case rate,10287.72,10287.72,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Aetna,Aetna,44794.32,,,,,,,per diem,44794.32,44794.32,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Aetna MGG,Aetna MGG,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,BCBS,BCBS,44794.32,,,,,,,per diem,44794.32,44794.32,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,BCBS MGG,BCBS MGG,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Cigna,Cigna,44794.32,,,,,,,per diem,44794.32,44794.32,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Cigna MGG,Cigna MGG,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Humana,Humana,44794.32,,,,,,,per diem,44794.32,44794.32,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Humana MGG,Humana MGG,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Optum VA,Optum VA,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,UHC,UHC,44794.32,,,,,,,per diem,44794.32,44794.32,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,UHC MGG,UHC MGG,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,VA,VA,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Wellcare MGG,Wellcare MGG,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Bright Health - commercial,Bright Health - commercial,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,37183,CPT,,,,Inpatient,,,44794.32,44794.32,Bright Health MGG,Bright Health MGG,44794.32,,,,,,,case rate,44794.32,44794.32,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Aetna,Aetna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Aetna MGG,Aetna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,BCBS,BCBS,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,BCBS MGG,BCBS MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Cigna,Cigna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Cigna MGG,Cigna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Humana,Humana,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Humana MGG,Humana MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Optum VA,Optum VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,UHC,UHC,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,UHC MGG,UHC MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,VA,VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Wellcare MGG,Wellcare MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Bright Health - commercial,Bright Health - commercial,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,36471,CPT,,,,Inpatient,,,518.16,518.16,Bright Health MGG,Bright Health MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Aetna,Aetna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Aetna MGG,Aetna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,BCBS,BCBS,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,BCBS MGG,BCBS MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Cigna,Cigna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Cigna MGG,Cigna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Humana,Humana,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Humana MGG,Humana MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Optum VA,Optum VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,UHC,UHC,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,UHC MGG,UHC MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,VA,VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Wellcare MGG,Wellcare MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Bright Health - commercial,Bright Health - commercial,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,36470,CPT,,,,Inpatient,,,518.16,518.16,Bright Health MGG,Bright Health MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Aetna,Aetna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Aetna MGG,Aetna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,BCBS,BCBS,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,BCBS MGG,BCBS MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Cigna,Cigna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Cigna MGG,Cigna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Humana,Humana,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Humana MGG,Humana MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Optum VA,Optum VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,UHC,UHC,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,UHC MGG,UHC MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,VA,VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Wellcare MGG,Wellcare MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Bright Health - commercial,Bright Health - commercial,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Bright Health MGG,Bright Health MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Aetna,Aetna,1159.74,,,,,,,per diem,1159.74,1159.74,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Aetna MGG,Aetna MGG,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,BCBS,BCBS,1159.74,,,,,,,per diem,1159.74,1159.74,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,BCBS MGG,BCBS MGG,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Cigna,Cigna,1159.74,,,,,,,per diem,1159.74,1159.74,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Cigna MGG,Cigna MGG,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Humana,Humana,1159.74,,,,,,,per diem,1159.74,1159.74,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Humana MGG,Humana MGG,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Optum VA,Optum VA,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,UHC,UHC,1159.74,,,,,,,per diem,1159.74,1159.74,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,UHC MGG,UHC MGG,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,VA,VA,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Wellcare MGG,Wellcare MGG,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Bright Health - commercial,Bright Health - commercial,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,42550,CPT,,,,Inpatient,,,1159.74,1159.74,Bright Health MGG,Bright Health MGG,1159.74,,,,,,,case rate,1159.74,1159.74,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Aetna,Aetna,4497.18,,,,,,,per diem,4497.18,4497.18,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Aetna MGG,Aetna MGG,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,BCBS,BCBS,4497.18,,,,,,,per diem,4497.18,4497.18,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,BCBS MGG,BCBS MGG,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Cigna,Cigna,4497.18,,,,,,,per diem,4497.18,4497.18,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Cigna MGG,Cigna MGG,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Humana,Humana,4497.18,,,,,,,per diem,4497.18,4497.18,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Humana MGG,Humana MGG,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Optum VA,Optum VA,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,UHC,UHC,4497.18,,,,,,,per diem,4497.18,4497.18,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,UHC MGG,UHC MGG,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,VA,VA,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Wellcare MGG,Wellcare MGG,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Bright Health - commercial,Bright Health - commercial,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,20501,CPT,,,,Inpatient,,,4497.18,4497.18,Bright Health MGG,Bright Health MGG,4497.18,,,,,,,case rate,4497.18,4497.18,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Aetna,Aetna,704.82,,,,,,,per diem,704.82,704.82,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Aetna MGG,Aetna MGG,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,BCBS,BCBS,704.82,,,,,,,per diem,704.82,704.82,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,BCBS MGG,BCBS MGG,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Cigna,Cigna,704.82,,,,,,,per diem,704.82,704.82,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Cigna MGG,Cigna MGG,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Humana,Humana,704.82,,,,,,,per diem,704.82,704.82,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Humana MGG,Humana MGG,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Optum VA,Optum VA,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,UHC,UHC,704.82,,,,,,,per diem,704.82,704.82,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,UHC MGG,UHC MGG,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,VA,VA,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Wellcare MGG,Wellcare MGG,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Bright Health - commercial,Bright Health - commercial,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,20500,CPT,,,,Inpatient,,,704.82,704.82,Bright Health MGG,Bright Health MGG,704.82,,,,,,,case rate,704.82,704.82,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Aetna,Aetna,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Aetna MGG,Aetna MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,BCBS,BCBS,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,BCBS MGG,BCBS MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Cigna,Cigna,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Cigna MGG,Cigna MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Humana,Humana,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Humana MGG,Humana MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Optum VA,Optum VA,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,UHC,UHC,1110.78,,,,,,,per diem,1110.78,1110.78,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,UHC MGG,UHC MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,VA,VA,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Wellcare MGG,Wellcare MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Bright Health - commercial,Bright Health - commercial,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,44373,CPT,,,,Inpatient,,,1110.78,1110.78,Bright Health MGG,Bright Health MGG,1110.78,,,,,,,case rate,1110.78,1110.78,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Aetna,Aetna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Aetna MGG,Aetna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,BCBS,BCBS,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,BCBS MGG,BCBS MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Cigna,Cigna,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Cigna MGG,Cigna MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Humana,Humana,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Humana MGG,Humana MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Optum VA,Optum VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,UHC,UHC,518.16,,,,,,,per diem,518.16,518.16,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,UHC MGG,UHC MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,VA,VA,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Wellcare MGG,Wellcare MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Bright Health - commercial,Bright Health - commercial,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,36468,CPT,,,,Inpatient,,,518.16,518.16,Bright Health MGG,Bright Health MGG,518.16,,,,,,,case rate,518.16,518.16,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Aetna,Aetna,967.98,,,,,,,per diem,967.98,967.98,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Aetna MGG,Aetna MGG,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,BCBS,BCBS,967.98,,,,,,,per diem,967.98,967.98,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,BCBS MGG,BCBS MGG,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Cigna,Cigna,967.98,,,,,,,per diem,967.98,967.98,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Cigna MGG,Cigna MGG,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Humana,Humana,967.98,,,,,,,per diem,967.98,967.98,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Humana MGG,Humana MGG,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Optum VA,Optum VA,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,UHC,UHC,967.98,,,,,,,per diem,967.98,967.98,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,UHC MGG,UHC MGG,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,VA,VA,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Wellcare MGG,Wellcare MGG,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Bright Health - commercial,Bright Health - commercial,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,62294,CPT,,,,Inpatient,,,967.98,967.98,Bright Health MGG,Bright Health MGG,967.98,,,,,,,case rate,967.98,967.98,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Aetna,Aetna,1810.5,,,,,,,per diem,1810.5,1810.5,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Aetna MGG,Aetna MGG,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,BCBS,BCBS,1810.5,,,,,,,per diem,1810.5,1810.5,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,BCBS MGG,BCBS MGG,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Cigna,Cigna,1810.5,,,,,,,per diem,1810.5,1810.5,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Cigna MGG,Cigna MGG,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Humana,Humana,1810.5,,,,,,,per diem,1810.5,1810.5,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Humana MGG,Humana MGG,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Optum VA,Optum VA,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,UHC,UHC,1810.5,,,,,,,per diem,1810.5,1810.5,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,UHC MGG,UHC MGG,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,VA,VA,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Wellcare MGG,Wellcare MGG,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Bright Health - commercial,Bright Health - commercial,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,62268,CPT,,,,Inpatient,,,1810.5,1810.5,Bright Health MGG,Bright Health MGG,1810.5,,,,,,,case rate,1810.5,1810.5,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Aetna,Aetna,853.74,,,,,,,per diem,853.74,853.74,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Aetna MGG,Aetna MGG,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,BCBS,BCBS,853.74,,,,,,,per diem,853.74,853.74,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,BCBS MGG,BCBS MGG,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Cigna,Cigna,853.74,,,,,,,per diem,853.74,853.74,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Cigna MGG,Cigna MGG,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Humana,Humana,853.74,,,,,,,per diem,853.74,853.74,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Humana MGG,Humana MGG,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Optum VA,Optum VA,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,UHC,UHC,853.74,,,,,,,per diem,853.74,853.74,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,UHC MGG,UHC MGG,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,VA,VA,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Wellcare MGG,Wellcare MGG,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Bright Health - commercial,Bright Health - commercial,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,38200,CPT,,,,Inpatient,,,853.74,853.74,Bright Health MGG,Bright Health MGG,853.74,,,,,,,case rate,853.74,853.74,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Aetna,Aetna,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Aetna MGG,Aetna MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,BCBS,BCBS,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,BCBS MGG,BCBS MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Cigna,Cigna,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Cigna MGG,Cigna MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Humana,Humana,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Humana MGG,Humana MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Optum VA,Optum VA,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,UHC,UHC,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,UHC MGG,UHC MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,VA,VA,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Wellcare MGG,Wellcare MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Bright Health - commercial,Bright Health - commercial,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,32555,CPT,,,,Inpatient,,,2619.36,2619.36,Bright Health MGG,Bright Health MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Aetna,Aetna,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Aetna MGG,Aetna MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,BCBS,BCBS,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,BCBS MGG,BCBS MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Cigna,Cigna,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Cigna MGG,Cigna MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Humana,Humana,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Humana MGG,Humana MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Optum VA,Optum VA,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,UHC,UHC,2619.36,,,,,,,per diem,2619.36,2619.36,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,UHC MGG,UHC MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,VA,VA,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Wellcare MGG,Wellcare MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Bright Health - commercial,Bright Health - commercial,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,32554,CPT,,,,Inpatient,,,2619.36,2619.36,Bright Health MGG,Bright Health MGG,2619.36,,,,,,,case rate,2619.36,2619.36,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Aetna,Aetna,1440.24,,,,,,,per diem,1440.24,1440.24,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Aetna MGG,Aetna MGG,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,BCBS,BCBS,1440.24,,,,,,,per diem,1440.24,1440.24,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,BCBS MGG,BCBS MGG,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Cigna,Cigna,1440.24,,,,,,,per diem,1440.24,1440.24,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Cigna MGG,Cigna MGG,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Humana,Humana,1440.24,,,,,,,per diem,1440.24,1440.24,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Humana MGG,Humana MGG,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Optum VA,Optum VA,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,UHC,UHC,1440.24,,,,,,,per diem,1440.24,1440.24,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,UHC MGG,UHC MGG,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,VA,VA,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Wellcare MGG,Wellcare MGG,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Bright Health - commercial,Bright Health - commercial,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,32551,CPT,,,,Inpatient,,,1440.24,1440.24,Bright Health MGG,Bright Health MGG,1440.24,,,,,,,case rate,1440.24,1440.24,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Aetna,Aetna,11471.94,,,,,,,per diem,11471.94,11471.94,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Aetna MGG,Aetna MGG,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,BCBS,BCBS,11471.94,,,,,,,per diem,11471.94,11471.94,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,BCBS MGG,BCBS MGG,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Cigna,Cigna,11471.94,,,,,,,per diem,11471.94,11471.94,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Cigna MGG,Cigna MGG,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Humana,Humana,11471.94,,,,,,,per diem,11471.94,11471.94,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Humana MGG,Humana MGG,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Optum VA,Optum VA,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,UHC,UHC,11471.94,,,,,,,per diem,11471.94,11471.94,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,UHC MGG,UHC MGG,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,VA,VA,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Wellcare MGG,Wellcare MGG,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Bright Health - commercial,Bright Health - commercial,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,36870,CPT,,,,Inpatient,,,11471.94,11471.94,Bright Health MGG,Bright Health MGG,11471.94,,,,,,,case rate,11471.94,11471.94,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Aetna,Aetna,15034.8,,,,,,,per diem,15034.8,15034.8,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Aetna MGG,Aetna MGG,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,BCBS,BCBS,15034.8,,,,,,,per diem,15034.8,15034.8,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,BCBS MGG,BCBS MGG,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Cigna,Cigna,15034.8,,,,,,,per diem,15034.8,15034.8,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Cigna MGG,Cigna MGG,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Humana,Humana,15034.8,,,,,,,per diem,15034.8,15034.8,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Humana MGG,Humana MGG,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Optum VA,Optum VA,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,UHC,UHC,15034.8,,,,,,,per diem,15034.8,15034.8,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,UHC MGG,UHC MGG,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,VA,VA,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Wellcare MGG,Wellcare MGG,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Bright Health - commercial,Bright Health - commercial,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,35875,CPT,,,,Inpatient,,,15034.8,15034.8,Bright Health MGG,Bright Health MGG,15034.8,,,,,,,case rate,15034.8,15034.8,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Aetna,Aetna,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Aetna MGG,Aetna MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,BCBS,BCBS,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,BCBS MGG,BCBS MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Cigna,Cigna,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Cigna MGG,Cigna MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Humana,Humana,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Humana MGG,Humana MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Optum VA,Optum VA,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,UHC,UHC,6370.92,,,,,,,per diem,6370.92,6370.92,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,UHC MGG,UHC MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,VA,VA,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Wellcare MGG,Wellcare MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Bright Health - commercial,Bright Health - commercial,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,37195,CPT,,,,Inpatient,,,6370.92,6370.92,Bright Health MGG,Bright Health MGG,6370.92,,,,,,,case rate,6370.92,6370.92,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Aetna,Aetna,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Aetna MGG,Aetna MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,BCBS,BCBS,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,BCBS MGG,BCBS MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Cigna,Cigna,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Cigna MGG,Cigna MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Humana,Humana,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Humana MGG,Humana MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Optum VA,Optum VA,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,UHC,UHC,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,UHC MGG,UHC MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,VA,VA,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Wellcare MGG,Wellcare MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Bright Health - commercial,Bright Health - commercial,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,37211,CPT,,,,Inpatient,,,4444.14,4444.14,Bright Health MGG,Bright Health MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Aetna,Aetna,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Aetna MGG,Aetna MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,BCBS,BCBS,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,BCBS MGG,BCBS MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Cigna,Cigna,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Cigna MGG,Cigna MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Humana,Humana,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Humana MGG,Humana MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Optum VA,Optum VA,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,UHC,UHC,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,UHC MGG,UHC MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,VA,VA,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Wellcare MGG,Wellcare MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Bright Health - commercial,Bright Health - commercial,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,37214,CPT,,,,Inpatient,,,4444.14,4444.14,Bright Health MGG,Bright Health MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Aetna,Aetna,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Aetna MGG,Aetna MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,BCBS,BCBS,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,BCBS MGG,BCBS MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Cigna,Cigna,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Cigna MGG,Cigna MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Humana,Humana,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Humana MGG,Humana MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Optum VA,Optum VA,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,UHC,UHC,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,UHC MGG,UHC MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,VA,VA,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Wellcare MGG,Wellcare MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Bright Health - commercial,Bright Health - commercial,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,37213,CPT,,,,Inpatient,,,4444.14,4444.14,Bright Health MGG,Bright Health MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Aetna,Aetna,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Aetna MGG,Aetna MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,BCBS,BCBS,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,BCBS MGG,BCBS MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Cigna,Cigna,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Cigna MGG,Cigna MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Humana,Humana,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Humana MGG,Humana MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Optum VA,Optum VA,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,UHC,UHC,4444.14,,,,,,,per diem,4444.14,4444.14,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,UHC MGG,UHC MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,VA,VA,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Wellcare MGG,Wellcare MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Bright Health - commercial,Bright Health - commercial,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,37212,CPT,,,,Inpatient,,,4444.14,4444.14,Bright Health MGG,Bright Health MGG,4444.14,,,,,,,case rate,4444.14,4444.14,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Aetna,Aetna,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Aetna MGG,Aetna MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,BCBS,BCBS,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,BCBS MGG,BCBS MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Cigna,Cigna,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Cigna MGG,Cigna MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Humana,Humana,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Humana MGG,Humana MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Optum VA,Optum VA,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,UHC,UHC,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,UHC MGG,UHC MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,VA,VA,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Wellcare MGG,Wellcare MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Bright Health - commercial,Bright Health - commercial,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,37200,CPT,,,,Inpatient,,,3872.94,3872.94,Bright Health MGG,Bright Health MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna,Aetna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Aetna MGG,Aetna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS,BCBS,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,BCBS MGG,BCBS MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna,Cigna,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Cigna MGG,Cigna MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Humana,Humana,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Humana MGG,Humana MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Optum VA,Optum VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,UHC,UHC,5644.68,,,,,,,per diem,5644.68,5644.68,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,UHC MGG,UHC MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,VA,VA,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Wellcare MGG,Wellcare MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health - commercial,Bright Health - commercial,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,37197,CPT,,,,Inpatient,,,5644.68,5644.68,Bright Health MGG,Bright Health MGG,5644.68,,,,,,,case rate,5644.68,5644.68,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna,Aetna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna MGG,Aetna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS,BCBS,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS MGG,BCBS MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna,Cigna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna MGG,Cigna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana,Humana,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana MGG,Humana MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Optum VA,Optum VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC,UHC,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC MGG,UHC MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,VA,VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Wellcare MGG,Wellcare MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health - commercial,Bright Health - commercial,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,0236T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health MGG,Bright Health MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna,Aetna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna MGG,Aetna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS,BCBS,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS MGG,BCBS MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna,Cigna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna MGG,Cigna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana,Humana,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana MGG,Humana MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Optum VA,Optum VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC,UHC,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC MGG,UHC MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,VA,VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Wellcare MGG,Wellcare MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health - commercial,Bright Health - commercial,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,0234T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health MGG,Bright Health MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna,Aetna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna MGG,Aetna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS,BCBS,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS MGG,BCBS MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna,Cigna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna MGG,Cigna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana,Humana,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana MGG,Humana MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Optum VA,Optum VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC,UHC,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC MGG,UHC MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,VA,VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Wellcare MGG,Wellcare MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health - commercial,Bright Health - commercial,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,0237T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health MGG,Bright Health MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna,Aetna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna MGG,Aetna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS,BCBS,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS MGG,BCBS MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna,Cigna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna MGG,Cigna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana,Humana,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana MGG,Humana MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Optum VA,Optum VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC,UHC,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC MGG,UHC MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,VA,VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Wellcare MGG,Wellcare MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health - commercial,Bright Health - commercial,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,0238T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health MGG,Bright Health MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna,Aetna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Aetna MGG,Aetna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS,BCBS,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,BCBS MGG,BCBS MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna,Cigna,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Cigna MGG,Cigna MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana,Humana,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Humana MGG,Humana MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Optum VA,Optum VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC,UHC,20344.92,,,,,,,per diem,20344.92,20344.92,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,UHC MGG,UHC MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,VA,VA,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Wellcare MGG,Wellcare MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health - commercial,Bright Health - commercial,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,0235T,CPT,,,,Inpatient,,,20344.92,20344.92,Bright Health MGG,Bright Health MGG,20344.92,,,,,,,case rate,20344.92,20344.92,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Aetna,Aetna,2835.6,,,,,,,per diem,2835.6,2835.6,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Aetna MGG,Aetna MGG,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,BCBS,BCBS,2835.6,,,,,,,per diem,2835.6,2835.6,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,BCBS MGG,BCBS MGG,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Cigna,Cigna,2835.6,,,,,,,per diem,2835.6,2835.6,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Cigna MGG,Cigna MGG,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Humana,Humana,2835.6,,,,,,,per diem,2835.6,2835.6,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Humana MGG,Humana MGG,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Optum VA,Optum VA,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,UHC,UHC,2835.6,,,,,,,per diem,2835.6,2835.6,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,UHC MGG,UHC MGG,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,VA,VA,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Wellcare MGG,Wellcare MGG,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Bright Health - commercial,Bright Health - commercial,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,49407,CPT,,,,Inpatient,,,2835.6,2835.6,Bright Health MGG,Bright Health MGG,2835.6,,,,,,,case rate,2835.6,2835.6,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Aetna,Aetna,6949.26,,,,,,,per diem,6949.26,6949.26,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Aetna MGG,Aetna MGG,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,BCBS,BCBS,6949.26,,,,,,,per diem,6949.26,6949.26,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,BCBS MGG,BCBS MGG,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Cigna,Cigna,6949.26,,,,,,,per diem,6949.26,6949.26,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Cigna MGG,Cigna MGG,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Humana,Humana,6949.26,,,,,,,per diem,6949.26,6949.26,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Humana MGG,Humana MGG,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Optum VA,Optum VA,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,UHC,UHC,6949.26,,,,,,,per diem,6949.26,6949.26,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,UHC MGG,UHC MGG,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,VA,VA,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Wellcare MGG,Wellcare MGG,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Bright Health - commercial,Bright Health - commercial,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,50387,CPT,,,,Inpatient,,,6949.26,6949.26,Bright Health MGG,Bright Health MGG,6949.26,,,,,,,case rate,6949.26,6949.26,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Aetna,Aetna,955.74,,,,,,,per diem,955.74,955.74,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Aetna MGG,Aetna MGG,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,BCBS,BCBS,955.74,,,,,,,per diem,955.74,955.74,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,BCBS MGG,BCBS MGG,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Cigna,Cigna,955.74,,,,,,,per diem,955.74,955.74,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Cigna MGG,Cigna MGG,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Humana,Humana,955.74,,,,,,,per diem,955.74,955.74,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Humana MGG,Humana MGG,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Optum VA,Optum VA,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,UHC,UHC,955.74,,,,,,,per diem,955.74,955.74,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,UHC MGG,UHC MGG,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,VA,VA,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Wellcare MGG,Wellcare MGG,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Bright Health - commercial,Bright Health - commercial,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,50684,CPT,,,,Inpatient,,,955.74,955.74,Bright Health MGG,Bright Health MGG,955.74,,,,,,,case rate,955.74,955.74,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Aetna,Aetna,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Aetna MGG,Aetna MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,BCBS,BCBS,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,BCBS MGG,BCBS MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Cigna,Cigna,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Cigna MGG,Cigna MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Humana,Humana,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Humana MGG,Humana MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Optum VA,Optum VA,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,UHC,UHC,909.84,,,,,,,per diem,909.84,909.84,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,UHC MGG,UHC MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,VA,VA,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Wellcare MGG,Wellcare MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Bright Health - commercial,Bright Health - commercial,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,50688,CPT,,,,Inpatient,,,909.84,909.84,Bright Health MGG,Bright Health MGG,909.84,,,,,,,case rate,909.84,909.84,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Aetna,Aetna,410.04,,,,,,,per diem,410.04,410.04,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Aetna MGG,Aetna MGG,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,BCBS,BCBS,410.04,,,,,,,per diem,410.04,410.04,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,BCBS MGG,BCBS MGG,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Cigna,Cigna,410.04,,,,,,,per diem,410.04,410.04,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Cigna MGG,Cigna MGG,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Humana,Humana,410.04,,,,,,,per diem,410.04,410.04,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Humana MGG,Humana MGG,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Optum VA,Optum VA,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,UHC,UHC,410.04,,,,,,,per diem,410.04,410.04,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,UHC MGG,UHC MGG,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,VA,VA,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Wellcare MGG,Wellcare MGG,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Bright Health - commercial,Bright Health - commercial,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,51610,CPT,,,,Inpatient,,,410.04,410.04,Bright Health MGG,Bright Health MGG,410.04,,,,,,,case rate,410.04,410.04,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Aetna,Aetna,13138.62,,,,,,,per diem,13138.62,13138.62,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Aetna MGG,Aetna MGG,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,BCBS,BCBS,13138.62,,,,,,,per diem,13138.62,13138.62,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,BCBS MGG,BCBS MGG,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Cigna,Cigna,13138.62,,,,,,,per diem,13138.62,13138.62,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Cigna MGG,Cigna MGG,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Humana,Humana,13138.62,,,,,,,per diem,13138.62,13138.62,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Humana MGG,Humana MGG,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Optum VA,Optum VA,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,UHC,UHC,13138.62,,,,,,,per diem,13138.62,13138.62,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,UHC MGG,UHC MGG,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,VA,VA,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Wellcare MGG,Wellcare MGG,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Bright Health - commercial,Bright Health - commercial,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,37188,CPT,,,,Inpatient,,,13138.62,13138.62,Bright Health MGG,Bright Health MGG,13138.62,,,,,,,case rate,13138.62,13138.62,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Aetna,Aetna,3872.33,,,,,,,per diem,3872.33,3872.33,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Aetna MGG,Aetna MGG,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,BCBS,BCBS,3872.33,,,,,,,per diem,3872.33,3872.33,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,BCBS MGG,BCBS MGG,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Cigna,Cigna,3872.33,,,,,,,per diem,3872.33,3872.33,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Cigna MGG,Cigna MGG,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Humana,Humana,3872.33,,,,,,,per diem,3872.33,3872.33,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Humana MGG,Humana MGG,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Optum VA,Optum VA,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,UHC,UHC,3872.33,,,,,,,per diem,3872.33,3872.33,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,UHC MGG,UHC MGG,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,VA,VA,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Wellcare MGG,Wellcare MGG,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Bright Health - commercial,Bright Health - commercial,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,36010,CPT,,,,Inpatient,,,3872.33,3872.33,Bright Health MGG,Bright Health MGG,3872.33,,,,,,,case rate,3872.33,3872.33,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Aetna,Aetna,38.76,,,,,,,per diem,38.76,38.76,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Aetna MGG,Aetna MGG,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,BCBS,BCBS,38.76,,,,,,,per diem,38.76,38.76,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,BCBS MGG,BCBS MGG,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Cigna,Cigna,38.76,,,,,,,per diem,38.76,38.76,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Cigna MGG,Cigna MGG,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Humana,Humana,38.76,,,,,,,per diem,38.76,38.76,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Humana MGG,Humana MGG,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Optum VA,Optum VA,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,UHC,UHC,38.76,,,,,,,per diem,38.76,38.76,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,UHC MGG,UHC MGG,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,VA,VA,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Wellcare MGG,Wellcare MGG,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Bright Health - commercial,Bright Health - commercial,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,36410,CPT,,,,Inpatient,,,38.76,38.76,Bright Health MGG,Bright Health MGG,38.76,,,,,,,case rate,38.76,38.76,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Aetna,Aetna,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Aetna MGG,Aetna MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,BCBS,BCBS,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,BCBS MGG,BCBS MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Cigna,Cigna,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Cigna MGG,Cigna MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Humana,Humana,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Humana MGG,Humana MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Optum VA,Optum VA,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,UHC,UHC,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,UHC MGG,UHC MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,VA,VA,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Wellcare MGG,Wellcare MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Bright Health - commercial,Bright Health - commercial,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,36400,CPT,,,,Inpatient,,,61.2,61.2,Bright Health MGG,Bright Health MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Aetna,Aetna,3573.06,,,,,,,per diem,3573.06,3573.06,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Aetna MGG,Aetna MGG,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,BCBS,BCBS,3573.06,,,,,,,per diem,3573.06,3573.06,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,BCBS MGG,BCBS MGG,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Cigna,Cigna,3573.06,,,,,,,per diem,3573.06,3573.06,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Cigna MGG,Cigna MGG,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Humana,Humana,3573.06,,,,,,,per diem,3573.06,3573.06,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Humana MGG,Humana MGG,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Optum VA,Optum VA,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,UHC,UHC,3573.06,,,,,,,per diem,3573.06,3573.06,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,UHC MGG,UHC MGG,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,VA,VA,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Wellcare MGG,Wellcare MGG,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Bright Health - commercial,Bright Health - commercial,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,37799,CPT,,,,Inpatient,,,3573.06,3573.06,Bright Health MGG,Bright Health MGG,3573.06,,,,,,,case rate,3573.06,3573.06,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Aetna,Aetna,876.18,,,,,,,per diem,876.18,876.18,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Aetna MGG,Aetna MGG,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,BCBS,BCBS,876.18,,,,,,,per diem,876.18,876.18,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,BCBS MGG,BCBS MGG,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Cigna,Cigna,876.18,,,,,,,per diem,876.18,876.18,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Cigna MGG,Cigna MGG,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Humana,Humana,876.18,,,,,,,per diem,876.18,876.18,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Humana MGG,Humana MGG,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Optum VA,Optum VA,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,UHC,UHC,876.18,,,,,,,per diem,876.18,876.18,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,UHC MGG,UHC MGG,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,VA,VA,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Wellcare MGG,Wellcare MGG,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Bright Health - commercial,Bright Health - commercial,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,36005,CPT,,,,Inpatient,,,876.18,876.18,Bright Health MGG,Bright Health MGG,876.18,,,,,,,case rate,876.18,876.18,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Aetna,Aetna,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Aetna MGG,Aetna MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,BCBS,BCBS,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,BCBS MGG,BCBS MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Cigna,Cigna,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Cigna MGG,Cigna MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Humana,Humana,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Humana MGG,Humana MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Optum VA,Optum VA,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,UHC,UHC,325.38,,,,,,,per diem,325.38,325.38,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,UHC MGG,UHC MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,VA,VA,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Wellcare MGG,Wellcare MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Bright Health - commercial,Bright Health - commercial,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,36500,CPT,,,,Inpatient,,,325.38,325.38,Bright Health MGG,Bright Health MGG,325.38,,,,,,,case rate,325.38,325.38,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Aetna,Aetna,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Aetna MGG,Aetna MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,BCBS,BCBS,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,BCBS MGG,BCBS MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Cigna,Cigna,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Cigna MGG,Cigna MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Humana,Humana,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Humana MGG,Humana MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Optum VA,Optum VA,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,UHC,UHC,12880.56,,,,,,,per diem,12880.56,12880.56,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,UHC MGG,UHC MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,VA,VA,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Wellcare MGG,Wellcare MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Bright Health - commercial,Bright Health - commercial,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,37187,CPT,,,,Inpatient,,,12880.56,12880.56,Bright Health MGG,Bright Health MGG,12880.56,,,,,,,case rate,12880.56,12880.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Aetna,Aetna,37018.86,,,,,,,per diem,37018.86,37018.86,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Aetna MGG,Aetna MGG,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,BCBS,BCBS,37018.86,,,,,,,per diem,37018.86,37018.86,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,BCBS MGG,BCBS MGG,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Cigna,Cigna,37018.86,,,,,,,per diem,37018.86,37018.86,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Cigna MGG,Cigna MGG,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Humana,Humana,37018.86,,,,,,,per diem,37018.86,37018.86,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Humana MGG,Humana MGG,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Optum VA,Optum VA,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,UHC,UHC,37018.86,,,,,,,per diem,37018.86,37018.86,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,UHC MGG,UHC MGG,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,VA,VA,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Wellcare MGG,Wellcare MGG,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Bright Health - commercial,Bright Health - commercial,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,37236,CPT,,,,Inpatient,,,37018.86,37018.86,Bright Health MGG,Bright Health MGG,37018.86,,,,,,,case rate,37018.86,37018.86,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Aetna,Aetna,17534.82,,,,,,,per diem,17534.82,17534.82,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Aetna MGG,Aetna MGG,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,BCBS,BCBS,17534.82,,,,,,,per diem,17534.82,17534.82,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,BCBS MGG,BCBS MGG,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Cigna,Cigna,17534.82,,,,,,,per diem,17534.82,17534.82,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Cigna MGG,Cigna MGG,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Humana,Humana,17534.82,,,,,,,per diem,17534.82,17534.82,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Humana MGG,Humana MGG,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Optum VA,Optum VA,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,UHC,UHC,17534.82,,,,,,,per diem,17534.82,17534.82,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,UHC MGG,UHC MGG,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,VA,VA,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Wellcare MGG,Wellcare MGG,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Bright Health - commercial,Bright Health - commercial,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,37237,CPT,,,,Inpatient,,,17534.82,17534.82,Bright Health MGG,Bright Health MGG,17534.82,,,,,,,case rate,17534.82,17534.82,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Aetna,Aetna,37173.9,,,,,,,per diem,37173.9,37173.9,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Aetna MGG,Aetna MGG,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,BCBS,BCBS,37173.9,,,,,,,per diem,37173.9,37173.9,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,BCBS MGG,BCBS MGG,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Cigna,Cigna,37173.9,,,,,,,per diem,37173.9,37173.9,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Cigna MGG,Cigna MGG,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Humana,Humana,37173.9,,,,,,,per diem,37173.9,37173.9,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Humana MGG,Humana MGG,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Optum VA,Optum VA,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,UHC,UHC,37173.9,,,,,,,per diem,37173.9,37173.9,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,UHC MGG,UHC MGG,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,VA,VA,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Wellcare MGG,Wellcare MGG,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Bright Health - commercial,Bright Health - commercial,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,37238,CPT,,,,Inpatient,,,37173.9,37173.9,Bright Health MGG,Bright Health MGG,37173.9,,,,,,,case rate,37173.9,37173.9,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Aetna,Aetna,17843.88,,,,,,,per diem,17843.88,17843.88,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Aetna MGG,Aetna MGG,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,BCBS,BCBS,17843.88,,,,,,,per diem,17843.88,17843.88,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,BCBS MGG,BCBS MGG,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Cigna,Cigna,17843.88,,,,,,,per diem,17843.88,17843.88,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Cigna MGG,Cigna MGG,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Humana,Humana,17843.88,,,,,,,per diem,17843.88,17843.88,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Humana MGG,Humana MGG,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Optum VA,Optum VA,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,UHC,UHC,17843.88,,,,,,,per diem,17843.88,17843.88,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,UHC MGG,UHC MGG,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,VA,VA,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Wellcare MGG,Wellcare MGG,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Bright Health - commercial,Bright Health - commercial,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,37239,CPT,,,,Inpatient,,,17843.88,17843.88,Bright Health MGG,Bright Health MGG,17843.88,,,,,,,case rate,17843.88,17843.88,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Aetna,Aetna,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Aetna MGG,Aetna MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,BCBS,BCBS,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,BCBS MGG,BCBS MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Cigna,Cigna,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Cigna MGG,Cigna MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Humana,Humana,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Humana MGG,Humana MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Optum VA,Optum VA,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,UHC,UHC,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,UHC MGG,UHC MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,VA,VA,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Wellcare MGG,Wellcare MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Bright Health - commercial,Bright Health - commercial,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,37241,CPT,,,,Inpatient,,,53714.22,53714.22,Bright Health MGG,Bright Health MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Aetna,Aetna,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Aetna MGG,Aetna MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,BCBS,BCBS,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,BCBS MGG,BCBS MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Cigna,Cigna,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Cigna MGG,Cigna MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Humana,Humana,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Humana MGG,Humana MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Optum VA,Optum VA,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,UHC,UHC,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,UHC MGG,UHC MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,VA,VA,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Wellcare MGG,Wellcare MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Bright Health - commercial,Bright Health - commercial,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,37242,CPT,,,,Inpatient,,,53714.22,53714.22,Bright Health MGG,Bright Health MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Aetna,Aetna,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Aetna MGG,Aetna MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,BCBS,BCBS,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,BCBS MGG,BCBS MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Cigna,Cigna,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Cigna MGG,Cigna MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Humana,Humana,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Humana MGG,Humana MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Optum VA,Optum VA,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,UHC,UHC,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,UHC MGG,UHC MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,VA,VA,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Wellcare MGG,Wellcare MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Bright Health - commercial,Bright Health - commercial,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,37243,CPT,,,,Inpatient,,,53714.22,53714.22,Bright Health MGG,Bright Health MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Aetna,Aetna,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Aetna MGG,Aetna MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,BCBS,BCBS,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,BCBS MGG,BCBS MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Cigna,Cigna,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Cigna MGG,Cigna MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Humana,Humana,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Humana MGG,Humana MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Optum VA,Optum VA,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,UHC,UHC,53714.22,,,,,,,per diem,53714.22,53714.22,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,UHC MGG,UHC MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,VA,VA,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Wellcare MGG,Wellcare MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Bright Health - commercial,Bright Health - commercial,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,37244,CPT,,,,Inpatient,,,53714.22,53714.22,Bright Health MGG,Bright Health MGG,53714.22,,,,,,,case rate,53714.22,53714.22,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna,Aetna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna MGG,Aetna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS,BCBS,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS MGG,BCBS MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna,Cigna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna MGG,Cigna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Humana,Humana,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Humana MGG,Humana MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Optum VA,Optum VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,UHC,UHC,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,UHC MGG,UHC MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,VA,VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Wellcare MGG,Wellcare MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health - commercial,Bright Health - commercial,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health MGG,Bright Health MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna,Aetna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna MGG,Aetna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS,BCBS,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS MGG,BCBS MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna,Cigna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna MGG,Cigna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Humana,Humana,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Humana MGG,Humana MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Optum VA,Optum VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,UHC,UHC,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,UHC MGG,UHC MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,VA,VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Wellcare MGG,Wellcare MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health - commercial,Bright Health - commercial,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health MGG,Bright Health MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Aetna,Aetna,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Aetna MGG,Aetna MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,BCBS,BCBS,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,BCBS MGG,BCBS MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Cigna,Cigna,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Cigna MGG,Cigna MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Humana,Humana,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Humana MGG,Humana MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Optum VA,Optum VA,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,UHC,UHC,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,UHC MGG,UHC MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,VA,VA,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Wellcare MGG,Wellcare MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Bright Health - commercial,Bright Health - commercial,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Bright Health MGG,Bright Health MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Aetna,Aetna,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Aetna MGG,Aetna MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,BCBS,BCBS,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,BCBS MGG,BCBS MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Cigna,Cigna,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Cigna MGG,Cigna MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Humana,Humana,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Humana MGG,Humana MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Optum VA,Optum VA,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,UHC,UHC,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,UHC MGG,UHC MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,VA,VA,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Wellcare MGG,Wellcare MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Bright Health - commercial,Bright Health - commercial,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,36253,CPT,,,,Inpatient,,,15701.88,15701.88,Bright Health MGG,Bright Health MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Aetna,Aetna,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Aetna MGG,Aetna MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,BCBS,BCBS,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,BCBS MGG,BCBS MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Cigna,Cigna,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Cigna MGG,Cigna MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Humana,Humana,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Humana MGG,Humana MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Optum VA,Optum VA,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,UHC,UHC,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,UHC MGG,UHC MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,VA,VA,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Wellcare MGG,Wellcare MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Bright Health - commercial,Bright Health - commercial,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Bright Health MGG,Bright Health MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Aetna,Aetna,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Aetna MGG,Aetna MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,BCBS,BCBS,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,BCBS MGG,BCBS MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Cigna,Cigna,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Cigna MGG,Cigna MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Humana,Humana,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Humana MGG,Humana MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Optum VA,Optum VA,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,UHC,UHC,15701.88,,,,,,,per diem,15701.88,15701.88,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,UHC MGG,UHC MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,VA,VA,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Wellcare MGG,Wellcare MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Bright Health - commercial,Bright Health - commercial,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,36251,CPT,,,,Inpatient,,,15701.88,15701.88,Bright Health MGG,Bright Health MGG,15701.88,,,,,,,case rate,15701.88,15701.88,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Aetna,Aetna,2955.96,,,,,,,per diem,2955.96,2955.96,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Aetna MGG,Aetna MGG,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,BCBS,BCBS,2955.96,,,,,,,per diem,2955.96,2955.96,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,BCBS MGG,BCBS MGG,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Cigna,Cigna,2955.96,,,,,,,per diem,2955.96,2955.96,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Cigna MGG,Cigna MGG,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Humana,Humana,2955.96,,,,,,,per diem,2955.96,2955.96,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Humana MGG,Humana MGG,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Optum VA,Optum VA,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,UHC,UHC,2955.96,,,,,,,per diem,2955.96,2955.96,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,UHC MGG,UHC MGG,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,VA,VA,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Wellcare MGG,Wellcare MGG,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Bright Health - commercial,Bright Health - commercial,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,32555,CPT,,,,Inpatient,,,2955.96,2955.96,Bright Health MGG,Bright Health MGG,2955.96,,,,,,,case rate,2955.96,2955.96,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Aetna,Aetna,8878.32,,,,,,,per diem,8878.32,8878.32,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Aetna MGG,Aetna MGG,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,BCBS,BCBS,8878.32,,,,,,,per diem,8878.32,8878.32,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,BCBS MGG,BCBS MGG,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Cigna,Cigna,8878.32,,,,,,,per diem,8878.32,8878.32,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Cigna MGG,Cigna MGG,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Humana,Humana,8878.32,,,,,,,per diem,8878.32,8878.32,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Humana MGG,Humana MGG,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Optum VA,Optum VA,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,UHC,UHC,8878.32,,,,,,,per diem,8878.32,8878.32,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,UHC MGG,UHC MGG,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,VA,VA,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Wellcare MGG,Wellcare MGG,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Bright Health - commercial,Bright Health - commercial,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,36478,CPT,,,,Inpatient,,,8878.32,8878.32,Bright Health MGG,Bright Health MGG,8878.32,,,,,,,case rate,8878.32,8878.32,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Aetna,Aetna,4091.22,,,,,,,per diem,4091.22,4091.22,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Aetna MGG,Aetna MGG,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,BCBS,BCBS,4091.22,,,,,,,per diem,4091.22,4091.22,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,BCBS MGG,BCBS MGG,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Cigna,Cigna,4091.22,,,,,,,per diem,4091.22,4091.22,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Cigna MGG,Cigna MGG,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Humana,Humana,4091.22,,,,,,,per diem,4091.22,4091.22,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Humana MGG,Humana MGG,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Optum VA,Optum VA,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,UHC,UHC,4091.22,,,,,,,per diem,4091.22,4091.22,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,UHC MGG,UHC MGG,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,VA,VA,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Wellcare MGG,Wellcare MGG,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Bright Health - commercial,Bright Health - commercial,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,64483,CPT,,,,Inpatient,,,4091.22,4091.22,Bright Health MGG,Bright Health MGG,4091.22,,,,,,,case rate,4091.22,4091.22,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Aetna,Aetna,13054.98,,,,,,,per diem,13054.98,13054.98,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Aetna MGG,Aetna MGG,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,BCBS,BCBS,13054.98,,,,,,,per diem,13054.98,13054.98,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,BCBS MGG,BCBS MGG,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Cigna,Cigna,13054.98,,,,,,,per diem,13054.98,13054.98,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Cigna MGG,Cigna MGG,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Humana,Humana,13054.98,,,,,,,per diem,13054.98,13054.98,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Humana MGG,Humana MGG,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Optum VA,Optum VA,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,UHC,UHC,13054.98,,,,,,,per diem,13054.98,13054.98,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,UHC MGG,UHC MGG,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,VA,VA,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Wellcare MGG,Wellcare MGG,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Bright Health - commercial,Bright Health - commercial,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,36479,CPT,,,,Inpatient,,,13054.98,13054.98,Bright Health MGG,Bright Health MGG,13054.98,,,,,,,case rate,13054.98,13054.98,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Aetna,Aetna,10728.36,,,,,,,per diem,10728.36,10728.36,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Aetna MGG,Aetna MGG,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,BCBS,BCBS,10728.36,,,,,,,per diem,10728.36,10728.36,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,BCBS MGG,BCBS MGG,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Cigna,Cigna,10728.36,,,,,,,per diem,10728.36,10728.36,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Cigna MGG,Cigna MGG,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Humana,Humana,10728.36,,,,,,,per diem,10728.36,10728.36,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Humana MGG,Humana MGG,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Optum VA,Optum VA,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,UHC,UHC,10728.36,,,,,,,per diem,10728.36,10728.36,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,UHC MGG,UHC MGG,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,VA,VA,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Wellcare MGG,Wellcare MGG,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Bright Health - commercial,Bright Health - commercial,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,44799,CPT,,,,Inpatient,,,10728.36,10728.36,Bright Health MGG,Bright Health MGG,10728.36,,,,,,,case rate,10728.36,10728.36,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Aetna,Aetna,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Aetna MGG,Aetna MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,BCBS,BCBS,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,BCBS MGG,BCBS MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Cigna,Cigna,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Cigna MGG,Cigna MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Humana,Humana,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Humana MGG,Humana MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Optum VA,Optum VA,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,UHC,UHC,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,UHC MGG,UHC MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,VA,VA,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Wellcare MGG,Wellcare MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Bright Health - commercial,Bright Health - commercial,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,22510,CPT,,,,Inpatient,,,15193.92,15193.92,Bright Health MGG,Bright Health MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Aetna,Aetna,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Aetna MGG,Aetna MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,BCBS,BCBS,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,BCBS MGG,BCBS MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Cigna,Cigna,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Cigna MGG,Cigna MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Humana,Humana,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Humana MGG,Humana MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Optum VA,Optum VA,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,UHC,UHC,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,UHC MGG,UHC MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,VA,VA,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Wellcare MGG,Wellcare MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Bright Health - commercial,Bright Health - commercial,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,22511,CPT,,,,Inpatient,,,15193.92,15193.92,Bright Health MGG,Bright Health MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Aetna,Aetna,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Aetna MGG,Aetna MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,BCBS,BCBS,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,BCBS MGG,BCBS MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Cigna,Cigna,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Cigna MGG,Cigna MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Humana,Humana,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Humana MGG,Humana MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Optum VA,Optum VA,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,UHC,UHC,15193.92,,,,,,,per diem,15193.92,15193.92,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,UHC MGG,UHC MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,VA,VA,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Wellcare MGG,Wellcare MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Bright Health - commercial,Bright Health - commercial,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,22512,CPT,,,,Inpatient,,,15193.92,15193.92,Bright Health MGG,Bright Health MGG,15193.92,,,,,,,case rate,15193.92,15193.92,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Aetna,Aetna,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Aetna MGG,Aetna MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,BCBS,BCBS,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,BCBS MGG,BCBS MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Cigna,Cigna,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Cigna MGG,Cigna MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Humana,Humana,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Humana MGG,Humana MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Optum VA,Optum VA,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,UHC,UHC,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,UHC MGG,UHC MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,VA,VA,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Wellcare MGG,Wellcare MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Bright Health - commercial,Bright Health - commercial,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,22513,CPT,,,,Inpatient,,,36922.98,36922.98,Bright Health MGG,Bright Health MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Aetna,Aetna,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Aetna MGG,Aetna MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,BCBS,BCBS,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,BCBS MGG,BCBS MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Cigna,Cigna,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Cigna MGG,Cigna MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Humana,Humana,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Humana MGG,Humana MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Optum VA,Optum VA,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,UHC,UHC,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,UHC MGG,UHC MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,VA,VA,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Wellcare MGG,Wellcare MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Bright Health - commercial,Bright Health - commercial,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,22514,CPT,,,,Inpatient,,,36922.98,36922.98,Bright Health MGG,Bright Health MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Aetna,Aetna,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Aetna MGG,Aetna MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,BCBS,BCBS,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,BCBS MGG,BCBS MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Cigna,Cigna,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Cigna MGG,Cigna MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Humana,Humana,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Humana MGG,Humana MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Optum VA,Optum VA,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,UHC,UHC,36922.98,,,,,,,per diem,36922.98,36922.98,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,UHC MGG,UHC MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,VA,VA,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Wellcare MGG,Wellcare MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Bright Health - commercial,Bright Health - commercial,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,22515,CPT,,,,Inpatient,,,36922.98,36922.98,Bright Health MGG,Bright Health MGG,36922.98,,,,,,,case rate,36922.98,36922.98,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna,Aetna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna MGG,Aetna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS,BCBS,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS MGG,BCBS MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna,Cigna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna MGG,Cigna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Humana,Humana,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Humana MGG,Humana MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Optum VA,Optum VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,UHC,UHC,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,UHC MGG,UHC MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,VA,VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Wellcare MGG,Wellcare MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health - commercial,Bright Health - commercial,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health MGG,Bright Health MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna,Aetna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna MGG,Aetna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS,BCBS,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS MGG,BCBS MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna,Cigna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna MGG,Cigna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Humana,Humana,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Humana MGG,Humana MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Optum VA,Optum VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,UHC,UHC,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,UHC MGG,UHC MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,VA,VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Wellcare MGG,Wellcare MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health - commercial,Bright Health - commercial,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health MGG,Bright Health MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna,Aetna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna MGG,Aetna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS,BCBS,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS MGG,BCBS MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna,Cigna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna MGG,Cigna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Humana,Humana,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Humana MGG,Humana MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Optum VA,Optum VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,UHC,UHC,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,UHC MGG,UHC MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,VA,VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Wellcare MGG,Wellcare MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health - commercial,Bright Health - commercial,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health MGG,Bright Health MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Aetna,Aetna,2531.43,,,,,,,per diem,2531.43,2531.43,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Aetna MGG,Aetna MGG,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,BCBS,BCBS,2531.43,,,,,,,per diem,2531.43,2531.43,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,BCBS MGG,BCBS MGG,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Cigna,Cigna,2531.43,,,,,,,per diem,2531.43,2531.43,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Cigna MGG,Cigna MGG,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Humana,Humana,2531.43,,,,,,,per diem,2531.43,2531.43,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Humana MGG,Humana MGG,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Optum VA,Optum VA,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,UHC,UHC,2531.43,,,,,,,per diem,2531.43,2531.43,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,UHC MGG,UHC MGG,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,VA,VA,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Wellcare MGG,Wellcare MGG,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Bright Health - commercial,Bright Health - commercial,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,62305,CPT,,,,Inpatient,,,2531.43,2531.43,Bright Health MGG,Bright Health MGG,2531.43,,,,,,,case rate,2531.43,2531.43,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Aetna,Aetna,7610.52,,,,,,,per diem,7610.52,7610.52,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Aetna MGG,Aetna MGG,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,BCBS,BCBS,7610.52,,,,,,,per diem,7610.52,7610.52,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,BCBS MGG,BCBS MGG,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Cigna,Cigna,7610.52,,,,,,,per diem,7610.52,7610.52,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Cigna MGG,Cigna MGG,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Humana,Humana,7610.52,,,,,,,per diem,7610.52,7610.52,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Humana MGG,Humana MGG,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Optum VA,Optum VA,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,UHC,UHC,7610.52,,,,,,,per diem,7610.52,7610.52,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,UHC MGG,UHC MGG,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,VA,VA,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Wellcare MGG,Wellcare MGG,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Bright Health - commercial,Bright Health - commercial,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,37218,CPT,,,,Inpatient,,,7610.52,7610.52,Bright Health MGG,Bright Health MGG,7610.52,,,,,,,case rate,7610.52,7610.52,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Aetna,Aetna,4527.78,,,,,,,per diem,4527.78,4527.78,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Aetna MGG,Aetna MGG,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,BCBS,BCBS,4527.78,,,,,,,per diem,4527.78,4527.78,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,BCBS MGG,BCBS MGG,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Cigna,Cigna,4527.78,,,,,,,per diem,4527.78,4527.78,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Cigna MGG,Cigna MGG,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Humana,Humana,4527.78,,,,,,,per diem,4527.78,4527.78,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Humana MGG,Humana MGG,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Optum VA,Optum VA,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,UHC,UHC,4527.78,,,,,,,per diem,4527.78,4527.78,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,UHC MGG,UHC MGG,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,VA,VA,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Wellcare MGG,Wellcare MGG,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Bright Health - commercial,Bright Health - commercial,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,47544,CPT,,,,Inpatient,,,4527.78,4527.78,Bright Health MGG,Bright Health MGG,4527.78,,,,,,,case rate,4527.78,4527.78,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Aetna,Aetna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Aetna MGG,Aetna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,BCBS,BCBS,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,BCBS MGG,BCBS MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Cigna,Cigna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Cigna MGG,Cigna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Humana,Humana,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Humana MGG,Humana MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Optum VA,Optum VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,UHC,UHC,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,UHC MGG,UHC MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,VA,VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Wellcare MGG,Wellcare MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Bright Health - commercial,Bright Health - commercial,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,61650,CPT,,,,Inpatient,,,717.06,717.06,Bright Health MGG,Bright Health MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Aetna,Aetna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Aetna MGG,Aetna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,BCBS,BCBS,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,BCBS MGG,BCBS MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Cigna,Cigna,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Cigna MGG,Cigna MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Humana,Humana,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Humana MGG,Humana MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Optum VA,Optum VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,UHC,UHC,717.06,,,,,,,per diem,717.06,717.06,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,UHC MGG,UHC MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,VA,VA,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Wellcare MGG,Wellcare MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Bright Health - commercial,Bright Health - commercial,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,61651,CPT,,,,Inpatient,,,717.06,717.06,Bright Health MGG,Bright Health MGG,717.06,,,,,,,case rate,717.06,717.06,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna,Aetna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna MGG,Aetna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS,BCBS,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS MGG,BCBS MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna,Cigna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna MGG,Cigna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Humana,Humana,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Humana MGG,Humana MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Optum VA,Optum VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,UHC,UHC,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,UHC MGG,UHC MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,VA,VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Wellcare MGG,Wellcare MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health - commercial,Bright Health - commercial,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health MGG,Bright Health MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna,Aetna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna MGG,Aetna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS,BCBS,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS MGG,BCBS MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna,Cigna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna MGG,Cigna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Humana,Humana,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Humana MGG,Humana MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Optum VA,Optum VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,UHC,UHC,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,UHC MGG,UHC MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,VA,VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Wellcare MGG,Wellcare MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health - commercial,Bright Health - commercial,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health MGG,Bright Health MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna,Aetna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna MGG,Aetna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS,BCBS,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS MGG,BCBS MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna,Cigna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna MGG,Cigna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Humana,Humana,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Humana MGG,Humana MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Optum VA,Optum VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,UHC,UHC,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,UHC MGG,UHC MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,VA,VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Wellcare MGG,Wellcare MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health - commercial,Bright Health - commercial,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health MGG,Bright Health MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna,Aetna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna MGG,Aetna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS,BCBS,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS MGG,BCBS MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna,Cigna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna MGG,Cigna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Humana,Humana,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Humana MGG,Humana MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Optum VA,Optum VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,UHC,UHC,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,UHC MGG,UHC MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,VA,VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Wellcare MGG,Wellcare MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health - commercial,Bright Health - commercial,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,50606,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health MGG,Bright Health MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Aetna,Aetna,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Aetna MGG,Aetna MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,BCBS,BCBS,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,BCBS MGG,BCBS MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Cigna,Cigna,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Cigna MGG,Cigna MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Humana,Humana,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Humana MGG,Humana MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Optum VA,Optum VA,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,UHC,UHC,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,UHC MGG,UHC MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,VA,VA,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Wellcare MGG,Wellcare MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Bright Health - commercial,Bright Health - commercial,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,37252,CPT,,,,Inpatient,,,530.4,530.4,Bright Health MGG,Bright Health MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Aetna,Aetna,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Aetna MGG,Aetna MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,BCBS,BCBS,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,BCBS MGG,BCBS MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Cigna,Cigna,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Cigna MGG,Cigna MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Humana,Humana,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Humana MGG,Humana MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Optum VA,Optum VA,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,UHC,UHC,530.4,,,,,,,per diem,530.4,530.4,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,UHC MGG,UHC MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,VA,VA,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Wellcare MGG,Wellcare MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Bright Health - commercial,Bright Health - commercial,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,37253,CPT,,,,Inpatient,,,530.4,530.4,Bright Health MGG,Bright Health MGG,530.4,,,,,,,case rate,530.4,530.4,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Aetna,Aetna,1956.36,,,,,,,per diem,1956.36,1956.36,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Aetna MGG,Aetna MGG,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,BCBS,BCBS,1956.36,,,,,,,per diem,1956.36,1956.36,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,BCBS MGG,BCBS MGG,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Cigna,Cigna,1956.36,,,,,,,per diem,1956.36,1956.36,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Cigna MGG,Cigna MGG,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Humana,Humana,1956.36,,,,,,,per diem,1956.36,1956.36,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Humana MGG,Humana MGG,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Optum VA,Optum VA,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,UHC,UHC,1956.36,,,,,,,per diem,1956.36,1956.36,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,UHC MGG,UHC MGG,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,VA,VA,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Wellcare MGG,Wellcare MGG,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Bright Health - commercial,Bright Health - commercial,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,47531,CPT,,,,Inpatient,,,1956.36,1956.36,Bright Health MGG,Bright Health MGG,1956.36,,,,,,,case rate,1956.36,1956.36,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Aetna,Aetna,2462.28,,,,,,,per diem,2462.28,2462.28,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Aetna MGG,Aetna MGG,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,BCBS,BCBS,2462.28,,,,,,,per diem,2462.28,2462.28,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,BCBS MGG,BCBS MGG,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Cigna,Cigna,2462.28,,,,,,,per diem,2462.28,2462.28,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Cigna MGG,Cigna MGG,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Humana,Humana,2462.28,,,,,,,per diem,2462.28,2462.28,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Humana MGG,Humana MGG,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Optum VA,Optum VA,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,UHC,UHC,2462.28,,,,,,,per diem,2462.28,2462.28,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,UHC MGG,UHC MGG,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,VA,VA,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Wellcare MGG,Wellcare MGG,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Bright Health - commercial,Bright Health - commercial,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,47537,CPT,,,,Inpatient,,,2462.28,2462.28,Bright Health MGG,Bright Health MGG,2462.28,,,,,,,case rate,2462.28,2462.28,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna,Aetna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna MGG,Aetna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS,BCBS,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS MGG,BCBS MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna,Cigna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna MGG,Cigna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Humana,Humana,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Humana MGG,Humana MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Optum VA,Optum VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,UHC,UHC,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,UHC MGG,UHC MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,VA,VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Wellcare MGG,Wellcare MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health - commercial,Bright Health - commercial,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health MGG,Bright Health MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna,Aetna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna MGG,Aetna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS,BCBS,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS MGG,BCBS MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna,Cigna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna MGG,Cigna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Humana,Humana,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Humana MGG,Humana MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Optum VA,Optum VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,UHC,UHC,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,UHC MGG,UHC MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,VA,VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Wellcare MGG,Wellcare MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health - commercial,Bright Health - commercial,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health MGG,Bright Health MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna,Aetna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna MGG,Aetna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS,BCBS,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS MGG,BCBS MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna,Cigna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna MGG,Cigna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Humana,Humana,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Humana MGG,Humana MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Optum VA,Optum VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,UHC,UHC,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,UHC MGG,UHC MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,VA,VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Wellcare MGG,Wellcare MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health - commercial,Bright Health - commercial,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health MGG,Bright Health MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna,Aetna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna MGG,Aetna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS,BCBS,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS MGG,BCBS MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna,Cigna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna MGG,Cigna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Humana,Humana,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Humana MGG,Humana MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Optum VA,Optum VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,UHC,UHC,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,UHC MGG,UHC MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,VA,VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Wellcare MGG,Wellcare MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health - commercial,Bright Health - commercial,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health MGG,Bright Health MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Aetna,Aetna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Aetna MGG,Aetna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,BCBS,BCBS,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,BCBS MGG,BCBS MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Cigna,Cigna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Cigna MGG,Cigna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Humana,Humana,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Humana MGG,Humana MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Optum VA,Optum VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,UHC,UHC,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,UHC MGG,UHC MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,VA,VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Wellcare MGG,Wellcare MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Bright Health - commercial,Bright Health - commercial,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8379.3,8379.3,Bright Health MGG,Bright Health MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna,Aetna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna MGG,Aetna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS,BCBS,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS MGG,BCBS MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna,Cigna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna MGG,Cigna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Humana,Humana,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Humana MGG,Humana MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Optum VA,Optum VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,UHC,UHC,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,UHC MGG,UHC MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,VA,VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Wellcare MGG,Wellcare MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health - commercial,Bright Health - commercial,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health MGG,Bright Health MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna,Aetna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna MGG,Aetna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS,BCBS,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS MGG,BCBS MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna,Cigna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna MGG,Cigna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Humana,Humana,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Humana MGG,Humana MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Optum VA,Optum VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,UHC,UHC,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,UHC MGG,UHC MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,VA,VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Wellcare MGG,Wellcare MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health - commercial,Bright Health - commercial,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health MGG,Bright Health MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna,Aetna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna MGG,Aetna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS,BCBS,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS MGG,BCBS MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna,Cigna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna MGG,Cigna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Humana,Humana,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Humana MGG,Humana MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Optum VA,Optum VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,UHC,UHC,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,UHC MGG,UHC MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,VA,VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Wellcare MGG,Wellcare MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health - commercial,Bright Health - commercial,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health MGG,Bright Health MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna,Aetna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna MGG,Aetna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS,BCBS,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS MGG,BCBS MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna,Cigna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna MGG,Cigna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Humana,Humana,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Humana MGG,Humana MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Optum VA,Optum VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,UHC,UHC,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,UHC MGG,UHC MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,VA,VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Wellcare MGG,Wellcare MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health - commercial,Bright Health - commercial,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health MGG,Bright Health MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Aetna,Aetna,8826.06,,,,,,,per diem,8826.06,8826.06,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Aetna MGG,Aetna MGG,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,BCBS,BCBS,8826.06,,,,,,,per diem,8826.06,8826.06,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,BCBS MGG,BCBS MGG,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Cigna,Cigna,8826.06,,,,,,,per diem,8826.06,8826.06,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Cigna MGG,Cigna MGG,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Humana,Humana,8826.06,,,,,,,per diem,8826.06,8826.06,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Humana MGG,Humana MGG,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Optum VA,Optum VA,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,UHC,UHC,8826.06,,,,,,,per diem,8826.06,8826.06,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,UHC MGG,UHC MGG,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,VA,VA,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Wellcare MGG,Wellcare MGG,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Bright Health - commercial,Bright Health - commercial,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,0,CPT,,,,Inpatient,,,8826.06,8826.06,Bright Health MGG,Bright Health MGG,8826.06,,,,,,,case rate,8826.06,8826.06,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Aetna,Aetna,3955.56,,,,,,,per diem,3955.56,3955.56,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Aetna MGG,Aetna MGG,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,BCBS,BCBS,3955.56,,,,,,,per diem,3955.56,3955.56,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,BCBS MGG,BCBS MGG,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Cigna,Cigna,3955.56,,,,,,,per diem,3955.56,3955.56,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Cigna MGG,Cigna MGG,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Humana,Humana,3955.56,,,,,,,per diem,3955.56,3955.56,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Humana MGG,Humana MGG,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Optum VA,Optum VA,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,UHC,UHC,3955.56,,,,,,,per diem,3955.56,3955.56,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,UHC MGG,UHC MGG,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,VA,VA,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Wellcare MGG,Wellcare MGG,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Bright Health - commercial,Bright Health - commercial,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,50706,CPT,,,,Inpatient,,,3955.56,3955.56,Bright Health MGG,Bright Health MGG,3955.56,,,,,,,case rate,3955.56,3955.56,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna,Aetna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna MGG,Aetna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS,BCBS,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS MGG,BCBS MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna,Cigna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna MGG,Cigna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Humana,Humana,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Humana MGG,Humana MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Optum VA,Optum VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,UHC,UHC,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,UHC MGG,UHC MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,VA,VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Wellcare MGG,Wellcare MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health - commercial,Bright Health - commercial,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,50430,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health MGG,Bright Health MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna,Aetna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Aetna MGG,Aetna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS,BCBS,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,BCBS MGG,BCBS MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna,Cigna,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Cigna MGG,Cigna MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Humana,Humana,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Humana MGG,Humana MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Optum VA,Optum VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,UHC,UHC,3344.58,,,,,,,per diem,3344.58,3344.58,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,UHC MGG,UHC MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,VA,VA,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Wellcare MGG,Wellcare MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health - commercial,Bright Health - commercial,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,50431,CPT,,,,Inpatient,,,3344.58,3344.58,Bright Health MGG,Bright Health MGG,3344.58,,,,,,,case rate,3344.58,3344.58,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Aetna,Aetna,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Aetna MGG,Aetna MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,BCBS,BCBS,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,BCBS MGG,BCBS MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Cigna,Cigna,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Cigna MGG,Cigna MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Humana,Humana,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Humana MGG,Humana MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Optum VA,Optum VA,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,UHC,UHC,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,UHC MGG,UHC MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,VA,VA,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Wellcare MGG,Wellcare MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Bright Health - commercial,Bright Health - commercial,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Bright Health MGG,Bright Health MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Aetna,Aetna,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Aetna MGG,Aetna MGG,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,BCBS,BCBS,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,BCBS MGG,BCBS MGG,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Cigna,Cigna,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Cigna MGG,Cigna MGG,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Humana,Humana,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Humana MGG,Humana MGG,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Optum VA,Optum VA,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,UHC,UHC,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,UHC MGG,UHC MGG,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,VA,VA,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Wellcare MGG,Wellcare MGG,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Bright Health - commercial,Bright Health - commercial,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,51702,CPT,,,,Inpatient,,,499.8,499.8,Bright Health MGG,Bright Health MGG,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,19281,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Aetna,Aetna,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Aetna MGG,Aetna MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,BCBS,BCBS,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,BCBS MGG,BCBS MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Cigna,Cigna,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Cigna MGG,Cigna MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Humana,Humana,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Humana MGG,Humana MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Optum VA,Optum VA,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,UHC,UHC,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,UHC MGG,UHC MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,VA,VA,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Wellcare MGG,Wellcare MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Bright Health - commercial,Bright Health - commercial,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,19282,CPT,,,,Inpatient,,,792.54,792.54,Bright Health MGG,Bright Health MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Aetna,Aetna,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Aetna MGG,Aetna MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,BCBS,BCBS,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,BCBS MGG,BCBS MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Cigna,Cigna,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Cigna MGG,Cigna MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Humana,Humana,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Humana MGG,Humana MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Optum VA,Optum VA,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,UHC,UHC,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,UHC MGG,UHC MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,VA,VA,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Wellcare MGG,Wellcare MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Bright Health - commercial,Bright Health - commercial,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,19283,CPT,,,,Inpatient,,,716.04,716.04,Bright Health MGG,Bright Health MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Aetna,Aetna,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Aetna MGG,Aetna MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,BCBS,BCBS,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,BCBS MGG,BCBS MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Cigna,Cigna,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Cigna MGG,Cigna MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Humana,Humana,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Humana MGG,Humana MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Optum VA,Optum VA,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,UHC,UHC,716.04,,,,,,,per diem,716.04,716.04,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,UHC MGG,UHC MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,VA,VA,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Wellcare MGG,Wellcare MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Bright Health - commercial,Bright Health - commercial,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,19284,CPT,,,,Inpatient,,,716.04,716.04,Bright Health MGG,Bright Health MGG,716.04,,,,,,,case rate,716.04,716.04,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Aetna,Aetna,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Aetna MGG,Aetna MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,BCBS,BCBS,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,BCBS MGG,BCBS MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Cigna,Cigna,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Cigna MGG,Cigna MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Humana,Humana,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Humana MGG,Humana MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Optum VA,Optum VA,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,UHC,UHC,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,UHC MGG,UHC MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,VA,VA,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Wellcare MGG,Wellcare MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Bright Health - commercial,Bright Health - commercial,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,36620,CPT,,,,Inpatient,,,673.2,673.2,Bright Health MGG,Bright Health MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Aetna,Aetna,1111.8,,,,,,,per diem,1111.8,1111.8,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Aetna MGG,Aetna MGG,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,BCBS,BCBS,1111.8,,,,,,,per diem,1111.8,1111.8,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,BCBS MGG,BCBS MGG,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Cigna,Cigna,1111.8,,,,,,,per diem,1111.8,1111.8,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Cigna MGG,Cigna MGG,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Humana,Humana,1111.8,,,,,,,per diem,1111.8,1111.8,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Humana MGG,Humana MGG,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Optum VA,Optum VA,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,UHC,UHC,1111.8,,,,,,,per diem,1111.8,1111.8,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,UHC MGG,UHC MGG,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,VA,VA,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Wellcare MGG,Wellcare MGG,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Bright Health - commercial,Bright Health - commercial,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,20605,CPT,,,,Inpatient,,,1111.8,1111.8,Bright Health MGG,Bright Health MGG,1111.8,,,,,,,case rate,1111.8,1111.8,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Aetna,Aetna,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Aetna MGG,Aetna MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,BCBS,BCBS,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,BCBS MGG,BCBS MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Cigna,Cigna,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Cigna MGG,Cigna MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Humana,Humana,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Humana MGG,Humana MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Optum VA,Optum VA,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,UHC,UHC,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,UHC MGG,UHC MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,VA,VA,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Wellcare MGG,Wellcare MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Bright Health - commercial,Bright Health - commercial,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,20610,CPT,,,,Inpatient,,,1321.92,1321.92,Bright Health MGG,Bright Health MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Aetna,Aetna,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Aetna MGG,Aetna MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,BCBS,BCBS,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,BCBS MGG,BCBS MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Cigna,Cigna,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Cigna MGG,Cigna MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Humana,Humana,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Humana MGG,Humana MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Optum VA,Optum VA,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,UHC,UHC,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,UHC MGG,UHC MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,VA,VA,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Wellcare MGG,Wellcare MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Bright Health - commercial,Bright Health - commercial,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Bright Health MGG,Bright Health MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Aetna,Aetna,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Aetna MGG,Aetna MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,BCBS,BCBS,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,BCBS MGG,BCBS MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Cigna,Cigna,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Cigna MGG,Cigna MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Humana,Humana,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Humana MGG,Humana MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Optum VA,Optum VA,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,UHC,UHC,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,UHC MGG,UHC MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,VA,VA,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Wellcare MGG,Wellcare MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Bright Health - commercial,Bright Health - commercial,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,312.12,312.12,Bright Health MGG,Bright Health MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Aetna,Aetna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Aetna MGG,Aetna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,BCBS,BCBS,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,BCBS MGG,BCBS MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Cigna,Cigna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Cigna MGG,Cigna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Humana,Humana,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Humana MGG,Humana MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Optum VA,Optum VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,UHC,UHC,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,UHC MGG,UHC MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,VA,VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Wellcare MGG,Wellcare MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Bright Health - commercial,Bright Health - commercial,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,24220,CPT,,,,Inpatient,,,208.08,208.08,Bright Health MGG,Bright Health MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Aetna,Aetna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Aetna MGG,Aetna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,BCBS,BCBS,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,BCBS MGG,BCBS MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Cigna,Cigna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Cigna MGG,Cigna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Humana,Humana,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Humana MGG,Humana MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Optum VA,Optum VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,UHC,UHC,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,UHC MGG,UHC MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,VA,VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Wellcare MGG,Wellcare MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Bright Health - commercial,Bright Health - commercial,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,27370,CPT,,,,Inpatient,,,208.08,208.08,Bright Health MGG,Bright Health MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Aetna,Aetna,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Aetna MGG,Aetna MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,BCBS,BCBS,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,BCBS MGG,BCBS MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Cigna,Cigna,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Cigna MGG,Cigna MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Humana,Humana,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Humana MGG,Humana MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Optum VA,Optum VA,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,UHC,UHC,187.68,,,,,,,per diem,187.68,187.68,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,UHC MGG,UHC MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,VA,VA,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Wellcare MGG,Wellcare MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Bright Health - commercial,Bright Health - commercial,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,23350,CPT,,,,Inpatient,,,187.68,187.68,Bright Health MGG,Bright Health MGG,187.68,,,,,,,case rate,187.68,187.68,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Aetna,Aetna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Aetna MGG,Aetna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,BCBS,BCBS,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,BCBS MGG,BCBS MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Cigna,Cigna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Cigna MGG,Cigna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Humana,Humana,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Humana MGG,Humana MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Optum VA,Optum VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,UHC,UHC,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,UHC MGG,UHC MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,VA,VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Wellcare MGG,Wellcare MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Bright Health - commercial,Bright Health - commercial,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,21116,CPT,,,,Inpatient,,,208.08,208.08,Bright Health MGG,Bright Health MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Aetna,Aetna,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Aetna MGG,Aetna MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,BCBS,BCBS,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,BCBS MGG,BCBS MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Cigna,Cigna,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Cigna MGG,Cigna MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Humana,Humana,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Humana MGG,Humana MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Optum VA,Optum VA,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,UHC,UHC,312.12,,,,,,,per diem,312.12,312.12,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,UHC MGG,UHC MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,VA,VA,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Wellcare MGG,Wellcare MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Bright Health - commercial,Bright Health - commercial,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,25246,CPT,,,,Inpatient,,,312.12,312.12,Bright Health MGG,Bright Health MGG,312.12,,,,,,,case rate,312.12,312.12,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Aetna,Aetna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Aetna MGG,Aetna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,BCBS,BCBS,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,BCBS MGG,BCBS MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Cigna,Cigna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Cigna MGG,Cigna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Humana,Humana,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Humana MGG,Humana MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Optum VA,Optum VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,UHC,UHC,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,UHC MGG,UHC MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,VA,VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Wellcare MGG,Wellcare MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Bright Health - commercial,Bright Health - commercial,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,27093,CPT,,,,Inpatient,,,208.08,208.08,Bright Health MGG,Bright Health MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Aetna,Aetna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Aetna MGG,Aetna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,BCBS,BCBS,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,BCBS MGG,BCBS MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Cigna,Cigna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Cigna MGG,Cigna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Humana,Humana,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Humana MGG,Humana MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Optum VA,Optum VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,UHC,UHC,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,UHC MGG,UHC MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,VA,VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Wellcare MGG,Wellcare MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Bright Health - commercial,Bright Health - commercial,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,32400,CPT,,,,Inpatient,,,961.86,961.86,Bright Health MGG,Bright Health MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Aetna,Aetna,2186.88,,,,,,,per diem,2186.88,2186.88,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Aetna MGG,Aetna MGG,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,BCBS,BCBS,2186.88,,,,,,,per diem,2186.88,2186.88,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,BCBS MGG,BCBS MGG,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Cigna,Cigna,2186.88,,,,,,,per diem,2186.88,2186.88,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Cigna MGG,Cigna MGG,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Humana,Humana,2186.88,,,,,,,per diem,2186.88,2186.88,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Humana MGG,Humana MGG,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Optum VA,Optum VA,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,UHC,UHC,2186.88,,,,,,,per diem,2186.88,2186.88,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,UHC MGG,UHC MGG,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,VA,VA,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Wellcare MGG,Wellcare MGG,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Bright Health - commercial,Bright Health - commercial,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,55700,CPT,,,,Inpatient,,,2186.88,2186.88,Bright Health MGG,Bright Health MGG,2186.88,,,,,,,case rate,2186.88,2186.88,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Aetna,Aetna,2028.78,,,,,,,per diem,2028.78,2028.78,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Aetna MGG,Aetna MGG,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,BCBS,BCBS,2028.78,,,,,,,per diem,2028.78,2028.78,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,BCBS MGG,BCBS MGG,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Cigna,Cigna,2028.78,,,,,,,per diem,2028.78,2028.78,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Cigna MGG,Cigna MGG,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Humana,Humana,2028.78,,,,,,,per diem,2028.78,2028.78,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Humana MGG,Humana MGG,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Optum VA,Optum VA,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,UHC,UHC,2028.78,,,,,,,per diem,2028.78,2028.78,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,UHC MGG,UHC MGG,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,VA,VA,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Wellcare MGG,Wellcare MGG,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Bright Health - commercial,Bright Health - commercial,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,20220,CPT,,,,Inpatient,,,2028.78,2028.78,Bright Health MGG,Bright Health MGG,2028.78,,,,,,,case rate,2028.78,2028.78,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Aetna,Aetna,2319.48,,,,,,,per diem,2319.48,2319.48,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Aetna MGG,Aetna MGG,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,BCBS,BCBS,2319.48,,,,,,,per diem,2319.48,2319.48,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,BCBS MGG,BCBS MGG,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Cigna,Cigna,2319.48,,,,,,,per diem,2319.48,2319.48,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Cigna MGG,Cigna MGG,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Humana,Humana,2319.48,,,,,,,per diem,2319.48,2319.48,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Humana MGG,Humana MGG,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Optum VA,Optum VA,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,UHC,UHC,2319.48,,,,,,,per diem,2319.48,2319.48,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,UHC MGG,UHC MGG,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,VA,VA,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Wellcare MGG,Wellcare MGG,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Bright Health - commercial,Bright Health - commercial,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,20225,CPT,,,,Inpatient,,,2319.48,2319.48,Bright Health MGG,Bright Health MGG,2319.48,,,,,,,case rate,2319.48,2319.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Aetna,Aetna,1916.58,,,,,,,per diem,1916.58,1916.58,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Aetna MGG,Aetna MGG,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,BCBS,BCBS,1916.58,,,,,,,per diem,1916.58,1916.58,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,BCBS MGG,BCBS MGG,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Cigna,Cigna,1916.58,,,,,,,per diem,1916.58,1916.58,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Cigna MGG,Cigna MGG,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Humana,Humana,1916.58,,,,,,,per diem,1916.58,1916.58,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Humana MGG,Humana MGG,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Optum VA,Optum VA,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,UHC,UHC,1916.58,,,,,,,per diem,1916.58,1916.58,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,UHC MGG,UHC MGG,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,VA,VA,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Wellcare MGG,Wellcare MGG,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Bright Health - commercial,Bright Health - commercial,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,47001,CPT,,,,Inpatient,,,1916.58,1916.58,Bright Health MGG,Bright Health MGG,1916.58,,,,,,,case rate,1916.58,1916.58,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Aetna,Aetna,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Aetna MGG,Aetna MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,BCBS,BCBS,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,BCBS MGG,BCBS MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Cigna,Cigna,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Cigna MGG,Cigna MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Humana,Humana,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Humana MGG,Humana MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Optum VA,Optum VA,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,UHC,UHC,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,UHC MGG,UHC MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,VA,VA,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Wellcare MGG,Wellcare MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Bright Health - commercial,Bright Health - commercial,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,47000,CPT,,,,Inpatient,,,1980.84,1980.84,Bright Health MGG,Bright Health MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Aetna,Aetna,2211.36,,,,,,,per diem,2211.36,2211.36,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Aetna MGG,Aetna MGG,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,BCBS,BCBS,2211.36,,,,,,,per diem,2211.36,2211.36,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,BCBS MGG,BCBS MGG,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Cigna,Cigna,2211.36,,,,,,,per diem,2211.36,2211.36,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Cigna MGG,Cigna MGG,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Humana,Humana,2211.36,,,,,,,per diem,2211.36,2211.36,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Humana MGG,Humana MGG,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Optum VA,Optum VA,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,UHC,UHC,2211.36,,,,,,,per diem,2211.36,2211.36,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,UHC MGG,UHC MGG,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,VA,VA,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Wellcare MGG,Wellcare MGG,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Bright Health - commercial,Bright Health - commercial,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,20206,CPT,,,,Inpatient,,,2211.36,2211.36,Bright Health MGG,Bright Health MGG,2211.36,,,,,,,case rate,2211.36,2211.36,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Aetna,Aetna,1899.24,,,,,,,per diem,1899.24,1899.24,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Aetna MGG,Aetna MGG,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,BCBS,BCBS,1899.24,,,,,,,per diem,1899.24,1899.24,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,BCBS MGG,BCBS MGG,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Cigna,Cigna,1899.24,,,,,,,per diem,1899.24,1899.24,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Cigna MGG,Cigna MGG,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Humana,Humana,1899.24,,,,,,,per diem,1899.24,1899.24,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Humana MGG,Humana MGG,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Optum VA,Optum VA,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,UHC,UHC,1899.24,,,,,,,per diem,1899.24,1899.24,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,UHC MGG,UHC MGG,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,VA,VA,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Wellcare MGG,Wellcare MGG,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Bright Health - commercial,Bright Health - commercial,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,21550,CPT,,,,Inpatient,,,1899.24,1899.24,Bright Health MGG,Bright Health MGG,1899.24,,,,,,,case rate,1899.24,1899.24,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Aetna,Aetna,1874.76,,,,,,,per diem,1874.76,1874.76,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Aetna MGG,Aetna MGG,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,BCBS,BCBS,1874.76,,,,,,,per diem,1874.76,1874.76,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,BCBS MGG,BCBS MGG,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Cigna,Cigna,1874.76,,,,,,,per diem,1874.76,1874.76,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Cigna MGG,Cigna MGG,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Humana,Humana,1874.76,,,,,,,per diem,1874.76,1874.76,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Humana MGG,Humana MGG,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Optum VA,Optum VA,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,UHC,UHC,1874.76,,,,,,,per diem,1874.76,1874.76,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,UHC MGG,UHC MGG,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,VA,VA,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Wellcare MGG,Wellcare MGG,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Bright Health - commercial,Bright Health - commercial,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,50200,CPT,,,,Inpatient,,,1874.76,1874.76,Bright Health MGG,Bright Health MGG,1874.76,,,,,,,case rate,1874.76,1874.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Aetna,Aetna,1080.18,,,,,,,per diem,1080.18,1080.18,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Aetna MGG,Aetna MGG,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,BCBS,BCBS,1080.18,,,,,,,per diem,1080.18,1080.18,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,BCBS MGG,BCBS MGG,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Cigna,Cigna,1080.18,,,,,,,per diem,1080.18,1080.18,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Cigna MGG,Cigna MGG,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Humana,Humana,1080.18,,,,,,,per diem,1080.18,1080.18,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Humana MGG,Humana MGG,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Optum VA,Optum VA,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,UHC,UHC,1080.18,,,,,,,per diem,1080.18,1080.18,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,UHC MGG,UHC MGG,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,VA,VA,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Wellcare MGG,Wellcare MGG,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Bright Health - commercial,Bright Health - commercial,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,60100,CPT,,,,Inpatient,,,1080.18,1080.18,Bright Health MGG,Bright Health MGG,1080.18,,,,,,,case rate,1080.18,1080.18,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Aetna,Aetna,2071.62,,,,,,,per diem,2071.62,2071.62,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Aetna MGG,Aetna MGG,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,BCBS,BCBS,2071.62,,,,,,,per diem,2071.62,2071.62,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,BCBS MGG,BCBS MGG,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Cigna,Cigna,2071.62,,,,,,,per diem,2071.62,2071.62,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Cigna MGG,Cigna MGG,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Humana,Humana,2071.62,,,,,,,per diem,2071.62,2071.62,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Humana MGG,Humana MGG,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Optum VA,Optum VA,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,UHC,UHC,2071.62,,,,,,,per diem,2071.62,2071.62,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,UHC MGG,UHC MGG,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,VA,VA,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Wellcare MGG,Wellcare MGG,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Bright Health - commercial,Bright Health - commercial,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,38505,CPT,,,,Inpatient,,,2071.62,2071.62,Bright Health MGG,Bright Health MGG,2071.62,,,,,,,case rate,2071.62,2071.62,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,61055,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Aetna,Aetna,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Aetna MGG,Aetna MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,BCBS,BCBS,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,BCBS MGG,BCBS MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Cigna,Cigna,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Cigna MGG,Cigna MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Humana,Humana,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Humana MGG,Humana MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Optum VA,Optum VA,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,UHC,UHC,1033.26,,,,,,,per diem,1033.26,1033.26,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,UHC MGG,UHC MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,VA,VA,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Wellcare MGG,Wellcare MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Bright Health - commercial,Bright Health - commercial,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,36200,CPT,,,,Inpatient,,,1033.26,1033.26,Bright Health MGG,Bright Health MGG,1033.26,,,,,,,case rate,1033.26,1033.26,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Aetna,Aetna,9250.38,,,,,,,per diem,9250.38,9250.38,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Aetna MGG,Aetna MGG,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,BCBS,BCBS,9250.38,,,,,,,per diem,9250.38,9250.38,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,BCBS MGG,BCBS MGG,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Cigna,Cigna,9250.38,,,,,,,per diem,9250.38,9250.38,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Cigna MGG,Cigna MGG,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Humana,Humana,9250.38,,,,,,,per diem,9250.38,9250.38,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Humana MGG,Humana MGG,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Optum VA,Optum VA,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,UHC,UHC,9250.38,,,,,,,per diem,9250.38,9250.38,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,UHC MGG,UHC MGG,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,VA,VA,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Wellcare MGG,Wellcare MGG,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Bright Health - commercial,Bright Health - commercial,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,36227,CPT,,,,Inpatient,,,9250.38,9250.38,Bright Health MGG,Bright Health MGG,9250.38,,,,,,,case rate,9250.38,9250.38,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Aetna,Aetna,839.46,,,,,,,per diem,839.46,839.46,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Aetna MGG,Aetna MGG,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,BCBS,BCBS,839.46,,,,,,,per diem,839.46,839.46,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,BCBS MGG,BCBS MGG,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Cigna,Cigna,839.46,,,,,,,per diem,839.46,839.46,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Cigna MGG,Cigna MGG,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Humana,Humana,839.46,,,,,,,per diem,839.46,839.46,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Humana MGG,Humana MGG,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Optum VA,Optum VA,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,UHC,UHC,839.46,,,,,,,per diem,839.46,839.46,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,UHC MGG,UHC MGG,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,VA,VA,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Wellcare MGG,Wellcare MGG,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Bright Health - commercial,Bright Health - commercial,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,51600,CPT,,,,Inpatient,,,839.46,839.46,Bright Health MGG,Bright Health MGG,839.46,,,,,,,case rate,839.46,839.46,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Aetna,Aetna,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Aetna MGG,Aetna MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,BCBS,BCBS,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,BCBS MGG,BCBS MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Cigna,Cigna,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Cigna MGG,Cigna MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Humana,Humana,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Humana MGG,Humana MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Optum VA,Optum VA,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,UHC,UHC,6334.2,,,,,,,per diem,6334.2,6334.2,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,UHC MGG,UHC MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,VA,VA,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Wellcare MGG,Wellcare MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Bright Health - commercial,Bright Health - commercial,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,36598,CPT,,,,Inpatient,,,6334.2,6334.2,Bright Health MGG,Bright Health MGG,6334.2,,,,,,,case rate,6334.2,6334.2,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Aetna,Aetna,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Aetna MGG,Aetna MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,BCBS,BCBS,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,BCBS MGG,BCBS MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Cigna,Cigna,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Cigna MGG,Cigna MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Humana,Humana,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Humana MGG,Humana MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Optum VA,Optum VA,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,UHC,UHC,659.94,,,,,,,per diem,659.94,659.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,UHC MGG,UHC MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,VA,VA,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Wellcare MGG,Wellcare MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Bright Health - commercial,Bright Health - commercial,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,49465,CPT,,,,Inpatient,,,659.94,659.94,Bright Health MGG,Bright Health MGG,659.94,,,,,,,case rate,659.94,659.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Aetna,Aetna,868.02,,,,,,,per diem,868.02,868.02,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Aetna MGG,Aetna MGG,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,BCBS,BCBS,868.02,,,,,,,per diem,868.02,868.02,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,BCBS MGG,BCBS MGG,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Cigna,Cigna,868.02,,,,,,,per diem,868.02,868.02,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Cigna MGG,Cigna MGG,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Humana,Humana,868.02,,,,,,,per diem,868.02,868.02,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Humana MGG,Humana MGG,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Optum VA,Optum VA,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,UHC,UHC,868.02,,,,,,,per diem,868.02,868.02,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,UHC MGG,UHC MGG,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,VA,VA,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Wellcare MGG,Wellcare MGG,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Bright Health - commercial,Bright Health - commercial,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,58340,CPT,,,,Inpatient,,,868.02,868.02,Bright Health MGG,Bright Health MGG,868.02,,,,,,,case rate,868.02,868.02,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Aetna,Aetna,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Aetna MGG,Aetna MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,BCBS,BCBS,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,BCBS MGG,BCBS MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Cigna,Cigna,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Cigna MGG,Cigna MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Humana,Humana,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Humana MGG,Humana MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Optum VA,Optum VA,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,UHC,UHC,3872.94,,,,,,,per diem,3872.94,3872.94,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,UHC MGG,UHC MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,VA,VA,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Wellcare MGG,Wellcare MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Bright Health - commercial,Bright Health - commercial,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,37191,CPT,,,,Inpatient,,,3872.94,3872.94,Bright Health MGG,Bright Health MGG,3872.94,,,,,,,case rate,3872.94,3872.94,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Aetna,Aetna,1786.02,,,,,,,per diem,1786.02,1786.02,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Aetna MGG,Aetna MGG,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,BCBS,BCBS,1786.02,,,,,,,per diem,1786.02,1786.02,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,BCBS MGG,BCBS MGG,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Cigna,Cigna,1786.02,,,,,,,per diem,1786.02,1786.02,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Cigna MGG,Cigna MGG,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Humana,Humana,1786.02,,,,,,,per diem,1786.02,1786.02,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Humana MGG,Humana MGG,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Optum VA,Optum VA,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,UHC,UHC,1786.02,,,,,,,per diem,1786.02,1786.02,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,UHC MGG,UHC MGG,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,VA,VA,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Wellcare MGG,Wellcare MGG,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Bright Health - commercial,Bright Health - commercial,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,62270,CPT,,,,Inpatient,,,1786.02,1786.02,Bright Health MGG,Bright Health MGG,1786.02,,,,,,,case rate,1786.02,1786.02,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Aetna,Aetna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Aetna MGG,Aetna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,BCBS,BCBS,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,BCBS MGG,BCBS MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Cigna,Cigna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Cigna MGG,Cigna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Humana,Humana,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Humana MGG,Humana MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Optum VA,Optum VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,UHC,UHC,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,UHC MGG,UHC MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,VA,VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Wellcare MGG,Wellcare MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Bright Health - commercial,Bright Health - commercial,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,62272,CPT,,,,Inpatient,,,598.74,598.74,Bright Health MGG,Bright Health MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Aetna,Aetna,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Aetna MGG,Aetna MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,BCBS,BCBS,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,BCBS MGG,BCBS MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Cigna,Cigna,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Cigna MGG,Cigna MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Humana,Humana,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Humana MGG,Humana MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Optum VA,Optum VA,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,UHC,UHC,1144.44,,,,,,,per diem,1144.44,1144.44,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,UHC MGG,UHC MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,VA,VA,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Wellcare MGG,Wellcare MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Bright Health - commercial,Bright Health - commercial,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,38790,CPT,,,,Inpatient,,,1144.44,1144.44,Bright Health MGG,Bright Health MGG,1144.44,,,,,,,case rate,1144.44,1144.44,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Aetna,Aetna,4415.58,,,,,,,per diem,4415.58,4415.58,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Aetna MGG,Aetna MGG,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,BCBS,BCBS,4415.58,,,,,,,per diem,4415.58,4415.58,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,BCBS MGG,BCBS MGG,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Cigna,Cigna,4415.58,,,,,,,per diem,4415.58,4415.58,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Cigna MGG,Cigna MGG,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Humana,Humana,4415.58,,,,,,,per diem,4415.58,4415.58,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Humana MGG,Humana MGG,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Optum VA,Optum VA,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,UHC,UHC,4415.58,,,,,,,per diem,4415.58,4415.58,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,UHC MGG,UHC MGG,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,VA,VA,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Wellcare MGG,Wellcare MGG,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Bright Health - commercial,Bright Health - commercial,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,62284,CPT,,,,Inpatient,,,4415.58,4415.58,Bright Health MGG,Bright Health MGG,4415.58,,,,,,,case rate,4415.58,4415.58,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Aetna,Aetna,2661.18,,,,,,,per diem,2661.18,2661.18,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Aetna MGG,Aetna MGG,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,BCBS,BCBS,2661.18,,,,,,,per diem,2661.18,2661.18,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,BCBS MGG,BCBS MGG,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Cigna,Cigna,2661.18,,,,,,,per diem,2661.18,2661.18,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Cigna MGG,Cigna MGG,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Humana,Humana,2661.18,,,,,,,per diem,2661.18,2661.18,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Humana MGG,Humana MGG,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Optum VA,Optum VA,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,UHC,UHC,2661.18,,,,,,,per diem,2661.18,2661.18,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,UHC MGG,UHC MGG,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,VA,VA,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Wellcare MGG,Wellcare MGG,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Bright Health - commercial,Bright Health - commercial,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,43752,CPT,,,,Inpatient,,,2661.18,2661.18,Bright Health MGG,Bright Health MGG,2661.18,,,,,,,case rate,2661.18,2661.18,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Aetna,Aetna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Aetna MGG,Aetna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,BCBS,BCBS,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,BCBS MGG,BCBS MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Cigna,Cigna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Cigna MGG,Cigna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Humana,Humana,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Humana MGG,Humana MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Optum VA,Optum VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,UHC,UHC,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,UHC MGG,UHC MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,VA,VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Wellcare MGG,Wellcare MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Bright Health - commercial,Bright Health - commercial,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Bright Health MGG,Bright Health MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Aetna,Aetna,2670.36,,,,,,,per diem,2670.36,2670.36,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Aetna MGG,Aetna MGG,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,BCBS,BCBS,2670.36,,,,,,,per diem,2670.36,2670.36,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,BCBS MGG,BCBS MGG,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Cigna,Cigna,2670.36,,,,,,,per diem,2670.36,2670.36,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Cigna MGG,Cigna MGG,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Humana,Humana,2670.36,,,,,,,per diem,2670.36,2670.36,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Humana MGG,Humana MGG,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Optum VA,Optum VA,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,UHC,UHC,2670.36,,,,,,,per diem,2670.36,2670.36,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,UHC MGG,UHC MGG,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,VA,VA,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Wellcare MGG,Wellcare MGG,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Bright Health - commercial,Bright Health - commercial,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,49460,CPT,,,,Inpatient,,,2670.36,2670.36,Bright Health MGG,Bright Health MGG,2670.36,,,,,,,case rate,2670.36,2670.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Aetna,Aetna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Aetna MGG,Aetna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,BCBS,BCBS,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,BCBS MGG,BCBS MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Cigna,Cigna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Cigna MGG,Cigna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Humana,Humana,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Humana MGG,Humana MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Optum VA,Optum VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,UHC,UHC,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,UHC MGG,UHC MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,VA,VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Wellcare MGG,Wellcare MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Bright Health - commercial,Bright Health - commercial,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,61070,CPT,,,,Inpatient,,,493.68,493.68,Bright Health MGG,Bright Health MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Aetna,Aetna,996.54,,,,,,,per diem,996.54,996.54,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Aetna MGG,Aetna MGG,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,BCBS,BCBS,996.54,,,,,,,per diem,996.54,996.54,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,BCBS MGG,BCBS MGG,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Cigna,Cigna,996.54,,,,,,,per diem,996.54,996.54,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Cigna MGG,Cigna MGG,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Humana,Humana,996.54,,,,,,,per diem,996.54,996.54,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Humana MGG,Humana MGG,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Optum VA,Optum VA,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,UHC,UHC,996.54,,,,,,,per diem,996.54,996.54,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,UHC MGG,UHC MGG,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,VA,VA,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Wellcare MGG,Wellcare MGG,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Bright Health - commercial,Bright Health - commercial,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,42550,CPT,,,,Inpatient,,,996.54,996.54,Bright Health MGG,Bright Health MGG,996.54,,,,,,,case rate,996.54,996.54,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Aetna,Aetna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Aetna MGG,Aetna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,BCBS,BCBS,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,BCBS MGG,BCBS MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Cigna,Cigna,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Cigna MGG,Cigna MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Humana,Humana,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Humana MGG,Humana MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Optum VA,Optum VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,UHC,UHC,208.08,,,,,,,per diem,208.08,208.08,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,UHC MGG,UHC MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,VA,VA,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Wellcare MGG,Wellcare MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Bright Health - commercial,Bright Health - commercial,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,36410,CPT,,,,Inpatient,,,208.08,208.08,Bright Health MGG,Bright Health MGG,208.08,,,,,,,case rate,208.08,208.08,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna,Aetna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna MGG,Aetna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS,BCBS,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS MGG,BCBS MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna,Cigna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna MGG,Cigna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Humana,Humana,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Humana MGG,Humana MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Optum VA,Optum VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,UHC,UHC,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,UHC MGG,UHC MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,VA,VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Wellcare MGG,Wellcare MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health - commercial,Bright Health - commercial,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,19081,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health MGG,Bright Health MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna,Aetna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna MGG,Aetna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS,BCBS,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS MGG,BCBS MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna,Cigna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna MGG,Cigna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Humana,Humana,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Humana MGG,Humana MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Optum VA,Optum VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,UHC,UHC,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,UHC MGG,UHC MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,VA,VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Wellcare MGG,Wellcare MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health - commercial,Bright Health - commercial,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,19082,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health MGG,Bright Health MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Aetna,Aetna,893.52,,,,,,,per diem,893.52,893.52,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Aetna MGG,Aetna MGG,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,BCBS,BCBS,893.52,,,,,,,per diem,893.52,893.52,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,BCBS MGG,BCBS MGG,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Cigna,Cigna,893.52,,,,,,,per diem,893.52,893.52,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Cigna MGG,Cigna MGG,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Humana,Humana,893.52,,,,,,,per diem,893.52,893.52,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Humana MGG,Humana MGG,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Optum VA,Optum VA,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,UHC,UHC,893.52,,,,,,,per diem,893.52,893.52,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,UHC MGG,UHC MGG,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,VA,VA,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Wellcare MGG,Wellcare MGG,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Bright Health - commercial,Bright Health - commercial,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,36005,CPT,,,,Inpatient,,,893.52,893.52,Bright Health MGG,Bright Health MGG,893.52,,,,,,,case rate,893.52,893.52,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Aetna,Aetna,1269.9,,,,,,,per diem,1269.9,1269.9,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Aetna MGG,Aetna MGG,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,BCBS,BCBS,1269.9,,,,,,,per diem,1269.9,1269.9,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,BCBS MGG,BCBS MGG,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Cigna,Cigna,1269.9,,,,,,,per diem,1269.9,1269.9,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Cigna MGG,Cigna MGG,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Humana,Humana,1269.9,,,,,,,per diem,1269.9,1269.9,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Humana MGG,Humana MGG,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Optum VA,Optum VA,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,UHC,UHC,1269.9,,,,,,,per diem,1269.9,1269.9,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,UHC MGG,UHC MGG,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,VA,VA,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Wellcare MGG,Wellcare MGG,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Bright Health - commercial,Bright Health - commercial,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,44500,CPT,,,,Inpatient,,,1269.9,1269.9,Bright Health MGG,Bright Health MGG,1269.9,,,,,,,case rate,1269.9,1269.9,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Aetna,Aetna,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Aetna MGG,Aetna MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,BCBS,BCBS,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,BCBS MGG,BCBS MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Cigna,Cigna,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Cigna MGG,Cigna MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Humana,Humana,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Humana MGG,Humana MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Optum VA,Optum VA,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,UHC,UHC,466.14,,,,,,,per diem,466.14,466.14,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,UHC MGG,UHC MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,VA,VA,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Wellcare MGG,Wellcare MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Bright Health - commercial,Bright Health - commercial,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,20501,CPT,,,,Inpatient,,,466.14,466.14,Bright Health MGG,Bright Health MGG,466.14,,,,,,,case rate,466.14,466.14,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna,Aetna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna MGG,Aetna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS,BCBS,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS MGG,BCBS MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna,Cigna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna MGG,Cigna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Humana,Humana,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Humana MGG,Humana MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Optum VA,Optum VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,UHC,UHC,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,UHC MGG,UHC MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,VA,VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Wellcare MGG,Wellcare MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health - commercial,Bright Health - commercial,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,62302,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health MGG,Bright Health MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna,Aetna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna MGG,Aetna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS,BCBS,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS MGG,BCBS MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna,Cigna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna MGG,Cigna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Humana,Humana,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Humana MGG,Humana MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Optum VA,Optum VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,UHC,UHC,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,UHC MGG,UHC MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,VA,VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Wellcare MGG,Wellcare MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health - commercial,Bright Health - commercial,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,62303,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health MGG,Bright Health MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna,Aetna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna MGG,Aetna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS,BCBS,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS MGG,BCBS MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna,Cigna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna MGG,Cigna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Humana,Humana,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Humana MGG,Humana MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Optum VA,Optum VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,UHC,UHC,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,UHC MGG,UHC MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,VA,VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Wellcare MGG,Wellcare MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health - commercial,Bright Health - commercial,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,62304,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health MGG,Bright Health MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna,Aetna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Aetna MGG,Aetna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS,BCBS,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,BCBS MGG,BCBS MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna,Cigna,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Cigna MGG,Cigna MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Humana,Humana,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Humana MGG,Humana MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Optum VA,Optum VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,UHC,UHC,3586.32,,,,,,,per diem,3586.32,3586.32,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,UHC MGG,UHC MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,VA,VA,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Wellcare MGG,Wellcare MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health - commercial,Bright Health - commercial,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,62305,CPT,,,,Inpatient,,,3586.32,3586.32,Bright Health MGG,Bright Health MGG,3586.32,,,,,,,case rate,3586.32,3586.32,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Aetna,Aetna,1687.08,,,,,,,per diem,1687.08,1687.08,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Aetna MGG,Aetna MGG,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,BCBS,BCBS,1687.08,,,,,,,per diem,1687.08,1687.08,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,BCBS MGG,BCBS MGG,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Cigna,Cigna,1687.08,,,,,,,per diem,1687.08,1687.08,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Cigna MGG,Cigna MGG,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Humana,Humana,1687.08,,,,,,,per diem,1687.08,1687.08,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Humana MGG,Humana MGG,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Optum VA,Optum VA,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,UHC,UHC,1687.08,,,,,,,per diem,1687.08,1687.08,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,UHC MGG,UHC MGG,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,VA,VA,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Wellcare MGG,Wellcare MGG,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Bright Health - commercial,Bright Health - commercial,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,47531,CPT,,,,Inpatient,,,1687.08,1687.08,Bright Health MGG,Bright Health MGG,1687.08,,,,,,,case rate,1687.08,1687.08,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,47532,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,47533,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,47534,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,47535,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,47536,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Aetna,Aetna,2685.66,,,,,,,per diem,2685.66,2685.66,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Aetna MGG,Aetna MGG,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,BCBS,BCBS,2685.66,,,,,,,per diem,2685.66,2685.66,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,BCBS MGG,BCBS MGG,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Cigna,Cigna,2685.66,,,,,,,per diem,2685.66,2685.66,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Cigna MGG,Cigna MGG,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Humana,Humana,2685.66,,,,,,,per diem,2685.66,2685.66,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Humana MGG,Humana MGG,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Optum VA,Optum VA,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,UHC,UHC,2685.66,,,,,,,per diem,2685.66,2685.66,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,UHC MGG,UHC MGG,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,VA,VA,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Wellcare MGG,Wellcare MGG,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Bright Health - commercial,Bright Health - commercial,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,47537,CPT,,,,Inpatient,,,2685.66,2685.66,Bright Health MGG,Bright Health MGG,2685.66,,,,,,,case rate,2685.66,2685.66,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna,Aetna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna MGG,Aetna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS,BCBS,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS MGG,BCBS MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna,Cigna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna MGG,Cigna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Humana,Humana,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Humana MGG,Humana MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Optum VA,Optum VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,UHC,UHC,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,UHC MGG,UHC MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,VA,VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Wellcare MGG,Wellcare MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health - commercial,Bright Health - commercial,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,47538,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health MGG,Bright Health MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna,Aetna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna MGG,Aetna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS,BCBS,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS MGG,BCBS MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna,Cigna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna MGG,Cigna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Humana,Humana,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Humana MGG,Humana MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Optum VA,Optum VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,UHC,UHC,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,UHC MGG,UHC MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,VA,VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Wellcare MGG,Wellcare MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health - commercial,Bright Health - commercial,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,47539,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health MGG,Bright Health MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna,Aetna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Aetna MGG,Aetna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS,BCBS,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,BCBS MGG,BCBS MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna,Cigna,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Cigna MGG,Cigna MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Humana,Humana,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Humana MGG,Humana MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Optum VA,Optum VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,UHC,UHC,22908.18,,,,,,,per diem,22908.18,22908.18,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,UHC MGG,UHC MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,VA,VA,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Wellcare MGG,Wellcare MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health - commercial,Bright Health - commercial,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,47540,CPT,,,,Inpatient,,,22908.18,22908.18,Bright Health MGG,Bright Health MGG,22908.18,,,,,,,case rate,22908.18,22908.18,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna,Aetna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Aetna MGG,Aetna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS,BCBS,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,BCBS MGG,BCBS MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna,Cigna,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Cigna MGG,Cigna MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Humana,Humana,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Humana MGG,Humana MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Optum VA,Optum VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,UHC,UHC,12110.46,,,,,,,per diem,12110.46,12110.46,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,UHC MGG,UHC MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,VA,VA,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Wellcare MGG,Wellcare MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health - commercial,Bright Health - commercial,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,47541,CPT,,,,Inpatient,,,12110.46,12110.46,Bright Health MGG,Bright Health MGG,12110.46,,,,,,,case rate,12110.46,12110.46,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Aetna,Aetna,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Aetna MGG,Aetna MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,BCBS,BCBS,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,BCBS MGG,BCBS MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Cigna,Cigna,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Cigna MGG,Cigna MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Humana,Humana,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Humana MGG,Humana MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Optum VA,Optum VA,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,UHC,UHC,772.14,,,,,,,per diem,772.14,772.14,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,UHC MGG,UHC MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,VA,VA,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Wellcare MGG,Wellcare MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Bright Health - commercial,Bright Health - commercial,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,11982,CPT,,,,Inpatient,,,772.14,772.14,Bright Health MGG,Bright Health MGG,772.14,,,,,,,case rate,772.14,772.14,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Aetna,Aetna,4891,,,,,,,per diem,4891,4891,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Aetna MGG,Aetna MGG,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,BCBS,BCBS,4891,,,,,,,per diem,4891,4891,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,BCBS MGG,BCBS MGG,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Cigna,Cigna,4891,,,,,,,per diem,4891,4891,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Cigna MGG,Cigna MGG,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Humana,Humana,4891,,,,,,,per diem,4891,4891,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Humana MGG,Humana MGG,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Optum VA,Optum VA,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,UHC,UHC,4891,,,,,,,per diem,4891,4891,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,UHC MGG,UHC MGG,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,VA,VA,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Wellcare MGG,Wellcare MGG,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Bright Health - commercial,Bright Health - commercial,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,4891,4891,Bright Health MGG,Bright Health MGG,4891,,,,,,,case rate,4891,4891,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Aetna,Aetna,3194.36,,,,,,,per diem,3194.36,3194.36,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Aetna MGG,Aetna MGG,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,BCBS,BCBS,3194.36,,,,,,,per diem,3194.36,3194.36,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,BCBS MGG,BCBS MGG,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Cigna,Cigna,3194.36,,,,,,,per diem,3194.36,3194.36,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Cigna MGG,Cigna MGG,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Humana,Humana,3194.36,,,,,,,per diem,3194.36,3194.36,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Humana MGG,Humana MGG,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Optum VA,Optum VA,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,UHC,UHC,3194.36,,,,,,,per diem,3194.36,3194.36,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,UHC MGG,UHC MGG,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,VA,VA,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Wellcare MGG,Wellcare MGG,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Bright Health - commercial,Bright Health - commercial,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3194.36,3194.36,Bright Health MGG,Bright Health MGG,3194.36,,,,,,,case rate,3194.36,3194.36,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Aetna,Aetna,3490.5,,,,,,,per diem,3490.5,3490.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Aetna MGG,Aetna MGG,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,BCBS,BCBS,3490.5,,,,,,,per diem,3490.5,3490.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,BCBS MGG,BCBS MGG,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Cigna,Cigna,3490.5,,,,,,,per diem,3490.5,3490.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Cigna MGG,Cigna MGG,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Humana,Humana,3490.5,,,,,,,per diem,3490.5,3490.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Humana MGG,Humana MGG,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Optum VA,Optum VA,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,UHC,UHC,3490.5,,,,,,,per diem,3490.5,3490.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,UHC MGG,UHC MGG,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,VA,VA,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Wellcare MGG,Wellcare MGG,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Bright Health - commercial,Bright Health - commercial,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST RT  ,74200013,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,3490.5,3490.5,Bright Health MGG,Bright Health MGG,3490.5,,,,,,,case rate,3490.5,3490.5,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Aetna,Aetna,2536,,,,,,,per diem,2536,2536,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Aetna MGG,Aetna MGG,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,BCBS,BCBS,2536,,,,,,,per diem,2536,2536,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,BCBS MGG,BCBS MGG,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Cigna,Cigna,2536,,,,,,,per diem,2536,2536,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Cigna MGG,Cigna MGG,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Humana,Humana,2536,,,,,,,per diem,2536,2536,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Humana MGG,Humana MGG,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Optum VA,Optum VA,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,UHC,UHC,2536,,,,,,,per diem,2536,2536,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,UHC MGG,UHC MGG,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,VA,VA,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Wellcare MGG,Wellcare MGG,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Bright Health - commercial,Bright Health - commercial,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2536,2536,Bright Health MGG,Bright Health MGG,2536,,,,,,,case rate,2536,2536,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Aetna,Aetna,11845,,,,,,,per diem,11845,11845,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Aetna MGG,Aetna MGG,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,BCBS,BCBS,11845,,,,,,,per diem,11845,11845,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,BCBS MGG,BCBS MGG,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Cigna,Cigna,11845,,,,,,,per diem,11845,11845,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Cigna MGG,Cigna MGG,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Humana,Humana,11845,,,,,,,per diem,11845,11845,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Humana MGG,Humana MGG,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Optum VA,Optum VA,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,UHC,UHC,11845,,,,,,,per diem,11845,11845,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,UHC MGG,UHC MGG,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,VA,VA,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Wellcare MGG,Wellcare MGG,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Bright Health - commercial,Bright Health - commercial,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,11845,11845,Bright Health MGG,Bright Health MGG,11845,,,,,,,case rate,11845,11845,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Aetna,Aetna,158,,,,,,,per diem,158,158,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Aetna MGG,Aetna MGG,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,BCBS,BCBS,158,,,,,,,per diem,158,158,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,BCBS MGG,BCBS MGG,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Cigna,Cigna,158,,,,,,,per diem,158,158,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Cigna MGG,Cigna MGG,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Humana,Humana,158,,,,,,,per diem,158,158,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Humana MGG,Humana MGG,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Optum VA,Optum VA,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,UHC,UHC,158,,,,,,,per diem,158,158,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,UHC MGG,UHC MGG,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,VA,VA,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Wellcare MGG,Wellcare MGG,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Bright Health - commercial,Bright Health - commercial,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,158,158,Bright Health MGG,Bright Health MGG,158,,,,,,,case rate,158,158,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Aetna,Aetna,3536.02,,,,,,,per diem,3536.02,3536.02,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Aetna MGG,Aetna MGG,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,BCBS,BCBS,3536.02,,,,,,,per diem,3536.02,3536.02,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,BCBS MGG,BCBS MGG,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Cigna,Cigna,3536.02,,,,,,,per diem,3536.02,3536.02,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Cigna MGG,Cigna MGG,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Humana,Humana,3536.02,,,,,,,per diem,3536.02,3536.02,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Humana MGG,Humana MGG,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Optum VA,Optum VA,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,UHC,UHC,3536.02,,,,,,,per diem,3536.02,3536.02,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,UHC MGG,UHC MGG,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,VA,VA,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Wellcare MGG,Wellcare MGG,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Bright Health - commercial,Bright Health - commercial,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3536.02,3536.02,Bright Health MGG,Bright Health MGG,3536.02,,,,,,,case rate,3536.02,3536.02,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Aetna,Aetna,2427,,,,,,,per diem,2427,2427,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Aetna MGG,Aetna MGG,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,BCBS,BCBS,2427,,,,,,,per diem,2427,2427,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,BCBS MGG,BCBS MGG,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Cigna,Cigna,2427,,,,,,,per diem,2427,2427,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Cigna MGG,Cigna MGG,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Humana,Humana,2427,,,,,,,per diem,2427,2427,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Humana MGG,Humana MGG,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Optum VA,Optum VA,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,UHC,UHC,2427,,,,,,,per diem,2427,2427,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,UHC MGG,UHC MGG,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,VA,VA,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Wellcare MGG,Wellcare MGG,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Bright Health - commercial,Bright Health - commercial,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2427,2427,Bright Health MGG,Bright Health MGG,2427,,,,,,,case rate,2427,2427,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Aetna,Aetna,8012.72,,,,,,,per diem,8012.72,8012.72,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Aetna MGG,Aetna MGG,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,BCBS,BCBS,8012.72,,,,,,,per diem,8012.72,8012.72,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,BCBS MGG,BCBS MGG,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Cigna,Cigna,8012.72,,,,,,,per diem,8012.72,8012.72,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Cigna MGG,Cigna MGG,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Humana,Humana,8012.72,,,,,,,per diem,8012.72,8012.72,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Humana MGG,Humana MGG,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Optum VA,Optum VA,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,UHC,UHC,8012.72,,,,,,,per diem,8012.72,8012.72,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,UHC MGG,UHC MGG,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,VA,VA,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Wellcare MGG,Wellcare MGG,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Bright Health - commercial,Bright Health - commercial,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8012.72,8012.72,Bright Health MGG,Bright Health MGG,8012.72,,,,,,,case rate,8012.72,8012.72,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Aetna,Aetna,2490,,,,,,,per diem,2490,2490,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Aetna MGG,Aetna MGG,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,BCBS,BCBS,2490,,,,,,,per diem,2490,2490,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,BCBS MGG,BCBS MGG,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Cigna,Cigna,2490,,,,,,,per diem,2490,2490,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Cigna MGG,Cigna MGG,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Humana,Humana,2490,,,,,,,per diem,2490,2490,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Humana MGG,Humana MGG,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Optum VA,Optum VA,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,UHC,UHC,2490,,,,,,,per diem,2490,2490,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,UHC MGG,UHC MGG,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,VA,VA,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Wellcare MGG,Wellcare MGG,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Bright Health - commercial,Bright Health - commercial,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2490,2490,Bright Health MGG,Bright Health MGG,2490,,,,,,,case rate,2490,2490,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Aetna,Aetna,2049.18,,,,,,,per diem,2049.18,2049.18,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Aetna MGG,Aetna MGG,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,BCBS,BCBS,2049.18,,,,,,,per diem,2049.18,2049.18,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,BCBS MGG,BCBS MGG,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Cigna,Cigna,2049.18,,,,,,,per diem,2049.18,2049.18,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Cigna MGG,Cigna MGG,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Humana,Humana,2049.18,,,,,,,per diem,2049.18,2049.18,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Humana MGG,Humana MGG,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Optum VA,Optum VA,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,UHC,UHC,2049.18,,,,,,,per diem,2049.18,2049.18,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,UHC MGG,UHC MGG,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,VA,VA,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Wellcare MGG,Wellcare MGG,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Bright Health - commercial,Bright Health - commercial,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2049.18,2049.18,Bright Health MGG,Bright Health MGG,2049.18,,,,,,,case rate,2049.18,2049.18,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Aetna,Aetna,256.6,,,,,,,per diem,256.6,256.6,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Aetna MGG,Aetna MGG,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,BCBS,BCBS,256.6,,,,,,,per diem,256.6,256.6,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,BCBS MGG,BCBS MGG,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Cigna,Cigna,256.6,,,,,,,per diem,256.6,256.6,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Cigna MGG,Cigna MGG,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Humana,Humana,256.6,,,,,,,per diem,256.6,256.6,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Humana MGG,Humana MGG,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Optum VA,Optum VA,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,UHC,UHC,256.6,,,,,,,per diem,256.6,256.6,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,UHC MGG,UHC MGG,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,VA,VA,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Wellcare MGG,Wellcare MGG,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Bright Health - commercial,Bright Health - commercial,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,256.6,256.6,Bright Health MGG,Bright Health MGG,256.6,,,,,,,case rate,256.6,256.6,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Aetna,Aetna,2087.68,,,,,,,per diem,2087.68,2087.68,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Aetna MGG,Aetna MGG,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,BCBS,BCBS,2087.68,,,,,,,per diem,2087.68,2087.68,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,BCBS MGG,BCBS MGG,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Cigna,Cigna,2087.68,,,,,,,per diem,2087.68,2087.68,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Cigna MGG,Cigna MGG,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Humana,Humana,2087.68,,,,,,,per diem,2087.68,2087.68,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Humana MGG,Humana MGG,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Optum VA,Optum VA,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,UHC,UHC,2087.68,,,,,,,per diem,2087.68,2087.68,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,UHC MGG,UHC MGG,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,VA,VA,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Wellcare MGG,Wellcare MGG,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Bright Health - commercial,Bright Health - commercial,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2087.68,2087.68,Bright Health MGG,Bright Health MGG,2087.68,,,,,,,case rate,2087.68,2087.68,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Aetna,Aetna,5742.32,,,,,,,per diem,5742.32,5742.32,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Aetna MGG,Aetna MGG,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,BCBS,BCBS,5742.32,,,,,,,per diem,5742.32,5742.32,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,BCBS MGG,BCBS MGG,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Cigna,Cigna,5742.32,,,,,,,per diem,5742.32,5742.32,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Cigna MGG,Cigna MGG,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Humana,Humana,5742.32,,,,,,,per diem,5742.32,5742.32,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Humana MGG,Humana MGG,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Optum VA,Optum VA,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,UHC,UHC,5742.32,,,,,,,per diem,5742.32,5742.32,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,UHC MGG,UHC MGG,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,VA,VA,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Wellcare MGG,Wellcare MGG,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Bright Health - commercial,Bright Health - commercial,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,5742.32,5742.32,Bright Health MGG,Bright Health MGG,5742.32,,,,,,,case rate,5742.32,5742.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Aetna,Aetna,1891.08,,,,,,,per diem,1891.08,1891.08,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Aetna MGG,Aetna MGG,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,BCBS,BCBS,1891.08,,,,,,,per diem,1891.08,1891.08,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,BCBS MGG,BCBS MGG,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Cigna,Cigna,1891.08,,,,,,,per diem,1891.08,1891.08,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Cigna MGG,Cigna MGG,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Humana,Humana,1891.08,,,,,,,per diem,1891.08,1891.08,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Humana MGG,Humana MGG,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Optum VA,Optum VA,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,UHC,UHC,1891.08,,,,,,,per diem,1891.08,1891.08,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,UHC MGG,UHC MGG,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,VA,VA,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Wellcare MGG,Wellcare MGG,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Bright Health - commercial,Bright Health - commercial,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1891.08,1891.08,Bright Health MGG,Bright Health MGG,1891.08,,,,,,,case rate,1891.08,1891.08,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Aetna,Aetna,5361.31,,,,,,,per diem,5361.31,5361.31,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Aetna MGG,Aetna MGG,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,BCBS,BCBS,5361.31,,,,,,,per diem,5361.31,5361.31,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,BCBS MGG,BCBS MGG,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Cigna,Cigna,5361.31,,,,,,,per diem,5361.31,5361.31,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Cigna MGG,Cigna MGG,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Humana,Humana,5361.31,,,,,,,per diem,5361.31,5361.31,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Humana MGG,Humana MGG,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Optum VA,Optum VA,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,UHC,UHC,5361.31,,,,,,,per diem,5361.31,5361.31,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,UHC MGG,UHC MGG,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,VA,VA,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Wellcare MGG,Wellcare MGG,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Bright Health - commercial,Bright Health - commercial,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5361.31,5361.31,Bright Health MGG,Bright Health MGG,5361.31,,,,,,,case rate,5361.31,5361.31,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Aetna,Aetna,5686.44,,,,,,,per diem,5686.44,5686.44,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Aetna MGG,Aetna MGG,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,BCBS,BCBS,5686.44,,,,,,,per diem,5686.44,5686.44,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,BCBS MGG,BCBS MGG,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Cigna,Cigna,5686.44,,,,,,,per diem,5686.44,5686.44,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Cigna MGG,Cigna MGG,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Humana,Humana,5686.44,,,,,,,per diem,5686.44,5686.44,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Humana MGG,Humana MGG,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Optum VA,Optum VA,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,UHC,UHC,5686.44,,,,,,,per diem,5686.44,5686.44,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,UHC MGG,UHC MGG,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,VA,VA,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Wellcare MGG,Wellcare MGG,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Bright Health - commercial,Bright Health - commercial,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5686.44,5686.44,Bright Health MGG,Bright Health MGG,5686.44,,,,,,,case rate,5686.44,5686.44,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Aetna,Aetna,2466,,,,,,,per diem,2466,2466,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Aetna MGG,Aetna MGG,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,BCBS,BCBS,2466,,,,,,,per diem,2466,2466,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,BCBS MGG,BCBS MGG,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Cigna,Cigna,2466,,,,,,,per diem,2466,2466,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Cigna MGG,Cigna MGG,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Humana,Humana,2466,,,,,,,per diem,2466,2466,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Humana MGG,Humana MGG,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Optum VA,Optum VA,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,UHC,UHC,2466,,,,,,,per diem,2466,2466,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,UHC MGG,UHC MGG,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,VA,VA,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Wellcare MGG,Wellcare MGG,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Bright Health - commercial,Bright Health - commercial,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,2466,2466,Bright Health MGG,Bright Health MGG,2466,,,,,,,case rate,2466,2466,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Aetna,Aetna,4590.86,,,,,,,per diem,4590.86,4590.86,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Aetna MGG,Aetna MGG,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,BCBS,BCBS,4590.86,,,,,,,per diem,4590.86,4590.86,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,BCBS MGG,BCBS MGG,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Cigna,Cigna,4590.86,,,,,,,per diem,4590.86,4590.86,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Cigna MGG,Cigna MGG,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Humana,Humana,4590.86,,,,,,,per diem,4590.86,4590.86,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Humana MGG,Humana MGG,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Optum VA,Optum VA,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,UHC,UHC,4590.86,,,,,,,per diem,4590.86,4590.86,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,UHC MGG,UHC MGG,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,VA,VA,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Wellcare MGG,Wellcare MGG,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Bright Health - commercial,Bright Health - commercial,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4590.86,4590.86,Bright Health MGG,Bright Health MGG,4590.86,,,,,,,case rate,4590.86,4590.86,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Aetna,Aetna,3410,,,,,,,per diem,3410,3410,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Aetna MGG,Aetna MGG,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,BCBS,BCBS,3410,,,,,,,per diem,3410,3410,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,BCBS MGG,BCBS MGG,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Cigna,Cigna,3410,,,,,,,per diem,3410,3410,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Cigna MGG,Cigna MGG,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Humana,Humana,3410,,,,,,,per diem,3410,3410,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Humana MGG,Humana MGG,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Optum VA,Optum VA,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,UHC,UHC,3410,,,,,,,per diem,3410,3410,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,UHC MGG,UHC MGG,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,VA,VA,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Wellcare MGG,Wellcare MGG,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Bright Health - commercial,Bright Health - commercial,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,3410,3410,Bright Health MGG,Bright Health MGG,3410,,,,,,,case rate,3410,3410,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Aetna,Aetna,3347,,,,,,,per diem,3347,3347,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Aetna MGG,Aetna MGG,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,BCBS,BCBS,3347,,,,,,,per diem,3347,3347,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,BCBS MGG,BCBS MGG,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Cigna,Cigna,3347,,,,,,,per diem,3347,3347,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Cigna MGG,Cigna MGG,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Humana,Humana,3347,,,,,,,per diem,3347,3347,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Humana MGG,Humana MGG,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Optum VA,Optum VA,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,UHC,UHC,3347,,,,,,,per diem,3347,3347,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,UHC MGG,UHC MGG,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,VA,VA,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Wellcare MGG,Wellcare MGG,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Bright Health - commercial,Bright Health - commercial,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3347,3347,Bright Health MGG,Bright Health MGG,3347,,,,,,,case rate,3347,3347,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Aetna,Aetna,6547.38,,,,,,,per diem,6547.38,6547.38,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Aetna MGG,Aetna MGG,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,BCBS,BCBS,6547.38,,,,,,,per diem,6547.38,6547.38,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,BCBS MGG,BCBS MGG,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Cigna,Cigna,6547.38,,,,,,,per diem,6547.38,6547.38,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Cigna MGG,Cigna MGG,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Humana,Humana,6547.38,,,,,,,per diem,6547.38,6547.38,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Humana MGG,Humana MGG,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Optum VA,Optum VA,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,UHC,UHC,6547.38,,,,,,,per diem,6547.38,6547.38,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,UHC MGG,UHC MGG,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,VA,VA,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Wellcare MGG,Wellcare MGG,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Bright Health - commercial,Bright Health - commercial,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6547.38,6547.38,Bright Health MGG,Bright Health MGG,6547.38,,,,,,,case rate,6547.38,6547.38,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Aetna,Aetna,3055.92,,,,,,,per diem,3055.92,3055.92,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Aetna MGG,Aetna MGG,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,BCBS,BCBS,3055.92,,,,,,,per diem,3055.92,3055.92,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,BCBS MGG,BCBS MGG,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Cigna,Cigna,3055.92,,,,,,,per diem,3055.92,3055.92,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Cigna MGG,Cigna MGG,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Humana,Humana,3055.92,,,,,,,per diem,3055.92,3055.92,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Humana MGG,Humana MGG,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Optum VA,Optum VA,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,UHC,UHC,3055.92,,,,,,,per diem,3055.92,3055.92,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,UHC MGG,UHC MGG,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,VA,VA,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Wellcare MGG,Wellcare MGG,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Bright Health - commercial,Bright Health - commercial,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3055.92,3055.92,Bright Health MGG,Bright Health MGG,3055.92,,,,,,,case rate,3055.92,3055.92,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Aetna,Aetna,2821.32,,,,,,,per diem,2821.32,2821.32,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Aetna MGG,Aetna MGG,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,BCBS,BCBS,2821.32,,,,,,,per diem,2821.32,2821.32,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,BCBS MGG,BCBS MGG,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Cigna,Cigna,2821.32,,,,,,,per diem,2821.32,2821.32,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Cigna MGG,Cigna MGG,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Humana,Humana,2821.32,,,,,,,per diem,2821.32,2821.32,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Humana MGG,Humana MGG,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Optum VA,Optum VA,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,UHC,UHC,2821.32,,,,,,,per diem,2821.32,2821.32,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,UHC MGG,UHC MGG,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,VA,VA,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Wellcare MGG,Wellcare MGG,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Bright Health - commercial,Bright Health - commercial,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2821.32,2821.32,Bright Health MGG,Bright Health MGG,2821.32,,,,,,,case rate,2821.32,2821.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Aetna,Aetna,1628.85,,,,,,,per diem,1628.85,1628.85,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Aetna MGG,Aetna MGG,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,BCBS,BCBS,1628.85,,,,,,,per diem,1628.85,1628.85,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,BCBS MGG,BCBS MGG,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Cigna,Cigna,1628.85,,,,,,,per diem,1628.85,1628.85,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Cigna MGG,Cigna MGG,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Humana,Humana,1628.85,,,,,,,per diem,1628.85,1628.85,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Humana MGG,Humana MGG,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Optum VA,Optum VA,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,UHC,UHC,1628.85,,,,,,,per diem,1628.85,1628.85,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,UHC MGG,UHC MGG,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,VA,VA,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Wellcare MGG,Wellcare MGG,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Bright Health - commercial,Bright Health - commercial,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1628.85,1628.85,Bright Health MGG,Bright Health MGG,1628.85,,,,,,,case rate,1628.85,1628.85,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Aetna,Aetna,1094.59,,,,,,,per diem,1094.59,1094.59,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Aetna MGG,Aetna MGG,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,BCBS,BCBS,1094.59,,,,,,,per diem,1094.59,1094.59,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,BCBS MGG,BCBS MGG,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Cigna,Cigna,1094.59,,,,,,,per diem,1094.59,1094.59,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Cigna MGG,Cigna MGG,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Humana,Humana,1094.59,,,,,,,per diem,1094.59,1094.59,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Humana MGG,Humana MGG,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Optum VA,Optum VA,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,UHC,UHC,1094.59,,,,,,,per diem,1094.59,1094.59,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,UHC MGG,UHC MGG,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,VA,VA,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Wellcare MGG,Wellcare MGG,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Bright Health - commercial,Bright Health - commercial,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1094.59,1094.59,Bright Health MGG,Bright Health MGG,1094.59,,,,,,,case rate,1094.59,1094.59,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Aetna,Aetna,4692,,,,,,,per diem,4692,4692,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Aetna MGG,Aetna MGG,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,BCBS,BCBS,4692,,,,,,,per diem,4692,4692,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,BCBS MGG,BCBS MGG,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Cigna,Cigna,4692,,,,,,,per diem,4692,4692,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Cigna MGG,Cigna MGG,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Humana,Humana,4692,,,,,,,per diem,4692,4692,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Humana MGG,Humana MGG,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Optum VA,Optum VA,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,UHC,UHC,4692,,,,,,,per diem,4692,4692,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,UHC MGG,UHC MGG,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,VA,VA,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Wellcare MGG,Wellcare MGG,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Bright Health - commercial,Bright Health - commercial,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4692,4692,Bright Health MGG,Bright Health MGG,4692,,,,,,,case rate,4692,4692,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Aetna,Aetna,3403,,,,,,,per diem,3403,3403,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Aetna MGG,Aetna MGG,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,BCBS,BCBS,3403,,,,,,,per diem,3403,3403,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,BCBS MGG,BCBS MGG,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Cigna,Cigna,3403,,,,,,,per diem,3403,3403,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Cigna MGG,Cigna MGG,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Humana,Humana,3403,,,,,,,per diem,3403,3403,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Humana MGG,Humana MGG,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Optum VA,Optum VA,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,UHC,UHC,3403,,,,,,,per diem,3403,3403,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,UHC MGG,UHC MGG,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,VA,VA,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Wellcare MGG,Wellcare MGG,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Bright Health - commercial,Bright Health - commercial,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3403,3403,Bright Health MGG,Bright Health MGG,3403,,,,,,,case rate,3403,3403,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Aetna,Aetna,804.96,,,,,,,per diem,804.96,804.96,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Aetna MGG,Aetna MGG,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,BCBS,BCBS,804.96,,,,,,,per diem,804.96,804.96,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,BCBS MGG,BCBS MGG,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Cigna,Cigna,804.96,,,,,,,per diem,804.96,804.96,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Cigna MGG,Cigna MGG,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Humana,Humana,804.96,,,,,,,per diem,804.96,804.96,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Humana MGG,Humana MGG,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Optum VA,Optum VA,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,UHC,UHC,804.96,,,,,,,per diem,804.96,804.96,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,UHC MGG,UHC MGG,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,VA,VA,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Wellcare MGG,Wellcare MGG,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Bright Health - commercial,Bright Health - commercial,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,804.96,804.96,Bright Health MGG,Bright Health MGG,804.96,,,,,,,case rate,804.96,804.96,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Aetna,Aetna,5239.74,,,,,,,per diem,5239.74,5239.74,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Aetna MGG,Aetna MGG,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,BCBS,BCBS,5239.74,,,,,,,per diem,5239.74,5239.74,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,BCBS MGG,BCBS MGG,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Cigna,Cigna,5239.74,,,,,,,per diem,5239.74,5239.74,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Cigna MGG,Cigna MGG,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Humana,Humana,5239.74,,,,,,,per diem,5239.74,5239.74,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Humana MGG,Humana MGG,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Optum VA,Optum VA,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,UHC,UHC,5239.74,,,,,,,per diem,5239.74,5239.74,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,UHC MGG,UHC MGG,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,VA,VA,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Wellcare MGG,Wellcare MGG,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Bright Health - commercial,Bright Health - commercial,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5239.74,5239.74,Bright Health MGG,Bright Health MGG,5239.74,,,,,,,case rate,5239.74,5239.74,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Aetna,Aetna,3133.06,,,,,,,per diem,3133.06,3133.06,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Aetna MGG,Aetna MGG,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,BCBS,BCBS,3133.06,,,,,,,per diem,3133.06,3133.06,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,BCBS MGG,BCBS MGG,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Cigna,Cigna,3133.06,,,,,,,per diem,3133.06,3133.06,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Cigna MGG,Cigna MGG,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Humana,Humana,3133.06,,,,,,,per diem,3133.06,3133.06,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Humana MGG,Humana MGG,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Optum VA,Optum VA,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,UHC,UHC,3133.06,,,,,,,per diem,3133.06,3133.06,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,UHC MGG,UHC MGG,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,VA,VA,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Wellcare MGG,Wellcare MGG,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Bright Health - commercial,Bright Health - commercial,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3133.06,3133.06,Bright Health MGG,Bright Health MGG,3133.06,,,,,,,case rate,3133.06,3133.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Aetna,Aetna,506.4,,,,,,,per diem,506.4,506.4,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Aetna MGG,Aetna MGG,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,BCBS,BCBS,506.4,,,,,,,per diem,506.4,506.4,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,BCBS MGG,BCBS MGG,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Cigna,Cigna,506.4,,,,,,,per diem,506.4,506.4,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Cigna MGG,Cigna MGG,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Humana,Humana,506.4,,,,,,,per diem,506.4,506.4,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Humana MGG,Humana MGG,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Optum VA,Optum VA,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,UHC,UHC,506.4,,,,,,,per diem,506.4,506.4,"Per diem rate, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,UHC MGG,UHC MGG,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,VA,VA,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Wellcare MGG,Wellcare MGG,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Bright Health - commercial,Bright Health - commercial,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI LOW EXT W/WO CONTRAST BIL ,74200407,CDM,610,RC,73720,CPT,,,50,Inpatient,,,506.4,506.4,Bright Health MGG,Bright Health MGG,506.4,,,,,,,case rate,506.4,506.4,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Aetna,Aetna,1724.82,,,,,,,per diem,1724.82,1724.82,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Aetna MGG,Aetna MGG,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,BCBS,BCBS,1724.82,,,,,,,per diem,1724.82,1724.82,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,BCBS MGG,BCBS MGG,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Cigna,Cigna,1724.82,,,,,,,per diem,1724.82,1724.82,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Cigna MGG,Cigna MGG,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Humana,Humana,1724.82,,,,,,,per diem,1724.82,1724.82,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Humana MGG,Humana MGG,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Optum VA,Optum VA,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,UHC,UHC,1724.82,,,,,,,per diem,1724.82,1724.82,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,UHC MGG,UHC MGG,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,VA,VA,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Wellcare MGG,Wellcare MGG,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Bright Health - commercial,Bright Health - commercial,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1724.82,1724.82,Bright Health MGG,Bright Health MGG,1724.82,,,,,,,case rate,1724.82,1724.82,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Aetna,Aetna,3205.86,,,,,,,per diem,3205.86,3205.86,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Aetna MGG,Aetna MGG,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,BCBS,BCBS,3205.86,,,,,,,per diem,3205.86,3205.86,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,BCBS MGG,BCBS MGG,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Cigna,Cigna,3205.86,,,,,,,per diem,3205.86,3205.86,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Cigna MGG,Cigna MGG,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Humana,Humana,3205.86,,,,,,,per diem,3205.86,3205.86,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Humana MGG,Humana MGG,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Optum VA,Optum VA,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,UHC,UHC,3205.86,,,,,,,per diem,3205.86,3205.86,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,UHC MGG,UHC MGG,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,VA,VA,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Wellcare MGG,Wellcare MGG,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Bright Health - commercial,Bright Health - commercial,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3205.86,3205.86,Bright Health MGG,Bright Health MGG,3205.86,,,,,,,case rate,3205.86,3205.86,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Aetna,Aetna,1778,,,,,,,per diem,1778,1778,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Aetna MGG,Aetna MGG,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,BCBS,BCBS,1778,,,,,,,per diem,1778,1778,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,BCBS MGG,BCBS MGG,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Cigna,Cigna,1778,,,,,,,per diem,1778,1778,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Cigna MGG,Cigna MGG,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Humana,Humana,1778,,,,,,,per diem,1778,1778,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Humana MGG,Humana MGG,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Optum VA,Optum VA,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,UHC,UHC,1778,,,,,,,per diem,1778,1778,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,UHC MGG,UHC MGG,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,VA,VA,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Wellcare MGG,Wellcare MGG,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Bright Health - commercial,Bright Health - commercial,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,1778,1778,Bright Health MGG,Bright Health MGG,1778,,,,,,,case rate,1778,1778,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Aetna,Aetna,5440.68,,,,,,,per diem,5440.68,5440.68,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Aetna MGG,Aetna MGG,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,BCBS,BCBS,5440.68,,,,,,,per diem,5440.68,5440.68,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,BCBS MGG,BCBS MGG,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Cigna,Cigna,5440.68,,,,,,,per diem,5440.68,5440.68,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Cigna MGG,Cigna MGG,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Humana,Humana,5440.68,,,,,,,per diem,5440.68,5440.68,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Humana MGG,Humana MGG,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Optum VA,Optum VA,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,UHC,UHC,5440.68,,,,,,,per diem,5440.68,5440.68,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,UHC MGG,UHC MGG,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,VA,VA,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Wellcare MGG,Wellcare MGG,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Bright Health - commercial,Bright Health - commercial,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5440.68,5440.68,Bright Health MGG,Bright Health MGG,5440.68,,,,,,,case rate,5440.68,5440.68,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Aetna,Aetna,6171,,,,,,,per diem,6171,6171,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Aetna MGG,Aetna MGG,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,BCBS,BCBS,6171,,,,,,,per diem,6171,6171,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,BCBS MGG,BCBS MGG,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Cigna,Cigna,6171,,,,,,,per diem,6171,6171,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Cigna MGG,Cigna MGG,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Humana,Humana,6171,,,,,,,per diem,6171,6171,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Humana MGG,Humana MGG,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Optum VA,Optum VA,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,UHC,UHC,6171,,,,,,,per diem,6171,6171,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,UHC MGG,UHC MGG,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,VA,VA,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Wellcare MGG,Wellcare MGG,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Bright Health - commercial,Bright Health - commercial,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6171,6171,Bright Health MGG,Bright Health MGG,6171,,,,,,,case rate,6171,6171,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Aetna,Aetna,2783.58,,,,,,,per diem,2783.58,2783.58,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Aetna MGG,Aetna MGG,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,BCBS,BCBS,2783.58,,,,,,,per diem,2783.58,2783.58,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,BCBS MGG,BCBS MGG,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Cigna,Cigna,2783.58,,,,,,,per diem,2783.58,2783.58,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Cigna MGG,Cigna MGG,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Humana,Humana,2783.58,,,,,,,per diem,2783.58,2783.58,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Humana MGG,Humana MGG,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Optum VA,Optum VA,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,UHC,UHC,2783.58,,,,,,,per diem,2783.58,2783.58,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,UHC MGG,UHC MGG,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,VA,VA,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Wellcare MGG,Wellcare MGG,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Bright Health - commercial,Bright Health - commercial,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2783.58,2783.58,Bright Health MGG,Bright Health MGG,2783.58,,,,,,,case rate,2783.58,2783.58,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Aetna,Aetna,4151.4,,,,,,,per diem,4151.4,4151.4,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Aetna MGG,Aetna MGG,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,BCBS,BCBS,4151.4,,,,,,,per diem,4151.4,4151.4,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,BCBS MGG,BCBS MGG,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Cigna,Cigna,4151.4,,,,,,,per diem,4151.4,4151.4,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Cigna MGG,Cigna MGG,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Humana,Humana,4151.4,,,,,,,per diem,4151.4,4151.4,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Humana MGG,Humana MGG,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Optum VA,Optum VA,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,UHC,UHC,4151.4,,,,,,,per diem,4151.4,4151.4,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,UHC MGG,UHC MGG,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,VA,VA,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Wellcare MGG,Wellcare MGG,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Bright Health - commercial,Bright Health - commercial,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4151.4,4151.4,Bright Health MGG,Bright Health MGG,4151.4,,,,,,,case rate,4151.4,4151.4,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Aetna,Aetna,4717.5,,,,,,,per diem,4717.5,4717.5,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Aetna MGG,Aetna MGG,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,BCBS,BCBS,4717.5,,,,,,,per diem,4717.5,4717.5,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,BCBS MGG,BCBS MGG,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Cigna,Cigna,4717.5,,,,,,,per diem,4717.5,4717.5,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Cigna MGG,Cigna MGG,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Humana,Humana,4717.5,,,,,,,per diem,4717.5,4717.5,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Humana MGG,Humana MGG,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Optum VA,Optum VA,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,UHC,UHC,4717.5,,,,,,,per diem,4717.5,4717.5,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,UHC MGG,UHC MGG,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,VA,VA,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Wellcare MGG,Wellcare MGG,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Bright Health - commercial,Bright Health - commercial,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4717.5,4717.5,Bright Health MGG,Bright Health MGG,4717.5,,,,,,,case rate,4717.5,4717.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Aetna,Aetna,805,,,,,,,per diem,805,805,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Aetna MGG,Aetna MGG,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,BCBS,BCBS,805,,,,,,,per diem,805,805,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,BCBS MGG,BCBS MGG,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Cigna,Cigna,805,,,,,,,per diem,805,805,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Cigna MGG,Cigna MGG,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Humana,Humana,805,,,,,,,per diem,805,805,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Humana MGG,Humana MGG,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Optum VA,Optum VA,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,UHC,UHC,805,,,,,,,per diem,805,805,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,UHC MGG,UHC MGG,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,VA,VA,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Wellcare MGG,Wellcare MGG,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Bright Health - commercial,Bright Health - commercial,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,805,805,Bright Health MGG,Bright Health MGG,805,,,,,,,case rate,805,805,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Aetna,Aetna,5228.24,,,,,,,per diem,5228.24,5228.24,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Aetna MGG,Aetna MGG,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,BCBS,BCBS,5228.24,,,,,,,per diem,5228.24,5228.24,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,BCBS MGG,BCBS MGG,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Cigna,Cigna,5228.24,,,,,,,per diem,5228.24,5228.24,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Cigna MGG,Cigna MGG,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Humana,Humana,5228.24,,,,,,,per diem,5228.24,5228.24,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Humana MGG,Humana MGG,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Optum VA,Optum VA,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,UHC,UHC,5228.24,,,,,,,per diem,5228.24,5228.24,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,UHC MGG,UHC MGG,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,VA,VA,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Wellcare MGG,Wellcare MGG,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Bright Health - commercial,Bright Health - commercial,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5228.24,5228.24,Bright Health MGG,Bright Health MGG,5228.24,,,,,,,case rate,5228.24,5228.24,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Aetna,Aetna,3126.5,,,,,,,per diem,3126.5,3126.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Aetna MGG,Aetna MGG,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,BCBS,BCBS,3126.5,,,,,,,per diem,3126.5,3126.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,BCBS MGG,BCBS MGG,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Cigna,Cigna,3126.5,,,,,,,per diem,3126.5,3126.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Cigna MGG,Cigna MGG,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Humana,Humana,3126.5,,,,,,,per diem,3126.5,3126.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Humana MGG,Humana MGG,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Optum VA,Optum VA,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,UHC,UHC,3126.5,,,,,,,per diem,3126.5,3126.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,UHC MGG,UHC MGG,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,VA,VA,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Wellcare MGG,Wellcare MGG,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Bright Health - commercial,Bright Health - commercial,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT RT  ,74200551,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,3126.5,3126.5,Bright Health MGG,Bright Health MGG,3126.5,,,,,,,case rate,3126.5,3126.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Aetna,Aetna,3240.3,,,,,,,per diem,3240.3,3240.3,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Aetna MGG,Aetna MGG,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,BCBS,BCBS,3240.3,,,,,,,per diem,3240.3,3240.3,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,BCBS MGG,BCBS MGG,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Cigna,Cigna,3240.3,,,,,,,per diem,3240.3,3240.3,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Cigna MGG,Cigna MGG,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Humana,Humana,3240.3,,,,,,,per diem,3240.3,3240.3,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Humana MGG,Humana MGG,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Optum VA,Optum VA,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,UHC,UHC,3240.3,,,,,,,per diem,3240.3,3240.3,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,UHC MGG,UHC MGG,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,VA,VA,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Wellcare MGG,Wellcare MGG,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Bright Health - commercial,Bright Health - commercial,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT RT ,74210011,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,3240.3,3240.3,Bright Health MGG,Bright Health MGG,3240.3,,,,,,,case rate,3240.3,3240.3,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Aetna,Aetna,2621.5,,,,,,,per diem,2621.5,2621.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Aetna MGG,Aetna MGG,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,BCBS,BCBS,2621.5,,,,,,,per diem,2621.5,2621.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,BCBS MGG,BCBS MGG,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Cigna,Cigna,2621.5,,,,,,,per diem,2621.5,2621.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Cigna MGG,Cigna MGG,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Humana,Humana,2621.5,,,,,,,per diem,2621.5,2621.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Humana MGG,Humana MGG,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Optum VA,Optum VA,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,UHC,UHC,2621.5,,,,,,,per diem,2621.5,2621.5,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,UHC MGG,UHC MGG,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,VA,VA,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Wellcare MGG,Wellcare MGG,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Bright Health - commercial,Bright Health - commercial,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT LT ,74210012,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,2621.5,2621.5,Bright Health MGG,Bright Health MGG,2621.5,,,,,,,case rate,2621.5,2621.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Aetna,Aetna,711.9,,,,,,,per diem,711.9,711.9,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Aetna MGG,Aetna MGG,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,BCBS,BCBS,711.9,,,,,,,per diem,711.9,711.9,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,BCBS MGG,BCBS MGG,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Cigna,Cigna,711.9,,,,,,,per diem,711.9,711.9,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Cigna MGG,Cigna MGG,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Humana,Humana,711.9,,,,,,,per diem,711.9,711.9,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Humana MGG,Humana MGG,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Optum VA,Optum VA,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,UHC,UHC,711.9,,,,,,,per diem,711.9,711.9,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,UHC MGG,UHC MGG,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,VA,VA,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Wellcare MGG,Wellcare MGG,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Bright Health - commercial,Bright Health - commercial,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,711.9,711.9,Bright Health MGG,Bright Health MGG,711.9,,,,,,,case rate,711.9,711.9,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Aetna,Aetna,672.43,,,,,,,per diem,672.43,672.43,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Aetna MGG,Aetna MGG,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,BCBS,BCBS,672.43,,,,,,,per diem,672.43,672.43,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,BCBS MGG,BCBS MGG,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Cigna,Cigna,672.43,,,,,,,per diem,672.43,672.43,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Cigna MGG,Cigna MGG,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Humana,Humana,672.43,,,,,,,per diem,672.43,672.43,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Humana MGG,Humana MGG,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Optum VA,Optum VA,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,UHC,UHC,672.43,,,,,,,per diem,672.43,672.43,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,UHC MGG,UHC MGG,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,VA,VA,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Wellcare MGG,Wellcare MGG,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Bright Health - commercial,Bright Health - commercial,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,672.43,672.43,Bright Health MGG,Bright Health MGG,672.43,,,,,,,case rate,672.43,672.43,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Aetna,Aetna,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Aetna MGG,Aetna MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,BCBS,BCBS,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,BCBS MGG,BCBS MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Cigna,Cigna,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Cigna MGG,Cigna MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Humana,Humana,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Humana MGG,Humana MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Optum VA,Optum VA,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,UHC,UHC,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,UHC MGG,UHC MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,VA,VA,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Wellcare MGG,Wellcare MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Bright Health - commercial,Bright Health - commercial,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3667.92,3667.92,Bright Health MGG,Bright Health MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Aetna,Aetna,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Aetna MGG,Aetna MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,BCBS,BCBS,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,BCBS MGG,BCBS MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Cigna,Cigna,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Cigna MGG,Cigna MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Humana,Humana,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Humana MGG,Humana MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Optum VA,Optum VA,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,UHC,UHC,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,UHC MGG,UHC MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,VA,VA,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Wellcare MGG,Wellcare MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Bright Health - commercial,Bright Health - commercial,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,1992.06,1992.06,Bright Health MGG,Bright Health MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Aetna,Aetna,3473.1,,,,,,,per diem,3473.1,3473.1,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Aetna MGG,Aetna MGG,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,BCBS,BCBS,3473.1,,,,,,,per diem,3473.1,3473.1,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,BCBS MGG,BCBS MGG,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Cigna,Cigna,3473.1,,,,,,,per diem,3473.1,3473.1,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Cigna MGG,Cigna MGG,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Humana,Humana,3473.1,,,,,,,per diem,3473.1,3473.1,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Humana MGG,Humana MGG,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Optum VA,Optum VA,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,UHC,UHC,3473.1,,,,,,,per diem,3473.1,3473.1,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,UHC MGG,UHC MGG,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,VA,VA,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Wellcare MGG,Wellcare MGG,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Bright Health - commercial,Bright Health - commercial,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3473.1,3473.1,Bright Health MGG,Bright Health MGG,3473.1,,,,,,,case rate,3473.1,3473.1,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Aetna,Aetna,483.08,,,,,,,per diem,483.08,483.08,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Aetna MGG,Aetna MGG,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,BCBS,BCBS,483.08,,,,,,,per diem,483.08,483.08,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,BCBS MGG,BCBS MGG,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Cigna,Cigna,483.08,,,,,,,per diem,483.08,483.08,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Cigna MGG,Cigna MGG,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Humana,Humana,483.08,,,,,,,per diem,483.08,483.08,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Humana MGG,Humana MGG,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Optum VA,Optum VA,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,UHC,UHC,483.08,,,,,,,per diem,483.08,483.08,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,UHC MGG,UHC MGG,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,VA,VA,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Wellcare MGG,Wellcare MGG,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Bright Health - commercial,Bright Health - commercial,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,483.08,483.08,Bright Health MGG,Bright Health MGG,483.08,,,,,,,case rate,483.08,483.08,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Aetna,Aetna,7449,,,,,,,per diem,7449,7449,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Aetna MGG,Aetna MGG,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,BCBS,BCBS,7449,,,,,,,per diem,7449,7449,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,BCBS MGG,BCBS MGG,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Cigna,Cigna,7449,,,,,,,per diem,7449,7449,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Cigna MGG,Cigna MGG,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Humana,Humana,7449,,,,,,,per diem,7449,7449,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Humana MGG,Humana MGG,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Optum VA,Optum VA,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,UHC,UHC,7449,,,,,,,per diem,7449,7449,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,UHC MGG,UHC MGG,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,VA,VA,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Wellcare MGG,Wellcare MGG,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Bright Health - commercial,Bright Health - commercial,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON RT  ,74210105,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,7449,7449,Bright Health MGG,Bright Health MGG,7449,,,,,,,case rate,7449,7449,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Aetna,Aetna,1259.79,,,,,,,per diem,1259.79,1259.79,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Aetna MGG,Aetna MGG,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,BCBS,BCBS,1259.79,,,,,,,per diem,1259.79,1259.79,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,BCBS MGG,BCBS MGG,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Cigna,Cigna,1259.79,,,,,,,per diem,1259.79,1259.79,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Cigna MGG,Cigna MGG,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Humana,Humana,1259.79,,,,,,,per diem,1259.79,1259.79,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Humana MGG,Humana MGG,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Optum VA,Optum VA,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,UHC,UHC,1259.79,,,,,,,per diem,1259.79,1259.79,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,UHC MGG,UHC MGG,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,VA,VA,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Wellcare MGG,Wellcare MGG,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Bright Health - commercial,Bright Health - commercial,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1259.79,1259.79,Bright Health MGG,Bright Health MGG,1259.79,,,,,,,case rate,1259.79,1259.79,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Aetna,Aetna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Aetna MGG,Aetna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,BCBS,BCBS,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,BCBS MGG,BCBS MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Cigna,Cigna,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Cigna MGG,Cigna MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Humana,Humana,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Humana MGG,Humana MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Optum VA,Optum VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,UHC,UHC,406.98,,,,,,,per diem,406.98,406.98,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,UHC MGG,UHC MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,VA,VA,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Wellcare MGG,Wellcare MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Bright Health - commercial,Bright Health - commercial,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,77081,CPT,,,,Inpatient,,,406.98,406.98,Bright Health MGG,Bright Health MGG,406.98,,,,,,,case rate,406.98,406.98,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Aetna,Aetna,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Aetna MGG,Aetna MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,BCBS,BCBS,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,BCBS MGG,BCBS MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Cigna,Cigna,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Cigna MGG,Cigna MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Humana,Humana,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Humana MGG,Humana MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Optum VA,Optum VA,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,UHC,UHC,3667.92,,,,,,,per diem,3667.92,3667.92,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,UHC MGG,UHC MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,VA,VA,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Wellcare MGG,Wellcare MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Bright Health - commercial,Bright Health - commercial,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,74185,CPT,,,,Inpatient,,,3667.92,3667.92,Bright Health MGG,Bright Health MGG,3667.92,,,,,,,case rate,3667.92,3667.92,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Aetna,Aetna,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Aetna MGG,Aetna MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,BCBS,BCBS,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,BCBS MGG,BCBS MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Cigna,Cigna,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Cigna MGG,Cigna MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Humana,Humana,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Humana MGG,Humana MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Optum VA,Optum VA,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,UHC,UHC,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,UHC MGG,UHC MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,VA,VA,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Wellcare MGG,Wellcare MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Bright Health - commercial,Bright Health - commercial,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Bright Health MGG,Bright Health MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Aetna,Aetna,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Aetna MGG,Aetna MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,BCBS,BCBS,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,BCBS MGG,BCBS MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Cigna,Cigna,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Cigna MGG,Cigna MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Humana,Humana,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Humana MGG,Humana MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Optum VA,Optum VA,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,UHC,UHC,1992.06,,,,,,,per diem,1992.06,1992.06,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,UHC MGG,UHC MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,VA,VA,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Wellcare MGG,Wellcare MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Bright Health - commercial,Bright Health - commercial,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,71555,CPT,,,,Inpatient,,,1992.06,1992.06,Bright Health MGG,Bright Health MGG,1992.06,,,,,,,case rate,1992.06,1992.06,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Aetna,Aetna,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Aetna MGG,Aetna MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,BCBS,BCBS,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,BCBS MGG,BCBS MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Cigna,Cigna,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Cigna MGG,Cigna MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Humana,Humana,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Humana MGG,Humana MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Optum VA,Optum VA,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,UHC,UHC,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,UHC MGG,UHC MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,VA,VA,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Wellcare MGG,Wellcare MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Bright Health - commercial,Bright Health - commercial,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Bright Health MGG,Bright Health MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Aetna,Aetna,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Aetna MGG,Aetna MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,BCBS,BCBS,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,BCBS MGG,BCBS MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Cigna,Cigna,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Cigna MGG,Cigna MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Humana,Humana,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Humana MGG,Humana MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Optum VA,Optum VA,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,UHC,UHC,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,UHC MGG,UHC MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,VA,VA,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Wellcare MGG,Wellcare MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Bright Health - commercial,Bright Health - commercial,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Bright Health MGG,Bright Health MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Aetna,Aetna,448.8,,,,,,,per diem,448.8,448.8,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Aetna MGG,Aetna MGG,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,BCBS,BCBS,448.8,,,,,,,per diem,448.8,448.8,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,BCBS MGG,BCBS MGG,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Cigna,Cigna,448.8,,,,,,,per diem,448.8,448.8,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Cigna MGG,Cigna MGG,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Humana,Humana,448.8,,,,,,,per diem,448.8,448.8,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Humana MGG,Humana MGG,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Optum VA,Optum VA,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,UHC,UHC,448.8,,,,,,,per diem,448.8,448.8,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,UHC MGG,UHC MGG,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,VA,VA,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Wellcare MGG,Wellcare MGG,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Bright Health - commercial,Bright Health - commercial,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,A9579,CPT,,,,Inpatient,1,EA,448.8,448.8,Bright Health MGG,Bright Health MGG,448.8,,,,,,,case rate,448.8,448.8,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Aetna,Aetna,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Aetna MGG,Aetna MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,BCBS,BCBS,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,BCBS MGG,BCBS MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Cigna,Cigna,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Cigna MGG,Cigna MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Humana,Humana,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Humana MGG,Humana MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Optum VA,Optum VA,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,UHC,UHC,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,UHC MGG,UHC MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,VA,VA,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Wellcare MGG,Wellcare MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Bright Health - commercial,Bright Health - commercial,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,75870,CPT,,,,Inpatient,,,3295.62,3295.62,Bright Health MGG,Bright Health MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna,Aetna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna MGG,Aetna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS,BCBS,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS MGG,BCBS MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna,Cigna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna MGG,Cigna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana,Humana,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana MGG,Humana MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Optum VA,Optum VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC,UHC,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC MGG,UHC MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,VA,VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Wellcare MGG,Wellcare MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health - commercial,Bright Health - commercial,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health MGG,Bright Health MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna,Aetna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna MGG,Aetna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS,BCBS,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS MGG,BCBS MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna,Cigna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna MGG,Cigna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana,Humana,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana MGG,Humana MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Optum VA,Optum VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC,UHC,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC MGG,UHC MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,VA,VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Wellcare MGG,Wellcare MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health - commercial,Bright Health - commercial,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health MGG,Bright Health MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna,Aetna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna MGG,Aetna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS,BCBS,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS MGG,BCBS MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna,Cigna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna MGG,Cigna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana,Humana,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana MGG,Humana MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Optum VA,Optum VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC,UHC,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC MGG,UHC MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,VA,VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Wellcare MGG,Wellcare MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health - commercial,Bright Health - commercial,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health MGG,Bright Health MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna,Aetna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna MGG,Aetna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS,BCBS,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS MGG,BCBS MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna,Cigna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna MGG,Cigna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana,Humana,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana MGG,Humana MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Optum VA,Optum VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC,UHC,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC MGG,UHC MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,VA,VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Wellcare MGG,Wellcare MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health - commercial,Bright Health - commercial,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health MGG,Bright Health MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna,Aetna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna MGG,Aetna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS,BCBS,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS MGG,BCBS MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna,Cigna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna MGG,Cigna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana,Humana,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana MGG,Humana MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Optum VA,Optum VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC,UHC,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC MGG,UHC MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,VA,VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Wellcare MGG,Wellcare MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health - commercial,Bright Health - commercial,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health MGG,Bright Health MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Aetna,Aetna,3591.42,,,,,,,per diem,3591.42,3591.42,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Aetna MGG,Aetna MGG,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,BCBS,BCBS,3591.42,,,,,,,per diem,3591.42,3591.42,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,BCBS MGG,BCBS MGG,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Cigna,Cigna,3591.42,,,,,,,per diem,3591.42,3591.42,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Cigna MGG,Cigna MGG,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Humana,Humana,3591.42,,,,,,,per diem,3591.42,3591.42,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Humana MGG,Humana MGG,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Optum VA,Optum VA,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,UHC,UHC,3591.42,,,,,,,per diem,3591.42,3591.42,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,UHC MGG,UHC MGG,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,VA,VA,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Wellcare MGG,Wellcare MGG,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Bright Health - commercial,Bright Health - commercial,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,73725,CPT,,,50,Inpatient,,,3591.42,3591.42,Bright Health MGG,Bright Health MGG,3591.42,,,,,,,case rate,3591.42,3591.42,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Aetna,Aetna,2580.6,,,,,,,per diem,2580.6,2580.6,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Aetna MGG,Aetna MGG,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,BCBS,BCBS,2580.6,,,,,,,per diem,2580.6,2580.6,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,BCBS MGG,BCBS MGG,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Cigna,Cigna,2580.6,,,,,,,per diem,2580.6,2580.6,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Cigna MGG,Cigna MGG,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Humana,Humana,2580.6,,,,,,,per diem,2580.6,2580.6,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Humana MGG,Humana MGG,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Optum VA,Optum VA,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,UHC,UHC,2580.6,,,,,,,per diem,2580.6,2580.6,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,UHC MGG,UHC MGG,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,VA,VA,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Wellcare MGG,Wellcare MGG,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Bright Health - commercial,Bright Health - commercial,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,72198,CPT,,,,Inpatient,,,2580.6,2580.6,Bright Health MGG,Bright Health MGG,2580.6,,,,,,,case rate,2580.6,2580.6,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Aetna,Aetna,2896.8,,,,,,,per diem,2896.8,2896.8,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Aetna MGG,Aetna MGG,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,BCBS,BCBS,2896.8,,,,,,,per diem,2896.8,2896.8,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,BCBS MGG,BCBS MGG,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Cigna,Cigna,2896.8,,,,,,,per diem,2896.8,2896.8,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Cigna MGG,Cigna MGG,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Humana,Humana,2896.8,,,,,,,per diem,2896.8,2896.8,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Humana MGG,Humana MGG,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Optum VA,Optum VA,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,UHC,UHC,2896.8,,,,,,,per diem,2896.8,2896.8,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,UHC MGG,UHC MGG,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,VA,VA,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Wellcare MGG,Wellcare MGG,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Bright Health - commercial,Bright Health - commercial,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,72159,CPT,,,,Inpatient,,,2896.8,2896.8,Bright Health MGG,Bright Health MGG,2896.8,,,,,,,case rate,2896.8,2896.8,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Aetna,Aetna,2596.92,,,,,,,per diem,2596.92,2596.92,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Aetna MGG,Aetna MGG,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,BCBS,BCBS,2596.92,,,,,,,per diem,2596.92,2596.92,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,BCBS MGG,BCBS MGG,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Cigna,Cigna,2596.92,,,,,,,per diem,2596.92,2596.92,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Cigna MGG,Cigna MGG,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Humana,Humana,2596.92,,,,,,,per diem,2596.92,2596.92,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Humana MGG,Humana MGG,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Optum VA,Optum VA,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,UHC,UHC,2596.92,,,,,,,per diem,2596.92,2596.92,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,UHC MGG,UHC MGG,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,VA,VA,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Wellcare MGG,Wellcare MGG,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Bright Health - commercial,Bright Health - commercial,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,77084,CPT,,,,Inpatient,,,2596.92,2596.92,Bright Health MGG,Bright Health MGG,2596.92,,,,,,,case rate,2596.92,2596.92,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Aetna,Aetna,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Aetna MGG,Aetna MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,BCBS,BCBS,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,BCBS MGG,BCBS MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Cigna,Cigna,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Cigna MGG,Cigna MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Humana,Humana,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Humana MGG,Humana MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Optum VA,Optum VA,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,UHC,UHC,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,UHC MGG,UHC MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,VA,VA,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Wellcare MGG,Wellcare MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Bright Health - commercial,Bright Health - commercial,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Bright Health MGG,Bright Health MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Aetna,Aetna,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Aetna MGG,Aetna MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,BCBS,BCBS,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,BCBS MGG,BCBS MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Cigna,Cigna,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Cigna MGG,Cigna MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Humana,Humana,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Humana MGG,Humana MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Optum VA,Optum VA,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,UHC,UHC,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,UHC MGG,UHC MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,VA,VA,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Wellcare MGG,Wellcare MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Bright Health - commercial,Bright Health - commercial,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Bright Health MGG,Bright Health MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Aetna,Aetna,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Aetna MGG,Aetna MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,BCBS,BCBS,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,BCBS MGG,BCBS MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Cigna,Cigna,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Cigna MGG,Cigna MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Humana,Humana,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Humana MGG,Humana MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Optum VA,Optum VA,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,UHC,UHC,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,UHC MGG,UHC MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,VA,VA,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Wellcare MGG,Wellcare MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Bright Health - commercial,Bright Health - commercial,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Bright Health MGG,Bright Health MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Aetna,Aetna,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Aetna MGG,Aetna MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,BCBS,BCBS,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,BCBS MGG,BCBS MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Cigna,Cigna,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Cigna MGG,Cigna MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Humana,Humana,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Humana MGG,Humana MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Optum VA,Optum VA,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,UHC,UHC,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,UHC MGG,UHC MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,VA,VA,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Wellcare MGG,Wellcare MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Bright Health - commercial,Bright Health - commercial,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Bright Health MGG,Bright Health MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Aetna,Aetna,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Aetna MGG,Aetna MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,BCBS,BCBS,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,BCBS MGG,BCBS MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Cigna,Cigna,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Cigna MGG,Cigna MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Humana,Humana,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Humana MGG,Humana MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Optum VA,Optum VA,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,UHC,UHC,3331.32,,,,,,,per diem,3331.32,3331.32,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,UHC MGG,UHC MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,VA,VA,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Wellcare MGG,Wellcare MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Bright Health - commercial,Bright Health - commercial,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,77059,CPT,,,,Inpatient,,,3331.32,3331.32,Bright Health MGG,Bright Health MGG,3331.32,,,,,,,case rate,3331.32,3331.32,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Aetna,Aetna,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Aetna MGG,Aetna MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,BCBS,BCBS,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,BCBS MGG,BCBS MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Cigna,Cigna,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Cigna MGG,Cigna MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Humana,Humana,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Humana MGG,Humana MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Optum VA,Optum VA,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,UHC,UHC,2231.76,,,,,,,per diem,2231.76,2231.76,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,UHC MGG,UHC MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,VA,VA,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Wellcare MGG,Wellcare MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Bright Health - commercial,Bright Health - commercial,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,77058,CPT,,,,Inpatient,,,2231.76,2231.76,Bright Health MGG,Bright Health MGG,2231.76,,,,,,,case rate,2231.76,2231.76,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Aetna,Aetna,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Aetna MGG,Aetna MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,BCBS,BCBS,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,BCBS MGG,BCBS MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Cigna,Cigna,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Cigna MGG,Cigna MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Humana,Humana,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Humana MGG,Humana MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Optum VA,Optum VA,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,UHC,UHC,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,UHC MGG,UHC MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,VA,VA,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Wellcare MGG,Wellcare MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Bright Health - commercial,Bright Health - commercial,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,75563,CPT,,,,Inpatient,,,3453.72,3453.72,Bright Health MGG,Bright Health MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Aetna,Aetna,2556.12,,,,,,,per diem,2556.12,2556.12,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Aetna MGG,Aetna MGG,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,BCBS,BCBS,2556.12,,,,,,,per diem,2556.12,2556.12,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,BCBS MGG,BCBS MGG,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Cigna,Cigna,2556.12,,,,,,,per diem,2556.12,2556.12,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Cigna MGG,Cigna MGG,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Humana,Humana,2556.12,,,,,,,per diem,2556.12,2556.12,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Humana MGG,Humana MGG,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Optum VA,Optum VA,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,UHC,UHC,2556.12,,,,,,,per diem,2556.12,2556.12,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,UHC MGG,UHC MGG,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,VA,VA,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Wellcare MGG,Wellcare MGG,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Bright Health - commercial,Bright Health - commercial,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,75565,CPT,,,,Inpatient,,,2556.12,2556.12,Bright Health MGG,Bright Health MGG,2556.12,,,,,,,case rate,2556.12,2556.12,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Aetna,Aetna,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Aetna MGG,Aetna MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,BCBS,BCBS,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,BCBS MGG,BCBS MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Cigna,Cigna,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Cigna MGG,Cigna MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Humana,Humana,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Humana MGG,Humana MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Optum VA,Optum VA,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,UHC,UHC,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,UHC MGG,UHC MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,VA,VA,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Wellcare MGG,Wellcare MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Bright Health - commercial,Bright Health - commercial,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,75559,CPT,,,,Inpatient,,,3004.92,3004.92,Bright Health MGG,Bright Health MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Aetna,Aetna,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Aetna MGG,Aetna MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,BCBS,BCBS,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,BCBS MGG,BCBS MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Cigna,Cigna,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Cigna MGG,Cigna MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Humana,Humana,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Humana MGG,Humana MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Optum VA,Optum VA,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,UHC,UHC,3004.92,,,,,,,per diem,3004.92,3004.92,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,UHC MGG,UHC MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,VA,VA,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Wellcare MGG,Wellcare MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Bright Health - commercial,Bright Health - commercial,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,75557,CPT,,,,Inpatient,,,3004.92,3004.92,Bright Health MGG,Bright Health MGG,3004.92,,,,,,,case rate,3004.92,3004.92,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Aetna,Aetna,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Aetna MGG,Aetna MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,BCBS,BCBS,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,BCBS MGG,BCBS MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Cigna,Cigna,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Cigna MGG,Cigna MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Humana,Humana,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Humana MGG,Humana MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Optum VA,Optum VA,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,UHC,UHC,3453.72,,,,,,,per diem,3453.72,3453.72,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,UHC MGG,UHC MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,VA,VA,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Wellcare MGG,Wellcare MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Bright Health - commercial,Bright Health - commercial,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,75561,CPT,,,,Inpatient,,,3453.72,3453.72,Bright Health MGG,Bright Health MGG,3453.72,,,,,,,case rate,3453.72,3453.72,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Aetna,Aetna,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Aetna MGG,Aetna MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,BCBS,BCBS,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,BCBS MGG,BCBS MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Cigna,Cigna,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Cigna MGG,Cigna MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Humana,Humana,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Humana MGG,Humana MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Optum VA,Optum VA,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,UHC,UHC,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,UHC MGG,UHC MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,VA,VA,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Wellcare MGG,Wellcare MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Bright Health - commercial,Bright Health - commercial,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,77022,CPT,,,,Inpatient,,,2250.12,2250.12,Bright Health MGG,Bright Health MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Aetna,Aetna,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Aetna MGG,Aetna MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,BCBS,BCBS,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,BCBS MGG,BCBS MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Cigna,Cigna,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Cigna MGG,Cigna MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Humana,Humana,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Humana MGG,Humana MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Optum VA,Optum VA,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,UHC,UHC,2250.12,,,,,,,per diem,2250.12,2250.12,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,UHC MGG,UHC MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,VA,VA,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Wellcare MGG,Wellcare MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Bright Health - commercial,Bright Health - commercial,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,77021,CPT,,,,Inpatient,,,2250.12,2250.12,Bright Health MGG,Bright Health MGG,2250.12,,,,,,,case rate,2250.12,2250.12,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Aetna,Aetna,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Aetna MGG,Aetna MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,BCBS,BCBS,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,BCBS MGG,BCBS MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Cigna,Cigna,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Cigna MGG,Cigna MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Humana,Humana,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Humana MGG,Humana MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Optum VA,Optum VA,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,UHC,UHC,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,UHC MGG,UHC MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,VA,VA,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Wellcare MGG,Wellcare MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Bright Health - commercial,Bright Health - commercial,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,73722,CPT,,,RT,Inpatient,,,9317.7,9317.7,Bright Health MGG,Bright Health MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Aetna,Aetna,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Aetna MGG,Aetna MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,BCBS,BCBS,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,BCBS MGG,BCBS MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Cigna,Cigna,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Cigna MGG,Cigna MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Humana,Humana,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Humana MGG,Humana MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Optum VA,Optum VA,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,UHC,UHC,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,UHC MGG,UHC MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,VA,VA,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Wellcare MGG,Wellcare MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Bright Health - commercial,Bright Health - commercial,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,73721,CPT,,,50,Inpatient,,,6253.62,6253.62,Bright Health MGG,Bright Health MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Aetna,Aetna,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Aetna MGG,Aetna MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,BCBS,BCBS,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,BCBS MGG,BCBS MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Cigna,Cigna,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Cigna MGG,Cigna MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Humana,Humana,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Humana MGG,Humana MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Optum VA,Optum VA,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,UHC,UHC,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,UHC MGG,UHC MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,VA,VA,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Wellcare MGG,Wellcare MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Bright Health - commercial,Bright Health - commercial,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,73721,CPT,,,LT,Inpatient,,,6253.62,6253.62,Bright Health MGG,Bright Health MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Aetna,Aetna,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Aetna MGG,Aetna MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,BCBS,BCBS,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,BCBS MGG,BCBS MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Cigna,Cigna,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Cigna MGG,Cigna MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Humana,Humana,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Humana MGG,Humana MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Optum VA,Optum VA,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,UHC,UHC,6253.62,,,,,,,per diem,6253.62,6253.62,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,UHC MGG,UHC MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,VA,VA,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Wellcare MGG,Wellcare MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Bright Health - commercial,Bright Health - commercial,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,73721,CPT,,,RT,Inpatient,,,6253.62,6253.62,Bright Health MGG,Bright Health MGG,6253.62,,,,,,,case rate,6253.62,6253.62,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Aetna,Aetna,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Aetna MGG,Aetna MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,BCBS,BCBS,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,BCBS MGG,BCBS MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Cigna,Cigna,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Cigna MGG,Cigna MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Humana,Humana,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Humana MGG,Humana MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Optum VA,Optum VA,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,UHC,UHC,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,UHC MGG,UHC MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,VA,VA,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Wellcare MGG,Wellcare MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Bright Health - commercial,Bright Health - commercial,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,73723,CPT,,,RT,Inpatient,,,10568.22,10568.22,Bright Health MGG,Bright Health MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Aetna,Aetna,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Aetna MGG,Aetna MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,BCBS,BCBS,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,BCBS MGG,BCBS MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Cigna,Cigna,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Cigna MGG,Cigna MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Humana,Humana,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Humana MGG,Humana MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Optum VA,Optum VA,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,UHC,UHC,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,UHC MGG,UHC MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,VA,VA,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Wellcare MGG,Wellcare MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Bright Health - commercial,Bright Health - commercial,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,73719,CPT,,,RT,Inpatient,,,4038.18,4038.18,Bright Health MGG,Bright Health MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Aetna,Aetna,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Aetna MGG,Aetna MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,BCBS,BCBS,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,BCBS MGG,BCBS MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Cigna,Cigna,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Cigna MGG,Cigna MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Humana,Humana,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Humana MGG,Humana MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Optum VA,Optum VA,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,UHC,UHC,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,UHC MGG,UHC MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,VA,VA,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Wellcare MGG,Wellcare MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Bright Health - commercial,Bright Health - commercial,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,2707.08,2707.08,Bright Health MGG,Bright Health MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Aetna,Aetna,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Aetna MGG,Aetna MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,BCBS,BCBS,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,BCBS MGG,BCBS MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Cigna,Cigna,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Cigna MGG,Cigna MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Humana,Humana,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Humana MGG,Humana MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Optum VA,Optum VA,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,UHC,UHC,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,UHC MGG,UHC MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,VA,VA,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Wellcare MGG,Wellcare MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Bright Health - commercial,Bright Health - commercial,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,73720,CPT,,,RT,Inpatient,,,4588.98,4588.98,Bright Health MGG,Bright Health MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Aetna,Aetna,2400.06,,,,,,,per diem,2400.06,2400.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Aetna MGG,Aetna MGG,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,BCBS,BCBS,2400.06,,,,,,,per diem,2400.06,2400.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,BCBS MGG,BCBS MGG,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Cigna,Cigna,2400.06,,,,,,,per diem,2400.06,2400.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Cigna MGG,Cigna MGG,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Humana,Humana,2400.06,,,,,,,per diem,2400.06,2400.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Humana MGG,Humana MGG,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Optum VA,Optum VA,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,UHC,UHC,2400.06,,,,,,,per diem,2400.06,2400.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,UHC MGG,UHC MGG,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,VA,VA,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Wellcare MGG,Wellcare MGG,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Bright Health - commercial,Bright Health - commercial,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,76390,CPT,,,,Inpatient,,,2400.06,2400.06,Bright Health MGG,Bright Health MGG,2400.06,,,,,,,case rate,2400.06,2400.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Aetna,Aetna,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Aetna MGG,Aetna MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,BCBS,BCBS,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,BCBS MGG,BCBS MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Cigna,Cigna,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Cigna MGG,Cigna MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Humana,Humana,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Humana MGG,Humana MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Optum VA,Optum VA,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,UHC,UHC,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,UHC MGG,UHC MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,VA,VA,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Wellcare MGG,Wellcare MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Bright Health - commercial,Bright Health - commercial,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,73222,CPT,,,50,Inpatient,,,5380.5,5380.5,Bright Health MGG,Bright Health MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Aetna,Aetna,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Aetna MGG,Aetna MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,BCBS,BCBS,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,BCBS MGG,BCBS MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Cigna,Cigna,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Cigna MGG,Cigna MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Humana,Humana,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Humana MGG,Humana MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Optum VA,Optum VA,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,UHC,UHC,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,UHC MGG,UHC MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,VA,VA,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Wellcare MGG,Wellcare MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Bright Health - commercial,Bright Health - commercial,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,73222,CPT,,,LT,Inpatient,,,5380.5,5380.5,Bright Health MGG,Bright Health MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Aetna,Aetna,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Aetna MGG,Aetna MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,BCBS,BCBS,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,BCBS MGG,BCBS MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Cigna,Cigna,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Cigna MGG,Cigna MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Humana,Humana,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Humana MGG,Humana MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Optum VA,Optum VA,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,UHC,UHC,5380.5,,,,,,,per diem,5380.5,5380.5,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,UHC MGG,UHC MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,VA,VA,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Wellcare MGG,Wellcare MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Bright Health - commercial,Bright Health - commercial,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,73222,CPT,,,RT,Inpatient,,,5380.5,5380.5,Bright Health MGG,Bright Health MGG,5380.5,,,,,,,case rate,5380.5,5380.5,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Aetna,Aetna,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Aetna MGG,Aetna MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,BCBS,BCBS,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,BCBS MGG,BCBS MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Cigna,Cigna,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Cigna MGG,Cigna MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Humana,Humana,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Humana MGG,Humana MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Optum VA,Optum VA,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,UHC,UHC,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,UHC MGG,UHC MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,VA,VA,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Wellcare MGG,Wellcare MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Bright Health - commercial,Bright Health - commercial,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,73221,CPT,,,50,Inpatient,,,3610.8,3610.8,Bright Health MGG,Bright Health MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Aetna,Aetna,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Aetna MGG,Aetna MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,BCBS,BCBS,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,BCBS MGG,BCBS MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Cigna,Cigna,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Cigna MGG,Cigna MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Humana,Humana,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Humana MGG,Humana MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Optum VA,Optum VA,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,UHC,UHC,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,UHC MGG,UHC MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,VA,VA,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Wellcare MGG,Wellcare MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Bright Health - commercial,Bright Health - commercial,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,3610.8,3610.8,Bright Health MGG,Bright Health MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Aetna,Aetna,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Aetna MGG,Aetna MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,BCBS,BCBS,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,BCBS MGG,BCBS MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Cigna,Cigna,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Cigna MGG,Cigna MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Humana,Humana,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Humana MGG,Humana MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Optum VA,Optum VA,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,UHC,UHC,3610.8,,,,,,,per diem,3610.8,3610.8,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,UHC MGG,UHC MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,VA,VA,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Wellcare MGG,Wellcare MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Bright Health - commercial,Bright Health - commercial,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,3610.8,3610.8,Bright Health MGG,Bright Health MGG,3610.8,,,,,,,case rate,3610.8,3610.8,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Aetna,Aetna,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Aetna MGG,Aetna MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,BCBS,BCBS,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,BCBS MGG,BCBS MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Cigna,Cigna,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Cigna MGG,Cigna MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Humana,Humana,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Humana MGG,Humana MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Optum VA,Optum VA,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,UHC,UHC,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,UHC MGG,UHC MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,VA,VA,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Wellcare MGG,Wellcare MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Bright Health - commercial,Bright Health - commercial,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,73223,CPT,,,RT,Inpatient,,,6102.66,6102.66,Bright Health MGG,Bright Health MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Aetna,Aetna,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Aetna MGG,Aetna MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,BCBS,BCBS,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,BCBS MGG,BCBS MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Cigna,Cigna,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Cigna MGG,Cigna MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Humana,Humana,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Humana MGG,Humana MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Optum VA,Optum VA,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,UHC,UHC,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,UHC MGG,UHC MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,VA,VA,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Wellcare MGG,Wellcare MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Bright Health - commercial,Bright Health - commercial,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3592.44,3592.44,Bright Health MGG,Bright Health MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Aetna,Aetna,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Aetna MGG,Aetna MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,BCBS,BCBS,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,BCBS MGG,BCBS MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Cigna,Cigna,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Cigna MGG,Cigna MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Humana,Humana,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Humana MGG,Humana MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Optum VA,Optum VA,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,UHC,UHC,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,UHC MGG,UHC MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,VA,VA,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Wellcare MGG,Wellcare MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Bright Health - commercial,Bright Health - commercial,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,2408.22,2408.22,Bright Health MGG,Bright Health MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Aetna,Aetna,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Aetna MGG,Aetna MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,BCBS,BCBS,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,BCBS MGG,BCBS MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Cigna,Cigna,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Cigna MGG,Cigna MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Humana,Humana,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Humana MGG,Humana MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Optum VA,Optum VA,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,UHC,UHC,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,UHC MGG,UHC MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,VA,VA,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Wellcare MGG,Wellcare MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Bright Health - commercial,Bright Health - commercial,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,73220,CPT,,,RT,Inpatient,,,4082.04,4082.04,Bright Health MGG,Bright Health MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Aetna,Aetna,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Aetna MGG,Aetna MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,BCBS,BCBS,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,BCBS MGG,BCBS MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Cigna,Cigna,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Cigna MGG,Cigna MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Humana,Humana,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Humana MGG,Humana MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Optum VA,Optum VA,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,UHC,UHC,2408.22,,,,,,,per diem,2408.22,2408.22,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,UHC MGG,UHC MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,VA,VA,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Wellcare MGG,Wellcare MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Bright Health - commercial,Bright Health - commercial,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,2408.22,2408.22,Bright Health MGG,Bright Health MGG,2408.22,,,,,,,case rate,2408.22,2408.22,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Aetna,Aetna,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Aetna MGG,Aetna MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,BCBS,BCBS,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,BCBS MGG,BCBS MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Cigna,Cigna,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Cigna MGG,Cigna MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Humana,Humana,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Humana MGG,Humana MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Optum VA,Optum VA,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,UHC,UHC,3592.44,,,,,,,per diem,3592.44,3592.44,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,UHC MGG,UHC MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,VA,VA,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Wellcare MGG,Wellcare MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Bright Health - commercial,Bright Health - commercial,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,73219,CPT,,,LT,Inpatient,,,3592.44,3592.44,Bright Health MGG,Bright Health MGG,3592.44,,,,,,,case rate,3592.44,3592.44,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Aetna,Aetna,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Aetna MGG,Aetna MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,BCBS,BCBS,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,BCBS MGG,BCBS MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Cigna,Cigna,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Cigna MGG,Cigna MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Humana,Humana,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Humana MGG,Humana MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Optum VA,Optum VA,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,UHC,UHC,4082.04,,,,,,,per diem,4082.04,4082.04,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,UHC MGG,UHC MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,VA,VA,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Wellcare MGG,Wellcare MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Bright Health - commercial,Bright Health - commercial,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,73220,CPT,,,LT,Inpatient,,,4082.04,4082.04,Bright Health MGG,Bright Health MGG,4082.04,,,,,,,case rate,4082.04,4082.04,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Aetna,Aetna,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Aetna MGG,Aetna MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,BCBS,BCBS,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,BCBS MGG,BCBS MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Cigna,Cigna,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Cigna MGG,Cigna MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Humana,Humana,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Humana MGG,Humana MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Optum VA,Optum VA,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,UHC,UHC,6102.66,,,,,,,per diem,6102.66,6102.66,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,UHC MGG,UHC MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,VA,VA,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Wellcare MGG,Wellcare MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Bright Health - commercial,Bright Health - commercial,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,73223,CPT,,,LT,Inpatient,,,6102.66,6102.66,Bright Health MGG,Bright Health MGG,6102.66,,,,,,,case rate,6102.66,6102.66,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Aetna,Aetna,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Aetna MGG,Aetna MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,BCBS,BCBS,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,BCBS MGG,BCBS MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Cigna,Cigna,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Cigna MGG,Cigna MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Humana,Humana,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Humana MGG,Humana MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Optum VA,Optum VA,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,UHC,UHC,2707.08,,,,,,,per diem,2707.08,2707.08,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,UHC MGG,UHC MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,VA,VA,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Wellcare MGG,Wellcare MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Bright Health - commercial,Bright Health - commercial,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,2707.08,2707.08,Bright Health MGG,Bright Health MGG,2707.08,,,,,,,case rate,2707.08,2707.08,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Aetna,Aetna,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Aetna MGG,Aetna MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,BCBS,BCBS,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,BCBS MGG,BCBS MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Cigna,Cigna,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Cigna MGG,Cigna MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Humana,Humana,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Humana MGG,Humana MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Optum VA,Optum VA,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,UHC,UHC,4038.18,,,,,,,per diem,4038.18,4038.18,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,UHC MGG,UHC MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,VA,VA,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Wellcare MGG,Wellcare MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Bright Health - commercial,Bright Health - commercial,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,73719,CPT,,,LT,Inpatient,,,4038.18,4038.18,Bright Health MGG,Bright Health MGG,4038.18,,,,,,,case rate,4038.18,4038.18,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Aetna,Aetna,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Aetna MGG,Aetna MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,BCBS,BCBS,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,BCBS MGG,BCBS MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Cigna,Cigna,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Cigna MGG,Cigna MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Humana,Humana,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Humana MGG,Humana MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Optum VA,Optum VA,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,UHC,UHC,4588.98,,,,,,,per diem,4588.98,4588.98,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,UHC MGG,UHC MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,VA,VA,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Wellcare MGG,Wellcare MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Bright Health - commercial,Bright Health - commercial,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,73720,CPT,,,LT,Inpatient,,,4588.98,4588.98,Bright Health MGG,Bright Health MGG,4588.98,,,,,,,case rate,4588.98,4588.98,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Aetna,Aetna,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Aetna MGG,Aetna MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,BCBS,BCBS,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,BCBS MGG,BCBS MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Cigna,Cigna,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Cigna MGG,Cigna MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Humana,Humana,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Humana MGG,Humana MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Optum VA,Optum VA,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,UHC,UHC,9317.7,,,,,,,per diem,9317.7,9317.7,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,UHC MGG,UHC MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,VA,VA,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Wellcare MGG,Wellcare MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Bright Health - commercial,Bright Health - commercial,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,73722,CPT,,,LT,Inpatient,,,9317.7,9317.7,Bright Health MGG,Bright Health MGG,9317.7,,,,,,,case rate,9317.7,9317.7,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Aetna,Aetna,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Aetna MGG,Aetna MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,BCBS,BCBS,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,BCBS MGG,BCBS MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Cigna,Cigna,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Cigna MGG,Cigna MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Humana,Humana,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Humana MGG,Humana MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Optum VA,Optum VA,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,UHC,UHC,10568.22,,,,,,,per diem,10568.22,10568.22,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,UHC MGG,UHC MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,VA,VA,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Wellcare MGG,Wellcare MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Bright Health - commercial,Bright Health - commercial,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,10568.22,10568.22,Bright Health MGG,Bright Health MGG,10568.22,,,,,,,case rate,10568.22,10568.22,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Aetna,Aetna,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Aetna MGG,Aetna MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,BCBS,BCBS,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,BCBS MGG,BCBS MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Cigna,Cigna,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Cigna MGG,Cigna MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Humana,Humana,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Humana MGG,Humana MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Optum VA,Optum VA,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,UHC,UHC,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,UHC MGG,UHC MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,VA,VA,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Wellcare MGG,Wellcare MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Bright Health - commercial,Bright Health - commercial,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,73725,CPT,,,RT,Inpatient,,,2602.02,2602.02,Bright Health MGG,Bright Health MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Aetna,Aetna,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Aetna MGG,Aetna MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,BCBS,BCBS,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,BCBS MGG,BCBS MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Cigna,Cigna,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Cigna MGG,Cigna MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Humana,Humana,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Humana MGG,Humana MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Optum VA,Optum VA,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,UHC,UHC,2602.02,,,,,,,per diem,2602.02,2602.02,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,UHC MGG,UHC MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,VA,VA,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Wellcare MGG,Wellcare MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Bright Health - commercial,Bright Health - commercial,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,73725,CPT,,,LT,Inpatient,,,2602.02,2602.02,Bright Health MGG,Bright Health MGG,2602.02,,,,,,,case rate,2602.02,2602.02,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Aetna,Aetna,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Aetna MGG,Aetna MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,BCBS,BCBS,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,BCBS MGG,BCBS MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Cigna,Cigna,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Cigna MGG,Cigna MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Humana,Humana,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Humana MGG,Humana MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Optum VA,Optum VA,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,UHC,UHC,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,UHC MGG,UHC MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,VA,VA,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Wellcare MGG,Wellcare MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Bright Health - commercial,Bright Health - commercial,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,73225,CPT,,,LT,Inpatient,,,2489.82,2489.82,Bright Health MGG,Bright Health MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Aetna,Aetna,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Aetna MGG,Aetna MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,BCBS,BCBS,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,BCBS MGG,BCBS MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Cigna,Cigna,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Cigna MGG,Cigna MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Humana,Humana,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Humana MGG,Humana MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Optum VA,Optum VA,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,UHC,UHC,2489.82,,,,,,,per diem,2489.82,2489.82,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,UHC MGG,UHC MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,VA,VA,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Wellcare MGG,Wellcare MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Bright Health - commercial,Bright Health - commercial,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,73225,CPT,,,RT,Inpatient,,,2489.82,2489.82,Bright Health MGG,Bright Health MGG,2489.82,,,,,,,case rate,2489.82,2489.82,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Aetna,Aetna,2881.5,,,,,,,per diem,2881.5,2881.5,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Aetna MGG,Aetna MGG,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,BCBS,BCBS,2881.5,,,,,,,per diem,2881.5,2881.5,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,BCBS MGG,BCBS MGG,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Cigna,Cigna,2881.5,,,,,,,per diem,2881.5,2881.5,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Cigna MGG,Cigna MGG,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Humana,Humana,2881.5,,,,,,,per diem,2881.5,2881.5,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Humana MGG,Humana MGG,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Optum VA,Optum VA,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,UHC,UHC,2881.5,,,,,,,per diem,2881.5,2881.5,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,UHC MGG,UHC MGG,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,VA,VA,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Wellcare MGG,Wellcare MGG,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Bright Health - commercial,Bright Health - commercial,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,72198,CPT,,,,Inpatient,,,2881.5,2881.5,Bright Health MGG,Bright Health MGG,2881.5,,,,,,,case rate,2881.5,2881.5,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Aetna,Aetna,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Aetna MGG,Aetna MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,BCBS,BCBS,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,BCBS MGG,BCBS MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Cigna,Cigna,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Cigna MGG,Cigna MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Humana,Humana,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Humana MGG,Humana MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Optum VA,Optum VA,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,UHC,UHC,118.32,,,,,,,per diem,118.32,118.32,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,UHC MGG,UHC MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,VA,VA,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Wellcare MGG,Wellcare MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Bright Health - commercial,Bright Health - commercial,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,A9581,CPT,,,,Inpatient,1,EA,118.32,118.32,Bright Health MGG,Bright Health MGG,118.32,,,,,,,case rate,118.32,118.32,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Aetna,Aetna,968.2,,,,,,,per diem,968.2,968.2,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Aetna MGG,Aetna MGG,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,BCBS,BCBS,968.2,,,,,,,per diem,968.2,968.2,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,BCBS MGG,BCBS MGG,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Cigna,Cigna,968.2,,,,,,,per diem,968.2,968.2,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Cigna MGG,Cigna MGG,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Humana,Humana,968.2,,,,,,,per diem,968.2,968.2,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Humana MGG,Humana MGG,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Optum VA,Optum VA,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,UHC,UHC,968.2,,,,,,,per diem,968.2,968.2,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,UHC MGG,UHC MGG,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,VA,VA,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Wellcare MGG,Wellcare MGG,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Bright Health - commercial,Bright Health - commercial,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,27095,CPT,,,,Inpatient,,,968.2,968.2,Bright Health MGG,Bright Health MGG,968.2,,,,,,,case rate,968.2,968.2,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Aetna,Aetna,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Aetna MGG,Aetna MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,BCBS,BCBS,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,BCBS MGG,BCBS MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Cigna,Cigna,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Cigna MGG,Cigna MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Humana,Humana,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Humana MGG,Humana MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Optum VA,Optum VA,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,UHC,UHC,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,UHC MGG,UHC MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,VA,VA,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Wellcare MGG,Wellcare MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Bright Health - commercial,Bright Health - commercial,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,27370,CPT,,,,Inpatient,,,1188.3,1188.3,Bright Health MGG,Bright Health MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Aetna,Aetna,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Aetna MGG,Aetna MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,BCBS,BCBS,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,BCBS MGG,BCBS MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Cigna,Cigna,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Cigna MGG,Cigna MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Humana,Humana,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Humana MGG,Humana MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Optum VA,Optum VA,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,UHC,UHC,1188.3,,,,,,,per diem,1188.3,1188.3,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,UHC MGG,UHC MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,VA,VA,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Wellcare MGG,Wellcare MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Bright Health - commercial,Bright Health - commercial,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,23350,CPT,,,,Inpatient,,,1188.3,1188.3,Bright Health MGG,Bright Health MGG,1188.3,,,,,,,case rate,1188.3,1188.3,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna,Aetna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna MGG,Aetna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS,BCBS,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS MGG,BCBS MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna,Cigna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna MGG,Cigna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Humana,Humana,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Humana MGG,Humana MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Optum VA,Optum VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,UHC,UHC,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,UHC MGG,UHC MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,VA,VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Wellcare MGG,Wellcare MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health - commercial,Bright Health - commercial,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,19085,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health MGG,Bright Health MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna,Aetna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna MGG,Aetna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS,BCBS,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS MGG,BCBS MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna,Cigna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna MGG,Cigna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Humana,Humana,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Humana MGG,Humana MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Optum VA,Optum VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,UHC,UHC,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,UHC MGG,UHC MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,VA,VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Wellcare MGG,Wellcare MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health - commercial,Bright Health - commercial,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,19086,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health MGG,Bright Health MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Aetna,Aetna,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Aetna MGG,Aetna MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,BCBS,BCBS,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,BCBS MGG,BCBS MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Cigna,Cigna,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Cigna MGG,Cigna MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Humana,Humana,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Humana MGG,Humana MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Optum VA,Optum VA,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,UHC,UHC,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,UHC MGG,UHC MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,VA,VA,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Wellcare MGG,Wellcare MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Bright Health - commercial,Bright Health - commercial,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,19287,CPT,,,,Inpatient,,,596.7,596.7,Bright Health MGG,Bright Health MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Aetna,Aetna,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Aetna MGG,Aetna MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,BCBS,BCBS,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,BCBS MGG,BCBS MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Cigna,Cigna,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Cigna MGG,Cigna MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Humana,Humana,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Humana MGG,Humana MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Optum VA,Optum VA,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,UHC,UHC,596.7,,,,,,,per diem,596.7,596.7,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,UHC MGG,UHC MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,VA,VA,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Wellcare MGG,Wellcare MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Bright Health - commercial,Bright Health - commercial,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,19288,CPT,,,,Inpatient,,,596.7,596.7,Bright Health MGG,Bright Health MGG,596.7,,,,,,,case rate,596.7,596.7,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Aetna,Aetna,2080.48,,,,,,,per diem,2080.48,2080.48,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Aetna MGG,Aetna MGG,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,BCBS,BCBS,2080.48,,,,,,,per diem,2080.48,2080.48,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,BCBS MGG,BCBS MGG,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Cigna,Cigna,2080.48,,,,,,,per diem,2080.48,2080.48,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Cigna MGG,Cigna MGG,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Humana,Humana,2080.48,,,,,,,per diem,2080.48,2080.48,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Humana MGG,Humana MGG,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Optum VA,Optum VA,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,UHC,UHC,2080.48,,,,,,,per diem,2080.48,2080.48,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,UHC MGG,UHC MGG,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,VA,VA,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Wellcare MGG,Wellcare MGG,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Bright Health - commercial,Bright Health - commercial,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2080.48,2080.48,Bright Health MGG,Bright Health MGG,2080.48,,,,,,,case rate,2080.48,2080.48,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Aetna,Aetna,572,,,,,,,per diem,572,572,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Aetna MGG,Aetna MGG,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,BCBS,BCBS,572,,,,,,,per diem,572,572,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,BCBS MGG,BCBS MGG,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Cigna,Cigna,572,,,,,,,per diem,572,572,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Cigna MGG,Cigna MGG,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Humana,Humana,572,,,,,,,per diem,572,572,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Humana MGG,Humana MGG,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Optum VA,Optum VA,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,UHC,UHC,572,,,,,,,per diem,572,572,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,UHC MGG,UHC MGG,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,VA,VA,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Wellcare MGG,Wellcare MGG,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Bright Health - commercial,Bright Health - commercial,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,572,572,Bright Health MGG,Bright Health MGG,572,,,,,,,case rate,572,572,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Aetna,Aetna,5087.5,,,,,,,per diem,5087.5,5087.5,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Aetna MGG,Aetna MGG,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,BCBS,BCBS,5087.5,,,,,,,per diem,5087.5,5087.5,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,BCBS MGG,BCBS MGG,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Cigna,Cigna,5087.5,,,,,,,per diem,5087.5,5087.5,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Cigna MGG,Cigna MGG,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Humana,Humana,5087.5,,,,,,,per diem,5087.5,5087.5,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Humana MGG,Humana MGG,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Optum VA,Optum VA,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,UHC,UHC,5087.5,,,,,,,per diem,5087.5,5087.5,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,UHC MGG,UHC MGG,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,VA,VA,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Wellcare MGG,Wellcare MGG,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Bright Health - commercial,Bright Health - commercial,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5087.5,5087.5,Bright Health MGG,Bright Health MGG,5087.5,,,,,,,case rate,5087.5,5087.5,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Aetna,Aetna,718.63,,,,,,,per diem,718.63,718.63,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Aetna MGG,Aetna MGG,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,BCBS,BCBS,718.63,,,,,,,per diem,718.63,718.63,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,BCBS MGG,BCBS MGG,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Cigna,Cigna,718.63,,,,,,,per diem,718.63,718.63,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Cigna MGG,Cigna MGG,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Humana,Humana,718.63,,,,,,,per diem,718.63,718.63,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Humana MGG,Humana MGG,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Optum VA,Optum VA,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,UHC,UHC,718.63,,,,,,,per diem,718.63,718.63,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,UHC MGG,UHC MGG,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,VA,VA,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Wellcare MGG,Wellcare MGG,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Bright Health - commercial,Bright Health - commercial,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,718.63,718.63,Bright Health MGG,Bright Health MGG,718.63,,,,,,,case rate,718.63,718.63,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Aetna,Aetna,3839.13,,,,,,,per diem,3839.13,3839.13,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Aetna MGG,Aetna MGG,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,BCBS,BCBS,3839.13,,,,,,,per diem,3839.13,3839.13,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,BCBS MGG,BCBS MGG,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Cigna,Cigna,3839.13,,,,,,,per diem,3839.13,3839.13,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Cigna MGG,Cigna MGG,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Humana,Humana,3839.13,,,,,,,per diem,3839.13,3839.13,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Humana MGG,Humana MGG,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Optum VA,Optum VA,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,UHC,UHC,3839.13,,,,,,,per diem,3839.13,3839.13,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,UHC MGG,UHC MGG,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,VA,VA,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Wellcare MGG,Wellcare MGG,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Bright Health - commercial,Bright Health - commercial,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,3839.13,3839.13,Bright Health MGG,Bright Health MGG,3839.13,,,,,,,case rate,3839.13,3839.13,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Aetna,Aetna,2880,,,,,,,per diem,2880,2880,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Aetna MGG,Aetna MGG,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,BCBS,BCBS,2880,,,,,,,per diem,2880,2880,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,BCBS MGG,BCBS MGG,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Cigna,Cigna,2880,,,,,,,per diem,2880,2880,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Cigna MGG,Cigna MGG,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Humana,Humana,2880,,,,,,,per diem,2880,2880,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Humana MGG,Humana MGG,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Optum VA,Optum VA,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,UHC,UHC,2880,,,,,,,per diem,2880,2880,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,UHC MGG,UHC MGG,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,VA,VA,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Wellcare MGG,Wellcare MGG,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Bright Health - commercial,Bright Health - commercial,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,2880,2880,Bright Health MGG,Bright Health MGG,2880,,,,,,,case rate,2880,2880,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Aetna,Aetna,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Aetna MGG,Aetna MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,BCBS,BCBS,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,BCBS MGG,BCBS MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Cigna,Cigna,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Cigna MGG,Cigna MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Humana,Humana,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Humana MGG,Humana MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Optum VA,Optum VA,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,UHC,UHC,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,UHC MGG,UHC MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,VA,VA,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Wellcare MGG,Wellcare MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Bright Health - commercial,Bright Health - commercial,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,340.77,340.77,Bright Health MGG,Bright Health MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Aetna,Aetna,301.97,,,,,,,per diem,301.97,301.97,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Aetna MGG,Aetna MGG,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,BCBS,BCBS,301.97,,,,,,,per diem,301.97,301.97,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,BCBS MGG,BCBS MGG,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Cigna,Cigna,301.97,,,,,,,per diem,301.97,301.97,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Cigna MGG,Cigna MGG,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Humana,Humana,301.97,,,,,,,per diem,301.97,301.97,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Humana MGG,Humana MGG,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Optum VA,Optum VA,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,UHC,UHC,301.97,,,,,,,per diem,301.97,301.97,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,UHC MGG,UHC MGG,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,VA,VA,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Wellcare MGG,Wellcare MGG,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Bright Health - commercial,Bright Health - commercial,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,301.97,301.97,Bright Health MGG,Bright Health MGG,301.97,,,,,,,case rate,301.97,301.97,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Aetna,Aetna,917.5,,,,,,,per diem,917.5,917.5,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Aetna MGG,Aetna MGG,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,BCBS,BCBS,917.5,,,,,,,per diem,917.5,917.5,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,BCBS MGG,BCBS MGG,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Cigna,Cigna,917.5,,,,,,,per diem,917.5,917.5,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Cigna MGG,Cigna MGG,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Humana,Humana,917.5,,,,,,,per diem,917.5,917.5,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Humana MGG,Humana MGG,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Optum VA,Optum VA,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,UHC,UHC,917.5,,,,,,,per diem,917.5,917.5,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,UHC MGG,UHC MGG,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,VA,VA,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Wellcare MGG,Wellcare MGG,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Bright Health - commercial,Bright Health - commercial,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,917.5,917.5,Bright Health MGG,Bright Health MGG,917.5,,,,,,,case rate,917.5,917.5,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Aetna,Aetna,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Aetna MGG,Aetna MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,BCBS,BCBS,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,BCBS MGG,BCBS MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Cigna,Cigna,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Cigna MGG,Cigna MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Humana,Humana,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Humana MGG,Humana MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Optum VA,Optum VA,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,UHC,UHC,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,UHC MGG,UHC MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,VA,VA,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Wellcare MGG,Wellcare MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Bright Health - commercial,Bright Health - commercial,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,408,408,Bright Health MGG,Bright Health MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Aetna,Aetna,369.04,,,,,,,per diem,369.04,369.04,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Aetna MGG,Aetna MGG,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,BCBS,BCBS,369.04,,,,,,,per diem,369.04,369.04,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,BCBS MGG,BCBS MGG,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Cigna,Cigna,369.04,,,,,,,per diem,369.04,369.04,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Cigna MGG,Cigna MGG,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Humana,Humana,369.04,,,,,,,per diem,369.04,369.04,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Humana MGG,Humana MGG,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Optum VA,Optum VA,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,UHC,UHC,369.04,,,,,,,per diem,369.04,369.04,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,UHC MGG,UHC MGG,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,VA,VA,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Wellcare MGG,Wellcare MGG,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Bright Health - commercial,Bright Health - commercial,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,369.04,369.04,Bright Health MGG,Bright Health MGG,369.04,,,,,,,case rate,369.04,369.04,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Aetna,Aetna,1476.01,,,,,,,per diem,1476.01,1476.01,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Aetna MGG,Aetna MGG,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,BCBS,BCBS,1476.01,,,,,,,per diem,1476.01,1476.01,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,BCBS MGG,BCBS MGG,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Cigna,Cigna,1476.01,,,,,,,per diem,1476.01,1476.01,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Cigna MGG,Cigna MGG,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Humana,Humana,1476.01,,,,,,,per diem,1476.01,1476.01,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Humana MGG,Humana MGG,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Optum VA,Optum VA,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,UHC,UHC,1476.01,,,,,,,per diem,1476.01,1476.01,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,UHC MGG,UHC MGG,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,VA,VA,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Wellcare MGG,Wellcare MGG,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Bright Health - commercial,Bright Health - commercial,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1476.01,1476.01,Bright Health MGG,Bright Health MGG,1476.01,,,,,,,case rate,1476.01,1476.01,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Aetna,Aetna,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Aetna MGG,Aetna MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,BCBS,BCBS,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,BCBS MGG,BCBS MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Cigna,Cigna,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Cigna MGG,Cigna MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Humana,Humana,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Humana MGG,Humana MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Optum VA,Optum VA,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,UHC,UHC,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,UHC MGG,UHC MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,VA,VA,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Wellcare MGG,Wellcare MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Bright Health - commercial,Bright Health - commercial,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,1326,1326,Bright Health MGG,Bright Health MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Aetna,Aetna,603.33,,,,,,,per diem,603.33,603.33,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Aetna MGG,Aetna MGG,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,BCBS,BCBS,603.33,,,,,,,per diem,603.33,603.33,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,BCBS MGG,BCBS MGG,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Cigna,Cigna,603.33,,,,,,,per diem,603.33,603.33,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Cigna MGG,Cigna MGG,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Humana,Humana,603.33,,,,,,,per diem,603.33,603.33,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Humana MGG,Humana MGG,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Optum VA,Optum VA,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,UHC,UHC,603.33,,,,,,,per diem,603.33,603.33,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,UHC MGG,UHC MGG,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,VA,VA,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Wellcare MGG,Wellcare MGG,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Bright Health - commercial,Bright Health - commercial,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,603.33,603.33,Bright Health MGG,Bright Health MGG,603.33,,,,,,,case rate,603.33,603.33,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Aetna,Aetna,1199.97,,,,,,,per diem,1199.97,1199.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Aetna MGG,Aetna MGG,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,BCBS,BCBS,1199.97,,,,,,,per diem,1199.97,1199.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,BCBS MGG,BCBS MGG,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Cigna,Cigna,1199.97,,,,,,,per diem,1199.97,1199.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Cigna MGG,Cigna MGG,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Humana,Humana,1199.97,,,,,,,per diem,1199.97,1199.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Humana MGG,Humana MGG,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Optum VA,Optum VA,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,UHC,UHC,1199.97,,,,,,,per diem,1199.97,1199.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,UHC MGG,UHC MGG,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,VA,VA,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Wellcare MGG,Wellcare MGG,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Bright Health - commercial,Bright Health - commercial,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1199.97,1199.97,Bright Health MGG,Bright Health MGG,1199.97,,,,,,,case rate,1199.97,1199.97,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Aetna,Aetna,941,,,,,,,per diem,941,941,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Aetna MGG,Aetna MGG,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,BCBS,BCBS,941,,,,,,,per diem,941,941,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,BCBS MGG,BCBS MGG,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Cigna,Cigna,941,,,,,,,per diem,941,941,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Cigna MGG,Cigna MGG,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Humana,Humana,941,,,,,,,per diem,941,941,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Humana MGG,Humana MGG,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Optum VA,Optum VA,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,UHC,UHC,941,,,,,,,per diem,941,941,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,UHC MGG,UHC MGG,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,VA,VA,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Wellcare MGG,Wellcare MGG,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Bright Health - commercial,Bright Health - commercial,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,941,941,Bright Health MGG,Bright Health MGG,941,,,,,,,case rate,941,941,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Aetna,Aetna,840.63,,,,,,,per diem,840.63,840.63,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Aetna MGG,Aetna MGG,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,BCBS,BCBS,840.63,,,,,,,per diem,840.63,840.63,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,BCBS MGG,BCBS MGG,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Cigna,Cigna,840.63,,,,,,,per diem,840.63,840.63,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Cigna MGG,Cigna MGG,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Humana,Humana,840.63,,,,,,,per diem,840.63,840.63,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Humana MGG,Humana MGG,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Optum VA,Optum VA,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,UHC,UHC,840.63,,,,,,,per diem,840.63,840.63,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,UHC MGG,UHC MGG,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,VA,VA,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Wellcare MGG,Wellcare MGG,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Bright Health - commercial,Bright Health - commercial,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,840.63,840.63,Bright Health MGG,Bright Health MGG,840.63,,,,,,,case rate,840.63,840.63,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Aetna,Aetna,408.29,,,,,,,per diem,408.29,408.29,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Aetna MGG,Aetna MGG,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,BCBS,BCBS,408.29,,,,,,,per diem,408.29,408.29,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,BCBS MGG,BCBS MGG,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Cigna,Cigna,408.29,,,,,,,per diem,408.29,408.29,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Cigna MGG,Cigna MGG,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Humana,Humana,408.29,,,,,,,per diem,408.29,408.29,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Humana MGG,Humana MGG,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Optum VA,Optum VA,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,UHC,UHC,408.29,,,,,,,per diem,408.29,408.29,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,UHC MGG,UHC MGG,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,VA,VA,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Wellcare MGG,Wellcare MGG,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Bright Health - commercial,Bright Health - commercial,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,408.29,408.29,Bright Health MGG,Bright Health MGG,408.29,,,,,,,case rate,408.29,408.29,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Aetna,Aetna,833.51,,,,,,,per diem,833.51,833.51,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Aetna MGG,Aetna MGG,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,BCBS,BCBS,833.51,,,,,,,per diem,833.51,833.51,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,BCBS MGG,BCBS MGG,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Cigna,Cigna,833.51,,,,,,,per diem,833.51,833.51,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Cigna MGG,Cigna MGG,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Humana,Humana,833.51,,,,,,,per diem,833.51,833.51,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Humana MGG,Humana MGG,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Optum VA,Optum VA,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,UHC,UHC,833.51,,,,,,,per diem,833.51,833.51,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,UHC MGG,UHC MGG,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,VA,VA,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Wellcare MGG,Wellcare MGG,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Bright Health - commercial,Bright Health - commercial,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,833.51,833.51,Bright Health MGG,Bright Health MGG,833.51,,,,,,,case rate,833.51,833.51,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Aetna,Aetna,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Aetna MGG,Aetna MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,BCBS,BCBS,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,BCBS MGG,BCBS MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Cigna,Cigna,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Cigna MGG,Cigna MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Humana,Humana,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Humana MGG,Humana MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Optum VA,Optum VA,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,UHC,UHC,550.25,,,,,,,per diem,550.25,550.25,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,UHC MGG,UHC MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,VA,VA,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Wellcare MGG,Wellcare MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Bright Health - commercial,Bright Health - commercial,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,550.25,550.25,Bright Health MGG,Bright Health MGG,550.25,,,,,,,case rate,550.25,550.25,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Aetna,Aetna,390.4,,,,,,,per diem,390.4,390.4,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Aetna MGG,Aetna MGG,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,BCBS,BCBS,390.4,,,,,,,per diem,390.4,390.4,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,BCBS MGG,BCBS MGG,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Cigna,Cigna,390.4,,,,,,,per diem,390.4,390.4,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Cigna MGG,Cigna MGG,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Humana,Humana,390.4,,,,,,,per diem,390.4,390.4,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Humana MGG,Humana MGG,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Optum VA,Optum VA,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,UHC,UHC,390.4,,,,,,,per diem,390.4,390.4,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,UHC MGG,UHC MGG,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,VA,VA,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Wellcare MGG,Wellcare MGG,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Bright Health - commercial,Bright Health - commercial,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,390.4,390.4,Bright Health MGG,Bright Health MGG,390.4,,,,,,,case rate,390.4,390.4,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Aetna,Aetna,580.66,,,,,,,per diem,580.66,580.66,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Aetna MGG,Aetna MGG,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,BCBS,BCBS,580.66,,,,,,,per diem,580.66,580.66,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,BCBS MGG,BCBS MGG,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Cigna,Cigna,580.66,,,,,,,per diem,580.66,580.66,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Cigna MGG,Cigna MGG,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Humana,Humana,580.66,,,,,,,per diem,580.66,580.66,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Humana MGG,Humana MGG,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Optum VA,Optum VA,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,UHC,UHC,580.66,,,,,,,per diem,580.66,580.66,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,UHC MGG,UHC MGG,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,VA,VA,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Wellcare MGG,Wellcare MGG,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Bright Health - commercial,Bright Health - commercial,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,580.66,580.66,Bright Health MGG,Bright Health MGG,580.66,,,,,,,case rate,580.66,580.66,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Aetna,Aetna,1012.86,,,,,,,per diem,1012.86,1012.86,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Aetna MGG,Aetna MGG,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,BCBS,BCBS,1012.86,,,,,,,per diem,1012.86,1012.86,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,BCBS MGG,BCBS MGG,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Cigna,Cigna,1012.86,,,,,,,per diem,1012.86,1012.86,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Cigna MGG,Cigna MGG,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Humana,Humana,1012.86,,,,,,,per diem,1012.86,1012.86,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Humana MGG,Humana MGG,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Optum VA,Optum VA,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,UHC,UHC,1012.86,,,,,,,per diem,1012.86,1012.86,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,UHC MGG,UHC MGG,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,VA,VA,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Wellcare MGG,Wellcare MGG,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Bright Health - commercial,Bright Health - commercial,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1012.86,1012.86,Bright Health MGG,Bright Health MGG,1012.86,,,,,,,case rate,1012.86,1012.86,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Aetna,Aetna,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Aetna MGG,Aetna MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,BCBS,BCBS,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,BCBS MGG,BCBS MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Cigna,Cigna,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Cigna MGG,Cigna MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Humana,Humana,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Humana MGG,Humana MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Optum VA,Optum VA,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,UHC,UHC,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,UHC MGG,UHC MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,VA,VA,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Wellcare MGG,Wellcare MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Bright Health - commercial,Bright Health - commercial,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,860.88,860.88,Bright Health MGG,Bright Health MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Aetna,Aetna,748.68,,,,,,,per diem,748.68,748.68,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Aetna MGG,Aetna MGG,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,BCBS,BCBS,748.68,,,,,,,per diem,748.68,748.68,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,BCBS MGG,BCBS MGG,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Cigna,Cigna,748.68,,,,,,,per diem,748.68,748.68,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Cigna MGG,Cigna MGG,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Humana,Humana,748.68,,,,,,,per diem,748.68,748.68,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Humana MGG,Humana MGG,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Optum VA,Optum VA,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,UHC,UHC,748.68,,,,,,,per diem,748.68,748.68,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,UHC MGG,UHC MGG,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,VA,VA,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Wellcare MGG,Wellcare MGG,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Bright Health - commercial,Bright Health - commercial,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,748.68,748.68,Bright Health MGG,Bright Health MGG,748.68,,,,,,,case rate,748.68,748.68,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Aetna,Aetna,396.78,,,,,,,per diem,396.78,396.78,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Aetna MGG,Aetna MGG,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,BCBS,BCBS,396.78,,,,,,,per diem,396.78,396.78,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,BCBS MGG,BCBS MGG,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Cigna,Cigna,396.78,,,,,,,per diem,396.78,396.78,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Cigna MGG,Cigna MGG,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Humana,Humana,396.78,,,,,,,per diem,396.78,396.78,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Humana MGG,Humana MGG,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Optum VA,Optum VA,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,UHC,UHC,396.78,,,,,,,per diem,396.78,396.78,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,UHC MGG,UHC MGG,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,VA,VA,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Wellcare MGG,Wellcare MGG,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Bright Health - commercial,Bright Health - commercial,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,396.78,396.78,Bright Health MGG,Bright Health MGG,396.78,,,,,,,case rate,396.78,396.78,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Aetna,Aetna,1164.84,,,,,,,per diem,1164.84,1164.84,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Aetna MGG,Aetna MGG,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,BCBS,BCBS,1164.84,,,,,,,per diem,1164.84,1164.84,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,BCBS MGG,BCBS MGG,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Cigna,Cigna,1164.84,,,,,,,per diem,1164.84,1164.84,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Cigna MGG,Cigna MGG,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Humana,Humana,1164.84,,,,,,,per diem,1164.84,1164.84,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Humana MGG,Humana MGG,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Optum VA,Optum VA,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,UHC,UHC,1164.84,,,,,,,per diem,1164.84,1164.84,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,UHC MGG,UHC MGG,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,VA,VA,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Wellcare MGG,Wellcare MGG,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Bright Health - commercial,Bright Health - commercial,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1164.84,1164.84,Bright Health MGG,Bright Health MGG,1164.84,,,,,,,case rate,1164.84,1164.84,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Aetna,Aetna,195.7,,,,,,,per diem,195.7,195.7,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Aetna MGG,Aetna MGG,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,BCBS,BCBS,195.7,,,,,,,per diem,195.7,195.7,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,BCBS MGG,BCBS MGG,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Cigna,Cigna,195.7,,,,,,,per diem,195.7,195.7,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Cigna MGG,Cigna MGG,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Humana,Humana,195.7,,,,,,,per diem,195.7,195.7,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Humana MGG,Humana MGG,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Optum VA,Optum VA,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,UHC,UHC,195.7,,,,,,,per diem,195.7,195.7,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,UHC MGG,UHC MGG,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,VA,VA,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Wellcare MGG,Wellcare MGG,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Bright Health - commercial,Bright Health - commercial,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,195.7,195.7,Bright Health MGG,Bright Health MGG,195.7,,,,,,,case rate,195.7,195.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Aetna,Aetna,606.7,,,,,,,per diem,606.7,606.7,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Aetna MGG,Aetna MGG,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,BCBS,BCBS,606.7,,,,,,,per diem,606.7,606.7,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,BCBS MGG,BCBS MGG,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Cigna,Cigna,606.7,,,,,,,per diem,606.7,606.7,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Cigna MGG,Cigna MGG,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Humana,Humana,606.7,,,,,,,per diem,606.7,606.7,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Humana MGG,Humana MGG,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Optum VA,Optum VA,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,UHC,UHC,606.7,,,,,,,per diem,606.7,606.7,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,UHC MGG,UHC MGG,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,VA,VA,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Wellcare MGG,Wellcare MGG,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Bright Health - commercial,Bright Health - commercial,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,606.7,606.7,Bright Health MGG,Bright Health MGG,606.7,,,,,,,case rate,606.7,606.7,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Aetna,Aetna,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Aetna MGG,Aetna MGG,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,BCBS,BCBS,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,BCBS MGG,BCBS MGG,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Cigna,Cigna,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Cigna MGG,Cigna MGG,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Humana,Humana,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Humana MGG,Humana MGG,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Optum VA,Optum VA,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,UHC,UHC,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,UHC MGG,UHC MGG,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,VA,VA,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Wellcare MGG,Wellcare MGG,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Bright Health - commercial,Bright Health - commercial,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,378,378,Bright Health MGG,Bright Health MGG,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Aetna,Aetna,1044.58,,,,,,,per diem,1044.58,1044.58,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Aetna MGG,Aetna MGG,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,BCBS,BCBS,1044.58,,,,,,,per diem,1044.58,1044.58,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,BCBS MGG,BCBS MGG,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Cigna,Cigna,1044.58,,,,,,,per diem,1044.58,1044.58,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Cigna MGG,Cigna MGG,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Humana,Humana,1044.58,,,,,,,per diem,1044.58,1044.58,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Humana MGG,Humana MGG,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Optum VA,Optum VA,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,UHC,UHC,1044.58,,,,,,,per diem,1044.58,1044.58,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,UHC MGG,UHC MGG,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,VA,VA,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Wellcare MGG,Wellcare MGG,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Bright Health - commercial,Bright Health - commercial,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1044.58,1044.58,Bright Health MGG,Bright Health MGG,1044.58,,,,,,,case rate,1044.58,1044.58,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Aetna,Aetna,905.41,,,,,,,per diem,905.41,905.41,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Aetna MGG,Aetna MGG,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,BCBS,BCBS,905.41,,,,,,,per diem,905.41,905.41,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,BCBS MGG,BCBS MGG,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Cigna,Cigna,905.41,,,,,,,per diem,905.41,905.41,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Cigna MGG,Cigna MGG,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Humana,Humana,905.41,,,,,,,per diem,905.41,905.41,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Humana MGG,Humana MGG,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Optum VA,Optum VA,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,UHC,UHC,905.41,,,,,,,per diem,905.41,905.41,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,UHC MGG,UHC MGG,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,VA,VA,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Wellcare MGG,Wellcare MGG,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Bright Health - commercial,Bright Health - commercial,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,905.41,905.41,Bright Health MGG,Bright Health MGG,905.41,,,,,,,case rate,905.41,905.41,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Aetna,Aetna,557.45,,,,,,,per diem,557.45,557.45,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Aetna MGG,Aetna MGG,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,BCBS,BCBS,557.45,,,,,,,per diem,557.45,557.45,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,BCBS MGG,BCBS MGG,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Cigna,Cigna,557.45,,,,,,,per diem,557.45,557.45,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Cigna MGG,Cigna MGG,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Humana,Humana,557.45,,,,,,,per diem,557.45,557.45,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Humana MGG,Humana MGG,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Optum VA,Optum VA,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,UHC,UHC,557.45,,,,,,,per diem,557.45,557.45,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,UHC MGG,UHC MGG,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,VA,VA,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Wellcare MGG,Wellcare MGG,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Bright Health - commercial,Bright Health - commercial,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,557.45,557.45,Bright Health MGG,Bright Health MGG,557.45,,,,,,,case rate,557.45,557.45,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Aetna,Aetna,743.52,,,,,,,per diem,743.52,743.52,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Aetna MGG,Aetna MGG,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,BCBS,BCBS,743.52,,,,,,,per diem,743.52,743.52,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,BCBS MGG,BCBS MGG,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Cigna,Cigna,743.52,,,,,,,per diem,743.52,743.52,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Cigna MGG,Cigna MGG,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Humana,Humana,743.52,,,,,,,per diem,743.52,743.52,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Humana MGG,Humana MGG,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Optum VA,Optum VA,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,UHC,UHC,743.52,,,,,,,per diem,743.52,743.52,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,UHC MGG,UHC MGG,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,VA,VA,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Wellcare MGG,Wellcare MGG,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Bright Health - commercial,Bright Health - commercial,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,743.52,743.52,Bright Health MGG,Bright Health MGG,743.52,,,,,,,case rate,743.52,743.52,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Aetna,Aetna,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Aetna MGG,Aetna MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,BCBS,BCBS,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,BCBS MGG,BCBS MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Cigna,Cigna,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Cigna MGG,Cigna MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Humana,Humana,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Humana MGG,Humana MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Optum VA,Optum VA,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,UHC,UHC,541.98,,,,,,,per diem,541.98,541.98,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,UHC MGG,UHC MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,VA,VA,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Wellcare MGG,Wellcare MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Bright Health - commercial,Bright Health - commercial,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,541.98,541.98,Bright Health MGG,Bright Health MGG,541.98,,,,,,,case rate,541.98,541.98,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Aetna,Aetna,662.5,,,,,,,per diem,662.5,662.5,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Aetna MGG,Aetna MGG,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,BCBS,BCBS,662.5,,,,,,,per diem,662.5,662.5,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,BCBS MGG,BCBS MGG,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Cigna,Cigna,662.5,,,,,,,per diem,662.5,662.5,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Cigna MGG,Cigna MGG,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Humana,Humana,662.5,,,,,,,per diem,662.5,662.5,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Humana MGG,Humana MGG,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Optum VA,Optum VA,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,UHC,UHC,662.5,,,,,,,per diem,662.5,662.5,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,UHC MGG,UHC MGG,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,VA,VA,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Wellcare MGG,Wellcare MGG,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Bright Health - commercial,Bright Health - commercial,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,662.5,662.5,Bright Health MGG,Bright Health MGG,662.5,,,,,,,case rate,662.5,662.5,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Aetna,Aetna,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Aetna MGG,Aetna MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,BCBS,BCBS,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,BCBS MGG,BCBS MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Cigna,Cigna,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Cigna MGG,Cigna MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Humana,Humana,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Humana MGG,Humana MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Optum VA,Optum VA,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,UHC,UHC,340.77,,,,,,,per diem,340.77,340.77,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,UHC MGG,UHC MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,VA,VA,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Wellcare MGG,Wellcare MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Bright Health - commercial,Bright Health - commercial,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,340.77,340.77,Bright Health MGG,Bright Health MGG,340.77,,,,,,,case rate,340.77,340.77,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Aetna,Aetna,456.6,,,,,,,per diem,456.6,456.6,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Aetna MGG,Aetna MGG,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,BCBS,BCBS,456.6,,,,,,,per diem,456.6,456.6,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,BCBS MGG,BCBS MGG,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Cigna,Cigna,456.6,,,,,,,per diem,456.6,456.6,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Cigna MGG,Cigna MGG,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Humana,Humana,456.6,,,,,,,per diem,456.6,456.6,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Humana MGG,Humana MGG,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Optum VA,Optum VA,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,UHC,UHC,456.6,,,,,,,per diem,456.6,456.6,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,UHC MGG,UHC MGG,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,VA,VA,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Wellcare MGG,Wellcare MGG,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Bright Health - commercial,Bright Health - commercial,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,456.6,456.6,Bright Health MGG,Bright Health MGG,456.6,,,,,,,case rate,456.6,456.6,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Aetna,Aetna,2422.81,,,,,,,per diem,2422.81,2422.81,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Aetna MGG,Aetna MGG,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,BCBS,BCBS,2422.81,,,,,,,per diem,2422.81,2422.81,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,BCBS MGG,BCBS MGG,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Cigna,Cigna,2422.81,,,,,,,per diem,2422.81,2422.81,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Cigna MGG,Cigna MGG,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Humana,Humana,2422.81,,,,,,,per diem,2422.81,2422.81,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Humana MGG,Humana MGG,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Optum VA,Optum VA,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,UHC,UHC,2422.81,,,,,,,per diem,2422.81,2422.81,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,UHC MGG,UHC MGG,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,VA,VA,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Wellcare MGG,Wellcare MGG,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Bright Health - commercial,Bright Health - commercial,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2422.81,2422.81,Bright Health MGG,Bright Health MGG,2422.81,,,,,,,case rate,2422.81,2422.81,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Aetna,Aetna,886.72,,,,,,,per diem,886.72,886.72,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Aetna MGG,Aetna MGG,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,BCBS,BCBS,886.72,,,,,,,per diem,886.72,886.72,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,BCBS MGG,BCBS MGG,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Cigna,Cigna,886.72,,,,,,,per diem,886.72,886.72,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Cigna MGG,Cigna MGG,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Humana,Humana,886.72,,,,,,,per diem,886.72,886.72,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Humana MGG,Humana MGG,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Optum VA,Optum VA,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,UHC,UHC,886.72,,,,,,,per diem,886.72,886.72,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,UHC MGG,UHC MGG,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,VA,VA,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Wellcare MGG,Wellcare MGG,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Bright Health - commercial,Bright Health - commercial,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,886.72,886.72,Bright Health MGG,Bright Health MGG,886.72,,,,,,,case rate,886.72,886.72,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Aetna,Aetna,492.67,,,,,,,per diem,492.67,492.67,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Aetna MGG,Aetna MGG,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,BCBS,BCBS,492.67,,,,,,,per diem,492.67,492.67,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,BCBS MGG,BCBS MGG,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Cigna,Cigna,492.67,,,,,,,per diem,492.67,492.67,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Cigna MGG,Cigna MGG,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Humana,Humana,492.67,,,,,,,per diem,492.67,492.67,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Humana MGG,Humana MGG,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Optum VA,Optum VA,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,UHC,UHC,492.67,,,,,,,per diem,492.67,492.67,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,UHC MGG,UHC MGG,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,VA,VA,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Wellcare MGG,Wellcare MGG,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Bright Health - commercial,Bright Health - commercial,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,492.67,492.67,Bright Health MGG,Bright Health MGG,492.67,,,,,,,case rate,492.67,492.67,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Aetna,Aetna,569.16,,,,,,,per diem,569.16,569.16,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Aetna MGG,Aetna MGG,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,BCBS,BCBS,569.16,,,,,,,per diem,569.16,569.16,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,BCBS MGG,BCBS MGG,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Cigna,Cigna,569.16,,,,,,,per diem,569.16,569.16,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Cigna MGG,Cigna MGG,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Humana,Humana,569.16,,,,,,,per diem,569.16,569.16,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Humana MGG,Humana MGG,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Optum VA,Optum VA,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,UHC,UHC,569.16,,,,,,,per diem,569.16,569.16,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,UHC MGG,UHC MGG,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,VA,VA,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Wellcare MGG,Wellcare MGG,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Bright Health - commercial,Bright Health - commercial,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,569.16,569.16,Bright Health MGG,Bright Health MGG,569.16,,,,,,,case rate,569.16,569.16,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Aetna,Aetna,1666.68,,,,,,,per diem,1666.68,1666.68,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Aetna MGG,Aetna MGG,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,BCBS,BCBS,1666.68,,,,,,,per diem,1666.68,1666.68,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,BCBS MGG,BCBS MGG,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Cigna,Cigna,1666.68,,,,,,,per diem,1666.68,1666.68,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Cigna MGG,Cigna MGG,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Humana,Humana,1666.68,,,,,,,per diem,1666.68,1666.68,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Humana MGG,Humana MGG,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Optum VA,Optum VA,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,UHC,UHC,1666.68,,,,,,,per diem,1666.68,1666.68,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,UHC MGG,UHC MGG,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,VA,VA,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Wellcare MGG,Wellcare MGG,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Bright Health - commercial,Bright Health - commercial,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1666.68,1666.68,Bright Health MGG,Bright Health MGG,1666.68,,,,,,,case rate,1666.68,1666.68,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Aetna,Aetna,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Aetna MGG,Aetna MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,BCBS,BCBS,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,BCBS MGG,BCBS MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Cigna,Cigna,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Cigna MGG,Cigna MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Humana,Humana,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Humana MGG,Humana MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Optum VA,Optum VA,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,UHC,UHC,301.92,,,,,,,per diem,301.92,301.92,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,UHC MGG,UHC MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,VA,VA,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Wellcare MGG,Wellcare MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Bright Health - commercial,Bright Health - commercial,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,301.92,301.92,Bright Health MGG,Bright Health MGG,301.92,,,,,,,case rate,301.92,301.92,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Aetna,Aetna,1540.21,,,,,,,per diem,1540.21,1540.21,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Aetna MGG,Aetna MGG,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,BCBS,BCBS,1540.21,,,,,,,per diem,1540.21,1540.21,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,BCBS MGG,BCBS MGG,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Cigna,Cigna,1540.21,,,,,,,per diem,1540.21,1540.21,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Cigna MGG,Cigna MGG,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Humana,Humana,1540.21,,,,,,,per diem,1540.21,1540.21,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Humana MGG,Humana MGG,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Optum VA,Optum VA,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,UHC,UHC,1540.21,,,,,,,per diem,1540.21,1540.21,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,UHC MGG,UHC MGG,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,VA,VA,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Wellcare MGG,Wellcare MGG,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Bright Health - commercial,Bright Health - commercial,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1540.21,1540.21,Bright Health MGG,Bright Health MGG,1540.21,,,,,,,case rate,1540.21,1540.21,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Aetna,Aetna,1093,,,,,,,per diem,1093,1093,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Aetna MGG,Aetna MGG,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,BCBS,BCBS,1093,,,,,,,per diem,1093,1093,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,BCBS MGG,BCBS MGG,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Cigna,Cigna,1093,,,,,,,per diem,1093,1093,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Cigna MGG,Cigna MGG,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Humana,Humana,1093,,,,,,,per diem,1093,1093,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Humana MGG,Humana MGG,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Optum VA,Optum VA,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,UHC,UHC,1093,,,,,,,per diem,1093,1093,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,UHC MGG,UHC MGG,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,VA,VA,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Wellcare MGG,Wellcare MGG,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Bright Health - commercial,Bright Health - commercial,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1093,1093,Bright Health MGG,Bright Health MGG,1093,,,,,,,case rate,1093,1093,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Aetna,Aetna,1244.5,,,,,,,per diem,1244.5,1244.5,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Aetna MGG,Aetna MGG,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,BCBS,BCBS,1244.5,,,,,,,per diem,1244.5,1244.5,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,BCBS MGG,BCBS MGG,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Cigna,Cigna,1244.5,,,,,,,per diem,1244.5,1244.5,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Cigna MGG,Cigna MGG,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Humana,Humana,1244.5,,,,,,,per diem,1244.5,1244.5,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Humana MGG,Humana MGG,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Optum VA,Optum VA,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,UHC,UHC,1244.5,,,,,,,per diem,1244.5,1244.5,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,UHC MGG,UHC MGG,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,VA,VA,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Wellcare MGG,Wellcare MGG,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Bright Health - commercial,Bright Health - commercial,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1244.5,1244.5,Bright Health MGG,Bright Health MGG,1244.5,,,,,,,case rate,1244.5,1244.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Aetna,Aetna,679.5,,,,,,,per diem,679.5,679.5,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Aetna MGG,Aetna MGG,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,BCBS,BCBS,679.5,,,,,,,per diem,679.5,679.5,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,BCBS MGG,BCBS MGG,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Cigna,Cigna,679.5,,,,,,,per diem,679.5,679.5,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Cigna MGG,Cigna MGG,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Humana,Humana,679.5,,,,,,,per diem,679.5,679.5,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Humana MGG,Humana MGG,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Optum VA,Optum VA,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,UHC,UHC,679.5,,,,,,,per diem,679.5,679.5,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,UHC MGG,UHC MGG,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,VA,VA,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Wellcare MGG,Wellcare MGG,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Bright Health - commercial,Bright Health - commercial,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,679.5,679.5,Bright Health MGG,Bright Health MGG,679.5,,,,,,,case rate,679.5,679.5,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Aetna,Aetna,697,,,,,,,per diem,697,697,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Aetna MGG,Aetna MGG,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,BCBS,BCBS,697,,,,,,,per diem,697,697,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,BCBS MGG,BCBS MGG,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Cigna,Cigna,697,,,,,,,per diem,697,697,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Cigna MGG,Cigna MGG,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Humana,Humana,697,,,,,,,per diem,697,697,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Humana MGG,Humana MGG,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Optum VA,Optum VA,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,UHC,UHC,697,,,,,,,per diem,697,697,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,UHC MGG,UHC MGG,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,VA,VA,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Wellcare MGG,Wellcare MGG,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Bright Health - commercial,Bright Health - commercial,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,697,697,Bright Health MGG,Bright Health MGG,697,,,,,,,case rate,697,697,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Aetna,Aetna,409.55,,,,,,,per diem,409.55,409.55,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Aetna MGG,Aetna MGG,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,BCBS,BCBS,409.55,,,,,,,per diem,409.55,409.55,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,BCBS MGG,BCBS MGG,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Cigna,Cigna,409.55,,,,,,,per diem,409.55,409.55,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Cigna MGG,Cigna MGG,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Humana,Humana,409.55,,,,,,,per diem,409.55,409.55,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Humana MGG,Humana MGG,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Optum VA,Optum VA,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,UHC,UHC,409.55,,,,,,,per diem,409.55,409.55,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,UHC MGG,UHC MGG,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,VA,VA,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Wellcare MGG,Wellcare MGG,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Bright Health - commercial,Bright Health - commercial,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,409.55,409.55,Bright Health MGG,Bright Health MGG,409.55,,,,,,,case rate,409.55,409.55,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Aetna,Aetna,472.59,,,,,,,per diem,472.59,472.59,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Aetna MGG,Aetna MGG,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,BCBS,BCBS,472.59,,,,,,,per diem,472.59,472.59,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,BCBS MGG,BCBS MGG,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Cigna,Cigna,472.59,,,,,,,per diem,472.59,472.59,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Cigna MGG,Cigna MGG,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Humana,Humana,472.59,,,,,,,per diem,472.59,472.59,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Humana MGG,Humana MGG,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Optum VA,Optum VA,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,UHC,UHC,472.59,,,,,,,per diem,472.59,472.59,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,UHC MGG,UHC MGG,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,VA,VA,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Wellcare MGG,Wellcare MGG,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Bright Health - commercial,Bright Health - commercial,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,472.59,472.59,Bright Health MGG,Bright Health MGG,472.59,,,,,,,case rate,472.59,472.59,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Aetna,Aetna,855.9,,,,,,,per diem,855.9,855.9,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Aetna MGG,Aetna MGG,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,BCBS,BCBS,855.9,,,,,,,per diem,855.9,855.9,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,BCBS MGG,BCBS MGG,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Cigna,Cigna,855.9,,,,,,,per diem,855.9,855.9,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Cigna MGG,Cigna MGG,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Humana,Humana,855.9,,,,,,,per diem,855.9,855.9,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Humana MGG,Humana MGG,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Optum VA,Optum VA,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,UHC,UHC,855.9,,,,,,,per diem,855.9,855.9,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,UHC MGG,UHC MGG,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,VA,VA,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Wellcare MGG,Wellcare MGG,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Bright Health - commercial,Bright Health - commercial,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,855.9,855.9,Bright Health MGG,Bright Health MGG,855.9,,,,,,,case rate,855.9,855.9,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Aetna,Aetna,695,,,,,,,per diem,695,695,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Aetna MGG,Aetna MGG,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,BCBS,BCBS,695,,,,,,,per diem,695,695,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,BCBS MGG,BCBS MGG,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Cigna,Cigna,695,,,,,,,per diem,695,695,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Cigna MGG,Cigna MGG,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Humana,Humana,695,,,,,,,per diem,695,695,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Humana MGG,Humana MGG,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Optum VA,Optum VA,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,UHC,UHC,695,,,,,,,per diem,695,695,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,UHC MGG,UHC MGG,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,VA,VA,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Wellcare MGG,Wellcare MGG,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Bright Health - commercial,Bright Health - commercial,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,695,695,Bright Health MGG,Bright Health MGG,695,,,,,,,case rate,695,695,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Aetna,Aetna,693,,,,,,,per diem,693,693,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Aetna MGG,Aetna MGG,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,BCBS,BCBS,693,,,,,,,per diem,693,693,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,BCBS MGG,BCBS MGG,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Cigna,Cigna,693,,,,,,,per diem,693,693,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Cigna MGG,Cigna MGG,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Humana,Humana,693,,,,,,,per diem,693,693,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Humana MGG,Humana MGG,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Optum VA,Optum VA,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,UHC,UHC,693,,,,,,,per diem,693,693,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,UHC MGG,UHC MGG,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,VA,VA,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Wellcare MGG,Wellcare MGG,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Bright Health - commercial,Bright Health - commercial,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,693,693,Bright Health MGG,Bright Health MGG,693,,,,,,,case rate,693,693,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Aetna,Aetna,230.28,,,,,,,per diem,230.28,230.28,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Aetna MGG,Aetna MGG,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,BCBS,BCBS,230.28,,,,,,,per diem,230.28,230.28,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,BCBS MGG,BCBS MGG,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Cigna,Cigna,230.28,,,,,,,per diem,230.28,230.28,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Cigna MGG,Cigna MGG,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Humana,Humana,230.28,,,,,,,per diem,230.28,230.28,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Humana MGG,Humana MGG,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Optum VA,Optum VA,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,UHC,UHC,230.28,,,,,,,per diem,230.28,230.28,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,UHC MGG,UHC MGG,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,VA,VA,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Wellcare MGG,Wellcare MGG,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Bright Health - commercial,Bright Health - commercial,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,230.28,230.28,Bright Health MGG,Bright Health MGG,230.28,,,,,,,case rate,230.28,230.28,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Aetna,Aetna,109.02,,,,,,,per diem,109.02,109.02,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Aetna MGG,Aetna MGG,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,BCBS,BCBS,109.02,,,,,,,per diem,109.02,109.02,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,BCBS MGG,BCBS MGG,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Cigna,Cigna,109.02,,,,,,,per diem,109.02,109.02,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Cigna MGG,Cigna MGG,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Humana,Humana,109.02,,,,,,,per diem,109.02,109.02,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Humana MGG,Humana MGG,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Optum VA,Optum VA,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,UHC,UHC,109.02,,,,,,,per diem,109.02,109.02,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,UHC MGG,UHC MGG,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,VA,VA,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Wellcare MGG,Wellcare MGG,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Bright Health - commercial,Bright Health - commercial,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,109.02,109.02,Bright Health MGG,Bright Health MGG,109.02,,,,,,,case rate,109.02,109.02,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Aetna,Aetna,499.62,,,,,,,per diem,499.62,499.62,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Aetna MGG,Aetna MGG,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,BCBS,BCBS,499.62,,,,,,,per diem,499.62,499.62,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,BCBS MGG,BCBS MGG,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Cigna,Cigna,499.62,,,,,,,per diem,499.62,499.62,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Cigna MGG,Cigna MGG,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Humana,Humana,499.62,,,,,,,per diem,499.62,499.62,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Humana MGG,Humana MGG,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Optum VA,Optum VA,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,UHC,UHC,499.62,,,,,,,per diem,499.62,499.62,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,UHC MGG,UHC MGG,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,VA,VA,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Wellcare MGG,Wellcare MGG,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Bright Health - commercial,Bright Health - commercial,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,499.62,499.62,Bright Health MGG,Bright Health MGG,499.62,,,,,,,case rate,499.62,499.62,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Aetna,Aetna,1690.31,,,,,,,per diem,1690.31,1690.31,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Aetna MGG,Aetna MGG,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,BCBS,BCBS,1690.31,,,,,,,per diem,1690.31,1690.31,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,BCBS MGG,BCBS MGG,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Cigna,Cigna,1690.31,,,,,,,per diem,1690.31,1690.31,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Cigna MGG,Cigna MGG,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Humana,Humana,1690.31,,,,,,,per diem,1690.31,1690.31,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Humana MGG,Humana MGG,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Optum VA,Optum VA,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,UHC,UHC,1690.31,,,,,,,per diem,1690.31,1690.31,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,UHC MGG,UHC MGG,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,VA,VA,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Wellcare MGG,Wellcare MGG,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Bright Health - commercial,Bright Health - commercial,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,75989,CPT,,,,Inpatient,,,1690.31,1690.31,Bright Health MGG,Bright Health MGG,1690.31,,,,,,,case rate,1690.31,1690.31,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Aetna,Aetna,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Aetna MGG,Aetna MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,BCBS,BCBS,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,BCBS MGG,BCBS MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Cigna,Cigna,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Cigna MGG,Cigna MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Humana,Humana,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Humana MGG,Humana MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Optum VA,Optum VA,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,UHC,UHC,719.1,,,,,,,per diem,719.1,719.1,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,UHC MGG,UHC MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,VA,VA,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Wellcare MGG,Wellcare MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Bright Health - commercial,Bright Health - commercial,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,76098,CPT,,,,Inpatient,,,719.1,719.1,Bright Health MGG,Bright Health MGG,719.1,,,,,,,case rate,719.1,719.1,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Aetna,Aetna,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Aetna MGG,Aetna MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,BCBS,BCBS,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,BCBS MGG,BCBS MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Cigna,Cigna,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Cigna MGG,Cigna MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Humana,Humana,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Humana MGG,Humana MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Optum VA,Optum VA,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,UHC,UHC,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,UHC MGG,UHC MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,VA,VA,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Wellcare MGG,Wellcare MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Bright Health - commercial,Bright Health - commercial,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,76641,CPT,,,LT,Inpatient,,,408,408,Bright Health MGG,Bright Health MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Aetna,Aetna,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Aetna MGG,Aetna MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,BCBS,BCBS,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,BCBS MGG,BCBS MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Cigna,Cigna,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Cigna MGG,Cigna MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Humana,Humana,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Humana MGG,Humana MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Optum VA,Optum VA,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,UHC,UHC,408,,,,,,,per diem,408,408,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,UHC MGG,UHC MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,VA,VA,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Wellcare MGG,Wellcare MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Bright Health - commercial,Bright Health - commercial,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,76641,CPT,,,RT,Inpatient,,,408,408,Bright Health MGG,Bright Health MGG,408,,,,,,,case rate,408,408,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Aetna,Aetna,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Aetna MGG,Aetna MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,BCBS,BCBS,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,BCBS MGG,BCBS MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Cigna,Cigna,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Cigna MGG,Cigna MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Humana,Humana,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Humana MGG,Humana MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Optum VA,Optum VA,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,UHC,UHC,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,UHC MGG,UHC MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,VA,VA,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Wellcare MGG,Wellcare MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Bright Health - commercial,Bright Health - commercial,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,76642,CPT,,,LT,Inpatient,,,334.56,334.56,Bright Health MGG,Bright Health MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Aetna,Aetna,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Aetna MGG,Aetna MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,BCBS,BCBS,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,BCBS MGG,BCBS MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Cigna,Cigna,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Cigna MGG,Cigna MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Humana,Humana,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Humana MGG,Humana MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Optum VA,Optum VA,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,UHC,UHC,334.56,,,,,,,per diem,334.56,334.56,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,UHC MGG,UHC MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,VA,VA,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Wellcare MGG,Wellcare MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Bright Health - commercial,Bright Health - commercial,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,76642,CPT,,,RT,Inpatient,,,334.56,334.56,Bright Health MGG,Bright Health MGG,334.56,,,,,,,case rate,334.56,334.56,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Aetna,Aetna,1539.18,,,,,,,per diem,1539.18,1539.18,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Aetna MGG,Aetna MGG,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,BCBS,BCBS,1539.18,,,,,,,per diem,1539.18,1539.18,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,BCBS MGG,BCBS MGG,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Cigna,Cigna,1539.18,,,,,,,per diem,1539.18,1539.18,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Cigna MGG,Cigna MGG,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Humana,Humana,1539.18,,,,,,,per diem,1539.18,1539.18,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Humana MGG,Humana MGG,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Optum VA,Optum VA,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,UHC,UHC,1539.18,,,,,,,per diem,1539.18,1539.18,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,UHC MGG,UHC MGG,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,VA,VA,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Wellcare MGG,Wellcare MGG,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Bright Health - commercial,Bright Health - commercial,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,76942,CPT,,,,Inpatient,,,1539.18,1539.18,Bright Health MGG,Bright Health MGG,1539.18,,,,,,,case rate,1539.18,1539.18,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Aetna,Aetna,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Aetna MGG,Aetna MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,BCBS,BCBS,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,BCBS MGG,BCBS MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Cigna,Cigna,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Cigna MGG,Cigna MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Humana,Humana,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Humana MGG,Humana MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Optum VA,Optum VA,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,UHC,UHC,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,UHC MGG,UHC MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,VA,VA,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Wellcare MGG,Wellcare MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Bright Health - commercial,Bright Health - commercial,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Bright Health MGG,Bright Health MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Aetna,Aetna,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Aetna MGG,Aetna MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,BCBS,BCBS,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,BCBS MGG,BCBS MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Cigna,Cigna,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Cigna MGG,Cigna MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Humana,Humana,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Humana MGG,Humana MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Optum VA,Optum VA,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,UHC,UHC,3319.08,,,,,,,per diem,3319.08,3319.08,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,UHC MGG,UHC MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,VA,VA,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Wellcare MGG,Wellcare MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Bright Health - commercial,Bright Health - commercial,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,76377,CPT,,,,Inpatient,,,3319.08,3319.08,Bright Health MGG,Bright Health MGG,3319.08,,,,,,,case rate,3319.08,3319.08,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna,Aetna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna MGG,Aetna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS,BCBS,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS MGG,BCBS MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna,Cigna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna MGG,Cigna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana,Humana,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana MGG,Humana MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Optum VA,Optum VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC,UHC,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC MGG,UHC MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,VA,VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Wellcare MGG,Wellcare MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health - commercial,Bright Health - commercial,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health MGG,Bright Health MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna,Aetna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna MGG,Aetna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS,BCBS,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS MGG,BCBS MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna,Cigna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna MGG,Cigna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana,Humana,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana MGG,Humana MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Optum VA,Optum VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC,UHC,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC MGG,UHC MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,VA,VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Wellcare MGG,Wellcare MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health - commercial,Bright Health - commercial,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health MGG,Bright Health MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna,Aetna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna MGG,Aetna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS,BCBS,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS MGG,BCBS MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna,Cigna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna MGG,Cigna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana,Humana,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana MGG,Humana MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Optum VA,Optum VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC,UHC,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC MGG,UHC MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,VA,VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Wellcare MGG,Wellcare MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health - commercial,Bright Health - commercial,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health MGG,Bright Health MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna,Aetna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna MGG,Aetna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS,BCBS,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS MGG,BCBS MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna,Cigna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna MGG,Cigna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana,Humana,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana MGG,Humana MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Optum VA,Optum VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC,UHC,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC MGG,UHC MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,VA,VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Wellcare MGG,Wellcare MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health - commercial,Bright Health - commercial,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health MGG,Bright Health MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna,Aetna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna MGG,Aetna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS,BCBS,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS MGG,BCBS MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna,Cigna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna MGG,Cigna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana,Humana,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana MGG,Humana MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Optum VA,Optum VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC,UHC,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC MGG,UHC MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,VA,VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Wellcare MGG,Wellcare MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health - commercial,Bright Health - commercial,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health MGG,Bright Health MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Aetna,Aetna,1467.78,,,,,,,per diem,1467.78,1467.78,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Aetna MGG,Aetna MGG,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,BCBS,BCBS,1467.78,,,,,,,per diem,1467.78,1467.78,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,BCBS MGG,BCBS MGG,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Cigna,Cigna,1467.78,,,,,,,per diem,1467.78,1467.78,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Cigna MGG,Cigna MGG,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Humana,Humana,1467.78,,,,,,,per diem,1467.78,1467.78,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Humana MGG,Humana MGG,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Optum VA,Optum VA,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,UHC,UHC,1467.78,,,,,,,per diem,1467.78,1467.78,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,UHC MGG,UHC MGG,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,VA,VA,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Wellcare MGG,Wellcare MGG,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Bright Health - commercial,Bright Health - commercial,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,93882,CPT,,,,Inpatient,,,1467.78,1467.78,Bright Health MGG,Bright Health MGG,1467.78,,,,,,,case rate,1467.78,1467.78,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Aetna,Aetna,589.56,,,,,,,per diem,589.56,589.56,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Aetna MGG,Aetna MGG,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,BCBS,BCBS,589.56,,,,,,,per diem,589.56,589.56,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,BCBS MGG,BCBS MGG,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Cigna,Cigna,589.56,,,,,,,per diem,589.56,589.56,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Cigna MGG,Cigna MGG,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Humana,Humana,589.56,,,,,,,per diem,589.56,589.56,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Humana MGG,Humana MGG,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Optum VA,Optum VA,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,UHC,UHC,589.56,,,,,,,per diem,589.56,589.56,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,UHC MGG,UHC MGG,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,VA,VA,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Wellcare MGG,Wellcare MGG,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Bright Health - commercial,Bright Health - commercial,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,76506,CPT,,,,Inpatient,,,589.56,589.56,Bright Health MGG,Bright Health MGG,589.56,,,,,,,case rate,589.56,589.56,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Aetna,Aetna,1032.24,,,,,,,per diem,1032.24,1032.24,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Aetna MGG,Aetna MGG,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,BCBS,BCBS,1032.24,,,,,,,per diem,1032.24,1032.24,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,BCBS MGG,BCBS MGG,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Cigna,Cigna,1032.24,,,,,,,per diem,1032.24,1032.24,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Cigna MGG,Cigna MGG,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Humana,Humana,1032.24,,,,,,,per diem,1032.24,1032.24,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Humana MGG,Humana MGG,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Optum VA,Optum VA,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,UHC,UHC,1032.24,,,,,,,per diem,1032.24,1032.24,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,UHC MGG,UHC MGG,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,VA,VA,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Wellcare MGG,Wellcare MGG,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Bright Health - commercial,Bright Health - commercial,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,1032.24,1032.24,Bright Health MGG,Bright Health MGG,1032.24,,,,,,,case rate,1032.24,1032.24,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Aetna,Aetna,1025.49,,,,,,,per diem,1025.49,1025.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Aetna MGG,Aetna MGG,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,BCBS,BCBS,1025.49,,,,,,,per diem,1025.49,1025.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,BCBS MGG,BCBS MGG,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Cigna,Cigna,1025.49,,,,,,,per diem,1025.49,1025.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Cigna MGG,Cigna MGG,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Humana,Humana,1025.49,,,,,,,per diem,1025.49,1025.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Humana MGG,Humana MGG,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Optum VA,Optum VA,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,UHC,UHC,1025.49,,,,,,,per diem,1025.49,1025.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,UHC MGG,UHC MGG,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,VA,VA,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Wellcare MGG,Wellcare MGG,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Bright Health - commercial,Bright Health - commercial,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,1025.49,1025.49,Bright Health MGG,Bright Health MGG,1025.49,,,,,,,case rate,1025.49,1025.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Aetna,Aetna,701,,,,,,,per diem,701,701,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Aetna MGG,Aetna MGG,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,BCBS,BCBS,701,,,,,,,per diem,701,701,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,BCBS MGG,BCBS MGG,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Cigna,Cigna,701,,,,,,,per diem,701,701,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Cigna MGG,Cigna MGG,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Humana,Humana,701,,,,,,,per diem,701,701,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Humana MGG,Humana MGG,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Optum VA,Optum VA,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,UHC,UHC,701,,,,,,,per diem,701,701,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,UHC MGG,UHC MGG,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,VA,VA,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Wellcare MGG,Wellcare MGG,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Bright Health - commercial,Bright Health - commercial,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,76881,CPT,,,,Inpatient,,,701,701,Bright Health MGG,Bright Health MGG,701,,,,,,,case rate,701,701,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Aetna,Aetna,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Aetna MGG,Aetna MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,BCBS,BCBS,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,BCBS MGG,BCBS MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Cigna,Cigna,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Cigna MGG,Cigna MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Humana,Humana,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Humana MGG,Humana MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Optum VA,Optum VA,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,UHC,UHC,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,UHC MGG,UHC MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,VA,VA,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Wellcare MGG,Wellcare MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Bright Health - commercial,Bright Health - commercial,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,320.28,320.28,Bright Health MGG,Bright Health MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Aetna,Aetna,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Aetna MGG,Aetna MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,BCBS,BCBS,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,BCBS MGG,BCBS MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Cigna,Cigna,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Cigna MGG,Cigna MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Humana,Humana,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Humana MGG,Humana MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Optum VA,Optum VA,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,UHC,UHC,320.28,,,,,,,per diem,320.28,320.28,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,UHC MGG,UHC MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,VA,VA,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Wellcare MGG,Wellcare MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Bright Health - commercial,Bright Health - commercial,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,320.28,320.28,Bright Health MGG,Bright Health MGG,320.28,,,,,,,case rate,320.28,320.28,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Aetna,Aetna,161.43,,,,,,,per diem,161.43,161.43,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Aetna MGG,Aetna MGG,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,BCBS,BCBS,161.43,,,,,,,per diem,161.43,161.43,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,BCBS MGG,BCBS MGG,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Cigna,Cigna,161.43,,,,,,,per diem,161.43,161.43,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Cigna MGG,Cigna MGG,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Humana,Humana,161.43,,,,,,,per diem,161.43,161.43,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Humana MGG,Humana MGG,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Optum VA,Optum VA,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,UHC,UHC,161.43,,,,,,,per diem,161.43,161.43,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,UHC MGG,UHC MGG,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,VA,VA,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Wellcare MGG,Wellcare MGG,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Bright Health - commercial,Bright Health - commercial,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,76882,CPT,,,,Inpatient,,,161.43,161.43,Bright Health MGG,Bright Health MGG,161.43,,,,,,,case rate,161.43,161.43,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Aetna,Aetna,2283.78,,,,,,,per diem,2283.78,2283.78,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Aetna MGG,Aetna MGG,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,BCBS,BCBS,2283.78,,,,,,,per diem,2283.78,2283.78,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,BCBS MGG,BCBS MGG,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Cigna,Cigna,2283.78,,,,,,,per diem,2283.78,2283.78,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Cigna MGG,Cigna MGG,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Humana,Humana,2283.78,,,,,,,per diem,2283.78,2283.78,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Humana MGG,Humana MGG,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Optum VA,Optum VA,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,UHC,UHC,2283.78,,,,,,,per diem,2283.78,2283.78,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,UHC MGG,UHC MGG,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,VA,VA,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Wellcare MGG,Wellcare MGG,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Bright Health - commercial,Bright Health - commercial,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,76818,CPT,,,,Inpatient,,,2283.78,2283.78,Bright Health MGG,Bright Health MGG,2283.78,,,,,,,case rate,2283.78,2283.78,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Aetna,Aetna,3011.04,,,,,,,per diem,3011.04,3011.04,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Aetna MGG,Aetna MGG,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,BCBS,BCBS,3011.04,,,,,,,per diem,3011.04,3011.04,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,BCBS MGG,BCBS MGG,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Cigna,Cigna,3011.04,,,,,,,per diem,3011.04,3011.04,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Cigna MGG,Cigna MGG,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Humana,Humana,3011.04,,,,,,,per diem,3011.04,3011.04,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Humana MGG,Humana MGG,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Optum VA,Optum VA,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,UHC,UHC,3011.04,,,,,,,per diem,3011.04,3011.04,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,UHC MGG,UHC MGG,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,VA,VA,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Wellcare MGG,Wellcare MGG,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Bright Health - commercial,Bright Health - commercial,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,76825,CPT,,,,Inpatient,,,3011.04,3011.04,Bright Health MGG,Bright Health MGG,3011.04,,,,,,,case rate,3011.04,3011.04,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Aetna,Aetna,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Aetna MGG,Aetna MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,BCBS,BCBS,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,BCBS MGG,BCBS MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Cigna,Cigna,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Cigna MGG,Cigna MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Humana,Humana,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Humana MGG,Humana MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Optum VA,Optum VA,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,UHC,UHC,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,UHC MGG,UHC MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,VA,VA,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Wellcare MGG,Wellcare MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Bright Health - commercial,Bright Health - commercial,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,76821,CPT,,,,Inpatient,,,574.26,574.26,Bright Health MGG,Bright Health MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Aetna,Aetna,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Aetna MGG,Aetna MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,BCBS,BCBS,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,BCBS MGG,BCBS MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Cigna,Cigna,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Cigna MGG,Cigna MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Humana,Humana,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Humana MGG,Humana MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Optum VA,Optum VA,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,UHC,UHC,574.26,,,,,,,per diem,574.26,574.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,UHC MGG,UHC MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,VA,VA,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Wellcare MGG,Wellcare MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Bright Health - commercial,Bright Health - commercial,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,76820,CPT,,,,Inpatient,,,574.26,574.26,Bright Health MGG,Bright Health MGG,574.26,,,,,,,case rate,574.26,574.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Aetna,Aetna,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Aetna MGG,Aetna MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,BCBS,BCBS,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,BCBS MGG,BCBS MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Cigna,Cigna,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Cigna MGG,Cigna MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Humana,Humana,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Humana MGG,Humana MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Optum VA,Optum VA,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,UHC,UHC,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,UHC MGG,UHC MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,VA,VA,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Wellcare MGG,Wellcare MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Bright Health - commercial,Bright Health - commercial,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,76828,CPT,,,,Inpatient,,,333.54,333.54,Bright Health MGG,Bright Health MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Aetna,Aetna,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Aetna MGG,Aetna MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,BCBS,BCBS,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,BCBS MGG,BCBS MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Cigna,Cigna,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Cigna MGG,Cigna MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Humana,Humana,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Humana MGG,Humana MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Optum VA,Optum VA,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,UHC,UHC,333.54,,,,,,,per diem,333.54,333.54,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,UHC MGG,UHC MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,VA,VA,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Wellcare MGG,Wellcare MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Bright Health - commercial,Bright Health - commercial,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,333.54,333.54,Bright Health MGG,Bright Health MGG,333.54,,,,,,,case rate,333.54,333.54,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Aetna,Aetna,2155.26,,,,,,,per diem,2155.26,2155.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Aetna MGG,Aetna MGG,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,BCBS,BCBS,2155.26,,,,,,,per diem,2155.26,2155.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,BCBS MGG,BCBS MGG,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Cigna,Cigna,2155.26,,,,,,,per diem,2155.26,2155.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Cigna MGG,Cigna MGG,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Humana,Humana,2155.26,,,,,,,per diem,2155.26,2155.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Humana MGG,Humana MGG,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Optum VA,Optum VA,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,UHC,UHC,2155.26,,,,,,,per diem,2155.26,2155.26,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,UHC MGG,UHC MGG,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,VA,VA,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Wellcare MGG,Wellcare MGG,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Bright Health - commercial,Bright Health - commercial,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,76826,CPT,,,,Inpatient,,,2155.26,2155.26,Bright Health MGG,Bright Health MGG,2155.26,,,,,,,case rate,2155.26,2155.26,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Aetna,Aetna,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Aetna MGG,Aetna MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,BCBS,BCBS,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,BCBS MGG,BCBS MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Cigna,Cigna,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Cigna MGG,Cigna MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Humana,Humana,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Humana MGG,Humana MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Optum VA,Optum VA,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,UHC,UHC,860.88,,,,,,,per diem,860.88,860.88,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,UHC MGG,UHC MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,VA,VA,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Wellcare MGG,Wellcare MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Bright Health - commercial,Bright Health - commercial,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,76948,CPT,,,,Inpatient,,,860.88,860.88,Bright Health MGG,Bright Health MGG,860.88,,,,,,,case rate,860.88,860.88,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Aetna,Aetna,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Aetna MGG,Aetna MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,BCBS,BCBS,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,BCBS MGG,BCBS MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Cigna,Cigna,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Cigna MGG,Cigna MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Humana,Humana,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Humana MGG,Humana MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Optum VA,Optum VA,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,UHC,UHC,820.08,,,,,,,per diem,820.08,820.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,UHC MGG,UHC MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,VA,VA,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Wellcare MGG,Wellcare MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Bright Health - commercial,Bright Health - commercial,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,76965,CPT,,,,Inpatient,,,820.08,820.08,Bright Health MGG,Bright Health MGG,820.08,,,,,,,case rate,820.08,820.08,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Aetna,Aetna,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Aetna MGG,Aetna MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,BCBS,BCBS,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,BCBS MGG,BCBS MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Cigna,Cigna,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Cigna MGG,Cigna MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Humana,Humana,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Humana MGG,Humana MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Optum VA,Optum VA,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,UHC,UHC,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,UHC MGG,UHC MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,VA,VA,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Wellcare MGG,Wellcare MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Bright Health - commercial,Bright Health - commercial,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Bright Health MGG,Bright Health MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Aetna,Aetna,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Aetna MGG,Aetna MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,BCBS,BCBS,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,BCBS MGG,BCBS MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Cigna,Cigna,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Cigna MGG,Cigna MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Humana,Humana,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Humana MGG,Humana MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Optum VA,Optum VA,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,UHC,UHC,966.96,,,,,,,per diem,966.96,966.96,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,UHC MGG,UHC MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,VA,VA,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Wellcare MGG,Wellcare MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Bright Health - commercial,Bright Health - commercial,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,76998,CPT,,,,Inpatient,,,966.96,966.96,Bright Health MGG,Bright Health MGG,966.96,,,,,,,case rate,966.96,966.96,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Aetna,Aetna,1122,,,,,,,per diem,1122,1122,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Aetna MGG,Aetna MGG,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,BCBS,BCBS,1122,,,,,,,per diem,1122,1122,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,BCBS MGG,BCBS MGG,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Cigna,Cigna,1122,,,,,,,per diem,1122,1122,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Cigna MGG,Cigna MGG,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Humana,Humana,1122,,,,,,,per diem,1122,1122,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Humana MGG,Humana MGG,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Optum VA,Optum VA,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,UHC,UHC,1122,,,,,,,per diem,1122,1122,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,UHC MGG,UHC MGG,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,VA,VA,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Wellcare MGG,Wellcare MGG,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Bright Health - commercial,Bright Health - commercial,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,76946,CPT,,,,Inpatient,,,1122,1122,Bright Health MGG,Bright Health MGG,1122,,,,,,,case rate,1122,1122,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Aetna,Aetna,845.58,,,,,,,per diem,845.58,845.58,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Aetna MGG,Aetna MGG,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,BCBS,BCBS,845.58,,,,,,,per diem,845.58,845.58,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,BCBS MGG,BCBS MGG,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Cigna,Cigna,845.58,,,,,,,per diem,845.58,845.58,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Cigna MGG,Cigna MGG,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Humana,Humana,845.58,,,,,,,per diem,845.58,845.58,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Humana MGG,Humana MGG,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Optum VA,Optum VA,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,UHC,UHC,845.58,,,,,,,per diem,845.58,845.58,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,UHC MGG,UHC MGG,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,VA,VA,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Wellcare MGG,Wellcare MGG,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Bright Health - commercial,Bright Health - commercial,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,76936,CPT,,,,Inpatient,,,845.58,845.58,Bright Health MGG,Bright Health MGG,845.58,,,,,,,case rate,845.58,845.58,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Aetna,Aetna,353.94,,,,,,,per diem,353.94,353.94,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Aetna MGG,Aetna MGG,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,BCBS,BCBS,353.94,,,,,,,per diem,353.94,353.94,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,BCBS MGG,BCBS MGG,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Cigna,Cigna,353.94,,,,,,,per diem,353.94,353.94,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Cigna MGG,Cigna MGG,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Humana,Humana,353.94,,,,,,,per diem,353.94,353.94,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Humana MGG,Humana MGG,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Optum VA,Optum VA,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,UHC,UHC,353.94,,,,,,,per diem,353.94,353.94,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,UHC MGG,UHC MGG,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,VA,VA,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Wellcare MGG,Wellcare MGG,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Bright Health - commercial,Bright Health - commercial,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,76940,CPT,,,,Inpatient,,,353.94,353.94,Bright Health MGG,Bright Health MGG,353.94,,,,,,,case rate,353.94,353.94,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Aetna,Aetna,383.52,,,,,,,per diem,383.52,383.52,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Aetna MGG,Aetna MGG,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,BCBS,BCBS,383.52,,,,,,,per diem,383.52,383.52,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,BCBS MGG,BCBS MGG,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Cigna,Cigna,383.52,,,,,,,per diem,383.52,383.52,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Cigna MGG,Cigna MGG,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Humana,Humana,383.52,,,,,,,per diem,383.52,383.52,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Humana MGG,Humana MGG,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Optum VA,Optum VA,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,UHC,UHC,383.52,,,,,,,per diem,383.52,383.52,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,UHC MGG,UHC MGG,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,VA,VA,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Wellcare MGG,Wellcare MGG,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Bright Health - commercial,Bright Health - commercial,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,76885,CPT,,,,Inpatient,,,383.52,383.52,Bright Health MGG,Bright Health MGG,383.52,,,,,,,case rate,383.52,383.52,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Aetna,Aetna,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Aetna MGG,Aetna MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,BCBS,BCBS,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,BCBS MGG,BCBS MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Cigna,Cigna,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Cigna MGG,Cigna MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Humana,Humana,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Humana MGG,Humana MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Optum VA,Optum VA,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,UHC,UHC,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,UHC MGG,UHC MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,VA,VA,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Wellcare MGG,Wellcare MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Bright Health - commercial,Bright Health - commercial,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,76886,CPT,,,,Inpatient,,,276.42,276.42,Bright Health MGG,Bright Health MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Aetna,Aetna,776.22,,,,,,,per diem,776.22,776.22,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Aetna MGG,Aetna MGG,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,BCBS,BCBS,776.22,,,,,,,per diem,776.22,776.22,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,BCBS MGG,BCBS MGG,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Cigna,Cigna,776.22,,,,,,,per diem,776.22,776.22,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Cigna MGG,Cigna MGG,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Humana,Humana,776.22,,,,,,,per diem,776.22,776.22,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Humana MGG,Humana MGG,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Optum VA,Optum VA,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,UHC,UHC,776.22,,,,,,,per diem,776.22,776.22,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,UHC MGG,UHC MGG,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,VA,VA,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Wellcare MGG,Wellcare MGG,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Bright Health - commercial,Bright Health - commercial,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,76776,CPT,,,,Inpatient,,,776.22,776.22,Bright Health MGG,Bright Health MGG,776.22,,,,,,,case rate,776.22,776.22,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Aetna,Aetna,558.96,,,,,,,per diem,558.96,558.96,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Aetna MGG,Aetna MGG,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,BCBS,BCBS,558.96,,,,,,,per diem,558.96,558.96,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,BCBS MGG,BCBS MGG,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Cigna,Cigna,558.96,,,,,,,per diem,558.96,558.96,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Cigna MGG,Cigna MGG,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Humana,Humana,558.96,,,,,,,per diem,558.96,558.96,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Humana MGG,Humana MGG,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Optum VA,Optum VA,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,UHC,UHC,558.96,,,,,,,per diem,558.96,558.96,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,UHC MGG,UHC MGG,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,VA,VA,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Wellcare MGG,Wellcare MGG,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Bright Health - commercial,Bright Health - commercial,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,76510,CPT,,,,Inpatient,,,558.96,558.96,Bright Health MGG,Bright Health MGG,558.96,,,,,,,case rate,558.96,558.96,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Aetna,Aetna,1377,,,,,,,per diem,1377,1377,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Aetna MGG,Aetna MGG,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,BCBS,BCBS,1377,,,,,,,per diem,1377,1377,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,BCBS MGG,BCBS MGG,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Cigna,Cigna,1377,,,,,,,per diem,1377,1377,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Cigna MGG,Cigna MGG,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Humana,Humana,1377,,,,,,,per diem,1377,1377,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Humana MGG,Humana MGG,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Optum VA,Optum VA,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,UHC,UHC,1377,,,,,,,per diem,1377,1377,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,UHC MGG,UHC MGG,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,VA,VA,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Wellcare MGG,Wellcare MGG,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Bright Health - commercial,Bright Health - commercial,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,76816,CPT,,,,Inpatient,,,1377,1377,Bright Health MGG,Bright Health MGG,1377,,,,,,,case rate,1377,1377,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Aetna,Aetna,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Aetna MGG,Aetna MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,BCBS,BCBS,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,BCBS MGG,BCBS MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Cigna,Cigna,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Cigna MGG,Cigna MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Humana,Humana,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Humana MGG,Humana MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Optum VA,Optum VA,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,UHC,UHC,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,UHC MGG,UHC MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,VA,VA,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Wellcare MGG,Wellcare MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Bright Health - commercial,Bright Health - commercial,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,76814,CPT,,,,Inpatient,,,340.68,340.68,Bright Health MGG,Bright Health MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Aetna,Aetna,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Aetna MGG,Aetna MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,BCBS,BCBS,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,BCBS MGG,BCBS MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Cigna,Cigna,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Cigna MGG,Cigna MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Humana,Humana,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Humana MGG,Humana MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Optum VA,Optum VA,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,UHC,UHC,340.68,,,,,,,per diem,340.68,340.68,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,UHC MGG,UHC MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,VA,VA,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Wellcare MGG,Wellcare MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Bright Health - commercial,Bright Health - commercial,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,76813,CPT,,,,Inpatient,,,340.68,340.68,Bright Health MGG,Bright Health MGG,340.68,,,,,,,case rate,340.68,340.68,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Aetna,Aetna,531.42,,,,,,,per diem,531.42,531.42,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Aetna MGG,Aetna MGG,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,BCBS,BCBS,531.42,,,,,,,per diem,531.42,531.42,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,BCBS MGG,BCBS MGG,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Cigna,Cigna,531.42,,,,,,,per diem,531.42,531.42,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Cigna MGG,Cigna MGG,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Humana,Humana,531.42,,,,,,,per diem,531.42,531.42,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Humana MGG,Humana MGG,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Optum VA,Optum VA,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,UHC,UHC,531.42,,,,,,,per diem,531.42,531.42,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,UHC MGG,UHC MGG,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,VA,VA,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Wellcare MGG,Wellcare MGG,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Bright Health - commercial,Bright Health - commercial,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,76812,CPT,,,,Inpatient,,,531.42,531.42,Bright Health MGG,Bright Health MGG,531.42,,,,,,,case rate,531.42,531.42,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Aetna,Aetna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Aetna MGG,Aetna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,BCBS,BCBS,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,BCBS MGG,BCBS MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Cigna,Cigna,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Cigna MGG,Cigna MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Humana,Humana,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Humana MGG,Humana MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Optum VA,Optum VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,UHC,UHC,470.22,,,,,,,per diem,470.22,470.22,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,UHC MGG,UHC MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,VA,VA,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Wellcare MGG,Wellcare MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Bright Health - commercial,Bright Health - commercial,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,76811,CPT,,,,Inpatient,,,470.22,470.22,Bright Health MGG,Bright Health MGG,470.22,,,,,,,case rate,470.22,470.22,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Aetna,Aetna,264.18,,,,,,,per diem,264.18,264.18,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Aetna MGG,Aetna MGG,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,BCBS,BCBS,264.18,,,,,,,per diem,264.18,264.18,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,BCBS MGG,BCBS MGG,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Cigna,Cigna,264.18,,,,,,,per diem,264.18,264.18,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Cigna MGG,Cigna MGG,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Humana,Humana,264.18,,,,,,,per diem,264.18,264.18,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Humana MGG,Humana MGG,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Optum VA,Optum VA,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,UHC,UHC,264.18,,,,,,,per diem,264.18,264.18,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,UHC MGG,UHC MGG,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,VA,VA,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Wellcare MGG,Wellcare MGG,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Bright Health - commercial,Bright Health - commercial,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,76831,CPT,,,,Inpatient,,,264.18,264.18,Bright Health MGG,Bright Health MGG,264.18,,,,,,,case rate,264.18,264.18,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Aetna,Aetna,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Aetna MGG,Aetna MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,BCBS,BCBS,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,BCBS MGG,BCBS MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Cigna,Cigna,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Cigna MGG,Cigna MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Humana,Humana,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Humana MGG,Humana MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Optum VA,Optum VA,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,UHC,UHC,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,UHC MGG,UHC MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,VA,VA,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Wellcare MGG,Wellcare MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Bright Health - commercial,Bright Health - commercial,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Bright Health MGG,Bright Health MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Aetna,Aetna,1222.98,,,,,,,per diem,1222.98,1222.98,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Aetna MGG,Aetna MGG,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,BCBS,BCBS,1222.98,,,,,,,per diem,1222.98,1222.98,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,BCBS MGG,BCBS MGG,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Cigna,Cigna,1222.98,,,,,,,per diem,1222.98,1222.98,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Cigna MGG,Cigna MGG,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Humana,Humana,1222.98,,,,,,,per diem,1222.98,1222.98,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Humana MGG,Humana MGG,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Optum VA,Optum VA,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,UHC,UHC,1222.98,,,,,,,per diem,1222.98,1222.98,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,UHC MGG,UHC MGG,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,VA,VA,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Wellcare MGG,Wellcare MGG,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Bright Health - commercial,Bright Health - commercial,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,76872,CPT,,,,Inpatient,,,1222.98,1222.98,Bright Health MGG,Bright Health MGG,1222.98,,,,,,,case rate,1222.98,1222.98,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Aetna,Aetna,919.02,,,,,,,per diem,919.02,919.02,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Aetna MGG,Aetna MGG,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,BCBS,BCBS,919.02,,,,,,,per diem,919.02,919.02,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,BCBS MGG,BCBS MGG,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Cigna,Cigna,919.02,,,,,,,per diem,919.02,919.02,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Cigna MGG,Cigna MGG,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Humana,Humana,919.02,,,,,,,per diem,919.02,919.02,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Humana MGG,Humana MGG,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Optum VA,Optum VA,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,UHC,UHC,919.02,,,,,,,per diem,919.02,919.02,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,UHC MGG,UHC MGG,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,VA,VA,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Wellcare MGG,Wellcare MGG,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Bright Health - commercial,Bright Health - commercial,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,93976,CPT,,,,Inpatient,,,919.02,919.02,Bright Health MGG,Bright Health MGG,919.02,,,,,,,case rate,919.02,919.02,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Aetna,Aetna,1408.62,,,,,,,per diem,1408.62,1408.62,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Aetna MGG,Aetna MGG,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,BCBS,BCBS,1408.62,,,,,,,per diem,1408.62,1408.62,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,BCBS MGG,BCBS MGG,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Cigna,Cigna,1408.62,,,,,,,per diem,1408.62,1408.62,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Cigna MGG,Cigna MGG,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Humana,Humana,1408.62,,,,,,,per diem,1408.62,1408.62,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Humana MGG,Humana MGG,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Optum VA,Optum VA,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,UHC,UHC,1408.62,,,,,,,per diem,1408.62,1408.62,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,UHC MGG,UHC MGG,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,VA,VA,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Wellcare MGG,Wellcare MGG,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Bright Health - commercial,Bright Health - commercial,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,93926,CPT,,,,Inpatient,,,1408.62,1408.62,Bright Health MGG,Bright Health MGG,1408.62,,,,,,,case rate,1408.62,1408.62,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Aetna,Aetna,1427.87,,,,,,,per diem,1427.87,1427.87,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Aetna MGG,Aetna MGG,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,BCBS,BCBS,1427.87,,,,,,,per diem,1427.87,1427.87,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,BCBS MGG,BCBS MGG,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Cigna,Cigna,1427.87,,,,,,,per diem,1427.87,1427.87,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Cigna MGG,Cigna MGG,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Humana,Humana,1427.87,,,,,,,per diem,1427.87,1427.87,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Humana MGG,Humana MGG,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Optum VA,Optum VA,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,UHC,UHC,1427.87,,,,,,,per diem,1427.87,1427.87,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,UHC MGG,UHC MGG,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,VA,VA,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Wellcare MGG,Wellcare MGG,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Bright Health - commercial,Bright Health - commercial,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,93931,CPT,,,,Inpatient,,,1427.87,1427.87,Bright Health MGG,Bright Health MGG,1427.87,,,,,,,case rate,1427.87,1427.87,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Aetna,Aetna,1103.64,,,,,,,per diem,1103.64,1103.64,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Aetna MGG,Aetna MGG,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,BCBS,BCBS,1103.64,,,,,,,per diem,1103.64,1103.64,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,BCBS MGG,BCBS MGG,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Cigna,Cigna,1103.64,,,,,,,per diem,1103.64,1103.64,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Cigna MGG,Cigna MGG,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Humana,Humana,1103.64,,,,,,,per diem,1103.64,1103.64,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Humana MGG,Humana MGG,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Optum VA,Optum VA,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,UHC,UHC,1103.64,,,,,,,per diem,1103.64,1103.64,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,UHC MGG,UHC MGG,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,VA,VA,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Wellcare MGG,Wellcare MGG,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Bright Health - commercial,Bright Health - commercial,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,93980,CPT,,,,Inpatient,,,1103.64,1103.64,Bright Health MGG,Bright Health MGG,1103.64,,,,,,,case rate,1103.64,1103.64,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Aetna,Aetna,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Aetna MGG,Aetna MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,BCBS,BCBS,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,BCBS MGG,BCBS MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Cigna,Cigna,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Cigna MGG,Cigna MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Humana,Humana,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Humana MGG,Humana MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Optum VA,Optum VA,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,UHC,UHC,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,UHC MGG,UHC MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,VA,VA,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Wellcare MGG,Wellcare MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Bright Health - commercial,Bright Health - commercial,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,1173.56,1173.56,Bright Health MGG,Bright Health MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Aetna,Aetna,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Aetna MGG,Aetna MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,BCBS,BCBS,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,BCBS MGG,BCBS MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Cigna,Cigna,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Cigna MGG,Cigna MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Humana,Humana,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Humana MGG,Humana MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Optum VA,Optum VA,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,UHC,UHC,1173.56,,,,,,,per diem,1173.56,1173.56,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,UHC MGG,UHC MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,VA,VA,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Wellcare MGG,Wellcare MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Bright Health - commercial,Bright Health - commercial,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,1173.56,1173.56,Bright Health MGG,Bright Health MGG,1173.56,,,,,,,case rate,1173.56,1173.56,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Aetna,Aetna,721.14,,,,,,,per diem,721.14,721.14,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Aetna MGG,Aetna MGG,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,BCBS,BCBS,721.14,,,,,,,per diem,721.14,721.14,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,BCBS MGG,BCBS MGG,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Cigna,Cigna,721.14,,,,,,,per diem,721.14,721.14,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Cigna MGG,Cigna MGG,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Humana,Humana,721.14,,,,,,,per diem,721.14,721.14,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Humana MGG,Humana MGG,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Optum VA,Optum VA,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,UHC,UHC,721.14,,,,,,,per diem,721.14,721.14,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,UHC MGG,UHC MGG,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,VA,VA,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Wellcare MGG,Wellcare MGG,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Bright Health - commercial,Bright Health - commercial,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,49423,CPT,,,,Inpatient,,,721.14,721.14,Bright Health MGG,Bright Health MGG,721.14,,,,,,,case rate,721.14,721.14,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,20610,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Aetna,Aetna,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Aetna MGG,Aetna MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,BCBS,BCBS,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,BCBS MGG,BCBS MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Cigna,Cigna,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Cigna MGG,Cigna MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Humana,Humana,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Humana MGG,Humana MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Optum VA,Optum VA,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,UHC,UHC,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,UHC MGG,UHC MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,VA,VA,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Wellcare MGG,Wellcare MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Bright Health - commercial,Bright Health - commercial,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,10160,CPT,,,,Inpatient,,,449.82,449.82,Bright Health MGG,Bright Health MGG,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Aetna,Aetna,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Aetna MGG,Aetna MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,BCBS,BCBS,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,BCBS MGG,BCBS MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Cigna,Cigna,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Cigna MGG,Cigna MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Humana,Humana,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Humana MGG,Humana MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Optum VA,Optum VA,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,UHC,UHC,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,UHC MGG,UHC MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,VA,VA,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Wellcare MGG,Wellcare MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Bright Health - commercial,Bright Health - commercial,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Bright Health MGG,Bright Health MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Aetna,Aetna,2537.76,,,,,,,per diem,2537.76,2537.76,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Aetna MGG,Aetna MGG,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,BCBS,BCBS,2537.76,,,,,,,per diem,2537.76,2537.76,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,BCBS MGG,BCBS MGG,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Cigna,Cigna,2537.76,,,,,,,per diem,2537.76,2537.76,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Cigna MGG,Cigna MGG,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Humana,Humana,2537.76,,,,,,,per diem,2537.76,2537.76,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Humana MGG,Humana MGG,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Optum VA,Optum VA,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,UHC,UHC,2537.76,,,,,,,per diem,2537.76,2537.76,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,UHC MGG,UHC MGG,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,VA,VA,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Wellcare MGG,Wellcare MGG,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Bright Health - commercial,Bright Health - commercial,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,32405,CPT,,,,Inpatient,,,2537.76,2537.76,Bright Health MGG,Bright Health MGG,2537.76,,,,,,,case rate,2537.76,2537.76,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Aetna,Aetna,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Aetna MGG,Aetna MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,BCBS,BCBS,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,BCBS MGG,BCBS MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Cigna,Cigna,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Cigna MGG,Cigna MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Humana,Humana,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Humana MGG,Humana MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Optum VA,Optum VA,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,UHC,UHC,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,UHC MGG,UHC MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,VA,VA,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Wellcare MGG,Wellcare MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Bright Health - commercial,Bright Health - commercial,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,32400,CPT,,,,Inpatient,,,2533.68,2533.68,Bright Health MGG,Bright Health MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Aetna,Aetna,1994.1,,,,,,,per diem,1994.1,1994.1,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Aetna MGG,Aetna MGG,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,BCBS,BCBS,1994.1,,,,,,,per diem,1994.1,1994.1,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,BCBS MGG,BCBS MGG,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Cigna,Cigna,1994.1,,,,,,,per diem,1994.1,1994.1,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Cigna MGG,Cigna MGG,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Humana,Humana,1994.1,,,,,,,per diem,1994.1,1994.1,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Humana MGG,Humana MGG,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Optum VA,Optum VA,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,UHC,UHC,1994.1,,,,,,,per diem,1994.1,1994.1,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,UHC MGG,UHC MGG,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,VA,VA,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Wellcare MGG,Wellcare MGG,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Bright Health - commercial,Bright Health - commercial,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,55700,CPT,,,,Inpatient,,,1994.1,1994.1,Bright Health MGG,Bright Health MGG,1994.1,,,,,,,case rate,1994.1,1994.1,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Aetna,Aetna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Aetna MGG,Aetna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,BCBS,BCBS,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,BCBS MGG,BCBS MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Cigna,Cigna,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Cigna MGG,Cigna MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Humana,Humana,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Humana MGG,Humana MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Optum VA,Optum VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,UHC,UHC,538.56,,,,,,,per diem,538.56,538.56,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,UHC MGG,UHC MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,VA,VA,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Wellcare MGG,Wellcare MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Bright Health - commercial,Bright Health - commercial,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,11100,CPT,,,,Inpatient,,,538.56,538.56,Bright Health MGG,Bright Health MGG,538.56,,,,,,,case rate,538.56,538.56,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Aetna,Aetna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Aetna MGG,Aetna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,BCBS,BCBS,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,BCBS MGG,BCBS MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Cigna,Cigna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Cigna MGG,Cigna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Humana,Humana,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Humana MGG,Humana MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Optum VA,Optum VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,UHC,UHC,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,UHC MGG,UHC MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,VA,VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Wellcare MGG,Wellcare MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Bright Health - commercial,Bright Health - commercial,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Bright Health MGG,Bright Health MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Aetna,Aetna,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Aetna MGG,Aetna MGG,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,BCBS,BCBS,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,BCBS MGG,BCBS MGG,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Cigna,Cigna,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Cigna MGG,Cigna MGG,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Humana,Humana,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Humana MGG,Humana MGG,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Optum VA,Optum VA,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,UHC,UHC,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,UHC MGG,UHC MGG,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,VA,VA,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Wellcare MGG,Wellcare MGG,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Bright Health - commercial,Bright Health - commercial,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,19001,CPT,,,,Inpatient,,,171.36,171.36,Bright Health MGG,Bright Health MGG,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Aetna,Aetna,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Aetna MGG,Aetna MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,BCBS,BCBS,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,BCBS MGG,BCBS MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Cigna,Cigna,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Cigna MGG,Cigna MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Humana,Humana,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Humana MGG,Humana MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Optum VA,Optum VA,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,UHC,UHC,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,UHC MGG,UHC MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,VA,VA,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Wellcare MGG,Wellcare MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Bright Health - commercial,Bright Health - commercial,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,19000,CPT,,,,Inpatient,,,758.88,758.88,Bright Health MGG,Bright Health MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Aetna,Aetna,2387.82,,,,,,,per diem,2387.82,2387.82,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Aetna MGG,Aetna MGG,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,BCBS,BCBS,2387.82,,,,,,,per diem,2387.82,2387.82,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,BCBS MGG,BCBS MGG,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Cigna,Cigna,2387.82,,,,,,,per diem,2387.82,2387.82,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Cigna MGG,Cigna MGG,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Humana,Humana,2387.82,,,,,,,per diem,2387.82,2387.82,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Humana MGG,Humana MGG,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Optum VA,Optum VA,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,UHC,UHC,2387.82,,,,,,,per diem,2387.82,2387.82,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,UHC MGG,UHC MGG,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,VA,VA,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Wellcare MGG,Wellcare MGG,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Bright Health - commercial,Bright Health - commercial,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,49180,CPT,,,,Inpatient,,,2387.82,2387.82,Bright Health MGG,Bright Health MGG,2387.82,,,,,,,case rate,2387.82,2387.82,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Aetna,Aetna,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Aetna MGG,Aetna MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,BCBS,BCBS,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,BCBS MGG,BCBS MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Cigna,Cigna,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Cigna MGG,Cigna MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Humana,Humana,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Humana MGG,Humana MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Optum VA,Optum VA,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,UHC,UHC,2307.24,,,,,,,per diem,2307.24,2307.24,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,UHC MGG,UHC MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,VA,VA,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Wellcare MGG,Wellcare MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Bright Health - commercial,Bright Health - commercial,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,47000,CPT,,,,Inpatient,,,2307.24,2307.24,Bright Health MGG,Bright Health MGG,2307.24,,,,,,,case rate,2307.24,2307.24,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Aetna,Aetna,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Aetna MGG,Aetna MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,BCBS,BCBS,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,BCBS MGG,BCBS MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Cigna,Cigna,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Cigna MGG,Cigna MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Humana,Humana,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Humana MGG,Humana MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Optum VA,Optum VA,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,UHC,UHC,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,UHC MGG,UHC MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,VA,VA,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Wellcare MGG,Wellcare MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Bright Health - commercial,Bright Health - commercial,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,20206,CPT,,,,Inpatient,,,1922.7,1922.7,Bright Health MGG,Bright Health MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,21550,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Aetna,Aetna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Aetna MGG,Aetna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,BCBS,BCBS,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,BCBS MGG,BCBS MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Cigna,Cigna,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Cigna MGG,Cigna MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Humana,Humana,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Humana MGG,Humana MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Optum VA,Optum VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,UHC,UHC,961.86,,,,,,,per diem,961.86,961.86,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,UHC MGG,UHC MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,VA,VA,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Wellcare MGG,Wellcare MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Bright Health - commercial,Bright Health - commercial,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,48102,CPT,,,,Inpatient,,,961.86,961.86,Bright Health MGG,Bright Health MGG,961.86,,,,,,,case rate,961.86,961.86,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Aetna,Aetna,1444.32,,,,,,,per diem,1444.32,1444.32,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Aetna MGG,Aetna MGG,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,BCBS,BCBS,1444.32,,,,,,,per diem,1444.32,1444.32,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,BCBS MGG,BCBS MGG,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Cigna,Cigna,1444.32,,,,,,,per diem,1444.32,1444.32,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Cigna MGG,Cigna MGG,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Humana,Humana,1444.32,,,,,,,per diem,1444.32,1444.32,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Humana MGG,Humana MGG,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Optum VA,Optum VA,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,UHC,UHC,1444.32,,,,,,,per diem,1444.32,1444.32,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,UHC MGG,UHC MGG,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,VA,VA,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Wellcare MGG,Wellcare MGG,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Bright Health - commercial,Bright Health - commercial,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,50200,CPT,,,,Inpatient,,,1444.32,1444.32,Bright Health MGG,Bright Health MGG,1444.32,,,,,,,case rate,1444.32,1444.32,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Aetna,Aetna,1113.84,,,,,,,per diem,1113.84,1113.84,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Aetna MGG,Aetna MGG,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,BCBS,BCBS,1113.84,,,,,,,per diem,1113.84,1113.84,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,BCBS MGG,BCBS MGG,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Cigna,Cigna,1113.84,,,,,,,per diem,1113.84,1113.84,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Cigna MGG,Cigna MGG,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Humana,Humana,1113.84,,,,,,,per diem,1113.84,1113.84,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Humana MGG,Humana MGG,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Optum VA,Optum VA,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,UHC,UHC,1113.84,,,,,,,per diem,1113.84,1113.84,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,UHC MGG,UHC MGG,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,VA,VA,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Wellcare MGG,Wellcare MGG,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Bright Health - commercial,Bright Health - commercial,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,42400,CPT,,,,Inpatient,,,1113.84,1113.84,Bright Health MGG,Bright Health MGG,1113.84,,,,,,,case rate,1113.84,1113.84,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Aetna,Aetna,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Aetna MGG,Aetna MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,BCBS,BCBS,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,BCBS MGG,BCBS MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Cigna,Cigna,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Cigna MGG,Cigna MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Humana,Humana,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Humana MGG,Humana MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Optum VA,Optum VA,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,UHC,UHC,2533.68,,,,,,,per diem,2533.68,2533.68,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,UHC MGG,UHC MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,VA,VA,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Wellcare MGG,Wellcare MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Bright Health - commercial,Bright Health - commercial,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,62269,CPT,,,,Inpatient,,,2533.68,2533.68,Bright Health MGG,Bright Health MGG,2533.68,,,,,,,case rate,2533.68,2533.68,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,60100,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,38505,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,59412,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Aetna,Aetna,833.34,,,,,,,per diem,833.34,833.34,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Aetna MGG,Aetna MGG,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,BCBS,BCBS,833.34,,,,,,,per diem,833.34,833.34,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,BCBS MGG,BCBS MGG,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Cigna,Cigna,833.34,,,,,,,per diem,833.34,833.34,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Cigna MGG,Cigna MGG,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Humana,Humana,833.34,,,,,,,per diem,833.34,833.34,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Humana MGG,Humana MGG,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Optum VA,Optum VA,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,UHC,UHC,833.34,,,,,,,per diem,833.34,833.34,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,UHC MGG,UHC MGG,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,VA,VA,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Wellcare MGG,Wellcare MGG,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Bright Health - commercial,Bright Health - commercial,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,58340,CPT,,,,Inpatient,,,833.34,833.34,Bright Health MGG,Bright Health MGG,833.34,,,,,,,case rate,833.34,833.34,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Aetna,Aetna,1101.6,,,,,,,per diem,1101.6,1101.6,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Aetna MGG,Aetna MGG,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,BCBS,BCBS,1101.6,,,,,,,per diem,1101.6,1101.6,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,BCBS MGG,BCBS MGG,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Cigna,Cigna,1101.6,,,,,,,per diem,1101.6,1101.6,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Cigna MGG,Cigna MGG,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Humana,Humana,1101.6,,,,,,,per diem,1101.6,1101.6,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Humana MGG,Humana MGG,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Optum VA,Optum VA,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,UHC,UHC,1101.6,,,,,,,per diem,1101.6,1101.6,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,UHC MGG,UHC MGG,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,VA,VA,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Wellcare MGG,Wellcare MGG,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Bright Health - commercial,Bright Health - commercial,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,49082,CPT,,,,Inpatient,,,1101.6,1101.6,Bright Health MGG,Bright Health MGG,1101.6,,,,,,,case rate,1101.6,1101.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Aetna,Aetna,3888.19,,,,,,,per diem,3888.19,3888.19,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Aetna MGG,Aetna MGG,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,BCBS,BCBS,3888.19,,,,,,,per diem,3888.19,3888.19,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,BCBS MGG,BCBS MGG,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Cigna,Cigna,3888.19,,,,,,,per diem,3888.19,3888.19,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Cigna MGG,Cigna MGG,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Humana,Humana,3888.19,,,,,,,per diem,3888.19,3888.19,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Humana MGG,Humana MGG,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Optum VA,Optum VA,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,UHC,UHC,3888.19,,,,,,,per diem,3888.19,3888.19,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,UHC MGG,UHC MGG,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,VA,VA,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Wellcare MGG,Wellcare MGG,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Bright Health - commercial,Bright Health - commercial,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,49083,CPT,,,,Inpatient,,,3888.19,3888.19,Bright Health MGG,Bright Health MGG,3888.19,,,,,,,case rate,3888.19,3888.19,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Aetna,Aetna,7655.1,,,,,,,per diem,7655.1,7655.1,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Aetna MGG,Aetna MGG,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,BCBS,BCBS,7655.1,,,,,,,per diem,7655.1,7655.1,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,BCBS MGG,BCBS MGG,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Cigna,Cigna,7655.1,,,,,,,per diem,7655.1,7655.1,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Cigna MGG,Cigna MGG,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Humana,Humana,7655.1,,,,,,,per diem,7655.1,7655.1,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Humana MGG,Humana MGG,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Optum VA,Optum VA,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,UHC,UHC,7655.1,,,,,,,per diem,7655.1,7655.1,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,UHC MGG,UHC MGG,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,VA,VA,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Wellcare MGG,Wellcare MGG,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Bright Health - commercial,Bright Health - commercial,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,26990,CPT,,,,Inpatient,,,7655.1,7655.1,Bright Health MGG,Bright Health MGG,7655.1,,,,,,,case rate,7655.1,7655.1,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Aetna,Aetna,1330.08,,,,,,,per diem,1330.08,1330.08,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Aetna MGG,Aetna MGG,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,BCBS,BCBS,1330.08,,,,,,,per diem,1330.08,1330.08,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,BCBS MGG,BCBS MGG,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Cigna,Cigna,1330.08,,,,,,,per diem,1330.08,1330.08,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Cigna MGG,Cigna MGG,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Humana,Humana,1330.08,,,,,,,per diem,1330.08,1330.08,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Humana MGG,Humana MGG,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Optum VA,Optum VA,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,UHC,UHC,1330.08,,,,,,,per diem,1330.08,1330.08,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,UHC MGG,UHC MGG,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,VA,VA,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Wellcare MGG,Wellcare MGG,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Bright Health - commercial,Bright Health - commercial,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,49084,CPT,,,,Inpatient,,,1330.08,1330.08,Bright Health MGG,Bright Health MGG,1330.08,,,,,,,case rate,1330.08,1330.08,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Aetna,Aetna,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Aetna MGG,Aetna MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,BCBS,BCBS,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,BCBS MGG,BCBS MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Cigna,Cigna,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Cigna MGG,Cigna MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Humana,Humana,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Humana MGG,Humana MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Optum VA,Optum VA,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,UHC,UHC,949.62,,,,,,,per diem,949.62,949.62,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,UHC MGG,UHC MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,VA,VA,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Wellcare MGG,Wellcare MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Bright Health - commercial,Bright Health - commercial,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,36002,CPT,,,,Inpatient,,,949.62,949.62,Bright Health MGG,Bright Health MGG,949.62,,,,,,,case rate,949.62,949.62,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Aetna,Aetna,2474.52,,,,,,,per diem,2474.52,2474.52,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Aetna MGG,Aetna MGG,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,BCBS,BCBS,2474.52,,,,,,,per diem,2474.52,2474.52,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,BCBS MGG,BCBS MGG,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Cigna,Cigna,2474.52,,,,,,,per diem,2474.52,2474.52,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Cigna MGG,Cigna MGG,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Humana,Humana,2474.52,,,,,,,per diem,2474.52,2474.52,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Humana MGG,Humana MGG,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Optum VA,Optum VA,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,UHC,UHC,2474.52,,,,,,,per diem,2474.52,2474.52,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,UHC MGG,UHC MGG,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,VA,VA,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Wellcare MGG,Wellcare MGG,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Bright Health - commercial,Bright Health - commercial,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,50390,CPT,,,,Inpatient,,,2474.52,2474.52,Bright Health MGG,Bright Health MGG,2474.52,,,,,,,case rate,2474.52,2474.52,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Aetna,Aetna,2403.12,,,,,,,per diem,2403.12,2403.12,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Aetna MGG,Aetna MGG,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,BCBS,BCBS,2403.12,,,,,,,per diem,2403.12,2403.12,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,BCBS MGG,BCBS MGG,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Cigna,Cigna,2403.12,,,,,,,per diem,2403.12,2403.12,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Cigna MGG,Cigna MGG,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Humana,Humana,2403.12,,,,,,,per diem,2403.12,2403.12,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Humana MGG,Humana MGG,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Optum VA,Optum VA,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,UHC,UHC,2403.12,,,,,,,per diem,2403.12,2403.12,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,UHC MGG,UHC MGG,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,VA,VA,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Wellcare MGG,Wellcare MGG,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Bright Health - commercial,Bright Health - commercial,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,32555,CPT,,,,Inpatient,,,2403.12,2403.12,Bright Health MGG,Bright Health MGG,2403.12,,,,,,,case rate,2403.12,2403.12,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Aetna,Aetna,2499,,,,,,,per diem,2499,2499,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Aetna MGG,Aetna MGG,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,BCBS,BCBS,2499,,,,,,,per diem,2499,2499,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,BCBS MGG,BCBS MGG,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Cigna,Cigna,2499,,,,,,,per diem,2499,2499,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Cigna MGG,Cigna MGG,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Humana,Humana,2499,,,,,,,per diem,2499,2499,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Humana MGG,Humana MGG,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Optum VA,Optum VA,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,UHC,UHC,2499,,,,,,,per diem,2499,2499,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,UHC MGG,UHC MGG,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,VA,VA,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Wellcare MGG,Wellcare MGG,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Bright Health - commercial,Bright Health - commercial,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,32554,CPT,,,,Inpatient,,,2499,2499,Bright Health MGG,Bright Health MGG,2499,,,,,,,case rate,2499,2499,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Aetna,Aetna,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Aetna MGG,Aetna MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,BCBS,BCBS,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,BCBS MGG,BCBS MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Cigna,Cigna,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Cigna MGG,Cigna MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Humana,Humana,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Humana MGG,Humana MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Optum VA,Optum VA,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,UHC,UHC,758.88,,,,,,,per diem,758.88,758.88,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,UHC MGG,UHC MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,VA,VA,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Wellcare MGG,Wellcare MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Bright Health - commercial,Bright Health - commercial,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,60300,CPT,,,,Inpatient,,,758.88,758.88,Bright Health MGG,Bright Health MGG,758.88,,,,,,,case rate,758.88,758.88,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Aetna,Aetna,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Aetna MGG,Aetna MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,BCBS,BCBS,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,BCBS MGG,BCBS MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Cigna,Cigna,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Cigna MGG,Cigna MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Humana,Humana,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Humana MGG,Humana MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Optum VA,Optum VA,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,UHC,UHC,194.82,,,,,,,per diem,194.82,194.82,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,UHC MGG,UHC MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,VA,VA,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Wellcare MGG,Wellcare MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Bright Health - commercial,Bright Health - commercial,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,36410,CPT,,,,Inpatient,,,194.82,194.82,Bright Health MGG,Bright Health MGG,194.82,,,,,,,case rate,194.82,194.82,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Aetna,Aetna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Aetna MGG,Aetna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,BCBS,BCBS,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,BCBS MGG,BCBS MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Cigna,Cigna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Cigna MGG,Cigna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Humana,Humana,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Humana MGG,Humana MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Optum VA,Optum VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,UHC,UHC,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,UHC MGG,UHC MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,VA,VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Wellcare MGG,Wellcare MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Bright Health - commercial,Bright Health - commercial,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Bright Health MGG,Bright Health MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna,Aetna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna MGG,Aetna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS,BCBS,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS MGG,BCBS MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna,Cigna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna MGG,Cigna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Humana,Humana,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Humana MGG,Humana MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Optum VA,Optum VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,UHC,UHC,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,UHC MGG,UHC MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,VA,VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Wellcare MGG,Wellcare MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health - commercial,Bright Health - commercial,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,19083,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health MGG,Bright Health MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna,Aetna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Aetna MGG,Aetna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS,BCBS,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,BCBS MGG,BCBS MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna,Cigna,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Cigna MGG,Cigna MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Humana,Humana,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Humana MGG,Humana MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Optum VA,Optum VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,UHC,UHC,4264.62,,,,,,,per diem,4264.62,4264.62,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,UHC MGG,UHC MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,VA,VA,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Wellcare MGG,Wellcare MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health - commercial,Bright Health - commercial,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,19084,CPT,,,,Inpatient,,,4264.62,4264.62,Bright Health MGG,Bright Health MGG,4264.62,,,,,,,case rate,4264.62,4264.62,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,19285,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Aetna,Aetna,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Aetna MGG,Aetna MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,BCBS,BCBS,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,BCBS MGG,BCBS MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Cigna,Cigna,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Cigna MGG,Cigna MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Humana,Humana,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Humana MGG,Humana MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Optum VA,Optum VA,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,UHC,UHC,792.54,,,,,,,per diem,792.54,792.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,UHC MGG,UHC MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,VA,VA,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Wellcare MGG,Wellcare MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Bright Health - commercial,Bright Health - commercial,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,19286,CPT,,,,Inpatient,,,792.54,792.54,Bright Health MGG,Bright Health MGG,792.54,,,,,,,case rate,792.54,792.54,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna,Aetna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna MGG,Aetna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS,BCBS,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS MGG,BCBS MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna,Cigna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna MGG,Cigna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Humana,Humana,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Humana MGG,Humana MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Optum VA,Optum VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,UHC,UHC,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,UHC MGG,UHC MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,VA,VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Wellcare MGG,Wellcare MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health - commercial,Bright Health - commercial,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health MGG,Bright Health MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna,Aetna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna MGG,Aetna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS,BCBS,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS MGG,BCBS MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna,Cigna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna MGG,Cigna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Humana,Humana,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Humana MGG,Humana MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Optum VA,Optum VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,UHC,UHC,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,UHC MGG,UHC MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,VA,VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Wellcare MGG,Wellcare MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health - commercial,Bright Health - commercial,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health MGG,Bright Health MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Aetna,Aetna,13103.94,,,,,,,per diem,13103.94,13103.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Aetna MGG,Aetna MGG,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,BCBS,BCBS,13103.94,,,,,,,per diem,13103.94,13103.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,BCBS MGG,BCBS MGG,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Cigna,Cigna,13103.94,,,,,,,per diem,13103.94,13103.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Cigna MGG,Cigna MGG,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Humana,Humana,13103.94,,,,,,,per diem,13103.94,13103.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Humana MGG,Humana MGG,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Optum VA,Optum VA,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,UHC,UHC,13103.94,,,,,,,per diem,13103.94,13103.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,UHC MGG,UHC MGG,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,VA,VA,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Wellcare MGG,Wellcare MGG,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Bright Health - commercial,Bright Health - commercial,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,47490,CPT,,,,Inpatient,,,13103.94,13103.94,Bright Health MGG,Bright Health MGG,13103.94,,,,,,,case rate,13103.94,13103.94,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Aetna,Aetna,10598.82,,,,,,,per diem,10598.82,10598.82,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Aetna MGG,Aetna MGG,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,BCBS,BCBS,10598.82,,,,,,,per diem,10598.82,10598.82,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,BCBS MGG,BCBS MGG,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Cigna,Cigna,10598.82,,,,,,,per diem,10598.82,10598.82,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Cigna MGG,Cigna MGG,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Humana,Humana,10598.82,,,,,,,per diem,10598.82,10598.82,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Humana MGG,Humana MGG,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Optum VA,Optum VA,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,UHC,UHC,10598.82,,,,,,,per diem,10598.82,10598.82,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,UHC MGG,UHC MGG,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,VA,VA,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Wellcare MGG,Wellcare MGG,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Bright Health - commercial,Bright Health - commercial,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,10598.82,10598.82,Bright Health MGG,Bright Health MGG,10598.82,,,,,,,case rate,10598.82,10598.82,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Aetna,Aetna,1755.42,,,,,,,per diem,1755.42,1755.42,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Aetna MGG,Aetna MGG,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,BCBS,BCBS,1755.42,,,,,,,per diem,1755.42,1755.42,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,BCBS MGG,BCBS MGG,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Cigna,Cigna,1755.42,,,,,,,per diem,1755.42,1755.42,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Cigna MGG,Cigna MGG,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Humana,Humana,1755.42,,,,,,,per diem,1755.42,1755.42,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Humana MGG,Humana MGG,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Optum VA,Optum VA,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,UHC,UHC,1755.42,,,,,,,per diem,1755.42,1755.42,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,UHC MGG,UHC MGG,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,VA,VA,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Wellcare MGG,Wellcare MGG,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Bright Health - commercial,Bright Health - commercial,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,59000,CPT,,,,Inpatient,,,1755.42,1755.42,Bright Health MGG,Bright Health MGG,1755.42,,,,,,,case rate,1755.42,1755.42,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Aetna,Aetna,3911.7,,,,,,,per diem,3911.7,3911.7,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Aetna MGG,Aetna MGG,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,BCBS,BCBS,3911.7,,,,,,,per diem,3911.7,3911.7,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,BCBS MGG,BCBS MGG,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Cigna,Cigna,3911.7,,,,,,,per diem,3911.7,3911.7,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Cigna MGG,Cigna MGG,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Humana,Humana,3911.7,,,,,,,per diem,3911.7,3911.7,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Humana MGG,Humana MGG,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Optum VA,Optum VA,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,UHC,UHC,3911.7,,,,,,,per diem,3911.7,3911.7,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,UHC MGG,UHC MGG,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,VA,VA,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Wellcare MGG,Wellcare MGG,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Bright Health - commercial,Bright Health - commercial,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,27041,CPT,,,,Inpatient,,,3911.7,3911.7,Bright Health MGG,Bright Health MGG,3911.7,,,,,,,case rate,3911.7,3911.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Aetna,Aetna,5033.7,,,,,,,per diem,5033.7,5033.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Aetna MGG,Aetna MGG,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,BCBS,BCBS,5033.7,,,,,,,per diem,5033.7,5033.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,BCBS MGG,BCBS MGG,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Cigna,Cigna,5033.7,,,,,,,per diem,5033.7,5033.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Cigna MGG,Cigna MGG,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Humana,Humana,5033.7,,,,,,,per diem,5033.7,5033.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Humana MGG,Humana MGG,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Optum VA,Optum VA,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,UHC,UHC,5033.7,,,,,,,per diem,5033.7,5033.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,UHC MGG,UHC MGG,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,VA,VA,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Wellcare MGG,Wellcare MGG,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Bright Health - commercial,Bright Health - commercial,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,10030,CPT,,,,Inpatient,,,5033.7,5033.7,Bright Health MGG,Bright Health MGG,5033.7,,,,,,,case rate,5033.7,5033.7,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Aetna,Aetna,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Aetna MGG,Aetna MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,BCBS,BCBS,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,BCBS MGG,BCBS MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Cigna,Cigna,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Cigna MGG,Cigna MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Humana,Humana,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Humana MGG,Humana MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Optum VA,Optum VA,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,UHC,UHC,1321.92,,,,,,,per diem,1321.92,1321.92,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,UHC MGG,UHC MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,VA,VA,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Wellcare MGG,Wellcare MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Bright Health - commercial,Bright Health - commercial,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,20604,CPT,,,,Inpatient,,,1321.92,1321.92,Bright Health MGG,Bright Health MGG,1321.92,,,,,,,case rate,1321.92,1321.92,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Aetna,Aetna,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Aetna MGG,Aetna MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,BCBS,BCBS,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,BCBS MGG,BCBS MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Cigna,Cigna,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Cigna MGG,Cigna MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Humana,Humana,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Humana MGG,Humana MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Optum VA,Optum VA,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,UHC,UHC,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,UHC MGG,UHC MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,VA,VA,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Wellcare MGG,Wellcare MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Bright Health - commercial,Bright Health - commercial,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Bright Health MGG,Bright Health MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Aetna,Aetna,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Aetna MGG,Aetna MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,BCBS,BCBS,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,BCBS MGG,BCBS MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Cigna,Cigna,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Cigna MGG,Cigna MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Humana,Humana,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Humana MGG,Humana MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Optum VA,Optum VA,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,UHC,UHC,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,UHC MGG,UHC MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,VA,VA,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Wellcare MGG,Wellcare MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Bright Health - commercial,Bright Health - commercial,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Bright Health MGG,Bright Health MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Aetna,Aetna,289.64,,,,,,,per diem,289.64,289.64,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Aetna MGG,Aetna MGG,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,BCBS,BCBS,289.64,,,,,,,per diem,289.64,289.64,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,BCBS MGG,BCBS MGG,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Cigna,Cigna,289.64,,,,,,,per diem,289.64,289.64,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Cigna MGG,Cigna MGG,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Humana,Humana,289.64,,,,,,,per diem,289.64,289.64,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Humana MGG,Humana MGG,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Optum VA,Optum VA,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,UHC,UHC,289.64,,,,,,,per diem,289.64,289.64,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,UHC MGG,UHC MGG,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,VA,VA,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Wellcare MGG,Wellcare MGG,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Bright Health - commercial,Bright Health - commercial,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,,,,,,Inpatient,,,289.64,289.64,Bright Health MGG,Bright Health MGG,289.64,,,,,,,case rate,289.64,289.64,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Aetna,Aetna,344.21,,,,,,,per diem,344.21,344.21,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Aetna MGG,Aetna MGG,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,BCBS,BCBS,344.21,,,,,,,per diem,344.21,344.21,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,BCBS MGG,BCBS MGG,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Cigna,Cigna,344.21,,,,,,,per diem,344.21,344.21,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Cigna MGG,Cigna MGG,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Humana,Humana,344.21,,,,,,,per diem,344.21,344.21,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Humana MGG,Humana MGG,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Optum VA,Optum VA,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,UHC,UHC,344.21,,,,,,,per diem,344.21,344.21,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,UHC MGG,UHC MGG,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,VA,VA,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Wellcare MGG,Wellcare MGG,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Bright Health - commercial,Bright Health - commercial,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,344.21,344.21,Bright Health MGG,Bright Health MGG,344.21,,,,,,,case rate,344.21,344.21,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Aetna,Aetna,455.45,,,,,,,per diem,455.45,455.45,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Aetna MGG,Aetna MGG,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,BCBS,BCBS,455.45,,,,,,,per diem,455.45,455.45,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,BCBS MGG,BCBS MGG,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Cigna,Cigna,455.45,,,,,,,per diem,455.45,455.45,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Cigna MGG,Cigna MGG,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Humana,Humana,455.45,,,,,,,per diem,455.45,455.45,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Humana MGG,Humana MGG,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Optum VA,Optum VA,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,UHC,UHC,455.45,,,,,,,per diem,455.45,455.45,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,UHC MGG,UHC MGG,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,VA,VA,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Wellcare MGG,Wellcare MGG,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Bright Health - commercial,Bright Health - commercial,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,455.45,455.45,Bright Health MGG,Bright Health MGG,455.45,,,,,,,case rate,455.45,455.45,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Aetna,Aetna,403.65,,,,,,,per diem,403.65,403.65,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Aetna MGG,Aetna MGG,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,BCBS,BCBS,403.65,,,,,,,per diem,403.65,403.65,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,BCBS MGG,BCBS MGG,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Cigna,Cigna,403.65,,,,,,,per diem,403.65,403.65,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Cigna MGG,Cigna MGG,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Humana,Humana,403.65,,,,,,,per diem,403.65,403.65,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Humana MGG,Humana MGG,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Optum VA,Optum VA,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,UHC,UHC,403.65,,,,,,,per diem,403.65,403.65,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,UHC MGG,UHC MGG,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,VA,VA,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Wellcare MGG,Wellcare MGG,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Bright Health - commercial,Bright Health - commercial,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,403.65,403.65,Bright Health MGG,Bright Health MGG,403.65,,,,,,,case rate,403.65,403.65,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Aetna,Aetna,1074.22,,,,,,,per diem,1074.22,1074.22,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Aetna MGG,Aetna MGG,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,BCBS,BCBS,1074.22,,,,,,,per diem,1074.22,1074.22,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,BCBS MGG,BCBS MGG,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Cigna,Cigna,1074.22,,,,,,,per diem,1074.22,1074.22,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Cigna MGG,Cigna MGG,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Humana,Humana,1074.22,,,,,,,per diem,1074.22,1074.22,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Humana MGG,Humana MGG,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Optum VA,Optum VA,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,UHC,UHC,1074.22,,,,,,,per diem,1074.22,1074.22,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,UHC MGG,UHC MGG,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,VA,VA,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Wellcare MGG,Wellcare MGG,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Bright Health - commercial,Bright Health - commercial,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,1074.22,1074.22,Bright Health MGG,Bright Health MGG,1074.22,,,,,,,case rate,1074.22,1074.22,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Aetna,Aetna,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Aetna MGG,Aetna MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,BCBS,BCBS,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,BCBS MGG,BCBS MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Cigna,Cigna,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Cigna MGG,Cigna MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Humana,Humana,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Humana MGG,Humana MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Optum VA,Optum VA,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,UHC,UHC,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,UHC MGG,UHC MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,VA,VA,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Wellcare MGG,Wellcare MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Bright Health - commercial,Bright Health - commercial,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,432,432,Bright Health MGG,Bright Health MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Aetna,Aetna,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Aetna MGG,Aetna MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,BCBS,BCBS,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,BCBS MGG,BCBS MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Cigna,Cigna,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Cigna MGG,Cigna MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Humana,Humana,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Humana MGG,Humana MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Optum VA,Optum VA,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,UHC,UHC,432,,,,,,,per diem,432,432,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,UHC MGG,UHC MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,VA,VA,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Wellcare MGG,Wellcare MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Bright Health - commercial,Bright Health - commercial,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,432,432,Bright Health MGG,Bright Health MGG,432,,,,,,,case rate,432,432,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Aetna,Aetna,797.48,,,,,,,per diem,797.48,797.48,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Aetna MGG,Aetna MGG,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,BCBS,BCBS,797.48,,,,,,,per diem,797.48,797.48,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,BCBS MGG,BCBS MGG,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Cigna,Cigna,797.48,,,,,,,per diem,797.48,797.48,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Cigna MGG,Cigna MGG,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Humana,Humana,797.48,,,,,,,per diem,797.48,797.48,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Humana MGG,Humana MGG,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Optum VA,Optum VA,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,UHC,UHC,797.48,,,,,,,per diem,797.48,797.48,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,UHC MGG,UHC MGG,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,VA,VA,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Wellcare MGG,Wellcare MGG,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Bright Health - commercial,Bright Health - commercial,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,797.48,797.48,Bright Health MGG,Bright Health MGG,797.48,,,,,,,case rate,797.48,797.48,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Aetna,Aetna,314.33,,,,,,,per diem,314.33,314.33,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Aetna MGG,Aetna MGG,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,BCBS,BCBS,314.33,,,,,,,per diem,314.33,314.33,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,BCBS MGG,BCBS MGG,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Cigna,Cigna,314.33,,,,,,,per diem,314.33,314.33,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Cigna MGG,Cigna MGG,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Humana,Humana,314.33,,,,,,,per diem,314.33,314.33,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Humana MGG,Humana MGG,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Optum VA,Optum VA,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,UHC,UHC,314.33,,,,,,,per diem,314.33,314.33,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,UHC MGG,UHC MGG,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,VA,VA,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Wellcare MGG,Wellcare MGG,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Bright Health - commercial,Bright Health - commercial,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,314.33,314.33,Bright Health MGG,Bright Health MGG,314.33,,,,,,,case rate,314.33,314.33,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Aetna,Aetna,282.75,,,,,,,per diem,282.75,282.75,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Aetna MGG,Aetna MGG,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,BCBS,BCBS,282.75,,,,,,,per diem,282.75,282.75,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,BCBS MGG,BCBS MGG,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Cigna,Cigna,282.75,,,,,,,per diem,282.75,282.75,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Cigna MGG,Cigna MGG,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Humana,Humana,282.75,,,,,,,per diem,282.75,282.75,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Humana MGG,Humana MGG,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Optum VA,Optum VA,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,UHC,UHC,282.75,,,,,,,per diem,282.75,282.75,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,UHC MGG,UHC MGG,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,VA,VA,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Wellcare MGG,Wellcare MGG,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Bright Health - commercial,Bright Health - commercial,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,282.75,282.75,Bright Health MGG,Bright Health MGG,282.75,,,,,,,case rate,282.75,282.75,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Aetna,Aetna,1779.84,,,,,,,per diem,1779.84,1779.84,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Aetna MGG,Aetna MGG,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,BCBS,BCBS,1779.84,,,,,,,per diem,1779.84,1779.84,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,BCBS MGG,BCBS MGG,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Cigna,Cigna,1779.84,,,,,,,per diem,1779.84,1779.84,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Cigna MGG,Cigna MGG,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Humana,Humana,1779.84,,,,,,,per diem,1779.84,1779.84,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Humana MGG,Humana MGG,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Optum VA,Optum VA,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,UHC,UHC,1779.84,,,,,,,per diem,1779.84,1779.84,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,UHC MGG,UHC MGG,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,VA,VA,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Wellcare MGG,Wellcare MGG,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Bright Health - commercial,Bright Health - commercial,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1779.84,1779.84,Bright Health MGG,Bright Health MGG,1779.84,,,,,,,case rate,1779.84,1779.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Aetna,Aetna,1908,,,,,,,per diem,1908,1908,"Per diem rate, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Aetna MGG,Aetna MGG,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,BCBS,BCBS,1908,,,,,,,per diem,1908,1908,"Per diem rate, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,BCBS MGG,BCBS MGG,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Cigna,Cigna,1908,,,,,,,per diem,1908,1908,"Per diem rate, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Cigna MGG,Cigna MGG,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Humana,Humana,1908,,,,,,,per diem,1908,1908,"Per diem rate, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Humana MGG,Humana MGG,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Optum VA,Optum VA,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,UHC,UHC,1908,,,,,,,per diem,1908,1908,"Per diem rate, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,UHC MGG,UHC MGG,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,VA,VA,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Wellcare MGG,Wellcare MGG,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Bright Health - commercial,Bright Health - commercial,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
US GUIDE FOR PERCUT DRAINAGE  ,75075989,CDM,402,RC,75989,CPT,,,,Inpatient,,,1908,1908,Bright Health MGG,Bright Health MGG,1908,,,,,,,case rate,1908,1908,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Aetna,Aetna,407,,,,,,,per diem,407,407,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Aetna MGG,Aetna MGG,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,BCBS,BCBS,407,,,,,,,per diem,407,407,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,BCBS MGG,BCBS MGG,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Cigna,Cigna,407,,,,,,,per diem,407,407,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Cigna MGG,Cigna MGG,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Humana,Humana,407,,,,,,,per diem,407,407,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Humana MGG,Humana MGG,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Optum VA,Optum VA,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,UHC,UHC,407,,,,,,,per diem,407,407,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,UHC MGG,UHC MGG,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,VA,VA,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Wellcare MGG,Wellcare MGG,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Bright Health - commercial,Bright Health - commercial,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,407,407,Bright Health MGG,Bright Health MGG,407,,,,,,,case rate,407,407,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Aetna,Aetna,1230.12,,,,,,,per diem,1230.12,1230.12,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Aetna MGG,Aetna MGG,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,BCBS,BCBS,1230.12,,,,,,,per diem,1230.12,1230.12,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,BCBS MGG,BCBS MGG,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Cigna,Cigna,1230.12,,,,,,,per diem,1230.12,1230.12,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Cigna MGG,Cigna MGG,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Humana,Humana,1230.12,,,,,,,per diem,1230.12,1230.12,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Humana MGG,Humana MGG,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Optum VA,Optum VA,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,UHC,UHC,1230.12,,,,,,,per diem,1230.12,1230.12,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,UHC MGG,UHC MGG,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,VA,VA,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Wellcare MGG,Wellcare MGG,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Bright Health - commercial,Bright Health - commercial,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1230.12,1230.12,Bright Health MGG,Bright Health MGG,1230.12,,,,,,,case rate,1230.12,1230.12,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Aetna,Aetna,642,,,,,,,per diem,642,642,"Per diem rate, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Aetna MGG,Aetna MGG,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,BCBS,BCBS,642,,,,,,,per diem,642,642,"Per diem rate, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,BCBS MGG,BCBS MGG,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Cigna,Cigna,642,,,,,,,per diem,642,642,"Per diem rate, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Cigna MGG,Cigna MGG,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Humana,Humana,642,,,,,,,per diem,642,642,"Per diem rate, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Humana MGG,Humana MGG,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Optum VA,Optum VA,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,UHC,UHC,642,,,,,,,per diem,642,642,"Per diem rate, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,UHC MGG,UHC MGG,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,VA,VA,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Wellcare MGG,Wellcare MGG,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Bright Health - commercial,Bright Health - commercial,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID UNILAT STUDY RT    ,75094001,CDM,921,RC,93882,CPT,,,RT,Inpatient,,,642,642,Bright Health MGG,Bright Health MGG,642,,,,,,,case rate,642,642,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Aetna,Aetna,1004.86,,,,,,,per diem,1004.86,1004.86,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Aetna MGG,Aetna MGG,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,BCBS,BCBS,1004.86,,,,,,,per diem,1004.86,1004.86,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,BCBS MGG,BCBS MGG,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Cigna,Cigna,1004.86,,,,,,,per diem,1004.86,1004.86,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Cigna MGG,Cigna MGG,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Humana,Humana,1004.86,,,,,,,per diem,1004.86,1004.86,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Humana MGG,Humana MGG,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Optum VA,Optum VA,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,UHC,UHC,1004.86,,,,,,,per diem,1004.86,1004.86,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,UHC MGG,UHC MGG,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,VA,VA,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Wellcare MGG,Wellcare MGG,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Bright Health - commercial,Bright Health - commercial,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1004.86,1004.86,Bright Health MGG,Bright Health MGG,1004.86,,,,,,,case rate,1004.86,1004.86,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Aetna,Aetna,608.56,,,,,,,per diem,608.56,608.56,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Aetna MGG,Aetna MGG,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,BCBS,BCBS,608.56,,,,,,,per diem,608.56,608.56,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,BCBS MGG,BCBS MGG,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Cigna,Cigna,608.56,,,,,,,per diem,608.56,608.56,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Cigna MGG,Cigna MGG,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Humana,Humana,608.56,,,,,,,per diem,608.56,608.56,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Humana MGG,Humana MGG,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Optum VA,Optum VA,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,UHC,UHC,608.56,,,,,,,per diem,608.56,608.56,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,UHC MGG,UHC MGG,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,VA,VA,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Wellcare MGG,Wellcare MGG,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Bright Health - commercial,Bright Health - commercial,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,608.56,608.56,Bright Health MGG,Bright Health MGG,608.56,,,,,,,case rate,608.56,608.56,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Aetna,Aetna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Aetna MGG,Aetna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,BCBS,BCBS,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,BCBS MGG,BCBS MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Cigna,Cigna,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Cigna MGG,Cigna MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Humana,Humana,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Humana MGG,Humana MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Optum VA,Optum VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,UHC,UHC,300,,,,,,,per diem,300,300,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,UHC MGG,UHC MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,VA,VA,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Wellcare MGG,Wellcare MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Bright Health - commercial,Bright Health - commercial,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,300,300,Bright Health MGG,Bright Health MGG,300,,,,,,,case rate,300,300,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Aetna,Aetna,2616.3,,,,,,,per diem,2616.3,2616.3,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Aetna MGG,Aetna MGG,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,BCBS,BCBS,2616.3,,,,,,,per diem,2616.3,2616.3,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,BCBS MGG,BCBS MGG,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Cigna,Cigna,2616.3,,,,,,,per diem,2616.3,2616.3,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Cigna MGG,Cigna MGG,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Humana,Humana,2616.3,,,,,,,per diem,2616.3,2616.3,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Humana MGG,Humana MGG,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Optum VA,Optum VA,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,UHC,UHC,2616.3,,,,,,,per diem,2616.3,2616.3,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,UHC MGG,UHC MGG,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,VA,VA,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Wellcare MGG,Wellcare MGG,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Bright Health - commercial,Bright Health - commercial,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2616.3,2616.3,Bright Health MGG,Bright Health MGG,2616.3,,,,,,,case rate,2616.3,2616.3,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Aetna,Aetna,2355.18,,,,,,,per diem,2355.18,2355.18,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Aetna MGG,Aetna MGG,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,BCBS,BCBS,2355.18,,,,,,,per diem,2355.18,2355.18,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,BCBS MGG,BCBS MGG,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Cigna,Cigna,2355.18,,,,,,,per diem,2355.18,2355.18,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Cigna MGG,Cigna MGG,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Humana,Humana,2355.18,,,,,,,per diem,2355.18,2355.18,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Humana MGG,Humana MGG,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Optum VA,Optum VA,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,UHC,UHC,2355.18,,,,,,,per diem,2355.18,2355.18,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,UHC MGG,UHC MGG,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,VA,VA,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Wellcare MGG,Wellcare MGG,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Bright Health - commercial,Bright Health - commercial,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2355.18,2355.18,Bright Health MGG,Bright Health MGG,2355.18,,,,,,,case rate,2355.18,2355.18,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Aetna,Aetna,1520.95,,,,,,,per diem,1520.95,1520.95,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Aetna MGG,Aetna MGG,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,BCBS,BCBS,1520.95,,,,,,,per diem,1520.95,1520.95,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,BCBS MGG,BCBS MGG,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Cigna,Cigna,1520.95,,,,,,,per diem,1520.95,1520.95,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Cigna MGG,Cigna MGG,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Humana,Humana,1520.95,,,,,,,per diem,1520.95,1520.95,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Humana MGG,Humana MGG,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Optum VA,Optum VA,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,UHC,UHC,1520.95,,,,,,,per diem,1520.95,1520.95,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,UHC MGG,UHC MGG,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,VA,VA,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Wellcare MGG,Wellcare MGG,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Bright Health - commercial,Bright Health - commercial,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1520.95,1520.95,Bright Health MGG,Bright Health MGG,1520.95,,,,,,,case rate,1520.95,1520.95,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Aetna,Aetna,1707.48,,,,,,,per diem,1707.48,1707.48,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Aetna MGG,Aetna MGG,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,BCBS,BCBS,1707.48,,,,,,,per diem,1707.48,1707.48,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,BCBS MGG,BCBS MGG,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Cigna,Cigna,1707.48,,,,,,,per diem,1707.48,1707.48,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Cigna MGG,Cigna MGG,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Humana,Humana,1707.48,,,,,,,per diem,1707.48,1707.48,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Humana MGG,Humana MGG,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Optum VA,Optum VA,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,UHC,UHC,1707.48,,,,,,,per diem,1707.48,1707.48,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,UHC MGG,UHC MGG,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,VA,VA,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Wellcare MGG,Wellcare MGG,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Bright Health - commercial,Bright Health - commercial,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1707.48,1707.48,Bright Health MGG,Bright Health MGG,1707.48,,,,,,,case rate,1707.48,1707.48,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Aetna,Aetna,1365.31,,,,,,,per diem,1365.31,1365.31,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Aetna MGG,Aetna MGG,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,BCBS,BCBS,1365.31,,,,,,,per diem,1365.31,1365.31,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,BCBS MGG,BCBS MGG,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Cigna,Cigna,1365.31,,,,,,,per diem,1365.31,1365.31,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Cigna MGG,Cigna MGG,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Humana,Humana,1365.31,,,,,,,per diem,1365.31,1365.31,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Humana MGG,Humana MGG,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Optum VA,Optum VA,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,UHC,UHC,1365.31,,,,,,,per diem,1365.31,1365.31,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,UHC MGG,UHC MGG,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,VA,VA,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Wellcare MGG,Wellcare MGG,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Bright Health - commercial,Bright Health - commercial,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1365.31,1365.31,Bright Health MGG,Bright Health MGG,1365.31,,,,,,,case rate,1365.31,1365.31,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Aetna,Aetna,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Aetna MGG,Aetna MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,BCBS,BCBS,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,BCBS MGG,BCBS MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Cigna,Cigna,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Cigna MGG,Cigna MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Humana,Humana,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Humana MGG,Humana MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Optum VA,Optum VA,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,UHC,UHC,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,UHC MGG,UHC MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,VA,VA,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Wellcare MGG,Wellcare MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Bright Health - commercial,Bright Health - commercial,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2464.32,2464.32,Bright Health MGG,Bright Health MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Aetna,Aetna,2207.28,,,,,,,per diem,2207.28,2207.28,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Aetna MGG,Aetna MGG,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,BCBS,BCBS,2207.28,,,,,,,per diem,2207.28,2207.28,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,BCBS MGG,BCBS MGG,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Cigna,Cigna,2207.28,,,,,,,per diem,2207.28,2207.28,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Cigna MGG,Cigna MGG,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Humana,Humana,2207.28,,,,,,,per diem,2207.28,2207.28,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Humana MGG,Humana MGG,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Optum VA,Optum VA,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,UHC,UHC,2207.28,,,,,,,per diem,2207.28,2207.28,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,UHC MGG,UHC MGG,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,VA,VA,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Wellcare MGG,Wellcare MGG,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Bright Health - commercial,Bright Health - commercial,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2207.28,2207.28,Bright Health MGG,Bright Health MGG,2207.28,,,,,,,case rate,2207.28,2207.28,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Aetna,Aetna,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Aetna MGG,Aetna MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,BCBS,BCBS,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,BCBS MGG,BCBS MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Cigna,Cigna,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Cigna MGG,Cigna MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Humana,Humana,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Humana MGG,Humana MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Optum VA,Optum VA,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,UHC,UHC,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,UHC MGG,UHC MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,VA,VA,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Wellcare MGG,Wellcare MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Bright Health - commercial,Bright Health - commercial,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4139.16,4139.16,Bright Health MGG,Bright Health MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Aetna,Aetna,2041.02,,,,,,,per diem,2041.02,2041.02,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Aetna MGG,Aetna MGG,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,BCBS,BCBS,2041.02,,,,,,,per diem,2041.02,2041.02,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,BCBS MGG,BCBS MGG,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Cigna,Cigna,2041.02,,,,,,,per diem,2041.02,2041.02,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Cigna MGG,Cigna MGG,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Humana,Humana,2041.02,,,,,,,per diem,2041.02,2041.02,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Humana MGG,Humana MGG,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Optum VA,Optum VA,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,UHC,UHC,2041.02,,,,,,,per diem,2041.02,2041.02,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,UHC MGG,UHC MGG,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,VA,VA,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Wellcare MGG,Wellcare MGG,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Bright Health - commercial,Bright Health - commercial,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2041.02,2041.02,Bright Health MGG,Bright Health MGG,2041.02,,,,,,,case rate,2041.02,2041.02,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Aetna,Aetna,3106.92,,,,,,,per diem,3106.92,3106.92,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Aetna MGG,Aetna MGG,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,BCBS,BCBS,3106.92,,,,,,,per diem,3106.92,3106.92,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,BCBS MGG,BCBS MGG,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Cigna,Cigna,3106.92,,,,,,,per diem,3106.92,3106.92,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Cigna MGG,Cigna MGG,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Humana,Humana,3106.92,,,,,,,per diem,3106.92,3106.92,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Humana MGG,Humana MGG,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Optum VA,Optum VA,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,UHC,UHC,3106.92,,,,,,,per diem,3106.92,3106.92,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,UHC MGG,UHC MGG,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,VA,VA,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Wellcare MGG,Wellcare MGG,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Bright Health - commercial,Bright Health - commercial,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3106.92,3106.92,Bright Health MGG,Bright Health MGG,3106.92,,,,,,,case rate,3106.92,3106.92,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Aetna,Aetna,1572.84,,,,,,,per diem,1572.84,1572.84,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Aetna MGG,Aetna MGG,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,BCBS,BCBS,1572.84,,,,,,,per diem,1572.84,1572.84,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,BCBS MGG,BCBS MGG,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Cigna,Cigna,1572.84,,,,,,,per diem,1572.84,1572.84,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Cigna MGG,Cigna MGG,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Humana,Humana,1572.84,,,,,,,per diem,1572.84,1572.84,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Humana MGG,Humana MGG,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Optum VA,Optum VA,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,UHC,UHC,1572.84,,,,,,,per diem,1572.84,1572.84,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,UHC MGG,UHC MGG,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,VA,VA,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Wellcare MGG,Wellcare MGG,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Bright Health - commercial,Bright Health - commercial,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1572.84,1572.84,Bright Health MGG,Bright Health MGG,1572.84,,,,,,,case rate,1572.84,1572.84,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Aetna,Aetna,2759.1,,,,,,,per diem,2759.1,2759.1,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Aetna MGG,Aetna MGG,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,BCBS,BCBS,2759.1,,,,,,,per diem,2759.1,2759.1,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,BCBS MGG,BCBS MGG,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Cigna,Cigna,2759.1,,,,,,,per diem,2759.1,2759.1,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Cigna MGG,Cigna MGG,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Humana,Humana,2759.1,,,,,,,per diem,2759.1,2759.1,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Humana MGG,Humana MGG,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Optum VA,Optum VA,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,UHC,UHC,2759.1,,,,,,,per diem,2759.1,2759.1,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,UHC MGG,UHC MGG,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,VA,VA,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Wellcare MGG,Wellcare MGG,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Bright Health - commercial,Bright Health - commercial,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2759.1,2759.1,Bright Health MGG,Bright Health MGG,2759.1,,,,,,,case rate,2759.1,2759.1,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Aetna,Aetna,1926.64,,,,,,,per diem,1926.64,1926.64,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Aetna MGG,Aetna MGG,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,BCBS,BCBS,1926.64,,,,,,,per diem,1926.64,1926.64,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,BCBS MGG,BCBS MGG,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Cigna,Cigna,1926.64,,,,,,,per diem,1926.64,1926.64,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Cigna MGG,Cigna MGG,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Humana,Humana,1926.64,,,,,,,per diem,1926.64,1926.64,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Humana MGG,Humana MGG,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Optum VA,Optum VA,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,UHC,UHC,1926.64,,,,,,,per diem,1926.64,1926.64,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,UHC MGG,UHC MGG,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,VA,VA,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Wellcare MGG,Wellcare MGG,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Bright Health - commercial,Bright Health - commercial,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,1926.64,1926.64,Bright Health MGG,Bright Health MGG,1926.64,,,,,,,case rate,1926.64,1926.64,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Aetna,Aetna,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Aetna MGG,Aetna MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,BCBS,BCBS,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,BCBS MGG,BCBS MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Cigna,Cigna,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Cigna MGG,Cigna MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Humana,Humana,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Humana MGG,Humana MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Optum VA,Optum VA,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,UHC,UHC,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,UHC MGG,UHC MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,VA,VA,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Wellcare MGG,Wellcare MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Bright Health - commercial,Bright Health - commercial,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1466.76,1466.76,Bright Health MGG,Bright Health MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Aetna,Aetna,2888.64,,,,,,,per diem,2888.64,2888.64,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Aetna MGG,Aetna MGG,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,BCBS,BCBS,2888.64,,,,,,,per diem,2888.64,2888.64,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,BCBS MGG,BCBS MGG,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Cigna,Cigna,2888.64,,,,,,,per diem,2888.64,2888.64,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Cigna MGG,Cigna MGG,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Humana,Humana,2888.64,,,,,,,per diem,2888.64,2888.64,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Humana MGG,Humana MGG,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Optum VA,Optum VA,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,UHC,UHC,2888.64,,,,,,,per diem,2888.64,2888.64,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,UHC MGG,UHC MGG,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,VA,VA,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Wellcare MGG,Wellcare MGG,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Bright Health - commercial,Bright Health - commercial,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,2888.64,2888.64,Bright Health MGG,Bright Health MGG,2888.64,,,,,,,case rate,2888.64,2888.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Aetna,Aetna,2566.32,,,,,,,per diem,2566.32,2566.32,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Aetna MGG,Aetna MGG,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,BCBS,BCBS,2566.32,,,,,,,per diem,2566.32,2566.32,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,BCBS MGG,BCBS MGG,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Cigna,Cigna,2566.32,,,,,,,per diem,2566.32,2566.32,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Cigna MGG,Cigna MGG,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Humana,Humana,2566.32,,,,,,,per diem,2566.32,2566.32,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Humana MGG,Humana MGG,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Optum VA,Optum VA,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,UHC,UHC,2566.32,,,,,,,per diem,2566.32,2566.32,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,UHC MGG,UHC MGG,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,VA,VA,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Wellcare MGG,Wellcare MGG,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Bright Health - commercial,Bright Health - commercial,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2566.32,2566.32,Bright Health MGG,Bright Health MGG,2566.32,,,,,,,case rate,2566.32,2566.32,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Aetna,Aetna,2701.52,,,,,,,per diem,2701.52,2701.52,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Aetna MGG,Aetna MGG,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,BCBS,BCBS,2701.52,,,,,,,per diem,2701.52,2701.52,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,BCBS MGG,BCBS MGG,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Cigna,Cigna,2701.52,,,,,,,per diem,2701.52,2701.52,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Cigna MGG,Cigna MGG,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Humana,Humana,2701.52,,,,,,,per diem,2701.52,2701.52,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Humana MGG,Humana MGG,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Optum VA,Optum VA,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,UHC,UHC,2701.52,,,,,,,per diem,2701.52,2701.52,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,UHC MGG,UHC MGG,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,VA,VA,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Wellcare MGG,Wellcare MGG,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Bright Health - commercial,Bright Health - commercial,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2701.52,2701.52,Bright Health MGG,Bright Health MGG,2701.52,,,,,,,case rate,2701.52,2701.52,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Aetna,Aetna,2237.88,,,,,,,per diem,2237.88,2237.88,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Aetna MGG,Aetna MGG,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,BCBS,BCBS,2237.88,,,,,,,per diem,2237.88,2237.88,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,BCBS MGG,BCBS MGG,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Cigna,Cigna,2237.88,,,,,,,per diem,2237.88,2237.88,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Cigna MGG,Cigna MGG,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Humana,Humana,2237.88,,,,,,,per diem,2237.88,2237.88,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Humana MGG,Humana MGG,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Optum VA,Optum VA,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,UHC,UHC,2237.88,,,,,,,per diem,2237.88,2237.88,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,UHC MGG,UHC MGG,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,VA,VA,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Wellcare MGG,Wellcare MGG,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Bright Health - commercial,Bright Health - commercial,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2237.88,2237.88,Bright Health MGG,Bright Health MGG,2237.88,,,,,,,case rate,2237.88,2237.88,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Aetna,Aetna,2903.94,,,,,,,per diem,2903.94,2903.94,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Aetna MGG,Aetna MGG,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,BCBS,BCBS,2903.94,,,,,,,per diem,2903.94,2903.94,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,BCBS MGG,BCBS MGG,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Cigna,Cigna,2903.94,,,,,,,per diem,2903.94,2903.94,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Cigna MGG,Cigna MGG,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Humana,Humana,2903.94,,,,,,,per diem,2903.94,2903.94,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Humana MGG,Humana MGG,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Optum VA,Optum VA,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,UHC,UHC,2903.94,,,,,,,per diem,2903.94,2903.94,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,UHC MGG,UHC MGG,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,VA,VA,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Wellcare MGG,Wellcare MGG,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Bright Health - commercial,Bright Health - commercial,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,2903.94,2903.94,Bright Health MGG,Bright Health MGG,2903.94,,,,,,,case rate,2903.94,2903.94,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Aetna,Aetna,1861.5,,,,,,,per diem,1861.5,1861.5,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Aetna MGG,Aetna MGG,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,BCBS,BCBS,1861.5,,,,,,,per diem,1861.5,1861.5,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,BCBS MGG,BCBS MGG,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Cigna,Cigna,1861.5,,,,,,,per diem,1861.5,1861.5,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Cigna MGG,Cigna MGG,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Humana,Humana,1861.5,,,,,,,per diem,1861.5,1861.5,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Humana MGG,Humana MGG,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Optum VA,Optum VA,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,UHC,UHC,1861.5,,,,,,,per diem,1861.5,1861.5,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,UHC MGG,UHC MGG,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,VA,VA,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Wellcare MGG,Wellcare MGG,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Bright Health - commercial,Bright Health - commercial,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1861.5,1861.5,Bright Health MGG,Bright Health MGG,1861.5,,,,,,,case rate,1861.5,1861.5,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Aetna,Aetna,1928.82,,,,,,,per diem,1928.82,1928.82,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Aetna MGG,Aetna MGG,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,BCBS,BCBS,1928.82,,,,,,,per diem,1928.82,1928.82,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,BCBS MGG,BCBS MGG,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Cigna,Cigna,1928.82,,,,,,,per diem,1928.82,1928.82,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Cigna MGG,Cigna MGG,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Humana,Humana,1928.82,,,,,,,per diem,1928.82,1928.82,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Humana MGG,Humana MGG,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Optum VA,Optum VA,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,UHC,UHC,1928.82,,,,,,,per diem,1928.82,1928.82,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,UHC MGG,UHC MGG,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,VA,VA,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Wellcare MGG,Wellcare MGG,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Bright Health - commercial,Bright Health - commercial,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,1928.82,1928.82,Bright Health MGG,Bright Health MGG,1928.82,,,,,,,case rate,1928.82,1928.82,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Aetna,Aetna,1642.2,,,,,,,per diem,1642.2,1642.2,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Aetna MGG,Aetna MGG,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,BCBS,BCBS,1642.2,,,,,,,per diem,1642.2,1642.2,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,BCBS MGG,BCBS MGG,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Cigna,Cigna,1642.2,,,,,,,per diem,1642.2,1642.2,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Cigna MGG,Cigna MGG,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Humana,Humana,1642.2,,,,,,,per diem,1642.2,1642.2,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Humana MGG,Humana MGG,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Optum VA,Optum VA,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,UHC,UHC,1642.2,,,,,,,per diem,1642.2,1642.2,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,UHC MGG,UHC MGG,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,VA,VA,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Wellcare MGG,Wellcare MGG,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Bright Health - commercial,Bright Health - commercial,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1642.2,1642.2,Bright Health MGG,Bright Health MGG,1642.2,,,,,,,case rate,1642.2,1642.2,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Aetna,Aetna,2379.44,,,,,,,per diem,2379.44,2379.44,"Per diem rate, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Aetna MGG,Aetna MGG,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,BCBS,BCBS,2379.44,,,,,,,per diem,2379.44,2379.44,"Per diem rate, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,BCBS MGG,BCBS MGG,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Cigna,Cigna,2379.44,,,,,,,per diem,2379.44,2379.44,"Per diem rate, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Cigna MGG,Cigna MGG,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Humana,Humana,2379.44,,,,,,,per diem,2379.44,2379.44,"Per diem rate, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Humana MGG,Humana MGG,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Optum VA,Optum VA,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,UHC,UHC,2379.44,,,,,,,per diem,2379.44,2379.44,"Per diem rate, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,UHC MGG,UHC MGG,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,VA,VA,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Wellcare MGG,Wellcare MGG,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Bright Health - commercial,Bright Health - commercial,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
V Q SCANS                     ,76000428,CDM,341,RC,78582,CPT,,,,Inpatient,,,2379.44,2379.44,Bright Health MGG,Bright Health MGG,2379.44,,,,,,,case rate,2379.44,2379.44,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Aetna,Aetna,384.54,,,,,,,per diem,384.54,384.54,"Per diem rate, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Aetna MGG,Aetna MGG,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,BCBS,BCBS,384.54,,,,,,,per diem,384.54,384.54,"Per diem rate, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,BCBS MGG,BCBS MGG,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Cigna,Cigna,384.54,,,,,,,per diem,384.54,384.54,"Per diem rate, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Cigna MGG,Cigna MGG,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Humana,Humana,384.54,,,,,,,per diem,384.54,384.54,"Per diem rate, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Humana MGG,Humana MGG,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Optum VA,Optum VA,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,UHC,UHC,384.54,,,,,,,per diem,384.54,384.54,"Per diem rate, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,UHC MGG,UHC MGG,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,VA,VA,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Wellcare MGG,Wellcare MGG,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Bright Health - commercial,Bright Health - commercial,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
RAI TC CHOLETEC               ,76000433,CDM,343,RC,A9537,CPT,,,,Inpatient,,,384.54,384.54,Bright Health MGG,Bright Health MGG,384.54,,,,,,,case rate,384.54,384.54,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Aetna,Aetna,524.43,,,,,,,per diem,524.43,524.43,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Aetna MGG,Aetna MGG,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,BCBS,BCBS,524.43,,,,,,,per diem,524.43,524.43,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,BCBS MGG,BCBS MGG,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Cigna,Cigna,524.43,,,,,,,per diem,524.43,524.43,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Cigna MGG,Cigna MGG,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Humana,Humana,524.43,,,,,,,per diem,524.43,524.43,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Humana MGG,Humana MGG,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Optum VA,Optum VA,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,UHC,UHC,524.43,,,,,,,per diem,524.43,524.43,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,UHC MGG,UHC MGG,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,VA,VA,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Wellcare MGG,Wellcare MGG,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Bright Health - commercial,Bright Health - commercial,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,524.43,524.43,Bright Health MGG,Bright Health MGG,524.43,,,,,,,case rate,524.43,524.43,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Aetna,Aetna,707.91,,,,,,,per diem,707.91,707.91,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Aetna MGG,Aetna MGG,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,BCBS,BCBS,707.91,,,,,,,per diem,707.91,707.91,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,BCBS MGG,BCBS MGG,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Cigna,Cigna,707.91,,,,,,,per diem,707.91,707.91,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Cigna MGG,Cigna MGG,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Humana,Humana,707.91,,,,,,,per diem,707.91,707.91,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Humana MGG,Humana MGG,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Optum VA,Optum VA,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,UHC,UHC,707.91,,,,,,,per diem,707.91,707.91,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,UHC MGG,UHC MGG,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,VA,VA,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Wellcare MGG,Wellcare MGG,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Bright Health - commercial,Bright Health - commercial,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,707.91,707.91,Bright Health MGG,Bright Health MGG,707.91,,,,,,,case rate,707.91,707.91,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Aetna,Aetna,3769.92,,,,,,,per diem,3769.92,3769.92,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Aetna MGG,Aetna MGG,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,BCBS,BCBS,3769.92,,,,,,,per diem,3769.92,3769.92,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,BCBS MGG,BCBS MGG,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Cigna,Cigna,3769.92,,,,,,,per diem,3769.92,3769.92,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Cigna MGG,Cigna MGG,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Humana,Humana,3769.92,,,,,,,per diem,3769.92,3769.92,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Humana MGG,Humana MGG,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Optum VA,Optum VA,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,UHC,UHC,3769.92,,,,,,,per diem,3769.92,3769.92,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,UHC MGG,UHC MGG,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,VA,VA,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Wellcare MGG,Wellcare MGG,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Bright Health - commercial,Bright Health - commercial,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3769.92,3769.92,Bright Health MGG,Bright Health MGG,3769.92,,,,,,,case rate,3769.92,3769.92,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Aetna,Aetna,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Aetna MGG,Aetna MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,BCBS,BCBS,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,BCBS MGG,BCBS MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Cigna,Cigna,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Cigna MGG,Cigna MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Humana,Humana,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Humana MGG,Humana MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Optum VA,Optum VA,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,UHC,UHC,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,UHC MGG,UHC MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,VA,VA,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Wellcare MGG,Wellcare MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Bright Health - commercial,Bright Health - commercial,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2114.46,2114.46,Bright Health MGG,Bright Health MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Aetna,Aetna,2470.44,,,,,,,per diem,2470.44,2470.44,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Aetna MGG,Aetna MGG,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,BCBS,BCBS,2470.44,,,,,,,per diem,2470.44,2470.44,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,BCBS MGG,BCBS MGG,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Cigna,Cigna,2470.44,,,,,,,per diem,2470.44,2470.44,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Cigna MGG,Cigna MGG,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Humana,Humana,2470.44,,,,,,,per diem,2470.44,2470.44,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Humana MGG,Humana MGG,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Optum VA,Optum VA,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,UHC,UHC,2470.44,,,,,,,per diem,2470.44,2470.44,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,UHC MGG,UHC MGG,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,VA,VA,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Wellcare MGG,Wellcare MGG,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Bright Health - commercial,Bright Health - commercial,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2470.44,2470.44,Bright Health MGG,Bright Health MGG,2470.44,,,,,,,case rate,2470.44,2470.44,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Aetna,Aetna,7587,,,,,,,per diem,7587,7587,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Aetna MGG,Aetna MGG,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,BCBS,BCBS,7587,,,,,,,per diem,7587,7587,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,BCBS MGG,BCBS MGG,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Cigna,Cigna,7587,,,,,,,per diem,7587,7587,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Cigna MGG,Cigna MGG,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Humana,Humana,7587,,,,,,,per diem,7587,7587,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Humana MGG,Humana MGG,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Optum VA,Optum VA,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,UHC,UHC,7587,,,,,,,per diem,7587,7587,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,UHC MGG,UHC MGG,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,VA,VA,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Wellcare MGG,Wellcare MGG,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Bright Health - commercial,Bright Health - commercial,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7587,7587,Bright Health MGG,Bright Health MGG,7587,,,,,,,case rate,7587,7587,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Aetna,Aetna,2020.3,,,,,,,per diem,2020.3,2020.3,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Aetna MGG,Aetna MGG,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,BCBS,BCBS,2020.3,,,,,,,per diem,2020.3,2020.3,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,BCBS MGG,BCBS MGG,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Cigna,Cigna,2020.3,,,,,,,per diem,2020.3,2020.3,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Cigna MGG,Cigna MGG,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Humana,Humana,2020.3,,,,,,,per diem,2020.3,2020.3,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Humana MGG,Humana MGG,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Optum VA,Optum VA,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,UHC,UHC,2020.3,,,,,,,per diem,2020.3,2020.3,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,UHC MGG,UHC MGG,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,VA,VA,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Wellcare MGG,Wellcare MGG,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Bright Health - commercial,Bright Health - commercial,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2020.3,2020.3,Bright Health MGG,Bright Health MGG,2020.3,,,,,,,case rate,2020.3,2020.3,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Aetna,Aetna,1935,,,,,,,per diem,1935,1935,"Per diem rate, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Aetna MGG,Aetna MGG,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,BCBS,BCBS,1935,,,,,,,per diem,1935,1935,"Per diem rate, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,BCBS MGG,BCBS MGG,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Cigna,Cigna,1935,,,,,,,per diem,1935,1935,"Per diem rate, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Cigna MGG,Cigna MGG,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Humana,Humana,1935,,,,,,,per diem,1935,1935,"Per diem rate, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Humana MGG,Humana MGG,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Optum VA,Optum VA,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,UHC,UHC,1935,,,,,,,per diem,1935,1935,"Per diem rate, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,UHC MGG,UHC MGG,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,VA,VA,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Wellcare MGG,Wellcare MGG,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Bright Health - commercial,Bright Health - commercial,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M MEDRONATE <30 MCI      ,76020008,CDM,343,RC,A9503,HCPCS,,,,Inpatient,,,1935,1935,Bright Health MGG,Bright Health MGG,1935,,,,,,,case rate,1935,1935,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Aetna,Aetna,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Aetna MGG,Aetna MGG,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,BCBS,BCBS,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,BCBS MGG,BCBS MGG,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Cigna,Cigna,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Cigna MGG,Cigna MGG,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Humana,Humana,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Humana MGG,Humana MGG,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Optum VA,Optum VA,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,UHC,UHC,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,UHC MGG,UHC MGG,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,VA,VA,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Wellcare MGG,Wellcare MGG,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Bright Health - commercial,Bright Health - commercial,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,57.11,57.11,Bright Health MGG,Bright Health MGG,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Aetna,Aetna,274,,,,,,,per diem,274,274,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Aetna MGG,Aetna MGG,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,BCBS,BCBS,274,,,,,,,per diem,274,274,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,BCBS MGG,BCBS MGG,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Cigna,Cigna,274,,,,,,,per diem,274,274,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Cigna MGG,Cigna MGG,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Humana,Humana,274,,,,,,,per diem,274,274,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Humana MGG,Humana MGG,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Optum VA,Optum VA,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,UHC,UHC,274,,,,,,,per diem,274,274,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,UHC MGG,UHC MGG,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,VA,VA,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Wellcare MGG,Wellcare MGG,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Bright Health - commercial,Bright Health - commercial,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,274,274,Bright Health MGG,Bright Health MGG,274,,,,,,,case rate,274,274,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Aetna,Aetna,28.93,,,,,,,per diem,28.93,28.93,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Aetna MGG,Aetna MGG,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,BCBS,BCBS,28.93,,,,,,,per diem,28.93,28.93,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,BCBS MGG,BCBS MGG,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Cigna,Cigna,28.93,,,,,,,per diem,28.93,28.93,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Cigna MGG,Cigna MGG,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Humana,Humana,28.93,,,,,,,per diem,28.93,28.93,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Humana MGG,Humana MGG,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Optum VA,Optum VA,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,UHC,UHC,28.93,,,,,,,per diem,28.93,28.93,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,UHC MGG,UHC MGG,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,VA,VA,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Wellcare MGG,Wellcare MGG,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Bright Health - commercial,Bright Health - commercial,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,28.93,28.93,Bright Health MGG,Bright Health MGG,28.93,,,,,,,case rate,28.93,28.93,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Aetna,Aetna,497.99,,,,,,,per diem,497.99,497.99,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Aetna MGG,Aetna MGG,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,BCBS,BCBS,497.99,,,,,,,per diem,497.99,497.99,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,BCBS MGG,BCBS MGG,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Cigna,Cigna,497.99,,,,,,,per diem,497.99,497.99,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Cigna MGG,Cigna MGG,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Humana,Humana,497.99,,,,,,,per diem,497.99,497.99,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Humana MGG,Humana MGG,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Optum VA,Optum VA,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,UHC,UHC,497.99,,,,,,,per diem,497.99,497.99,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,UHC MGG,UHC MGG,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,VA,VA,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Wellcare MGG,Wellcare MGG,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Bright Health - commercial,Bright Health - commercial,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,497.99,497.99,Bright Health MGG,Bright Health MGG,497.99,,,,,,,case rate,497.99,497.99,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Aetna,Aetna,1957.38,,,,,,,per diem,1957.38,1957.38,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Aetna MGG,Aetna MGG,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,BCBS,BCBS,1957.38,,,,,,,per diem,1957.38,1957.38,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,BCBS MGG,BCBS MGG,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Cigna,Cigna,1957.38,,,,,,,per diem,1957.38,1957.38,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Cigna MGG,Cigna MGG,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Humana,Humana,1957.38,,,,,,,per diem,1957.38,1957.38,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Humana MGG,Humana MGG,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Optum VA,Optum VA,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,UHC,UHC,1957.38,,,,,,,per diem,1957.38,1957.38,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,UHC MGG,UHC MGG,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,VA,VA,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Wellcare MGG,Wellcare MGG,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Bright Health - commercial,Bright Health - commercial,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,1957.38,1957.38,Bright Health MGG,Bright Health MGG,1957.38,,,,,,,case rate,1957.38,1957.38,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Aetna,Aetna,1089.91,,,,,,,per diem,1089.91,1089.91,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Aetna MGG,Aetna MGG,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,BCBS,BCBS,1089.91,,,,,,,per diem,1089.91,1089.91,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,BCBS MGG,BCBS MGG,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Cigna,Cigna,1089.91,,,,,,,per diem,1089.91,1089.91,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Cigna MGG,Cigna MGG,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Humana,Humana,1089.91,,,,,,,per diem,1089.91,1089.91,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Humana MGG,Humana MGG,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Optum VA,Optum VA,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,UHC,UHC,1089.91,,,,,,,per diem,1089.91,1089.91,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,UHC MGG,UHC MGG,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,VA,VA,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Wellcare MGG,Wellcare MGG,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Bright Health - commercial,Bright Health - commercial,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1089.91,1089.91,Bright Health MGG,Bright Health MGG,1089.91,,,,,,,case rate,1089.91,1089.91,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Aetna,Aetna,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Aetna MGG,Aetna MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,BCBS,BCBS,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,BCBS MGG,BCBS MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Cigna,Cigna,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Cigna MGG,Cigna MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Humana,Humana,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Humana MGG,Humana MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Optum VA,Optum VA,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,UHC,UHC,4139.16,,,,,,,per diem,4139.16,4139.16,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,UHC MGG,UHC MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,VA,VA,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Wellcare MGG,Wellcare MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Bright Health - commercial,Bright Health - commercial,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4139.16,4139.16,Bright Health MGG,Bright Health MGG,4139.16,,,,,,,case rate,4139.16,4139.16,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Aetna,Aetna,3932.1,,,,,,,per diem,3932.1,3932.1,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Aetna MGG,Aetna MGG,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,BCBS,BCBS,3932.1,,,,,,,per diem,3932.1,3932.1,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,BCBS MGG,BCBS MGG,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Cigna,Cigna,3932.1,,,,,,,per diem,3932.1,3932.1,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Cigna MGG,Cigna MGG,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Humana,Humana,3932.1,,,,,,,per diem,3932.1,3932.1,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Humana MGG,Humana MGG,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Optum VA,Optum VA,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,UHC,UHC,3932.1,,,,,,,per diem,3932.1,3932.1,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,UHC MGG,UHC MGG,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,VA,VA,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Wellcare MGG,Wellcare MGG,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Bright Health - commercial,Bright Health - commercial,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,3932.1,3932.1,Bright Health MGG,Bright Health MGG,3932.1,,,,,,,case rate,3932.1,3932.1,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Aetna,Aetna,2546.94,,,,,,,per diem,2546.94,2546.94,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Aetna MGG,Aetna MGG,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,BCBS,BCBS,2546.94,,,,,,,per diem,2546.94,2546.94,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,BCBS MGG,BCBS MGG,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Cigna,Cigna,2546.94,,,,,,,per diem,2546.94,2546.94,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Cigna MGG,Cigna MGG,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Humana,Humana,2546.94,,,,,,,per diem,2546.94,2546.94,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Humana MGG,Humana MGG,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Optum VA,Optum VA,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,UHC,UHC,2546.94,,,,,,,per diem,2546.94,2546.94,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,UHC MGG,UHC MGG,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,VA,VA,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Wellcare MGG,Wellcare MGG,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Bright Health - commercial,Bright Health - commercial,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2546.94,2546.94,Bright Health MGG,Bright Health MGG,2546.94,,,,,,,case rate,2546.94,2546.94,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Aetna,Aetna,6912.54,,,,,,,per diem,6912.54,6912.54,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Aetna MGG,Aetna MGG,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,BCBS,BCBS,6912.54,,,,,,,per diem,6912.54,6912.54,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,BCBS MGG,BCBS MGG,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Cigna,Cigna,6912.54,,,,,,,per diem,6912.54,6912.54,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Cigna MGG,Cigna MGG,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Humana,Humana,6912.54,,,,,,,per diem,6912.54,6912.54,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Humana MGG,Humana MGG,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Optum VA,Optum VA,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,UHC,UHC,6912.54,,,,,,,per diem,6912.54,6912.54,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,UHC MGG,UHC MGG,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,VA,VA,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Wellcare MGG,Wellcare MGG,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Bright Health - commercial,Bright Health - commercial,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,6912.54,6912.54,Bright Health MGG,Bright Health MGG,6912.54,,,,,,,case rate,6912.54,6912.54,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna,Aetna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna MGG,Aetna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS,BCBS,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS MGG,BCBS MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna,Cigna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna MGG,Cigna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Humana,Humana,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Humana MGG,Humana MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Optum VA,Optum VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,UHC,UHC,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,UHC MGG,UHC MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,VA,VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Wellcare MGG,Wellcare MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health - commercial,Bright Health - commercial,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health MGG,Bright Health MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna,Aetna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna MGG,Aetna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS,BCBS,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS MGG,BCBS MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna,Cigna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna MGG,Cigna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Humana,Humana,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Humana MGG,Humana MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Optum VA,Optum VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,UHC,UHC,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,UHC MGG,UHC MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,VA,VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Wellcare MGG,Wellcare MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health - commercial,Bright Health - commercial,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health MGG,Bright Health MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna,Aetna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna MGG,Aetna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS,BCBS,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS MGG,BCBS MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna,Cigna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna MGG,Cigna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Humana,Humana,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Humana MGG,Humana MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Optum VA,Optum VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,UHC,UHC,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,UHC MGG,UHC MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,VA,VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Wellcare MGG,Wellcare MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health - commercial,Bright Health - commercial,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health MGG,Bright Health MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna,Aetna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna MGG,Aetna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS,BCBS,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS MGG,BCBS MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna,Cigna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna MGG,Cigna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Humana,Humana,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Humana MGG,Humana MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Optum VA,Optum VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,UHC,UHC,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,UHC MGG,UHC MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,VA,VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Wellcare MGG,Wellcare MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health - commercial,Bright Health - commercial,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health MGG,Bright Health MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna,Aetna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Aetna MGG,Aetna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS,BCBS,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,BCBS MGG,BCBS MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna,Cigna,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Cigna MGG,Cigna MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Humana,Humana,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Humana MGG,Humana MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Optum VA,Optum VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,UHC,UHC,4754.22,,,,,,,per diem,4754.22,4754.22,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,UHC MGG,UHC MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,VA,VA,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Wellcare MGG,Wellcare MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health - commercial,Bright Health - commercial,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4754.22,4754.22,Bright Health MGG,Bright Health MGG,4754.22,,,,,,,case rate,4754.22,4754.22,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Aetna,Aetna,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Aetna MGG,Aetna MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,BCBS,BCBS,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,BCBS MGG,BCBS MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Cigna,Cigna,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Cigna MGG,Cigna MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Humana,Humana,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Humana MGG,Humana MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Optum VA,Optum VA,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,UHC,UHC,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,UHC MGG,UHC MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,VA,VA,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Wellcare MGG,Wellcare MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Bright Health - commercial,Bright Health - commercial,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7142.04,7142.04,Bright Health MGG,Bright Health MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Aetna,Aetna,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Aetna MGG,Aetna MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,BCBS,BCBS,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,BCBS MGG,BCBS MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Cigna,Cigna,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Cigna MGG,Cigna MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Humana,Humana,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Humana MGG,Humana MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Optum VA,Optum VA,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,UHC,UHC,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,UHC MGG,UHC MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,VA,VA,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Wellcare MGG,Wellcare MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Bright Health - commercial,Bright Health - commercial,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,5928.24,5928.24,Bright Health MGG,Bright Health MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Aetna,Aetna,2757.06,,,,,,,per diem,2757.06,2757.06,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Aetna MGG,Aetna MGG,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,BCBS,BCBS,2757.06,,,,,,,per diem,2757.06,2757.06,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,BCBS MGG,BCBS MGG,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Cigna,Cigna,2757.06,,,,,,,per diem,2757.06,2757.06,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Cigna MGG,Cigna MGG,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Humana,Humana,2757.06,,,,,,,per diem,2757.06,2757.06,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Humana MGG,Humana MGG,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Optum VA,Optum VA,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,UHC,UHC,2757.06,,,,,,,per diem,2757.06,2757.06,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,UHC MGG,UHC MGG,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,VA,VA,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Wellcare MGG,Wellcare MGG,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Bright Health - commercial,Bright Health - commercial,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,78104,CPT,,,,Inpatient,,,2757.06,2757.06,Bright Health MGG,Bright Health MGG,2757.06,,,,,,,case rate,2757.06,2757.06,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Aetna,Aetna,1305.6,,,,,,,per diem,1305.6,1305.6,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Aetna MGG,Aetna MGG,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,BCBS,BCBS,1305.6,,,,,,,per diem,1305.6,1305.6,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,BCBS MGG,BCBS MGG,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Cigna,Cigna,1305.6,,,,,,,per diem,1305.6,1305.6,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Cigna MGG,Cigna MGG,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Humana,Humana,1305.6,,,,,,,per diem,1305.6,1305.6,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Humana MGG,Humana MGG,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Optum VA,Optum VA,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,UHC,UHC,1305.6,,,,,,,per diem,1305.6,1305.6,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,UHC MGG,UHC MGG,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,VA,VA,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Wellcare MGG,Wellcare MGG,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Bright Health - commercial,Bright Health - commercial,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,78650,CPT,,,,Inpatient,,,1305.6,1305.6,Bright Health MGG,Bright Health MGG,1305.6,,,,,,,case rate,1305.6,1305.6,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Aetna,Aetna,1298.46,,,,,,,per diem,1298.46,1298.46,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Aetna MGG,Aetna MGG,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,BCBS,BCBS,1298.46,,,,,,,per diem,1298.46,1298.46,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,BCBS MGG,BCBS MGG,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Cigna,Cigna,1298.46,,,,,,,per diem,1298.46,1298.46,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Cigna MGG,Cigna MGG,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Humana,Humana,1298.46,,,,,,,per diem,1298.46,1298.46,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Humana MGG,Humana MGG,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Optum VA,Optum VA,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,UHC,UHC,1298.46,,,,,,,per diem,1298.46,1298.46,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,UHC MGG,UHC MGG,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,VA,VA,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Wellcare MGG,Wellcare MGG,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Bright Health - commercial,Bright Health - commercial,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,78645,CPT,,,,Inpatient,,,1298.46,1298.46,Bright Health MGG,Bright Health MGG,1298.46,,,,,,,case rate,1298.46,1298.46,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Aetna,Aetna,3221.16,,,,,,,per diem,3221.16,3221.16,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Aetna MGG,Aetna MGG,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,BCBS,BCBS,3221.16,,,,,,,per diem,3221.16,3221.16,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,BCBS MGG,BCBS MGG,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Cigna,Cigna,3221.16,,,,,,,per diem,3221.16,3221.16,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Cigna MGG,Cigna MGG,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Humana,Humana,3221.16,,,,,,,per diem,3221.16,3221.16,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Humana MGG,Humana MGG,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Optum VA,Optum VA,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,UHC,UHC,3221.16,,,,,,,per diem,3221.16,3221.16,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,UHC MGG,UHC MGG,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,VA,VA,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Wellcare MGG,Wellcare MGG,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Bright Health - commercial,Bright Health - commercial,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,78227,CPT,,,,Inpatient,,,3221.16,3221.16,Bright Health MGG,Bright Health MGG,3221.16,,,,,,,case rate,3221.16,3221.16,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Aetna,Aetna,2617.32,,,,,,,per diem,2617.32,2617.32,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Aetna MGG,Aetna MGG,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,BCBS,BCBS,2617.32,,,,,,,per diem,2617.32,2617.32,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,BCBS MGG,BCBS MGG,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Cigna,Cigna,2617.32,,,,,,,per diem,2617.32,2617.32,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Cigna MGG,Cigna MGG,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Humana,Humana,2617.32,,,,,,,per diem,2617.32,2617.32,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Humana MGG,Humana MGG,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Optum VA,Optum VA,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,UHC,UHC,2617.32,,,,,,,per diem,2617.32,2617.32,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,UHC MGG,UHC MGG,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,VA,VA,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Wellcare MGG,Wellcare MGG,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Bright Health - commercial,Bright Health - commercial,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,78807,CPT,,,,Inpatient,,,2617.32,2617.32,Bright Health MGG,Bright Health MGG,2617.32,,,,,,,case rate,2617.32,2617.32,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Aetna,Aetna,2614.26,,,,,,,per diem,2614.26,2614.26,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Aetna MGG,Aetna MGG,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,BCBS,BCBS,2614.26,,,,,,,per diem,2614.26,2614.26,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,BCBS MGG,BCBS MGG,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Cigna,Cigna,2614.26,,,,,,,per diem,2614.26,2614.26,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Cigna MGG,Cigna MGG,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Humana,Humana,2614.26,,,,,,,per diem,2614.26,2614.26,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Humana MGG,Humana MGG,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Optum VA,Optum VA,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,UHC,UHC,2614.26,,,,,,,per diem,2614.26,2614.26,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,UHC MGG,UHC MGG,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,VA,VA,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Wellcare MGG,Wellcare MGG,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Bright Health - commercial,Bright Health - commercial,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,77778,CPT,,,,Inpatient,,,2614.26,2614.26,Bright Health MGG,Bright Health MGG,2614.26,,,,,,,case rate,2614.26,2614.26,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Aetna,Aetna,14939.94,,,,,,,per diem,14939.94,14939.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Aetna MGG,Aetna MGG,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,BCBS,BCBS,14939.94,,,,,,,per diem,14939.94,14939.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,BCBS MGG,BCBS MGG,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Cigna,Cigna,14939.94,,,,,,,per diem,14939.94,14939.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Cigna MGG,Cigna MGG,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Humana,Humana,14939.94,,,,,,,per diem,14939.94,14939.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Humana MGG,Humana MGG,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Optum VA,Optum VA,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,UHC,UHC,14939.94,,,,,,,per diem,14939.94,14939.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,UHC MGG,UHC MGG,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,VA,VA,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Wellcare MGG,Wellcare MGG,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Bright Health - commercial,Bright Health - commercial,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,A9508,CPT,,,,Inpatient,,,14939.94,14939.94,Bright Health MGG,Bright Health MGG,14939.94,,,,,,,case rate,14939.94,14939.94,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Aetna,Aetna,5297.88,,,,,,,per diem,5297.88,5297.88,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Aetna MGG,Aetna MGG,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,BCBS,BCBS,5297.88,,,,,,,per diem,5297.88,5297.88,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,BCBS MGG,BCBS MGG,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Cigna,Cigna,5297.88,,,,,,,per diem,5297.88,5297.88,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Cigna MGG,Cigna MGG,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Humana,Humana,5297.88,,,,,,,per diem,5297.88,5297.88,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Humana MGG,Humana MGG,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Optum VA,Optum VA,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,UHC,UHC,5297.88,,,,,,,per diem,5297.88,5297.88,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,UHC MGG,UHC MGG,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,VA,VA,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Wellcare MGG,Wellcare MGG,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Bright Health - commercial,Bright Health - commercial,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,78709,CPT,,,,Inpatient,,,5297.88,5297.88,Bright Health MGG,Bright Health MGG,5297.88,,,,,,,case rate,5297.88,5297.88,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Aetna,Aetna,2521.44,,,,,,,per diem,2521.44,2521.44,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Aetna MGG,Aetna MGG,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,BCBS,BCBS,2521.44,,,,,,,per diem,2521.44,2521.44,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,BCBS MGG,BCBS MGG,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Cigna,Cigna,2521.44,,,,,,,per diem,2521.44,2521.44,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Cigna MGG,Cigna MGG,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Humana,Humana,2521.44,,,,,,,per diem,2521.44,2521.44,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Humana MGG,Humana MGG,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Optum VA,Optum VA,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,UHC,UHC,2521.44,,,,,,,per diem,2521.44,2521.44,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,UHC MGG,UHC MGG,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,VA,VA,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Wellcare MGG,Wellcare MGG,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Bright Health - commercial,Bright Health - commercial,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,78700,CPT,,,,Inpatient,,,2521.44,2521.44,Bright Health MGG,Bright Health MGG,2521.44,,,,,,,case rate,2521.44,2521.44,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Aetna,Aetna,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Aetna MGG,Aetna MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,BCBS,BCBS,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,BCBS MGG,BCBS MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Cigna,Cigna,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Cigna MGG,Cigna MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Humana,Humana,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Humana MGG,Humana MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Optum VA,Optum VA,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,UHC,UHC,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,UHC MGG,UHC MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,VA,VA,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Wellcare MGG,Wellcare MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Bright Health - commercial,Bright Health - commercial,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,78206,CPT,,,,Inpatient,,,1715.64,1715.64,Bright Health MGG,Bright Health MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Aetna,Aetna,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Aetna MGG,Aetna MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,BCBS,BCBS,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,BCBS MGG,BCBS MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Cigna,Cigna,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Cigna MGG,Cigna MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Humana,Humana,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Humana MGG,Humana MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Optum VA,Optum VA,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,UHC,UHC,1715.64,,,,,,,per diem,1715.64,1715.64,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,UHC MGG,UHC MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,VA,VA,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Wellcare MGG,Wellcare MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Bright Health - commercial,Bright Health - commercial,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,78202,CPT,,,,Inpatient,,,1715.64,1715.64,Bright Health MGG,Bright Health MGG,1715.64,,,,,,,case rate,1715.64,1715.64,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Aetna,Aetna,6383.16,,,,,,,per diem,6383.16,6383.16,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Aetna MGG,Aetna MGG,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,BCBS,BCBS,6383.16,,,,,,,per diem,6383.16,6383.16,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,BCBS MGG,BCBS MGG,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Cigna,Cigna,6383.16,,,,,,,per diem,6383.16,6383.16,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Cigna MGG,Cigna MGG,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Humana,Humana,6383.16,,,,,,,per diem,6383.16,6383.16,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Humana MGG,Humana MGG,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Optum VA,Optum VA,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,UHC,UHC,6383.16,,,,,,,per diem,6383.16,6383.16,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,UHC MGG,UHC MGG,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,VA,VA,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Wellcare MGG,Wellcare MGG,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Bright Health - commercial,Bright Health - commercial,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,78195,CPT,,,,Inpatient,,,6383.16,6383.16,Bright Health MGG,Bright Health MGG,6383.16,,,,,,,case rate,6383.16,6383.16,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Aetna,Aetna,3340.5,,,,,,,per diem,3340.5,3340.5,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Aetna MGG,Aetna MGG,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,BCBS,BCBS,3340.5,,,,,,,per diem,3340.5,3340.5,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,BCBS MGG,BCBS MGG,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Cigna,Cigna,3340.5,,,,,,,per diem,3340.5,3340.5,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Cigna MGG,Cigna MGG,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Humana,Humana,3340.5,,,,,,,per diem,3340.5,3340.5,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Humana MGG,Humana MGG,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Optum VA,Optum VA,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,UHC,UHC,3340.5,,,,,,,per diem,3340.5,3340.5,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,UHC MGG,UHC MGG,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,VA,VA,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Wellcare MGG,Wellcare MGG,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Bright Health - commercial,Bright Health - commercial,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,79403,CPT,,,,Inpatient,,,3340.5,3340.5,Bright Health MGG,Bright Health MGG,3340.5,,,,,,,case rate,3340.5,3340.5,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Aetna,Aetna,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Aetna MGG,Aetna MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,BCBS,BCBS,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,BCBS MGG,BCBS MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Cigna,Cigna,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Cigna MGG,Cigna MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Humana,Humana,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Humana MGG,Humana MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Optum VA,Optum VA,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,UHC,UHC,7142.04,,,,,,,per diem,7142.04,7142.04,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,UHC MGG,UHC MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,VA,VA,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Wellcare MGG,Wellcare MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Bright Health - commercial,Bright Health - commercial,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,78454,CPT,,,,Inpatient,,,7142.04,7142.04,Bright Health MGG,Bright Health MGG,7142.04,,,,,,,case rate,7142.04,7142.04,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Aetna,Aetna,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Aetna MGG,Aetna MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,BCBS,BCBS,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,BCBS MGG,BCBS MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Cigna,Cigna,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Cigna MGG,Cigna MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Humana,Humana,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Humana MGG,Humana MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Optum VA,Optum VA,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,UHC,UHC,5928.24,,,,,,,per diem,5928.24,5928.24,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,UHC MGG,UHC MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,VA,VA,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Wellcare MGG,Wellcare MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Bright Health - commercial,Bright Health - commercial,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,78453,CPT,,,,Inpatient,,,5928.24,5928.24,Bright Health MGG,Bright Health MGG,5928.24,,,,,,,case rate,5928.24,5928.24,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Aetna,Aetna,2036.94,,,,,,,per diem,2036.94,2036.94,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Aetna MGG,Aetna MGG,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,BCBS,BCBS,2036.94,,,,,,,per diem,2036.94,2036.94,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,BCBS MGG,BCBS MGG,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Cigna,Cigna,2036.94,,,,,,,per diem,2036.94,2036.94,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Cigna MGG,Cigna MGG,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Humana,Humana,2036.94,,,,,,,per diem,2036.94,2036.94,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Humana MGG,Humana MGG,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Optum VA,Optum VA,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,UHC,UHC,2036.94,,,,,,,per diem,2036.94,2036.94,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,UHC MGG,UHC MGG,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,VA,VA,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Wellcare MGG,Wellcare MGG,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Bright Health - commercial,Bright Health - commercial,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,78466,CPT,,,,Inpatient,,,2036.94,2036.94,Bright Health MGG,Bright Health MGG,2036.94,,,,,,,case rate,2036.94,2036.94,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Aetna,Aetna,1314.78,,,,,,,per diem,1314.78,1314.78,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Aetna MGG,Aetna MGG,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,BCBS,BCBS,1314.78,,,,,,,per diem,1314.78,1314.78,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,BCBS MGG,BCBS MGG,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Cigna,Cigna,1314.78,,,,,,,per diem,1314.78,1314.78,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Cigna MGG,Cigna MGG,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Humana,Humana,1314.78,,,,,,,per diem,1314.78,1314.78,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Humana MGG,Humana MGG,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Optum VA,Optum VA,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,UHC,UHC,1314.78,,,,,,,per diem,1314.78,1314.78,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,UHC MGG,UHC MGG,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,VA,VA,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Wellcare MGG,Wellcare MGG,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Bright Health - commercial,Bright Health - commercial,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,78291,CPT,,,,Inpatient,,,1314.78,1314.78,Bright Health MGG,Bright Health MGG,1314.78,,,,,,,case rate,1314.78,1314.78,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Aetna,Aetna,5460.06,,,,,,,per diem,5460.06,5460.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Aetna MGG,Aetna MGG,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,BCBS,BCBS,5460.06,,,,,,,per diem,5460.06,5460.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,BCBS MGG,BCBS MGG,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Cigna,Cigna,5460.06,,,,,,,per diem,5460.06,5460.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Cigna MGG,Cigna MGG,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Humana,Humana,5460.06,,,,,,,per diem,5460.06,5460.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Humana MGG,Humana MGG,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Optum VA,Optum VA,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,UHC,UHC,5460.06,,,,,,,per diem,5460.06,5460.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,UHC MGG,UHC MGG,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,VA,VA,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Wellcare MGG,Wellcare MGG,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Bright Health - commercial,Bright Health - commercial,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,A9512,CPT,,,,Inpatient,,,5460.06,5460.06,Bright Health MGG,Bright Health MGG,5460.06,,,,,,,case rate,5460.06,5460.06,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Aetna,Aetna,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Aetna MGG,Aetna MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,BCBS,BCBS,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,BCBS MGG,BCBS MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Cigna,Cigna,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Cigna MGG,Cigna MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Humana,Humana,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Humana MGG,Humana MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Optum VA,Optum VA,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,UHC,UHC,2464.32,,,,,,,per diem,2464.32,2464.32,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,UHC MGG,UHC MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,VA,VA,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Wellcare MGG,Wellcare MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Bright Health - commercial,Bright Health - commercial,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,78597,CPT,,,,Inpatient,,,2464.32,2464.32,Bright Health MGG,Bright Health MGG,2464.32,,,,,,,case rate,2464.32,2464.32,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Aetna,Aetna,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Aetna MGG,Aetna MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,BCBS,BCBS,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,BCBS MGG,BCBS MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Cigna,Cigna,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Cigna MGG,Cigna MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Humana,Humana,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Humana MGG,Humana MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Optum VA,Optum VA,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,UHC,UHC,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,UHC MGG,UHC MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,VA,VA,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Wellcare MGG,Wellcare MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Bright Health - commercial,Bright Health - commercial,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,79445,CPT,,,,Inpatient,,,1466.76,1466.76,Bright Health MGG,Bright Health MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Aetna,Aetna,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Aetna MGG,Aetna MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,BCBS,BCBS,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,BCBS MGG,BCBS MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Cigna,Cigna,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Cigna MGG,Cigna MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Humana,Humana,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Humana MGG,Humana MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Optum VA,Optum VA,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,UHC,UHC,1466.76,,,,,,,per diem,1466.76,1466.76,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,UHC MGG,UHC MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,VA,VA,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Wellcare MGG,Wellcare MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Bright Health - commercial,Bright Health - commercial,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,79101,CPT,,,,Inpatient,,,1466.76,1466.76,Bright Health MGG,Bright Health MGG,1466.76,,,,,,,case rate,1466.76,1466.76,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Aetna,Aetna,1.02,,,,,,,per diem,1.02,1.02,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Aetna MGG,Aetna MGG,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,BCBS,BCBS,1.02,,,,,,,per diem,1.02,1.02,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,BCBS MGG,BCBS MGG,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Cigna,Cigna,1.02,,,,,,,per diem,1.02,1.02,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Cigna MGG,Cigna MGG,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Humana,Humana,1.02,,,,,,,per diem,1.02,1.02,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Humana MGG,Humana MGG,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Optum VA,Optum VA,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,UHC,UHC,1.02,,,,,,,per diem,1.02,1.02,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,UHC MGG,UHC MGG,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,VA,VA,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Wellcare MGG,Wellcare MGG,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Bright Health - commercial,Bright Health - commercial,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,C9898,CPT,,,,Inpatient,,,1.02,1.02,Bright Health MGG,Bright Health MGG,1.02,,,,,,,case rate,1.02,1.02,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Aetna,Aetna,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Aetna MGG,Aetna MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,BCBS,BCBS,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,BCBS MGG,BCBS MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Cigna,Cigna,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Cigna MGG,Cigna MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Humana,Humana,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Humana MGG,Humana MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Optum VA,Optum VA,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,UHC,UHC,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,UHC MGG,UHC MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,VA,VA,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Wellcare MGG,Wellcare MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Bright Health - commercial,Bright Health - commercial,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,78761,CPT,,,,Inpatient,,,835.38,835.38,Bright Health MGG,Bright Health MGG,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Aetna,Aetna,1290.3,,,,,,,per diem,1290.3,1290.3,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Aetna MGG,Aetna MGG,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,BCBS,BCBS,1290.3,,,,,,,per diem,1290.3,1290.3,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,BCBS MGG,BCBS MGG,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Cigna,Cigna,1290.3,,,,,,,per diem,1290.3,1290.3,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Cigna MGG,Cigna MGG,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Humana,Humana,1290.3,,,,,,,per diem,1290.3,1290.3,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Humana MGG,Humana MGG,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Optum VA,Optum VA,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,UHC,UHC,1290.3,,,,,,,per diem,1290.3,1290.3,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,UHC MGG,UHC MGG,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,VA,VA,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Wellcare MGG,Wellcare MGG,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Bright Health - commercial,Bright Health - commercial,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,78015,CPT,,,,Inpatient,,,1290.3,1290.3,Bright Health MGG,Bright Health MGG,1290.3,,,,,,,case rate,1290.3,1290.3,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Aetna,Aetna,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Aetna MGG,Aetna MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,BCBS,BCBS,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,BCBS MGG,BCBS MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Cigna,Cigna,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Cigna MGG,Cigna MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Humana,Humana,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Humana MGG,Humana MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Optum VA,Optum VA,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,UHC,UHC,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,UHC MGG,UHC MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,VA,VA,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Wellcare MGG,Wellcare MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Bright Health - commercial,Bright Health - commercial,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,78018,CPT,,,,Inpatient,,,1870.68,1870.68,Bright Health MGG,Bright Health MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Aetna,Aetna,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Aetna MGG,Aetna MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,BCBS,BCBS,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,BCBS MGG,BCBS MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Cigna,Cigna,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Cigna MGG,Cigna MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Humana,Humana,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Humana MGG,Humana MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Optum VA,Optum VA,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,UHC,UHC,1326,,,,,,,per diem,1326,1326,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,UHC MGG,UHC MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,VA,VA,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Wellcare MGG,Wellcare MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Bright Health - commercial,Bright Health - commercial,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,78014,CPT,,,,Inpatient,,,1326,1326,Bright Health MGG,Bright Health MGG,1326,,,,,,,case rate,1326,1326,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Aetna,Aetna,1047.54,,,,,,,per diem,1047.54,1047.54,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Aetna MGG,Aetna MGG,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,BCBS,BCBS,1047.54,,,,,,,per diem,1047.54,1047.54,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,BCBS MGG,BCBS MGG,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Cigna,Cigna,1047.54,,,,,,,per diem,1047.54,1047.54,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Cigna MGG,Cigna MGG,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Humana,Humana,1047.54,,,,,,,per diem,1047.54,1047.54,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Humana MGG,Humana MGG,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Optum VA,Optum VA,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,UHC,UHC,1047.54,,,,,,,per diem,1047.54,1047.54,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,UHC MGG,UHC MGG,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,VA,VA,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Wellcare MGG,Wellcare MGG,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Bright Health - commercial,Bright Health - commercial,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,78013,CPT,,,,Inpatient,,,1047.54,1047.54,Bright Health MGG,Bright Health MGG,1047.54,,,,,,,case rate,1047.54,1047.54,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Aetna,Aetna,653.82,,,,,,,per diem,653.82,653.82,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Aetna MGG,Aetna MGG,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,BCBS,BCBS,653.82,,,,,,,per diem,653.82,653.82,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,BCBS MGG,BCBS MGG,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Cigna,Cigna,653.82,,,,,,,per diem,653.82,653.82,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Cigna MGG,Cigna MGG,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Humana,Humana,653.82,,,,,,,per diem,653.82,653.82,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Humana MGG,Humana MGG,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Optum VA,Optum VA,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,UHC,UHC,653.82,,,,,,,per diem,653.82,653.82,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,UHC MGG,UHC MGG,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,VA,VA,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Wellcare MGG,Wellcare MGG,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Bright Health - commercial,Bright Health - commercial,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,78012,CPT,,,,Inpatient,,,653.82,653.82,Bright Health MGG,Bright Health MGG,653.82,,,,,,,case rate,653.82,653.82,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Aetna,Aetna,2276.64,,,,,,,per diem,2276.64,2276.64,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Aetna MGG,Aetna MGG,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,BCBS,BCBS,2276.64,,,,,,,per diem,2276.64,2276.64,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,BCBS MGG,BCBS MGG,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Cigna,Cigna,2276.64,,,,,,,per diem,2276.64,2276.64,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Cigna MGG,Cigna MGG,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Humana,Humana,2276.64,,,,,,,per diem,2276.64,2276.64,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Humana MGG,Humana MGG,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Optum VA,Optum VA,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,UHC,UHC,2276.64,,,,,,,per diem,2276.64,2276.64,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,UHC MGG,UHC MGG,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,VA,VA,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Wellcare MGG,Wellcare MGG,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Bright Health - commercial,Bright Health - commercial,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,78800,CPT,,,,Inpatient,,,2276.64,2276.64,Bright Health MGG,Bright Health MGG,2276.64,,,,,,,case rate,2276.64,2276.64,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Aetna,Aetna,1423.92,,,,,,,per diem,1423.92,1423.92,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Aetna MGG,Aetna MGG,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,BCBS,BCBS,1423.92,,,,,,,per diem,1423.92,1423.92,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,BCBS MGG,BCBS MGG,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Cigna,Cigna,1423.92,,,,,,,per diem,1423.92,1423.92,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Cigna MGG,Cigna MGG,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Humana,Humana,1423.92,,,,,,,per diem,1423.92,1423.92,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Humana MGG,Humana MGG,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Optum VA,Optum VA,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,UHC,UHC,1423.92,,,,,,,per diem,1423.92,1423.92,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,UHC MGG,UHC MGG,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,VA,VA,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Wellcare MGG,Wellcare MGG,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Bright Health - commercial,Bright Health - commercial,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,78267,CPT,,,,Inpatient,,,1423.92,1423.92,Bright Health MGG,Bright Health MGG,1423.92,,,,,,,case rate,1423.92,1423.92,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Aetna,Aetna,825.18,,,,,,,per diem,825.18,825.18,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Aetna MGG,Aetna MGG,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,BCBS,BCBS,825.18,,,,,,,per diem,825.18,825.18,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,BCBS MGG,BCBS MGG,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Cigna,Cigna,825.18,,,,,,,per diem,825.18,825.18,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Cigna MGG,Cigna MGG,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Humana,Humana,825.18,,,,,,,per diem,825.18,825.18,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Humana MGG,Humana MGG,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Optum VA,Optum VA,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,UHC,UHC,825.18,,,,,,,per diem,825.18,825.18,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,UHC MGG,UHC MGG,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,VA,VA,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Wellcare MGG,Wellcare MGG,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Bright Health - commercial,Bright Health - commercial,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,A9539,CPT,,,,Inpatient,,,825.18,825.18,Bright Health MGG,Bright Health MGG,825.18,,,,,,,case rate,825.18,825.18,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Aetna,Aetna,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Aetna MGG,Aetna MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,BCBS,BCBS,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,BCBS MGG,BCBS MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Cigna,Cigna,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Cigna MGG,Cigna MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Humana,Humana,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Humana MGG,Humana MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Optum VA,Optum VA,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,UHC,UHC,590.58,,,,,,,per diem,590.58,590.58,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,UHC MGG,UHC MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,VA,VA,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Wellcare MGG,Wellcare MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Bright Health - commercial,Bright Health - commercial,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,A9538,CPT,,,,Inpatient,,,590.58,590.58,Bright Health MGG,Bright Health MGG,590.58,,,,,,,case rate,590.58,590.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Aetna,Aetna,488.58,,,,,,,per diem,488.58,488.58,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Aetna MGG,Aetna MGG,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,BCBS,BCBS,488.58,,,,,,,per diem,488.58,488.58,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,BCBS MGG,BCBS MGG,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Cigna,Cigna,488.58,,,,,,,per diem,488.58,488.58,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Cigna MGG,Cigna MGG,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Humana,Humana,488.58,,,,,,,per diem,488.58,488.58,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Humana MGG,Humana MGG,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Optum VA,Optum VA,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,UHC,UHC,488.58,,,,,,,per diem,488.58,488.58,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,UHC MGG,UHC MGG,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,VA,VA,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Wellcare MGG,Wellcare MGG,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Bright Health - commercial,Bright Health - commercial,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,A9500,CPT,,,,Inpatient,,,488.58,488.58,Bright Health MGG,Bright Health MGG,488.58,,,,,,,case rate,488.58,488.58,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Aetna,Aetna,2448,,,,,,,per diem,2448,2448,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Aetna MGG,Aetna MGG,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,BCBS,BCBS,2448,,,,,,,per diem,2448,2448,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,BCBS MGG,BCBS MGG,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Cigna,Cigna,2448,,,,,,,per diem,2448,2448,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Cigna MGG,Cigna MGG,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Humana,Humana,2448,,,,,,,per diem,2448,2448,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Humana MGG,Humana MGG,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Optum VA,Optum VA,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,UHC,UHC,2448,,,,,,,per diem,2448,2448,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,UHC MGG,UHC MGG,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,VA,VA,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Wellcare MGG,Wellcare MGG,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Bright Health - commercial,Bright Health - commercial,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,77290,CPT,,,,Inpatient,,,2448,2448,Bright Health MGG,Bright Health MGG,2448,,,,,,,case rate,2448,2448,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Aetna,Aetna,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Aetna MGG,Aetna MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,BCBS,BCBS,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,BCBS MGG,BCBS MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Cigna,Cigna,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Cigna MGG,Cigna MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Humana,Humana,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Humana MGG,Humana MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Optum VA,Optum VA,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,UHC,UHC,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,UHC MGG,UHC MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,VA,VA,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Wellcare MGG,Wellcare MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Bright Health - commercial,Bright Health - commercial,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,J2805,CPT,,,,Inpatient,1,EA,2995.74,2995.74,Bright Health MGG,Bright Health MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Aetna,Aetna,39834.06,,,,,,,per diem,39834.06,39834.06,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Aetna MGG,Aetna MGG,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,BCBS,BCBS,39834.06,,,,,,,per diem,39834.06,39834.06,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,BCBS MGG,BCBS MGG,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Cigna,Cigna,39834.06,,,,,,,per diem,39834.06,39834.06,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Cigna MGG,Cigna MGG,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Humana,Humana,39834.06,,,,,,,per diem,39834.06,39834.06,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Humana MGG,Humana MGG,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Optum VA,Optum VA,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,UHC,UHC,39834.06,,,,,,,per diem,39834.06,39834.06,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,UHC MGG,UHC MGG,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,VA,VA,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Wellcare MGG,Wellcare MGG,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Bright Health - commercial,Bright Health - commercial,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,A9604,CPT,,,,Inpatient,,,39834.06,39834.06,Bright Health MGG,Bright Health MGG,39834.06,,,,,,,case rate,39834.06,39834.06,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Aetna,Aetna,4218.72,,,,,,,per diem,4218.72,4218.72,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Aetna MGG,Aetna MGG,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,BCBS,BCBS,4218.72,,,,,,,per diem,4218.72,4218.72,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,BCBS MGG,BCBS MGG,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Cigna,Cigna,4218.72,,,,,,,per diem,4218.72,4218.72,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Cigna MGG,Cigna MGG,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Humana,Humana,4218.72,,,,,,,per diem,4218.72,4218.72,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Humana MGG,Humana MGG,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Optum VA,Optum VA,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,UHC,UHC,4218.72,,,,,,,per diem,4218.72,4218.72,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,UHC MGG,UHC MGG,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,VA,VA,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Wellcare MGG,Wellcare MGG,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Bright Health - commercial,Bright Health - commercial,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,77470,CPT,,,,Inpatient,,,4218.72,4218.72,Bright Health MGG,Bright Health MGG,4218.72,,,,,,,case rate,4218.72,4218.72,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Aetna,Aetna,37014.78,,,,,,,per diem,37014.78,37014.78,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Aetna MGG,Aetna MGG,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,BCBS,BCBS,37014.78,,,,,,,per diem,37014.78,37014.78,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,BCBS MGG,BCBS MGG,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Cigna,Cigna,37014.78,,,,,,,per diem,37014.78,37014.78,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Cigna MGG,Cigna MGG,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Humana,Humana,37014.78,,,,,,,per diem,37014.78,37014.78,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Humana MGG,Humana MGG,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Optum VA,Optum VA,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,UHC,UHC,37014.78,,,,,,,per diem,37014.78,37014.78,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,UHC MGG,UHC MGG,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,VA,VA,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Wellcare MGG,Wellcare MGG,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Bright Health - commercial,Bright Health - commercial,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,A9600,CPT,,,,Inpatient,,,37014.78,37014.78,Bright Health MGG,Bright Health MGG,37014.78,,,,,,,case rate,37014.78,37014.78,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Aetna,Aetna,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Aetna MGG,Aetna MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,BCBS,BCBS,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,BCBS MGG,BCBS MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Cigna,Cigna,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Cigna MGG,Cigna MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Humana,Humana,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Humana MGG,Humana MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Optum VA,Optum VA,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,UHC,UHC,1870.68,,,,,,,per diem,1870.68,1870.68,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,UHC MGG,UHC MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,VA,VA,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Wellcare MGG,Wellcare MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Bright Health - commercial,Bright Health - commercial,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,A9551,CPT,,,,Inpatient,,,1870.68,1870.68,Bright Health MGG,Bright Health MGG,1870.68,,,,,,,case rate,1870.68,1870.68,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Aetna,Aetna,944.52,,,,,,,per diem,944.52,944.52,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Aetna MGG,Aetna MGG,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,BCBS,BCBS,944.52,,,,,,,per diem,944.52,944.52,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,BCBS MGG,BCBS MGG,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Cigna,Cigna,944.52,,,,,,,per diem,944.52,944.52,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Cigna MGG,Cigna MGG,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Humana,Humana,944.52,,,,,,,per diem,944.52,944.52,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Humana MGG,Humana MGG,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Optum VA,Optum VA,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,UHC,UHC,944.52,,,,,,,per diem,944.52,944.52,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,UHC MGG,UHC MGG,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,VA,VA,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Wellcare MGG,Wellcare MGG,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Bright Health - commercial,Bright Health - commercial,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,A9541,CPT,,,,Inpatient,,,944.52,944.52,Bright Health MGG,Bright Health MGG,944.52,,,,,,,case rate,944.52,944.52,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Aetna,Aetna,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Aetna MGG,Aetna MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,BCBS,BCBS,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,BCBS MGG,BCBS MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Cigna,Cigna,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Cigna MGG,Cigna MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Humana,Humana,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Humana MGG,Humana MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Optum VA,Optum VA,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,UHC,UHC,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,UHC MGG,UHC MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,VA,VA,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Wellcare MGG,Wellcare MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Bright Health - commercial,Bright Health - commercial,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,77790,CPT,,,,Inpatient,,,257.04,257.04,Bright Health MGG,Bright Health MGG,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Aetna,Aetna,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Aetna MGG,Aetna MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,BCBS,BCBS,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,BCBS MGG,BCBS MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Cigna,Cigna,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Cigna MGG,Cigna MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Humana,Humana,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Humana MGG,Humana MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Optum VA,Optum VA,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,UHC,UHC,132.6,,,,,,,per diem,132.6,132.6,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,UHC MGG,UHC MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,VA,VA,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Wellcare MGG,Wellcare MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Bright Health - commercial,Bright Health - commercial,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,A9505,CPT,,,,Inpatient,,,132.6,132.6,Bright Health MGG,Bright Health MGG,132.6,,,,,,,case rate,132.6,132.6,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Aetna,Aetna,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Aetna MGG,Aetna MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,BCBS,BCBS,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,BCBS MGG,BCBS MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Cigna,Cigna,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Cigna MGG,Cigna MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Humana,Humana,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Humana MGG,Humana MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Optum VA,Optum VA,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,UHC,UHC,2176.68,,,,,,,per diem,2176.68,2176.68,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,UHC MGG,UHC MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,VA,VA,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Wellcare MGG,Wellcare MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Bright Health - commercial,Bright Health - commercial,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,76873,CPT,,,,Inpatient,,,2176.68,2176.68,Bright Health MGG,Bright Health MGG,2176.68,,,,,,,case rate,2176.68,2176.68,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Aetna,Aetna,937.38,,,,,,,per diem,937.38,937.38,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Aetna MGG,Aetna MGG,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,BCBS,BCBS,937.38,,,,,,,per diem,937.38,937.38,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,BCBS MGG,BCBS MGG,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Cigna,Cigna,937.38,,,,,,,per diem,937.38,937.38,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Cigna MGG,Cigna MGG,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Humana,Humana,937.38,,,,,,,per diem,937.38,937.38,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Humana MGG,Humana MGG,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Optum VA,Optum VA,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,UHC,UHC,937.38,,,,,,,per diem,937.38,937.38,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,UHC MGG,UHC MGG,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,VA,VA,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Wellcare MGG,Wellcare MGG,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Bright Health - commercial,Bright Health - commercial,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,A9558,CPT,,,,Inpatient,,,937.38,937.38,Bright Health MGG,Bright Health MGG,937.38,,,,,,,case rate,937.38,937.38,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Aetna,Aetna,5401.92,,,,,,,per diem,5401.92,5401.92,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Aetna MGG,Aetna MGG,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,BCBS,BCBS,5401.92,,,,,,,per diem,5401.92,5401.92,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,BCBS MGG,BCBS MGG,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Cigna,Cigna,5401.92,,,,,,,per diem,5401.92,5401.92,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Cigna MGG,Cigna MGG,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Humana,Humana,5401.92,,,,,,,per diem,5401.92,5401.92,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Humana MGG,Humana MGG,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Optum VA,Optum VA,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,UHC,UHC,5401.92,,,,,,,per diem,5401.92,5401.92,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,UHC MGG,UHC MGG,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,VA,VA,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Wellcare MGG,Wellcare MGG,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Bright Health - commercial,Bright Health - commercial,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,A9504,CPT,,,,Inpatient,,,5401.92,5401.92,Bright Health MGG,Bright Health MGG,5401.92,,,,,,,case rate,5401.92,5401.92,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Aetna,Aetna,15064.38,,,,,,,per diem,15064.38,15064.38,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Aetna MGG,Aetna MGG,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,BCBS,BCBS,15064.38,,,,,,,per diem,15064.38,15064.38,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,BCBS MGG,BCBS MGG,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Cigna,Cigna,15064.38,,,,,,,per diem,15064.38,15064.38,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Cigna MGG,Cigna MGG,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Humana,Humana,15064.38,,,,,,,per diem,15064.38,15064.38,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Humana MGG,Humana MGG,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Optum VA,Optum VA,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,UHC,UHC,15064.38,,,,,,,per diem,15064.38,15064.38,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,UHC MGG,UHC MGG,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,VA,VA,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Wellcare MGG,Wellcare MGG,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Bright Health - commercial,Bright Health - commercial,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,A9568,CPT,,,,Inpatient,,,15064.38,15064.38,Bright Health MGG,Bright Health MGG,15064.38,,,,,,,case rate,15064.38,15064.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Aetna,Aetna,4372.74,,,,,,,per diem,4372.74,4372.74,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Aetna MGG,Aetna MGG,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,BCBS,BCBS,4372.74,,,,,,,per diem,4372.74,4372.74,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,BCBS MGG,BCBS MGG,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Cigna,Cigna,4372.74,,,,,,,per diem,4372.74,4372.74,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Cigna MGG,Cigna MGG,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Humana,Humana,4372.74,,,,,,,per diem,4372.74,4372.74,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Humana MGG,Humana MGG,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Optum VA,Optum VA,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,UHC,UHC,4372.74,,,,,,,per diem,4372.74,4372.74,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,UHC MGG,UHC MGG,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,VA,VA,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Wellcare MGG,Wellcare MGG,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Bright Health - commercial,Bright Health - commercial,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,A9557,CPT,,,,Inpatient,,,4372.74,4372.74,Bright Health MGG,Bright Health MGG,4372.74,,,,,,,case rate,4372.74,4372.74,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Aetna,Aetna,7698.96,,,,,,,per diem,7698.96,7698.96,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Aetna MGG,Aetna MGG,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,BCBS,BCBS,7698.96,,,,,,,per diem,7698.96,7698.96,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,BCBS MGG,BCBS MGG,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Cigna,Cigna,7698.96,,,,,,,per diem,7698.96,7698.96,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Cigna MGG,Cigna MGG,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Humana,Humana,7698.96,,,,,,,per diem,7698.96,7698.96,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Humana MGG,Humana MGG,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Optum VA,Optum VA,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,UHC,UHC,7698.96,,,,,,,per diem,7698.96,7698.96,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,UHC MGG,UHC MGG,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,VA,VA,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Wellcare MGG,Wellcare MGG,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Bright Health - commercial,Bright Health - commercial,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,A9536,CPT,,,,Inpatient,,,7698.96,7698.96,Bright Health MGG,Bright Health MGG,7698.96,,,,,,,case rate,7698.96,7698.96,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Aetna,Aetna,2468.4,,,,,,,per diem,2468.4,2468.4,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Aetna MGG,Aetna MGG,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,BCBS,BCBS,2468.4,,,,,,,per diem,2468.4,2468.4,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,BCBS MGG,BCBS MGG,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Cigna,Cigna,2468.4,,,,,,,per diem,2468.4,2468.4,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Cigna MGG,Cigna MGG,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Humana,Humana,2468.4,,,,,,,per diem,2468.4,2468.4,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Humana MGG,Humana MGG,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Optum VA,Optum VA,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,UHC,UHC,2468.4,,,,,,,per diem,2468.4,2468.4,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,UHC MGG,UHC MGG,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,VA,VA,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Wellcare MGG,Wellcare MGG,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Bright Health - commercial,Bright Health - commercial,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,A9521,CPT,,,,Inpatient,,,2468.4,2468.4,Bright Health MGG,Bright Health MGG,2468.4,,,,,,,case rate,2468.4,2468.4,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Aetna,Aetna,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Aetna MGG,Aetna MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,BCBS,BCBS,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,BCBS MGG,BCBS MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Cigna,Cigna,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Cigna MGG,Cigna MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Humana,Humana,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Humana MGG,Humana MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Optum VA,Optum VA,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,UHC,UHC,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,UHC MGG,UHC MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,VA,VA,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Wellcare MGG,Wellcare MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Bright Health - commercial,Bright Health - commercial,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,A9556,CPT,,,,Inpatient,,,57.12,57.12,Bright Health MGG,Bright Health MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Aetna,Aetna,705.84,,,,,,,per diem,705.84,705.84,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Aetna MGG,Aetna MGG,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,BCBS,BCBS,705.84,,,,,,,per diem,705.84,705.84,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,BCBS MGG,BCBS MGG,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Cigna,Cigna,705.84,,,,,,,per diem,705.84,705.84,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Cigna MGG,Cigna MGG,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Humana,Humana,705.84,,,,,,,per diem,705.84,705.84,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Humana MGG,Humana MGG,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Optum VA,Optum VA,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,UHC,UHC,705.84,,,,,,,per diem,705.84,705.84,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,UHC MGG,UHC MGG,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,VA,VA,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Wellcare MGG,Wellcare MGG,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Bright Health - commercial,Bright Health - commercial,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,A9516,CPT,,,,Inpatient,,,705.84,705.84,Bright Health MGG,Bright Health MGG,705.84,,,,,,,case rate,705.84,705.84,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Aetna,Aetna,1602.42,,,,,,,per diem,1602.42,1602.42,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Aetna MGG,Aetna MGG,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,BCBS,BCBS,1602.42,,,,,,,per diem,1602.42,1602.42,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,BCBS MGG,BCBS MGG,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Cigna,Cigna,1602.42,,,,,,,per diem,1602.42,1602.42,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Cigna MGG,Cigna MGG,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Humana,Humana,1602.42,,,,,,,per diem,1602.42,1602.42,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Humana MGG,Humana MGG,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Optum VA,Optum VA,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,UHC,UHC,1602.42,,,,,,,per diem,1602.42,1602.42,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,UHC MGG,UHC MGG,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,VA,VA,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Wellcare MGG,Wellcare MGG,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Bright Health - commercial,Bright Health - commercial,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,A9517,CPT,,,,Inpatient,,,1602.42,1602.42,Bright Health MGG,Bright Health MGG,1602.42,,,,,,,case rate,1602.42,1602.42,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Aetna,Aetna,806.82,,,,,,,per diem,806.82,806.82,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Aetna MGG,Aetna MGG,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,BCBS,BCBS,806.82,,,,,,,per diem,806.82,806.82,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,BCBS MGG,BCBS MGG,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Cigna,Cigna,806.82,,,,,,,per diem,806.82,806.82,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Cigna MGG,Cigna MGG,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Humana,Humana,806.82,,,,,,,per diem,806.82,806.82,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Humana MGG,Humana MGG,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Optum VA,Optum VA,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,UHC,UHC,806.82,,,,,,,per diem,806.82,806.82,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,UHC MGG,UHC MGG,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,VA,VA,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Wellcare MGG,Wellcare MGG,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Bright Health - commercial,Bright Health - commercial,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,A9530,CPT,,,,Inpatient,,,806.82,806.82,Bright Health MGG,Bright Health MGG,806.82,,,,,,,case rate,806.82,806.82,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Aetna,Aetna,21318,,,,,,,per diem,21318,21318,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Aetna MGG,Aetna MGG,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,BCBS,BCBS,21318,,,,,,,per diem,21318,21318,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,BCBS MGG,BCBS MGG,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Cigna,Cigna,21318,,,,,,,per diem,21318,21318,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Cigna MGG,Cigna MGG,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Humana,Humana,21318,,,,,,,per diem,21318,21318,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Humana MGG,Humana MGG,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Optum VA,Optum VA,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,UHC,UHC,21318,,,,,,,per diem,21318,21318,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,UHC MGG,UHC MGG,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,VA,VA,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Wellcare MGG,Wellcare MGG,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Bright Health - commercial,Bright Health - commercial,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,A9507,CPT,,,,Inpatient,,,21318,21318,Bright Health MGG,Bright Health MGG,21318,,,,,,,case rate,21318,21318,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Aetna,Aetna,2341.92,,,,,,,per diem,2341.92,2341.92,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Aetna MGG,Aetna MGG,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,BCBS,BCBS,2341.92,,,,,,,per diem,2341.92,2341.92,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,BCBS MGG,BCBS MGG,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Cigna,Cigna,2341.92,,,,,,,per diem,2341.92,2341.92,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Cigna MGG,Cigna MGG,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Humana,Humana,2341.92,,,,,,,per diem,2341.92,2341.92,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Humana MGG,Humana MGG,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Optum VA,Optum VA,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,UHC,UHC,2341.92,,,,,,,per diem,2341.92,2341.92,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,UHC MGG,UHC MGG,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,VA,VA,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Wellcare MGG,Wellcare MGG,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Bright Health - commercial,Bright Health - commercial,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,A9547,CPT,,,,Inpatient,,,2341.92,2341.92,Bright Health MGG,Bright Health MGG,2341.92,,,,,,,case rate,2341.92,2341.92,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Aetna,Aetna,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Aetna MGG,Aetna MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,BCBS,BCBS,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,BCBS MGG,BCBS MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Cigna,Cigna,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Cigna MGG,Cigna MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Humana,Humana,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Humana MGG,Humana MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Optum VA,Optum VA,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,UHC,UHC,2204.22,,,,,,,per diem,2204.22,2204.22,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,UHC MGG,UHC MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,VA,VA,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Wellcare MGG,Wellcare MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Bright Health - commercial,Bright Health - commercial,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,A9548,CPT,,,,Inpatient,,,2204.22,2204.22,Bright Health MGG,Bright Health MGG,2204.22,,,,,,,case rate,2204.22,2204.22,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Aetna,Aetna,22114.62,,,,,,,per diem,22114.62,22114.62,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Aetna MGG,Aetna MGG,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,BCBS,BCBS,22114.62,,,,,,,per diem,22114.62,22114.62,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,BCBS MGG,BCBS MGG,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Cigna,Cigna,22114.62,,,,,,,per diem,22114.62,22114.62,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Cigna MGG,Cigna MGG,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Humana,Humana,22114.62,,,,,,,per diem,22114.62,22114.62,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Humana MGG,Humana MGG,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Optum VA,Optum VA,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,UHC,UHC,22114.62,,,,,,,per diem,22114.62,22114.62,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,UHC MGG,UHC MGG,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,VA,VA,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Wellcare MGG,Wellcare MGG,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Bright Health - commercial,Bright Health - commercial,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,A9572,CPT,,,,Inpatient,,,22114.62,22114.62,Bright Health MGG,Bright Health MGG,22114.62,,,,,,,case rate,22114.62,22114.62,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Aetna,Aetna,23119.32,,,,,,,per diem,23119.32,23119.32,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Aetna MGG,Aetna MGG,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,BCBS,BCBS,23119.32,,,,,,,per diem,23119.32,23119.32,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,BCBS MGG,BCBS MGG,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Cigna,Cigna,23119.32,,,,,,,per diem,23119.32,23119.32,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Cigna MGG,Cigna MGG,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Humana,Humana,23119.32,,,,,,,per diem,23119.32,23119.32,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Humana MGG,Humana MGG,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Optum VA,Optum VA,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,UHC,UHC,23119.32,,,,,,,per diem,23119.32,23119.32,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,UHC MGG,UHC MGG,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,VA,VA,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Wellcare MGG,Wellcare MGG,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Bright Health - commercial,Bright Health - commercial,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,A4642,CPT,,,,Inpatient,,,23119.32,23119.32,Bright Health MGG,Bright Health MGG,23119.32,,,,,,,case rate,23119.32,23119.32,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Aetna,Aetna,1324.98,,,,,,,per diem,1324.98,1324.98,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Aetna MGG,Aetna MGG,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,BCBS,BCBS,1324.98,,,,,,,per diem,1324.98,1324.98,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,BCBS MGG,BCBS MGG,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Cigna,Cigna,1324.98,,,,,,,per diem,1324.98,1324.98,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Cigna MGG,Cigna MGG,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Humana,Humana,1324.98,,,,,,,per diem,1324.98,1324.98,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Humana MGG,Humana MGG,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Optum VA,Optum VA,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,UHC,UHC,1324.98,,,,,,,per diem,1324.98,1324.98,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,UHC MGG,UHC MGG,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,VA,VA,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Wellcare MGG,Wellcare MGG,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Bright Health - commercial,Bright Health - commercial,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,A9560,CPT,,,,Inpatient,,,1324.98,1324.98,Bright Health MGG,Bright Health MGG,1324.98,,,,,,,case rate,1324.98,1324.98,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Aetna,Aetna,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Aetna MGG,Aetna MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,BCBS,BCBS,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,BCBS MGG,BCBS MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Cigna,Cigna,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Cigna MGG,Cigna MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Humana,Humana,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Humana MGG,Humana MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Optum VA,Optum VA,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,UHC,UHC,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,UHC MGG,UHC MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,VA,VA,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Wellcare MGG,Wellcare MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Bright Health - commercial,Bright Health - commercial,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,A9540,CPT,,,,Inpatient,,,61.2,61.2,Bright Health MGG,Bright Health MGG,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Aetna,Aetna,259.08,,,,,,,per diem,259.08,259.08,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Aetna MGG,Aetna MGG,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,BCBS,BCBS,259.08,,,,,,,per diem,259.08,259.08,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,BCBS MGG,BCBS MGG,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Cigna,Cigna,259.08,,,,,,,per diem,259.08,259.08,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Cigna MGG,Cigna MGG,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Humana,Humana,259.08,,,,,,,per diem,259.08,259.08,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Humana MGG,Humana MGG,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Optum VA,Optum VA,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,UHC,UHC,259.08,,,,,,,per diem,259.08,259.08,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,UHC MGG,UHC MGG,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,VA,VA,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Wellcare MGG,Wellcare MGG,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Bright Health - commercial,Bright Health - commercial,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,A9503,CPT,,,,Inpatient,,,259.08,259.08,Bright Health MGG,Bright Health MGG,259.08,,,,,,,case rate,259.08,259.08,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Aetna,Aetna,3029.4,,,,,,,per diem,3029.4,3029.4,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Aetna MGG,Aetna MGG,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,BCBS,BCBS,3029.4,,,,,,,per diem,3029.4,3029.4,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,BCBS MGG,BCBS MGG,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Cigna,Cigna,3029.4,,,,,,,per diem,3029.4,3029.4,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Cigna MGG,Cigna MGG,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Humana,Humana,3029.4,,,,,,,per diem,3029.4,3029.4,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Humana MGG,Humana MGG,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Optum VA,Optum VA,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,UHC,UHC,3029.4,,,,,,,per diem,3029.4,3029.4,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,UHC MGG,UHC MGG,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,VA,VA,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Wellcare MGG,Wellcare MGG,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Bright Health - commercial,Bright Health - commercial,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,A9562,CPT,,,,Inpatient,,,3029.4,3029.4,Bright Health MGG,Bright Health MGG,3029.4,,,,,,,case rate,3029.4,3029.4,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna,Aetna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna MGG,Aetna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS,BCBS,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS MGG,BCBS MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna,Cigna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna MGG,Cigna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana,Humana,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana MGG,Humana MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Optum VA,Optum VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC,UHC,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC MGG,UHC MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,VA,VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Wellcare MGG,Wellcare MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health - commercial,Bright Health - commercial,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health MGG,Bright Health MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna,Aetna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna MGG,Aetna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS,BCBS,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS MGG,BCBS MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna,Cigna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna MGG,Cigna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana,Humana,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana MGG,Humana MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Optum VA,Optum VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC,UHC,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC MGG,UHC MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,VA,VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Wellcare MGG,Wellcare MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health - commercial,Bright Health - commercial,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health MGG,Bright Health MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna,Aetna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna MGG,Aetna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS,BCBS,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS MGG,BCBS MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna,Cigna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna MGG,Cigna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana,Humana,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana MGG,Humana MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Optum VA,Optum VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC,UHC,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC MGG,UHC MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,VA,VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Wellcare MGG,Wellcare MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health - commercial,Bright Health - commercial,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health MGG,Bright Health MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna,Aetna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna MGG,Aetna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS,BCBS,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS MGG,BCBS MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna,Cigna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna MGG,Cigna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana,Humana,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana MGG,Humana MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Optum VA,Optum VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC,UHC,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC MGG,UHC MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,VA,VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Wellcare MGG,Wellcare MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health - commercial,Bright Health - commercial,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health MGG,Bright Health MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna,Aetna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna MGG,Aetna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS,BCBS,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS MGG,BCBS MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna,Cigna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna MGG,Cigna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana,Humana,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana MGG,Humana MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Optum VA,Optum VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC,UHC,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC MGG,UHC MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,VA,VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Wellcare MGG,Wellcare MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health - commercial,Bright Health - commercial,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health MGG,Bright Health MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Aetna,Aetna,2598.96,,,,,,,per diem,2598.96,2598.96,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Aetna MGG,Aetna MGG,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,BCBS,BCBS,2598.96,,,,,,,per diem,2598.96,2598.96,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,BCBS MGG,BCBS MGG,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Cigna,Cigna,2598.96,,,,,,,per diem,2598.96,2598.96,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Cigna MGG,Cigna MGG,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Humana,Humana,2598.96,,,,,,,per diem,2598.96,2598.96,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Humana MGG,Humana MGG,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Optum VA,Optum VA,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,UHC,UHC,2598.96,,,,,,,per diem,2598.96,2598.96,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,UHC MGG,UHC MGG,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,VA,VA,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Wellcare MGG,Wellcare MGG,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Bright Health - commercial,Bright Health - commercial,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,A9567,CPT,,,,Inpatient,,,2598.96,2598.96,Bright Health MGG,Bright Health MGG,2598.96,,,,,,,case rate,2598.96,2598.96,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Aetna,Aetna,5672.22,,,,,,,per diem,5672.22,5672.22,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Aetna MGG,Aetna MGG,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,BCBS,BCBS,5672.22,,,,,,,per diem,5672.22,5672.22,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,BCBS MGG,BCBS MGG,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Cigna,Cigna,5672.22,,,,,,,per diem,5672.22,5672.22,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Cigna MGG,Cigna MGG,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Humana,Humana,5672.22,,,,,,,per diem,5672.22,5672.22,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Humana MGG,Humana MGG,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Optum VA,Optum VA,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,UHC,UHC,5672.22,,,,,,,per diem,5672.22,5672.22,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,UHC MGG,UHC MGG,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,VA,VA,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Wellcare MGG,Wellcare MGG,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Bright Health - commercial,Bright Health - commercial,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,A9569,CPT,,,,Inpatient,,,5672.22,5672.22,Bright Health MGG,Bright Health MGG,5672.22,,,,,,,case rate,5672.22,5672.22,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Aetna,Aetna,13965.84,,,,,,,per diem,13965.84,13965.84,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Aetna MGG,Aetna MGG,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,BCBS,BCBS,13965.84,,,,,,,per diem,13965.84,13965.84,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,BCBS MGG,BCBS MGG,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Cigna,Cigna,13965.84,,,,,,,per diem,13965.84,13965.84,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Cigna MGG,Cigna MGG,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Humana,Humana,13965.84,,,,,,,per diem,13965.84,13965.84,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Humana MGG,Humana MGG,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Optum VA,Optum VA,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,UHC,UHC,13965.84,,,,,,,per diem,13965.84,13965.84,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,UHC MGG,UHC MGG,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,VA,VA,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Wellcare MGG,Wellcare MGG,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Bright Health - commercial,Bright Health - commercial,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,A9570,CPT,,,,Inpatient,,,13965.84,13965.84,Bright Health MGG,Bright Health MGG,13965.84,,,,,,,case rate,13965.84,13965.84,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Aetna,Aetna,632.4,,,,,,,per diem,632.4,632.4,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Aetna MGG,Aetna MGG,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,BCBS,BCBS,632.4,,,,,,,per diem,632.4,632.4,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,BCBS MGG,BCBS MGG,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Cigna,Cigna,632.4,,,,,,,per diem,632.4,632.4,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Cigna MGG,Cigna MGG,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Humana,Humana,632.4,,,,,,,per diem,632.4,632.4,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Humana MGG,Humana MGG,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Optum VA,Optum VA,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,UHC,UHC,632.4,,,,,,,per diem,632.4,632.4,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,UHC MGG,UHC MGG,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,VA,VA,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Wellcare MGG,Wellcare MGG,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Bright Health - commercial,Bright Health - commercial,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,77316,CPT,,,,Inpatient,,,632.4,632.4,Bright Health MGG,Bright Health MGG,632.4,,,,,,,case rate,632.4,632.4,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Aetna,Aetna,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Aetna MGG,Aetna MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,BCBS,BCBS,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,BCBS MGG,BCBS MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Cigna,Cigna,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Cigna MGG,Cigna MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Humana,Humana,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Humana MGG,Humana MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Optum VA,Optum VA,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,UHC,UHC,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,UHC MGG,UHC MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,VA,VA,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Wellcare MGG,Wellcare MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Bright Health - commercial,Bright Health - commercial,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,77317,CPT,,,,Inpatient,,,1759.5,1759.5,Bright Health MGG,Bright Health MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Aetna,Aetna,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Aetna MGG,Aetna MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,BCBS,BCBS,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,BCBS MGG,BCBS MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Cigna,Cigna,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Cigna MGG,Cigna MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Humana,Humana,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Humana MGG,Humana MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Optum VA,Optum VA,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,UHC,UHC,1759.5,,,,,,,per diem,1759.5,1759.5,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,UHC MGG,UHC MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,VA,VA,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Wellcare MGG,Wellcare MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Bright Health - commercial,Bright Health - commercial,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,77318,CPT,,,,Inpatient,,,1759.5,1759.5,Bright Health MGG,Bright Health MGG,1759.5,,,,,,,case rate,1759.5,1759.5,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Aetna,Aetna,1850.28,,,,,,,per diem,1850.28,1850.28,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Aetna MGG,Aetna MGG,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,BCBS,BCBS,1850.28,,,,,,,per diem,1850.28,1850.28,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,BCBS MGG,BCBS MGG,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Cigna,Cigna,1850.28,,,,,,,per diem,1850.28,1850.28,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Cigna MGG,Cigna MGG,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Humana,Humana,1850.28,,,,,,,per diem,1850.28,1850.28,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Humana MGG,Humana MGG,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Optum VA,Optum VA,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,UHC,UHC,1850.28,,,,,,,per diem,1850.28,1850.28,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,UHC MGG,UHC MGG,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,VA,VA,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Wellcare MGG,Wellcare MGG,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Bright Health - commercial,Bright Health - commercial,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,78265,CPT,,,,Inpatient,,,1850.28,1850.28,Bright Health MGG,Bright Health MGG,1850.28,,,,,,,case rate,1850.28,1850.28,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Aetna,Aetna,2455.14,,,,,,,per diem,2455.14,2455.14,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Aetna MGG,Aetna MGG,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,BCBS,BCBS,2455.14,,,,,,,per diem,2455.14,2455.14,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,BCBS MGG,BCBS MGG,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Cigna,Cigna,2455.14,,,,,,,per diem,2455.14,2455.14,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Cigna MGG,Cigna MGG,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Humana,Humana,2455.14,,,,,,,per diem,2455.14,2455.14,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Humana MGG,Humana MGG,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Optum VA,Optum VA,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,UHC,UHC,2455.14,,,,,,,per diem,2455.14,2455.14,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,UHC MGG,UHC MGG,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,VA,VA,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Wellcare MGG,Wellcare MGG,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Bright Health - commercial,Bright Health - commercial,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,78266,CPT,,,,Inpatient,,,2455.14,2455.14,Bright Health MGG,Bright Health MGG,2455.14,,,,,,,case rate,2455.14,2455.14,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Aetna,Aetna,2534.7,,,,,,,per diem,2534.7,2534.7,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Aetna MGG,Aetna MGG,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,BCBS,BCBS,2534.7,,,,,,,per diem,2534.7,2534.7,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,BCBS MGG,BCBS MGG,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Cigna,Cigna,2534.7,,,,,,,per diem,2534.7,2534.7,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Cigna MGG,Cigna MGG,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Humana,Humana,2534.7,,,,,,,per diem,2534.7,2534.7,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Humana MGG,Humana MGG,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Optum VA,Optum VA,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,UHC,UHC,2534.7,,,,,,,per diem,2534.7,2534.7,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,UHC MGG,UHC MGG,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,VA,VA,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Wellcare MGG,Wellcare MGG,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Bright Health - commercial,Bright Health - commercial,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,A9520,CPT,,,,Inpatient,,,2534.7,2534.7,Bright Health MGG,Bright Health MGG,2534.7,,,,,,,case rate,2534.7,2534.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Aetna,Aetna,11510.7,,,,,,,per diem,11510.7,11510.7,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Aetna MGG,Aetna MGG,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,BCBS,BCBS,11510.7,,,,,,,per diem,11510.7,11510.7,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,BCBS MGG,BCBS MGG,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Cigna,Cigna,11510.7,,,,,,,per diem,11510.7,11510.7,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Cigna MGG,Cigna MGG,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Humana,Humana,11510.7,,,,,,,per diem,11510.7,11510.7,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Humana MGG,Humana MGG,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Optum VA,Optum VA,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,UHC,UHC,11510.7,,,,,,,per diem,11510.7,11510.7,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,UHC MGG,UHC MGG,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,VA,VA,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Wellcare MGG,Wellcare MGG,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Bright Health - commercial,Bright Health - commercial,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,A9584,CPT,,,,Inpatient,,,11510.7,11510.7,Bright Health MGG,Bright Health MGG,11510.7,,,,,,,case rate,11510.7,11510.7,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Aetna,Aetna,2979.42,,,,,,,per diem,2979.42,2979.42,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Aetna MGG,Aetna MGG,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,BCBS,BCBS,2979.42,,,,,,,per diem,2979.42,2979.42,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,BCBS MGG,BCBS MGG,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Cigna,Cigna,2979.42,,,,,,,per diem,2979.42,2979.42,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Cigna MGG,Cigna MGG,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Humana,Humana,2979.42,,,,,,,per diem,2979.42,2979.42,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Humana MGG,Humana MGG,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Optum VA,Optum VA,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,UHC,UHC,2979.42,,,,,,,per diem,2979.42,2979.42,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,UHC MGG,UHC MGG,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,VA,VA,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Wellcare MGG,Wellcare MGG,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Bright Health - commercial,Bright Health - commercial,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,34000,CPT,,,75,Inpatient,,,2979.42,2979.42,Bright Health MGG,Bright Health MGG,2979.42,,,,,,,case rate,2979.42,2979.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Aetna,Aetna,523.26,,,,,,,per diem,523.26,523.26,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Aetna MGG,Aetna MGG,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,BCBS,BCBS,523.26,,,,,,,per diem,523.26,523.26,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,BCBS MGG,BCBS MGG,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Cigna,Cigna,523.26,,,,,,,per diem,523.26,523.26,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Cigna MGG,Cigna MGG,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Humana,Humana,523.26,,,,,,,per diem,523.26,523.26,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Humana MGG,Humana MGG,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Optum VA,Optum VA,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,UHC,UHC,523.26,,,,,,,per diem,523.26,523.26,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,UHC MGG,UHC MGG,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,VA,VA,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Wellcare MGG,Wellcare MGG,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Bright Health - commercial,Bright Health - commercial,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,34000,CPT,,,68,Inpatient,,,523.26,523.26,Bright Health MGG,Bright Health MGG,523.26,,,,,,,case rate,523.26,523.26,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Aetna,Aetna,2560.2,,,,,,,per diem,2560.2,2560.2,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Aetna MGG,Aetna MGG,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,BCBS,BCBS,2560.2,,,,,,,per diem,2560.2,2560.2,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,BCBS MGG,BCBS MGG,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Cigna,Cigna,2560.2,,,,,,,per diem,2560.2,2560.2,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Cigna MGG,Cigna MGG,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Humana,Humana,2560.2,,,,,,,per diem,2560.2,2560.2,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Humana MGG,Humana MGG,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Optum VA,Optum VA,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,UHC,UHC,2560.2,,,,,,,per diem,2560.2,2560.2,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,UHC MGG,UHC MGG,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,VA,VA,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Wellcare MGG,Wellcare MGG,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Bright Health - commercial,Bright Health - commercial,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,34000,CPT,,,77,Inpatient,,,2560.2,2560.2,Bright Health MGG,Bright Health MGG,2560.2,,,,,,,case rate,2560.2,2560.2,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Aetna,Aetna,10.36,,,,,,,per diem,10.36,10.36,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Aetna MGG,Aetna MGG,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,BCBS,BCBS,10.36,,,,,,,per diem,10.36,10.36,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,BCBS MGG,BCBS MGG,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Cigna,Cigna,10.36,,,,,,,per diem,10.36,10.36,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Cigna MGG,Cigna MGG,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Humana,Humana,10.36,,,,,,,per diem,10.36,10.36,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Humana MGG,Humana MGG,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Optum VA,Optum VA,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,UHC,UHC,10.36,,,,,,,per diem,10.36,10.36,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,UHC MGG,UHC MGG,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,VA,VA,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Wellcare MGG,Wellcare MGG,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Bright Health - commercial,Bright Health - commercial,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,10.36,10.36,Bright Health MGG,Bright Health MGG,10.36,,,,,,,case rate,10.36,10.36,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Aetna,Aetna,180.26,,,,,,,per diem,180.26,180.26,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Aetna MGG,Aetna MGG,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,BCBS,BCBS,180.26,,,,,,,per diem,180.26,180.26,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,BCBS MGG,BCBS MGG,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Cigna,Cigna,180.26,,,,,,,per diem,180.26,180.26,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Cigna MGG,Cigna MGG,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Humana,Humana,180.26,,,,,,,per diem,180.26,180.26,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Humana MGG,Humana MGG,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Optum VA,Optum VA,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,UHC,UHC,180.26,,,,,,,per diem,180.26,180.26,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,UHC MGG,UHC MGG,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,VA,VA,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Wellcare MGG,Wellcare MGG,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Bright Health - commercial,Bright Health - commercial,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,180.26,180.26,Bright Health MGG,Bright Health MGG,180.26,,,,,,,case rate,180.26,180.26,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Aetna,Aetna,56.35,,,,,,,per diem,56.35,56.35,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Aetna MGG,Aetna MGG,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,BCBS,BCBS,56.35,,,,,,,per diem,56.35,56.35,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,BCBS MGG,BCBS MGG,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Cigna,Cigna,56.35,,,,,,,per diem,56.35,56.35,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Cigna MGG,Cigna MGG,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Humana,Humana,56.35,,,,,,,per diem,56.35,56.35,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Humana MGG,Humana MGG,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Optum VA,Optum VA,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,UHC,UHC,56.35,,,,,,,per diem,56.35,56.35,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,UHC MGG,UHC MGG,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,VA,VA,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Wellcare MGG,Wellcare MGG,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Bright Health - commercial,Bright Health - commercial,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,56.35,56.35,Bright Health MGG,Bright Health MGG,56.35,,,,,,,case rate,56.35,56.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Aetna,Aetna,2169.86,,,,,,,per diem,2169.86,2169.86,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Aetna MGG,Aetna MGG,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,BCBS,BCBS,2169.86,,,,,,,per diem,2169.86,2169.86,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,BCBS MGG,BCBS MGG,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Cigna,Cigna,2169.86,,,,,,,per diem,2169.86,2169.86,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Cigna MGG,Cigna MGG,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Humana,Humana,2169.86,,,,,,,per diem,2169.86,2169.86,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Humana MGG,Humana MGG,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Optum VA,Optum VA,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,UHC,UHC,2169.86,,,,,,,per diem,2169.86,2169.86,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,UHC MGG,UHC MGG,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,VA,VA,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Wellcare MGG,Wellcare MGG,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Bright Health - commercial,Bright Health - commercial,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2169.86,2169.86,Bright Health MGG,Bright Health MGG,2169.86,,,,,,,case rate,2169.86,2169.86,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Aetna,Aetna,2081.36,,,,,,,per diem,2081.36,2081.36,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Aetna MGG,Aetna MGG,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,BCBS,BCBS,2081.36,,,,,,,per diem,2081.36,2081.36,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,BCBS MGG,BCBS MGG,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Cigna,Cigna,2081.36,,,,,,,per diem,2081.36,2081.36,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Cigna MGG,Cigna MGG,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Humana,Humana,2081.36,,,,,,,per diem,2081.36,2081.36,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Humana MGG,Humana MGG,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Optum VA,Optum VA,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,UHC,UHC,2081.36,,,,,,,per diem,2081.36,2081.36,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,UHC MGG,UHC MGG,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,VA,VA,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Wellcare MGG,Wellcare MGG,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Bright Health - commercial,Bright Health - commercial,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,2081.36,2081.36,Bright Health MGG,Bright Health MGG,2081.36,,,,,,,case rate,2081.36,2081.36,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Aetna,Aetna,662.55,,,,,,,per diem,662.55,662.55,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Aetna MGG,Aetna MGG,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,BCBS,BCBS,662.55,,,,,,,per diem,662.55,662.55,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,BCBS MGG,BCBS MGG,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Cigna,Cigna,662.55,,,,,,,per diem,662.55,662.55,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Cigna MGG,Cigna MGG,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Humana,Humana,662.55,,,,,,,per diem,662.55,662.55,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Humana MGG,Humana MGG,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Optum VA,Optum VA,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,UHC,UHC,662.55,,,,,,,per diem,662.55,662.55,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,UHC MGG,UHC MGG,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,VA,VA,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Wellcare MGG,Wellcare MGG,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Bright Health - commercial,Bright Health - commercial,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,662.55,662.55,Bright Health MGG,Bright Health MGG,662.55,,,,,,,case rate,662.55,662.55,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Aetna,Aetna,6186.06,,,,,,,per diem,6186.06,6186.06,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Aetna MGG,Aetna MGG,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,BCBS,BCBS,6186.06,,,,,,,per diem,6186.06,6186.06,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,BCBS MGG,BCBS MGG,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Cigna,Cigna,6186.06,,,,,,,per diem,6186.06,6186.06,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Cigna MGG,Cigna MGG,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Humana,Humana,6186.06,,,,,,,per diem,6186.06,6186.06,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Humana MGG,Humana MGG,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Optum VA,Optum VA,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,UHC,UHC,6186.06,,,,,,,per diem,6186.06,6186.06,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,UHC MGG,UHC MGG,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,VA,VA,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Wellcare MGG,Wellcare MGG,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Bright Health - commercial,Bright Health - commercial,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6186.06,6186.06,Bright Health MGG,Bright Health MGG,6186.06,,,,,,,case rate,6186.06,6186.06,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Aetna,Aetna,3665.26,,,,,,,per diem,3665.26,3665.26,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Aetna MGG,Aetna MGG,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,BCBS,BCBS,3665.26,,,,,,,per diem,3665.26,3665.26,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,BCBS MGG,BCBS MGG,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Cigna,Cigna,3665.26,,,,,,,per diem,3665.26,3665.26,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Cigna MGG,Cigna MGG,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Humana,Humana,3665.26,,,,,,,per diem,3665.26,3665.26,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Humana MGG,Humana MGG,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Optum VA,Optum VA,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,UHC,UHC,3665.26,,,,,,,per diem,3665.26,3665.26,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,UHC MGG,UHC MGG,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,VA,VA,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Wellcare MGG,Wellcare MGG,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Bright Health - commercial,Bright Health - commercial,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3665.26,3665.26,Bright Health MGG,Bright Health MGG,3665.26,,,,,,,case rate,3665.26,3665.26,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Aetna,Aetna,268.45,,,,,,,per diem,268.45,268.45,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Aetna MGG,Aetna MGG,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,BCBS,BCBS,268.45,,,,,,,per diem,268.45,268.45,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,BCBS MGG,BCBS MGG,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Cigna,Cigna,268.45,,,,,,,per diem,268.45,268.45,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Cigna MGG,Cigna MGG,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Humana,Humana,268.45,,,,,,,per diem,268.45,268.45,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Humana MGG,Humana MGG,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Optum VA,Optum VA,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,UHC,UHC,268.45,,,,,,,per diem,268.45,268.45,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,UHC MGG,UHC MGG,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,VA,VA,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Wellcare MGG,Wellcare MGG,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Bright Health - commercial,Bright Health - commercial,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,268.45,268.45,Bright Health MGG,Bright Health MGG,268.45,,,,,,,case rate,268.45,268.45,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Aetna,Aetna,1080.86,,,,,,,per diem,1080.86,1080.86,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Aetna MGG,Aetna MGG,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,BCBS,BCBS,1080.86,,,,,,,per diem,1080.86,1080.86,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,BCBS MGG,BCBS MGG,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Cigna,Cigna,1080.86,,,,,,,per diem,1080.86,1080.86,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Cigna MGG,Cigna MGG,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Humana,Humana,1080.86,,,,,,,per diem,1080.86,1080.86,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Humana MGG,Humana MGG,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Optum VA,Optum VA,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,UHC,UHC,1080.86,,,,,,,per diem,1080.86,1080.86,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,UHC MGG,UHC MGG,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,VA,VA,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Wellcare MGG,Wellcare MGG,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Bright Health - commercial,Bright Health - commercial,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1080.86,1080.86,Bright Health MGG,Bright Health MGG,1080.86,,,,,,,case rate,1080.86,1080.86,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Aetna,Aetna,2692.8,,,,,,,per diem,2692.8,2692.8,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Aetna MGG,Aetna MGG,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,BCBS,BCBS,2692.8,,,,,,,per diem,2692.8,2692.8,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,BCBS MGG,BCBS MGG,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Cigna,Cigna,2692.8,,,,,,,per diem,2692.8,2692.8,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Cigna MGG,Cigna MGG,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Humana,Humana,2692.8,,,,,,,per diem,2692.8,2692.8,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Humana MGG,Humana MGG,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Optum VA,Optum VA,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,UHC,UHC,2692.8,,,,,,,per diem,2692.8,2692.8,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,UHC MGG,UHC MGG,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,VA,VA,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Wellcare MGG,Wellcare MGG,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Bright Health - commercial,Bright Health - commercial,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2692.8,2692.8,Bright Health MGG,Bright Health MGG,2692.8,,,,,,,case rate,2692.8,2692.8,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Aetna,Aetna,3904.56,,,,,,,per diem,3904.56,3904.56,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Aetna MGG,Aetna MGG,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,BCBS,BCBS,3904.56,,,,,,,per diem,3904.56,3904.56,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,BCBS MGG,BCBS MGG,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Cigna,Cigna,3904.56,,,,,,,per diem,3904.56,3904.56,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Cigna MGG,Cigna MGG,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Humana,Humana,3904.56,,,,,,,per diem,3904.56,3904.56,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Humana MGG,Humana MGG,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Optum VA,Optum VA,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,UHC,UHC,3904.56,,,,,,,per diem,3904.56,3904.56,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,UHC MGG,UHC MGG,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,VA,VA,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Wellcare MGG,Wellcare MGG,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Bright Health - commercial,Bright Health - commercial,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,3904.56,3904.56,Bright Health MGG,Bright Health MGG,3904.56,,,,,,,case rate,3904.56,3904.56,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Aetna,Aetna,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Aetna MGG,Aetna MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,BCBS,BCBS,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,BCBS MGG,BCBS MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Cigna,Cigna,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Cigna MGG,Cigna MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Humana,Humana,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Humana MGG,Humana MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Optum VA,Optum VA,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,UHC,UHC,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,UHC MGG,UHC MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,VA,VA,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Wellcare MGG,Wellcare MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Bright Health - commercial,Bright Health - commercial,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,365,365,Bright Health MGG,Bright Health MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Aetna,Aetna,3069.96,,,,,,,per diem,3069.96,3069.96,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Aetna MGG,Aetna MGG,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,BCBS,BCBS,3069.96,,,,,,,per diem,3069.96,3069.96,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,BCBS MGG,BCBS MGG,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Cigna,Cigna,3069.96,,,,,,,per diem,3069.96,3069.96,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Cigna MGG,Cigna MGG,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Humana,Humana,3069.96,,,,,,,per diem,3069.96,3069.96,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Humana MGG,Humana MGG,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Optum VA,Optum VA,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,UHC,UHC,3069.96,,,,,,,per diem,3069.96,3069.96,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,UHC MGG,UHC MGG,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,VA,VA,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Wellcare MGG,Wellcare MGG,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Bright Health - commercial,Bright Health - commercial,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3069.96,3069.96,Bright Health MGG,Bright Health MGG,3069.96,,,,,,,case rate,3069.96,3069.96,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Aetna,Aetna,7470,,,,,,,per diem,7470,7470,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Aetna MGG,Aetna MGG,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,BCBS,BCBS,7470,,,,,,,per diem,7470,7470,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,BCBS MGG,BCBS MGG,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Cigna,Cigna,7470,,,,,,,per diem,7470,7470,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Cigna MGG,Cigna MGG,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Humana,Humana,7470,,,,,,,per diem,7470,7470,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Humana MGG,Humana MGG,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Optum VA,Optum VA,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,UHC,UHC,7470,,,,,,,per diem,7470,7470,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,UHC MGG,UHC MGG,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,VA,VA,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Wellcare MGG,Wellcare MGG,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Bright Health - commercial,Bright Health - commercial,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,7470,7470,Bright Health MGG,Bright Health MGG,7470,,,,,,,case rate,7470,7470,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Aetna,Aetna,576.12,,,,,,,per diem,576.12,576.12,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Aetna MGG,Aetna MGG,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,BCBS,BCBS,576.12,,,,,,,per diem,576.12,576.12,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,BCBS MGG,BCBS MGG,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Cigna,Cigna,576.12,,,,,,,per diem,576.12,576.12,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Cigna MGG,Cigna MGG,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Humana,Humana,576.12,,,,,,,per diem,576.12,576.12,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Humana MGG,Humana MGG,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Optum VA,Optum VA,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,UHC,UHC,576.12,,,,,,,per diem,576.12,576.12,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,UHC MGG,UHC MGG,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,VA,VA,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Wellcare MGG,Wellcare MGG,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Bright Health - commercial,Bright Health - commercial,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,576.12,576.12,Bright Health MGG,Bright Health MGG,576.12,,,,,,,case rate,576.12,576.12,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Aetna,Aetna,2831.45,,,,,,,per diem,2831.45,2831.45,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Aetna MGG,Aetna MGG,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,BCBS,BCBS,2831.45,,,,,,,per diem,2831.45,2831.45,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,BCBS MGG,BCBS MGG,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Cigna,Cigna,2831.45,,,,,,,per diem,2831.45,2831.45,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Cigna MGG,Cigna MGG,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Humana,Humana,2831.45,,,,,,,per diem,2831.45,2831.45,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Humana MGG,Humana MGG,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Optum VA,Optum VA,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,UHC,UHC,2831.45,,,,,,,per diem,2831.45,2831.45,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,UHC MGG,UHC MGG,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,VA,VA,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Wellcare MGG,Wellcare MGG,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Bright Health - commercial,Bright Health - commercial,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2831.45,2831.45,Bright Health MGG,Bright Health MGG,2831.45,,,,,,,case rate,2831.45,2831.45,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Aetna,Aetna,6123,,,,,,,per diem,6123,6123,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Aetna MGG,Aetna MGG,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,BCBS,BCBS,6123,,,,,,,per diem,6123,6123,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,BCBS MGG,BCBS MGG,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Cigna,Cigna,6123,,,,,,,per diem,6123,6123,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Cigna MGG,Cigna MGG,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Humana,Humana,6123,,,,,,,per diem,6123,6123,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Humana MGG,Humana MGG,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Optum VA,Optum VA,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,UHC,UHC,6123,,,,,,,per diem,6123,6123,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,UHC MGG,UHC MGG,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,VA,VA,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Wellcare MGG,Wellcare MGG,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Bright Health - commercial,Bright Health - commercial,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,6123,6123,Bright Health MGG,Bright Health MGG,6123,,,,,,,case rate,6123,6123,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Aetna,Aetna,132.2,,,,,,,per diem,132.2,132.2,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Aetna MGG,Aetna MGG,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,BCBS,BCBS,132.2,,,,,,,per diem,132.2,132.2,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,BCBS MGG,BCBS MGG,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Cigna,Cigna,132.2,,,,,,,per diem,132.2,132.2,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Cigna MGG,Cigna MGG,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Humana,Humana,132.2,,,,,,,per diem,132.2,132.2,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Humana MGG,Humana MGG,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Optum VA,Optum VA,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,UHC,UHC,132.2,,,,,,,per diem,132.2,132.2,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,UHC MGG,UHC MGG,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,VA,VA,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Wellcare MGG,Wellcare MGG,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Bright Health - commercial,Bright Health - commercial,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,132.2,132.2,Bright Health MGG,Bright Health MGG,132.2,,,,,,,case rate,132.2,132.2,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Aetna,Aetna,328.23,,,,,,,per diem,328.23,328.23,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Aetna MGG,Aetna MGG,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,BCBS,BCBS,328.23,,,,,,,per diem,328.23,328.23,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,BCBS MGG,BCBS MGG,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Cigna,Cigna,328.23,,,,,,,per diem,328.23,328.23,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Cigna MGG,Cigna MGG,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Humana,Humana,328.23,,,,,,,per diem,328.23,328.23,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Humana MGG,Humana MGG,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Optum VA,Optum VA,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,UHC,UHC,328.23,,,,,,,per diem,328.23,328.23,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,UHC MGG,UHC MGG,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,VA,VA,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Wellcare MGG,Wellcare MGG,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Bright Health - commercial,Bright Health - commercial,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,328.23,328.23,Bright Health MGG,Bright Health MGG,328.23,,,,,,,case rate,328.23,328.23,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Aetna,Aetna,3422.37,,,,,,,per diem,3422.37,3422.37,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Aetna MGG,Aetna MGG,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,BCBS,BCBS,3422.37,,,,,,,per diem,3422.37,3422.37,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,BCBS MGG,BCBS MGG,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Cigna,Cigna,3422.37,,,,,,,per diem,3422.37,3422.37,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Cigna MGG,Cigna MGG,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Humana,Humana,3422.37,,,,,,,per diem,3422.37,3422.37,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Humana MGG,Humana MGG,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Optum VA,Optum VA,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,UHC,UHC,3422.37,,,,,,,per diem,3422.37,3422.37,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,UHC MGG,UHC MGG,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,VA,VA,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Wellcare MGG,Wellcare MGG,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Bright Health - commercial,Bright Health - commercial,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3422.37,3422.37,Bright Health MGG,Bright Health MGG,3422.37,,,,,,,case rate,3422.37,3422.37,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Aetna,Aetna,2556.47,,,,,,,per diem,2556.47,2556.47,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Aetna MGG,Aetna MGG,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,BCBS,BCBS,2556.47,,,,,,,per diem,2556.47,2556.47,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,BCBS MGG,BCBS MGG,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Cigna,Cigna,2556.47,,,,,,,per diem,2556.47,2556.47,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Cigna MGG,Cigna MGG,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Humana,Humana,2556.47,,,,,,,per diem,2556.47,2556.47,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Humana MGG,Humana MGG,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Optum VA,Optum VA,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,UHC,UHC,2556.47,,,,,,,per diem,2556.47,2556.47,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,UHC MGG,UHC MGG,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,VA,VA,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Wellcare MGG,Wellcare MGG,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Bright Health - commercial,Bright Health - commercial,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2556.47,2556.47,Bright Health MGG,Bright Health MGG,2556.47,,,,,,,case rate,2556.47,2556.47,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Aetna,Aetna,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Aetna MGG,Aetna MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,BCBS,BCBS,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,BCBS MGG,BCBS MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Cigna,Cigna,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Cigna MGG,Cigna MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Humana,Humana,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Humana MGG,Humana MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Optum VA,Optum VA,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,UHC,UHC,365,,,,,,,per diem,365,365,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,UHC MGG,UHC MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,VA,VA,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Wellcare MGG,Wellcare MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Bright Health - commercial,Bright Health - commercial,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,365,365,Bright Health MGG,Bright Health MGG,365,,,,,,,case rate,365,365,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Aetna,Aetna,6348,,,,,,,per diem,6348,6348,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Aetna MGG,Aetna MGG,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,BCBS,BCBS,6348,,,,,,,per diem,6348,6348,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,BCBS MGG,BCBS MGG,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Cigna,Cigna,6348,,,,,,,per diem,6348,6348,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Cigna MGG,Cigna MGG,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Humana,Humana,6348,,,,,,,per diem,6348,6348,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Humana MGG,Humana MGG,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Optum VA,Optum VA,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,UHC,UHC,6348,,,,,,,per diem,6348,6348,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,UHC MGG,UHC MGG,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,VA,VA,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Wellcare MGG,Wellcare MGG,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Bright Health - commercial,Bright Health - commercial,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,6348,6348,Bright Health MGG,Bright Health MGG,6348,,,,,,,case rate,6348,6348,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Aetna,Aetna,10013.34,,,,,,,per diem,10013.34,10013.34,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Aetna MGG,Aetna MGG,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,BCBS,BCBS,10013.34,,,,,,,per diem,10013.34,10013.34,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,BCBS MGG,BCBS MGG,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Cigna,Cigna,10013.34,,,,,,,per diem,10013.34,10013.34,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Cigna MGG,Cigna MGG,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Humana,Humana,10013.34,,,,,,,per diem,10013.34,10013.34,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Humana MGG,Humana MGG,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Optum VA,Optum VA,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,UHC,UHC,10013.34,,,,,,,per diem,10013.34,10013.34,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,UHC MGG,UHC MGG,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,VA,VA,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Wellcare MGG,Wellcare MGG,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Bright Health - commercial,Bright Health - commercial,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10013.34,10013.34,Bright Health MGG,Bright Health MGG,10013.34,,,,,,,case rate,10013.34,10013.34,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Aetna,Aetna,2638.57,,,,,,,per diem,2638.57,2638.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Aetna MGG,Aetna MGG,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,BCBS,BCBS,2638.57,,,,,,,per diem,2638.57,2638.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,BCBS MGG,BCBS MGG,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Cigna,Cigna,2638.57,,,,,,,per diem,2638.57,2638.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Cigna MGG,Cigna MGG,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Humana,Humana,2638.57,,,,,,,per diem,2638.57,2638.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Humana MGG,Humana MGG,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Optum VA,Optum VA,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,UHC,UHC,2638.57,,,,,,,per diem,2638.57,2638.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,UHC MGG,UHC MGG,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,VA,VA,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Wellcare MGG,Wellcare MGG,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Bright Health - commercial,Bright Health - commercial,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2638.57,2638.57,Bright Health MGG,Bright Health MGG,2638.57,,,,,,,case rate,2638.57,2638.57,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Aetna,Aetna,4208.52,,,,,,,per diem,4208.52,4208.52,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Aetna MGG,Aetna MGG,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,BCBS,BCBS,4208.52,,,,,,,per diem,4208.52,4208.52,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,BCBS MGG,BCBS MGG,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Cigna,Cigna,4208.52,,,,,,,per diem,4208.52,4208.52,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Cigna MGG,Cigna MGG,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Humana,Humana,4208.52,,,,,,,per diem,4208.52,4208.52,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Humana MGG,Humana MGG,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Optum VA,Optum VA,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,UHC,UHC,4208.52,,,,,,,per diem,4208.52,4208.52,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,UHC MGG,UHC MGG,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,VA,VA,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Wellcare MGG,Wellcare MGG,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Bright Health - commercial,Bright Health - commercial,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4208.52,4208.52,Bright Health MGG,Bright Health MGG,4208.52,,,,,,,case rate,4208.52,4208.52,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Aetna,Aetna,722.28,,,,,,,per diem,722.28,722.28,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Aetna MGG,Aetna MGG,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,BCBS,BCBS,722.28,,,,,,,per diem,722.28,722.28,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,BCBS MGG,BCBS MGG,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Cigna,Cigna,722.28,,,,,,,per diem,722.28,722.28,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Cigna MGG,Cigna MGG,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Humana,Humana,722.28,,,,,,,per diem,722.28,722.28,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Humana MGG,Humana MGG,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Optum VA,Optum VA,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,UHC,UHC,722.28,,,,,,,per diem,722.28,722.28,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,UHC MGG,UHC MGG,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,VA,VA,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Wellcare MGG,Wellcare MGG,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Bright Health - commercial,Bright Health - commercial,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,722.28,722.28,Bright Health MGG,Bright Health MGG,722.28,,,,,,,case rate,722.28,722.28,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Aetna,Aetna,2606.68,,,,,,,per diem,2606.68,2606.68,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Aetna MGG,Aetna MGG,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,BCBS,BCBS,2606.68,,,,,,,per diem,2606.68,2606.68,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,BCBS MGG,BCBS MGG,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Cigna,Cigna,2606.68,,,,,,,per diem,2606.68,2606.68,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Cigna MGG,Cigna MGG,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Humana,Humana,2606.68,,,,,,,per diem,2606.68,2606.68,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Humana MGG,Humana MGG,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Optum VA,Optum VA,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,UHC,UHC,2606.68,,,,,,,per diem,2606.68,2606.68,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,UHC MGG,UHC MGG,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,VA,VA,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Wellcare MGG,Wellcare MGG,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Bright Health - commercial,Bright Health - commercial,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,2606.68,2606.68,Bright Health MGG,Bright Health MGG,2606.68,,,,,,,case rate,2606.68,2606.68,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Aetna,Aetna,4129.98,,,,,,,per diem,4129.98,4129.98,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Aetna MGG,Aetna MGG,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,BCBS,BCBS,4129.98,,,,,,,per diem,4129.98,4129.98,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,BCBS MGG,BCBS MGG,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Cigna,Cigna,4129.98,,,,,,,per diem,4129.98,4129.98,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Cigna MGG,Cigna MGG,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Humana,Humana,4129.98,,,,,,,per diem,4129.98,4129.98,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Humana MGG,Humana MGG,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Optum VA,Optum VA,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,UHC,UHC,4129.98,,,,,,,per diem,4129.98,4129.98,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,UHC MGG,UHC MGG,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,VA,VA,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Wellcare MGG,Wellcare MGG,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Bright Health - commercial,Bright Health - commercial,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4129.98,4129.98,Bright Health MGG,Bright Health MGG,4129.98,,,,,,,case rate,4129.98,4129.98,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Aetna,Aetna,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Aetna MGG,Aetna MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,BCBS,BCBS,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,BCBS MGG,BCBS MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Cigna,Cigna,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Cigna MGG,Cigna MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Humana,Humana,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Humana MGG,Humana MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Optum VA,Optum VA,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,UHC,UHC,1194.42,,,,,,,per diem,1194.42,1194.42,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,UHC MGG,UHC MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,VA,VA,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Wellcare MGG,Wellcare MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Bright Health - commercial,Bright Health - commercial,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1194.42,1194.42,Bright Health MGG,Bright Health MGG,1194.42,,,,,,,case rate,1194.42,1194.42,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Aetna,Aetna,2494.66,,,,,,,per diem,2494.66,2494.66,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Aetna MGG,Aetna MGG,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,BCBS,BCBS,2494.66,,,,,,,per diem,2494.66,2494.66,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,BCBS MGG,BCBS MGG,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Cigna,Cigna,2494.66,,,,,,,per diem,2494.66,2494.66,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Cigna MGG,Cigna MGG,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Humana,Humana,2494.66,,,,,,,per diem,2494.66,2494.66,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Humana MGG,Humana MGG,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Optum VA,Optum VA,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,UHC,UHC,2494.66,,,,,,,per diem,2494.66,2494.66,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,UHC MGG,UHC MGG,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,VA,VA,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Wellcare MGG,Wellcare MGG,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Bright Health - commercial,Bright Health - commercial,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2494.66,2494.66,Bright Health MGG,Bright Health MGG,2494.66,,,,,,,case rate,2494.66,2494.66,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Aetna,Aetna,3957,,,,,,,per diem,3957,3957,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Aetna MGG,Aetna MGG,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,BCBS,BCBS,3957,,,,,,,per diem,3957,3957,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,BCBS MGG,BCBS MGG,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Cigna,Cigna,3957,,,,,,,per diem,3957,3957,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Cigna MGG,Cigna MGG,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Humana,Humana,3957,,,,,,,per diem,3957,3957,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Humana MGG,Humana MGG,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Optum VA,Optum VA,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,UHC,UHC,3957,,,,,,,per diem,3957,3957,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,UHC MGG,UHC MGG,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,VA,VA,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Wellcare MGG,Wellcare MGG,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Bright Health - commercial,Bright Health - commercial,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3957,3957,Bright Health MGG,Bright Health MGG,3957,,,,,,,case rate,3957,3957,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Aetna,Aetna,5658.56,,,,,,,per diem,5658.56,5658.56,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Aetna MGG,Aetna MGG,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,BCBS,BCBS,5658.56,,,,,,,per diem,5658.56,5658.56,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,BCBS MGG,BCBS MGG,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Cigna,Cigna,5658.56,,,,,,,per diem,5658.56,5658.56,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Cigna MGG,Cigna MGG,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Humana,Humana,5658.56,,,,,,,per diem,5658.56,5658.56,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Humana MGG,Humana MGG,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Optum VA,Optum VA,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,UHC,UHC,5658.56,,,,,,,per diem,5658.56,5658.56,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,UHC MGG,UHC MGG,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,VA,VA,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Wellcare MGG,Wellcare MGG,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Bright Health - commercial,Bright Health - commercial,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5658.56,5658.56,Bright Health MGG,Bright Health MGG,5658.56,,,,,,,case rate,5658.56,5658.56,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Aetna,Aetna,2075.26,,,,,,,per diem,2075.26,2075.26,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Aetna MGG,Aetna MGG,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,BCBS,BCBS,2075.26,,,,,,,per diem,2075.26,2075.26,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,BCBS MGG,BCBS MGG,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Cigna,Cigna,2075.26,,,,,,,per diem,2075.26,2075.26,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Cigna MGG,Cigna MGG,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Humana,Humana,2075.26,,,,,,,per diem,2075.26,2075.26,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Humana MGG,Humana MGG,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Optum VA,Optum VA,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,UHC,UHC,2075.26,,,,,,,per diem,2075.26,2075.26,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,UHC MGG,UHC MGG,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,VA,VA,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Wellcare MGG,Wellcare MGG,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Bright Health - commercial,Bright Health - commercial,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2075.26,2075.26,Bright Health MGG,Bright Health MGG,2075.26,,,,,,,case rate,2075.26,2075.26,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Aetna,Aetna,5736.15,,,,,,,per diem,5736.15,5736.15,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Aetna MGG,Aetna MGG,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,BCBS,BCBS,5736.15,,,,,,,per diem,5736.15,5736.15,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,BCBS MGG,BCBS MGG,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Cigna,Cigna,5736.15,,,,,,,per diem,5736.15,5736.15,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Cigna MGG,Cigna MGG,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Humana,Humana,5736.15,,,,,,,per diem,5736.15,5736.15,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Humana MGG,Humana MGG,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Optum VA,Optum VA,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,UHC,UHC,5736.15,,,,,,,per diem,5736.15,5736.15,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,UHC MGG,UHC MGG,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,VA,VA,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Wellcare MGG,Wellcare MGG,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Bright Health - commercial,Bright Health - commercial,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,5736.15,5736.15,Bright Health MGG,Bright Health MGG,5736.15,,,,,,,case rate,5736.15,5736.15,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Aetna,Aetna,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Aetna MGG,Aetna MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,BCBS,BCBS,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,BCBS MGG,BCBS MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Cigna,Cigna,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Cigna MGG,Cigna MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Humana,Humana,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Humana MGG,Humana MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Optum VA,Optum VA,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,UHC,UHC,432.48,,,,,,,per diem,432.48,432.48,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,UHC MGG,UHC MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,VA,VA,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Wellcare MGG,Wellcare MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Bright Health - commercial,Bright Health - commercial,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,432.48,432.48,Bright Health MGG,Bright Health MGG,432.48,,,,,,,case rate,432.48,432.48,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Aetna,Aetna,121.6,,,,,,,per diem,121.6,121.6,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Aetna MGG,Aetna MGG,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,BCBS,BCBS,121.6,,,,,,,per diem,121.6,121.6,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,BCBS MGG,BCBS MGG,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Cigna,Cigna,121.6,,,,,,,per diem,121.6,121.6,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Cigna MGG,Cigna MGG,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Humana,Humana,121.6,,,,,,,per diem,121.6,121.6,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Humana MGG,Humana MGG,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Optum VA,Optum VA,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,UHC,UHC,121.6,,,,,,,per diem,121.6,121.6,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,UHC MGG,UHC MGG,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,VA,VA,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Wellcare MGG,Wellcare MGG,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Bright Health - commercial,Bright Health - commercial,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,121.6,121.6,Bright Health MGG,Bright Health MGG,121.6,,,,,,,case rate,121.6,121.6,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Aetna,Aetna,3944.64,,,,,,,per diem,3944.64,3944.64,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Aetna MGG,Aetna MGG,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,BCBS,BCBS,3944.64,,,,,,,per diem,3944.64,3944.64,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,BCBS MGG,BCBS MGG,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Cigna,Cigna,3944.64,,,,,,,per diem,3944.64,3944.64,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Cigna MGG,Cigna MGG,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Humana,Humana,3944.64,,,,,,,per diem,3944.64,3944.64,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Humana MGG,Humana MGG,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Optum VA,Optum VA,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,UHC,UHC,3944.64,,,,,,,per diem,3944.64,3944.64,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,UHC MGG,UHC MGG,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,VA,VA,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Wellcare MGG,Wellcare MGG,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Bright Health - commercial,Bright Health - commercial,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,3944.64,3944.64,Bright Health MGG,Bright Health MGG,3944.64,,,,,,,case rate,3944.64,3944.64,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Aetna,Aetna,2611.15,,,,,,,per diem,2611.15,2611.15,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Aetna MGG,Aetna MGG,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,BCBS,BCBS,2611.15,,,,,,,per diem,2611.15,2611.15,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,BCBS MGG,BCBS MGG,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Cigna,Cigna,2611.15,,,,,,,per diem,2611.15,2611.15,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Cigna MGG,Cigna MGG,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Humana,Humana,2611.15,,,,,,,per diem,2611.15,2611.15,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Humana MGG,Humana MGG,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Optum VA,Optum VA,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,UHC,UHC,2611.15,,,,,,,per diem,2611.15,2611.15,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,UHC MGG,UHC MGG,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,VA,VA,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Wellcare MGG,Wellcare MGG,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Bright Health - commercial,Bright Health - commercial,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2611.15,2611.15,Bright Health MGG,Bright Health MGG,2611.15,,,,,,,case rate,2611.15,2611.15,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Aetna,Aetna,3875.95,,,,,,,per diem,3875.95,3875.95,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Aetna MGG,Aetna MGG,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,BCBS,BCBS,3875.95,,,,,,,per diem,3875.95,3875.95,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,BCBS MGG,BCBS MGG,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Cigna,Cigna,3875.95,,,,,,,per diem,3875.95,3875.95,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Cigna MGG,Cigna MGG,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Humana,Humana,3875.95,,,,,,,per diem,3875.95,3875.95,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Humana MGG,Humana MGG,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Optum VA,Optum VA,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,UHC,UHC,3875.95,,,,,,,per diem,3875.95,3875.95,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,UHC MGG,UHC MGG,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,VA,VA,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Wellcare MGG,Wellcare MGG,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Bright Health - commercial,Bright Health - commercial,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,3875.95,3875.95,Bright Health MGG,Bright Health MGG,3875.95,,,,,,,case rate,3875.95,3875.95,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Aetna,Aetna,2077.55,,,,,,,per diem,2077.55,2077.55,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Aetna MGG,Aetna MGG,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,BCBS,BCBS,2077.55,,,,,,,per diem,2077.55,2077.55,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,BCBS MGG,BCBS MGG,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Cigna,Cigna,2077.55,,,,,,,per diem,2077.55,2077.55,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Cigna MGG,Cigna MGG,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Humana,Humana,2077.55,,,,,,,per diem,2077.55,2077.55,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Humana MGG,Humana MGG,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Optum VA,Optum VA,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,UHC,UHC,2077.55,,,,,,,per diem,2077.55,2077.55,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,UHC MGG,UHC MGG,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,VA,VA,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Wellcare MGG,Wellcare MGG,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Bright Health - commercial,Bright Health - commercial,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2077.55,2077.55,Bright Health MGG,Bright Health MGG,2077.55,,,,,,,case rate,2077.55,2077.55,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Aetna,Aetna,1312.58,,,,,,,per diem,1312.58,1312.58,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Aetna MGG,Aetna MGG,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,BCBS,BCBS,1312.58,,,,,,,per diem,1312.58,1312.58,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,BCBS MGG,BCBS MGG,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Cigna,Cigna,1312.58,,,,,,,per diem,1312.58,1312.58,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Cigna MGG,Cigna MGG,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Humana,Humana,1312.58,,,,,,,per diem,1312.58,1312.58,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Humana MGG,Humana MGG,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Optum VA,Optum VA,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,UHC,UHC,1312.58,,,,,,,per diem,1312.58,1312.58,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,UHC MGG,UHC MGG,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,VA,VA,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Wellcare MGG,Wellcare MGG,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Bright Health - commercial,Bright Health - commercial,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1312.58,1312.58,Bright Health MGG,Bright Health MGG,1312.58,,,,,,,case rate,1312.58,1312.58,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Aetna,Aetna,5224.63,,,,,,,per diem,5224.63,5224.63,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Aetna MGG,Aetna MGG,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,BCBS,BCBS,5224.63,,,,,,,per diem,5224.63,5224.63,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,BCBS MGG,BCBS MGG,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Cigna,Cigna,5224.63,,,,,,,per diem,5224.63,5224.63,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Cigna MGG,Cigna MGG,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Humana,Humana,5224.63,,,,,,,per diem,5224.63,5224.63,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Humana MGG,Humana MGG,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Optum VA,Optum VA,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,UHC,UHC,5224.63,,,,,,,per diem,5224.63,5224.63,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,UHC MGG,UHC MGG,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,VA,VA,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Wellcare MGG,Wellcare MGG,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Bright Health - commercial,Bright Health - commercial,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5224.63,5224.63,Bright Health MGG,Bright Health MGG,5224.63,,,,,,,case rate,5224.63,5224.63,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Aetna,Aetna,474.3,,,,,,,per diem,474.3,474.3,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Aetna MGG,Aetna MGG,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,BCBS,BCBS,474.3,,,,,,,per diem,474.3,474.3,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,BCBS MGG,BCBS MGG,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Cigna,Cigna,474.3,,,,,,,per diem,474.3,474.3,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Cigna MGG,Cigna MGG,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Humana,Humana,474.3,,,,,,,per diem,474.3,474.3,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Humana MGG,Humana MGG,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Optum VA,Optum VA,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,UHC,UHC,474.3,,,,,,,per diem,474.3,474.3,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,UHC MGG,UHC MGG,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,VA,VA,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Wellcare MGG,Wellcare MGG,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Bright Health - commercial,Bright Health - commercial,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,474.3,474.3,Bright Health MGG,Bright Health MGG,474.3,,,,,,,case rate,474.3,474.3,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Aetna,Aetna,3038.16,,,,,,,per diem,3038.16,3038.16,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Aetna MGG,Aetna MGG,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,BCBS,BCBS,3038.16,,,,,,,per diem,3038.16,3038.16,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,BCBS MGG,BCBS MGG,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Cigna,Cigna,3038.16,,,,,,,per diem,3038.16,3038.16,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Cigna MGG,Cigna MGG,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Humana,Humana,3038.16,,,,,,,per diem,3038.16,3038.16,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Humana MGG,Humana MGG,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Optum VA,Optum VA,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,UHC,UHC,3038.16,,,,,,,per diem,3038.16,3038.16,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,UHC MGG,UHC MGG,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,VA,VA,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Wellcare MGG,Wellcare MGG,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Bright Health - commercial,Bright Health - commercial,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3038.16,3038.16,Bright Health MGG,Bright Health MGG,3038.16,,,,,,,case rate,3038.16,3038.16,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Aetna,Aetna,4966.38,,,,,,,per diem,4966.38,4966.38,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Aetna MGG,Aetna MGG,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,BCBS,BCBS,4966.38,,,,,,,per diem,4966.38,4966.38,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,BCBS MGG,BCBS MGG,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Cigna,Cigna,4966.38,,,,,,,per diem,4966.38,4966.38,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Cigna MGG,Cigna MGG,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Humana,Humana,4966.38,,,,,,,per diem,4966.38,4966.38,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Humana MGG,Humana MGG,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Optum VA,Optum VA,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,UHC,UHC,4966.38,,,,,,,per diem,4966.38,4966.38,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,UHC MGG,UHC MGG,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,VA,VA,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Wellcare MGG,Wellcare MGG,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Bright Health - commercial,Bright Health - commercial,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,4966.38,4966.38,Bright Health MGG,Bright Health MGG,4966.38,,,,,,,case rate,4966.38,4966.38,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Aetna,Aetna,5429.46,,,,,,,per diem,5429.46,5429.46,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Aetna MGG,Aetna MGG,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,BCBS,BCBS,5429.46,,,,,,,per diem,5429.46,5429.46,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,BCBS MGG,BCBS MGG,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Cigna,Cigna,5429.46,,,,,,,per diem,5429.46,5429.46,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Cigna MGG,Cigna MGG,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Humana,Humana,5429.46,,,,,,,per diem,5429.46,5429.46,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Humana MGG,Humana MGG,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Optum VA,Optum VA,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,UHC,UHC,5429.46,,,,,,,per diem,5429.46,5429.46,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,UHC MGG,UHC MGG,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,VA,VA,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Wellcare MGG,Wellcare MGG,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Bright Health - commercial,Bright Health - commercial,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5429.46,5429.46,Bright Health MGG,Bright Health MGG,5429.46,,,,,,,case rate,5429.46,5429.46,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Aetna,Aetna,1304.25,,,,,,,per diem,1304.25,1304.25,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Aetna MGG,Aetna MGG,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,BCBS,BCBS,1304.25,,,,,,,per diem,1304.25,1304.25,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,BCBS MGG,BCBS MGG,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Cigna,Cigna,1304.25,,,,,,,per diem,1304.25,1304.25,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Cigna MGG,Cigna MGG,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Humana,Humana,1304.25,,,,,,,per diem,1304.25,1304.25,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Humana MGG,Humana MGG,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Optum VA,Optum VA,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,UHC,UHC,1304.25,,,,,,,per diem,1304.25,1304.25,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,UHC MGG,UHC MGG,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,VA,VA,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Wellcare MGG,Wellcare MGG,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Bright Health - commercial,Bright Health - commercial,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,1304.25,1304.25,Bright Health MGG,Bright Health MGG,1304.25,,,,,,,case rate,1304.25,1304.25,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Aetna,Aetna,6971.16,,,,,,,per diem,6971.16,6971.16,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Aetna MGG,Aetna MGG,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,BCBS,BCBS,6971.16,,,,,,,per diem,6971.16,6971.16,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,BCBS MGG,BCBS MGG,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Cigna,Cigna,6971.16,,,,,,,per diem,6971.16,6971.16,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Cigna MGG,Cigna MGG,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Humana,Humana,6971.16,,,,,,,per diem,6971.16,6971.16,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Humana MGG,Humana MGG,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Optum VA,Optum VA,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,UHC,UHC,6971.16,,,,,,,per diem,6971.16,6971.16,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,UHC MGG,UHC MGG,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,VA,VA,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Wellcare MGG,Wellcare MGG,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Bright Health - commercial,Bright Health - commercial,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,6971.16,6971.16,Bright Health MGG,Bright Health MGG,6971.16,,,,,,,case rate,6971.16,6971.16,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Aetna,Aetna,6582,,,,,,,per diem,6582,6582,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Aetna MGG,Aetna MGG,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,BCBS,BCBS,6582,,,,,,,per diem,6582,6582,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,BCBS MGG,BCBS MGG,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Cigna,Cigna,6582,,,,,,,per diem,6582,6582,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Cigna MGG,Cigna MGG,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Humana,Humana,6582,,,,,,,per diem,6582,6582,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Humana MGG,Humana MGG,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Optum VA,Optum VA,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,UHC,UHC,6582,,,,,,,per diem,6582,6582,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,UHC MGG,UHC MGG,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,VA,VA,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Wellcare MGG,Wellcare MGG,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Bright Health - commercial,Bright Health - commercial,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6582,6582,Bright Health MGG,Bright Health MGG,6582,,,,,,,case rate,6582,6582,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Aetna,Aetna,639.69,,,,,,,per diem,639.69,639.69,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Aetna MGG,Aetna MGG,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,BCBS,BCBS,639.69,,,,,,,per diem,639.69,639.69,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,BCBS MGG,BCBS MGG,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Cigna,Cigna,639.69,,,,,,,per diem,639.69,639.69,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Cigna MGG,Cigna MGG,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Humana,Humana,639.69,,,,,,,per diem,639.69,639.69,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Humana MGG,Humana MGG,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Optum VA,Optum VA,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,UHC,UHC,639.69,,,,,,,per diem,639.69,639.69,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,UHC MGG,UHC MGG,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,VA,VA,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Wellcare MGG,Wellcare MGG,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Bright Health - commercial,Bright Health - commercial,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,639.69,639.69,Bright Health MGG,Bright Health MGG,639.69,,,,,,,case rate,639.69,639.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Aetna,Aetna,2722.27,,,,,,,per diem,2722.27,2722.27,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Aetna MGG,Aetna MGG,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,BCBS,BCBS,2722.27,,,,,,,per diem,2722.27,2722.27,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,BCBS MGG,BCBS MGG,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Cigna,Cigna,2722.27,,,,,,,per diem,2722.27,2722.27,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Cigna MGG,Cigna MGG,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Humana,Humana,2722.27,,,,,,,per diem,2722.27,2722.27,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Humana MGG,Humana MGG,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Optum VA,Optum VA,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,UHC,UHC,2722.27,,,,,,,per diem,2722.27,2722.27,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,UHC MGG,UHC MGG,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,VA,VA,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Wellcare MGG,Wellcare MGG,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Bright Health - commercial,Bright Health - commercial,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2722.27,2722.27,Bright Health MGG,Bright Health MGG,2722.27,,,,,,,case rate,2722.27,2722.27,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Aetna,Aetna,12315.42,,,,,,,per diem,12315.42,12315.42,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Aetna MGG,Aetna MGG,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,BCBS,BCBS,12315.42,,,,,,,per diem,12315.42,12315.42,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,BCBS MGG,BCBS MGG,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Cigna,Cigna,12315.42,,,,,,,per diem,12315.42,12315.42,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Cigna MGG,Cigna MGG,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Humana,Humana,12315.42,,,,,,,per diem,12315.42,12315.42,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Humana MGG,Humana MGG,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Optum VA,Optum VA,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,UHC,UHC,12315.42,,,,,,,per diem,12315.42,12315.42,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,UHC MGG,UHC MGG,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,VA,VA,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Wellcare MGG,Wellcare MGG,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Bright Health - commercial,Bright Health - commercial,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12315.42,12315.42,Bright Health MGG,Bright Health MGG,12315.42,,,,,,,case rate,12315.42,12315.42,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Aetna,Aetna,876.83,,,,,,,per diem,876.83,876.83,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Aetna MGG,Aetna MGG,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,BCBS,BCBS,876.83,,,,,,,per diem,876.83,876.83,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,BCBS MGG,BCBS MGG,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Cigna,Cigna,876.83,,,,,,,per diem,876.83,876.83,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Cigna MGG,Cigna MGG,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Humana,Humana,876.83,,,,,,,per diem,876.83,876.83,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Humana MGG,Humana MGG,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Optum VA,Optum VA,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,UHC,UHC,876.83,,,,,,,per diem,876.83,876.83,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,UHC MGG,UHC MGG,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,VA,VA,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Wellcare MGG,Wellcare MGG,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Bright Health - commercial,Bright Health - commercial,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,876.83,876.83,Bright Health MGG,Bright Health MGG,876.83,,,,,,,case rate,876.83,876.83,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Aetna,Aetna,1008.18,,,,,,,per diem,1008.18,1008.18,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Aetna MGG,Aetna MGG,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,BCBS,BCBS,1008.18,,,,,,,per diem,1008.18,1008.18,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,BCBS MGG,BCBS MGG,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Cigna,Cigna,1008.18,,,,,,,per diem,1008.18,1008.18,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Cigna MGG,Cigna MGG,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Humana,Humana,1008.18,,,,,,,per diem,1008.18,1008.18,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Humana MGG,Humana MGG,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Optum VA,Optum VA,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,UHC,UHC,1008.18,,,,,,,per diem,1008.18,1008.18,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,UHC MGG,UHC MGG,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,VA,VA,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Wellcare MGG,Wellcare MGG,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Bright Health - commercial,Bright Health - commercial,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1008.18,1008.18,Bright Health MGG,Bright Health MGG,1008.18,,,,,,,case rate,1008.18,1008.18,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Aetna,Aetna,1158,,,,,,,per diem,1158,1158,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Aetna MGG,Aetna MGG,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,BCBS,BCBS,1158,,,,,,,per diem,1158,1158,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,BCBS MGG,BCBS MGG,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Cigna,Cigna,1158,,,,,,,per diem,1158,1158,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Cigna MGG,Cigna MGG,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Humana,Humana,1158,,,,,,,per diem,1158,1158,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Humana MGG,Humana MGG,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Optum VA,Optum VA,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,UHC,UHC,1158,,,,,,,per diem,1158,1158,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,UHC MGG,UHC MGG,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,VA,VA,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Wellcare MGG,Wellcare MGG,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Bright Health - commercial,Bright Health - commercial,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST RT  ,77010013,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,1158,1158,Bright Health MGG,Bright Health MGG,1158,,,,,,,case rate,1158,1158,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Aetna,Aetna,342.33,,,,,,,per diem,342.33,342.33,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Aetna MGG,Aetna MGG,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,BCBS,BCBS,342.33,,,,,,,per diem,342.33,342.33,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,BCBS MGG,BCBS MGG,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Cigna,Cigna,342.33,,,,,,,per diem,342.33,342.33,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Cigna MGG,Cigna MGG,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Humana,Humana,342.33,,,,,,,per diem,342.33,342.33,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Humana MGG,Humana MGG,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Optum VA,Optum VA,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,UHC,UHC,342.33,,,,,,,per diem,342.33,342.33,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,UHC MGG,UHC MGG,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,VA,VA,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Wellcare MGG,Wellcare MGG,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Bright Health - commercial,Bright Health - commercial,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,342.33,342.33,Bright Health MGG,Bright Health MGG,342.33,,,,,,,case rate,342.33,342.33,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Aetna,Aetna,740,,,,,,,per diem,740,740,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Aetna MGG,Aetna MGG,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,BCBS,BCBS,740,,,,,,,per diem,740,740,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,BCBS MGG,BCBS MGG,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Cigna,Cigna,740,,,,,,,per diem,740,740,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Cigna MGG,Cigna MGG,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Humana,Humana,740,,,,,,,per diem,740,740,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Humana MGG,Humana MGG,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Optum VA,Optum VA,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,UHC,UHC,740,,,,,,,per diem,740,740,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,UHC MGG,UHC MGG,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,VA,VA,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Wellcare MGG,Wellcare MGG,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Bright Health - commercial,Bright Health - commercial,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,740,740,Bright Health MGG,Bright Health MGG,740,,,,,,,case rate,740,740,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Aetna,Aetna,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Aetna MGG,Aetna MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,BCBS,BCBS,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,BCBS MGG,BCBS MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Cigna,Cigna,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Cigna MGG,Cigna MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Humana,Humana,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Humana MGG,Humana MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Optum VA,Optum VA,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,UHC,UHC,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,UHC MGG,UHC MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,VA,VA,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Wellcare MGG,Wellcare MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Bright Health - commercial,Bright Health - commercial,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,1267.32,1267.32,Bright Health MGG,Bright Health MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Aetna,Aetna,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Aetna MGG,Aetna MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,BCBS,BCBS,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,BCBS MGG,BCBS MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Cigna,Cigna,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Cigna MGG,Cigna MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Humana,Humana,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Humana MGG,Humana MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Optum VA,Optum VA,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,UHC,UHC,1267.32,,,,,,,per diem,1267.32,1267.32,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,UHC MGG,UHC MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,VA,VA,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Wellcare MGG,Wellcare MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Bright Health - commercial,Bright Health - commercial,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,1267.32,1267.32,Bright Health MGG,Bright Health MGG,1267.32,,,,,,,case rate,1267.32,1267.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Aetna,Aetna,421.26,,,,,,,per diem,421.26,421.26,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Aetna MGG,Aetna MGG,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,BCBS,BCBS,421.26,,,,,,,per diem,421.26,421.26,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,BCBS MGG,BCBS MGG,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Cigna,Cigna,421.26,,,,,,,per diem,421.26,421.26,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Cigna MGG,Cigna MGG,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Humana,Humana,421.26,,,,,,,per diem,421.26,421.26,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Humana MGG,Humana MGG,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Optum VA,Optum VA,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,UHC,UHC,421.26,,,,,,,per diem,421.26,421.26,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,UHC MGG,UHC MGG,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,VA,VA,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Wellcare MGG,Wellcare MGG,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Bright Health - commercial,Bright Health - commercial,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,94770,CPT,,,,Inpatient,,,421.26,421.26,Bright Health MGG,Bright Health MGG,421.26,,,,,,,case rate,421.26,421.26,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Aetna,Aetna,1782.96,,,,,,,per diem,1782.96,1782.96,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Aetna MGG,Aetna MGG,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,BCBS,BCBS,1782.96,,,,,,,per diem,1782.96,1782.96,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,BCBS MGG,BCBS MGG,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Cigna,Cigna,1782.96,,,,,,,per diem,1782.96,1782.96,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Cigna MGG,Cigna MGG,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Humana,Humana,1782.96,,,,,,,per diem,1782.96,1782.96,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Humana MGG,Humana MGG,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Optum VA,Optum VA,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,UHC,UHC,1782.96,,,,,,,per diem,1782.96,1782.96,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,UHC MGG,UHC MGG,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,VA,VA,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Wellcare MGG,Wellcare MGG,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Bright Health - commercial,Bright Health - commercial,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,75989,CPT,,,,Inpatient,,,1782.96,1782.96,Bright Health MGG,Bright Health MGG,1782.96,,,,,,,case rate,1782.96,1782.96,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Aetna,Aetna,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Aetna MGG,Aetna MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,BCBS,BCBS,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,BCBS MGG,BCBS MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Cigna,Cigna,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Cigna MGG,Cigna MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Humana,Humana,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Humana MGG,Humana MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Optum VA,Optum VA,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,UHC,UHC,5664.06,,,,,,,per diem,5664.06,5664.06,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,UHC MGG,UHC MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,VA,VA,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Wellcare MGG,Wellcare MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Bright Health - commercial,Bright Health - commercial,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,75716,CPT,,,,Inpatient,,,5664.06,5664.06,Bright Health MGG,Bright Health MGG,5664.06,,,,,,,case rate,5664.06,5664.06,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Aetna,Aetna,1629.96,,,,,,,per diem,1629.96,1629.96,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Aetna MGG,Aetna MGG,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,BCBS,BCBS,1629.96,,,,,,,per diem,1629.96,1629.96,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,BCBS MGG,BCBS MGG,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Cigna,Cigna,1629.96,,,,,,,per diem,1629.96,1629.96,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Cigna MGG,Cigna MGG,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Humana,Humana,1629.96,,,,,,,per diem,1629.96,1629.96,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Humana MGG,Humana MGG,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Optum VA,Optum VA,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,UHC,UHC,1629.96,,,,,,,per diem,1629.96,1629.96,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,UHC MGG,UHC MGG,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,VA,VA,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Wellcare MGG,Wellcare MGG,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Bright Health - commercial,Bright Health - commercial,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,75984,CPT,,,,Inpatient,,,1629.96,1629.96,Bright Health MGG,Bright Health MGG,1629.96,,,,,,,case rate,1629.96,1629.96,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Aetna,Aetna,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Aetna MGG,Aetna MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,BCBS,BCBS,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,BCBS MGG,BCBS MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Cigna,Cigna,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Cigna MGG,Cigna MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Humana,Humana,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Humana MGG,Humana MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Optum VA,Optum VA,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,UHC,UHC,1255.62,,,,,,,per diem,1255.62,1255.62,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,UHC MGG,UHC MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,VA,VA,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Wellcare MGG,Wellcare MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Bright Health - commercial,Bright Health - commercial,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,77003,CPT,,,,Inpatient,,,1255.62,1255.62,Bright Health MGG,Bright Health MGG,1255.62,,,,,,,case rate,1255.62,1255.62,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Aetna,Aetna,1529.12,,,,,,,per diem,1529.12,1529.12,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Aetna MGG,Aetna MGG,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,BCBS,BCBS,1529.12,,,,,,,per diem,1529.12,1529.12,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,BCBS MGG,BCBS MGG,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Cigna,Cigna,1529.12,,,,,,,per diem,1529.12,1529.12,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Cigna MGG,Cigna MGG,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Humana,Humana,1529.12,,,,,,,per diem,1529.12,1529.12,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Humana MGG,Humana MGG,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Optum VA,Optum VA,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,UHC,UHC,1529.12,,,,,,,per diem,1529.12,1529.12,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,UHC MGG,UHC MGG,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,VA,VA,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Wellcare MGG,Wellcare MGG,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Bright Health - commercial,Bright Health - commercial,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,76942,CPT,,,,Inpatient,,,1529.12,1529.12,Bright Health MGG,Bright Health MGG,1529.12,,,,,,,case rate,1529.12,1529.12,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Aetna,Aetna,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Aetna MGG,Aetna MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,BCBS,BCBS,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,BCBS MGG,BCBS MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Cigna,Cigna,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Cigna MGG,Cigna MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Humana,Humana,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Humana MGG,Humana MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Optum VA,Optum VA,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,UHC,UHC,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,UHC MGG,UHC MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,VA,VA,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Wellcare MGG,Wellcare MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Bright Health - commercial,Bright Health - commercial,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,73706,CPT,,,LT,Inpatient,,,1863.54,1863.54,Bright Health MGG,Bright Health MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Aetna,Aetna,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Aetna MGG,Aetna MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,BCBS,BCBS,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,BCBS MGG,BCBS MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Cigna,Cigna,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Cigna MGG,Cigna MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Humana,Humana,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Humana MGG,Humana MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Optum VA,Optum VA,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,UHC,UHC,1863.54,,,,,,,per diem,1863.54,1863.54,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,UHC MGG,UHC MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,VA,VA,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Wellcare MGG,Wellcare MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Bright Health - commercial,Bright Health - commercial,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,73706,CPT,,,RT,Inpatient,,,1863.54,1863.54,Bright Health MGG,Bright Health MGG,1863.54,,,,,,,case rate,1863.54,1863.54,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Aetna,Aetna,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Aetna MGG,Aetna MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,BCBS,BCBS,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,BCBS MGG,BCBS MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Cigna,Cigna,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Cigna MGG,Cigna MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Humana,Humana,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Humana MGG,Humana MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Optum VA,Optum VA,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,UHC,UHC,2995.74,,,,,,,per diem,2995.74,2995.74,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,UHC MGG,UHC MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,VA,VA,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Wellcare MGG,Wellcare MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Bright Health - commercial,Bright Health - commercial,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,77012,CPT,,,,Inpatient,,,2995.74,2995.74,Bright Health MGG,Bright Health MGG,2995.74,,,,,,,case rate,2995.74,2995.74,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Aetna,Aetna,3420.47,,,,,,,per diem,3420.47,3420.47,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Aetna MGG,Aetna MGG,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,BCBS,BCBS,3420.47,,,,,,,per diem,3420.47,3420.47,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,BCBS MGG,BCBS MGG,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Cigna,Cigna,3420.47,,,,,,,per diem,3420.47,3420.47,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Cigna MGG,Cigna MGG,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Humana,Humana,3420.47,,,,,,,per diem,3420.47,3420.47,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Humana MGG,Humana MGG,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Optum VA,Optum VA,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,UHC,UHC,3420.47,,,,,,,per diem,3420.47,3420.47,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,UHC MGG,UHC MGG,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,VA,VA,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Wellcare MGG,Wellcare MGG,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Bright Health - commercial,Bright Health - commercial,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,74174,CPT,,,,Inpatient,,,3420.47,3420.47,Bright Health MGG,Bright Health MGG,3420.47,,,,,,,case rate,3420.47,3420.47,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Aetna,Aetna,3405.81,,,,,,,per diem,3405.81,3405.81,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Aetna MGG,Aetna MGG,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,BCBS,BCBS,3405.81,,,,,,,per diem,3405.81,3405.81,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,BCBS MGG,BCBS MGG,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Cigna,Cigna,3405.81,,,,,,,per diem,3405.81,3405.81,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Cigna MGG,Cigna MGG,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Humana,Humana,3405.81,,,,,,,per diem,3405.81,3405.81,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Humana MGG,Humana MGG,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Optum VA,Optum VA,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,UHC,UHC,3405.81,,,,,,,per diem,3405.81,3405.81,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,UHC MGG,UHC MGG,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,VA,VA,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Wellcare MGG,Wellcare MGG,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Bright Health - commercial,Bright Health - commercial,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,75574,CPT,,,,Inpatient,,,3405.81,3405.81,Bright Health MGG,Bright Health MGG,3405.81,,,,,,,case rate,3405.81,3405.81,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Aetna,Aetna,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Aetna MGG,Aetna MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,BCBS,BCBS,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,BCBS MGG,BCBS MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Cigna,Cigna,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Cigna MGG,Cigna MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Humana,Humana,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Humana MGG,Humana MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Optum VA,Optum VA,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,UHC,UHC,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,UHC MGG,UHC MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,VA,VA,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Wellcare MGG,Wellcare MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Bright Health - commercial,Bright Health - commercial,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,73206,CPT,,,50,Inpatient,,,1980.84,1980.84,Bright Health MGG,Bright Health MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Aetna,Aetna,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Aetna MGG,Aetna MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,BCBS,BCBS,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,BCBS MGG,BCBS MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Cigna,Cigna,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Cigna MGG,Cigna MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Humana,Humana,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Humana MGG,Humana MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Optum VA,Optum VA,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,UHC,UHC,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,UHC MGG,UHC MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,VA,VA,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Wellcare MGG,Wellcare MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Bright Health - commercial,Bright Health - commercial,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,73206,CPT,,,LT,Inpatient,,,1980.84,1980.84,Bright Health MGG,Bright Health MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Aetna,Aetna,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Aetna MGG,Aetna MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,BCBS,BCBS,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,BCBS MGG,BCBS MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Cigna,Cigna,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Cigna MGG,Cigna MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Humana,Humana,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Humana MGG,Humana MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Optum VA,Optum VA,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,UHC,UHC,1980.84,,,,,,,per diem,1980.84,1980.84,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,UHC MGG,UHC MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,VA,VA,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Wellcare MGG,Wellcare MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Bright Health - commercial,Bright Health - commercial,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,73206,CPT,,,RT,Inpatient,,,1980.84,1980.84,Bright Health MGG,Bright Health MGG,1980.84,,,,,,,case rate,1980.84,1980.84,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Aetna,Aetna,1732.98,,,,,,,per diem,1732.98,1732.98,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Aetna MGG,Aetna MGG,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,BCBS,BCBS,1732.98,,,,,,,per diem,1732.98,1732.98,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,BCBS MGG,BCBS MGG,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Cigna,Cigna,1732.98,,,,,,,per diem,1732.98,1732.98,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Cigna MGG,Cigna MGG,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Humana,Humana,1732.98,,,,,,,per diem,1732.98,1732.98,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Humana MGG,Humana MGG,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Optum VA,Optum VA,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,UHC,UHC,1732.98,,,,,,,per diem,1732.98,1732.98,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,UHC MGG,UHC MGG,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,VA,VA,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Wellcare MGG,Wellcare MGG,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Bright Health - commercial,Bright Health - commercial,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,0042T,CPT,,,,Inpatient,,,1732.98,1732.98,Bright Health MGG,Bright Health MGG,1732.98,,,,,,,case rate,1732.98,1732.98,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Aetna,Aetna,2914.14,,,,,,,per diem,2914.14,2914.14,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Aetna MGG,Aetna MGG,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,BCBS,BCBS,2914.14,,,,,,,per diem,2914.14,2914.14,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,BCBS MGG,BCBS MGG,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Cigna,Cigna,2914.14,,,,,,,per diem,2914.14,2914.14,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Cigna MGG,Cigna MGG,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Humana,Humana,2914.14,,,,,,,per diem,2914.14,2914.14,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Humana MGG,Humana MGG,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Optum VA,Optum VA,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,UHC,UHC,2914.14,,,,,,,per diem,2914.14,2914.14,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,UHC MGG,UHC MGG,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,VA,VA,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Wellcare MGG,Wellcare MGG,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Bright Health - commercial,Bright Health - commercial,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,75571,CPT,,,,Inpatient,,,2914.14,2914.14,Bright Health MGG,Bright Health MGG,2914.14,,,,,,,case rate,2914.14,2914.14,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Aetna,Aetna,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Aetna MGG,Aetna MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,BCBS,BCBS,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,BCBS MGG,BCBS MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Cigna,Cigna,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Cigna MGG,Cigna MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Humana,Humana,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Humana MGG,Humana MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Optum VA,Optum VA,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,UHC,UHC,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,UHC MGG,UHC MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,VA,VA,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Wellcare MGG,Wellcare MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Bright Health - commercial,Bright Health - commercial,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,75573,CPT,,,,Inpatient,,,3428.22,3428.22,Bright Health MGG,Bright Health MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Aetna,Aetna,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Aetna MGG,Aetna MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,BCBS,BCBS,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,BCBS MGG,BCBS MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Cigna,Cigna,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Cigna MGG,Cigna MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Humana,Humana,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Humana MGG,Humana MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Optum VA,Optum VA,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,UHC,UHC,3428.22,,,,,,,per diem,3428.22,3428.22,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,UHC MGG,UHC MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,VA,VA,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Wellcare MGG,Wellcare MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Bright Health - commercial,Bright Health - commercial,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,75572,CPT,,,,Inpatient,,,3428.22,3428.22,Bright Health MGG,Bright Health MGG,3428.22,,,,,,,case rate,3428.22,3428.22,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Aetna,Aetna,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Aetna MGG,Aetna MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,BCBS,BCBS,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,BCBS MGG,BCBS MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Cigna,Cigna,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Cigna MGG,Cigna MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Humana,Humana,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Humana MGG,Humana MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Optum VA,Optum VA,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,UHC,UHC,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,UHC MGG,UHC MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,VA,VA,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Wellcare MGG,Wellcare MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Bright Health - commercial,Bright Health - commercial,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,3972.9,3972.9,Bright Health MGG,Bright Health MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Aetna,Aetna,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Aetna MGG,Aetna MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,BCBS,BCBS,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,BCBS MGG,BCBS MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Cigna,Cigna,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Cigna MGG,Cigna MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Humana,Humana,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Humana MGG,Humana MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Optum VA,Optum VA,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,UHC,UHC,3972.9,,,,,,,per diem,3972.9,3972.9,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,UHC MGG,UHC MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,VA,VA,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Wellcare MGG,Wellcare MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Bright Health - commercial,Bright Health - commercial,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,73701,CPT,,,LT,Inpatient,,,3972.9,3972.9,Bright Health MGG,Bright Health MGG,3972.9,,,,,,,case rate,3972.9,3972.9,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Aetna,Aetna,1784.84,,,,,,,per diem,1784.84,1784.84,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Aetna MGG,Aetna MGG,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,BCBS,BCBS,1784.84,,,,,,,per diem,1784.84,1784.84,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,BCBS MGG,BCBS MGG,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Cigna,Cigna,1784.84,,,,,,,per diem,1784.84,1784.84,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Cigna MGG,Cigna MGG,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Humana,Humana,1784.84,,,,,,,per diem,1784.84,1784.84,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Humana MGG,Humana MGG,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Optum VA,Optum VA,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,UHC,UHC,1784.84,,,,,,,per diem,1784.84,1784.84,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,UHC MGG,UHC MGG,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,VA,VA,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Wellcare MGG,Wellcare MGG,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Bright Health - commercial,Bright Health - commercial,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,73700,CPT,,,,Inpatient,,,1784.84,1784.84,Bright Health MGG,Bright Health MGG,1784.84,,,,,,,case rate,1784.84,1784.84,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Aetna,Aetna,4258.5,,,,,,,per diem,4258.5,4258.5,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Aetna MGG,Aetna MGG,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,BCBS,BCBS,4258.5,,,,,,,per diem,4258.5,4258.5,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,BCBS MGG,BCBS MGG,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Cigna,Cigna,4258.5,,,,,,,per diem,4258.5,4258.5,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Cigna MGG,Cigna MGG,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Humana,Humana,4258.5,,,,,,,per diem,4258.5,4258.5,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Humana MGG,Humana MGG,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Optum VA,Optum VA,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,UHC,UHC,4258.5,,,,,,,per diem,4258.5,4258.5,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,UHC MGG,UHC MGG,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,VA,VA,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Wellcare MGG,Wellcare MGG,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Bright Health - commercial,Bright Health - commercial,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,73201,CPT,,,RT,Inpatient,,,4258.5,4258.5,Bright Health MGG,Bright Health MGG,4258.5,,,,,,,case rate,4258.5,4258.5,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Aetna,Aetna,2998.46,,,,,,,per diem,2998.46,2998.46,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Aetna MGG,Aetna MGG,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,BCBS,BCBS,2998.46,,,,,,,per diem,2998.46,2998.46,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,BCBS MGG,BCBS MGG,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Cigna,Cigna,2998.46,,,,,,,per diem,2998.46,2998.46,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Cigna MGG,Cigna MGG,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Humana,Humana,2998.46,,,,,,,per diem,2998.46,2998.46,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Humana MGG,Humana MGG,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Optum VA,Optum VA,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,UHC,UHC,2998.46,,,,,,,per diem,2998.46,2998.46,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,UHC MGG,UHC MGG,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,VA,VA,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Wellcare MGG,Wellcare MGG,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Bright Health - commercial,Bright Health - commercial,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,2998.46,2998.46,Bright Health MGG,Bright Health MGG,2998.46,,,,,,,case rate,2998.46,2998.46,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Aetna,Aetna,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Aetna MGG,Aetna MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,BCBS,BCBS,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,BCBS MGG,BCBS MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Cigna,Cigna,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Cigna MGG,Cigna MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Humana,Humana,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Humana MGG,Humana MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Optum VA,Optum VA,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,UHC,UHC,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,UHC MGG,UHC MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,VA,VA,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Wellcare MGG,Wellcare MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Bright Health - commercial,Bright Health - commercial,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,73200,CPT,,,RT,Inpatient,,,3434.34,3434.34,Bright Health MGG,Bright Health MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Aetna,Aetna,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Aetna MGG,Aetna MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,BCBS,BCBS,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,BCBS MGG,BCBS MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Cigna,Cigna,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Cigna MGG,Cigna MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Humana,Humana,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Humana MGG,Humana MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Optum VA,Optum VA,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,UHC,UHC,3434.34,,,,,,,per diem,3434.34,3434.34,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,UHC MGG,UHC MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,VA,VA,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Wellcare MGG,Wellcare MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Bright Health - commercial,Bright Health - commercial,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,3434.34,3434.34,Bright Health MGG,Bright Health MGG,3434.34,,,,,,,case rate,3434.34,3434.34,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Aetna,Aetna,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Aetna MGG,Aetna MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,BCBS,BCBS,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,BCBS MGG,BCBS MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Cigna,Cigna,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Cigna MGG,Cigna MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Humana,Humana,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Humana MGG,Humana MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Optum VA,Optum VA,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,UHC,UHC,276.42,,,,,,,per diem,276.42,276.42,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,UHC MGG,UHC MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,VA,VA,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Wellcare MGG,Wellcare MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Bright Health - commercial,Bright Health - commercial,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,77073,CPT,,,,Inpatient,,,276.42,276.42,Bright Health MGG,Bright Health MGG,276.42,,,,,,,case rate,276.42,276.42,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna,Aetna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Aetna MGG,Aetna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS,BCBS,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,BCBS MGG,BCBS MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna,Cigna,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Cigna MGG,Cigna MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana,Humana,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Humana MGG,Humana MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Optum VA,Optum VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC,UHC,843.54,,,,,,,per diem,843.54,843.54,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,UHC MGG,UHC MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,VA,VA,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Wellcare MGG,Wellcare MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health - commercial,Bright Health - commercial,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,99148,CPT,,,,Inpatient,,,843.54,843.54,Bright Health MGG,Bright Health MGG,843.54,,,,,,,case rate,843.54,843.54,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna,Aetna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Aetna MGG,Aetna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS,BCBS,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,BCBS MGG,BCBS MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna,Cigna,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Cigna MGG,Cigna MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana,Humana,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Humana MGG,Humana MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Optum VA,Optum VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC,UHC,622.2,,,,,,,per diem,622.2,622.2,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,UHC MGG,UHC MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,VA,VA,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Wellcare MGG,Wellcare MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health - commercial,Bright Health - commercial,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,99149,CPT,,,,Inpatient,,,622.2,622.2,Bright Health MGG,Bright Health MGG,622.2,,,,,,,case rate,622.2,622.2,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna,Aetna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Aetna MGG,Aetna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS,BCBS,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,BCBS MGG,BCBS MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna,Cigna,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Cigna MGG,Cigna MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana,Humana,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Humana MGG,Humana MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Optum VA,Optum VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC,UHC,669.12,,,,,,,per diem,669.12,669.12,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,UHC MGG,UHC MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,VA,VA,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Wellcare MGG,Wellcare MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health - commercial,Bright Health - commercial,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,99144,CPT,,,,Inpatient,,,669.12,669.12,Bright Health MGG,Bright Health MGG,669.12,,,,,,,case rate,669.12,669.12,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna,Aetna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Aetna MGG,Aetna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS,BCBS,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,BCBS MGG,BCBS MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna,Cigna,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Cigna MGG,Cigna MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana,Humana,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Humana MGG,Humana MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Optum VA,Optum VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC,UHC,368.22,,,,,,,per diem,368.22,368.22,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,UHC MGG,UHC MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,VA,VA,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Wellcare MGG,Wellcare MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health - commercial,Bright Health - commercial,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,99150,CPT,,,,Inpatient,,,368.22,368.22,Bright Health MGG,Bright Health MGG,368.22,,,,,,,case rate,368.22,368.22,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna,Aetna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Aetna MGG,Aetna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS,BCBS,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,BCBS MGG,BCBS MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna,Cigna,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Cigna MGG,Cigna MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana,Humana,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Humana MGG,Humana MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Optum VA,Optum VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC,UHC,281.52,,,,,,,per diem,281.52,281.52,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,UHC MGG,UHC MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,VA,VA,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Wellcare MGG,Wellcare MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health - commercial,Bright Health - commercial,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,99145,CPT,,,,Inpatient,,,281.52,281.52,Bright Health MGG,Bright Health MGG,281.52,,,,,,,case rate,281.52,281.52,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Aetna,Aetna,991.44,,,,,,,per diem,991.44,991.44,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Aetna MGG,Aetna MGG,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,BCBS,BCBS,991.44,,,,,,,per diem,991.44,991.44,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,BCBS MGG,BCBS MGG,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Cigna,Cigna,991.44,,,,,,,per diem,991.44,991.44,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Cigna MGG,Cigna MGG,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Humana,Humana,991.44,,,,,,,per diem,991.44,991.44,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Humana MGG,Humana MGG,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Optum VA,Optum VA,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,UHC,UHC,991.44,,,,,,,per diem,991.44,991.44,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,UHC MGG,UHC MGG,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,VA,VA,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Wellcare MGG,Wellcare MGG,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Bright Health - commercial,Bright Health - commercial,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,77013,CPT,,,,Inpatient,,,991.44,991.44,Bright Health MGG,Bright Health MGG,991.44,,,,,,,case rate,991.44,991.44,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Aetna,Aetna,182.77,,,,,,,per diem,182.77,182.77,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Aetna MGG,Aetna MGG,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,BCBS,BCBS,182.77,,,,,,,per diem,182.77,182.77,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,BCBS MGG,BCBS MGG,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Cigna,Cigna,182.77,,,,,,,per diem,182.77,182.77,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Cigna MGG,Cigna MGG,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Humana,Humana,182.77,,,,,,,per diem,182.77,182.77,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Humana MGG,Humana MGG,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Optum VA,Optum VA,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,UHC,UHC,182.77,,,,,,,per diem,182.77,182.77,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,UHC MGG,UHC MGG,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,VA,VA,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Wellcare MGG,Wellcare MGG,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Bright Health - commercial,Bright Health - commercial,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,G0297,CPT,,,,Inpatient,,,182.77,182.77,Bright Health MGG,Bright Health MGG,182.77,,,,,,,case rate,182.77,182.77,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Aetna,Aetna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Aetna MGG,Aetna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,BCBS,BCBS,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,BCBS MGG,BCBS MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Cigna,Cigna,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Cigna MGG,Cigna MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Humana,Humana,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Humana MGG,Humana MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Optum VA,Optum VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,UHC,UHC,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,UHC MGG,UHC MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,VA,VA,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Wellcare MGG,Wellcare MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Bright Health - commercial,Bright Health - commercial,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,Q9963,CPT,,,,Inpatient,1,EA,84,84,Bright Health MGG,Bright Health MGG,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Aetna,Aetna,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Aetna MGG,Aetna MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,BCBS,BCBS,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,BCBS MGG,BCBS MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Cigna,Cigna,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Cigna MGG,Cigna MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Humana,Humana,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Humana MGG,Humana MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Optum VA,Optum VA,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,UHC,UHC,30.6,,,,,,,per diem,30.6,30.6,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,UHC MGG,UHC MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,VA,VA,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Wellcare MGG,Wellcare MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Bright Health - commercial,Bright Health - commercial,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,75571,CPT,,,,Inpatient,,,30.6,30.6,Bright Health MGG,Bright Health MGG,30.6,,,,,,,case rate,30.6,30.6,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,49423,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Aetna,Aetna,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Aetna MGG,Aetna MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,BCBS,BCBS,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,BCBS MGG,BCBS MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Cigna,Cigna,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Cigna MGG,Cigna MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Humana,Humana,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Humana MGG,Humana MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Optum VA,Optum VA,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,UHC,UHC,2114.46,,,,,,,per diem,2114.46,2114.46,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,UHC MGG,UHC MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,VA,VA,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Wellcare MGG,Wellcare MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Bright Health - commercial,Bright Health - commercial,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,49424,CPT,,,,Inpatient,,,2114.46,2114.46,Bright Health MGG,Bright Health MGG,2114.46,,,,,,,case rate,2114.46,2114.46,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Aetna,Aetna,959.82,,,,,,,per diem,959.82,959.82,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Aetna MGG,Aetna MGG,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,BCBS,BCBS,959.82,,,,,,,per diem,959.82,959.82,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,BCBS MGG,BCBS MGG,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Cigna,Cigna,959.82,,,,,,,per diem,959.82,959.82,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Cigna MGG,Cigna MGG,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Humana,Humana,959.82,,,,,,,per diem,959.82,959.82,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Humana MGG,Humana MGG,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Optum VA,Optum VA,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,UHC,UHC,959.82,,,,,,,per diem,959.82,959.82,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,UHC MGG,UHC MGG,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,VA,VA,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Wellcare MGG,Wellcare MGG,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Bright Health - commercial,Bright Health - commercial,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,64530,CPT,,,,Inpatient,,,959.82,959.82,Bright Health MGG,Bright Health MGG,959.82,,,,,,,case rate,959.82,959.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Aetna,Aetna,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Aetna MGG,Aetna MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,BCBS,BCBS,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,BCBS MGG,BCBS MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Cigna,Cigna,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Cigna MGG,Cigna MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Humana,Humana,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Humana MGG,Humana MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Optum VA,Optum VA,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,UHC,UHC,1141.38,,,,,,,per diem,1141.38,1141.38,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,UHC MGG,UHC MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,VA,VA,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Wellcare MGG,Wellcare MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Bright Health - commercial,Bright Health - commercial,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,20605,CPT,,,,Inpatient,,,1141.38,1141.38,Bright Health MGG,Bright Health MGG,1141.38,,,,,,,case rate,1141.38,1141.38,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Aetna,Aetna,1352.52,,,,,,,per diem,1352.52,1352.52,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Aetna MGG,Aetna MGG,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,BCBS,BCBS,1352.52,,,,,,,per diem,1352.52,1352.52,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,BCBS MGG,BCBS MGG,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Cigna,Cigna,1352.52,,,,,,,per diem,1352.52,1352.52,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Cigna MGG,Cigna MGG,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Humana,Humana,1352.52,,,,,,,per diem,1352.52,1352.52,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Humana MGG,Humana MGG,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Optum VA,Optum VA,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,UHC,UHC,1352.52,,,,,,,per diem,1352.52,1352.52,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,UHC MGG,UHC MGG,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,VA,VA,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Wellcare MGG,Wellcare MGG,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Bright Health - commercial,Bright Health - commercial,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,20610,CPT,,,,Inpatient,,,1352.52,1352.52,Bright Health MGG,Bright Health MGG,1352.52,,,,,,,case rate,1352.52,1352.52,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Aetna,Aetna,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Aetna MGG,Aetna MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,BCBS,BCBS,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,BCBS MGG,BCBS MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Cigna,Cigna,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Cigna MGG,Cigna MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Humana,Humana,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Humana MGG,Humana MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Optum VA,Optum VA,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,UHC,UHC,240.72,,,,,,,per diem,240.72,240.72,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,UHC MGG,UHC MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,VA,VA,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Wellcare MGG,Wellcare MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Bright Health - commercial,Bright Health - commercial,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,20600,CPT,,,,Inpatient,,,240.72,240.72,Bright Health MGG,Bright Health MGG,240.72,,,,,,,case rate,240.72,240.72,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Aetna,Aetna,464.1,,,,,,,per diem,464.1,464.1,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Aetna MGG,Aetna MGG,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,BCBS,BCBS,464.1,,,,,,,per diem,464.1,464.1,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,BCBS MGG,BCBS MGG,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Cigna,Cigna,464.1,,,,,,,per diem,464.1,464.1,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Cigna MGG,Cigna MGG,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Humana,Humana,464.1,,,,,,,per diem,464.1,464.1,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Humana MGG,Humana MGG,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Optum VA,Optum VA,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,UHC,UHC,464.1,,,,,,,per diem,464.1,464.1,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,UHC MGG,UHC MGG,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,VA,VA,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Wellcare MGG,Wellcare MGG,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Bright Health - commercial,Bright Health - commercial,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,10160,CPT,,,,Inpatient,,,464.1,464.1,Bright Health MGG,Bright Health MGG,464.1,,,,,,,case rate,464.1,464.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Aetna,Aetna,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Aetna MGG,Aetna MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,BCBS,BCBS,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,BCBS MGG,BCBS MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Cigna,Cigna,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Cigna MGG,Cigna MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Humana,Humana,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Humana MGG,Humana MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Optum VA,Optum VA,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,UHC,UHC,906.78,,,,,,,per diem,906.78,906.78,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,UHC MGG,UHC MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,VA,VA,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Wellcare MGG,Wellcare MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Bright Health - commercial,Bright Health - commercial,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,10022,CPT,,,,Inpatient,,,906.78,906.78,Bright Health MGG,Bright Health MGG,906.78,,,,,,,case rate,906.78,906.78,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Aetna,Aetna,1486.14,,,,,,,per diem,1486.14,1486.14,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Aetna MGG,Aetna MGG,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,BCBS,BCBS,1486.14,,,,,,,per diem,1486.14,1486.14,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,BCBS MGG,BCBS MGG,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Cigna,Cigna,1486.14,,,,,,,per diem,1486.14,1486.14,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Cigna MGG,Cigna MGG,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Humana,Humana,1486.14,,,,,,,per diem,1486.14,1486.14,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Humana MGG,Humana MGG,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Optum VA,Optum VA,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,UHC,UHC,1486.14,,,,,,,per diem,1486.14,1486.14,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,UHC MGG,UHC MGG,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,VA,VA,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Wellcare MGG,Wellcare MGG,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Bright Health - commercial,Bright Health - commercial,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,20999,CPT,,,,Inpatient,,,1486.14,1486.14,Bright Health MGG,Bright Health MGG,1486.14,,,,,,,case rate,1486.14,1486.14,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Aetna,Aetna,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Aetna MGG,Aetna MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,BCBS,BCBS,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,BCBS MGG,BCBS MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Cigna,Cigna,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Cigna MGG,Cigna MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Humana,Humana,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Humana MGG,Humana MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Optum VA,Optum VA,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,UHC,UHC,3295.62,,,,,,,per diem,3295.62,3295.62,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,UHC MGG,UHC MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,VA,VA,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Wellcare MGG,Wellcare MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Bright Health - commercial,Bright Health - commercial,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,32405,CPT,,,,Inpatient,,,3295.62,3295.62,Bright Health MGG,Bright Health MGG,3295.62,,,,,,,case rate,3295.62,3295.62,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,32400,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Aetna,Aetna,1668.72,,,,,,,per diem,1668.72,1668.72,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Aetna MGG,Aetna MGG,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,BCBS,BCBS,1668.72,,,,,,,per diem,1668.72,1668.72,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,BCBS MGG,BCBS MGG,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Cigna,Cigna,1668.72,,,,,,,per diem,1668.72,1668.72,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Cigna MGG,Cigna MGG,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Humana,Humana,1668.72,,,,,,,per diem,1668.72,1668.72,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Humana MGG,Humana MGG,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Optum VA,Optum VA,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,UHC,UHC,1668.72,,,,,,,per diem,1668.72,1668.72,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,UHC MGG,UHC MGG,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,VA,VA,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Wellcare MGG,Wellcare MGG,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Bright Health - commercial,Bright Health - commercial,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,51080,CPT,,,,Inpatient,,,1668.72,1668.72,Bright Health MGG,Bright Health MGG,1668.72,,,,,,,case rate,1668.72,1668.72,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Aetna,Aetna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Aetna MGG,Aetna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,BCBS,BCBS,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,BCBS MGG,BCBS MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Cigna,Cigna,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Cigna MGG,Cigna MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Humana,Humana,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Humana MGG,Humana MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Optum VA,Optum VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,UHC,UHC,875.16,,,,,,,per diem,875.16,875.16,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,UHC MGG,UHC MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,VA,VA,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Wellcare MGG,Wellcare MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Bright Health - commercial,Bright Health - commercial,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,51101,CPT,,,,Inpatient,,,875.16,875.16,Bright Health MGG,Bright Health MGG,875.16,,,,,,,case rate,875.16,875.16,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,51102,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Aetna,Aetna,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Aetna MGG,Aetna MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,BCBS,BCBS,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,BCBS MGG,BCBS MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Cigna,Cigna,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Cigna MGG,Cigna MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Humana,Humana,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Humana MGG,Humana MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Optum VA,Optum VA,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,UHC,UHC,2567.34,,,,,,,per diem,2567.34,2567.34,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,UHC MGG,UHC MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,VA,VA,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Wellcare MGG,Wellcare MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Bright Health - commercial,Bright Health - commercial,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,49180,CPT,,,,Inpatient,,,2567.34,2567.34,Bright Health MGG,Bright Health MGG,2567.34,,,,,,,case rate,2567.34,2567.34,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Aetna,Aetna,1969.62,,,,,,,per diem,1969.62,1969.62,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Aetna MGG,Aetna MGG,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,BCBS,BCBS,1969.62,,,,,,,per diem,1969.62,1969.62,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,BCBS MGG,BCBS MGG,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Cigna,Cigna,1969.62,,,,,,,per diem,1969.62,1969.62,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Cigna MGG,Cigna MGG,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Humana,Humana,1969.62,,,,,,,per diem,1969.62,1969.62,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Humana MGG,Humana MGG,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Optum VA,Optum VA,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,UHC,UHC,1969.62,,,,,,,per diem,1969.62,1969.62,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,UHC MGG,UHC MGG,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,VA,VA,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Wellcare MGG,Wellcare MGG,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Bright Health - commercial,Bright Health - commercial,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,20220,CPT,,,,Inpatient,,,1969.62,1969.62,Bright Health MGG,Bright Health MGG,1969.62,,,,,,,case rate,1969.62,1969.62,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Aetna,Aetna,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Aetna MGG,Aetna MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,BCBS,BCBS,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,BCBS MGG,BCBS MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Cigna,Cigna,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Cigna MGG,Cigna MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Humana,Humana,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Humana MGG,Humana MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Optum VA,Optum VA,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,UHC,UHC,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,UHC MGG,UHC MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,VA,VA,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Wellcare MGG,Wellcare MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Bright Health - commercial,Bright Health - commercial,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,20225,CPT,,,,Inpatient,,,2121.6,2121.6,Bright Health MGG,Bright Health MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Aetna,Aetna,8837.28,,,,,,,per diem,8837.28,8837.28,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Aetna MGG,Aetna MGG,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,BCBS,BCBS,8837.28,,,,,,,per diem,8837.28,8837.28,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,BCBS MGG,BCBS MGG,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Cigna,Cigna,8837.28,,,,,,,per diem,8837.28,8837.28,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Cigna MGG,Cigna MGG,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Humana,Humana,8837.28,,,,,,,per diem,8837.28,8837.28,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Humana MGG,Humana MGG,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Optum VA,Optum VA,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,UHC,UHC,8837.28,,,,,,,per diem,8837.28,8837.28,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,UHC MGG,UHC MGG,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,VA,VA,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Wellcare MGG,Wellcare MGG,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Bright Health - commercial,Bright Health - commercial,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,22999,CPT,,,,Inpatient,,,8837.28,8837.28,Bright Health MGG,Bright Health MGG,8837.28,,,,,,,case rate,8837.28,8837.28,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Aetna,Aetna,1860.48,,,,,,,per diem,1860.48,1860.48,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Aetna MGG,Aetna MGG,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,BCBS,BCBS,1860.48,,,,,,,per diem,1860.48,1860.48,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,BCBS MGG,BCBS MGG,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Cigna,Cigna,1860.48,,,,,,,per diem,1860.48,1860.48,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Cigna MGG,Cigna MGG,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Humana,Humana,1860.48,,,,,,,per diem,1860.48,1860.48,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Humana MGG,Humana MGG,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Optum VA,Optum VA,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,UHC,UHC,1860.48,,,,,,,per diem,1860.48,1860.48,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,UHC MGG,UHC MGG,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,VA,VA,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Wellcare MGG,Wellcare MGG,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Bright Health - commercial,Bright Health - commercial,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,47001,CPT,,,,Inpatient,,,1860.48,1860.48,Bright Health MGG,Bright Health MGG,1860.48,,,,,,,case rate,1860.48,1860.48,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Aetna,Aetna,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Aetna MGG,Aetna MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,BCBS,BCBS,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,BCBS MGG,BCBS MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Cigna,Cigna,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Cigna MGG,Cigna MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Humana,Humana,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Humana MGG,Humana MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Optum VA,Optum VA,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,UHC,UHC,1922.7,,,,,,,per diem,1922.7,1922.7,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,UHC MGG,UHC MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,VA,VA,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Wellcare MGG,Wellcare MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Bright Health - commercial,Bright Health - commercial,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,47000,CPT,,,,Inpatient,,,1922.7,1922.7,Bright Health MGG,Bright Health MGG,1922.7,,,,,,,case rate,1922.7,1922.7,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Aetna,Aetna,2153.22,,,,,,,per diem,2153.22,2153.22,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Aetna MGG,Aetna MGG,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,BCBS,BCBS,2153.22,,,,,,,per diem,2153.22,2153.22,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,BCBS MGG,BCBS MGG,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Cigna,Cigna,2153.22,,,,,,,per diem,2153.22,2153.22,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Cigna MGG,Cigna MGG,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Humana,Humana,2153.22,,,,,,,per diem,2153.22,2153.22,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Humana MGG,Humana MGG,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Optum VA,Optum VA,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,UHC,UHC,2153.22,,,,,,,per diem,2153.22,2153.22,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,UHC MGG,UHC MGG,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,VA,VA,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Wellcare MGG,Wellcare MGG,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Bright Health - commercial,Bright Health - commercial,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,20206,CPT,,,,Inpatient,,,2153.22,2153.22,Bright Health MGG,Bright Health MGG,2153.22,,,,,,,case rate,2153.22,2153.22,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna,Aetna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Aetna MGG,Aetna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS,BCBS,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,BCBS MGG,BCBS MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna,Cigna,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Cigna MGG,Cigna MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Humana,Humana,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Humana MGG,Humana MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Optum VA,Optum VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,UHC,UHC,1584.06,,,,,,,per diem,1584.06,1584.06,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,UHC MGG,UHC MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,VA,VA,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Wellcare MGG,Wellcare MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health - commercial,Bright Health - commercial,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,48102,CPT,,,,Inpatient,,,1584.06,1584.06,Bright Health MGG,Bright Health MGG,1584.06,,,,,,,case rate,1584.06,1584.06,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Aetna,Aetna,1819.68,,,,,,,per diem,1819.68,1819.68,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Aetna MGG,Aetna MGG,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,BCBS,BCBS,1819.68,,,,,,,per diem,1819.68,1819.68,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,BCBS MGG,BCBS MGG,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Cigna,Cigna,1819.68,,,,,,,per diem,1819.68,1819.68,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Cigna MGG,Cigna MGG,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Humana,Humana,1819.68,,,,,,,per diem,1819.68,1819.68,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Humana MGG,Humana MGG,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Optum VA,Optum VA,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,UHC,UHC,1819.68,,,,,,,per diem,1819.68,1819.68,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,UHC MGG,UHC MGG,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,VA,VA,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Wellcare MGG,Wellcare MGG,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Bright Health - commercial,Bright Health - commercial,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,50200,CPT,,,,Inpatient,,,1819.68,1819.68,Bright Health MGG,Bright Health MGG,1819.68,,,,,,,case rate,1819.68,1819.68,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Aetna,Aetna,2787.66,,,,,,,per diem,2787.66,2787.66,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Aetna MGG,Aetna MGG,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,BCBS,BCBS,2787.66,,,,,,,per diem,2787.66,2787.66,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,BCBS MGG,BCBS MGG,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Cigna,Cigna,2787.66,,,,,,,per diem,2787.66,2787.66,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Cigna MGG,Cigna MGG,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Humana,Humana,2787.66,,,,,,,per diem,2787.66,2787.66,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Humana MGG,Humana MGG,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Optum VA,Optum VA,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,UHC,UHC,2787.66,,,,,,,per diem,2787.66,2787.66,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,UHC MGG,UHC MGG,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,VA,VA,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Wellcare MGG,Wellcare MGG,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Bright Health - commercial,Bright Health - commercial,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,62269,CPT,,,,Inpatient,,,2787.66,2787.66,Bright Health MGG,Bright Health MGG,2787.66,,,,,,,case rate,2787.66,2787.66,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Aetna,Aetna,1109.76,,,,,,,per diem,1109.76,1109.76,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Aetna MGG,Aetna MGG,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,BCBS,BCBS,1109.76,,,,,,,per diem,1109.76,1109.76,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,BCBS MGG,BCBS MGG,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Cigna,Cigna,1109.76,,,,,,,per diem,1109.76,1109.76,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Cigna MGG,Cigna MGG,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Humana,Humana,1109.76,,,,,,,per diem,1109.76,1109.76,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Humana MGG,Humana MGG,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Optum VA,Optum VA,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,UHC,UHC,1109.76,,,,,,,per diem,1109.76,1109.76,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,UHC MGG,UHC MGG,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,VA,VA,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Wellcare MGG,Wellcare MGG,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Bright Health - commercial,Bright Health - commercial,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,60100,CPT,,,,Inpatient,,,1109.76,1109.76,Bright Health MGG,Bright Health MGG,1109.76,,,,,,,case rate,1109.76,1109.76,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Aetna,Aetna,2011.44,,,,,,,per diem,2011.44,2011.44,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Aetna MGG,Aetna MGG,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,BCBS,BCBS,2011.44,,,,,,,per diem,2011.44,2011.44,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,BCBS MGG,BCBS MGG,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Cigna,Cigna,2011.44,,,,,,,per diem,2011.44,2011.44,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Cigna MGG,Cigna MGG,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Humana,Humana,2011.44,,,,,,,per diem,2011.44,2011.44,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Humana MGG,Humana MGG,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Optum VA,Optum VA,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,UHC,UHC,2011.44,,,,,,,per diem,2011.44,2011.44,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,UHC MGG,UHC MGG,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,VA,VA,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Wellcare MGG,Wellcare MGG,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Bright Health - commercial,Bright Health - commercial,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,38505,CPT,,,,Inpatient,,,2011.44,2011.44,Bright Health MGG,Bright Health MGG,2011.44,,,,,,,case rate,2011.44,2011.44,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Aetna,Aetna,345.78,,,,,,,per diem,345.78,345.78,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Aetna MGG,Aetna MGG,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,BCBS,BCBS,345.78,,,,,,,per diem,345.78,345.78,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,BCBS MGG,BCBS MGG,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Cigna,Cigna,345.78,,,,,,,per diem,345.78,345.78,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Cigna MGG,Cigna MGG,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Humana,Humana,345.78,,,,,,,per diem,345.78,345.78,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Humana MGG,Humana MGG,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Optum VA,Optum VA,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,UHC,UHC,345.78,,,,,,,per diem,345.78,345.78,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,UHC MGG,UHC MGG,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,VA,VA,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Wellcare MGG,Wellcare MGG,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Bright Health - commercial,Bright Health - commercial,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,17250,CPT,,,,Inpatient,,,345.78,345.78,Bright Health MGG,Bright Health MGG,345.78,,,,,,,case rate,345.78,345.78,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Aetna,Aetna,2495.94,,,,,,,per diem,2495.94,2495.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Aetna MGG,Aetna MGG,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,BCBS,BCBS,2495.94,,,,,,,per diem,2495.94,2495.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,BCBS MGG,BCBS MGG,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Cigna,Cigna,2495.94,,,,,,,per diem,2495.94,2495.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Cigna MGG,Cigna MGG,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Humana,Humana,2495.94,,,,,,,per diem,2495.94,2495.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Humana MGG,Humana MGG,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Optum VA,Optum VA,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,UHC,UHC,2495.94,,,,,,,per diem,2495.94,2495.94,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,UHC MGG,UHC MGG,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,VA,VA,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Wellcare MGG,Wellcare MGG,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Bright Health - commercial,Bright Health - commercial,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,47490,CPT,,,,Inpatient,,,2495.94,2495.94,Bright Health MGG,Bright Health MGG,2495.94,,,,,,,case rate,2495.94,2495.94,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Aetna,Aetna,1727.88,,,,,,,per diem,1727.88,1727.88,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Aetna MGG,Aetna MGG,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,BCBS,BCBS,1727.88,,,,,,,per diem,1727.88,1727.88,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,BCBS MGG,BCBS MGG,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Cigna,Cigna,1727.88,,,,,,,per diem,1727.88,1727.88,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Cigna MGG,Cigna MGG,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Humana,Humana,1727.88,,,,,,,per diem,1727.88,1727.88,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Humana MGG,Humana MGG,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Optum VA,Optum VA,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,UHC,UHC,1727.88,,,,,,,per diem,1727.88,1727.88,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,UHC MGG,UHC MGG,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,VA,VA,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Wellcare MGG,Wellcare MGG,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Bright Health - commercial,Bright Health - commercial,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,64680,CPT,,,,Inpatient,,,1727.88,1727.88,Bright Health MGG,Bright Health MGG,1727.88,,,,,,,case rate,1727.88,1727.88,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Aetna,Aetna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Aetna MGG,Aetna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,BCBS,BCBS,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,BCBS MGG,BCBS MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Cigna,Cigna,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Cigna MGG,Cigna MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Humana,Humana,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Humana MGG,Humana MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Optum VA,Optum VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,UHC,UHC,598.74,,,,,,,per diem,598.74,598.74,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,UHC MGG,UHC MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,VA,VA,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Wellcare MGG,Wellcare MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Bright Health - commercial,Bright Health - commercial,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,62310,CPT,,,,Inpatient,,,598.74,598.74,Bright Health MGG,Bright Health MGG,598.74,,,,,,,case rate,598.74,598.74,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Aetna,Aetna,585.48,,,,,,,per diem,585.48,585.48,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Aetna MGG,Aetna MGG,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,BCBS,BCBS,585.48,,,,,,,per diem,585.48,585.48,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,BCBS MGG,BCBS MGG,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Cigna,Cigna,585.48,,,,,,,per diem,585.48,585.48,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Cigna MGG,Cigna MGG,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Humana,Humana,585.48,,,,,,,per diem,585.48,585.48,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Humana MGG,Humana MGG,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Optum VA,Optum VA,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,UHC,UHC,585.48,,,,,,,per diem,585.48,585.48,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,UHC MGG,UHC MGG,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,VA,VA,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Wellcare MGG,Wellcare MGG,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Bright Health - commercial,Bright Health - commercial,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,10060,CPT,,,,Inpatient,,,585.48,585.48,Bright Health MGG,Bright Health MGG,585.48,,,,,,,case rate,585.48,585.48,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Aetna,Aetna,1329.06,,,,,,,per diem,1329.06,1329.06,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Aetna MGG,Aetna MGG,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,BCBS,BCBS,1329.06,,,,,,,per diem,1329.06,1329.06,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,BCBS MGG,BCBS MGG,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Cigna,Cigna,1329.06,,,,,,,per diem,1329.06,1329.06,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Cigna MGG,Cigna MGG,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Humana,Humana,1329.06,,,,,,,per diem,1329.06,1329.06,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Humana MGG,Humana MGG,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Optum VA,Optum VA,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,UHC,UHC,1329.06,,,,,,,per diem,1329.06,1329.06,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,UHC MGG,UHC MGG,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,VA,VA,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Wellcare MGG,Wellcare MGG,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Bright Health - commercial,Bright Health - commercial,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,10140,CPT,,,,Inpatient,,,1329.06,1329.06,Bright Health MGG,Bright Health MGG,1329.06,,,,,,,case rate,1329.06,1329.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Aetna,Aetna,1182.18,,,,,,,per diem,1182.18,1182.18,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Aetna MGG,Aetna MGG,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,BCBS,BCBS,1182.18,,,,,,,per diem,1182.18,1182.18,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,BCBS MGG,BCBS MGG,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Cigna,Cigna,1182.18,,,,,,,per diem,1182.18,1182.18,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Cigna MGG,Cigna MGG,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Humana,Humana,1182.18,,,,,,,per diem,1182.18,1182.18,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Humana MGG,Humana MGG,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Optum VA,Optum VA,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,UHC,UHC,1182.18,,,,,,,per diem,1182.18,1182.18,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,UHC MGG,UHC MGG,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,VA,VA,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Wellcare MGG,Wellcare MGG,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Bright Health - commercial,Bright Health - commercial,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,49082,CPT,,,,Inpatient,,,1182.18,1182.18,Bright Health MGG,Bright Health MGG,1182.18,,,,,,,case rate,1182.18,1182.18,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Aetna,Aetna,1369.86,,,,,,,per diem,1369.86,1369.86,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Aetna MGG,Aetna MGG,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,BCBS,BCBS,1369.86,,,,,,,per diem,1369.86,1369.86,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,BCBS MGG,BCBS MGG,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Cigna,Cigna,1369.86,,,,,,,per diem,1369.86,1369.86,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Cigna MGG,Cigna MGG,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Humana,Humana,1369.86,,,,,,,per diem,1369.86,1369.86,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Humana MGG,Humana MGG,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Optum VA,Optum VA,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,UHC,UHC,1369.86,,,,,,,per diem,1369.86,1369.86,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,UHC MGG,UHC MGG,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,VA,VA,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Wellcare MGG,Wellcare MGG,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Bright Health - commercial,Bright Health - commercial,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,49083,CPT,,,,Inpatient,,,1369.86,1369.86,Bright Health MGG,Bright Health MGG,1369.86,,,,,,,case rate,1369.86,1369.86,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Aetna,Aetna,786.42,,,,,,,per diem,786.42,786.42,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Aetna MGG,Aetna MGG,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,BCBS,BCBS,786.42,,,,,,,per diem,786.42,786.42,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,BCBS MGG,BCBS MGG,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Cigna,Cigna,786.42,,,,,,,per diem,786.42,786.42,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Cigna MGG,Cigna MGG,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Humana,Humana,786.42,,,,,,,per diem,786.42,786.42,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Humana MGG,Humana MGG,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Optum VA,Optum VA,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,UHC,UHC,786.42,,,,,,,per diem,786.42,786.42,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,UHC MGG,UHC MGG,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,VA,VA,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Wellcare MGG,Wellcare MGG,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Bright Health - commercial,Bright Health - commercial,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,33010,CPT,,,,Inpatient,,,786.42,786.42,Bright Health MGG,Bright Health MGG,786.42,,,,,,,case rate,786.42,786.42,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Aetna,Aetna,1435.14,,,,,,,per diem,1435.14,1435.14,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Aetna MGG,Aetna MGG,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,BCBS,BCBS,1435.14,,,,,,,per diem,1435.14,1435.14,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,BCBS MGG,BCBS MGG,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Cigna,Cigna,1435.14,,,,,,,per diem,1435.14,1435.14,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Cigna MGG,Cigna MGG,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Humana,Humana,1435.14,,,,,,,per diem,1435.14,1435.14,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Humana MGG,Humana MGG,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Optum VA,Optum VA,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,UHC,UHC,1435.14,,,,,,,per diem,1435.14,1435.14,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,UHC MGG,UHC MGG,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,VA,VA,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Wellcare MGG,Wellcare MGG,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Bright Health - commercial,Bright Health - commercial,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,49084,CPT,,,,Inpatient,,,1435.14,1435.14,Bright Health MGG,Bright Health MGG,1435.14,,,,,,,case rate,1435.14,1435.14,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Aetna,Aetna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Aetna MGG,Aetna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,BCBS,BCBS,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,BCBS MGG,BCBS MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Cigna,Cigna,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Cigna MGG,Cigna MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Humana,Humana,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Humana MGG,Humana MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Optum VA,Optum VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,UHC,UHC,493.68,,,,,,,per diem,493.68,493.68,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,UHC MGG,UHC MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,VA,VA,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Wellcare MGG,Wellcare MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Bright Health - commercial,Bright Health - commercial,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,32560,CPT,,,,Inpatient,,,493.68,493.68,Bright Health MGG,Bright Health MGG,493.68,,,,,,,case rate,493.68,493.68,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Aetna,Aetna,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Aetna MGG,Aetna MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,BCBS,BCBS,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,BCBS MGG,BCBS MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Cigna,Cigna,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Cigna MGG,Cigna MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Humana,Humana,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Humana MGG,Humana MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Optum VA,Optum VA,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,UHC,UHC,4733.82,,,,,,,per diem,4733.82,4733.82,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,UHC MGG,UHC MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,VA,VA,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Wellcare MGG,Wellcare MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Bright Health - commercial,Bright Health - commercial,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,32960,CPT,,,,Inpatient,,,4733.82,4733.82,Bright Health MGG,Bright Health MGG,4733.82,,,,,,,case rate,4733.82,4733.82,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Aetna,Aetna,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Aetna MGG,Aetna MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,BCBS,BCBS,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,BCBS MGG,BCBS MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Cigna,Cigna,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Cigna MGG,Cigna MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Humana,Humana,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Humana MGG,Humana MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Optum VA,Optum VA,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,UHC,UHC,2121.6,,,,,,,per diem,2121.6,2121.6,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,UHC MGG,UHC MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,VA,VA,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Wellcare MGG,Wellcare MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Bright Health - commercial,Bright Health - commercial,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,45020,CPT,,,,Inpatient,,,2121.6,2121.6,Bright Health MGG,Bright Health MGG,2121.6,,,,,,,case rate,2121.6,2121.6,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Aetna,Aetna,3109.98,,,,,,,per diem,3109.98,3109.98,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Aetna MGG,Aetna MGG,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,BCBS,BCBS,3109.98,,,,,,,per diem,3109.98,3109.98,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,BCBS MGG,BCBS MGG,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Cigna,Cigna,3109.98,,,,,,,per diem,3109.98,3109.98,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Cigna MGG,Cigna MGG,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Humana,Humana,3109.98,,,,,,,per diem,3109.98,3109.98,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Humana MGG,Humana MGG,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Optum VA,Optum VA,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,UHC,UHC,3109.98,,,,,,,per diem,3109.98,3109.98,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,UHC MGG,UHC MGG,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,VA,VA,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Wellcare MGG,Wellcare MGG,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Bright Health - commercial,Bright Health - commercial,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,50390,CPT,,,,Inpatient,,,3109.98,3109.98,Bright Health MGG,Bright Health MGG,3109.98,,,,,,,case rate,3109.98,3109.98,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Aetna,Aetna,489.6,,,,,,,per diem,489.6,489.6,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Aetna MGG,Aetna MGG,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,BCBS,BCBS,489.6,,,,,,,per diem,489.6,489.6,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,BCBS MGG,BCBS MGG,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Cigna,Cigna,489.6,,,,,,,per diem,489.6,489.6,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Cigna MGG,Cigna MGG,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Humana,Humana,489.6,,,,,,,per diem,489.6,489.6,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Humana MGG,Humana MGG,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Optum VA,Optum VA,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,UHC,UHC,489.6,,,,,,,per diem,489.6,489.6,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,UHC MGG,UHC MGG,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,VA,VA,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Wellcare MGG,Wellcare MGG,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Bright Health - commercial,Bright Health - commercial,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,53899,CPT,,,,Inpatient,,,489.6,489.6,Bright Health MGG,Bright Health MGG,489.6,,,,,,,case rate,489.6,489.6,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Aetna,Aetna,1544.28,,,,,,,per diem,1544.28,1544.28,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Aetna MGG,Aetna MGG,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,BCBS,BCBS,1544.28,,,,,,,per diem,1544.28,1544.28,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,BCBS MGG,BCBS MGG,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Cigna,Cigna,1544.28,,,,,,,per diem,1544.28,1544.28,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Cigna MGG,Cigna MGG,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Humana,Humana,1544.28,,,,,,,per diem,1544.28,1544.28,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Humana MGG,Humana MGG,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Optum VA,Optum VA,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,UHC,UHC,1544.28,,,,,,,per diem,1544.28,1544.28,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,UHC MGG,UHC MGG,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,VA,VA,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Wellcare MGG,Wellcare MGG,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Bright Health - commercial,Bright Health - commercial,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,62268,CPT,,,,Inpatient,,,1544.28,1544.28,Bright Health MGG,Bright Health MGG,1544.28,,,,,,,case rate,1544.28,1544.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Aetna,Aetna,2451.06,,,,,,,per diem,2451.06,2451.06,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Aetna MGG,Aetna MGG,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,BCBS,BCBS,2451.06,,,,,,,per diem,2451.06,2451.06,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,BCBS MGG,BCBS MGG,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Cigna,Cigna,2451.06,,,,,,,per diem,2451.06,2451.06,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Cigna MGG,Cigna MGG,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Humana,Humana,2451.06,,,,,,,per diem,2451.06,2451.06,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Humana MGG,Humana MGG,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Optum VA,Optum VA,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,UHC,UHC,2451.06,,,,,,,per diem,2451.06,2451.06,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,UHC MGG,UHC MGG,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,VA,VA,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Wellcare MGG,Wellcare MGG,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Bright Health - commercial,Bright Health - commercial,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,32555,CPT,,,,Inpatient,,,2451.06,2451.06,Bright Health MGG,Bright Health MGG,2451.06,,,,,,,case rate,2451.06,2451.06,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Aetna,Aetna,2594.88,,,,,,,per diem,2594.88,2594.88,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Aetna MGG,Aetna MGG,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,BCBS,BCBS,2594.88,,,,,,,per diem,2594.88,2594.88,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,BCBS MGG,BCBS MGG,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Cigna,Cigna,2594.88,,,,,,,per diem,2594.88,2594.88,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Cigna MGG,Cigna MGG,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Humana,Humana,2594.88,,,,,,,per diem,2594.88,2594.88,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Humana MGG,Humana MGG,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Optum VA,Optum VA,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,UHC,UHC,2594.88,,,,,,,per diem,2594.88,2594.88,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,UHC MGG,UHC MGG,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,VA,VA,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Wellcare MGG,Wellcare MGG,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Bright Health - commercial,Bright Health - commercial,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,32554,CPT,,,,Inpatient,,,2594.88,2594.88,Bright Health MGG,Bright Health MGG,2594.88,,,,,,,case rate,2594.88,2594.88,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Aetna,Aetna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Aetna MGG,Aetna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,BCBS,BCBS,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,BCBS MGG,BCBS MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Cigna,Cigna,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Cigna MGG,Cigna MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Humana,Humana,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Humana MGG,Humana MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Optum VA,Optum VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,UHC,UHC,1297.44,,,,,,,per diem,1297.44,1297.44,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,UHC MGG,UHC MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,VA,VA,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Wellcare MGG,Wellcare MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Bright Health - commercial,Bright Health - commercial,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,32551,CPT,,,,Inpatient,,,1297.44,1297.44,Bright Health MGG,Bright Health MGG,1297.44,,,,,,,case rate,1297.44,1297.44,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Aetna,Aetna,2587.74,,,,,,,per diem,2587.74,2587.74,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Aetna MGG,Aetna MGG,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,BCBS,BCBS,2587.74,,,,,,,per diem,2587.74,2587.74,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,BCBS MGG,BCBS MGG,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Cigna,Cigna,2587.74,,,,,,,per diem,2587.74,2587.74,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Cigna MGG,Cigna MGG,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Humana,Humana,2587.74,,,,,,,per diem,2587.74,2587.74,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Humana MGG,Humana MGG,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Optum VA,Optum VA,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,UHC,UHC,2587.74,,,,,,,per diem,2587.74,2587.74,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,UHC MGG,UHC MGG,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,VA,VA,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Wellcare MGG,Wellcare MGG,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Bright Health - commercial,Bright Health - commercial,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,49407,CPT,,,,Inpatient,,,2587.74,2587.74,Bright Health MGG,Bright Health MGG,2587.74,,,,,,,case rate,2587.74,2587.74,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna,Aetna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna MGG,Aetna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS,BCBS,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS MGG,BCBS MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna,Cigna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna MGG,Cigna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Humana,Humana,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Humana MGG,Humana MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Optum VA,Optum VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,UHC,UHC,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,UHC MGG,UHC MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,VA,VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Wellcare MGG,Wellcare MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health - commercial,Bright Health - commercial,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,49405,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health MGG,Bright Health MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna,Aetna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Aetna MGG,Aetna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS,BCBS,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,BCBS MGG,BCBS MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna,Cigna,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Cigna MGG,Cigna MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Humana,Humana,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Humana MGG,Humana MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Optum VA,Optum VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,UHC,UHC,7430.7,,,,,,,per diem,7430.7,7430.7,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,UHC MGG,UHC MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,VA,VA,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Wellcare MGG,Wellcare MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health - commercial,Bright Health - commercial,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,49406,CPT,,,,Inpatient,,,7430.7,7430.7,Bright Health MGG,Bright Health MGG,7430.7,,,,,,,case rate,7430.7,7430.7,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Aetna,Aetna,24092.4,,,,,,,per diem,24092.4,24092.4,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Aetna MGG,Aetna MGG,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,BCBS,BCBS,24092.4,,,,,,,per diem,24092.4,24092.4,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,BCBS MGG,BCBS MGG,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Cigna,Cigna,24092.4,,,,,,,per diem,24092.4,24092.4,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Cigna MGG,Cigna MGG,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Humana,Humana,24092.4,,,,,,,per diem,24092.4,24092.4,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Humana MGG,Humana MGG,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Optum VA,Optum VA,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,UHC,UHC,24092.4,,,,,,,per diem,24092.4,24092.4,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,UHC MGG,UHC MGG,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,VA,VA,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Wellcare MGG,Wellcare MGG,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Bright Health - commercial,Bright Health - commercial,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,47382,CPT,,,,Inpatient,,,24092.4,24092.4,Bright Health MGG,Bright Health MGG,24092.4,,,,,,,case rate,24092.4,24092.4,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Aetna,Aetna,4404.36,,,,,,,per diem,4404.36,4404.36,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Aetna MGG,Aetna MGG,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,BCBS,BCBS,4404.36,,,,,,,per diem,4404.36,4404.36,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,BCBS MGG,BCBS MGG,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Cigna,Cigna,4404.36,,,,,,,per diem,4404.36,4404.36,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Cigna MGG,Cigna MGG,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Humana,Humana,4404.36,,,,,,,per diem,4404.36,4404.36,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Humana MGG,Humana MGG,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Optum VA,Optum VA,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,UHC,UHC,4404.36,,,,,,,per diem,4404.36,4404.36,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,UHC MGG,UHC MGG,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,VA,VA,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Wellcare MGG,Wellcare MGG,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Bright Health - commercial,Bright Health - commercial,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,60699,CPT,,,,Inpatient,,,4404.36,4404.36,Bright Health MGG,Bright Health MGG,4404.36,,,,,,,case rate,4404.36,4404.36,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,20604,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,20606,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna,Aetna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Aetna MGG,Aetna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS,BCBS,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,BCBS MGG,BCBS MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna,Cigna,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Cigna MGG,Cigna MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Humana,Humana,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Humana MGG,Humana MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Optum VA,Optum VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,UHC,UHC,1382.1,,,,,,,per diem,1382.1,1382.1,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,UHC MGG,UHC MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,VA,VA,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Wellcare MGG,Wellcare MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health - commercial,Bright Health - commercial,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,20611,CPT,,,,Inpatient,,,1382.1,1382.1,Bright Health MGG,Bright Health MGG,1382.1,,,,,,,case rate,1382.1,1382.1,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Aetna,Aetna,1746.24,,,,,,,per diem,1746.24,1746.24,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Aetna MGG,Aetna MGG,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,BCBS,BCBS,1746.24,,,,,,,per diem,1746.24,1746.24,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,BCBS MGG,BCBS MGG,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Cigna,Cigna,1746.24,,,,,,,per diem,1746.24,1746.24,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Cigna MGG,Cigna MGG,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Humana,Humana,1746.24,,,,,,,per diem,1746.24,1746.24,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Humana MGG,Humana MGG,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Optum VA,Optum VA,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,UHC,UHC,1746.24,,,,,,,per diem,1746.24,1746.24,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,UHC MGG,UHC MGG,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,VA,VA,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Wellcare MGG,Wellcare MGG,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Bright Health - commercial,Bright Health - commercial,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,38999,CPT,,,,Inpatient,,,1746.24,1746.24,Bright Health MGG,Bright Health MGG,1746.24,,,,,,,case rate,1746.24,1746.24,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Aetna,Aetna,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Aetna MGG,Aetna MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,BCBS,BCBS,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,BCBS MGG,BCBS MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Cigna,Cigna,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Cigna MGG,Cigna MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Humana,Humana,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Humana MGG,Humana MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Optum VA,Optum VA,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,UHC,UHC,3129.36,,,,,,,per diem,3129.36,3129.36,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,UHC MGG,UHC MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,VA,VA,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Wellcare MGG,Wellcare MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Bright Health - commercial,Bright Health - commercial,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,49446,CPT,,,,Inpatient,,,3129.36,3129.36,Bright Health MGG,Bright Health MGG,3129.36,,,,,,,case rate,3129.36,3129.36,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Aetna,Aetna,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Aetna MGG,Aetna MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,BCBS,BCBS,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,BCBS MGG,BCBS MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Cigna,Cigna,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Cigna MGG,Cigna MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Humana,Humana,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Humana MGG,Humana MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Optum VA,Optum VA,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,UHC,UHC,4598.16,,,,,,,per diem,4598.16,4598.16,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,UHC MGG,UHC MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,VA,VA,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Wellcare MGG,Wellcare MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Bright Health - commercial,Bright Health - commercial,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,27613,CPT,,,,Inpatient,,,4598.16,4598.16,Bright Health MGG,Bright Health MGG,4598.16,,,,,,,case rate,4598.16,4598.16,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna,Aetna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna MGG,Aetna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS,BCBS,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS MGG,BCBS MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna,Cigna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna MGG,Cigna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Humana,Humana,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Humana MGG,Humana MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Optum VA,Optum VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,UHC,UHC,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,UHC MGG,UHC MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,VA,VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Wellcare MGG,Wellcare MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health - commercial,Bright Health - commercial,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,50432,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health MGG,Bright Health MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna,Aetna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna MGG,Aetna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS,BCBS,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS MGG,BCBS MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna,Cigna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna MGG,Cigna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Humana,Humana,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Humana MGG,Humana MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Optum VA,Optum VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,UHC,UHC,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,UHC MGG,UHC MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,VA,VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Wellcare MGG,Wellcare MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health - commercial,Bright Health - commercial,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health MGG,Bright Health MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna,Aetna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Aetna MGG,Aetna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS,BCBS,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,BCBS MGG,BCBS MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna,Cigna,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Cigna MGG,Cigna MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Humana,Humana,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Humana MGG,Humana MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Optum VA,Optum VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,UHC,UHC,8379.3,,,,,,,per diem,8379.3,8379.3,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,UHC MGG,UHC MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,VA,VA,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Wellcare MGG,Wellcare MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health - commercial,Bright Health - commercial,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,50433,CPT,,,,Inpatient,,,8379.3,8379.3,Bright Health MGG,Bright Health MGG,8379.3,,,,,,,case rate,8379.3,8379.3,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna,Aetna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna MGG,Aetna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS,BCBS,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS MGG,BCBS MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna,Cigna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna MGG,Cigna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Humana,Humana,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Humana MGG,Humana MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Optum VA,Optum VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,UHC,UHC,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,UHC MGG,UHC MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,VA,VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Wellcare MGG,Wellcare MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health - commercial,Bright Health - commercial,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health MGG,Bright Health MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna,Aetna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna MGG,Aetna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS,BCBS,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS MGG,BCBS MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna,Cigna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna MGG,Cigna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Humana,Humana,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Humana MGG,Humana MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Optum VA,Optum VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,UHC,UHC,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,UHC MGG,UHC MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,VA,VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Wellcare MGG,Wellcare MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health - commercial,Bright Health - commercial,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,50434,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health MGG,Bright Health MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna,Aetna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna MGG,Aetna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS,BCBS,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS MGG,BCBS MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna,Cigna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna MGG,Cigna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Humana,Humana,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Humana MGG,Humana MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Optum VA,Optum VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,UHC,UHC,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,UHC MGG,UHC MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,VA,VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Wellcare MGG,Wellcare MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health - commercial,Bright Health - commercial,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health MGG,Bright Health MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna,Aetna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Aetna MGG,Aetna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS,BCBS,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,BCBS MGG,BCBS MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna,Cigna,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Cigna MGG,Cigna MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Humana,Humana,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Humana MGG,Humana MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Optum VA,Optum VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,UHC,UHC,2761.14,,,,,,,per diem,2761.14,2761.14,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,UHC MGG,UHC MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,VA,VA,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Wellcare MGG,Wellcare MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health - commercial,Bright Health - commercial,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,50435,CPT,,,,Inpatient,,,2761.14,2761.14,Bright Health MGG,Bright Health MGG,2761.14,,,,,,,case rate,2761.14,2761.14,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,50693,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,50694,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna,Aetna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Aetna MGG,Aetna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS,BCBS,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,BCBS MGG,BCBS MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna,Cigna,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Cigna MGG,Cigna MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Humana,Humana,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Humana MGG,Humana MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Optum VA,Optum VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,UHC,UHC,12479.7,,,,,,,per diem,12479.7,12479.7,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,UHC MGG,UHC MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,VA,VA,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Wellcare MGG,Wellcare MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health - commercial,Bright Health - commercial,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,50695,CPT,,,,Inpatient,,,12479.7,12479.7,Bright Health MGG,Bright Health MGG,12479.7,,,,,,,case rate,12479.7,12479.7,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Aetna,Aetna,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Aetna MGG,Aetna MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,BCBS,BCBS,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,BCBS MGG,BCBS MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Cigna,Cigna,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Cigna MGG,Cigna MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Humana,Humana,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Humana MGG,Humana MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Optum VA,Optum VA,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,UHC,UHC,10695.72,,,,,,,per diem,10695.72,10695.72,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,UHC MGG,UHC MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,VA,VA,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Wellcare MGG,Wellcare MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Bright Health - commercial,Bright Health - commercial,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,27614,CPT,,,,Inpatient,,,10695.72,10695.72,Bright Health MGG,Bright Health MGG,10695.72,,,,,,,case rate,10695.72,10695.72,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Aetna,Aetna,456.96,,,,,,,per diem,456.96,456.96,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Aetna MGG,Aetna MGG,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,BCBS,BCBS,456.96,,,,,,,per diem,456.96,456.96,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,BCBS MGG,BCBS MGG,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Cigna,Cigna,456.96,,,,,,,per diem,456.96,456.96,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Cigna MGG,Cigna MGG,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Humana,Humana,456.96,,,,,,,per diem,456.96,456.96,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Humana MGG,Humana MGG,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Optum VA,Optum VA,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,UHC,UHC,456.96,,,,,,,per diem,456.96,456.96,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,UHC MGG,UHC MGG,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,VA,VA,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Wellcare MGG,Wellcare MGG,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Bright Health - commercial,Bright Health - commercial,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,51605,CPT,,,,Inpatient,,,456.96,456.96,Bright Health MGG,Bright Health MGG,456.96,,,,,,,case rate,456.96,456.96,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Aetna,Aetna,5298.9,,,,,,,per diem,5298.9,5298.9,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Aetna MGG,Aetna MGG,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,BCBS,BCBS,5298.9,,,,,,,per diem,5298.9,5298.9,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,BCBS MGG,BCBS MGG,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Cigna,Cigna,5298.9,,,,,,,per diem,5298.9,5298.9,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Cigna MGG,Cigna MGG,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Humana,Humana,5298.9,,,,,,,per diem,5298.9,5298.9,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Humana MGG,Humana MGG,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Optum VA,Optum VA,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,UHC,UHC,5298.9,,,,,,,per diem,5298.9,5298.9,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,UHC MGG,UHC MGG,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,VA,VA,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Wellcare MGG,Wellcare MGG,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Bright Health - commercial,Bright Health - commercial,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,49185,CPT,,,,Inpatient,,,5298.9,5298.9,Bright Health MGG,Bright Health MGG,5298.9,,,,,,,case rate,5298.9,5298.9,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Aetna,Aetna,248.19,,,,,,,per diem,248.19,248.19,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Aetna MGG,Aetna MGG,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,BCBS,BCBS,248.19,,,,,,,per diem,248.19,248.19,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,BCBS MGG,BCBS MGG,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Cigna,Cigna,248.19,,,,,,,per diem,248.19,248.19,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Cigna MGG,Cigna MGG,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Humana,Humana,248.19,,,,,,,per diem,248.19,248.19,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Humana MGG,Humana MGG,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Optum VA,Optum VA,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,UHC,UHC,248.19,,,,,,,per diem,248.19,248.19,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,UHC MGG,UHC MGG,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,VA,VA,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Wellcare MGG,Wellcare MGG,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Bright Health - commercial,Bright Health - commercial,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,248.19,248.19,Bright Health MGG,Bright Health MGG,248.19,,,,,,,case rate,248.19,248.19,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Aetna,Aetna,2884.67,,,,,,,per diem,2884.67,2884.67,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Aetna MGG,Aetna MGG,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,BCBS,BCBS,2884.67,,,,,,,per diem,2884.67,2884.67,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,BCBS MGG,BCBS MGG,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Cigna,Cigna,2884.67,,,,,,,per diem,2884.67,2884.67,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Cigna MGG,Cigna MGG,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Humana,Humana,2884.67,,,,,,,per diem,2884.67,2884.67,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Humana MGG,Humana MGG,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Optum VA,Optum VA,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,UHC,UHC,2884.67,,,,,,,per diem,2884.67,2884.67,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,UHC MGG,UHC MGG,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,VA,VA,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Wellcare MGG,Wellcare MGG,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Bright Health - commercial,Bright Health - commercial,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,2884.67,2884.67,Bright Health MGG,Bright Health MGG,2884.67,,,,,,,case rate,2884.67,2884.67,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Aetna,Aetna,1681.48,,,,,,,per diem,1681.48,1681.48,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Aetna MGG,Aetna MGG,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,BCBS,BCBS,1681.48,,,,,,,per diem,1681.48,1681.48,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,BCBS MGG,BCBS MGG,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Cigna,Cigna,1681.48,,,,,,,per diem,1681.48,1681.48,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Cigna MGG,Cigna MGG,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Humana,Humana,1681.48,,,,,,,per diem,1681.48,1681.48,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Humana MGG,Humana MGG,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Optum VA,Optum VA,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,UHC,UHC,1681.48,,,,,,,per diem,1681.48,1681.48,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,UHC MGG,UHC MGG,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,VA,VA,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Wellcare MGG,Wellcare MGG,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Bright Health - commercial,Bright Health - commercial,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1681.48,1681.48,Bright Health MGG,Bright Health MGG,1681.48,,,,,,,case rate,1681.48,1681.48,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Aetna,Aetna,2041.01,,,,,,,per diem,2041.01,2041.01,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Aetna MGG,Aetna MGG,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,BCBS,BCBS,2041.01,,,,,,,per diem,2041.01,2041.01,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,BCBS MGG,BCBS MGG,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Cigna,Cigna,2041.01,,,,,,,per diem,2041.01,2041.01,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Cigna MGG,Cigna MGG,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Humana,Humana,2041.01,,,,,,,per diem,2041.01,2041.01,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Humana MGG,Humana MGG,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Optum VA,Optum VA,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,UHC,UHC,2041.01,,,,,,,per diem,2041.01,2041.01,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,UHC MGG,UHC MGG,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,VA,VA,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Wellcare MGG,Wellcare MGG,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Bright Health - commercial,Bright Health - commercial,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2041.01,2041.01,Bright Health MGG,Bright Health MGG,2041.01,,,,,,,case rate,2041.01,2041.01,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Aetna,Aetna,2085.85,,,,,,,per diem,2085.85,2085.85,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Aetna MGG,Aetna MGG,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,BCBS,BCBS,2085.85,,,,,,,per diem,2085.85,2085.85,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,BCBS MGG,BCBS MGG,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Cigna,Cigna,2085.85,,,,,,,per diem,2085.85,2085.85,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Cigna MGG,Cigna MGG,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Humana,Humana,2085.85,,,,,,,per diem,2085.85,2085.85,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Humana MGG,Humana MGG,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Optum VA,Optum VA,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,UHC,UHC,2085.85,,,,,,,per diem,2085.85,2085.85,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,UHC MGG,UHC MGG,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,VA,VA,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Wellcare MGG,Wellcare MGG,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Bright Health - commercial,Bright Health - commercial,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,,,,,,Inpatient,,,2085.85,2085.85,Bright Health MGG,Bright Health MGG,2085.85,,,,,,,case rate,2085.85,2085.85,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Aetna,Aetna,709.75,,,,,,,per diem,709.75,709.75,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Aetna MGG,Aetna MGG,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,BCBS,BCBS,709.75,,,,,,,per diem,709.75,709.75,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,BCBS MGG,BCBS MGG,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Cigna,Cigna,709.75,,,,,,,per diem,709.75,709.75,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Cigna MGG,Cigna MGG,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Humana,Humana,709.75,,,,,,,per diem,709.75,709.75,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Humana MGG,Humana MGG,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Optum VA,Optum VA,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,UHC,UHC,709.75,,,,,,,per diem,709.75,709.75,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,UHC MGG,UHC MGG,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,VA,VA,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Wellcare MGG,Wellcare MGG,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Bright Health - commercial,Bright Health - commercial,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,709.75,709.75,Bright Health MGG,Bright Health MGG,709.75,,,,,,,case rate,709.75,709.75,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Aetna,Aetna,3220.5,,,,,,,per diem,3220.5,3220.5,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Aetna MGG,Aetna MGG,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,BCBS,BCBS,3220.5,,,,,,,per diem,3220.5,3220.5,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,BCBS MGG,BCBS MGG,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Cigna,Cigna,3220.5,,,,,,,per diem,3220.5,3220.5,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Cigna MGG,Cigna MGG,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Humana,Humana,3220.5,,,,,,,per diem,3220.5,3220.5,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Humana MGG,Humana MGG,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Optum VA,Optum VA,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,UHC,UHC,3220.5,,,,,,,per diem,3220.5,3220.5,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,UHC MGG,UHC MGG,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,VA,VA,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Wellcare MGG,Wellcare MGG,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Bright Health - commercial,Bright Health - commercial,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3220.5,3220.5,Bright Health MGG,Bright Health MGG,3220.5,,,,,,,case rate,3220.5,3220.5,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Aetna,Aetna,1139.69,,,,,,,per diem,1139.69,1139.69,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Aetna MGG,Aetna MGG,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,BCBS,BCBS,1139.69,,,,,,,per diem,1139.69,1139.69,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,BCBS MGG,BCBS MGG,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Cigna,Cigna,1139.69,,,,,,,per diem,1139.69,1139.69,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Cigna MGG,Cigna MGG,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Humana,Humana,1139.69,,,,,,,per diem,1139.69,1139.69,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Humana MGG,Humana MGG,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Optum VA,Optum VA,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,UHC,UHC,1139.69,,,,,,,per diem,1139.69,1139.69,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,UHC MGG,UHC MGG,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,VA,VA,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Wellcare MGG,Wellcare MGG,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Bright Health - commercial,Bright Health - commercial,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1139.69,1139.69,Bright Health MGG,Bright Health MGG,1139.69,,,,,,,case rate,1139.69,1139.69,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Aetna,Aetna,1358.64,,,,,,,per diem,1358.64,1358.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Aetna MGG,Aetna MGG,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,BCBS,BCBS,1358.64,,,,,,,per diem,1358.64,1358.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,BCBS MGG,BCBS MGG,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Cigna,Cigna,1358.64,,,,,,,per diem,1358.64,1358.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Cigna MGG,Cigna MGG,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Humana,Humana,1358.64,,,,,,,per diem,1358.64,1358.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Humana MGG,Humana MGG,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Optum VA,Optum VA,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,UHC,UHC,1358.64,,,,,,,per diem,1358.64,1358.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,UHC MGG,UHC MGG,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,VA,VA,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Wellcare MGG,Wellcare MGG,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Bright Health - commercial,Bright Health - commercial,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1358.64,1358.64,Bright Health MGG,Bright Health MGG,1358.64,,,,,,,case rate,1358.64,1358.64,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Aetna,Aetna,488.88,,,,,,,per diem,488.88,488.88,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Aetna MGG,Aetna MGG,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,BCBS,BCBS,488.88,,,,,,,per diem,488.88,488.88,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,BCBS MGG,BCBS MGG,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Cigna,Cigna,488.88,,,,,,,per diem,488.88,488.88,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Cigna MGG,Cigna MGG,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Humana,Humana,488.88,,,,,,,per diem,488.88,488.88,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Humana MGG,Humana MGG,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Optum VA,Optum VA,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,UHC,UHC,488.88,,,,,,,per diem,488.88,488.88,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,UHC MGG,UHC MGG,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,VA,VA,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Wellcare MGG,Wellcare MGG,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Bright Health - commercial,Bright Health - commercial,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,488.88,488.88,Bright Health MGG,Bright Health MGG,488.88,,,,,,,case rate,488.88,488.88,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Aetna,Aetna,154,,,,,,,per diem,154,154,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Aetna MGG,Aetna MGG,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,BCBS,BCBS,154,,,,,,,per diem,154,154,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,BCBS MGG,BCBS MGG,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Cigna,Cigna,154,,,,,,,per diem,154,154,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Cigna MGG,Cigna MGG,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Humana,Humana,154,,,,,,,per diem,154,154,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Humana MGG,Humana MGG,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Optum VA,Optum VA,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,UHC,UHC,154,,,,,,,per diem,154,154,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,UHC MGG,UHC MGG,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,VA,VA,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Wellcare MGG,Wellcare MGG,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Bright Health - commercial,Bright Health - commercial,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,154,154,Bright Health MGG,Bright Health MGG,154,,,,,,,case rate,154,154,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Aetna,Aetna,115,,,,,,,per diem,115,115,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Aetna MGG,Aetna MGG,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,BCBS,BCBS,115,,,,,,,per diem,115,115,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,BCBS MGG,BCBS MGG,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Cigna,Cigna,115,,,,,,,per diem,115,115,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Cigna MGG,Cigna MGG,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Humana,Humana,115,,,,,,,per diem,115,115,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Humana MGG,Humana MGG,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Optum VA,Optum VA,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,UHC,UHC,115,,,,,,,per diem,115,115,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,UHC MGG,UHC MGG,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,VA,VA,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Wellcare MGG,Wellcare MGG,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Bright Health - commercial,Bright Health - commercial,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,115,115,Bright Health MGG,Bright Health MGG,115,,,,,,,case rate,115,115,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Aetna,Aetna,730.66,,,,,,,per diem,730.66,730.66,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Aetna MGG,Aetna MGG,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,BCBS,BCBS,730.66,,,,,,,per diem,730.66,730.66,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,BCBS MGG,BCBS MGG,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Cigna,Cigna,730.66,,,,,,,per diem,730.66,730.66,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Cigna MGG,Cigna MGG,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Humana,Humana,730.66,,,,,,,per diem,730.66,730.66,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Humana MGG,Humana MGG,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Optum VA,Optum VA,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,UHC,UHC,730.66,,,,,,,per diem,730.66,730.66,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,UHC MGG,UHC MGG,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,VA,VA,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Wellcare MGG,Wellcare MGG,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Bright Health - commercial,Bright Health - commercial,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,730.66,730.66,Bright Health MGG,Bright Health MGG,730.66,,,,,,,case rate,730.66,730.66,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Aetna,Aetna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Aetna MGG,Aetna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,BCBS,BCBS,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,BCBS MGG,BCBS MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Cigna,Cigna,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Cigna MGG,Cigna MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Humana,Humana,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Humana MGG,Humana MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Optum VA,Optum VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,UHC,UHC,156,,,,,,,per diem,156,156,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,UHC MGG,UHC MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,VA,VA,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Wellcare MGG,Wellcare MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Bright Health - commercial,Bright Health - commercial,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,156,156,Bright Health MGG,Bright Health MGG,156,,,,,,,case rate,156,156,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Aetna,Aetna,1849.05,,,,,,,per diem,1849.05,1849.05,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Aetna MGG,Aetna MGG,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,BCBS,BCBS,1849.05,,,,,,,per diem,1849.05,1849.05,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,BCBS MGG,BCBS MGG,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Cigna,Cigna,1849.05,,,,,,,per diem,1849.05,1849.05,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Cigna MGG,Cigna MGG,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Humana,Humana,1849.05,,,,,,,per diem,1849.05,1849.05,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Humana MGG,Humana MGG,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Optum VA,Optum VA,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,UHC,UHC,1849.05,,,,,,,per diem,1849.05,1849.05,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,UHC MGG,UHC MGG,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,VA,VA,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Wellcare MGG,Wellcare MGG,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Bright Health - commercial,Bright Health - commercial,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1849.05,1849.05,Bright Health MGG,Bright Health MGG,1849.05,,,,,,,case rate,1849.05,1849.05,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Aetna,Aetna,1814.01,,,,,,,per diem,1814.01,1814.01,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Aetna MGG,Aetna MGG,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,BCBS,BCBS,1814.01,,,,,,,per diem,1814.01,1814.01,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,BCBS MGG,BCBS MGG,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Cigna,Cigna,1814.01,,,,,,,per diem,1814.01,1814.01,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Cigna MGG,Cigna MGG,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Humana,Humana,1814.01,,,,,,,per diem,1814.01,1814.01,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Humana MGG,Humana MGG,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Optum VA,Optum VA,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,UHC,UHC,1814.01,,,,,,,per diem,1814.01,1814.01,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,UHC MGG,UHC MGG,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,VA,VA,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Wellcare MGG,Wellcare MGG,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Bright Health - commercial,Bright Health - commercial,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1814.01,1814.01,Bright Health MGG,Bright Health MGG,1814.01,,,,,,,case rate,1814.01,1814.01,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Aetna,Aetna,1084.2,,,,,,,per diem,1084.2,1084.2,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Aetna MGG,Aetna MGG,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,BCBS,BCBS,1084.2,,,,,,,per diem,1084.2,1084.2,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,BCBS MGG,BCBS MGG,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Cigna,Cigna,1084.2,,,,,,,per diem,1084.2,1084.2,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Cigna MGG,Cigna MGG,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Humana,Humana,1084.2,,,,,,,per diem,1084.2,1084.2,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Humana MGG,Humana MGG,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Optum VA,Optum VA,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,UHC,UHC,1084.2,,,,,,,per diem,1084.2,1084.2,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,UHC MGG,UHC MGG,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,VA,VA,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Wellcare MGG,Wellcare MGG,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Bright Health - commercial,Bright Health - commercial,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1084.2,1084.2,Bright Health MGG,Bright Health MGG,1084.2,,,,,,,case rate,1084.2,1084.2,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Aetna,Aetna,464.88,,,,,,,per diem,464.88,464.88,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Aetna MGG,Aetna MGG,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,BCBS,BCBS,464.88,,,,,,,per diem,464.88,464.88,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,BCBS MGG,BCBS MGG,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Cigna,Cigna,464.88,,,,,,,per diem,464.88,464.88,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Cigna MGG,Cigna MGG,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Humana,Humana,464.88,,,,,,,per diem,464.88,464.88,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Humana MGG,Humana MGG,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Optum VA,Optum VA,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,UHC,UHC,464.88,,,,,,,per diem,464.88,464.88,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,UHC MGG,UHC MGG,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,VA,VA,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Wellcare MGG,Wellcare MGG,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Bright Health - commercial,Bright Health - commercial,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,464.88,464.88,Bright Health MGG,Bright Health MGG,464.88,,,,,,,case rate,464.88,464.88,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Aetna,Aetna,24.91,,,,,,,per diem,24.91,24.91,"Per diem rate, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Aetna MGG,Aetna MGG,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,BCBS,BCBS,24.91,,,,,,,per diem,24.91,24.91,"Per diem rate, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,BCBS MGG,BCBS MGG,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Cigna,Cigna,24.91,,,,,,,per diem,24.91,24.91,"Per diem rate, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Cigna MGG,Cigna MGG,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Humana,Humana,24.91,,,,,,,per diem,24.91,24.91,"Per diem rate, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Humana MGG,Humana MGG,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Optum VA,Optum VA,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,UHC,UHC,24.91,,,,,,,per diem,24.91,24.91,"Per diem rate, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,UHC MGG,UHC MGG,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,VA,VA,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Wellcare MGG,Wellcare MGG,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Bright Health - commercial,Bright Health - commercial,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACETIC ACID 0.25% IRRIG.      ,92000802,CDM,250,RC,,,,,,Inpatient,1,EA,24.91,24.91,Bright Health MGG,Bright Health MGG,24.91,,,,,,,case rate,24.91,24.91,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92000907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92001527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Aetna,Aetna,11.35,,,,,,,per diem,11.35,11.35,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Aetna MGG,Aetna MGG,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,BCBS,BCBS,11.35,,,,,,,per diem,11.35,11.35,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,BCBS MGG,BCBS MGG,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Cigna,Cigna,11.35,,,,,,,per diem,11.35,11.35,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Cigna MGG,Cigna MGG,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Humana,Humana,11.35,,,,,,,per diem,11.35,11.35,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Humana MGG,Humana MGG,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Optum VA,Optum VA,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,UHC,UHC,11.35,,,,,,,per diem,11.35,11.35,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,UHC MGG,UHC MGG,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,VA,VA,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Wellcare MGG,Wellcare MGG,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Bright Health - commercial,Bright Health - commercial,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 500-125MG TAB   ,92001967,CDM,250,RC,,,,,,Inpatient,1,EA,11.35,11.35,Bright Health MGG,Bright Health MGG,11.35,,,,,,,case rate,11.35,11.35,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92002812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 300MG SUP             ,92002864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Aetna,Aetna,182.73,,,,,,,per diem,182.73,182.73,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Aetna MGG,Aetna MGG,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,BCBS,BCBS,182.73,,,,,,,per diem,182.73,182.73,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,BCBS MGG,BCBS MGG,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Cigna,Cigna,182.73,,,,,,,per diem,182.73,182.73,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Cigna MGG,Cigna MGG,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Humana,Humana,182.73,,,,,,,per diem,182.73,182.73,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Humana MGG,Humana MGG,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Optum VA,Optum VA,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,UHC,UHC,182.73,,,,,,,per diem,182.73,182.73,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,UHC MGG,UHC MGG,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,VA,VA,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Wellcare MGG,Wellcare MGG,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Bright Health - commercial,Bright Health - commercial,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,182.73,182.73,Bright Health MGG,Bright Health MGG,182.73,,,,,,,case rate,182.73,182.73,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
B COMPLEX TAB                 ,92003604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 0.5MG TAB     ,92004040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Aetna,Aetna,151.35,,,,,,,per diem,151.35,151.35,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Aetna MGG,Aetna MGG,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,BCBS,BCBS,151.35,,,,,,,per diem,151.35,151.35,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,BCBS MGG,BCBS MGG,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Cigna,Cigna,151.35,,,,,,,per diem,151.35,151.35,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Cigna MGG,Cigna MGG,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Humana,Humana,151.35,,,,,,,per diem,151.35,151.35,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Humana MGG,Humana MGG,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Optum VA,Optum VA,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,UHC,UHC,151.35,,,,,,,per diem,151.35,151.35,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,UHC MGG,UHC MGG,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,VA,VA,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Wellcare MGG,Wellcare MGG,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Bright Health - commercial,Bright Health - commercial,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CREAM  ,92004169,CDM,250,RC,,,,,,Inpatient,1,EA,151.35,151.35,Bright Health MGG,Bright Health MGG,151.35,,,,,,,case rate,151.35,151.35,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB EC          ,92004375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92004445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Aetna,Aetna,10.73,,,,,,,per diem,10.73,10.73,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Aetna MGG,Aetna MGG,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,BCBS,BCBS,10.73,,,,,,,per diem,10.73,10.73,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,BCBS MGG,BCBS MGG,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Cigna,Cigna,10.73,,,,,,,per diem,10.73,10.73,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Cigna MGG,Cigna MGG,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Humana,Humana,10.73,,,,,,,per diem,10.73,10.73,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Humana MGG,Humana MGG,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Optum VA,Optum VA,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,UHC,UHC,10.73,,,,,,,per diem,10.73,10.73,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,UHC MGG,UHC MGG,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,VA,VA,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Wellcare MGG,Wellcare MGG,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Bright Health - commercial,Bright Health - commercial,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 5/6.25 TAB    ,92004455,CDM,250,RC,,,,,,Inpatient,1,EA,10.73,10.73,Bright Health MGG,Bright Health MGG,10.73,,,,,,,case rate,10.73,10.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Aetna,Aetna,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Aetna MGG,Aetna MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,BCBS,BCBS,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,BCBS MGG,BCBS MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Cigna,Cigna,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Cigna MGG,Cigna MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Humana,Humana,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Humana MGG,Humana MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Optum VA,Optum VA,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,UHC,UHC,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,UHC MGG,UHC MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,VA,VA,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Wellcare MGG,Wellcare MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Bright Health - commercial,Bright Health - commercial,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004527,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Bright Health MGG,Bright Health MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Aetna,Aetna,686.59,,,,,,,per diem,686.59,686.59,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Aetna MGG,Aetna MGG,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,BCBS,BCBS,686.59,,,,,,,per diem,686.59,686.59,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,BCBS MGG,BCBS MGG,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Cigna,Cigna,686.59,,,,,,,per diem,686.59,686.59,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Cigna MGG,Cigna MGG,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Humana,Humana,686.59,,,,,,,per diem,686.59,686.59,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Humana MGG,Humana MGG,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Optum VA,Optum VA,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,UHC,UHC,686.59,,,,,,,per diem,686.59,686.59,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,UHC MGG,UHC MGG,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,VA,VA,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Wellcare MGG,Wellcare MGG,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Bright Health - commercial,Bright Health - commercial,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2% EYE DROPS    ,92004528,CDM,250,RC,,,,,,Inpatient,1,EA,686.59,686.59,Bright Health MGG,Bright Health MGG,686.59,,,,,,,case rate,686.59,686.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Aetna,Aetna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Aetna MGG,Aetna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,BCBS,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS MGG,BCBS MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Cigna,Cigna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Cigna MGG,Cigna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Humana,Humana,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Humana MGG,Humana MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Optum VA,Optum VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UHC,UHC,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UHC MGG,UHC MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA,VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Wellcare MGG,Wellcare MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Bright Health - commercial,Bright Health - commercial,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92004596,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Bright Health MGG,Bright Health MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Aetna,Aetna,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Aetna MGG,Aetna MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,BCBS,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS MGG,BCBS MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Cigna,Cigna,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Cigna MGG,Cigna MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Humana,Humana,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Humana MGG,Humana MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Optum VA,Optum VA,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,UHC,UHC,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,UHC MGG,UHC MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,VA,VA,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Wellcare MGG,Wellcare MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Bright Health - commercial,Bright Health - commercial,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92004613,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Bright Health MGG,Bright Health MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92005417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92005570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna,Aetna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna MGG,Aetna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,BCBS,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS MGG,BCBS MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna,Cigna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna MGG,Cigna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana,Humana,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana MGG,Humana MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Optum VA,Optum VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC,UHC,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC MGG,UHC MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,VA,VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Wellcare MGG,Wellcare MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health - commercial,Bright Health - commercial,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92005751,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health MGG,Bright Health MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 25MG CAP     ,92006202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Aetna,Aetna,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Aetna MGG,Aetna MGG,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,BCBS,BCBS,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,BCBS MGG,BCBS MGG,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Cigna,Cigna,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Cigna MGG,Cigna MGG,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Humana,Humana,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Humana MGG,Humana MGG,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Optum VA,Optum VA,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,UHC,UHC,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,UHC MGG,UHC MGG,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,VA,VA,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Wellcare MGG,Wellcare MGG,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Bright Health - commercial,Bright Health - commercial,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE 0.12% RINSE     ,92006218,CDM,250,RC,,,,,,Inpatient,1,EA,61.65,61.65,Bright Health MGG,Bright Health MGG,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Aetna,Aetna,44.66,,,,,,,per diem,44.66,44.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Aetna MGG,Aetna MGG,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,BCBS,BCBS,44.66,,,,,,,per diem,44.66,44.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,BCBS MGG,BCBS MGG,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Cigna,Cigna,44.66,,,,,,,per diem,44.66,44.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Cigna MGG,Cigna MGG,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Humana,Humana,44.66,,,,,,,per diem,44.66,44.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Humana MGG,Humana MGG,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Optum VA,Optum VA,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,UHC,UHC,44.66,,,,,,,per diem,44.66,44.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,UHC MGG,UHC MGG,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,VA,VA,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Wellcare MGG,Wellcare MGG,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Bright Health - commercial,Bright Health - commercial,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 100MG TAB      ,92006326,CDM,250,RC,,,,,,Inpatient,1,EA,44.66,44.66,Bright Health MGG,Bright Health MGG,44.66,,,,,,,case rate,44.66,44.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Aetna,Aetna,15.43,,,,,,,per diem,15.43,15.43,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Aetna MGG,Aetna MGG,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,BCBS,BCBS,15.43,,,,,,,per diem,15.43,15.43,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,BCBS MGG,BCBS MGG,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Cigna,Cigna,15.43,,,,,,,per diem,15.43,15.43,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Cigna MGG,Cigna MGG,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Humana,Humana,15.43,,,,,,,per diem,15.43,15.43,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Humana MGG,Humana MGG,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Optum VA,Optum VA,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,UHC,UHC,15.43,,,,,,,per diem,15.43,15.43,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,UHC MGG,UHC MGG,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,VA,VA,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Wellcare MGG,Wellcare MGG,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Bright Health - commercial,Bright Health - commercial,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 10MG TAB       ,92006336,CDM,250,RC,,,,,,Inpatient,1,EA,15.43,15.43,Bright Health MGG,Bright Health MGG,15.43,,,,,,,case rate,15.43,15.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92006957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Aetna,Aetna,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Aetna MGG,Aetna MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,BCBS,BCBS,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,BCBS MGG,BCBS MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Cigna,Cigna,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Cigna MGG,Cigna MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Humana,Humana,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Humana MGG,Humana MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Optum VA,Optum VA,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,UHC,UHC,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,UHC MGG,UHC MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,VA,VA,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Wellcare MGG,Wellcare MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Bright Health - commercial,Bright Health - commercial,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CREAM        ,92007027,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Bright Health MGG,Bright Health MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Aetna,Aetna,127.08,,,,,,,per diem,127.08,127.08,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Aetna MGG,Aetna MGG,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,BCBS,BCBS,127.08,,,,,,,per diem,127.08,127.08,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,BCBS MGG,BCBS MGG,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Cigna,Cigna,127.08,,,,,,,per diem,127.08,127.08,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Cigna MGG,Cigna MGG,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Humana,Humana,127.08,,,,,,,per diem,127.08,127.08,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Humana MGG,Humana MGG,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Optum VA,Optum VA,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,UHC,UHC,127.08,,,,,,,per diem,127.08,127.08,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,UHC MGG,UHC MGG,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,VA,VA,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Wellcare MGG,Wellcare MGG,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Bright Health - commercial,Bright Health - commercial,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE 25MG CAP         ,92007076,CDM,250,RC,,,,,,Inpatient,1,EA,127.08,127.08,Bright Health MGG,Bright Health MGG,127.08,,,,,,,case rate,127.08,127.08,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Aetna,Aetna,10.37,,,,,,,per diem,10.37,10.37,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Aetna MGG,Aetna MGG,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,BCBS,BCBS,10.37,,,,,,,per diem,10.37,10.37,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,BCBS MGG,BCBS MGG,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Cigna,Cigna,10.37,,,,,,,per diem,10.37,10.37,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Cigna MGG,Cigna MGG,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Humana,Humana,10.37,,,,,,,per diem,10.37,10.37,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Humana MGG,Humana MGG,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Optum VA,Optum VA,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,UHC,UHC,10.37,,,,,,,per diem,10.37,10.37,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,UHC MGG,UHC MGG,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,VA,VA,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Wellcare MGG,Wellcare MGG,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Bright Health - commercial,Bright Health - commercial,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92007252,CDM,250,RC,,,,,,Inpatient,1,EA,10.37,10.37,Bright Health MGG,Bright Health MGG,10.37,,,,,,,case rate,10.37,10.37,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 2MG TAB         ,92008243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG TAB         ,92008246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN 250MG CAP       ,92008688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE 20MG TAB          ,92008733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Aetna,Aetna,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Aetna MGG,Aetna MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,BCBS,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS MGG,BCBS MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Cigna,Cigna,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Cigna MGG,Cigna MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Humana,Humana,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Humana MGG,Humana MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Optum VA,Optum VA,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UHC,UHC,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UHC MGG,UHC MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,VA,VA,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Wellcare MGG,Wellcare MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Bright Health - commercial,Bright Health - commercial,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DILTIAZEM 90MG TAB            ,92008989,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Bright Health MGG,Bright Health MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92009408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN 10MG CAP              ,92009818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 50MG CAP          ,92009979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Aetna,Aetna,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Aetna MGG,Aetna MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,BCBS,BCBS,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,BCBS MGG,BCBS MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Cigna,Cigna,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Cigna MGG,Cigna MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Humana,Humana,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Humana MGG,Humana MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Optum VA,Optum VA,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,UHC,UHC,35.46,,,,,,,per diem,35.46,35.46,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,UHC MGG,UHC MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,VA,VA,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Wellcare MGG,Wellcare MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Bright Health - commercial,Bright Health - commercial,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.1MG/ML SYRINGE  ,92010557,CDM,250,RC,,,,,,Inpatient,1,EA,35.46,35.46,Bright Health MGG,Bright Health MGG,35.46,,,,,,,case rate,35.46,35.46,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 324MG TAB   ,92011236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna,Aetna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna MGG,Aetna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,BCBS,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS MGG,BCBS MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna,Cigna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna MGG,Cigna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana,Humana,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana MGG,Humana MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Optum VA,Optum VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC,UHC,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC MGG,UHC MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,VA,VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Wellcare MGG,Wellcare MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health - commercial,Bright Health - commercial,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FERROUS SULF 220MG/5ML ELX    ,92011254,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health MGG,Bright Health MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Aetna,Aetna,136.65,,,,,,,per diem,136.65,136.65,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Aetna MGG,Aetna MGG,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,BCBS,BCBS,136.65,,,,,,,per diem,136.65,136.65,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,BCBS MGG,BCBS MGG,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Cigna,Cigna,136.65,,,,,,,per diem,136.65,136.65,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Cigna MGG,Cigna MGG,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Humana,Humana,136.65,,,,,,,per diem,136.65,136.65,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Humana MGG,Humana MGG,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Optum VA,Optum VA,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,UHC,UHC,136.65,,,,,,,per diem,136.65,136.65,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,UHC MGG,UHC MGG,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,VA,VA,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Wellcare MGG,Wellcare MGG,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Bright Health - commercial,Bright Health - commercial,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CREAM      ,92011586,CDM,250,RC,,,,,,Inpatient,1,EA,136.65,136.65,Bright Health MGG,Bright Health MGG,136.65,,,,,,,case rate,136.65,136.65,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Aetna,Aetna,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Aetna MGG,Aetna MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,BCBS,BCBS,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,BCBS MGG,BCBS MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Cigna,Cigna,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Cigna MGG,Cigna MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Humana,Humana,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Humana MGG,Humana MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Optum VA,Optum VA,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,UHC,UHC,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,UHC MGG,UHC MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,VA,VA,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Wellcare MGG,Wellcare MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Bright Health - commercial,Bright Health - commercial,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Bright Health MGG,Bright Health MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Aetna,Aetna,7.45,,,,,,,per diem,7.45,7.45,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Aetna MGG,Aetna MGG,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,BCBS,BCBS,7.45,,,,,,,per diem,7.45,7.45,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,BCBS MGG,BCBS MGG,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Cigna,Cigna,7.45,,,,,,,per diem,7.45,7.45,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Cigna MGG,Cigna MGG,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Humana,Humana,7.45,,,,,,,per diem,7.45,7.45,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Humana MGG,Humana MGG,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Optum VA,Optum VA,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,UHC,UHC,7.45,,,,,,,per diem,7.45,7.45,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,UHC MGG,UHC MGG,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,VA,VA,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Wellcare MGG,Wellcare MGG,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Bright Health - commercial,Bright Health - commercial,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011688,CDM,250,RC,,,,,,Inpatient,1,EA,7.45,7.45,Bright Health MGG,Bright Health MGG,7.45,,,,,,,case rate,7.45,7.45,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Aetna,Aetna,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Aetna MGG,Aetna MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,BCBS,BCBS,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,BCBS MGG,BCBS MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Cigna,Cigna,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Cigna MGG,Cigna MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Humana,Humana,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Humana MGG,Humana MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Optum VA,Optum VA,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,UHC,UHC,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,UHC MGG,UHC MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,VA,VA,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Wellcare MGG,Wellcare MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Bright Health - commercial,Bright Health - commercial,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92011872,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Bright Health MGG,Bright Health MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Aetna,Aetna,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Aetna MGG,Aetna MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,BCBS,BCBS,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,BCBS MGG,BCBS MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Cigna,Cigna,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Cigna MGG,Cigna MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Humana,Humana,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Humana MGG,Humana MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Optum VA,Optum VA,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,UHC,UHC,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,UHC MGG,UHC MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,VA,VA,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Wellcare MGG,Wellcare MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Bright Health - commercial,Bright Health - commercial,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% CREAM         ,92012284,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Bright Health MGG,Bright Health MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92012470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92012483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN ADULT SUP            ,92012523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92012683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Aetna,Aetna,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Aetna MGG,Aetna MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,BCBS,BCBS,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,BCBS MGG,BCBS MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Cigna,Cigna,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Cigna MGG,Cigna MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Humana,Humana,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Humana MGG,Humana MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Optum VA,Optum VA,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,UHC,UHC,7.73,,,,,,,per diem,7.73,7.73,"Per diem rate, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,UHC MGG,UHC MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,VA,VA,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Wellcare MGG,Wellcare MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Bright Health - commercial,Bright Health - commercial,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
GUANFACINE 2MG TAB            ,92012750,CDM,250,RC,,,,,,Inpatient,1,EA,7.73,7.73,Bright Health MGG,Bright Health MGG,7.73,,,,,,,case rate,7.73,7.73,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Aetna,Aetna,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Aetna MGG,Aetna MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,BCBS,BCBS,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,BCBS MGG,BCBS MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Cigna,Cigna,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Cigna MGG,Cigna MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Humana,Humana,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Humana MGG,Humana MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Optum VA,Optum VA,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,UHC,UHC,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,UHC MGG,UHC MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,VA,VA,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Wellcare MGG,Wellcare MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Bright Health - commercial,Bright Health - commercial,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CREAM       ,92013750,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Bright Health MGG,Bright Health MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92013892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92013923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92014578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92014768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92014859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Aetna,Aetna,335.01,,,,,,,per diem,335.01,335.01,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Aetna MGG,Aetna MGG,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,BCBS,BCBS,335.01,,,,,,,per diem,335.01,335.01,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,BCBS MGG,BCBS MGG,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Cigna,Cigna,335.01,,,,,,,per diem,335.01,335.01,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Cigna MGG,Cigna MGG,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Humana,Humana,335.01,,,,,,,per diem,335.01,335.01,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Humana MGG,Humana MGG,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Optum VA,Optum VA,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,UHC,UHC,335.01,,,,,,,per diem,335.01,335.01,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,UHC MGG,UHC MGG,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,VA,VA,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Wellcare MGG,Wellcare MGG,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Bright Health - commercial,Bright Health - commercial,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.03% SPRAY       ,92015109,CDM,250,RC,,,,,,Inpatient,1,EA,335.01,335.01,Bright Health MGG,Bright Health MGG,335.01,,,,,,,case rate,335.01,335.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Aetna,Aetna,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Aetna MGG,Aetna MGG,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,BCBS,BCBS,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,BCBS MGG,BCBS MGG,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Cigna,Cigna,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Cigna MGG,Cigna MGG,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Humana,Humana,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Humana MGG,Humana MGG,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Optum VA,Optum VA,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,UHC,UHC,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,UHC MGG,UHC MGG,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,VA,VA,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Wellcare MGG,Wellcare MGG,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Bright Health - commercial,Bright Health - commercial,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92015125,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,Bright Health MGG,Bright Health MGG,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 10MG TAB        ,92015427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Aetna,Aetna,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Aetna MGG,Aetna MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,BCBS,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS MGG,BCBS MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Cigna,Cigna,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Cigna MGG,Cigna MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Humana,Humana,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Humana MGG,Humana MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Optum VA,Optum VA,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UHC,UHC,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UHC MGG,UHC MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,VA,VA,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Wellcare MGG,Wellcare MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Bright Health - commercial,Bright Health - commercial,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92015610,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Bright Health MGG,Bright Health MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Aetna,Aetna,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Aetna MGG,Aetna MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,BCBS,BCBS,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,BCBS MGG,BCBS MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Cigna,Cigna,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Cigna MGG,Cigna MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Humana,Humana,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Humana MGG,Humana MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Optum VA,Optum VA,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,UHC,UHC,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,UHC MGG,UHC MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,VA,VA,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Wellcare MGG,Wellcare MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Bright Health - commercial,Bright Health - commercial,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5 MG TAB   ,92016076,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Bright Health MGG,Bright Health MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 50MCG TAB       ,92016288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 40MG TAB           ,92016709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92016975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Aetna,Aetna,6.34,,,,,,,per diem,6.34,6.34,"Per diem rate, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Aetna MGG,Aetna MGG,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,BCBS,BCBS,6.34,,,,,,,per diem,6.34,6.34,"Per diem rate, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,BCBS MGG,BCBS MGG,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Cigna,Cigna,6.34,,,,,,,per diem,6.34,6.34,"Per diem rate, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Cigna MGG,Cigna MGG,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Humana,Humana,6.34,,,,,,,per diem,6.34,6.34,"Per diem rate, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Humana MGG,Humana MGG,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Optum VA,Optum VA,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,UHC,UHC,6.34,,,,,,,per diem,6.34,6.34,"Per diem rate, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,UHC MGG,UHC MGG,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,VA,VA,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Wellcare MGG,Wellcare MGG,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Bright Health - commercial,Bright Health - commercial,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MAGNESIUM SULFATE 50% VL      ,92017396,CDM,250,RC,,,,,,Inpatient,1,EA,6.34,6.34,Bright Health MGG,Bright Health MGG,6.34,,,,,,,case rate,6.34,6.34,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92018091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Aetna,Aetna,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Aetna MGG,Aetna MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,BCBS,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS MGG,BCBS MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Cigna,Cigna,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Cigna MGG,Cigna MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Humana,Humana,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Humana MGG,Humana MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Optum VA,Optum VA,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,UHC,UHC,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,UHC MGG,UHC MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,VA,VA,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Wellcare MGG,Wellcare MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Bright Health - commercial,Bright Health - commercial,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92018268,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,Bright Health MGG,Bright Health MGG,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92018318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Aetna,Aetna,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Aetna MGG,Aetna MGG,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,BCBS,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS MGG,BCBS MGG,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Cigna,Cigna,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Cigna MGG,Cigna MGG,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Humana,Humana,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Humana MGG,Humana MGG,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Optum VA,Optum VA,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,UHC,UHC,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,UHC MGG,UHC MGG,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,VA,VA,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Wellcare MGG,Wellcare MGG,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Bright Health - commercial,Bright Health - commercial,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,Bright Health MGG,Bright Health MGG,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Aetna,Aetna,9.08,,,,,,,per diem,9.08,9.08,"Per diem rate, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Aetna MGG,Aetna MGG,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,BCBS,BCBS,9.08,,,,,,,per diem,9.08,9.08,"Per diem rate, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,BCBS MGG,BCBS MGG,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Cigna,Cigna,9.08,,,,,,,per diem,9.08,9.08,"Per diem rate, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Cigna MGG,Cigna MGG,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Humana,Humana,9.08,,,,,,,per diem,9.08,9.08,"Per diem rate, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Humana MGG,Humana MGG,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Optum VA,Optum VA,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,UHC,UHC,9.08,,,,,,,per diem,9.08,9.08,"Per diem rate, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,UHC MGG,UHC MGG,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,VA,VA,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Wellcare MGG,Wellcare MGG,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Bright Health - commercial,Bright Health - commercial,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MEXILETINE 200MG CAP          ,92018500,CDM,250,RC,,,,,,Inpatient,1,EA,9.08,9.08,Bright Health MGG,Bright Health MGG,9.08,,,,,,,case rate,9.08,9.08,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Aetna,Aetna,35.55,,,,,,,per diem,35.55,35.55,"Per diem rate, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Aetna MGG,Aetna MGG,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,BCBS,BCBS,35.55,,,,,,,per diem,35.55,35.55,"Per diem rate, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,BCBS MGG,BCBS MGG,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Cigna,Cigna,35.55,,,,,,,per diem,35.55,35.55,"Per diem rate, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Cigna MGG,Cigna MGG,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Humana,Humana,35.55,,,,,,,per diem,35.55,35.55,"Per diem rate, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Humana MGG,Humana MGG,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Optum VA,Optum VA,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,UHC,UHC,35.55,,,,,,,per diem,35.55,35.55,"Per diem rate, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,UHC MGG,UHC MGG,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,VA,VA,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Wellcare MGG,Wellcare MGG,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Bright Health - commercial,Bright Health - commercial,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE 3 200MG VAG SUPP   ,92018528,CDM,250,RC,,,,,,Inpatient,1,EA,35.55,35.55,Bright Health MGG,Bright Health MGG,35.55,,,,,,,case rate,35.55,35.55,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CREAM   ,92018571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92018773,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Aetna,Aetna,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Aetna MGG,Aetna MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,BCBS,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS MGG,BCBS MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Cigna,Cigna,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Cigna MGG,Cigna MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Humana,Humana,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Humana MGG,Humana MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Optum VA,Optum VA,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UHC,UHC,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UHC MGG,UHC MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,VA,VA,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Wellcare MGG,Wellcare MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Bright Health - commercial,Bright Health - commercial,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Bright Health MGG,Bright Health MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92019595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Aetna,Aetna,194.4,,,,,,,per diem,194.4,194.4,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Aetna MGG,Aetna MGG,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,BCBS,BCBS,194.4,,,,,,,per diem,194.4,194.4,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,BCBS MGG,BCBS MGG,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Cigna,Cigna,194.4,,,,,,,per diem,194.4,194.4,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Cigna MGG,Cigna MGG,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Humana,Humana,194.4,,,,,,,per diem,194.4,194.4,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Humana MGG,Humana MGG,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Optum VA,Optum VA,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,UHC,UHC,194.4,,,,,,,per diem,194.4,194.4,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,UHC MGG,UHC MGG,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,VA,VA,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Wellcare MGG,Wellcare MGG,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Bright Health - commercial,Bright Health - commercial,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML SYRINGE     ,92019664,CDM,250,RC,,,,,,Inpatient,1,EA,194.4,194.4,Bright Health MGG,Bright Health MGG,194.4,,,,,,,case rate,194.4,194.4,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Aetna,Aetna,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Aetna MGG,Aetna MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,BCBS,BCBS,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,BCBS MGG,BCBS MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Cigna,Cigna,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Cigna MGG,Cigna MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Humana,Humana,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Humana MGG,Humana MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Optum VA,Optum VA,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,UHC,UHC,12.83,,,,,,,per diem,12.83,12.83,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,UHC MGG,UHC MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,VA,VA,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Wellcare MGG,Wellcare MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Bright Health - commercial,Bright Health - commercial,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92019675,CDM,250,RC,,,,,,Inpatient,1,EA,12.83,12.83,Bright Health MGG,Bright Health MGG,12.83,,,,,,,case rate,12.83,12.83,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN 500MG TAB            ,92020075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Aetna,Aetna,8.9,,,,,,,per diem,8.9,8.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Aetna MGG,Aetna MGG,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,BCBS,BCBS,8.9,,,,,,,per diem,8.9,8.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,BCBS MGG,BCBS MGG,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Cigna,Cigna,8.9,,,,,,,per diem,8.9,8.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Cigna MGG,Cigna MGG,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Humana,Humana,8.9,,,,,,,per diem,8.9,8.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Humana MGG,Humana MGG,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Optum VA,Optum VA,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,UHC,UHC,8.9,,,,,,,per diem,8.9,8.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,UHC MGG,UHC MGG,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,VA,VA,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Wellcare MGG,Wellcare MGG,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Bright Health - commercial,Bright Health - commercial,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE ER 60MG TAB        ,92020458,CDM,250,RC,,,,,,Inpatient,1,EA,8.9,8.9,Bright Health MGG,Bright Health MGG,8.9,,,,,,,case rate,8.9,8.9,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CAP SA    ,92020543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92020756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Aetna,Aetna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Aetna MGG,Aetna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,BCBS,BCBS,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,BCBS MGG,BCBS MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Cigna,Cigna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Cigna MGG,Cigna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Humana,Humana,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Humana MGG,Humana MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Optum VA,Optum VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,UHC,UHC,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,UHC MGG,UHC MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,VA,VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Wellcare MGG,Wellcare MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Bright Health - commercial,Bright Health - commercial,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Bright Health MGG,Bright Health MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Aetna,Aetna,348.21,,,,,,,per diem,348.21,348.21,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Aetna MGG,Aetna MGG,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,BCBS,BCBS,348.21,,,,,,,per diem,348.21,348.21,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,BCBS MGG,BCBS MGG,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Cigna,Cigna,348.21,,,,,,,per diem,348.21,348.21,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Cigna MGG,Cigna MGG,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Humana,Humana,348.21,,,,,,,per diem,348.21,348.21,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Humana MGG,Humana MGG,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Optum VA,Optum VA,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,UHC,UHC,348.21,,,,,,,per diem,348.21,348.21,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,UHC MGG,UHC MGG,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,VA,VA,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Wellcare MGG,Wellcare MGG,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Bright Health - commercial,Bright Health - commercial,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92020914,CDM,250,RC,,,,,,Inpatient,1,EA,348.21,348.21,Bright Health MGG,Bright Health MGG,348.21,,,,,,,case rate,348.21,348.21,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Aetna,Aetna,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Aetna MGG,Aetna MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,BCBS,BCBS,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,BCBS MGG,BCBS MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Cigna,Cigna,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Cigna MGG,Cigna MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Humana,Humana,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Humana MGG,Humana MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Optum VA,Optum VA,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,UHC,UHC,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,UHC MGG,UHC MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,VA,VA,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Wellcare MGG,Wellcare MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Bright Health - commercial,Bright Health - commercial,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Bright Health MGG,Bright Health MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Aetna,Aetna,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Aetna MGG,Aetna MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,BCBS,BCBS,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,BCBS MGG,BCBS MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Cigna,Cigna,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Cigna MGG,Cigna MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Humana,Humana,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Humana MGG,Humana MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Optum VA,Optum VA,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,UHC,UHC,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,UHC MGG,UHC MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,VA,VA,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Wellcare MGG,Wellcare MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Bright Health - commercial,Bright Health - commercial,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Bright Health MGG,Bright Health MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OYSTER SHELL 250MG  VIT D TB  ,92021363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Aetna,Aetna,172.79,,,,,,,per diem,172.79,172.79,"Per diem rate, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Aetna MGG,Aetna MGG,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,BCBS,BCBS,172.79,,,,,,,per diem,172.79,172.79,"Per diem rate, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,BCBS MGG,BCBS MGG,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Cigna,Cigna,172.79,,,,,,,per diem,172.79,172.79,"Per diem rate, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Cigna MGG,Cigna MGG,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Humana,Humana,172.79,,,,,,,per diem,172.79,172.79,"Per diem rate, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Humana MGG,Humana MGG,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Optum VA,Optum VA,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,UHC,UHC,172.79,,,,,,,per diem,172.79,172.79,"Per diem rate, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,UHC MGG,UHC MGG,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,VA,VA,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Wellcare MGG,Wellcare MGG,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Bright Health - commercial,Bright Health - commercial,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN G SOD 5MMU VL      ,92021598,CDM,250,RC,,,,,,Inpatient,1,EA,172.79,172.79,Bright Health MGG,Bright Health MGG,172.79,,,,,,,case rate,172.79,172.79,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92021641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Aetna,Aetna,371.25,,,,,,,per diem,371.25,371.25,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Aetna MGG,Aetna MGG,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,BCBS,BCBS,371.25,,,,,,,per diem,371.25,371.25,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,BCBS MGG,BCBS MGG,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Cigna,Cigna,371.25,,,,,,,per diem,371.25,371.25,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Cigna MGG,Cigna MGG,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Humana,Humana,371.25,,,,,,,per diem,371.25,371.25,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Humana MGG,Humana MGG,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Optum VA,Optum VA,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,UHC,UHC,371.25,,,,,,,per diem,371.25,371.25,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,UHC MGG,UHC MGG,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,VA,VA,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Wellcare MGG,Wellcare MGG,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Bright Health - commercial,Bright Health - commercial,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,371.25,371.25,Bright Health MGG,Bright Health MGG,371.25,,,,,,,case rate,371.25,371.25,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Aetna,Aetna,45.54,,,,,,,per diem,45.54,45.54,"Per diem rate, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Aetna MGG,Aetna MGG,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,BCBS,BCBS,45.54,,,,,,,per diem,45.54,45.54,"Per diem rate, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,BCBS MGG,BCBS MGG,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Cigna,Cigna,45.54,,,,,,,per diem,45.54,45.54,"Per diem rate, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Cigna MGG,Cigna MGG,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Humana,Humana,45.54,,,,,,,per diem,45.54,45.54,"Per diem rate, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Humana MGG,Humana MGG,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Optum VA,Optum VA,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,UHC,UHC,45.54,,,,,,,per diem,45.54,45.54,"Per diem rate, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,UHC MGG,UHC MGG,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,VA,VA,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Wellcare MGG,Wellcare MGG,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Bright Health - commercial,Bright Health - commercial,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PFIZERPEN 5 MILLION UNITS VL  ,92021948,CDM,250,RC,,,,,,Inpatient,1,EA,45.54,45.54,Bright Health MGG,Bright Health MGG,45.54,,,,,,,case rate,45.54,45.54,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92022017,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92022050,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Aetna,Aetna,86.33,,,,,,,per diem,86.33,86.33,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Aetna MGG,Aetna MGG,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,BCBS,BCBS,86.33,,,,,,,per diem,86.33,86.33,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,BCBS MGG,BCBS MGG,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Cigna,Cigna,86.33,,,,,,,per diem,86.33,86.33,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Cigna MGG,Cigna MGG,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Humana,Humana,86.33,,,,,,,per diem,86.33,86.33,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Humana MGG,Humana MGG,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Optum VA,Optum VA,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,UHC,UHC,86.33,,,,,,,per diem,86.33,86.33,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,UHC MGG,UHC MGG,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,VA,VA,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Wellcare MGG,Wellcare MGG,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Bright Health - commercial,Bright Health - commercial,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 65MG/ML VL      ,92022205,CDM,250,RC,,,,,,Inpatient,1,EA,86.33,86.33,Bright Health MGG,Bright Health MGG,86.33,,,,,,,case rate,86.33,86.33,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Aetna,Aetna,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Aetna MGG,Aetna MGG,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,BCBS,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS MGG,BCBS MGG,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Cigna,Cigna,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Cigna MGG,Cigna MGG,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Humana,Humana,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Humana MGG,Humana MGG,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Optum VA,Optum VA,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,UHC,UHC,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,UHC MGG,UHC MGG,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,VA,VA,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Wellcare MGG,Wellcare MGG,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Bright Health - commercial,Bright Health - commercial,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022806,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,Bright Health MGG,Bright Health MGG,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Aetna,Aetna,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Aetna MGG,Aetna MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,BCBS,BCBS,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,BCBS MGG,BCBS MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Cigna,Cigna,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Cigna MGG,Cigna MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Humana,Humana,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Humana MGG,Humana MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Optum VA,Optum VA,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,UHC,UHC,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,UHC MGG,UHC MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,VA,VA,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Wellcare MGG,Wellcare MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Bright Health - commercial,Bright Health - commercial,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
POVIDONE-IODINE 10% OINT      ,92022807,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Bright Health MGG,Bright Health MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92023011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Aetna,Aetna,66.6,,,,,,,per diem,66.6,66.6,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Aetna MGG,Aetna MGG,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,BCBS,BCBS,66.6,,,,,,,per diem,66.6,66.6,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,BCBS MGG,BCBS MGG,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Cigna,Cigna,66.6,,,,,,,per diem,66.6,66.6,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Cigna MGG,Cigna MGG,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Humana,Humana,66.6,,,,,,,per diem,66.6,66.6,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Humana MGG,Humana MGG,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Optum VA,Optum VA,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,UHC,UHC,66.6,,,,,,,per diem,66.6,66.6,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,UHC MGG,UHC MGG,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,VA,VA,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Wellcare MGG,Wellcare MGG,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Bright Health - commercial,Bright Health - commercial,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG/ML VL    ,92023377,CDM,250,RC,,,,,,Inpatient,1,EA,66.6,66.6,Bright Health MGG,Bright Health MGG,66.6,,,,,,,case rate,66.6,66.6,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE 30MG TAB      ,92023906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Aetna,Aetna,13.71,,,,,,,per diem,13.71,13.71,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Aetna MGG,Aetna MGG,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,BCBS,BCBS,13.71,,,,,,,per diem,13.71,13.71,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,BCBS MGG,BCBS MGG,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Cigna,Cigna,13.71,,,,,,,per diem,13.71,13.71,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Cigna MGG,Cigna MGG,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Humana,Humana,13.71,,,,,,,per diem,13.71,13.71,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Humana MGG,Humana MGG,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Optum VA,Optum VA,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,UHC,UHC,13.71,,,,,,,per diem,13.71,13.71,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,UHC MGG,UHC MGG,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,VA,VA,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Wellcare MGG,Wellcare MGG,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Bright Health - commercial,Bright Health - commercial,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHAMPOO   ,92024769,CDM,250,RC,,,,,,Inpatient,1,EA,13.71,13.71,Bright Health MGG,Bright Health MGG,13.71,,,,,,,case rate,13.71,13.71,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Aetna,Aetna,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Aetna MGG,Aetna MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,BCBS,BCBS,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,BCBS MGG,BCBS MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Cigna,Cigna,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Cigna MGG,Cigna MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Humana,Humana,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Humana MGG,Humana MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Optum VA,Optum VA,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,UHC,UHC,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,UHC MGG,UHC MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,VA,VA,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Wellcare MGG,Wellcare MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Bright Health - commercial,Bright Health - commercial,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025175,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Bright Health MGG,Bright Health MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Aetna,Aetna,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Aetna MGG,Aetna MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,BCBS,BCBS,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,BCBS MGG,BCBS MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Cigna,Cigna,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Cigna MGG,Cigna MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Humana,Humana,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Humana MGG,Humana MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Optum VA,Optum VA,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,UHC,UHC,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,UHC MGG,UHC MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,VA,VA,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Wellcare MGG,Wellcare MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Bright Health - commercial,Bright Health - commercial,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025176,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Bright Health MGG,Bright Health MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Aetna,Aetna,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Aetna MGG,Aetna MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,BCBS,BCBS,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,BCBS MGG,BCBS MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Cigna,Cigna,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Cigna MGG,Cigna MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Humana,Humana,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Humana MGG,Humana MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Optum VA,Optum VA,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,UHC,UHC,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,UHC MGG,UHC MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,VA,VA,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Wellcare MGG,Wellcare MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Bright Health - commercial,Bright Health - commercial,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% IRRIG.   ,92025182,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Bright Health MGG,Bright Health MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 120MG TAB             ,92025376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Aetna,Aetna,7.69,,,,,,,per diem,7.69,7.69,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Aetna MGG,Aetna MGG,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,BCBS,BCBS,7.69,,,,,,,per diem,7.69,7.69,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,BCBS MGG,BCBS MGG,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Cigna,Cigna,7.69,,,,,,,per diem,7.69,7.69,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Cigna MGG,Cigna MGG,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Humana,Humana,7.69,,,,,,,per diem,7.69,7.69,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Humana MGG,Humana MGG,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Optum VA,Optum VA,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,UHC,UHC,7.69,,,,,,,per diem,7.69,7.69,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,UHC MGG,UHC MGG,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,VA,VA,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Wellcare MGG,Wellcare MGG,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Bright Health - commercial,Bright Health - commercial,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025390,CDM,250,RC,,,,,,Inpatient,1,EA,7.69,7.69,Bright Health MGG,Bright Health MGG,7.69,,,,,,,case rate,7.69,7.69,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Aetna,Aetna,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Aetna MGG,Aetna MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,BCBS,BCBS,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,BCBS MGG,BCBS MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Cigna,Cigna,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Cigna MGG,Cigna MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Humana,Humana,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Humana MGG,Humana MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Optum VA,Optum VA,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,UHC,UHC,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,UHC MGG,UHC MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,VA,VA,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Wellcare MGG,Wellcare MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Bright Health - commercial,Bright Health - commercial,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
STERILE WATER FOR INJECTION   ,92025505,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Bright Health MGG,Bright Health MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Aetna,Aetna,31.8,,,,,,,per diem,31.8,31.8,"Per diem rate, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Aetna MGG,Aetna MGG,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,BCBS,BCBS,31.8,,,,,,,per diem,31.8,31.8,"Per diem rate, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,BCBS MGG,BCBS MGG,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Cigna,Cigna,31.8,,,,,,,per diem,31.8,31.8,"Per diem rate, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Cigna MGG,Cigna MGG,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Humana,Humana,31.8,,,,,,,per diem,31.8,31.8,"Per diem rate, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Humana MGG,Humana MGG,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Optum VA,Optum VA,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,UHC,UHC,31.8,,,,,,,per diem,31.8,31.8,"Per diem rate, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,UHC MGG,UHC MGG,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,VA,VA,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Wellcare MGG,Wellcare MGG,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Bright Health - commercial,Bright Health - commercial,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
"STERILE WATER,IRRIGATION      ",92025529,CDM,250,RC,,,,,,Inpatient,1,EA,31.8,31.8,Bright Health MGG,Bright Health MGG,31.8,,,,,,,case rate,31.8,31.8,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92025987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 30MG TAB              ,92026744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Aetna,Aetna,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Aetna MGG,Aetna MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,BCBS,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS MGG,BCBS MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Cigna,Cigna,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Cigna MGG,Cigna MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Humana,Humana,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Humana MGG,Humana MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Optum VA,Optum VA,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,UHC,UHC,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,UHC MGG,UHC MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,VA,VA,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Wellcare MGG,Wellcare MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Bright Health - commercial,Bright Health - commercial,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TORSEMIDE 100MG TAB           ,92027107,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,Bright Health MGG,Bright Health MGG,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92027156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Aetna,Aetna,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Aetna MGG,Aetna MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,BCBS,BCBS,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,BCBS MGG,BCBS MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Cigna,Cigna,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Cigna MGG,Cigna MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Humana,Humana,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Humana MGG,Humana MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Optum VA,Optum VA,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,UHC,UHC,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,UHC MGG,UHC MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,VA,VA,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Wellcare MGG,Wellcare MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Bright Health - commercial,Bright Health - commercial,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRANSDERM-SCOP 1.5MG/72HR     ,92027181,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Bright Health MGG,Bright Health MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Aetna,Aetna,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Aetna MGG,Aetna MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,BCBS,BCBS,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,BCBS MGG,BCBS MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Cigna,Cigna,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Cigna MGG,Cigna MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Humana,Humana,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Humana MGG,Humana MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Optum VA,Optum VA,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,UHC,UHC,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,UHC MGG,UHC MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,VA,VA,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Wellcare MGG,Wellcare MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Bright Health - commercial,Bright Health - commercial,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027211,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Bright Health MGG,Bright Health MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna,Aetna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna MGG,Aetna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS,BCBS,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS MGG,BCBS MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna,Cigna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna MGG,Cigna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana,Humana,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana MGG,Humana MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Optum VA,Optum VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC,UHC,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC MGG,UHC MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,VA,VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Wellcare MGG,Wellcare MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health - commercial,Bright Health - commercial,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRAZODONE 100MG TAB           ,92027217,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health MGG,Bright Health MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Aetna,Aetna,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Aetna MGG,Aetna MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,BCBS,BCBS,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,BCBS MGG,BCBS MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Cigna,Cigna,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Cigna MGG,Cigna MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Humana,Humana,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Humana MGG,Humana MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Optum VA,Optum VA,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,UHC,UHC,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,UHC MGG,UHC MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,VA,VA,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Wellcare MGG,Wellcare MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Bright Health - commercial,Bright Health - commercial,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OINT      ,92027317,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Bright Health MGG,Bright Health MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Aetna,Aetna,11.67,,,,,,,per diem,11.67,11.67,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Aetna MGG,Aetna MGG,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,BCBS,BCBS,11.67,,,,,,,per diem,11.67,11.67,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,BCBS MGG,BCBS MGG,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Cigna,Cigna,11.67,,,,,,,per diem,11.67,11.67,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Cigna MGG,Cigna MGG,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Humana,Humana,11.67,,,,,,,per diem,11.67,11.67,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Humana MGG,Humana MGG,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Optum VA,Optum VA,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,UHC,UHC,11.67,,,,,,,per diem,11.67,11.67,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,UHC MGG,UHC MGG,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,VA,VA,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Wellcare MGG,Wellcare MGG,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Bright Health - commercial,Bright Health - commercial,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027318,CDM,250,RC,,,,,,Inpatient,1,EA,11.67,11.67,Bright Health MGG,Bright Health MGG,11.67,,,,,,,case rate,11.67,11.67,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Aetna,Aetna,28.95,,,,,,,per diem,28.95,28.95,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Aetna MGG,Aetna MGG,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,BCBS,BCBS,28.95,,,,,,,per diem,28.95,28.95,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,BCBS MGG,BCBS MGG,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Cigna,Cigna,28.95,,,,,,,per diem,28.95,28.95,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Cigna MGG,Cigna MGG,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Humana,Humana,28.95,,,,,,,per diem,28.95,28.95,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Humana MGG,Humana MGG,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Optum VA,Optum VA,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,UHC,UHC,28.95,,,,,,,per diem,28.95,28.95,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,UHC MGG,UHC MGG,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,VA,VA,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Wellcare MGG,Wellcare MGG,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Bright Health - commercial,Bright Health - commercial,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92027320,CDM,250,RC,,,,,,Inpatient,1,EA,28.95,28.95,Bright Health MGG,Bright Health MGG,28.95,,,,,,,case rate,28.95,28.95,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Aetna,Aetna,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Aetna MGG,Aetna MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,BCBS,BCBS,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,BCBS MGG,BCBS MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Cigna,Cigna,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Cigna MGG,Cigna MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Humana,Humana,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Humana MGG,Humana MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Optum VA,Optum VA,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,UHC,UHC,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,UHC MGG,UHC MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,VA,VA,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Wellcare MGG,Wellcare MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Bright Health - commercial,Bright Health - commercial,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027394,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Bright Health MGG,Bright Health MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 CP   ,92027406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Aetna,Aetna,6.47,,,,,,,per diem,6.47,6.47,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Aetna MGG,Aetna MGG,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,BCBS,BCBS,6.47,,,,,,,per diem,6.47,6.47,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,BCBS MGG,BCBS MGG,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Cigna,Cigna,6.47,,,,,,,per diem,6.47,6.47,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Cigna MGG,Cigna MGG,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Humana,Humana,6.47,,,,,,,per diem,6.47,6.47,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Humana MGG,Humana MGG,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Optum VA,Optum VA,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,UHC,UHC,6.47,,,,,,,per diem,6.47,6.47,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,UHC MGG,UHC MGG,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,VA,VA,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Wellcare MGG,Wellcare MGG,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Bright Health - commercial,Bright Health - commercial,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL 2MG TAB       ,92027532,CDM,250,RC,,,,,,Inpatient,1,EA,6.47,6.47,Bright Health MGG,Bright Health MGG,6.47,,,,,,,case rate,6.47,6.47,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB           ,92028149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 120MG TAB SA        ,92028167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 80MG TAB            ,92028222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000 UNIT CAP     ",92028458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna,Aetna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna MGG,Aetna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,BCBS,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS MGG,BCBS MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna,Cigna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna MGG,Cigna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana,Humana,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana MGG,Humana MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Optum VA,Optum VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC,UHC,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC MGG,UHC MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Wellcare MGG,Wellcare MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health - commercial,Bright Health - commercial,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WARFARIN SODIUM 2MG TAB       ,92029202,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health MGG,Bright Health MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC-220 CAP                  ,92029580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Aetna,Aetna,11.24,,,,,,,per diem,11.24,11.24,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Aetna MGG,Aetna MGG,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,BCBS,BCBS,11.24,,,,,,,per diem,11.24,11.24,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,BCBS MGG,BCBS MGG,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Cigna,Cigna,11.24,,,,,,,per diem,11.24,11.24,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Cigna MGG,Cigna MGG,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Humana,Humana,11.24,,,,,,,per diem,11.24,11.24,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Humana MGG,Humana MGG,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Optum VA,Optum VA,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,UHC,UHC,11.24,,,,,,,per diem,11.24,11.24,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,UHC MGG,UHC MGG,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,VA,VA,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Wellcare MGG,Wellcare MGG,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Bright Health - commercial,Bright Health - commercial,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92030574,CDM,250,RC,,,,,,Inpatient,1,EA,11.24,11.24,Bright Health MGG,Bright Health MGG,11.24,,,,,,,case rate,11.24,11.24,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Aetna,Aetna,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Aetna MGG,Aetna MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,BCBS,BCBS,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,BCBS MGG,BCBS MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Cigna,Cigna,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Cigna MGG,Cigna MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Humana,Humana,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Humana MGG,Humana MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Optum VA,Optum VA,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,UHC,UHC,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,UHC MGG,UHC MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,VA,VA,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Wellcare MGG,Wellcare MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Bright Health - commercial,Bright Health - commercial,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL 90MCG INHALER       ,92030798,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Bright Health MGG,Bright Health MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92031635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Aetna,Aetna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Aetna MGG,Aetna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,BCBS,BCBS,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,BCBS MGG,BCBS MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Cigna,Cigna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Cigna MGG,Cigna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Humana,Humana,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Humana MGG,Humana MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Optum VA,Optum VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,UHC,UHC,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,UHC MGG,UHC MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,VA,VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Wellcare MGG,Wellcare MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Bright Health - commercial,Bright Health - commercial,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOX TR-K CLV 875-125MG TAB   ,92031815,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Bright Health MGG,Bright Health MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92032040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Aetna,Aetna,16.47,,,,,,,per diem,16.47,16.47,"Per diem rate, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Aetna MGG,Aetna MGG,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,BCBS,BCBS,16.47,,,,,,,per diem,16.47,16.47,"Per diem rate, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,BCBS MGG,BCBS MGG,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Cigna,Cigna,16.47,,,,,,,per diem,16.47,16.47,"Per diem rate, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Cigna MGG,Cigna MGG,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Humana,Humana,16.47,,,,,,,per diem,16.47,16.47,"Per diem rate, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Humana MGG,Humana MGG,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Optum VA,Optum VA,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,UHC,UHC,16.47,,,,,,,per diem,16.47,16.47,"Per diem rate, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,UHC MGG,UHC MGG,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,VA,VA,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Wellcare MGG,Wellcare MGG,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Bright Health - commercial,Bright Health - commercial,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
AQUAPHOR OINT                 ,92032482,CDM,250,RC,,,,,,Inpatient,1,EA,16.47,16.47,Bright Health MGG,Bright Health MGG,16.47,,,,,,,case rate,16.47,16.47,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92032948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92034213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Aetna,Aetna,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Aetna MGG,Aetna MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,BCBS,BCBS,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,BCBS MGG,BCBS MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Cigna,Cigna,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Cigna MGG,Cigna MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Humana,Humana,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Humana MGG,Humana MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Optum VA,Optum VA,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,UHC,UHC,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,UHC MGG,UHC MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,VA,VA,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Wellcare MGG,Wellcare MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Bright Health - commercial,Bright Health - commercial,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% DROPS ,92034823,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Bright Health MGG,Bright Health MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE 4MG TAB      ,92036085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Aetna,Aetna,30.66,,,,,,,per diem,30.66,30.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Aetna MGG,Aetna MGG,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,BCBS,BCBS,30.66,,,,,,,per diem,30.66,30.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,BCBS MGG,BCBS MGG,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Cigna,Cigna,30.66,,,,,,,per diem,30.66,30.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Cigna MGG,Cigna MGG,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Humana,Humana,30.66,,,,,,,per diem,30.66,30.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Humana MGG,Humana MGG,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Optum VA,Optum VA,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,UHC,UHC,30.66,,,,,,,per diem,30.66,30.66,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,UHC MGG,UHC MGG,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,VA,VA,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Wellcare MGG,Wellcare MGG,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Bright Health - commercial,Bright Health - commercial,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE 50MG TAB       ,92036158,CDM,250,RC,,,,,,Inpatient,1,EA,30.66,30.66,Bright Health MGG,Bright Health MGG,30.66,,,,,,,case rate,30.66,30.66,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92037375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Aetna,Aetna,22.72,,,,,,,per diem,22.72,22.72,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Aetna MGG,Aetna MGG,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,BCBS,BCBS,22.72,,,,,,,per diem,22.72,22.72,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,BCBS MGG,BCBS MGG,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Cigna,Cigna,22.72,,,,,,,per diem,22.72,22.72,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Cigna MGG,Cigna MGG,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Humana,Humana,22.72,,,,,,,per diem,22.72,22.72,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Humana MGG,Humana MGG,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Optum VA,Optum VA,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,UHC,UHC,22.72,,,,,,,per diem,22.72,22.72,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,UHC MGG,UHC MGG,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,VA,VA,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Wellcare MGG,Wellcare MGG,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Bright Health - commercial,Bright Health - commercial,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 4MG/ML VL       ,92038345,CDM,250,RC,,,,,,Inpatient,1,EA,22.72,22.72,Bright Health MGG,Bright Health MGG,22.72,,,,,,,case rate,22.72,22.72,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92038481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92039171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Aetna,Aetna,57.54,,,,,,,per diem,57.54,57.54,"Per diem rate, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Aetna MGG,Aetna MGG,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,BCBS,BCBS,57.54,,,,,,,per diem,57.54,57.54,"Per diem rate, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,BCBS MGG,BCBS MGG,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Cigna,Cigna,57.54,,,,,,,per diem,57.54,57.54,"Per diem rate, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Cigna MGG,Cigna MGG,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Humana,Humana,57.54,,,,,,,per diem,57.54,57.54,"Per diem rate, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Humana MGG,Humana MGG,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Optum VA,Optum VA,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,UHC,UHC,57.54,,,,,,,per diem,57.54,57.54,"Per diem rate, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,UHC MGG,UHC MGG,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,VA,VA,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Wellcare MGG,Wellcare MGG,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Bright Health - commercial,Bright Health - commercial,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
GENTAMICIN 3MG/ML EYE DROPS   ,92042622,CDM,250,RC,,,,,,Inpatient,1,EA,57.54,57.54,Bright Health MGG,Bright Health MGG,57.54,,,,,,,case rate,57.54,57.54,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Aetna,Aetna,11.13,,,,,,,per diem,11.13,11.13,"Per diem rate, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Aetna MGG,Aetna MGG,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,BCBS,BCBS,11.13,,,,,,,per diem,11.13,11.13,"Per diem rate, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,BCBS MGG,BCBS MGG,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Cigna,Cigna,11.13,,,,,,,per diem,11.13,11.13,"Per diem rate, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Cigna MGG,Cigna MGG,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Humana,Humana,11.13,,,,,,,per diem,11.13,11.13,"Per diem rate, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Humana MGG,Humana MGG,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Optum VA,Optum VA,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,UHC,UHC,11.13,,,,,,,per diem,11.13,11.13,"Per diem rate, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,UHC MGG,UHC MGG,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,VA,VA,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Wellcare MGG,Wellcare MGG,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Bright Health - commercial,Bright Health - commercial,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
"HEPARIN NA 1,000 U/ML VL      ",92043586,CDM,250,RC,,,,,,Inpatient,1,EA,11.13,11.13,Bright Health MGG,Bright Health MGG,11.13,,,,,,,case rate,11.13,11.13,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Aetna,Aetna,51.55,,,,,,,per diem,51.55,51.55,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Aetna MGG,Aetna MGG,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,BCBS,BCBS,51.55,,,,,,,per diem,51.55,51.55,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,BCBS MGG,BCBS MGG,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Cigna,Cigna,51.55,,,,,,,per diem,51.55,51.55,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Cigna MGG,Cigna MGG,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Humana,Humana,51.55,,,,,,,per diem,51.55,51.55,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Humana MGG,Humana MGG,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Optum VA,Optum VA,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,UHC,UHC,51.55,,,,,,,per diem,51.55,51.55,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,UHC MGG,UHC MGG,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,VA,VA,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Wellcare MGG,Wellcare MGG,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Bright Health - commercial,Bright Health - commercial,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92043680,CDM,250,RC,,,,,,Inpatient,1,EA,51.55,51.55,Bright Health MGG,Bright Health MGG,51.55,,,,,,,case rate,51.55,51.55,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92043683,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SU .125MG TB SL   ,92044818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92044949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92045795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92048744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUCINEX 600MG TAB             ,92049608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051668,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 5MG TAB      ,92053957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92054800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 150MG TAB           ,92057818,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92057844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Aetna,Aetna,241.77,,,,,,,per diem,241.77,241.77,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Aetna MGG,Aetna MGG,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,BCBS,BCBS,241.77,,,,,,,per diem,241.77,241.77,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,BCBS MGG,BCBS MGG,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Cigna,Cigna,241.77,,,,,,,per diem,241.77,241.77,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Cigna MGG,Cigna MGG,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Humana,Humana,241.77,,,,,,,per diem,241.77,241.77,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Humana MGG,Humana MGG,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Optum VA,Optum VA,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,UHC,UHC,241.77,,,,,,,per diem,241.77,241.77,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,UHC MGG,UHC MGG,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,VA,VA,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Wellcare MGG,Wellcare MGG,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Bright Health - commercial,Bright Health - commercial,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PASTE      ,92057967,CDM,250,RC,,,,,,Inpatient,1,EA,241.77,241.77,Bright Health MGG,Bright Health MGG,241.77,,,,,,,case rate,241.77,241.77,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna,Aetna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna MGG,Aetna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS,BCBS,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS MGG,BCBS MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna,Cigna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna MGG,Cigna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana,Humana,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana MGG,Humana MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Optum VA,Optum VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC,UHC,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC MGG,UHC MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,VA,VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Wellcare MGG,Wellcare MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health - commercial,Bright Health - commercial,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health MGG,Bright Health MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Aetna,Aetna,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Aetna MGG,Aetna MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,BCBS,BCBS,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,BCBS MGG,BCBS MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Cigna,Cigna,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Cigna MGG,Cigna MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Humana,Humana,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Humana MGG,Humana MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Optum VA,Optum VA,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,UHC,UHC,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,UHC MGG,UHC MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,VA,VA,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Wellcare MGG,Wellcare MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Bright Health - commercial,Bright Health - commercial,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG SUPPOS      ,92061212,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Bright Health MGG,Bright Health MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Aetna,Aetna,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Aetna MGG,Aetna MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,BCBS,BCBS,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,BCBS MGG,BCBS MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Cigna,Cigna,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Cigna MGG,Cigna MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Humana,Humana,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Humana MGG,Humana MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Optum VA,Optum VA,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,UHC,UHC,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,UHC MGG,UHC MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,VA,VA,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Wellcare MGG,Wellcare MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Bright Health - commercial,Bright Health - commercial,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,9.86,9.86,Bright Health MGG,Bright Health MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Aetna,Aetna,11.2,,,,,,,per diem,11.2,11.2,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Aetna MGG,Aetna MGG,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,BCBS,BCBS,11.2,,,,,,,per diem,11.2,11.2,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,BCBS MGG,BCBS MGG,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Cigna,Cigna,11.2,,,,,,,per diem,11.2,11.2,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Cigna MGG,Cigna MGG,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Humana,Humana,11.2,,,,,,,per diem,11.2,11.2,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Humana MGG,Humana MGG,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Optum VA,Optum VA,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,UHC,UHC,11.2,,,,,,,per diem,11.2,11.2,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,UHC MGG,UHC MGG,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,VA,VA,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Wellcare MGG,Wellcare MGG,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Bright Health - commercial,Bright Health - commercial,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92061579,CDM,250,RC,,,,,,Inpatient,1,EA,11.2,11.2,Bright Health MGG,Bright Health MGG,11.2,,,,,,,case rate,11.2,11.2,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THERA M PLUS TAB              ,92063235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN TR 500MG CAP       ,92063723,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Aetna,Aetna,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Aetna MGG,Aetna MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,BCBS,BCBS,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,BCBS MGG,BCBS MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Cigna,Cigna,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Cigna MGG,Cigna MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Humana,Humana,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Humana MGG,Humana MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Optum VA,Optum VA,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,UHC,UHC,63.23,,,,,,,per diem,63.23,63.23,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,UHC MGG,UHC MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,VA,VA,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Wellcare MGG,Wellcare MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Bright Health - commercial,Bright Health - commercial,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE-BETAMETH CREAM   ,92063824,CDM,250,RC,,,,,,Inpatient,1,EA,63.23,63.23,Bright Health MGG,Bright Health MGG,63.23,,,,,,,case rate,63.23,63.23,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Aetna,Aetna,90.76,,,,,,,per diem,90.76,90.76,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Aetna MGG,Aetna MGG,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,BCBS,BCBS,90.76,,,,,,,per diem,90.76,90.76,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,BCBS MGG,BCBS MGG,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Cigna,Cigna,90.76,,,,,,,per diem,90.76,90.76,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Cigna MGG,Cigna MGG,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Humana,Humana,90.76,,,,,,,per diem,90.76,90.76,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Humana MGG,Humana MGG,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Optum VA,Optum VA,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,UHC,UHC,90.76,,,,,,,per diem,90.76,90.76,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,UHC MGG,UHC MGG,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,VA,VA,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Wellcare MGG,Wellcare MGG,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Bright Health - commercial,Bright Health - commercial,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% SHAMPOO       ,92064421,CDM,250,RC,,,,,,Inpatient,1,EA,90.76,90.76,Bright Health MGG,Bright Health MGG,90.76,,,,,,,case rate,90.76,90.76,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92064679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Aetna,Aetna,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Aetna MGG,Aetna MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,BCBS,BCBS,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,BCBS MGG,BCBS MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Cigna,Cigna,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Cigna MGG,Cigna MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Humana,Humana,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Humana MGG,Humana MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Optum VA,Optum VA,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,UHC,UHC,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,UHC MGG,UHC MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,VA,VA,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Wellcare MGG,Wellcare MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Bright Health - commercial,Bright Health - commercial,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066302,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Bright Health MGG,Bright Health MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Aetna,Aetna,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Aetna MGG,Aetna MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,BCBS,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS MGG,BCBS MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Cigna,Cigna,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Cigna MGG,Cigna MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Humana,Humana,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Humana MGG,Humana MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Optum VA,Optum VA,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,UHC,UHC,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,UHC MGG,UHC MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,VA,VA,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Wellcare MGG,Wellcare MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Bright Health - commercial,Bright Health - commercial,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% EYE DROPS  ,92066304,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,Bright Health MGG,Bright Health MGG,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Aetna,Aetna,202.14,,,,,,,per diem,202.14,202.14,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Aetna MGG,Aetna MGG,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,BCBS,BCBS,202.14,,,,,,,per diem,202.14,202.14,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,BCBS MGG,BCBS MGG,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Cigna,Cigna,202.14,,,,,,,per diem,202.14,202.14,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Cigna MGG,Cigna MGG,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Humana,Humana,202.14,,,,,,,per diem,202.14,202.14,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Humana MGG,Humana MGG,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Optum VA,Optum VA,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,UHC,UHC,202.14,,,,,,,per diem,202.14,202.14,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,UHC MGG,UHC MGG,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,VA,VA,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Wellcare MGG,Wellcare MGG,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Bright Health - commercial,Bright Health - commercial,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% EYE DROP   ,92066366,CDM,250,RC,,,,,,Inpatient,1,EA,202.14,202.14,Bright Health MGG,Bright Health MGG,202.14,,,,,,,case rate,202.14,202.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Aetna,Aetna,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Aetna MGG,Aetna MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,BCBS,BCBS,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,BCBS MGG,BCBS MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Cigna,Cigna,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Cigna MGG,Cigna MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Humana,Humana,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Humana MGG,Humana MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Optum VA,Optum VA,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,UHC,UHC,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,UHC MGG,UHC MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,VA,VA,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Wellcare MGG,Wellcare MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Bright Health - commercial,Bright Health - commercial,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% CREAM     ,92066510,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Bright Health MGG,Bright Health MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Aetna,Aetna,42.03,,,,,,,per diem,42.03,42.03,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Aetna MGG,Aetna MGG,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,BCBS,BCBS,42.03,,,,,,,per diem,42.03,42.03,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,BCBS MGG,BCBS MGG,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Cigna,Cigna,42.03,,,,,,,per diem,42.03,42.03,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Cigna MGG,Cigna MGG,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Humana,Humana,42.03,,,,,,,per diem,42.03,42.03,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Humana MGG,Humana MGG,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Optum VA,Optum VA,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,UHC,UHC,42.03,,,,,,,per diem,42.03,42.03,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,UHC MGG,UHC MGG,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,VA,VA,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Wellcare MGG,Wellcare MGG,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Bright Health - commercial,Bright Health - commercial,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 150MG TAB         ,92066701,CDM,250,RC,,,,,,Inpatient,1,EA,42.03,42.03,Bright Health MGG,Bright Health MGG,42.03,,,,,,,case rate,42.03,42.03,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92067163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Aetna,Aetna,25.51,,,,,,,per diem,25.51,25.51,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Aetna MGG,Aetna MGG,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,BCBS,BCBS,25.51,,,,,,,per diem,25.51,25.51,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,BCBS MGG,BCBS MGG,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Cigna,Cigna,25.51,,,,,,,per diem,25.51,25.51,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Cigna MGG,Cigna MGG,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Humana,Humana,25.51,,,,,,,per diem,25.51,25.51,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Humana MGG,Humana MGG,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Optum VA,Optum VA,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,UHC,UHC,25.51,,,,,,,per diem,25.51,25.51,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,UHC MGG,UHC MGG,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,VA,VA,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Wellcare MGG,Wellcare MGG,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Bright Health - commercial,Bright Health - commercial,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.1MG/ML VL        ,92067257,CDM,250,RC,,,,,,Inpatient,1,EA,25.51,25.51,Bright Health MGG,Bright Health MGG,25.51,,,,,,,case rate,25.51,25.51,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92067408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Aetna,Aetna,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Aetna MGG,Aetna MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,BCBS,BCBS,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,BCBS MGG,BCBS MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Cigna,Cigna,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Cigna MGG,Cigna MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Humana,Humana,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Humana MGG,Humana MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Optum VA,Optum VA,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,UHC,UHC,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,UHC MGG,UHC MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,VA,VA,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Wellcare MGG,Wellcare MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Bright Health - commercial,Bright Health - commercial,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CILOSTAZOL 100MG TAB          ,92067485,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Bright Health MGG,Bright Health MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92067851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Aetna,Aetna,17.37,,,,,,,per diem,17.37,17.37,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Aetna MGG,Aetna MGG,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,BCBS,BCBS,17.37,,,,,,,per diem,17.37,17.37,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,BCBS MGG,BCBS MGG,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Cigna,Cigna,17.37,,,,,,,per diem,17.37,17.37,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Cigna MGG,Cigna MGG,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Humana,Humana,17.37,,,,,,,per diem,17.37,17.37,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Humana MGG,Humana MGG,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Optum VA,Optum VA,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,UHC,UHC,17.37,,,,,,,per diem,17.37,17.37,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,UHC MGG,UHC MGG,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,VA,VA,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Wellcare MGG,Wellcare MGG,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Bright Health - commercial,Bright Health - commercial,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CREAM      ,92067915,CDM,250,RC,,,,,,Inpatient,1,EA,17.37,17.37,Bright Health MGG,Bright Health MGG,17.37,,,,,,,case rate,17.37,17.37,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Aetna,Aetna,46.26,,,,,,,per diem,46.26,46.26,"Per diem rate, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Aetna MGG,Aetna MGG,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,BCBS,BCBS,46.26,,,,,,,per diem,46.26,46.26,"Per diem rate, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,BCBS MGG,BCBS MGG,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Cigna,Cigna,46.26,,,,,,,per diem,46.26,46.26,"Per diem rate, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Cigna MGG,Cigna MGG,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Humana,Humana,46.26,,,,,,,per diem,46.26,46.26,"Per diem rate, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Humana MGG,Humana MGG,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Optum VA,Optum VA,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,UHC,UHC,46.26,,,,,,,per diem,46.26,46.26,"Per diem rate, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,UHC MGG,UHC MGG,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,VA,VA,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Wellcare MGG,Wellcare MGG,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Bright Health - commercial,Bright Health - commercial,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VESICARE 5MG TAB              ,92067933,CDM,250,RC,,,,,,Inpatient,1,EA,46.26,46.26,Bright Health MGG,Bright Health MGG,46.26,,,,,,,case rate,46.26,46.26,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Aetna,Aetna,115.74,,,,,,,per diem,115.74,115.74,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Aetna MGG,Aetna MGG,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,BCBS,BCBS,115.74,,,,,,,per diem,115.74,115.74,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,BCBS MGG,BCBS MGG,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Cigna,Cigna,115.74,,,,,,,per diem,115.74,115.74,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Cigna MGG,Cigna MGG,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Humana,Humana,115.74,,,,,,,per diem,115.74,115.74,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Humana MGG,Humana MGG,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Optum VA,Optum VA,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,UHC,UHC,115.74,,,,,,,per diem,115.74,115.74,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,UHC MGG,UHC MGG,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,VA,VA,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Wellcare MGG,Wellcare MGG,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Bright Health - commercial,Bright Health - commercial,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068368,CDM,250,RC,,,,,,Inpatient,1,EA,115.74,115.74,Bright Health MGG,Bright Health MGG,115.74,,,,,,,case rate,115.74,115.74,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Aetna,Aetna,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Aetna MGG,Aetna MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,BCBS,BCBS,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,BCBS MGG,BCBS MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Cigna,Cigna,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Cigna MGG,Cigna MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Humana,Humana,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Humana MGG,Humana MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Optum VA,Optum VA,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,UHC,UHC,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,UHC MGG,UHC MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,VA,VA,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Wellcare MGG,Wellcare MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Bright Health - commercial,Bright Health - commercial,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92068404,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Bright Health MGG,Bright Health MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Aetna,Aetna,116.38,,,,,,,per diem,116.38,116.38,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Aetna MGG,Aetna MGG,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,BCBS,BCBS,116.38,,,,,,,per diem,116.38,116.38,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,BCBS MGG,BCBS MGG,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Cigna,Cigna,116.38,,,,,,,per diem,116.38,116.38,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Cigna MGG,Cigna MGG,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Humana,Humana,116.38,,,,,,,per diem,116.38,116.38,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Humana MGG,Humana MGG,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Optum VA,Optum VA,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,UHC,UHC,116.38,,,,,,,per diem,116.38,116.38,"Per diem rate, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,UHC MGG,UHC MGG,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,VA,VA,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Wellcare MGG,Wellcare MGG,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Bright Health - commercial,Bright Health - commercial,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
VERAPAMIL 2.5MG/ML VL         ,92068576,CDM,250,RC,,,,,,Inpatient,1,EA,116.38,116.38,Bright Health MGG,Bright Health MGG,116.38,,,,,,,case rate,116.38,116.38,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Aetna,Aetna,18.05,,,,,,,per diem,18.05,18.05,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Aetna MGG,Aetna MGG,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,BCBS,BCBS,18.05,,,,,,,per diem,18.05,18.05,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,BCBS MGG,BCBS MGG,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Cigna,Cigna,18.05,,,,,,,per diem,18.05,18.05,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Cigna MGG,Cigna MGG,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Humana,Humana,18.05,,,,,,,per diem,18.05,18.05,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Humana MGG,Humana MGG,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Optum VA,Optum VA,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,UHC,UHC,18.05,,,,,,,per diem,18.05,18.05,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,UHC MGG,UHC MGG,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,VA,VA,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Wellcare MGG,Wellcare MGG,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Bright Health - commercial,Bright Health - commercial,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92068819,CDM,250,RC,,,,,,Inpatient,1,EA,18.05,18.05,Bright Health MGG,Bright Health MGG,18.05,,,,,,,case rate,18.05,18.05,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Aetna,Aetna,10.88,,,,,,,per diem,10.88,10.88,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Aetna MGG,Aetna MGG,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,BCBS,BCBS,10.88,,,,,,,per diem,10.88,10.88,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,BCBS MGG,BCBS MGG,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Cigna,Cigna,10.88,,,,,,,per diem,10.88,10.88,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Cigna MGG,Cigna MGG,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Humana,Humana,10.88,,,,,,,per diem,10.88,10.88,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Humana MGG,Humana MGG,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Optum VA,Optum VA,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,UHC,UHC,10.88,,,,,,,per diem,10.88,10.88,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,UHC MGG,UHC MGG,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,VA,VA,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Wellcare MGG,Wellcare MGG,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Bright Health - commercial,Bright Health - commercial,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 40MG CAP       ,92068943,CDM,250,RC,,,,,,Inpatient,1,EA,10.88,10.88,Bright Health MGG,Bright Health MGG,10.88,,,,,,,case rate,10.88,10.88,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Aetna,Aetna,6.95,,,,,,,per diem,6.95,6.95,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Aetna MGG,Aetna MGG,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,BCBS,BCBS,6.95,,,,,,,per diem,6.95,6.95,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,BCBS MGG,BCBS MGG,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Cigna,Cigna,6.95,,,,,,,per diem,6.95,6.95,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Cigna MGG,Cigna MGG,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Humana,Humana,6.95,,,,,,,per diem,6.95,6.95,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Humana MGG,Humana MGG,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Optum VA,Optum VA,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,UHC,UHC,6.95,,,,,,,per diem,6.95,6.95,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,UHC MGG,UHC MGG,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,VA,VA,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Wellcare MGG,Wellcare MGG,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Bright Health - commercial,Bright Health - commercial,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92068972,CDM,250,RC,,,,,,Inpatient,1,EA,6.95,6.95,Bright Health MGG,Bright Health MGG,6.95,,,,,,,case rate,6.95,6.95,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Aetna,Aetna,5.35,,,,,,,per diem,5.35,5.35,"Per diem rate, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Aetna MGG,Aetna MGG,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,BCBS,BCBS,5.35,,,,,,,per diem,5.35,5.35,"Per diem rate, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,BCBS MGG,BCBS MGG,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Cigna,Cigna,5.35,,,,,,,per diem,5.35,5.35,"Per diem rate, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Cigna MGG,Cigna MGG,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Humana,Humana,5.35,,,,,,,per diem,5.35,5.35,"Per diem rate, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Humana MGG,Humana MGG,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Optum VA,Optum VA,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,UHC,UHC,5.35,,,,,,,per diem,5.35,5.35,"Per diem rate, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,UHC MGG,UHC MGG,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,VA,VA,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Wellcare MGG,Wellcare MGG,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Bright Health - commercial,Bright Health - commercial,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
BETHANECHOL 25MG TAB          ,92069514,CDM,250,RC,,,,,,Inpatient,1,EA,5.35,5.35,Bright Health MGG,Bright Health MGG,5.35,,,,,,,case rate,5.35,5.35,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Aetna,Aetna,15.86,,,,,,,per diem,15.86,15.86,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Aetna MGG,Aetna MGG,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,BCBS,BCBS,15.86,,,,,,,per diem,15.86,15.86,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,BCBS MGG,BCBS MGG,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Cigna,Cigna,15.86,,,,,,,per diem,15.86,15.86,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Cigna MGG,Cigna MGG,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Humana,Humana,15.86,,,,,,,per diem,15.86,15.86,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Humana MGG,Humana MGG,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Optum VA,Optum VA,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,UHC,UHC,15.86,,,,,,,per diem,15.86,15.86,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,UHC MGG,UHC MGG,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,VA,VA,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Wellcare MGG,Wellcare MGG,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Bright Health - commercial,Bright Health - commercial,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 0.1MG TAB   ,92069732,CDM,250,RC,,,,,,Inpatient,1,EA,15.86,15.86,Bright Health MGG,Bright Health MGG,15.86,,,,,,,case rate,15.86,15.86,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Aetna,Aetna,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Aetna MGG,Aetna MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,BCBS,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS MGG,BCBS MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Cigna,Cigna,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Cigna MGG,Cigna MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Humana,Humana,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Humana MGG,Humana MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Optum VA,Optum VA,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,UHC,UHC,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,UHC MGG,UHC MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,VA,VA,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Wellcare MGG,Wellcare MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Bright Health - commercial,Bright Health - commercial,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TAB ER     ,92069980,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,Bright Health MGG,Bright Health MGG,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Aetna,Aetna,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Aetna MGG,Aetna MGG,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,BCBS,BCBS,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,BCBS MGG,BCBS MGG,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Cigna,Cigna,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Cigna MGG,Cigna MGG,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Humana,Humana,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Humana MGG,Humana MGG,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Optum VA,Optum VA,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,UHC,UHC,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,UHC MGG,UHC MGG,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,VA,VA,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Wellcare MGG,Wellcare MGG,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Bright Health - commercial,Bright Health - commercial,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML SYRINGE       ,92070139,CDM,250,RC,,,,,,Inpatient,1,EA,10.33,10.33,Bright Health MGG,Bright Health MGG,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Aetna,Aetna,72.18,,,,,,,per diem,72.18,72.18,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Aetna MGG,Aetna MGG,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,BCBS,BCBS,72.18,,,,,,,per diem,72.18,72.18,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,BCBS MGG,BCBS MGG,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Cigna,Cigna,72.18,,,,,,,per diem,72.18,72.18,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Cigna MGG,Cigna MGG,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Humana,Humana,72.18,,,,,,,per diem,72.18,72.18,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Humana MGG,Humana MGG,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Optum VA,Optum VA,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,UHC,UHC,72.18,,,,,,,per diem,72.18,72.18,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,UHC MGG,UHC MGG,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,VA,VA,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Wellcare MGG,Wellcare MGG,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Bright Health - commercial,Bright Health - commercial,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML VL          ,92070158,CDM,250,RC,,,,,,Inpatient,1,EA,72.18,72.18,Bright Health MGG,Bright Health MGG,72.18,,,,,,,case rate,72.18,72.18,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Aetna,Aetna,49.22,,,,,,,per diem,49.22,49.22,"Per diem rate, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Aetna MGG,Aetna MGG,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,BCBS,BCBS,49.22,,,,,,,per diem,49.22,49.22,"Per diem rate, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,BCBS MGG,BCBS MGG,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Cigna,Cigna,49.22,,,,,,,per diem,49.22,49.22,"Per diem rate, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Cigna MGG,Cigna MGG,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Humana,Humana,49.22,,,,,,,per diem,49.22,49.22,"Per diem rate, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Humana MGG,Humana MGG,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Optum VA,Optum VA,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,UHC,UHC,49.22,,,,,,,per diem,49.22,49.22,"Per diem rate, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,UHC MGG,UHC MGG,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,VA,VA,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Wellcare MGG,Wellcare MGG,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Bright Health - commercial,Bright Health - commercial,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEFLUNOMIDE 10MG TAB          ,92070848,CDM,250,RC,,,,,,Inpatient,1,EA,49.22,49.22,Bright Health MGG,Bright Health MGG,49.22,,,,,,,case rate,49.22,49.22,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM 500+D TAB             ,92072007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92072243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Aetna,Aetna,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Aetna MGG,Aetna MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,BCBS,BCBS,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,BCBS MGG,BCBS MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Cigna,Cigna,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Cigna MGG,Cigna MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Humana,Humana,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Humana MGG,Humana MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Optum VA,Optum VA,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,UHC,UHC,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,UHC MGG,UHC MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,VA,VA,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Wellcare MGG,Wellcare MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Bright Health - commercial,Bright Health - commercial,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/ML SUSP    ",92073668,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Bright Health MGG,Bright Health MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Aetna,Aetna,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Aetna MGG,Aetna MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,BCBS,BCBS,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,BCBS MGG,BCBS MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Cigna,Cigna,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Cigna MGG,Cigna MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Humana,Humana,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Humana MGG,Humana MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Optum VA,Optum VA,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,UHC,UHC,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,UHC MGG,UHC MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,VA,VA,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Wellcare MGG,Wellcare MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Bright Health - commercial,Bright Health - commercial,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92073940,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Bright Health MGG,Bright Health MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Aetna,Aetna,218.43,,,,,,,per diem,218.43,218.43,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Aetna MGG,Aetna MGG,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,BCBS,BCBS,218.43,,,,,,,per diem,218.43,218.43,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,BCBS MGG,BCBS MGG,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Cigna,Cigna,218.43,,,,,,,per diem,218.43,218.43,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Cigna MGG,Cigna MGG,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Humana,Humana,218.43,,,,,,,per diem,218.43,218.43,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Humana MGG,Humana MGG,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Optum VA,Optum VA,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,UHC,UHC,218.43,,,,,,,per diem,218.43,218.43,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,UHC MGG,UHC MGG,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,VA,VA,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Wellcare MGG,Wellcare MGG,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Bright Health - commercial,Bright Health - commercial,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE .77% CREAM ,92075458,CDM,250,RC,,,,,,Inpatient,1,EA,218.43,218.43,Bright Health MGG,Bright Health MGG,218.43,,,,,,,case rate,218.43,218.43,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Aetna,Aetna,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Aetna MGG,Aetna MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,BCBS,BCBS,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,BCBS MGG,BCBS MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Cigna,Cigna,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Cigna MGG,Cigna MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Humana,Humana,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Humana MGG,Humana MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Optum VA,Optum VA,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,UHC,UHC,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,UHC MGG,UHC MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,VA,VA,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Wellcare MGG,Wellcare MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Bright Health - commercial,Bright Health - commercial,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
GABAPENTIN 600MG TAB          ,92075615,CDM,250,RC,,,,,,Inpatient,1,EA,7.27,7.27,Bright Health MGG,Bright Health MGG,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92075706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Aetna,Aetna,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Aetna MGG,Aetna MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,BCBS,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS MGG,BCBS MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Cigna,Cigna,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Cigna MGG,Cigna MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Humana,Humana,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Humana MGG,Humana MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Optum VA,Optum VA,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UHC,UHC,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UHC MGG,UHC MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,VA,VA,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Wellcare MGG,Wellcare MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Bright Health - commercial,Bright Health - commercial,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
GLIPIZIDE ER 2.5MG TAB        ,92077585,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Bright Health MGG,Bright Health MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Aetna,Aetna,9.38,,,,,,,per diem,9.38,9.38,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Aetna MGG,Aetna MGG,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,BCBS,BCBS,9.38,,,,,,,per diem,9.38,9.38,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,BCBS MGG,BCBS MGG,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Cigna,Cigna,9.38,,,,,,,per diem,9.38,9.38,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Cigna MGG,Cigna MGG,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Humana,Humana,9.38,,,,,,,per diem,9.38,9.38,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Humana MGG,Humana MGG,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Optum VA,Optum VA,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,UHC,UHC,9.38,,,,,,,per diem,9.38,9.38,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,UHC MGG,UHC MGG,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,VA,VA,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Wellcare MGG,Wellcare MGG,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Bright Health - commercial,Bright Health - commercial,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,9.38,9.38,Bright Health MGG,Bright Health MGG,9.38,,,,,,,case rate,9.38,9.38,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Aetna,Aetna,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Aetna MGG,Aetna MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,BCBS,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS MGG,BCBS MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Cigna,Cigna,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Cigna MGG,Cigna MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Humana,Humana,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Humana MGG,Humana MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Optum VA,Optum VA,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UHC,UHC,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UHC MGG,UHC MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,VA,VA,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Wellcare MGG,Wellcare MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Bright Health - commercial,Bright Health - commercial,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR PATCH      ,92078107,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Bright Health MGG,Bright Health MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna,Aetna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna MGG,Aetna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,BCBS,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS MGG,BCBS MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna,Cigna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna MGG,Cigna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana,Humana,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana MGG,Humana MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Optum VA,Optum VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC,UHC,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC MGG,UHC MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,VA,VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Wellcare MGG,Wellcare MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health - commercial,Bright Health - commercial,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92078353,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health MGG,Bright Health MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Aetna,Aetna,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Aetna MGG,Aetna MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,BCBS,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS MGG,BCBS MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Cigna,Cigna,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Cigna MGG,Cigna MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Humana,Humana,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Humana MGG,Humana MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Optum VA,Optum VA,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UHC,UHC,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UHC MGG,UHC MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,VA,VA,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Wellcare MGG,Wellcare MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Bright Health - commercial,Bright Health - commercial,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24HR PATCH       ,92078406,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Bright Health MGG,Bright Health MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92078636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Aetna,Aetna,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Aetna MGG,Aetna MGG,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,BCBS,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS MGG,BCBS MGG,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Cigna,Cigna,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Cigna MGG,Cigna MGG,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Humana,Humana,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Humana MGG,Humana MGG,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Optum VA,Optum VA,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UHC,UHC,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UHC MGG,UHC MGG,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,VA,VA,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Wellcare MGG,Wellcare MGG,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Bright Health - commercial,Bright Health - commercial,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92078767,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,Bright Health MGG,Bright Health MGG,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92078914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92079304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Aetna,Aetna,39.07,,,,,,,per diem,39.07,39.07,"Per diem rate, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Aetna MGG,Aetna MGG,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,BCBS,BCBS,39.07,,,,,,,per diem,39.07,39.07,"Per diem rate, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,BCBS MGG,BCBS MGG,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Cigna,Cigna,39.07,,,,,,,per diem,39.07,39.07,"Per diem rate, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Cigna MGG,Cigna MGG,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Humana,Humana,39.07,,,,,,,per diem,39.07,39.07,"Per diem rate, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Humana MGG,Humana MGG,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Optum VA,Optum VA,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,UHC,UHC,39.07,,,,,,,per diem,39.07,39.07,"Per diem rate, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,UHC MGG,UHC MGG,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,VA,VA,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Wellcare MGG,Wellcare MGG,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Bright Health - commercial,Bright Health - commercial,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
TERBINAFINE HCL 250MG TAB     ,92080587,CDM,250,RC,,,,,,Inpatient,1,EA,39.07,39.07,Bright Health MGG,Bright Health MGG,39.07,,,,,,,case rate,39.07,39.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92080783,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92080784,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92081155,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Aetna,Aetna,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Aetna MGG,Aetna MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,BCBS,BCBS,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,BCBS MGG,BCBS MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Cigna,Cigna,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Cigna MGG,Cigna MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Humana,Humana,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Humana MGG,Humana MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Optum VA,Optum VA,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,UHC,UHC,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,UHC MGG,UHC MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,VA,VA,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Wellcare MGG,Wellcare MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Bright Health - commercial,Bright Health - commercial,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 250MG TAB         ,92081710,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Bright Health MGG,Bright Health MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Aetna,Aetna,26.77,,,,,,,per diem,26.77,26.77,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Aetna MGG,Aetna MGG,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,BCBS,BCBS,26.77,,,,,,,per diem,26.77,26.77,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,BCBS MGG,BCBS MGG,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Cigna,Cigna,26.77,,,,,,,per diem,26.77,26.77,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Cigna MGG,Cigna MGG,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Humana,Humana,26.77,,,,,,,per diem,26.77,26.77,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Humana MGG,Humana MGG,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Optum VA,Optum VA,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,UHC,UHC,26.77,,,,,,,per diem,26.77,26.77,"Per diem rate, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,UHC MGG,UHC MGG,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,VA,VA,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Wellcare MGG,Wellcare MGG,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Bright Health - commercial,Bright Health - commercial,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FAMCICLOVIR 500MG TAB         ,92081711,CDM,250,RC,,,,,,Inpatient,1,EA,26.77,26.77,Bright Health MGG,Bright Health MGG,26.77,,,,,,,case rate,26.77,26.77,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Aetna,Aetna,160.08,,,,,,,per diem,160.08,160.08,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Aetna MGG,Aetna MGG,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,BCBS,BCBS,160.08,,,,,,,per diem,160.08,160.08,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,BCBS MGG,BCBS MGG,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Cigna,Cigna,160.08,,,,,,,per diem,160.08,160.08,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Cigna MGG,Cigna MGG,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Humana,Humana,160.08,,,,,,,per diem,160.08,160.08,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Humana MGG,Humana MGG,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Optum VA,Optum VA,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,UHC,UHC,160.08,,,,,,,per diem,160.08,160.08,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,UHC MGG,UHC MGG,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,VA,VA,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Wellcare MGG,Wellcare MGG,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Bright Health - commercial,Bright Health - commercial,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92081727,CDM,250,RC,,,,,,Inpatient,1,EA,160.08,160.08,Bright Health MGG,Bright Health MGG,160.08,,,,,,,case rate,160.08,160.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Aetna,Aetna,79.08,,,,,,,per diem,79.08,79.08,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Aetna MGG,Aetna MGG,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,BCBS,BCBS,79.08,,,,,,,per diem,79.08,79.08,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,BCBS MGG,BCBS MGG,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Cigna,Cigna,79.08,,,,,,,per diem,79.08,79.08,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Cigna MGG,Cigna MGG,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Humana,Humana,79.08,,,,,,,per diem,79.08,79.08,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Humana MGG,Humana MGG,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Optum VA,Optum VA,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,UHC,UHC,79.08,,,,,,,per diem,79.08,79.08,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,UHC MGG,UHC MGG,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,VA,VA,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Wellcare MGG,Wellcare MGG,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Bright Health - commercial,Bright Health - commercial,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92081731,CDM,250,RC,,,,,,Inpatient,1,EA,79.08,79.08,Bright Health MGG,Bright Health MGG,79.08,,,,,,,case rate,79.08,79.08,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OINT       ,92083061,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Aetna,Aetna,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Aetna MGG,Aetna MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,BCBS,BCBS,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,BCBS MGG,BCBS MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Cigna,Cigna,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Cigna MGG,Cigna MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Humana,Humana,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Humana MGG,Humana MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Optum VA,Optum VA,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,UHC,UHC,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,UHC MGG,UHC MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,VA,VA,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Wellcare MGG,Wellcare MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Bright Health - commercial,Bright Health - commercial,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
BYSTOLIC 5MG TAB              ,92085528,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Bright Health MGG,Bright Health MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC ER 50MG TAB   ,92085997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Aetna,Aetna,15.32,,,,,,,per diem,15.32,15.32,"Per diem rate, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Aetna MGG,Aetna MGG,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,BCBS,BCBS,15.32,,,,,,,per diem,15.32,15.32,"Per diem rate, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,BCBS MGG,BCBS MGG,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Cigna,Cigna,15.32,,,,,,,per diem,15.32,15.32,"Per diem rate, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Cigna MGG,Cigna MGG,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Humana,Humana,15.32,,,,,,,per diem,15.32,15.32,"Per diem rate, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Humana MGG,Humana MGG,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Optum VA,Optum VA,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,UHC,UHC,15.32,,,,,,,per diem,15.32,15.32,"Per diem rate, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,UHC MGG,UHC MGG,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,VA,VA,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Wellcare MGG,Wellcare MGG,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Bright Health - commercial,Bright Health - commercial,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CEFDINIR 300MG CAP            ,92086263,CDM,250,RC,,,,,,Inpatient,1,EA,15.32,15.32,Bright Health MGG,Bright Health MGG,15.32,,,,,,,case rate,15.32,15.32,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Aetna,Aetna,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Aetna MGG,Aetna MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,BCBS,BCBS,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,BCBS MGG,BCBS MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Cigna,Cigna,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Cigna MGG,Cigna MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Humana,Humana,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Humana MGG,Humana MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Optum VA,Optum VA,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,UHC,UHC,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,UHC MGG,UHC MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,VA,VA,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Wellcare MGG,Wellcare MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Bright Health - commercial,Bright Health - commercial,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML     ,92089319,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Bright Health MGG,Bright Health MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Aetna,Aetna,56.12,,,,,,,per diem,56.12,56.12,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Aetna MGG,Aetna MGG,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,BCBS,BCBS,56.12,,,,,,,per diem,56.12,56.12,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,BCBS MGG,BCBS MGG,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Cigna,Cigna,56.12,,,,,,,per diem,56.12,56.12,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Cigna MGG,Cigna MGG,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Humana,Humana,56.12,,,,,,,per diem,56.12,56.12,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Humana MGG,Humana MGG,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Optum VA,Optum VA,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,UHC,UHC,56.12,,,,,,,per diem,56.12,56.12,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,UHC MGG,UHC MGG,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,VA,VA,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Wellcare MGG,Wellcare MGG,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Bright Health - commercial,Bright Health - commercial,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,56.12,56.12,Bright Health MGG,Bright Health MGG,56.12,,,,,,,case rate,56.12,56.12,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Aetna,Aetna,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Aetna MGG,Aetna MGG,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,BCBS,BCBS,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,BCBS MGG,BCBS MGG,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Cigna,Cigna,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Cigna MGG,Cigna MGG,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Humana,Humana,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Humana MGG,Humana MGG,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Optum VA,Optum VA,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,UHC,UHC,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,UHC MGG,UHC MGG,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,VA,VA,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Wellcare MGG,Wellcare MGG,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Bright Health - commercial,Bright Health - commercial,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,000 CAP EC    ",92091496,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,Bright Health MGG,Bright Health MGG,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Aetna,Aetna,522.51,,,,,,,per diem,522.51,522.51,"Per diem rate, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Aetna MGG,Aetna MGG,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,BCBS,BCBS,522.51,,,,,,,per diem,522.51,522.51,"Per diem rate, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,BCBS MGG,BCBS MGG,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Cigna,Cigna,522.51,,,,,,,per diem,522.51,522.51,"Per diem rate, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Cigna MGG,Cigna MGG,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Humana,Humana,522.51,,,,,,,per diem,522.51,522.51,"Per diem rate, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Humana MGG,Humana MGG,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Optum VA,Optum VA,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,UHC,UHC,522.51,,,,,,,per diem,522.51,522.51,"Per diem rate, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,UHC MGG,UHC MGG,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,VA,VA,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Wellcare MGG,Wellcare MGG,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Bright Health - commercial,Bright Health - commercial,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
RELISTOR 12MG/0.6ML VL        ,92091561,CDM,250,RC,,,,,,Inpatient,1,EA,522.51,522.51,Bright Health MGG,Bright Health MGG,522.51,,,,,,,case rate,522.51,522.51,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Aetna,Aetna,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Aetna MGG,Aetna MGG,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,BCBS,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS MGG,BCBS MGG,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Cigna,Cigna,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Cigna MGG,Cigna MGG,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Humana,Humana,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Humana MGG,Humana MGG,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Optum VA,Optum VA,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,UHC,UHC,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,UHC MGG,UHC MGG,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,VA,VA,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Wellcare MGG,Wellcare MGG,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Bright Health - commercial,Bright Health - commercial,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092854,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,Bright Health MGG,Bright Health MGG,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna,Aetna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna MGG,Aetna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,BCBS,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS MGG,BCBS MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna,Cigna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna MGG,Cigna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana,Humana,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana MGG,Humana MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Optum VA,Optum VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC,UHC,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC MGG,UHC MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,VA,VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Wellcare MGG,Wellcare MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health - commercial,Bright Health - commercial,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health MGG,Bright Health MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Aetna,Aetna,19.52,,,,,,,per diem,19.52,19.52,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Aetna MGG,Aetna MGG,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,BCBS,BCBS,19.52,,,,,,,per diem,19.52,19.52,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,BCBS MGG,BCBS MGG,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Cigna,Cigna,19.52,,,,,,,per diem,19.52,19.52,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Cigna MGG,Cigna MGG,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Humana,Humana,19.52,,,,,,,per diem,19.52,19.52,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Humana MGG,Humana MGG,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Optum VA,Optum VA,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,UHC,UHC,19.52,,,,,,,per diem,19.52,19.52,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,UHC MGG,UHC MGG,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,VA,VA,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Wellcare MGG,Wellcare MGG,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Bright Health - commercial,Bright Health - commercial,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92093047,CDM,250,RC,,,,,,Inpatient,1,EA,19.52,19.52,Bright Health MGG,Bright Health MGG,19.52,,,,,,,case rate,19.52,19.52,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Aetna,Aetna,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Aetna MGG,Aetna MGG,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,BCBS,BCBS,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,BCBS MGG,BCBS MGG,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Cigna,Cigna,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Cigna MGG,Cigna MGG,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Humana,Humana,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Humana MGG,Humana MGG,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Optum VA,Optum VA,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,UHC,UHC,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,UHC MGG,UHC MGG,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,VA,VA,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Wellcare MGG,Wellcare MGG,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Bright Health - commercial,Bright Health - commercial,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,19.64,19.64,Bright Health MGG,Bright Health MGG,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Aetna,Aetna,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Aetna MGG,Aetna MGG,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,BCBS,BCBS,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,BCBS MGG,BCBS MGG,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Cigna,Cigna,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Cigna MGG,Cigna MGG,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Humana,Humana,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Humana MGG,Humana MGG,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Optum VA,Optum VA,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,UHC,UHC,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,UHC MGG,UHC MGG,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,VA,VA,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Wellcare MGG,Wellcare MGG,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Bright Health - commercial,Bright Health - commercial,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5MG TAB         ,92093307,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,Bright Health MGG,Bright Health MGG,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Aetna,Aetna,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Aetna MGG,Aetna MGG,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,BCBS,BCBS,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,BCBS MGG,BCBS MGG,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Cigna,Cigna,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Cigna MGG,Cigna MGG,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Humana,Humana,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Humana MGG,Humana MGG,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Optum VA,Optum VA,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,UHC,UHC,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,UHC MGG,UHC MGG,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,VA,VA,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Wellcare MGG,Wellcare MGG,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Bright Health - commercial,Bright Health - commercial,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92093316,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,Bright Health MGG,Bright Health MGG,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG CAP         ,92093565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Aetna,Aetna,13.02,,,,,,,per diem,13.02,13.02,"Per diem rate, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Aetna MGG,Aetna MGG,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,BCBS,BCBS,13.02,,,,,,,per diem,13.02,13.02,"Per diem rate, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,BCBS MGG,BCBS MGG,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Cigna,Cigna,13.02,,,,,,,per diem,13.02,13.02,"Per diem rate, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Cigna MGG,Cigna MGG,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Humana,Humana,13.02,,,,,,,per diem,13.02,13.02,"Per diem rate, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Humana MGG,Humana MGG,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Optum VA,Optum VA,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,UHC,UHC,13.02,,,,,,,per diem,13.02,13.02,"Per diem rate, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,UHC MGG,UHC MGG,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,VA,VA,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Wellcare MGG,Wellcare MGG,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Bright Health - commercial,Bright Health - commercial,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
EPLERENONE 25MG TAB           ,92093733,CDM,250,RC,,,,,,Inpatient,1,EA,13.02,13.02,Bright Health MGG,Bright Health MGG,13.02,,,,,,,case rate,13.02,13.02,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Aetna,Aetna,9.55,,,,,,,per diem,9.55,9.55,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Aetna MGG,Aetna MGG,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,BCBS,BCBS,9.55,,,,,,,per diem,9.55,9.55,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,BCBS MGG,BCBS MGG,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Cigna,Cigna,9.55,,,,,,,per diem,9.55,9.55,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Cigna MGG,Cigna MGG,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Humana,Humana,9.55,,,,,,,per diem,9.55,9.55,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Humana MGG,Humana MGG,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Optum VA,Optum VA,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,UHC,UHC,9.55,,,,,,,per diem,9.55,9.55,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,UHC MGG,UHC MGG,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,VA,VA,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Wellcare MGG,Wellcare MGG,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Bright Health - commercial,Bright Health - commercial,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093778,CDM,250,RC,,,,,,Inpatient,1,EA,9.55,9.55,Bright Health MGG,Bright Health MGG,9.55,,,,,,,case rate,9.55,9.55,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Aetna,Aetna,45.5,,,,,,,per diem,45.5,45.5,"Per diem rate, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Aetna MGG,Aetna MGG,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,BCBS,BCBS,45.5,,,,,,,per diem,45.5,45.5,"Per diem rate, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,BCBS MGG,BCBS MGG,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Cigna,Cigna,45.5,,,,,,,per diem,45.5,45.5,"Per diem rate, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Cigna MGG,Cigna MGG,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Humana,Humana,45.5,,,,,,,per diem,45.5,45.5,"Per diem rate, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Humana MGG,Humana MGG,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Optum VA,Optum VA,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,UHC,UHC,45.5,,,,,,,per diem,45.5,45.5,"Per diem rate, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,UHC MGG,UHC MGG,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,VA,VA,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Wellcare MGG,Wellcare MGG,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Bright Health - commercial,Bright Health - commercial,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
TERBINAFINE 1% CREAM          ,92094132,CDM,250,RC,,,,,,Inpatient,1,EA,45.5,45.5,Bright Health MGG,Bright Health MGG,45.5,,,,,,,case rate,45.5,45.5,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Aetna,Aetna,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Aetna MGG,Aetna MGG,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,BCBS,BCBS,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,BCBS MGG,BCBS MGG,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Cigna,Cigna,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Cigna MGG,Cigna MGG,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Humana,Humana,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Humana MGG,Humana MGG,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Optum VA,Optum VA,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,UHC,UHC,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,UHC MGG,UHC MGG,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,VA,VA,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Wellcare MGG,Wellcare MGG,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Bright Health - commercial,Bright Health - commercial,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,Bright Health MGG,Bright Health MGG,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Aetna,Aetna,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Aetna MGG,Aetna MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,BCBS,BCBS,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,BCBS MGG,BCBS MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Cigna,Cigna,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Cigna MGG,Cigna MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Humana,Humana,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Humana MGG,Humana MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Optum VA,Optum VA,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,UHC,UHC,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,UHC MGG,UHC MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,VA,VA,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Wellcare MGG,Wellcare MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Bright Health - commercial,Bright Health - commercial,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% EYE DROPS  ,92094966,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Bright Health MGG,Bright Health MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Aetna,Aetna,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Aetna MGG,Aetna MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,BCBS,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS MGG,BCBS MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Cigna,Cigna,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Cigna MGG,Cigna MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Humana,Humana,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Humana MGG,Humana MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Optum VA,Optum VA,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,UHC,UHC,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,UHC MGG,UHC MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,VA,VA,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Wellcare MGG,Wellcare MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Bright Health - commercial,Bright Health - commercial,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Bright Health MGG,Bright Health MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Aetna,Aetna,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Aetna MGG,Aetna MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,BCBS,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS MGG,BCBS MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Cigna,Cigna,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Cigna MGG,Cigna MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Humana,Humana,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Humana MGG,Humana MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Optum VA,Optum VA,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,UHC,UHC,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,UHC MGG,UHC MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,VA,VA,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Wellcare MGG,Wellcare MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Bright Health - commercial,Bright Health - commercial,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.25MG TAB        ,92095523,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Bright Health MGG,Bright Health MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Aetna,Aetna,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Aetna MGG,Aetna MGG,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,BCBS,BCBS,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,BCBS MGG,BCBS MGG,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Cigna,Cigna,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Cigna MGG,Cigna MGG,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Humana,Humana,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Humana MGG,Humana MGG,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Optum VA,Optum VA,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,UHC,UHC,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,UHC MGG,UHC MGG,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,VA,VA,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Wellcare MGG,Wellcare MGG,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Bright Health - commercial,Bright Health - commercial,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
SUMATRIPTAN 6MG/0.5ML VL      ,92095572,CDM,250,RC,,,,,,Inpatient,1,EA,183.75,183.75,Bright Health MGG,Bright Health MGG,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE POLACRILEX 4MG GUM   ,92096389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Aetna,Aetna,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Aetna MGG,Aetna MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,BCBS,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS MGG,BCBS MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Cigna,Cigna,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Cigna MGG,Cigna MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Humana,Humana,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Humana MGG,Humana MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Optum VA,Optum VA,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,UHC,UHC,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,UHC MGG,UHC MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,VA,VA,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Wellcare MGG,Wellcare MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Bright Health - commercial,Bright Health - commercial,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92096536,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Bright Health MGG,Bright Health MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92096571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Aetna,Aetna,42.08,,,,,,,per diem,42.08,42.08,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Aetna MGG,Aetna MGG,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,BCBS,BCBS,42.08,,,,,,,per diem,42.08,42.08,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,BCBS MGG,BCBS MGG,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Cigna,Cigna,42.08,,,,,,,per diem,42.08,42.08,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Cigna MGG,Cigna MGG,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Humana,Humana,42.08,,,,,,,per diem,42.08,42.08,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Humana MGG,Humana MGG,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Optum VA,Optum VA,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,UHC,UHC,42.08,,,,,,,per diem,42.08,42.08,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,UHC MGG,UHC MGG,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,VA,VA,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Wellcare MGG,Wellcare MGG,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Bright Health - commercial,Bright Health - commercial,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096595,CDM,250,RC,,,,,,Inpatient,1,EA,42.08,42.08,Bright Health MGG,Bright Health MGG,42.08,,,,,,,case rate,42.08,42.08,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92096597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Aetna,Aetna,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Aetna MGG,Aetna MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,BCBS,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS MGG,BCBS MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Cigna,Cigna,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Cigna MGG,Cigna MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Humana,Humana,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Humana MGG,Humana MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Optum VA,Optum VA,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UHC,UHC,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UHC MGG,UHC MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,VA,VA,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Wellcare MGG,Wellcare MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Bright Health - commercial,Bright Health - commercial,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 100MG/ML SOL    ,92096650,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Bright Health MGG,Bright Health MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Aetna,Aetna,355.62,,,,,,,per diem,355.62,355.62,"Per diem rate, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Aetna MGG,Aetna MGG,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,BCBS,BCBS,355.62,,,,,,,per diem,355.62,355.62,"Per diem rate, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,BCBS MGG,BCBS MGG,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Cigna,Cigna,355.62,,,,,,,per diem,355.62,355.62,"Per diem rate, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Cigna MGG,Cigna MGG,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Humana,Humana,355.62,,,,,,,per diem,355.62,355.62,"Per diem rate, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Humana MGG,Humana MGG,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Optum VA,Optum VA,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,UHC,UHC,355.62,,,,,,,per diem,355.62,355.62,"Per diem rate, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,UHC MGG,UHC MGG,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,VA,VA,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Wellcare MGG,Wellcare MGG,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Bright Health - commercial,Bright Health - commercial,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
CALCITONIN-SALMON 200 UNITS SP,92097067,CDM,250,RC,,,,,,Inpatient,1,EA,355.62,355.62,Bright Health MGG,Bright Health MGG,355.62,,,,,,,case rate,355.62,355.62,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Aetna,Aetna,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Aetna MGG,Aetna MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,BCBS,BCBS,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,BCBS MGG,BCBS MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Cigna,Cigna,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Cigna MGG,Cigna MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Humana,Humana,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Humana MGG,Humana MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Optum VA,Optum VA,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,UHC,UHC,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,UHC MGG,UHC MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,VA,VA,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Wellcare MGG,Wellcare MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Bright Health - commercial,Bright Health - commercial,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL 80MG CAP ER       ,92097533,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Bright Health MGG,Bright Health MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Aetna,Aetna,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Aetna MGG,Aetna MGG,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,BCBS,BCBS,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,BCBS MGG,BCBS MGG,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Cigna,Cigna,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Cigna MGG,Cigna MGG,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Humana,Humana,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Humana MGG,Humana MGG,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Optum VA,Optum VA,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,UHC,UHC,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,UHC MGG,UHC MGG,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,VA,VA,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Wellcare MGG,Wellcare MGG,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Bright Health - commercial,Bright Health - commercial,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
CEFPODOXIME 100MG TABLET      ,92097831,CDM,250,RC,,,,,,Inpatient,1,EA,20.21,20.21,Bright Health MGG,Bright Health MGG,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92101311,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92101770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Aetna,Aetna,5.05,,,,,,,per diem,5.05,5.05,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Aetna MGG,Aetna MGG,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,BCBS,BCBS,5.05,,,,,,,per diem,5.05,5.05,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,BCBS MGG,BCBS MGG,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Cigna,Cigna,5.05,,,,,,,per diem,5.05,5.05,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Cigna MGG,Cigna MGG,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Humana,Humana,5.05,,,,,,,per diem,5.05,5.05,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Humana MGG,Humana MGG,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Optum VA,Optum VA,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,UHC,UHC,5.05,,,,,,,per diem,5.05,5.05,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,UHC MGG,UHC MGG,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,VA,VA,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Wellcare MGG,Wellcare MGG,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Bright Health - commercial,Bright Health - commercial,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92102123,CDM,250,RC,,,,,,Inpatient,1,EA,5.05,5.05,Bright Health MGG,Bright Health MGG,5.05,,,,,,,case rate,5.05,5.05,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 50MG TAB          ,92102190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Aetna,Aetna,82.38,,,,,,,per diem,82.38,82.38,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Aetna MGG,Aetna MGG,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,BCBS,BCBS,82.38,,,,,,,per diem,82.38,82.38,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,BCBS MGG,BCBS MGG,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Cigna,Cigna,82.38,,,,,,,per diem,82.38,82.38,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Cigna MGG,Cigna MGG,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Humana,Humana,82.38,,,,,,,per diem,82.38,82.38,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Humana MGG,Humana MGG,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Optum VA,Optum VA,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,UHC,UHC,82.38,,,,,,,per diem,82.38,82.38,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,UHC MGG,UHC MGG,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,VA,VA,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Wellcare MGG,Wellcare MGG,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Bright Health - commercial,Bright Health - commercial,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM POWDER  ",92102306,CDM,250,RC,,,,,,Inpatient,1,EA,82.38,82.38,Bright Health MGG,Bright Health MGG,82.38,,,,,,,case rate,82.38,82.38,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Aetna,Aetna,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Aetna MGG,Aetna MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,BCBS,BCBS,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,BCBS MGG,BCBS MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Cigna,Cigna,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Cigna MGG,Cigna MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Humana,Humana,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Humana MGG,Humana MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Optum VA,Optum VA,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,UHC,UHC,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,UHC MGG,UHC MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,VA,VA,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Wellcare MGG,Wellcare MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Bright Health - commercial,Bright Health - commercial,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% OPHTH SOL      ,92103479,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Bright Health MGG,Bright Health MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500 UNIT/GM OINT   ,92104161,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN 5MG CAP             ,92104522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92104726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna,Aetna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna MGG,Aetna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,BCBS,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS MGG,BCBS MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna,Cigna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna MGG,Cigna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana,Humana,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana MGG,Humana MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Optum VA,Optum VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC,UHC,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC MGG,UHC MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,VA,VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Wellcare MGG,Wellcare MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health - commercial,Bright Health - commercial,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health MGG,Bright Health MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Aetna,Aetna,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Aetna MGG,Aetna MGG,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,BCBS,BCBS,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,BCBS MGG,BCBS MGG,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Cigna,Cigna,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Cigna MGG,Cigna MGG,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Humana,Humana,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Humana MGG,Humana MGG,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Optum VA,Optum VA,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,UHC,UHC,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,UHC MGG,UHC MGG,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,VA,VA,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Wellcare MGG,Wellcare MGG,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Bright Health - commercial,Bright Health - commercial,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,Bright Health MGG,Bright Health MGG,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 1000MG TAB          ,92104840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BR 60MG TAB    ,92104915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Aetna,Aetna,67.62,,,,,,,per diem,67.62,67.62,"Per diem rate, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Aetna MGG,Aetna MGG,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,BCBS,BCBS,67.62,,,,,,,per diem,67.62,67.62,"Per diem rate, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,BCBS MGG,BCBS MGG,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Cigna,Cigna,67.62,,,,,,,per diem,67.62,67.62,"Per diem rate, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Cigna MGG,Cigna MGG,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Humana,Humana,67.62,,,,,,,per diem,67.62,67.62,"Per diem rate, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Humana MGG,Humana MGG,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Optum VA,Optum VA,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,UHC,UHC,67.62,,,,,,,per diem,67.62,67.62,"Per diem rate, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,UHC MGG,UHC MGG,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,VA,VA,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Wellcare MGG,Wellcare MGG,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Bright Health - commercial,Bright Health - commercial,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
AQUAPHOR 41% HEALING OINT     ,92105460,CDM,250,RC,,,,,,Inpatient,1,EA,67.62,67.62,Bright Health MGG,Bright Health MGG,67.62,,,,,,,case rate,67.62,67.62,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Aetna,Aetna,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Aetna MGG,Aetna MGG,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,BCBS,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS MGG,BCBS MGG,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Cigna,Cigna,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Cigna MGG,Cigna MGG,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Humana,Humana,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Humana MGG,Humana MGG,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Optum VA,Optum VA,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,UHC,UHC,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,UHC MGG,UHC MGG,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,VA,VA,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Wellcare MGG,Wellcare MGG,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Bright Health - commercial,Bright Health - commercial,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAPS         ,92105478,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,Bright Health MGG,Bright Health MGG,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Aetna,Aetna,346.55,,,,,,,per diem,346.55,346.55,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Aetna MGG,Aetna MGG,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,BCBS,BCBS,346.55,,,,,,,per diem,346.55,346.55,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,BCBS MGG,BCBS MGG,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Cigna,Cigna,346.55,,,,,,,per diem,346.55,346.55,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Cigna MGG,Cigna MGG,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Humana,Humana,346.55,,,,,,,per diem,346.55,346.55,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Humana MGG,Humana MGG,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Optum VA,Optum VA,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,UHC,UHC,346.55,,,,,,,per diem,346.55,346.55,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,UHC MGG,UHC MGG,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,VA,VA,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Wellcare MGG,Wellcare MGG,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Bright Health - commercial,Bright Health - commercial,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,346.55,346.55,Bright Health MGG,Bright Health MGG,346.55,,,,,,,case rate,346.55,346.55,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Aetna,Aetna,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Aetna MGG,Aetna MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,BCBS,BCBS,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,BCBS MGG,BCBS MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Cigna,Cigna,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Cigna MGG,Cigna MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Humana,Humana,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Humana MGG,Humana MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Optum VA,Optum VA,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,UHC,UHC,53.12,,,,,,,per diem,53.12,53.12,"Per diem rate, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,UHC MGG,UHC MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,VA,VA,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Wellcare MGG,Wellcare MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Bright Health - commercial,Bright Health - commercial,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
AMPICILLIN 2 GM VL            ,92105521,CDM,250,RC,,,,,,Inpatient,1,EA,53.12,53.12,Bright Health MGG,Bright Health MGG,53.12,,,,,,,case rate,53.12,53.12,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Aetna,Aetna,57.8,,,,,,,per diem,57.8,57.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Aetna MGG,Aetna MGG,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,BCBS,BCBS,57.8,,,,,,,per diem,57.8,57.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,BCBS MGG,BCBS MGG,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Cigna,Cigna,57.8,,,,,,,per diem,57.8,57.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Cigna MGG,Cigna MGG,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Humana,Humana,57.8,,,,,,,per diem,57.8,57.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Humana MGG,Humana MGG,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Optum VA,Optum VA,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,UHC,UHC,57.8,,,,,,,per diem,57.8,57.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,UHC MGG,UHC MGG,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,VA,VA,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Wellcare MGG,Wellcare MGG,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Bright Health - commercial,Bright Health - commercial,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,57.8,57.8,Bright Health MGG,Bright Health MGG,57.8,,,,,,,case rate,57.8,57.8,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92106762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Aetna,Aetna,84.83,,,,,,,per diem,84.83,84.83,"Per diem rate, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Aetna MGG,Aetna MGG,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,BCBS,BCBS,84.83,,,,,,,per diem,84.83,84.83,"Per diem rate, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,BCBS MGG,BCBS MGG,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Cigna,Cigna,84.83,,,,,,,per diem,84.83,84.83,"Per diem rate, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Cigna MGG,Cigna MGG,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Humana,Humana,84.83,,,,,,,per diem,84.83,84.83,"Per diem rate, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Humana MGG,Humana MGG,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Optum VA,Optum VA,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,UHC,UHC,84.83,,,,,,,per diem,84.83,84.83,"Per diem rate, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,UHC MGG,UHC MGG,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,VA,VA,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Wellcare MGG,Wellcare MGG,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Bright Health - commercial,Bright Health - commercial,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
OXACILLIN 2GM INJ             ,92106802,CDM,250,RC,,,,,,Inpatient,1,EA,84.83,84.83,Bright Health MGG,Bright Health MGG,84.83,,,,,,,case rate,84.83,84.83,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1 MG CAP        ,92106894,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92106931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Aetna,Aetna,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Aetna MGG,Aetna MGG,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,BCBS,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS MGG,BCBS MGG,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Cigna,Cigna,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Cigna MGG,Cigna MGG,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Humana,Humana,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Humana MGG,Humana MGG,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Optum VA,Optum VA,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UHC,UHC,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UHC MGG,UHC MGG,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA,VA,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Wellcare MGG,Wellcare MGG,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Bright Health - commercial,Bright Health - commercial,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VENLAFAXINE ER 150MG CAP      ,92107005,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,Bright Health MGG,Bright Health MGG,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Aetna,Aetna,33.59,,,,,,,per diem,33.59,33.59,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Aetna MGG,Aetna MGG,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,BCBS,BCBS,33.59,,,,,,,per diem,33.59,33.59,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,BCBS MGG,BCBS MGG,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Cigna,Cigna,33.59,,,,,,,per diem,33.59,33.59,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Cigna MGG,Cigna MGG,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Humana,Humana,33.59,,,,,,,per diem,33.59,33.59,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Humana MGG,Humana MGG,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Optum VA,Optum VA,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,UHC,UHC,33.59,,,,,,,per diem,33.59,33.59,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,UHC MGG,UHC MGG,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,VA,VA,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Wellcare MGG,Wellcare MGG,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Bright Health - commercial,Bright Health - commercial,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,33.59,33.59,Bright Health MGG,Bright Health MGG,33.59,,,,,,,case rate,33.59,33.59,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Aetna,Aetna,42.82,,,,,,,per diem,42.82,42.82,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Aetna MGG,Aetna MGG,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,BCBS,BCBS,42.82,,,,,,,per diem,42.82,42.82,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,BCBS MGG,BCBS MGG,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Cigna,Cigna,42.82,,,,,,,per diem,42.82,42.82,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Cigna MGG,Cigna MGG,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Humana,Humana,42.82,,,,,,,per diem,42.82,42.82,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Humana MGG,Humana MGG,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Optum VA,Optum VA,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,UHC,UHC,42.82,,,,,,,per diem,42.82,42.82,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,UHC MGG,UHC MGG,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,VA,VA,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Wellcare MGG,Wellcare MGG,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Bright Health - commercial,Bright Health - commercial,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92107086,CDM,250,RC,,,,,,Inpatient,1,EA,42.82,42.82,Bright Health MGG,Bright Health MGG,42.82,,,,,,,case rate,42.82,42.82,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Aetna,Aetna,7.54,,,,,,,per diem,7.54,7.54,"Per diem rate, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Aetna MGG,Aetna MGG,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,BCBS,BCBS,7.54,,,,,,,per diem,7.54,7.54,"Per diem rate, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,BCBS MGG,BCBS MGG,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Cigna,Cigna,7.54,,,,,,,per diem,7.54,7.54,"Per diem rate, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Cigna MGG,Cigna MGG,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Humana,Humana,7.54,,,,,,,per diem,7.54,7.54,"Per diem rate, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Humana MGG,Humana MGG,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Optum VA,Optum VA,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,UHC,UHC,7.54,,,,,,,per diem,7.54,7.54,"Per diem rate, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,UHC MGG,UHC MGG,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,VA,VA,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Wellcare MGG,Wellcare MGG,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Bright Health - commercial,Bright Health - commercial,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
TROSPIUM 20MG TAB             ,92107189,CDM,250,RC,,,,,,Inpatient,1,EA,7.54,7.54,Bright Health MGG,Bright Health MGG,7.54,,,,,,,case rate,7.54,7.54,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Aetna,Aetna,6.76,,,,,,,per diem,6.76,6.76,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Aetna MGG,Aetna MGG,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,BCBS,BCBS,6.76,,,,,,,per diem,6.76,6.76,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,BCBS MGG,BCBS MGG,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Cigna,Cigna,6.76,,,,,,,per diem,6.76,6.76,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Cigna MGG,Cigna MGG,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Humana,Humana,6.76,,,,,,,per diem,6.76,6.76,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Humana MGG,Humana MGG,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Optum VA,Optum VA,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,UHC,UHC,6.76,,,,,,,per diem,6.76,6.76,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,UHC MGG,UHC MGG,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,VA,VA,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Wellcare MGG,Wellcare MGG,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Bright Health - commercial,Bright Health - commercial,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,6.76,6.76,Bright Health MGG,Bright Health MGG,6.76,,,,,,,case rate,6.76,6.76,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Aetna,Aetna,6.22,,,,,,,per diem,6.22,6.22,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Aetna MGG,Aetna MGG,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,BCBS,BCBS,6.22,,,,,,,per diem,6.22,6.22,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,BCBS MGG,BCBS MGG,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Cigna,Cigna,6.22,,,,,,,per diem,6.22,6.22,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Cigna MGG,Cigna MGG,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Humana,Humana,6.22,,,,,,,per diem,6.22,6.22,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Humana MGG,Humana MGG,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Optum VA,Optum VA,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,UHC,UHC,6.22,,,,,,,per diem,6.22,6.22,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,UHC MGG,UHC MGG,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,VA,VA,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Wellcare MGG,Wellcare MGG,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Bright Health - commercial,Bright Health - commercial,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1 MG TAB          ,92107554,CDM,250,RC,,,,,,Inpatient,1,EA,6.22,6.22,Bright Health MGG,Bright Health MGG,6.22,,,,,,,case rate,6.22,6.22,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Aetna,Aetna,66.45,,,,,,,per diem,66.45,66.45,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Aetna MGG,Aetna MGG,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,BCBS,BCBS,66.45,,,,,,,per diem,66.45,66.45,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,BCBS MGG,BCBS MGG,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Cigna,Cigna,66.45,,,,,,,per diem,66.45,66.45,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Cigna MGG,Cigna MGG,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Humana,Humana,66.45,,,,,,,per diem,66.45,66.45,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Humana MGG,Humana MGG,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Optum VA,Optum VA,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,UHC,UHC,66.45,,,,,,,per diem,66.45,66.45,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,UHC MGG,UHC MGG,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,VA,VA,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Wellcare MGG,Wellcare MGG,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Bright Health - commercial,Bright Health - commercial,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92107642,CDM,250,RC,,,,,,Inpatient,1,EA,66.45,66.45,Bright Health MGG,Bright Health MGG,66.45,,,,,,,case rate,66.45,66.45,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Aetna,Aetna,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Aetna MGG,Aetna MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,BCBS,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS MGG,BCBS MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Cigna,Cigna,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Cigna MGG,Cigna MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Humana,Humana,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Humana MGG,Humana MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Optum VA,Optum VA,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UHC,UHC,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UHC MGG,UHC MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA,VA,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Wellcare MGG,Wellcare MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Bright Health - commercial,Bright Health - commercial,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
IPRATROPIUM 0.5MG/2.5ML SOL   ,92107765,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Bright Health MGG,Bright Health MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Aetna,Aetna,6.59,,,,,,,per diem,6.59,6.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Aetna MGG,Aetna MGG,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,BCBS,BCBS,6.59,,,,,,,per diem,6.59,6.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,BCBS MGG,BCBS MGG,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Cigna,Cigna,6.59,,,,,,,per diem,6.59,6.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Cigna MGG,Cigna MGG,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Humana,Humana,6.59,,,,,,,per diem,6.59,6.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Humana MGG,Humana MGG,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Optum VA,Optum VA,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,UHC,UHC,6.59,,,,,,,per diem,6.59,6.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,UHC MGG,UHC MGG,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,VA,VA,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Wellcare MGG,Wellcare MGG,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Bright Health - commercial,Bright Health - commercial,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL 60MG ER CAP       ,92107791,CDM,250,RC,,,,,,Inpatient,1,EA,6.59,6.59,Bright Health MGG,Bright Health MGG,6.59,,,,,,,case rate,6.59,6.59,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Aetna,Aetna,13.52,,,,,,,per diem,13.52,13.52,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Aetna MGG,Aetna MGG,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,BCBS,BCBS,13.52,,,,,,,per diem,13.52,13.52,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,BCBS MGG,BCBS MGG,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Cigna,Cigna,13.52,,,,,,,per diem,13.52,13.52,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Cigna MGG,Cigna MGG,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Humana,Humana,13.52,,,,,,,per diem,13.52,13.52,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Humana MGG,Humana MGG,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Optum VA,Optum VA,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,UHC,UHC,13.52,,,,,,,per diem,13.52,13.52,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,UHC MGG,UHC MGG,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,VA,VA,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Wellcare MGG,Wellcare MGG,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Bright Health - commercial,Bright Health - commercial,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 20MG TAB         ,92107874,CDM,250,RC,,,,,,Inpatient,1,EA,13.52,13.52,Bright Health MGG,Bright Health MGG,13.52,,,,,,,case rate,13.52,13.52,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92107886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Aetna,Aetna,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Aetna MGG,Aetna MGG,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,BCBS,BCBS,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,BCBS MGG,BCBS MGG,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Cigna,Cigna,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Cigna MGG,Cigna MGG,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Humana,Humana,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Humana MGG,Humana MGG,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Optum VA,Optum VA,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,UHC,UHC,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,UHC MGG,UHC MGG,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,VA,VA,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Wellcare MGG,Wellcare MGG,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Bright Health - commercial,Bright Health - commercial,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,Bright Health MGG,Bright Health MGG,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE 4 MG TAB           ,92108916,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna,Aetna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna MGG,Aetna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,BCBS,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS MGG,BCBS MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna,Cigna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna MGG,Cigna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana,Humana,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana MGG,Humana MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Optum VA,Optum VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC,UHC,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC MGG,UHC MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Wellcare MGG,Wellcare MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health - commercial,Bright Health - commercial,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health MGG,Bright Health MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
ACYCLOVIR 50MG/ML20ML INJ     ,92120100,CDM,636,RC,J0133,HCPCS,,,,Inpatient,1,EA,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Aetna,Aetna,188.19,,,,,,,per diem,188.19,188.19,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Aetna MGG,Aetna MGG,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,BCBS,BCBS,188.19,,,,,,,per diem,188.19,188.19,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,BCBS MGG,BCBS MGG,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Cigna,Cigna,188.19,,,,,,,per diem,188.19,188.19,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Cigna MGG,Cigna MGG,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Humana,Humana,188.19,,,,,,,per diem,188.19,188.19,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Humana MGG,Humana MGG,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Optum VA,Optum VA,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,UHC,UHC,188.19,,,,,,,per diem,188.19,188.19,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,UHC MGG,UHC MGG,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,VA,VA,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Wellcare MGG,Wellcare MGG,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Bright Health - commercial,Bright Health - commercial,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG PEN         ,92120113,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,188.19,188.19,Bright Health MGG,Bright Health MGG,188.19,,,,,,,case rate,188.19,188.19,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Aetna,Aetna,562.5,,,,,,,per diem,562.5,562.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Aetna MGG,Aetna MGG,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,BCBS,BCBS,562.5,,,,,,,per diem,562.5,562.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,BCBS MGG,BCBS MGG,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Cigna,Cigna,562.5,,,,,,,per diem,562.5,562.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Cigna MGG,Cigna MGG,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Humana,Humana,562.5,,,,,,,per diem,562.5,562.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Humana MGG,Humana MGG,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Optum VA,Optum VA,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,UHC,UHC,562.5,,,,,,,per diem,562.5,562.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,UHC MGG,UHC MGG,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,VA,VA,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Wellcare MGG,Wellcare MGG,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Bright Health - commercial,Bright Health - commercial,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.15MG PEN        ,92120115,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,562.5,562.5,Bright Health MGG,Bright Health MGG,562.5,,,,,,,case rate,562.5,562.5,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Aetna,Aetna,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Aetna MGG,Aetna MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,BCBS,BCBS,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,BCBS MGG,BCBS MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Cigna,Cigna,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Cigna MGG,Cigna MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Humana,Humana,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Humana MGG,Humana MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Optum VA,Optum VA,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,UHC,UHC,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,UHC MGG,UHC MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,VA,VA,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Wellcare MGG,Wellcare MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Bright Health - commercial,Bright Health - commercial,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,24.62,24.62,Bright Health MGG,Bright Health MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Aetna,Aetna,20.52,,,,,,,per diem,20.52,20.52,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Aetna MGG,Aetna MGG,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,BCBS,BCBS,20.52,,,,,,,per diem,20.52,20.52,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,BCBS MGG,BCBS MGG,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Cigna,Cigna,20.52,,,,,,,per diem,20.52,20.52,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Cigna MGG,Cigna MGG,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Humana,Humana,20.52,,,,,,,per diem,20.52,20.52,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Humana MGG,Humana MGG,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Optum VA,Optum VA,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,UHC,UHC,20.52,,,,,,,per diem,20.52,20.52,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,UHC MGG,UHC MGG,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,VA,VA,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Wellcare MGG,Wellcare MGG,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Bright Health - commercial,Bright Health - commercial,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM PWD INJ          ,92120268,CDM,636,RC,J0692,HCPCS,,,,Inpatient,1,EA,20.52,20.52,Bright Health MGG,Bright Health MGG,20.52,,,,,,,case rate,20.52,20.52,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Aetna,Aetna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Aetna MGG,Aetna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,BCBS,BCBS,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,BCBS MGG,BCBS MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Cigna,Cigna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Cigna MGG,Cigna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Humana,Humana,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Humana MGG,Humana MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Optum VA,Optum VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,UHC,UHC,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,UHC MGG,UHC MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,VA,VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Wellcare MGG,Wellcare MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Bright Health - commercial,Bright Health - commercial,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
PHENYTOIN 50MG/ML 2ML INJ     ,92120423,CDM,636,RC,J1165,HCPCS,,,,Inpatient,1,EA,5.1,5.1,Bright Health MGG,Bright Health MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Aetna,Aetna,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Aetna MGG,Aetna MGG,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,BCBS,BCBS,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,BCBS MGG,BCBS MGG,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Cigna,Cigna,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Cigna MGG,Cigna MGG,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Humana,Humana,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Humana MGG,Humana MGG,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Optum VA,Optum VA,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,UHC,UHC,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,UHC MGG,UHC MGG,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,VA,VA,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Wellcare MGG,Wellcare MGG,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Bright Health - commercial,Bright Health - commercial,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 0.5MG/0.5MLSYR     ,92120444,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,10.26,10.26,Bright Health MGG,Bright Health MGG,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Aetna,Aetna,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Aetna MGG,Aetna MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,BCBS,BCBS,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,BCBS MGG,BCBS MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Cigna,Cigna,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Cigna MGG,Cigna MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Humana,Humana,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Humana MGG,Humana MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Optum VA,Optum VA,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,UHC,UHC,9.86,,,,,,,per diem,9.86,9.86,"Per diem rate, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,UHC MGG,UHC MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,VA,VA,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Wellcare MGG,Wellcare MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Bright Health - commercial,Bright Health - commercial,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
HYDROMORPH 2MG/ML 1MLVIAL     ,92120446,CDM,636,RC,J1170,HCPCS,,,,Inpatient,1,EA,9.86,9.86,Bright Health MGG,Bright Health MGG,9.86,,,,,,,case rate,9.86,9.86,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Aetna,Aetna,262.56,,,,,,,per diem,262.56,262.56,"Per diem rate, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Aetna MGG,Aetna MGG,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,BCBS,BCBS,262.56,,,,,,,per diem,262.56,262.56,"Per diem rate, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,BCBS MGG,BCBS MGG,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Cigna,Cigna,262.56,,,,,,,per diem,262.56,262.56,"Per diem rate, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Cigna MGG,Cigna MGG,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Humana,Humana,262.56,,,,,,,per diem,262.56,262.56,"Per diem rate, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Humana MGG,Humana MGG,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Optum VA,Optum VA,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,UHC,UHC,262.56,,,,,,,per diem,262.56,262.56,"Per diem rate, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,UHC MGG,UHC MGG,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,VA,VA,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Wellcare MGG,Wellcare MGG,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Bright Health - commercial,Bright Health - commercial,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
FONDAPARIN 10MG/0.8ML SYR     ,92120668,CDM,636,RC,J1652,HCPCS,,,,Inpatient,1,EA,262.56,262.56,Bright Health MGG,Bright Health MGG,262.56,,,,,,,case rate,262.56,262.56,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Aetna,Aetna,207.9,,,,,,,per diem,207.9,207.9,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Aetna MGG,Aetna MGG,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,BCBS,BCBS,207.9,,,,,,,per diem,207.9,207.9,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,BCBS MGG,BCBS MGG,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Cigna,Cigna,207.9,,,,,,,per diem,207.9,207.9,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Cigna MGG,Cigna MGG,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Humana,Humana,207.9,,,,,,,per diem,207.9,207.9,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Humana MGG,Humana MGG,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Optum VA,Optum VA,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,UHC,UHC,207.9,,,,,,,per diem,207.9,207.9,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,UHC MGG,UHC MGG,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,VA,VA,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Wellcare MGG,Wellcare MGG,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Bright Health - commercial,Bright Health - commercial,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,207.9,207.9,Bright Health MGG,Bright Health MGG,207.9,,,,,,,case rate,207.9,207.9,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Aetna,Aetna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Aetna MGG,Aetna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,BCBS,BCBS,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,BCBS MGG,BCBS MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Cigna,Cigna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Cigna MGG,Cigna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Humana,Humana,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Humana MGG,Humana MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Optum VA,Optum VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,UHC,UHC,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,UHC MGG,UHC MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,VA,VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Wellcare MGG,Wellcare MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Bright Health - commercial,Bright Health - commercial,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
PROPRANOLOL 1MG/1ML PEDIV     ,92120693,CDM,636,RC,J1800,HCPCS,,,,Inpatient,1,EA,30,30,Bright Health MGG,Bright Health MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Aetna,Aetna,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Aetna MGG,Aetna MGG,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,BCBS,BCBS,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,BCBS MGG,BCBS MGG,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Cigna,Cigna,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Cigna MGG,Cigna MGG,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Humana,Humana,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Humana MGG,Humana MGG,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Optum VA,Optum VA,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,UHC,UHC,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,UHC MGG,UHC MGG,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,VA,VA,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Wellcare MGG,Wellcare MGG,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Bright Health - commercial,Bright Health - commercial,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LEVOFLOXAC 750MG 150ML PB     ,92120759,CDM,636,RC,J1956,HCPCS,,,,Inpatient,1,EA,26.81,26.81,Bright Health MGG,Bright Health MGG,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG/50ML IVPB     ,92120802,CDM,636,RC,J2185,HCPCS,,,,Inpatient,1,EA,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Aetna,Aetna,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Aetna MGG,Aetna MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,BCBS,BCBS,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,BCBS MGG,BCBS MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Cigna,Cigna,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Cigna MGG,Cigna MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Humana,Humana,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Humana MGG,Humana MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Optum VA,Optum VA,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,UHC,UHC,673.2,,,,,,,per diem,673.2,673.2,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,UHC MGG,UHC MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,VA,VA,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Wellcare MGG,Wellcare MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Bright Health - commercial,Bright Health - commercial,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,673.2,673.2,Bright Health MGG,Bright Health MGG,673.2,,,,,,,case rate,673.2,673.2,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Aetna,Aetna,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Aetna MGG,Aetna MGG,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,BCBS,BCBS,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,BCBS MGG,BCBS MGG,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Cigna,Cigna,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Cigna MGG,Cigna MGG,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Humana,Humana,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Humana MGG,Humana MGG,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Optum VA,Optum VA,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,UHC,UHC,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,UHC MGG,UHC MGG,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,VA,VA,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Wellcare MGG,Wellcare MGG,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Bright Health - commercial,Bright Health - commercial,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
MORPHIN PF 10MG/ML1ML INJ     ,92120860,CDM,636,RC,J2270,HCPCS,,,,Inpatient,1,EA,9.17,9.17,Bright Health MGG,Bright Health MGG,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Aetna,Aetna,82.65,,,,,,,per diem,82.65,82.65,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Aetna MGG,Aetna MGG,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,BCBS,BCBS,82.65,,,,,,,per diem,82.65,82.65,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,BCBS MGG,BCBS MGG,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Cigna,Cigna,82.65,,,,,,,per diem,82.65,82.65,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Cigna MGG,Cigna MGG,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Humana,Humana,82.65,,,,,,,per diem,82.65,82.65,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Humana MGG,Humana MGG,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Optum VA,Optum VA,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,UHC,UHC,82.65,,,,,,,per diem,82.65,82.65,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,UHC MGG,UHC MGG,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,VA,VA,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Wellcare MGG,Wellcare MGG,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Bright Health - commercial,Bright Health - commercial,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,82.65,82.65,Bright Health MGG,Bright Health MGG,82.65,,,,,,,case rate,82.65,82.65,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Aetna,Aetna,578.56,,,,,,,per diem,578.56,578.56,"Per diem rate, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Aetna MGG,Aetna MGG,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,BCBS,BCBS,578.56,,,,,,,per diem,578.56,578.56,"Per diem rate, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,BCBS MGG,BCBS MGG,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Cigna,Cigna,578.56,,,,,,,per diem,578.56,578.56,"Per diem rate, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Cigna MGG,Cigna MGG,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Humana,Humana,578.56,,,,,,,per diem,578.56,578.56,"Per diem rate, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Humana MGG,Humana MGG,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Optum VA,Optum VA,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,UHC,UHC,578.56,,,,,,,per diem,578.56,578.56,"Per diem rate, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,UHC MGG,UHC MGG,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,VA,VA,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Wellcare MGG,Wellcare MGG,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Bright Health - commercial,Bright Health - commercial,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
ALTEPLASE 2MG INJ             ,92121075,CDM,636,RC,J2997,HCPCS,,,,Inpatient,1,EA,578.56,578.56,Bright Health MGG,Bright Health MGG,578.56,,,,,,,case rate,578.56,578.56,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Aetna,Aetna,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Aetna MGG,Aetna MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,BCBS,BCBS,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,BCBS MGG,BCBS MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Cigna,Cigna,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Cigna MGG,Cigna MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Humana,Humana,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Humana MGG,Humana MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Optum VA,Optum VA,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,UHC,UHC,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,UHC MGG,UHC MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,VA,VA,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Wellcare MGG,Wellcare MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Bright Health - commercial,Bright Health - commercial,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG INJ          ,92121153,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,11.25,11.25,Bright Health MGG,Bright Health MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Aetna,Aetna,27.24,,,,,,,per diem,27.24,27.24,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Aetna MGG,Aetna MGG,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,BCBS,BCBS,27.24,,,,,,,per diem,27.24,27.24,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,BCBS MGG,BCBS MGG,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Cigna,Cigna,27.24,,,,,,,per diem,27.24,27.24,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Cigna MGG,Cigna MGG,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Humana,Humana,27.24,,,,,,,per diem,27.24,27.24,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Humana MGG,Humana MGG,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Optum VA,Optum VA,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,UHC,UHC,27.24,,,,,,,per diem,27.24,27.24,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,UHC MGG,UHC MGG,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,VA,VA,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Wellcare MGG,Wellcare MGG,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Bright Health - commercial,Bright Health - commercial,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/100MLPB     ,92121195,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,27.24,27.24,Bright Health MGG,Bright Health MGG,27.24,,,,,,,case rate,27.24,27.24,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Aetna,Aetna,86.98,,,,,,,per diem,86.98,86.98,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Aetna MGG,Aetna MGG,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,BCBS,BCBS,86.98,,,,,,,per diem,86.98,86.98,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,BCBS MGG,BCBS MGG,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Cigna,Cigna,86.98,,,,,,,per diem,86.98,86.98,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Cigna MGG,Cigna MGG,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Humana,Humana,86.98,,,,,,,per diem,86.98,86.98,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Humana MGG,Humana MGG,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Optum VA,Optum VA,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,UHC,UHC,86.98,,,,,,,per diem,86.98,86.98,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,UHC MGG,UHC MGG,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,VA,VA,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Wellcare MGG,Wellcare MGG,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Bright Health - commercial,Bright Health - commercial,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG INJ         ,92121283,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,86.98,86.98,Bright Health MGG,Bright Health MGG,86.98,,,,,,,case rate,86.98,86.98,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Aetna,Aetna,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Aetna MGG,Aetna MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,BCBS,BCBS,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,BCBS MGG,BCBS MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Cigna,Cigna,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Cigna MGG,Cigna MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Humana,Humana,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Humana MGG,Humana MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Optum VA,Optum VA,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,UHC,UHC,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,UHC MGG,UHC MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,VA,VA,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Wellcare MGG,Wellcare MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Bright Health - commercial,Bright Health - commercial,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
LACTATED RINGERS 500MLINJ     ,92121480,CDM,636,RC,J7120,HCPCS,,,,Inpatient,1,EA,10.05,10.05,Bright Health MGG,Bright Health MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Aetna,Aetna,45.25,,,,,,,per diem,45.25,45.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Aetna MGG,Aetna MGG,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,BCBS,BCBS,45.25,,,,,,,per diem,45.25,45.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,BCBS MGG,BCBS MGG,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Cigna,Cigna,45.25,,,,,,,per diem,45.25,45.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Cigna MGG,Cigna MGG,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Humana,Humana,45.25,,,,,,,per diem,45.25,45.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Humana MGG,Humana MGG,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Optum VA,Optum VA,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,UHC,UHC,45.25,,,,,,,per diem,45.25,45.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,UHC MGG,UHC MGG,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,VA,VA,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Wellcare MGG,Wellcare MGG,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Bright Health - commercial,Bright Health - commercial,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG CAP        ,92121521,CDM,636,RC,J7502,HCPCS,,,,Inpatient,1,EA,45.25,45.25,Bright Health MGG,Bright Health MGG,45.25,,,,,,,case rate,45.25,45.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92121588,CDM,637,RC,J8540,HCPCS,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Aetna,Aetna,962.06,,,,,,,per diem,962.06,962.06,"Per diem rate, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Aetna MGG,Aetna MGG,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,BCBS,BCBS,962.06,,,,,,,per diem,962.06,962.06,"Per diem rate, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,BCBS MGG,BCBS MGG,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Cigna,Cigna,962.06,,,,,,,per diem,962.06,962.06,"Per diem rate, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Cigna MGG,Cigna MGG,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Humana,Humana,962.06,,,,,,,per diem,962.06,962.06,"Per diem rate, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Humana MGG,Humana MGG,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Optum VA,Optum VA,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,UHC,UHC,962.06,,,,,,,per diem,962.06,962.06,"Per diem rate, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,UHC MGG,UHC MGG,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,VA,VA,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Wellcare MGG,Wellcare MGG,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Bright Health - commercial,Bright Health - commercial,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 10000U ESRD SDV       ,92121827,CDM,635,RC,Q4081,HCPCS,,,,Inpatient,1,EA,962.06,962.06,Bright Health MGG,Bright Health MGG,962.06,,,,,,,case rate,962.06,962.06,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Aetna,Aetna,1924.2,,,,,,,per diem,1924.2,1924.2,"Per diem rate, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Aetna MGG,Aetna MGG,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,BCBS,BCBS,1924.2,,,,,,,per diem,1924.2,1924.2,"Per diem rate, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,BCBS MGG,BCBS MGG,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Cigna,Cigna,1924.2,,,,,,,per diem,1924.2,1924.2,"Per diem rate, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Cigna MGG,Cigna MGG,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Humana,Humana,1924.2,,,,,,,per diem,1924.2,1924.2,"Per diem rate, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Humana MGG,Humana MGG,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Optum VA,Optum VA,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,UHC,UHC,1924.2,,,,,,,per diem,1924.2,1924.2,"Per diem rate, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,UHC MGG,UHC MGG,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,VA,VA,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Wellcare MGG,Wellcare MGG,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Bright Health - commercial,Bright Health - commercial,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
EPOETIN 2000U ESRD SDV        ,92121831,CDM,634,RC,Q4081,HCPCS,,,,Inpatient,1,EA,1924.2,1924.2,Bright Health MGG,Bright Health MGG,1924.2,,,,,,,case rate,1924.2,1924.2,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10MG TAB        ,92125005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Aetna,Aetna,12.41,,,,,,,per diem,12.41,12.41,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Aetna MGG,Aetna MGG,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,BCBS,BCBS,12.41,,,,,,,per diem,12.41,12.41,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,BCBS MGG,BCBS MGG,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Cigna,Cigna,12.41,,,,,,,per diem,12.41,12.41,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Cigna MGG,Cigna MGG,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Humana,Humana,12.41,,,,,,,per diem,12.41,12.41,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Humana MGG,Humana MGG,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Optum VA,Optum VA,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,UHC,UHC,12.41,,,,,,,per diem,12.41,12.41,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,UHC MGG,UHC MGG,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,VA,VA,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Wellcare MGG,Wellcare MGG,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Bright Health - commercial,Bright Health - commercial,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUPP           ,92125009,CDM,250,RC,,,,,,Inpatient,1,EA,12.41,12.41,Bright Health MGG,Bright Health MGG,12.41,,,,,,,case rate,12.41,12.41,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Aetna,Aetna,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Aetna MGG,Aetna MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,BCBS,BCBS,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,BCBS MGG,BCBS MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Cigna,Cigna,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Cigna MGG,Cigna MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Humana,Humana,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Humana MGG,Humana MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Optum VA,Optum VA,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,UHC,UHC,12.11,,,,,,,per diem,12.11,12.11,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,UHC MGG,UHC MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,VA,VA,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Wellcare MGG,Wellcare MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Bright Health - commercial,Bright Health - commercial,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92125012,CDM,250,RC,,,,,,Inpatient,1,EA,12.11,12.11,Bright Health MGG,Bright Health MGG,12.11,,,,,,,case rate,12.11,12.11,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92125046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CHW TAB      ,92125047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Aetna,Aetna,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Aetna MGG,Aetna MGG,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,BCBS,BCBS,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,BCBS MGG,BCBS MGG,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Cigna,Cigna,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Cigna MGG,Cigna MGG,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Humana,Humana,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Humana MGG,Humana MGG,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Optum VA,Optum VA,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,UHC,UHC,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,UHC MGG,UHC MGG,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,VA,VA,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Wellcare MGG,Wellcare MGG,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Bright Health - commercial,Bright Health - commercial,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
WARFARIN 7.5MG TAB            ,92125050,CDM,250,RC,,,,,,Inpatient,1,EA,10.75,10.75,Bright Health MGG,Bright Health MGG,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE 50MG TAB           ,92125066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Aetna,Aetna,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Aetna MGG,Aetna MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,BCBS,BCBS,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,BCBS MGG,BCBS MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Cigna,Cigna,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Cigna MGG,Cigna MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Humana,Humana,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Humana MGG,Humana MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Optum VA,Optum VA,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,UHC,UHC,7.79,,,,,,,per diem,7.79,7.79,"Per diem rate, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,UHC MGG,UHC MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,VA,VA,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Wellcare MGG,Wellcare MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Bright Health - commercial,Bright Health - commercial,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
WARFARIN 4MG TAB              ,92125075,CDM,250,RC,,,,,,Inpatient,1,EA,7.79,7.79,Bright Health MGG,Bright Health MGG,7.79,,,,,,,case rate,7.79,7.79,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Aetna,Aetna,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Aetna MGG,Aetna MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,BCBS,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS MGG,BCBS MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Cigna,Cigna,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Cigna MGG,Cigna MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Humana,Humana,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Humana MGG,Humana MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Optum VA,Optum VA,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UHC,UHC,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UHC MGG,UHC MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA,VA,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Wellcare MGG,Wellcare MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Bright Health - commercial,Bright Health - commercial,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92125099,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Bright Health MGG,Bright Health MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Aetna,Aetna,8.26,,,,,,,per diem,8.26,8.26,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Aetna MGG,Aetna MGG,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,BCBS,BCBS,8.26,,,,,,,per diem,8.26,8.26,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,BCBS MGG,BCBS MGG,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Cigna,Cigna,8.26,,,,,,,per diem,8.26,8.26,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Cigna MGG,Cigna MGG,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Humana,Humana,8.26,,,,,,,per diem,8.26,8.26,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Humana MGG,Humana MGG,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Optum VA,Optum VA,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,UHC,UHC,8.26,,,,,,,per diem,8.26,8.26,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,UHC MGG,UHC MGG,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,VA,VA,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Wellcare MGG,Wellcare MGG,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Bright Health - commercial,Bright Health - commercial,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92125107,CDM,250,RC,,,,,,Inpatient,1,EA,8.26,8.26,Bright Health MGG,Bright Health MGG,8.26,,,,,,,case rate,8.26,8.26,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SACCHAROMYCES 250MG CAP       ,92125110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD/HOMT 5-1.5/5 5ML     ,92125113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Aetna,Aetna,344.25,,,,,,,per diem,344.25,344.25,"Per diem rate, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Aetna MGG,Aetna MGG,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,BCBS,BCBS,344.25,,,,,,,per diem,344.25,344.25,"Per diem rate, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,BCBS MGG,BCBS MGG,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Cigna,Cigna,344.25,,,,,,,per diem,344.25,344.25,"Per diem rate, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Cigna MGG,Cigna MGG,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Humana,Humana,344.25,,,,,,,per diem,344.25,344.25,"Per diem rate, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Humana MGG,Humana MGG,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Optum VA,Optum VA,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,UHC,UHC,344.25,,,,,,,per diem,344.25,344.25,"Per diem rate, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,UHC MGG,UHC MGG,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,VA,VA,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Wellcare MGG,Wellcare MGG,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Bright Health - commercial,Bright Health - commercial,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
ALBUMIN 25PCT 100ML INJ       ,92125123,CDM,250,RC,,,,,,Inpatient,1,EA,344.25,344.25,Bright Health MGG,Bright Health MGG,344.25,,,,,,,case rate,344.25,344.25,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Aetna,Aetna,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Aetna MGG,Aetna MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,BCBS,BCBS,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,BCBS MGG,BCBS MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Cigna,Cigna,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Cigna MGG,Cigna MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Humana,Humana,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Humana MGG,Humana MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Optum VA,Optum VA,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,UHC,UHC,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,UHC MGG,UHC MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,VA,VA,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Wellcare MGG,Wellcare MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Bright Health - commercial,Bright Health - commercial,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
DOCOSANOL 10PCT 2GM TOP       ,92125165,CDM,250,RC,,,,,,Inpatient,1,EA,55.65,55.65,Bright Health MGG,Bright Health MGG,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 20GM/30ML LIQ       ,92125169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Aetna,Aetna,11.38,,,,,,,per diem,11.38,11.38,"Per diem rate, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Aetna MGG,Aetna MGG,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,BCBS,BCBS,11.38,,,,,,,per diem,11.38,11.38,"Per diem rate, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,BCBS MGG,BCBS MGG,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Cigna,Cigna,11.38,,,,,,,per diem,11.38,11.38,"Per diem rate, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Cigna MGG,Cigna MGG,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Humana,Humana,11.38,,,,,,,per diem,11.38,11.38,"Per diem rate, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Humana MGG,Humana MGG,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Optum VA,Optum VA,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,UHC,UHC,11.38,,,,,,,per diem,11.38,11.38,"Per diem rate, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,UHC MGG,UHC MGG,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,VA,VA,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Wellcare MGG,Wellcare MGG,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Bright Health - commercial,Bright Health - commercial,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
ACETAMIN 160MG/5ML 5ML EL     ,92125171,CDM,250,RC,,,,,,Inpatient,1,EA,11.38,11.38,Bright Health MGG,Bright Health MGG,11.38,,,,,,,case rate,11.38,11.38,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5PCT 0.9 NACL 1000ML INJ     ,92125173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Aetna,Aetna,69.34,,,,,,,per diem,69.34,69.34,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Aetna MGG,Aetna MGG,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,BCBS,BCBS,69.34,,,,,,,per diem,69.34,69.34,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,BCBS MGG,BCBS MGG,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Cigna,Cigna,69.34,,,,,,,per diem,69.34,69.34,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Cigna MGG,Cigna MGG,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Humana,Humana,69.34,,,,,,,per diem,69.34,69.34,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Humana MGG,Humana MGG,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Optum VA,Optum VA,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,UHC,UHC,69.34,,,,,,,per diem,69.34,69.34,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,UHC MGG,UHC MGG,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,VA,VA,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Wellcare MGG,Wellcare MGG,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Bright Health - commercial,Bright Health - commercial,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,69.34,69.34,Bright Health MGG,Bright Health MGG,69.34,,,,,,,case rate,69.34,69.34,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Aetna,Aetna,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Aetna MGG,Aetna MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,BCBS,BCBS,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,BCBS MGG,BCBS MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Cigna,Cigna,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Cigna MGG,Cigna MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Humana,Humana,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Humana MGG,Humana MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Optum VA,Optum VA,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,UHC,UHC,55.08,,,,,,,per diem,55.08,55.08,"Per diem rate, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,UHC MGG,UHC MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,VA,VA,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Wellcare MGG,Wellcare MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Bright Health - commercial,Bright Health - commercial,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
PRASUGREL 10MG TAB            ,92125200,CDM,250,RC,,,,,,Inpatient,1,EA,55.08,55.08,Bright Health MGG,Bright Health MGG,55.08,,,,,,,case rate,55.08,55.08,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Aetna,Aetna,25.52,,,,,,,per diem,25.52,25.52,"Per diem rate, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Aetna MGG,Aetna MGG,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,BCBS,BCBS,25.52,,,,,,,per diem,25.52,25.52,"Per diem rate, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,BCBS MGG,BCBS MGG,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Cigna,Cigna,25.52,,,,,,,per diem,25.52,25.52,"Per diem rate, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Cigna MGG,Cigna MGG,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Humana,Humana,25.52,,,,,,,per diem,25.52,25.52,"Per diem rate, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Humana MGG,Humana MGG,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Optum VA,Optum VA,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,UHC,UHC,25.52,,,,,,,per diem,25.52,25.52,"Per diem rate, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,UHC MGG,UHC MGG,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,VA,VA,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Wellcare MGG,Wellcare MGG,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Bright Health - commercial,Bright Health - commercial,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
TICAGRELOR 90MG TAB           ,92125206,CDM,250,RC,,,,,,Inpatient,1,EA,25.52,25.52,Bright Health MGG,Bright Health MGG,25.52,,,,,,,case rate,25.52,25.52,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Aetna,Aetna,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Aetna MGG,Aetna MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,BCBS,BCBS,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,BCBS MGG,BCBS MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Cigna,Cigna,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Cigna MGG,Cigna MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Humana,Humana,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Humana MGG,Humana MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Optum VA,Optum VA,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,UHC,UHC,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,UHC MGG,UHC MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,VA,VA,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Wellcare MGG,Wellcare MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Bright Health - commercial,Bright Health - commercial,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Bright Health MGG,Bright Health MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Aetna,Aetna,22.29,,,,,,,per diem,22.29,22.29,"Per diem rate, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Aetna MGG,Aetna MGG,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,BCBS,BCBS,22.29,,,,,,,per diem,22.29,22.29,"Per diem rate, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,BCBS MGG,BCBS MGG,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Cigna,Cigna,22.29,,,,,,,per diem,22.29,22.29,"Per diem rate, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Cigna MGG,Cigna MGG,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Humana,Humana,22.29,,,,,,,per diem,22.29,22.29,"Per diem rate, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Humana MGG,Humana MGG,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Optum VA,Optum VA,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,UHC,UHC,22.29,,,,,,,per diem,22.29,22.29,"Per diem rate, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,UHC MGG,UHC MGG,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,VA,VA,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Wellcare MGG,Wellcare MGG,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Bright Health - commercial,Bright Health - commercial,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
AMIODARONE 100MG TAB          ,92125210,CDM,250,RC,,,,,,Inpatient,1,EA,22.29,22.29,Bright Health MGG,Bright Health MGG,22.29,,,,,,,case rate,22.29,22.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Aetna,Aetna,13.31,,,,,,,per diem,13.31,13.31,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Aetna MGG,Aetna MGG,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,BCBS,BCBS,13.31,,,,,,,per diem,13.31,13.31,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,BCBS MGG,BCBS MGG,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Cigna,Cigna,13.31,,,,,,,per diem,13.31,13.31,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Cigna MGG,Cigna MGG,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Humana,Humana,13.31,,,,,,,per diem,13.31,13.31,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Humana MGG,Humana MGG,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Optum VA,Optum VA,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,UHC,UHC,13.31,,,,,,,per diem,13.31,13.31,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,UHC MGG,UHC MGG,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,VA,VA,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Wellcare MGG,Wellcare MGG,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Bright Health - commercial,Bright Health - commercial,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92125211,CDM,250,RC,,,,,,Inpatient,1,EA,13.31,13.31,Bright Health MGG,Bright Health MGG,13.31,,,,,,,case rate,13.31,13.31,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Aetna,Aetna,73.84,,,,,,,per diem,73.84,73.84,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Aetna MGG,Aetna MGG,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,BCBS,BCBS,73.84,,,,,,,per diem,73.84,73.84,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,BCBS MGG,BCBS MGG,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Cigna,Cigna,73.84,,,,,,,per diem,73.84,73.84,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Cigna MGG,Cigna MGG,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Humana,Humana,73.84,,,,,,,per diem,73.84,73.84,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Humana MGG,Humana MGG,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Optum VA,Optum VA,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,UHC,UHC,73.84,,,,,,,per diem,73.84,73.84,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,UHC MGG,UHC MGG,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,VA,VA,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Wellcare MGG,Wellcare MGG,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Bright Health - commercial,Bright Health - commercial,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 750MG TAB        ,92125216,CDM,250,RC,,,,,,Inpatient,1,EA,73.84,73.84,Bright Health MGG,Bright Health MGG,73.84,,,,,,,case rate,73.84,73.84,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92125217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Aetna,Aetna,74.52,,,,,,,per diem,74.52,74.52,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Aetna MGG,Aetna MGG,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,BCBS,BCBS,74.52,,,,,,,per diem,74.52,74.52,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,BCBS MGG,BCBS MGG,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Cigna,Cigna,74.52,,,,,,,per diem,74.52,74.52,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Cigna MGG,Cigna MGG,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Humana,Humana,74.52,,,,,,,per diem,74.52,74.52,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Humana MGG,Humana MGG,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Optum VA,Optum VA,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,UHC,UHC,74.52,,,,,,,per diem,74.52,74.52,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,UHC MGG,UHC MGG,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,VA,VA,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Wellcare MGG,Wellcare MGG,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Bright Health - commercial,Bright Health - commercial,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92125218,CDM,250,RC,,,,,,Inpatient,1,EA,74.52,74.52,Bright Health MGG,Bright Health MGG,74.52,,,,,,,case rate,74.52,74.52,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 500MG TAB           ,92125219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Aetna,Aetna,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Aetna MGG,Aetna MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,BCBS,BCBS,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,BCBS MGG,BCBS MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Cigna,Cigna,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Cigna MGG,Cigna MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Humana,Humana,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Humana MGG,Humana MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Optum VA,Optum VA,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,UHC,UHC,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,UHC MGG,UHC MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,VA,VA,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Wellcare MGG,Wellcare MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Bright Health - commercial,Bright Health - commercial,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Bright Health MGG,Bright Health MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/0.5ML SOL       ,92125233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Aetna,Aetna,10.89,,,,,,,per diem,10.89,10.89,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Aetna MGG,Aetna MGG,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,BCBS,BCBS,10.89,,,,,,,per diem,10.89,10.89,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,BCBS MGG,BCBS MGG,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Cigna,Cigna,10.89,,,,,,,per diem,10.89,10.89,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Cigna MGG,Cigna MGG,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Humana,Humana,10.89,,,,,,,per diem,10.89,10.89,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Humana MGG,Humana MGG,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Optum VA,Optum VA,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,UHC,UHC,10.89,,,,,,,per diem,10.89,10.89,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,UHC MGG,UHC MGG,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,VA,VA,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Wellcare MGG,Wellcare MGG,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Bright Health - commercial,Bright Health - commercial,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100/5ML LIQ     ,92125234,CDM,250,RC,,,,,,Inpatient,1,EA,10.89,10.89,Bright Health MGG,Bright Health MGG,10.89,,,,,,,case rate,10.89,10.89,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Aetna,Aetna,23.22,,,,,,,per diem,23.22,23.22,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Aetna MGG,Aetna MGG,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,BCBS,BCBS,23.22,,,,,,,per diem,23.22,23.22,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,BCBS MGG,BCBS MGG,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Cigna,Cigna,23.22,,,,,,,per diem,23.22,23.22,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Cigna MGG,Cigna MGG,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Humana,Humana,23.22,,,,,,,per diem,23.22,23.22,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Humana MGG,Humana MGG,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Optum VA,Optum VA,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,UHC,UHC,23.22,,,,,,,per diem,23.22,23.22,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,UHC MGG,UHC MGG,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,VA,VA,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Wellcare MGG,Wellcare MGG,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Bright Health - commercial,Bright Health - commercial,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 8MG ODT         ,92125241,CDM,250,RC,,,,,,Inpatient,1,EA,23.22,23.22,Bright Health MGG,Bright Health MGG,23.22,,,,,,,case rate,23.22,23.22,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG CAP           ,92125246,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Aetna,Aetna,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Aetna MGG,Aetna MGG,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,BCBS,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS MGG,BCBS MGG,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Cigna,Cigna,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Cigna MGG,Cigna MGG,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Humana,Humana,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Humana MGG,Humana MGG,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Optum VA,Optum VA,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,UHC,UHC,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,UHC MGG,UHC MGG,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,VA,VA,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Wellcare MGG,Wellcare MGG,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Bright Health - commercial,Bright Health - commercial,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CELECOXIB 100MG CAP           ,92125268,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,Bright Health MGG,Bright Health MGG,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Aetna,Aetna,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Aetna MGG,Aetna MGG,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,BCBS,BCBS,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,BCBS MGG,BCBS MGG,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Cigna,Cigna,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Cigna MGG,Cigna MGG,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Humana,Humana,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Humana MGG,Humana MGG,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Optum VA,Optum VA,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,UHC,UHC,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,UHC MGG,UHC MGG,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,VA,VA,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Wellcare MGG,Wellcare MGG,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Bright Health - commercial,Bright Health - commercial,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ASPIRIN/DIPYRADAMOLE 25-200MG ,92125273,CDM,250,RC,,,,,,Inpatient,1,EA,29.55,29.55,Bright Health MGG,Bright Health MGG,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DINITRATE 20 MG TAB,92125275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Aetna,Aetna,52.57,,,,,,,per diem,52.57,52.57,"Per diem rate, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Aetna MGG,Aetna MGG,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,BCBS,BCBS,52.57,,,,,,,per diem,52.57,52.57,"Per diem rate, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,BCBS MGG,BCBS MGG,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Cigna,Cigna,52.57,,,,,,,per diem,52.57,52.57,"Per diem rate, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Cigna MGG,Cigna MGG,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Humana,Humana,52.57,,,,,,,per diem,52.57,52.57,"Per diem rate, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Humana MGG,Humana MGG,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Optum VA,Optum VA,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,UHC,UHC,52.57,,,,,,,per diem,52.57,52.57,"Per diem rate, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,UHC MGG,UHC MGG,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,VA,VA,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Wellcare MGG,Wellcare MGG,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Bright Health - commercial,Bright Health - commercial,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
MICONAZOLE 200 MG VAGINAL (3) ,92125282,CDM,250,RC,,,,,,Inpatient,1,EA,52.57,52.57,Bright Health MGG,Bright Health MGG,52.57,,,,,,,case rate,52.57,52.57,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCHARIDE 150MG CAP ,92125286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Aetna,Aetna,72.44,,,,,,,per diem,72.44,72.44,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Aetna MGG,Aetna MGG,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,BCBS,BCBS,72.44,,,,,,,per diem,72.44,72.44,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,BCBS MGG,BCBS MGG,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Cigna,Cigna,72.44,,,,,,,per diem,72.44,72.44,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Cigna MGG,Cigna MGG,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Humana,Humana,72.44,,,,,,,per diem,72.44,72.44,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Humana MGG,Humana MGG,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Optum VA,Optum VA,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,UHC,UHC,72.44,,,,,,,per diem,72.44,72.44,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,UHC MGG,UHC MGG,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,VA,VA,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Wellcare MGG,Wellcare MGG,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Bright Health - commercial,Bright Health - commercial,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100 MG CAP       ,92125287,CDM,250,RC,,,,,,Inpatient,1,EA,72.44,72.44,Bright Health MGG,Bright Health MGG,72.44,,,,,,,case rate,72.44,72.44,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCOPYRROLATE 1 MG TAB       ,92125288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Aetna,Aetna,7.6,,,,,,,per diem,7.6,7.6,"Per diem rate, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Aetna MGG,Aetna MGG,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,BCBS,BCBS,7.6,,,,,,,per diem,7.6,7.6,"Per diem rate, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,BCBS MGG,BCBS MGG,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Cigna,Cigna,7.6,,,,,,,per diem,7.6,7.6,"Per diem rate, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Cigna MGG,Cigna MGG,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Humana,Humana,7.6,,,,,,,per diem,7.6,7.6,"Per diem rate, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Humana MGG,Humana MGG,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Optum VA,Optum VA,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,UHC,UHC,7.6,,,,,,,per diem,7.6,7.6,"Per diem rate, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,UHC MGG,UHC MGG,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,VA,VA,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Wellcare MGG,Wellcare MGG,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Bright Health - commercial,Bright Health - commercial,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
VERAPAMIL 240 MG ER TAB       ,92125296,CDM,250,RC,,,,,,Inpatient,1,EA,7.6,7.6,Bright Health MGG,Bright Health MGG,7.6,,,,,,,case rate,7.6,7.6,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Aetna,Aetna,45.34,,,,,,,per diem,45.34,45.34,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Aetna MGG,Aetna MGG,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,BCBS,BCBS,45.34,,,,,,,per diem,45.34,45.34,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,BCBS MGG,BCBS MGG,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Cigna,Cigna,45.34,,,,,,,per diem,45.34,45.34,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Cigna MGG,Cigna MGG,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Humana,Humana,45.34,,,,,,,per diem,45.34,45.34,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Humana MGG,Humana MGG,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Optum VA,Optum VA,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,UHC,UHC,45.34,,,,,,,per diem,45.34,45.34,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,UHC MGG,UHC MGG,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,VA,VA,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Wellcare MGG,Wellcare MGG,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Bright Health - commercial,Bright Health - commercial,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC SOL,92125303,CDM,250,RC,,,,,,Inpatient,1,EA,45.34,45.34,Bright Health MGG,Bright Health MGG,45.34,,,,,,,case rate,45.34,45.34,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL ORAL 200,92125354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Aetna,Aetna,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Aetna MGG,Aetna MGG,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,BCBS,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS MGG,BCBS MGG,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Cigna,Cigna,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Cigna MGG,Cigna MGG,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Humana,Humana,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Humana MGG,Humana MGG,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Optum VA,Optum VA,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,UHC,UHC,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,UHC MGG,UHC MGG,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,VA,VA,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Wellcare MGG,Wellcare MGG,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Bright Health - commercial,Bright Health - commercial,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-BUTALBITAL-CAFFE,92125358,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,Bright Health MGG,Bright Health MGG,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN VITAMIN B COMPLEX,92125365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Aetna,Aetna,10.95,,,,,,,per diem,10.95,10.95,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Aetna MGG,Aetna MGG,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,BCBS,BCBS,10.95,,,,,,,per diem,10.95,10.95,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,BCBS MGG,BCBS MGG,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Cigna,Cigna,10.95,,,,,,,per diem,10.95,10.95,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Cigna MGG,Cigna MGG,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Humana,Humana,10.95,,,,,,,per diem,10.95,10.95,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Humana MGG,Humana MGG,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Optum VA,Optum VA,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,UHC,UHC,10.95,,,,,,,per diem,10.95,10.95,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,UHC MGG,UHC MGG,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,VA,VA,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Wellcare MGG,Wellcare MGG,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Bright Health - commercial,Bright Health - commercial,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92125366,CDM,250,RC,,,,,,Inpatient,1,EA,10.95,10.95,Bright Health MGG,Bright Health MGG,10.95,,,,,,,case rate,10.95,10.95,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Aetna,Aetna,316.01,,,,,,,per diem,316.01,316.01,"Per diem rate, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Aetna MGG,Aetna MGG,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,BCBS,BCBS,316.01,,,,,,,per diem,316.01,316.01,"Per diem rate, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,BCBS MGG,BCBS MGG,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Cigna,Cigna,316.01,,,,,,,per diem,316.01,316.01,"Per diem rate, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Cigna MGG,Cigna MGG,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Humana,Humana,316.01,,,,,,,per diem,316.01,316.01,"Per diem rate, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Humana MGG,Humana MGG,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Optum VA,Optum VA,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,UHC,UHC,316.01,,,,,,,per diem,316.01,316.01,"Per diem rate, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,UHC MGG,UHC MGG,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,VA,VA,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Wellcare MGG,Wellcare MGG,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Bright Health - commercial,Bright Health - commercial,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
SERTRALINE ORAL 25 MG TAB     ,92125382,CDM,250,RC,,,,,,Inpatient,1,EA,316.01,316.01,Bright Health MGG,Bright Health MGG,316.01,,,,,,,case rate,316.01,316.01,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Aetna,Aetna,17.22,,,,,,,per diem,17.22,17.22,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Aetna MGG,Aetna MGG,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,BCBS,BCBS,17.22,,,,,,,per diem,17.22,17.22,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,BCBS MGG,BCBS MGG,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Cigna,Cigna,17.22,,,,,,,per diem,17.22,17.22,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Cigna MGG,Cigna MGG,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Humana,Humana,17.22,,,,,,,per diem,17.22,17.22,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Humana MGG,Humana MGG,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Optum VA,Optum VA,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,UHC,UHC,17.22,,,,,,,per diem,17.22,17.22,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,UHC MGG,UHC MGG,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,VA,VA,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Wellcare MGG,Wellcare MGG,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Bright Health - commercial,Bright Health - commercial,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 10 MG TAB     ,92125384,CDM,250,RC,,,,,,Inpatient,1,EA,17.22,17.22,Bright Health MGG,Bright Health MGG,17.22,,,,,,,case rate,17.22,17.22,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Aetna,Aetna,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Aetna MGG,Aetna MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,BCBS,BCBS,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,BCBS MGG,BCBS MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Cigna,Cigna,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Cigna MGG,Cigna MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Humana,Humana,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Humana MGG,Humana MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Optum VA,Optum VA,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,UHC,UHC,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,UHC MGG,UHC MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,VA,VA,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Wellcare MGG,Wellcare MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Bright Health - commercial,Bright Health - commercial,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
OCULAR LUBRICANT OPTHALMIC GEL,92125388,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Bright Health MGG,Bright Health MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Aetna,Aetna,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Aetna MGG,Aetna MGG,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,BCBS,BCBS,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,BCBS MGG,BCBS MGG,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Cigna,Cigna,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Cigna MGG,Cigna MGG,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Humana,Humana,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Humana MGG,Humana MGG,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Optum VA,Optum VA,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,UHC,UHC,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,UHC MGG,UHC MGG,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,VA,VA,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Wellcare MGG,Wellcare MGG,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Bright Health - commercial,Bright Health - commercial,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL TOPICAL,92125394,CDM,250,RC,,,,,,Inpatient,1,EA,89.25,89.25,Bright Health MGG,Bright Health MGG,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Aetna,Aetna,59.52,,,,,,,per diem,59.52,59.52,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Aetna MGG,Aetna MGG,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,BCBS,BCBS,59.52,,,,,,,per diem,59.52,59.52,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,BCBS MGG,BCBS MGG,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Cigna,Cigna,59.52,,,,,,,per diem,59.52,59.52,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Cigna MGG,Cigna MGG,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Humana,Humana,59.52,,,,,,,per diem,59.52,59.52,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Humana MGG,Humana MGG,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Optum VA,Optum VA,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,UHC,UHC,59.52,,,,,,,per diem,59.52,59.52,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,UHC MGG,UHC MGG,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,VA,VA,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Wellcare MGG,Wellcare MGG,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Bright Health - commercial,Bright Health - commercial,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE ORAL 40 MG ECGR  ,92125396,CDM,250,RC,,,,,,Inpatient,1,EA,59.52,59.52,Bright Health MGG,Bright Health MGG,59.52,,,,,,,case rate,59.52,59.52,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Aetna,Aetna,59.58,,,,,,,per diem,59.58,59.58,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Aetna MGG,Aetna MGG,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,BCBS,BCBS,59.58,,,,,,,per diem,59.58,59.58,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,BCBS MGG,BCBS MGG,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Cigna,Cigna,59.58,,,,,,,per diem,59.58,59.58,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Cigna MGG,Cigna MGG,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Humana,Humana,59.58,,,,,,,per diem,59.58,59.58,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Humana MGG,Humana MGG,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Optum VA,Optum VA,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,UHC,UHC,59.58,,,,,,,per diem,59.58,59.58,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,UHC MGG,UHC MGG,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,VA,VA,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Wellcare MGG,Wellcare MGG,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Bright Health - commercial,Bright Health - commercial,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,59.58,59.58,Bright Health MGG,Bright Health MGG,59.58,,,,,,,case rate,59.58,59.58,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Aetna,Aetna,25.22,,,,,,,per diem,25.22,25.22,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Aetna MGG,Aetna MGG,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,BCBS,BCBS,25.22,,,,,,,per diem,25.22,25.22,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,BCBS MGG,BCBS MGG,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Cigna,Cigna,25.22,,,,,,,per diem,25.22,25.22,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Cigna MGG,Cigna MGG,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Humana,Humana,25.22,,,,,,,per diem,25.22,25.22,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Humana MGG,Humana MGG,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Optum VA,Optum VA,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,UHC,UHC,25.22,,,,,,,per diem,25.22,25.22,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,UHC MGG,UHC MGG,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,VA,VA,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Wellcare MGG,Wellcare MGG,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Bright Health - commercial,Bright Health - commercial,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE ERT ORAL 36 MG,92125399,CDM,250,RC,,,,,,Inpatient,1,EA,25.22,25.22,Bright Health MGG,Bright Health MGG,25.22,,,,,,,case rate,25.22,25.22,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Aetna,Aetna,1046.19,,,,,,,per diem,1046.19,1046.19,"Per diem rate, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Aetna MGG,Aetna MGG,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,BCBS,BCBS,1046.19,,,,,,,per diem,1046.19,1046.19,"Per diem rate, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,BCBS MGG,BCBS MGG,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Cigna,Cigna,1046.19,,,,,,,per diem,1046.19,1046.19,"Per diem rate, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Cigna MGG,Cigna MGG,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Humana,Humana,1046.19,,,,,,,per diem,1046.19,1046.19,"Per diem rate, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Humana MGG,Humana MGG,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Optum VA,Optum VA,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,UHC,UHC,1046.19,,,,,,,per diem,1046.19,1046.19,"Per diem rate, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,UHC MGG,UHC MGG,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,VA,VA,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Wellcare MGG,Wellcare MGG,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Bright Health - commercial,Bright Health - commercial,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
OLOPATADINE OPHTHALMIC 0.1% OP,92125410,CDM,250,RC,,,,,,Inpatient,1,EA,1046.19,1046.19,Bright Health MGG,Bright Health MGG,1046.19,,,,,,,case rate,1046.19,1046.19,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL ORAL 500 MG TAB ,92125444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Aetna,Aetna,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Aetna MGG,Aetna MGG,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,BCBS,BCBS,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,BCBS MGG,BCBS MGG,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Cigna,Cigna,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Cigna MGG,Cigna MGG,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Humana,Humana,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Humana MGG,Humana MGG,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Optum VA,Optum VA,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,UHC,UHC,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,UHC MGG,UHC MGG,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,VA,VA,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Wellcare MGG,Wellcare MGG,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Bright Health - commercial,Bright Health - commercial,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
OXYCODONE  ORAL 30 MG ERT     ,92125478,CDM,250,RC,,,,,,Inpatient,1,EA,13.46,13.46,Bright Health MGG,Bright Health MGG,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE ORAL 500 MG ,92125519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Aetna,Aetna,14.82,,,,,,,per diem,14.82,14.82,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Aetna MGG,Aetna MGG,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,BCBS,BCBS,14.82,,,,,,,per diem,14.82,14.82,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,BCBS MGG,BCBS MGG,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Cigna,Cigna,14.82,,,,,,,per diem,14.82,14.82,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Cigna MGG,Cigna MGG,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Humana,Humana,14.82,,,,,,,per diem,14.82,14.82,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Humana MGG,Humana MGG,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Optum VA,Optum VA,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,UHC,UHC,14.82,,,,,,,per diem,14.82,14.82,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,UHC MGG,UHC MGG,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,VA,VA,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Wellcare MGG,Wellcare MGG,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Bright Health - commercial,Bright Health - commercial,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,14.82,14.82,Bright Health MGG,Bright Health MGG,14.82,,,,,,,case rate,14.82,14.82,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.5MG TAB         ,92125533,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ACETAMINOPHEN       ,92125581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna,Aetna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna MGG,Aetna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS,BCBS,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS MGG,BCBS MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna,Cigna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna MGG,Cigna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana,Humana,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana MGG,Humana MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Optum VA,Optum VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC,UHC,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC MGG,UHC MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,VA,VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Wellcare MGG,Wellcare MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health - commercial,Bright Health - commercial,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM INJ           ,92125583,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health MGG,Bright Health MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B12 500MCG TAB        ,92125595,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92125599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Aetna,Aetna,60.68,,,,,,,per diem,60.68,60.68,"Per diem rate, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Aetna MGG,Aetna MGG,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,BCBS,BCBS,60.68,,,,,,,per diem,60.68,60.68,"Per diem rate, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,BCBS MGG,BCBS MGG,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Cigna,Cigna,60.68,,,,,,,per diem,60.68,60.68,"Per diem rate, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Cigna MGG,Cigna MGG,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Humana,Humana,60.68,,,,,,,per diem,60.68,60.68,"Per diem rate, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Humana MGG,Humana MGG,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Optum VA,Optum VA,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,UHC,UHC,60.68,,,,,,,per diem,60.68,60.68,"Per diem rate, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,UHC MGG,UHC MGG,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,VA,VA,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Wellcare MGG,Wellcare MGG,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Bright Health - commercial,Bright Health - commercial,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
SILDENAFIL 20MG TAB           ,92125619,CDM,250,RC,,,,,,Inpatient,1,EA,60.68,60.68,Bright Health MGG,Bright Health MGG,60.68,,,,,,,case rate,60.68,60.68,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Aetna,Aetna,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Aetna MGG,Aetna MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,BCBS,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS MGG,BCBS MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Cigna,Cigna,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Cigna MGG,Cigna MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Humana,Humana,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Humana MGG,Humana MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Optum VA,Optum VA,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UHC,UHC,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UHC MGG,UHC MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,VA,VA,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Wellcare MGG,Wellcare MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Bright Health - commercial,Bright Health - commercial,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
BALSALAZIDE 750MG CAP         ,92125622,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Bright Health MGG,Bright Health MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Aetna,Aetna,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Aetna MGG,Aetna MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,BCBS,BCBS,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,BCBS MGG,BCBS MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Cigna,Cigna,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Cigna MGG,Cigna MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Humana,Humana,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Humana MGG,Humana MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Optum VA,Optum VA,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,UHC,UHC,8.04,,,,,,,per diem,8.04,8.04,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,UHC MGG,UHC MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,VA,VA,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Wellcare MGG,Wellcare MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Bright Health - commercial,Bright Health - commercial,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,8.04,8.04,Bright Health MGG,Bright Health MGG,8.04,,,,,,,case rate,8.04,8.04,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Aetna,Aetna,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Aetna MGG,Aetna MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,BCBS,BCBS,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,BCBS MGG,BCBS MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Cigna,Cigna,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Cigna MGG,Cigna MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Humana,Humana,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Humana MGG,Humana MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Optum VA,Optum VA,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,UHC,UHC,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,UHC MGG,UHC MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,VA,VA,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Wellcare MGG,Wellcare MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Bright Health - commercial,Bright Health - commercial,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92125748,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Bright Health MGG,Bright Health MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Aetna,Aetna,287.13,,,,,,,per diem,287.13,287.13,"Per diem rate, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Aetna MGG,Aetna MGG,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,BCBS,BCBS,287.13,,,,,,,per diem,287.13,287.13,"Per diem rate, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,BCBS MGG,BCBS MGG,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Cigna,Cigna,287.13,,,,,,,per diem,287.13,287.13,"Per diem rate, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Cigna MGG,Cigna MGG,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Humana,Humana,287.13,,,,,,,per diem,287.13,287.13,"Per diem rate, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Humana MGG,Humana MGG,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Optum VA,Optum VA,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,UHC,UHC,287.13,,,,,,,per diem,287.13,287.13,"Per diem rate, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,UHC MGG,UHC MGG,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,VA,VA,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Wellcare MGG,Wellcare MGG,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Bright Health - commercial,Bright Health - commercial,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
IPRATROPIUM BROMIDE 0.06%     ,92125752,CDM,250,RC,,,,,,Inpatient,1,EA,287.13,287.13,Bright Health MGG,Bright Health MGG,287.13,,,,,,,case rate,287.13,287.13,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Aetna,Aetna,179.97,,,,,,,per diem,179.97,179.97,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Aetna MGG,Aetna MGG,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,BCBS,BCBS,179.97,,,,,,,per diem,179.97,179.97,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,BCBS MGG,BCBS MGG,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Cigna,Cigna,179.97,,,,,,,per diem,179.97,179.97,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Cigna MGG,Cigna MGG,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Humana,Humana,179.97,,,,,,,per diem,179.97,179.97,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Humana MGG,Humana MGG,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Optum VA,Optum VA,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,UHC,UHC,179.97,,,,,,,per diem,179.97,179.97,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,UHC MGG,UHC MGG,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,VA,VA,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Wellcare MGG,Wellcare MGG,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Bright Health - commercial,Bright Health - commercial,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP O/S      ,92125766,CDM,250,RC,,,,,,Inpatient,1,EA,179.97,179.97,Bright Health MGG,Bright Health MGG,179.97,,,,,,,case rate,179.97,179.97,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ PKT       ,92125812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Aetna,Aetna,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Aetna MGG,Aetna MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,BCBS,BCBS,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,BCBS MGG,BCBS MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Cigna,Cigna,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Cigna MGG,Cigna MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Humana,Humana,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Humana MGG,Humana MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Optum VA,Optum VA,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,UHC,UHC,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,UHC MGG,UHC MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,VA,VA,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Wellcare MGG,Wellcare MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Bright Health - commercial,Bright Health - commercial,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% DRP     ,92125825,CDM,250,RC,,,,,,Inpatient,1,EA,83.25,83.25,Bright Health MGG,Bright Health MGG,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Aetna,Aetna,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Aetna MGG,Aetna MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,BCBS,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS MGG,BCBS MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Cigna,Cigna,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Cigna MGG,Cigna MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Humana,Humana,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Humana MGG,Humana MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Optum VA,Optum VA,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UHC,UHC,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UHC MGG,UHC MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA,VA,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Wellcare MGG,Wellcare MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Bright Health - commercial,Bright Health - commercial,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92125840,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Bright Health MGG,Bright Health MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Aetna,Aetna,2304,,,,,,,per diem,2304,2304,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Aetna MGG,Aetna MGG,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,BCBS,BCBS,2304,,,,,,,per diem,2304,2304,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,BCBS MGG,BCBS MGG,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Cigna,Cigna,2304,,,,,,,per diem,2304,2304,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Cigna MGG,Cigna MGG,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Humana,Humana,2304,,,,,,,per diem,2304,2304,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Humana MGG,Humana MGG,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Optum VA,Optum VA,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,UHC,UHC,2304,,,,,,,per diem,2304,2304,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,UHC MGG,UHC MGG,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,VA,VA,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Wellcare MGG,Wellcare MGG,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Bright Health - commercial,Bright Health - commercial,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92125843,CDM,250,RC,,,,,,Inpatient,1,EA,2304,2304,Bright Health MGG,Bright Health MGG,2304,,,,,,,case rate,2304,2304,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Aetna,Aetna,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Aetna MGG,Aetna MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,BCBS,BCBS,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,BCBS MGG,BCBS MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Cigna,Cigna,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Cigna MGG,Cigna MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Humana,Humana,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Humana MGG,Humana MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Optum VA,Optum VA,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,UHC,UHC,5.09,,,,,,,per diem,5.09,5.09,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,UHC MGG,UHC MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,VA,VA,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Wellcare MGG,Wellcare MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Bright Health - commercial,Bright Health - commercial,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92125870,CDM,250,RC,,,,,,Inpatient,1,EA,5.09,5.09,Bright Health MGG,Bright Health MGG,5.09,,,,,,,case rate,5.09,5.09,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE 1250MG      ,92125877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Aetna,Aetna,355.14,,,,,,,per diem,355.14,355.14,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Aetna MGG,Aetna MGG,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,BCBS,BCBS,355.14,,,,,,,per diem,355.14,355.14,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,BCBS MGG,BCBS MGG,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Cigna,Cigna,355.14,,,,,,,per diem,355.14,355.14,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Cigna MGG,Cigna MGG,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Humana,Humana,355.14,,,,,,,per diem,355.14,355.14,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Humana MGG,Humana MGG,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Optum VA,Optum VA,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,UHC,UHC,355.14,,,,,,,per diem,355.14,355.14,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,UHC MGG,UHC MGG,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,VA,VA,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Wellcare MGG,Wellcare MGG,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Bright Health - commercial,Bright Health - commercial,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE 100U/ML      ,92125902,CDM,250,RC,,,,,,Inpatient,1,EA,355.14,355.14,Bright Health MGG,Bright Health MGG,355.14,,,,,,,case rate,355.14,355.14,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Aetna,Aetna,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Aetna MGG,Aetna MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,BCBS,BCBS,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,BCBS MGG,BCBS MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Cigna,Cigna,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Cigna MGG,Cigna MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Humana,Humana,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Humana MGG,Humana MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Optum VA,Optum VA,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,UHC,UHC,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,UHC MGG,UHC MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,VA,VA,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Wellcare MGG,Wellcare MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Bright Health - commercial,Bright Health - commercial,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
PALIPERIDONE  6MG TAB         ,92125933,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Bright Health MGG,Bright Health MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Aetna,Aetna,52.2,,,,,,,per diem,52.2,52.2,"Per diem rate, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Aetna MGG,Aetna MGG,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,BCBS,BCBS,52.2,,,,,,,per diem,52.2,52.2,"Per diem rate, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,BCBS MGG,BCBS MGG,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Cigna,Cigna,52.2,,,,,,,per diem,52.2,52.2,"Per diem rate, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Cigna MGG,Cigna MGG,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Humana,Humana,52.2,,,,,,,per diem,52.2,52.2,"Per diem rate, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Humana MGG,Humana MGG,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Optum VA,Optum VA,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,UHC,UHC,52.2,,,,,,,per diem,52.2,52.2,"Per diem rate, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,UHC MGG,UHC MGG,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,VA,VA,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Wellcare MGG,Wellcare MGG,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Bright Health - commercial,Bright Health - commercial,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
K CITRATE 1080MG/10MEQ        ,92125934,CDM,250,RC,,,,,,Inpatient,1,EA,52.2,52.2,Bright Health MGG,Bright Health MGG,52.2,,,,,,,case rate,52.2,52.2,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE 4% TOPICAL 50ML     ,92125946,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTIN TAB 5000MCG            ,92125987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Aetna,Aetna,398.88,,,,,,,per diem,398.88,398.88,"Per diem rate, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Aetna MGG,Aetna MGG,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,BCBS,BCBS,398.88,,,,,,,per diem,398.88,398.88,"Per diem rate, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,BCBS MGG,BCBS MGG,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Cigna,Cigna,398.88,,,,,,,per diem,398.88,398.88,"Per diem rate, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Cigna MGG,Cigna MGG,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Humana,Humana,398.88,,,,,,,per diem,398.88,398.88,"Per diem rate, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Humana MGG,Humana MGG,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Optum VA,Optum VA,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,UHC,UHC,398.88,,,,,,,per diem,398.88,398.88,"Per diem rate, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,UHC MGG,UHC MGG,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,VA,VA,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Wellcare MGG,Wellcare MGG,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Bright Health - commercial,Bright Health - commercial,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
UMECLIDINIUM & VILANTEROL     ,92126021,CDM,250,RC,,,,,,Inpatient,1,EA,398.88,398.88,Bright Health MGG,Bright Health MGG,398.88,,,,,,,case rate,398.88,398.88,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Aetna,Aetna,22.93,,,,,,,per diem,22.93,22.93,"Per diem rate, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Aetna MGG,Aetna MGG,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,BCBS,BCBS,22.93,,,,,,,per diem,22.93,22.93,"Per diem rate, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,BCBS MGG,BCBS MGG,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Cigna,Cigna,22.93,,,,,,,per diem,22.93,22.93,"Per diem rate, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Cigna MGG,Cigna MGG,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Humana,Humana,22.93,,,,,,,per diem,22.93,22.93,"Per diem rate, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Humana MGG,Humana MGG,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Optum VA,Optum VA,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,UHC,UHC,22.93,,,,,,,per diem,22.93,22.93,"Per diem rate, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,UHC MGG,UHC MGG,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,VA,VA,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Wellcare MGG,Wellcare MGG,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Bright Health - commercial,Bright Health - commercial,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
URSODIOL 300 MG CAP           ,92126064,CDM,250,RC,,,,,,Inpatient,1,EA,22.93,22.93,Bright Health MGG,Bright Health MGG,22.93,,,,,,,case rate,22.93,22.93,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG CAP       ,92126081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Aetna,Aetna,109.66,,,,,,,per diem,109.66,109.66,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Aetna MGG,Aetna MGG,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,BCBS,BCBS,109.66,,,,,,,per diem,109.66,109.66,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,BCBS MGG,BCBS MGG,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Cigna,Cigna,109.66,,,,,,,per diem,109.66,109.66,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Cigna MGG,Cigna MGG,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Humana,Humana,109.66,,,,,,,per diem,109.66,109.66,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Humana MGG,Humana MGG,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Optum VA,Optum VA,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,UHC,UHC,109.66,,,,,,,per diem,109.66,109.66,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,UHC MGG,UHC MGG,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,VA,VA,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Wellcare MGG,Wellcare MGG,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Bright Health - commercial,Bright Health - commercial,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% DRP      ,92126087,CDM,250,RC,,,,,,Inpatient,1,EA,109.66,109.66,Bright Health MGG,Bright Health MGG,109.66,,,,,,,case rate,109.66,109.66,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Aetna,Aetna,178.52,,,,,,,per diem,178.52,178.52,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Aetna MGG,Aetna MGG,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,BCBS,BCBS,178.52,,,,,,,per diem,178.52,178.52,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,BCBS MGG,BCBS MGG,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Cigna,Cigna,178.52,,,,,,,per diem,178.52,178.52,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Cigna MGG,Cigna MGG,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Humana,Humana,178.52,,,,,,,per diem,178.52,178.52,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Humana MGG,Humana MGG,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Optum VA,Optum VA,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,UHC,UHC,178.52,,,,,,,per diem,178.52,178.52,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,UHC MGG,UHC MGG,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,VA,VA,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Wellcare MGG,Wellcare MGG,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Bright Health - commercial,Bright Health - commercial,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,178.52,178.52,Bright Health MGG,Bright Health MGG,178.52,,,,,,,case rate,178.52,178.52,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna,Aetna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna MGG,Aetna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS,BCBS,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS MGG,BCBS MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna,Cigna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna MGG,Cigna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana,Humana,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana MGG,Humana MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Optum VA,Optum VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC,UHC,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC MGG,UHC MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,VA,VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Wellcare MGG,Wellcare MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health - commercial,Bright Health - commercial,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE (SOD PHO     ,92127165,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health MGG,Bright Health MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Aetna,Aetna,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Aetna MGG,Aetna MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,BCBS,BCBS,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,BCBS MGG,BCBS MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Cigna,Cigna,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Cigna MGG,Cigna MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Humana,Humana,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Humana MGG,Humana MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Optum VA,Optum VA,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,UHC,UHC,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,UHC MGG,UHC MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,VA,VA,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Wellcare MGG,Wellcare MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Bright Health - commercial,Bright Health - commercial,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% 15gm Ointmen     ,92127175,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Bright Health MGG,Bright Health MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna,Aetna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna MGG,Aetna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS,BCBS,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS MGG,BCBS MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna,Cigna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna MGG,Cigna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana,Humana,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana MGG,Humana MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Optum VA,Optum VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC,UHC,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC MGG,UHC MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,VA,VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Wellcare MGG,Wellcare MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health - commercial,Bright Health - commercial,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health MGG,Bright Health MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Aetna,Aetna,47.7,,,,,,,per diem,47.7,47.7,"Per diem rate, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Aetna MGG,Aetna MGG,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,BCBS,BCBS,47.7,,,,,,,per diem,47.7,47.7,"Per diem rate, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,BCBS MGG,BCBS MGG,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Cigna,Cigna,47.7,,,,,,,per diem,47.7,47.7,"Per diem rate, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Cigna MGG,Cigna MGG,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Humana,Humana,47.7,,,,,,,per diem,47.7,47.7,"Per diem rate, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Humana MGG,Humana MGG,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Optum VA,Optum VA,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,UHC,UHC,47.7,,,,,,,per diem,47.7,47.7,"Per diem rate, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,UHC MGG,UHC MGG,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,VA,VA,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Wellcare MGG,Wellcare MGG,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Bright Health - commercial,Bright Health - commercial,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
DEX 50% (DEXTROSE 50%) 1M     ,92127278,CDM,250,RC,,,,,,Inpatient,1,EA,47.7,47.7,Bright Health MGG,Bright Health MGG,47.7,,,,,,,case rate,47.7,47.7,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Aetna,Aetna,119.71,,,,,,,per diem,119.71,119.71,"Per diem rate, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Aetna MGG,Aetna MGG,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,BCBS,BCBS,119.71,,,,,,,per diem,119.71,119.71,"Per diem rate, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,BCBS MGG,BCBS MGG,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Cigna,Cigna,119.71,,,,,,,per diem,119.71,119.71,"Per diem rate, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Cigna MGG,Cigna MGG,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Humana,Humana,119.71,,,,,,,per diem,119.71,119.71,"Per diem rate, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Humana MGG,Humana MGG,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Optum VA,Optum VA,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,UHC,UHC,119.71,,,,,,,per diem,119.71,119.71,"Per diem rate, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,UHC MGG,UHC MGG,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,VA,VA,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Wellcare MGG,Wellcare MGG,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Bright Health - commercial,Bright Health - commercial,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
EUCERIN CREAM 120GM           ,92128289,CDM,250,RC,,,,,,Inpatient,1,EA,119.71,119.71,Bright Health MGG,Bright Health MGG,119.71,,,,,,,case rate,119.71,119.71,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Aetna,Aetna,41.86,,,,,,,per diem,41.86,41.86,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Aetna MGG,Aetna MGG,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,BCBS,BCBS,41.86,,,,,,,per diem,41.86,41.86,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,BCBS MGG,BCBS MGG,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Cigna,Cigna,41.86,,,,,,,per diem,41.86,41.86,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Cigna MGG,Cigna MGG,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Humana,Humana,41.86,,,,,,,per diem,41.86,41.86,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Humana MGG,Humana MGG,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Optum VA,Optum VA,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,UHC,UHC,41.86,,,,,,,per diem,41.86,41.86,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,UHC MGG,UHC MGG,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,VA,VA,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Wellcare MGG,Wellcare MGG,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Bright Health - commercial,Bright Health - commercial,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,41.86,41.86,Bright Health MGG,Bright Health MGG,41.86,,,,,,,case rate,41.86,41.86,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Aetna,Aetna,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Aetna MGG,Aetna MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,BCBS,BCBS,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,BCBS MGG,BCBS MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Cigna,Cigna,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Cigna MGG,Cigna MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Humana,Humana,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Humana MGG,Humana MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Optum VA,Optum VA,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,UHC,UHC,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,UHC MGG,UHC MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,VA,VA,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Wellcare MGG,Wellcare MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Bright Health - commercial,Bright Health - commercial,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
TOPIRAMATE (TOPAMAX) 100M     ,92128434,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Bright Health MGG,Bright Health MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna,Aetna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna MGG,Aetna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,BCBS,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS MGG,BCBS MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna,Cigna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna MGG,Cigna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana,Humana,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana MGG,Humana MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Optum VA,Optum VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC,UHC,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC MGG,UHC MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,VA,VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Wellcare MGG,Wellcare MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health - commercial,Bright Health - commercial,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DIPHENHYDRAM/ZN  AC (ANTI     ,92128451,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health MGG,Bright Health MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM PWD PKT 3.4GM PW     ,92128499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Aetna,Aetna,159.25,,,,,,,per diem,159.25,159.25,"Per diem rate, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Aetna MGG,Aetna MGG,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,BCBS,BCBS,159.25,,,,,,,per diem,159.25,159.25,"Per diem rate, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,BCBS MGG,BCBS MGG,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Cigna,Cigna,159.25,,,,,,,per diem,159.25,159.25,"Per diem rate, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Cigna MGG,Cigna MGG,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Humana,Humana,159.25,,,,,,,per diem,159.25,159.25,"Per diem rate, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Humana MGG,Humana MGG,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Optum VA,Optum VA,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,UHC,UHC,159.25,,,,,,,per diem,159.25,159.25,"Per diem rate, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,UHC MGG,UHC MGG,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,VA,VA,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Wellcare MGG,Wellcare MGG,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Bright Health - commercial,Bright Health - commercial,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
LURASIDONE 20MG TAB           ,92128521,CDM,250,RC,,,,,,Inpatient,1,EA,159.25,159.25,Bright Health MGG,Bright Health MGG,159.25,,,,,,,case rate,159.25,159.25,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Aetna,Aetna,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Aetna MGG,Aetna MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,BCBS,BCBS,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,BCBS MGG,BCBS MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Cigna,Cigna,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Cigna MGG,Cigna MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Humana,Humana,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Humana MGG,Humana MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Optum VA,Optum VA,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,UHC,UHC,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,UHC MGG,UHC MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,VA,VA,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Wellcare MGG,Wellcare MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Bright Health - commercial,Bright Health - commercial,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
PANTOPRAZOLE 40 MG GRANULES   ,92128558,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Bright Health MGG,Bright Health MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna,Aetna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna MGG,Aetna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,BCBS,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS MGG,BCBS MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna,Cigna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna MGG,Cigna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana,Humana,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana MGG,Humana MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Optum VA,Optum VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC,UHC,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC MGG,UHC MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Wellcare MGG,Wellcare MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health - commercial,Bright Health - commercial,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 2MG TAB            ,92128567,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health MGG,Bright Health MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Aetna,Aetna,51.56,,,,,,,per diem,51.56,51.56,"Per diem rate, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Aetna MGG,Aetna MGG,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,BCBS,BCBS,51.56,,,,,,,per diem,51.56,51.56,"Per diem rate, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,BCBS MGG,BCBS MGG,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Cigna,Cigna,51.56,,,,,,,per diem,51.56,51.56,"Per diem rate, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Cigna MGG,Cigna MGG,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Humana,Humana,51.56,,,,,,,per diem,51.56,51.56,"Per diem rate, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Humana MGG,Humana MGG,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Optum VA,Optum VA,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,UHC,UHC,51.56,,,,,,,per diem,51.56,51.56,"Per diem rate, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,UHC MGG,UHC MGG,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,VA,VA,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Wellcare MGG,Wellcare MGG,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Bright Health - commercial,Bright Health - commercial,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
MIRABEGRON 25MG TAB           ,92128569,CDM,250,RC,,,,,,Inpatient,1,EA,51.56,51.56,Bright Health MGG,Bright Health MGG,51.56,,,,,,,case rate,51.56,51.56,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Aetna,Aetna,7.39,,,,,,,per diem,7.39,7.39,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Aetna MGG,Aetna MGG,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,BCBS,BCBS,7.39,,,,,,,per diem,7.39,7.39,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,BCBS MGG,BCBS MGG,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Cigna,Cigna,7.39,,,,,,,per diem,7.39,7.39,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Cigna MGG,Cigna MGG,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Humana,Humana,7.39,,,,,,,per diem,7.39,7.39,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Humana MGG,Humana MGG,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Optum VA,Optum VA,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,UHC,UHC,7.39,,,,,,,per diem,7.39,7.39,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,UHC MGG,UHC MGG,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,VA,VA,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Wellcare MGG,Wellcare MGG,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Bright Health - commercial,Bright Health - commercial,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,7.39,7.39,Bright Health MGG,Bright Health MGG,7.39,,,,,,,case rate,7.39,7.39,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92128586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Aetna,Aetna,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Aetna MGG,Aetna MGG,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,BCBS,BCBS,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,BCBS MGG,BCBS MGG,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Cigna,Cigna,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Cigna MGG,Cigna MGG,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Humana,Humana,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Humana MGG,Humana MGG,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Optum VA,Optum VA,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,UHC,UHC,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,UHC MGG,UHC MGG,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,VA,VA,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Wellcare MGG,Wellcare MGG,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Bright Health - commercial,Bright Health - commercial,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE 60MG CAP         ,92128743,CDM,250,RC,,,,,,Inpatient,1,EA,26.89,26.89,Bright Health MGG,Bright Health MGG,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Aetna,Aetna,12.64,,,,,,,per diem,12.64,12.64,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Aetna MGG,Aetna MGG,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,BCBS,BCBS,12.64,,,,,,,per diem,12.64,12.64,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,BCBS MGG,BCBS MGG,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Cigna,Cigna,12.64,,,,,,,per diem,12.64,12.64,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Cigna MGG,Cigna MGG,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Humana,Humana,12.64,,,,,,,per diem,12.64,12.64,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Humana MGG,Humana MGG,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Optum VA,Optum VA,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,UHC,UHC,12.64,,,,,,,per diem,12.64,12.64,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,UHC MGG,UHC MGG,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,VA,VA,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Wellcare MGG,Wellcare MGG,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Bright Health - commercial,Bright Health - commercial,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,12.64,12.64,Bright Health MGG,Bright Health MGG,12.64,,,,,,,case rate,12.64,12.64,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Aetna,Aetna,45.97,,,,,,,per diem,45.97,45.97,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Aetna MGG,Aetna MGG,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,BCBS,BCBS,45.97,,,,,,,per diem,45.97,45.97,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,BCBS MGG,BCBS MGG,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Cigna,Cigna,45.97,,,,,,,per diem,45.97,45.97,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Cigna MGG,Cigna MGG,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Humana,Humana,45.97,,,,,,,per diem,45.97,45.97,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Humana MGG,Humana MGG,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Optum VA,Optum VA,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,UHC,UHC,45.97,,,,,,,per diem,45.97,45.97,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,UHC MGG,UHC MGG,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,VA,VA,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Wellcare MGG,Wellcare MGG,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Bright Health - commercial,Bright Health - commercial,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,45.97,45.97,Bright Health MGG,Bright Health MGG,45.97,,,,,,,case rate,45.97,45.97,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Aetna,Aetna,22.27,,,,,,,per diem,22.27,22.27,"Per diem rate, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Aetna MGG,Aetna MGG,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,BCBS,BCBS,22.27,,,,,,,per diem,22.27,22.27,"Per diem rate, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,BCBS MGG,BCBS MGG,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Cigna,Cigna,22.27,,,,,,,per diem,22.27,22.27,"Per diem rate, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Cigna MGG,Cigna MGG,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Humana,Humana,22.27,,,,,,,per diem,22.27,22.27,"Per diem rate, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Humana MGG,Humana MGG,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Optum VA,Optum VA,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,UHC,UHC,22.27,,,,,,,per diem,22.27,22.27,"Per diem rate, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,UHC MGG,UHC MGG,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,VA,VA,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Wellcare MGG,Wellcare MGG,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Bright Health - commercial,Bright Health - commercial,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LUBIPROSTONE 24MCG CAP        ,92128794,CDM,250,RC,,,,,,Inpatient,1,EA,22.27,22.27,Bright Health MGG,Bright Health MGG,22.27,,,,,,,case rate,22.27,22.27,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Aetna,Aetna,58.88,,,,,,,per diem,58.88,58.88,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Aetna MGG,Aetna MGG,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,BCBS,BCBS,58.88,,,,,,,per diem,58.88,58.88,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,BCBS MGG,BCBS MGG,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Cigna,Cigna,58.88,,,,,,,per diem,58.88,58.88,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Cigna MGG,Cigna MGG,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Humana,Humana,58.88,,,,,,,per diem,58.88,58.88,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Humana MGG,Humana MGG,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Optum VA,Optum VA,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,UHC,UHC,58.88,,,,,,,per diem,58.88,58.88,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,UHC MGG,UHC MGG,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,VA,VA,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Wellcare MGG,Wellcare MGG,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Bright Health - commercial,Bright Health - commercial,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,58.88,58.88,Bright Health MGG,Bright Health MGG,58.88,,,,,,,case rate,58.88,58.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Aetna,Aetna,734.88,,,,,,,per diem,734.88,734.88,"Per diem rate, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Aetna MGG,Aetna MGG,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,BCBS,BCBS,734.88,,,,,,,per diem,734.88,734.88,"Per diem rate, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,BCBS MGG,BCBS MGG,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Cigna,Cigna,734.88,,,,,,,per diem,734.88,734.88,"Per diem rate, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Cigna MGG,Cigna MGG,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Humana,Humana,734.88,,,,,,,per diem,734.88,734.88,"Per diem rate, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Humana MGG,Humana MGG,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Optum VA,Optum VA,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,UHC,UHC,734.88,,,,,,,per diem,734.88,734.88,"Per diem rate, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,UHC MGG,UHC MGG,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,VA,VA,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Wellcare MGG,Wellcare MGG,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Bright Health - commercial,Bright Health - commercial,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
BRIMONIDINE/TIMOLOL 0.2%/0.5% ,92128808,CDM,250,RC,,,,,,Inpatient,1,EA,734.88,734.88,Bright Health MGG,Bright Health MGG,734.88,,,,,,,case rate,734.88,734.88,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE 50MG TAB           ,92128850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Aetna,Aetna,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Aetna MGG,Aetna MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,BCBS,BCBS,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,BCBS MGG,BCBS MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Cigna,Cigna,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Cigna MGG,Cigna MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Humana,Humana,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Humana MGG,Humana MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Optum VA,Optum VA,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,UHC,UHC,62,,,,,,,per diem,62,62,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,UHC MGG,UHC MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,VA,VA,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Wellcare MGG,Wellcare MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Bright Health - commercial,Bright Health - commercial,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,62,62,Bright Health MGG,Bright Health MGG,62,,,,,,,case rate,62,62,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650 MG RECT     ,92128927,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Aetna,Aetna,44.89,,,,,,,per diem,44.89,44.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Aetna MGG,Aetna MGG,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,BCBS,BCBS,44.89,,,,,,,per diem,44.89,44.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,BCBS MGG,BCBS MGG,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Cigna,Cigna,44.89,,,,,,,per diem,44.89,44.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Cigna MGG,Cigna MGG,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Humana,Humana,44.89,,,,,,,per diem,44.89,44.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Humana MGG,Humana MGG,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Optum VA,Optum VA,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,UHC,UHC,44.89,,,,,,,per diem,44.89,44.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,UHC MGG,UHC MGG,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,VA,VA,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Wellcare MGG,Wellcare MGG,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Bright Health - commercial,Bright Health - commercial,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 200 MG/ML      ,92128928,CDM,250,RC,,,,,,Inpatient,1,EA,44.89,44.89,Bright Health MGG,Bright Health MGG,44.89,,,,,,,case rate,44.89,44.89,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Aetna,Aetna,81.78,,,,,,,per diem,81.78,81.78,"Per diem rate, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Aetna MGG,Aetna MGG,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,BCBS,BCBS,81.78,,,,,,,per diem,81.78,81.78,"Per diem rate, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,BCBS MGG,BCBS MGG,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Cigna,Cigna,81.78,,,,,,,per diem,81.78,81.78,"Per diem rate, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Cigna MGG,Cigna MGG,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Humana,Humana,81.78,,,,,,,per diem,81.78,81.78,"Per diem rate, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Humana MGG,Humana MGG,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Optum VA,Optum VA,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,UHC,UHC,81.78,,,,,,,per diem,81.78,81.78,"Per diem rate, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,UHC MGG,UHC MGG,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,VA,VA,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Wellcare MGG,Wellcare MGG,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Bright Health - commercial,Bright Health - commercial,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALBUTEROL SULFATE HFA 90      ,92128934,CDM,250,RC,,,,,,Inpatient,1,EA,81.78,81.78,Bright Health MGG,Bright Health MGG,81.78,,,,,,,case rate,81.78,81.78,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 50 MG TABLE     ,92128941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Aetna,Aetna,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Aetna MGG,Aetna MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,BCBS,BCBS,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,BCBS MGG,BCBS MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Cigna,Cigna,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Cigna MGG,Cigna MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Humana,Humana,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Humana MGG,Humana MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Optum VA,Optum VA,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,UHC,UHC,31.74,,,,,,,per diem,31.74,31.74,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,UHC MGG,UHC MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,VA,VA,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Wellcare MGG,Wellcare MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Bright Health - commercial,Bright Health - commercial,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,31.74,31.74,Bright Health MGG,Bright Health MGG,31.74,,,,,,,case rate,31.74,31.74,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Aetna,Aetna,315.72,,,,,,,per diem,315.72,315.72,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Aetna MGG,Aetna MGG,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,BCBS,BCBS,315.72,,,,,,,per diem,315.72,315.72,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,BCBS MGG,BCBS MGG,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Cigna,Cigna,315.72,,,,,,,per diem,315.72,315.72,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Cigna MGG,Cigna MGG,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Humana,Humana,315.72,,,,,,,per diem,315.72,315.72,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Humana MGG,Humana MGG,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Optum VA,Optum VA,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,UHC,UHC,315.72,,,,,,,per diem,315.72,315.72,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,UHC MGG,UHC MGG,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,VA,VA,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Wellcare MGG,Wellcare MGG,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Bright Health - commercial,Bright Health - commercial,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,315.72,315.72,Bright Health MGG,Bright Health MGG,315.72,,,,,,,case rate,315.72,315.72,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN ZINC 500 UNIT/     ,92128956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Aetna,Aetna,27.57,,,,,,,per diem,27.57,27.57,"Per diem rate, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Aetna MGG,Aetna MGG,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,BCBS,BCBS,27.57,,,,,,,per diem,27.57,27.57,"Per diem rate, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,BCBS MGG,BCBS MGG,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Cigna,Cigna,27.57,,,,,,,per diem,27.57,27.57,"Per diem rate, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Cigna MGG,Cigna MGG,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Humana,Humana,27.57,,,,,,,per diem,27.57,27.57,"Per diem rate, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Humana MGG,Humana MGG,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Optum VA,Optum VA,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,UHC,UHC,27.57,,,,,,,per diem,27.57,27.57,"Per diem rate, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,UHC MGG,UHC MGG,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,VA,VA,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Wellcare MGG,Wellcare MGG,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Bright Health - commercial,Bright Health - commercial,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BACITRACIN-POLYMYXIN B 50     ,92128957,CDM,250,RC,,,,,,Inpatient,1,EA,27.57,27.57,Bright Health MGG,Bright Health MGG,27.57,,,,,,,case rate,27.57,27.57,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Aetna,Aetna,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Aetna MGG,Aetna MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,BCBS,BCBS,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,BCBS MGG,BCBS MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Cigna,Cigna,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Cigna MGG,Cigna MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Humana,Humana,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Humana MGG,Humana MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Optum VA,Optum VA,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,UHC,UHC,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,UHC MGG,UHC MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,VA,VA,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Wellcare MGG,Wellcare MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Bright Health - commercial,Bright Health - commercial,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BALSAM PERU-CASTOR OIL 87     ,92128958,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Bright Health MGG,Bright Health MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Aetna,Aetna,666.66,,,,,,,per diem,666.66,666.66,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Aetna MGG,Aetna MGG,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,BCBS,BCBS,666.66,,,,,,,per diem,666.66,666.66,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,BCBS MGG,BCBS MGG,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Cigna,Cigna,666.66,,,,,,,per diem,666.66,666.66,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Cigna MGG,Cigna MGG,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Humana,Humana,666.66,,,,,,,per diem,666.66,666.66,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Humana MGG,Humana MGG,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Optum VA,Optum VA,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,UHC,UHC,666.66,,,,,,,per diem,666.66,666.66,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,UHC MGG,UHC MGG,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,VA,VA,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Wellcare MGG,Wellcare MGG,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Bright Health - commercial,Bright Health - commercial,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.1 PCT EYE DRO   ,92128973,CDM,250,RC,,,,,,Inpatient,1,EA,666.66,666.66,Bright Health MGG,Bright Health MGG,666.66,,,,,,,case rate,666.66,666.66,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Aetna,Aetna,575.04,,,,,,,per diem,575.04,575.04,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Aetna MGG,Aetna MGG,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,BCBS,BCBS,575.04,,,,,,,per diem,575.04,575.04,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,BCBS MGG,BCBS MGG,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Cigna,Cigna,575.04,,,,,,,per diem,575.04,575.04,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Cigna MGG,Cigna MGG,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Humana,Humana,575.04,,,,,,,per diem,575.04,575.04,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Humana MGG,Humana MGG,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Optum VA,Optum VA,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,UHC,UHC,575.04,,,,,,,per diem,575.04,575.04,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,UHC MGG,UHC MGG,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,VA,VA,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Wellcare MGG,Wellcare MGG,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Bright Health - commercial,Bright Health - commercial,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.15 PCT EYE DR   ,92128974,CDM,250,RC,,,,,,Inpatient,1,EA,575.04,575.04,Bright Health MGG,Bright Health MGG,575.04,,,,,,,case rate,575.04,575.04,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Aetna,Aetna,16.02,,,,,,,per diem,16.02,16.02,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Aetna MGG,Aetna MGG,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,BCBS,BCBS,16.02,,,,,,,per diem,16.02,16.02,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,BCBS MGG,BCBS MGG,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Cigna,Cigna,16.02,,,,,,,per diem,16.02,16.02,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Cigna MGG,Cigna MGG,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Humana,Humana,16.02,,,,,,,per diem,16.02,16.02,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Humana MGG,Humana MGG,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Optum VA,Optum VA,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,UHC,UHC,16.02,,,,,,,per diem,16.02,16.02,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,UHC MGG,UHC MGG,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,VA,VA,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Wellcare MGG,Wellcare MGG,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Bright Health - commercial,Bright Health - commercial,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,16.02,16.02,Bright Health MGG,Bright Health MGG,16.02,,,,,,,case rate,16.02,16.02,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Aetna,Aetna,927.4,,,,,,,per diem,927.4,927.4,"Per diem rate, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Aetna MGG,Aetna MGG,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,BCBS,BCBS,927.4,,,,,,,per diem,927.4,927.4,"Per diem rate, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,BCBS MGG,BCBS MGG,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Cigna,Cigna,927.4,,,,,,,per diem,927.4,927.4,"Per diem rate, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Cigna MGG,Cigna MGG,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Humana,Humana,927.4,,,,,,,per diem,927.4,927.4,"Per diem rate, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Humana MGG,Humana MGG,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Optum VA,Optum VA,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,UHC,UHC,927.4,,,,,,,per diem,927.4,927.4,"Per diem rate, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,UHC MGG,UHC MGG,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,VA,VA,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Wellcare MGG,Wellcare MGG,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Bright Health - commercial,Bright Health - commercial,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
BUDESONIDE-FORMOTEROL HFA     ,92128981,CDM,250,RC,,,,,,Inpatient,1,EA,927.4,927.4,Bright Health MGG,Bright Health MGG,927.4,,,,,,,case rate,927.4,927.4,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Aetna,Aetna,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Aetna MGG,Aetna MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,BCBS,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS MGG,BCBS MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Cigna,Cigna,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Cigna MGG,Cigna MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Humana,Humana,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Humana MGG,Humana MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Optum VA,Optum VA,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UHC,UHC,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UHC MGG,UHC MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,VA,VA,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Wellcare MGG,Wellcare MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Bright Health - commercial,Bright Health - commercial,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CALAMINE 8 PCT-ZINC OXIDE 8   ,92128987,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Bright Health MGG,Bright Health MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WE     ,92129017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Aetna,Aetna,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Aetna MGG,Aetna MGG,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,BCBS,BCBS,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,BCBS MGG,BCBS MGG,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Cigna,Cigna,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Cigna MGG,Cigna MGG,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Humana,Humana,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Humana MGG,Humana MGG,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Optum VA,Optum VA,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,UHC,UHC,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,UHC MGG,UHC MGG,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,VA,VA,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Wellcare MGG,Wellcare MGG,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Bright Health - commercial,Bright Health - commercial,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESEVELAM 625 MG TABLET     ,92129021,CDM,250,RC,,,,,,Inpatient,1,EA,11.87,11.87,Bright Health MGG,Bright Health MGG,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Aetna,Aetna,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Aetna MGG,Aetna MGG,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,BCBS,BCBS,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,BCBS MGG,BCBS MGG,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Cigna,Cigna,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Cigna MGG,Cigna MGG,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Humana,Humana,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Humana MGG,Humana MGG,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Optum VA,Optum VA,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,UHC,UHC,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,UHC MGG,UHC MGG,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,VA,VA,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Wellcare MGG,Wellcare MGG,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Bright Health - commercial,Bright Health - commercial,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLESTIPOL 1 GRAM TABLET      ,92129022,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,Bright Health MGG,Bright Health MGG,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Aetna,Aetna,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Aetna MGG,Aetna MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,BCBS,BCBS,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,BCBS MGG,BCBS MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Cigna,Cigna,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Cigna MGG,Cigna MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Humana,Humana,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Humana MGG,Humana MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Optum VA,Optum VA,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,UHC,UHC,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,UHC MGG,UHC MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,VA,VA,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Wellcare MGG,Wellcare MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Bright Health - commercial,Bright Health - commercial,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE CLOSTRIDIUM H     ,92129023,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Bright Health MGG,Bright Health MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Aetna,Aetna,38.74,,,,,,,per diem,38.74,38.74,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Aetna MGG,Aetna MGG,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,BCBS,BCBS,38.74,,,,,,,per diem,38.74,38.74,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,BCBS MGG,BCBS MGG,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Cigna,Cigna,38.74,,,,,,,per diem,38.74,38.74,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Cigna MGG,Cigna MGG,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Humana,Humana,38.74,,,,,,,per diem,38.74,38.74,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Humana MGG,Humana MGG,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Optum VA,Optum VA,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,UHC,UHC,38.74,,,,,,,per diem,38.74,38.74,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,UHC MGG,UHC MGG,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,VA,VA,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Wellcare MGG,Wellcare MGG,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Bright Health - commercial,Bright Health - commercial,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 0.05 PCT EYE D   ,92129026,CDM,250,RC,,,,,,Inpatient,1,EA,38.74,38.74,Bright Health MGG,Bright Health MGG,38.74,,,,,,,case rate,38.74,38.74,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DAPTOMYCIN IVPB               ,92129030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Aetna,Aetna,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Aetna MGG,Aetna MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,BCBS,BCBS,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,BCBS MGG,BCBS MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Cigna,Cigna,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Cigna MGG,Cigna MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Humana,Humana,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Humana MGG,Humana MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Optum VA,Optum VA,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,UHC,UHC,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,UHC MGG,UHC MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,VA,VA,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Wellcare MGG,Wellcare MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Bright Health - commercial,Bright Health - commercial,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DEXTROSE 5 PCT IN WATER D5    ,92129046,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Bright Health MGG,Bright Health MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Aetna,Aetna,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Aetna MGG,Aetna MGG,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,BCBS,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS MGG,BCBS MGG,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Cigna,Cigna,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Cigna MGG,Cigna MGG,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Humana,Humana,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Humana MGG,Humana MGG,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Optum VA,Optum VA,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,UHC,UHC,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,UHC MGG,UHC MGG,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,VA,VA,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Wellcare MGG,Wellcare MGG,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Bright Health - commercial,Bright Health - commercial,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE-ZINC ACET     ,92129053,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,Bright Health MGG,Bright Health MGG,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Aetna,Aetna,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Aetna MGG,Aetna MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,BCBS,BCBS,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,BCBS MGG,BCBS MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Cigna,Cigna,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Cigna MGG,Cigna MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Humana,Humana,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Humana MGG,Humana MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Optum VA,Optum VA,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,UHC,UHC,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,UHC MGG,UHC MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,VA,VA,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Wellcare MGG,Wellcare MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Bright Health - commercial,Bright Health - commercial,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
"DIVALPROEX 500 MG TABLET,     ",92129057,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Bright Health MGG,Bright Health MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 50 MG/5 M     ,92129058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Aetna,Aetna,421.45,,,,,,,per diem,421.45,421.45,"Per diem rate, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Aetna MGG,Aetna MGG,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,BCBS,BCBS,421.45,,,,,,,per diem,421.45,421.45,"Per diem rate, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,BCBS MGG,BCBS MGG,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Cigna,Cigna,421.45,,,,,,,per diem,421.45,421.45,"Per diem rate, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Cigna MGG,Cigna MGG,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Humana,Humana,421.45,,,,,,,per diem,421.45,421.45,"Per diem rate, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Humana MGG,Humana MGG,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Optum VA,Optum VA,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,UHC,UHC,421.45,,,,,,,per diem,421.45,421.45,"Per diem rate, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,UHC MGG,UHC MGG,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,VA,VA,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Wellcare MGG,Wellcare MGG,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Bright Health - commercial,Bright Health - commercial,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
ERTAPENEM 1 GRAM INFUSION     ,92129068,CDM,250,RC,,,,,,Inpatient,1,EA,421.45,421.45,Bright Health MGG,Bright Health MGG,421.45,,,,,,,case rate,421.45,421.45,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Aetna,Aetna,45.19,,,,,,,per diem,45.19,45.19,"Per diem rate, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Aetna MGG,Aetna MGG,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,BCBS,BCBS,45.19,,,,,,,per diem,45.19,45.19,"Per diem rate, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,BCBS MGG,BCBS MGG,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Cigna,Cigna,45.19,,,,,,,per diem,45.19,45.19,"Per diem rate, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Cigna MGG,Cigna MGG,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Humana,Humana,45.19,,,,,,,per diem,45.19,45.19,"Per diem rate, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Humana MGG,Humana MGG,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Optum VA,Optum VA,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,UHC,UHC,45.19,,,,,,,per diem,45.19,45.19,"Per diem rate, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,UHC MGG,UHC MGG,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,VA,VA,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Wellcare MGG,Wellcare MGG,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Bright Health - commercial,Bright Health - commercial,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FESOTERODINE ER 4 MG TABL     ,92129078,CDM,250,RC,,,,,,Inpatient,1,EA,45.19,45.19,Bright Health MGG,Bright Health MGG,45.19,,,,,,,case rate,45.19,45.19,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna,Aetna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna MGG,Aetna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,BCBS,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS MGG,BCBS MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna,Cigna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna MGG,Cigna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana,Humana,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana MGG,Humana MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Optum VA,Optum VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC,UHC,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC MGG,UHC MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,VA,VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Wellcare MGG,Wellcare MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health - commercial,Bright Health - commercial,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FLECAINIDE 50 MG TABLET       ,92129081,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health MGG,Bright Health MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE 7.5 MG-ACETAM     ,92129108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Aetna,Aetna,316.5,,,,,,,per diem,316.5,316.5,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Aetna MGG,Aetna MGG,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,BCBS,BCBS,316.5,,,,,,,per diem,316.5,316.5,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,BCBS MGG,BCBS MGG,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Cigna,Cigna,316.5,,,,,,,per diem,316.5,316.5,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Cigna MGG,Cigna MGG,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Humana,Humana,316.5,,,,,,,per diem,316.5,316.5,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Humana MGG,Humana MGG,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Optum VA,Optum VA,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,UHC,UHC,316.5,,,,,,,per diem,316.5,316.5,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,UHC MGG,UHC MGG,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,VA,VA,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Wellcare MGG,Wellcare MGG,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Bright Health - commercial,Bright Health - commercial,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5 PCT EYE DROPS   ,92129127,CDM,250,RC,,,,,,Inpatient,1,EA,316.5,316.5,Bright Health MGG,Bright Health MGG,316.5,,,,,,,case rate,316.5,316.5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL 200 MG TABLET       ,92129131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LACTASE 3,000 UNIT TABLET     ",92129133,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCCINATE ER 2     ,92129173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Aetna,Aetna,831.78,,,,,,,per diem,831.78,831.78,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Aetna MGG,Aetna MGG,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,BCBS,BCBS,831.78,,,,,,,per diem,831.78,831.78,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,BCBS MGG,BCBS MGG,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Cigna,Cigna,831.78,,,,,,,per diem,831.78,831.78,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Cigna MGG,Cigna MGG,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Humana,Humana,831.78,,,,,,,per diem,831.78,831.78,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Humana MGG,Humana MGG,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Optum VA,Optum VA,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,UHC,UHC,831.78,,,,,,,per diem,831.78,831.78,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,UHC MGG,UHC MGG,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,VA,VA,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Wellcare MGG,Wellcare MGG,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Bright Health - commercial,Bright Health - commercial,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 1 PCT TOPICAL   ,92129177,CDM,250,RC,,,,,,Inpatient,1,EA,831.78,831.78,Bright Health MGG,Bright Health MGG,831.78,,,,,,,case rate,831.78,831.78,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Aetna,Aetna,1159.56,,,,,,,per diem,1159.56,1159.56,"Per diem rate, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Aetna MGG,Aetna MGG,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,BCBS,BCBS,1159.56,,,,,,,per diem,1159.56,1159.56,"Per diem rate, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,BCBS MGG,BCBS MGG,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Cigna,Cigna,1159.56,,,,,,,per diem,1159.56,1159.56,"Per diem rate, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Cigna MGG,Cigna MGG,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Humana,Humana,1159.56,,,,,,,per diem,1159.56,1159.56,"Per diem rate, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Humana MGG,Humana MGG,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Optum VA,Optum VA,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,UHC,UHC,1159.56,,,,,,,per diem,1159.56,1159.56,"Per diem rate, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,UHC MGG,UHC MGG,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,VA,VA,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Wellcare MGG,Wellcare MGG,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Bright Health - commercial,Bright Health - commercial,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 220 MCG 14 DO      ,92129180,CDM,250,RC,,,,,,Inpatient,1,EA,1159.56,1159.56,Bright Health MGG,Bright Health MGG,1159.56,,,,,,,case rate,1159.56,1159.56,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Aetna,Aetna,768.75,,,,,,,per diem,768.75,768.75,"Per diem rate, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Aetna MGG,Aetna MGG,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,BCBS,BCBS,768.75,,,,,,,per diem,768.75,768.75,"Per diem rate, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,BCBS MGG,BCBS MGG,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Cigna,Cigna,768.75,,,,,,,per diem,768.75,768.75,"Per diem rate, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Cigna MGG,Cigna MGG,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Humana,Humana,768.75,,,,,,,per diem,768.75,768.75,"Per diem rate, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Humana MGG,Humana MGG,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Optum VA,Optum VA,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,UHC,UHC,768.75,,,,,,,per diem,768.75,768.75,"Per diem rate, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,UHC MGG,UHC MGG,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,VA,VA,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Wellcare MGG,Wellcare MGG,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Bright Health - commercial,Bright Health - commercial,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MOMETASONE 50 MCG/ACTUATI     ,92129181,CDM,250,RC,,,,,,Inpatient,1,EA,768.75,768.75,Bright Health MGG,Bright Health MGG,768.75,,,,,,,case rate,768.75,768.75,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15 MG TABLET         ,92129183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Aetna,Aetna,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Aetna MGG,Aetna MGG,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,BCBS,BCBS,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,BCBS MGG,BCBS MGG,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Cigna,Cigna,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Cigna MGG,Cigna MGG,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Humana,Humana,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Humana MGG,Humana MGG,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Optum VA,Optum VA,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,UHC,UHC,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,UHC MGG,UHC MGG,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,VA,VA,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Wellcare MGG,Wellcare MGG,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Bright Health - commercial,Bright Health - commercial,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
"MORPHINE ER 15 MG TABLET,     ",92129185,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,Bright Health MGG,Bright Health MGG,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Aetna,Aetna,502.05,,,,,,,per diem,502.05,502.05,"Per diem rate, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Aetna MGG,Aetna MGG,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,BCBS,BCBS,502.05,,,,,,,per diem,502.05,502.05,"Per diem rate, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,BCBS MGG,BCBS MGG,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Cigna,Cigna,502.05,,,,,,,per diem,502.05,502.05,"Per diem rate, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Cigna MGG,Cigna MGG,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Humana,Humana,502.05,,,,,,,per diem,502.05,502.05,"Per diem rate, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Humana MGG,Humana MGG,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Optum VA,Optum VA,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,UHC,UHC,502.05,,,,,,,per diem,502.05,502.05,"Per diem rate, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,UHC MGG,UHC MGG,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,VA,VA,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Wellcare MGG,Wellcare MGG,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Bright Health - commercial,Bright Health - commercial,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
MOXIFLOXACIN 0.5 % EYE DR     ,92129188,CDM,250,RC,,,,,,Inpatient,1,EA,502.05,502.05,Bright Health MGG,Bright Health MGG,502.05,,,,,,,case rate,502.05,502.05,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Aetna,Aetna,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Aetna MGG,Aetna MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,BCBS,BCBS,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,BCBS MGG,BCBS MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Cigna,Cigna,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Cigna MGG,Cigna MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Humana,Humana,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Humana MGG,Humana MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Optum VA,Optum VA,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,UHC,UHC,19.9,,,,,,,per diem,19.9,19.9,"Per diem rate, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,UHC MGG,UHC MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,VA,VA,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Wellcare MGG,Wellcare MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Bright Health - commercial,Bright Health - commercial,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEBIVOLOL 10 MG TABLET        ,92129196,CDM,250,RC,,,,,,Inpatient,1,EA,19.9,19.9,Bright Health MGG,Bright Health MGG,19.9,,,,,,,case rate,19.9,19.9,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Aetna,Aetna,195.15,,,,,,,per diem,195.15,195.15,"Per diem rate, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Aetna MGG,Aetna MGG,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,BCBS,BCBS,195.15,,,,,,,per diem,195.15,195.15,"Per diem rate, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,BCBS MGG,BCBS MGG,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Cigna,Cigna,195.15,,,,,,,per diem,195.15,195.15,"Per diem rate, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Cigna MGG,Cigna MGG,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Humana,Humana,195.15,,,,,,,per diem,195.15,195.15,"Per diem rate, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Humana MGG,Humana MGG,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Optum VA,Optum VA,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,UHC,UHC,195.15,,,,,,,per diem,195.15,195.15,"Per diem rate, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,UHC MGG,UHC MGG,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,VA,VA,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Wellcare MGG,Wellcare MGG,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Bright Health - commercial,Bright Health - commercial,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NEOMYCIN-BACITRACIN-POLYM     ,92129200,CDM,250,RC,,,,,,Inpatient,1,EA,195.15,195.15,Bright Health MGG,Bright Health MGG,195.15,,,,,,,case rate,195.15,195.15,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Aetna,Aetna,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Aetna MGG,Aetna MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,BCBS,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS MGG,BCBS MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Cigna,Cigna,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Cigna MGG,Cigna MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Humana,Humana,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Humana MGG,Humana MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Optum VA,Optum VA,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UHC,UHC,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UHC MGG,UHC MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA,VA,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Wellcare MGG,Wellcare MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Bright Health - commercial,Bright Health - commercial,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MONOHYDRAT     ,92129206,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Bright Health MGG,Bright Health MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Aetna,Aetna,50.16,,,,,,,per diem,50.16,50.16,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Aetna MGG,Aetna MGG,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,BCBS,BCBS,50.16,,,,,,,per diem,50.16,50.16,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,BCBS MGG,BCBS MGG,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Cigna,Cigna,50.16,,,,,,,per diem,50.16,50.16,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Cigna MGG,Cigna MGG,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Humana,Humana,50.16,,,,,,,per diem,50.16,50.16,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Humana MGG,Humana MGG,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Optum VA,Optum VA,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,UHC,UHC,50.16,,,,,,,per diem,50.16,50.16,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,UHC MGG,UHC MGG,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,VA,VA,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Wellcare MGG,Wellcare MGG,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Bright Health - commercial,Bright Health - commercial,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 30 MG CAPSULE     ,92129214,CDM,250,RC,,,,,,Inpatient,1,EA,50.16,50.16,Bright Health MGG,Bright Health MGG,50.16,,,,,,,case rate,50.16,50.16,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Aetna,Aetna,54.68,,,,,,,per diem,54.68,54.68,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Aetna MGG,Aetna MGG,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,BCBS,BCBS,54.68,,,,,,,per diem,54.68,54.68,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,BCBS MGG,BCBS MGG,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Cigna,Cigna,54.68,,,,,,,per diem,54.68,54.68,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Cigna MGG,Cigna MGG,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Humana,Humana,54.68,,,,,,,per diem,54.68,54.68,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Humana MGG,Humana MGG,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Optum VA,Optum VA,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,UHC,UHC,54.68,,,,,,,per diem,54.68,54.68,"Per diem rate, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,UHC MGG,UHC MGG,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,VA,VA,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Wellcare MGG,Wellcare MGG,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Bright Health - commercial,Bright Health - commercial,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OSELTAMIVIR 75 MG CAPSULE     ,92129215,CDM,250,RC,,,,,,Inpatient,1,EA,54.68,54.68,Bright Health MGG,Bright Health MGG,54.68,,,,,,,case rate,54.68,54.68,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Aetna,Aetna,26.6,,,,,,,per diem,26.6,26.6,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Aetna MGG,Aetna MGG,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,BCBS,BCBS,26.6,,,,,,,per diem,26.6,26.6,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,BCBS MGG,BCBS MGG,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Cigna,Cigna,26.6,,,,,,,per diem,26.6,26.6,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Cigna MGG,Cigna MGG,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Humana,Humana,26.6,,,,,,,per diem,26.6,26.6,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Humana MGG,Humana MGG,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Optum VA,Optum VA,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,UHC,UHC,26.6,,,,,,,per diem,26.6,26.6,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,UHC MGG,UHC MGG,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,VA,VA,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Wellcare MGG,Wellcare MGG,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Bright Health - commercial,Bright Health - commercial,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TABLET        ,92129218,CDM,250,RC,,,,,,Inpatient,1,EA,26.6,26.6,Bright Health MGG,Bright Health MGG,26.6,,,,,,,case rate,26.6,26.6,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Aetna,Aetna,32.08,,,,,,,per diem,32.08,32.08,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Aetna MGG,Aetna MGG,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,BCBS,BCBS,32.08,,,,,,,per diem,32.08,32.08,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,BCBS MGG,BCBS MGG,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Cigna,Cigna,32.08,,,,,,,per diem,32.08,32.08,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Cigna MGG,Cigna MGG,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Humana,Humana,32.08,,,,,,,per diem,32.08,32.08,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Humana MGG,Humana MGG,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Optum VA,Optum VA,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,UHC,UHC,32.08,,,,,,,per diem,32.08,32.08,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,UHC MGG,UHC MGG,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,VA,VA,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Wellcare MGG,Wellcare MGG,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Bright Health - commercial,Bright Health - commercial,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG TABLET        ,92129219,CDM,250,RC,,,,,,Inpatient,1,EA,32.08,32.08,Bright Health MGG,Bright Health MGG,32.08,,,,,,,case rate,32.08,32.08,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Aetna,Aetna,21.88,,,,,,,per diem,21.88,21.88,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Aetna MGG,Aetna MGG,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,BCBS,BCBS,21.88,,,,,,,per diem,21.88,21.88,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,BCBS MGG,BCBS MGG,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Cigna,Cigna,21.88,,,,,,,per diem,21.88,21.88,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Cigna MGG,Cigna MGG,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Humana,Humana,21.88,,,,,,,per diem,21.88,21.88,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Humana MGG,Humana MGG,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Optum VA,Optum VA,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,UHC,UHC,21.88,,,,,,,per diem,21.88,21.88,"Per diem rate, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,UHC MGG,UHC MGG,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,VA,VA,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Wellcare MGG,Wellcare MGG,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Bright Health - commercial,Bright Health - commercial,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
OXYCODONE 20 MG/ML ORAL C     ,92129220,CDM,250,RC,,,,,,Inpatient,1,EA,21.88,21.88,Bright Health MGG,Bright Health MGG,21.88,,,,,,,case rate,21.88,21.88,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Aetna,Aetna,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Aetna MGG,Aetna MGG,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,BCBS,BCBS,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,BCBS MGG,BCBS MGG,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Cigna,Cigna,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Cigna MGG,Cigna MGG,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Humana,Humana,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Humana MGG,Humana MGG,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Optum VA,Optum VA,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,UHC,UHC,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,UHC MGG,UHC MGG,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,VA,VA,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Wellcare MGG,Wellcare MGG,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Bright Health - commercial,Bright Health - commercial,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG CHEWABLE      ,92129238,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,Bright Health MGG,Bright Health MGG,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Aetna,Aetna,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Aetna MGG,Aetna MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,BCBS,BCBS,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,BCBS MGG,BCBS MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Cigna,Cigna,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Cigna MGG,Cigna MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Humana,Humana,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Humana MGG,Humana MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Optum VA,Optum VA,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,UHC,UHC,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,UHC MGG,UHC MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,VA,VA,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Wellcare MGG,Wellcare MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Bright Health - commercial,Bright Health - commercial,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 2     ,92129243,CDM,250,RC,,,,,,Inpatient,1,EA,38.16,38.16,Bright Health MGG,Bright Health MGG,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Aetna,Aetna,51.53,,,,,,,per diem,51.53,51.53,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Aetna MGG,Aetna MGG,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,BCBS,BCBS,51.53,,,,,,,per diem,51.53,51.53,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,BCBS MGG,BCBS MGG,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Cigna,Cigna,51.53,,,,,,,per diem,51.53,51.53,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Cigna MGG,Cigna MGG,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Humana,Humana,51.53,,,,,,,per diem,51.53,51.53,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Humana MGG,Humana MGG,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Optum VA,Optum VA,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,UHC,UHC,51.53,,,,,,,per diem,51.53,51.53,"Per diem rate, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,UHC MGG,UHC MGG,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,VA,VA,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Wellcare MGG,Wellcare MGG,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Bright Health - commercial,Bright Health - commercial,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
PIPERACILLIN-TAZOBACTAM 3     ,92129244,CDM,250,RC,,,,,,Inpatient,1,EA,51.53,51.53,Bright Health MGG,Bright Health MGG,51.53,,,,,,,case rate,51.53,51.53,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM & SODIUM PHOSPH     ,92129250,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POTASSIUM, SODIUM PHOSPHA     ",92129256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Aetna,Aetna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Aetna MGG,Aetna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,BCBS,BCBS,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,BCBS MGG,BCBS MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Cigna,Cigna,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Cigna MGG,Cigna MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Humana,Humana,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Humana MGG,Humana MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Optum VA,Optum VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,UHC,UHC,9.75,,,,,,,per diem,9.75,9.75,"Per diem rate, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,UHC MGG,UHC MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,VA,VA,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Wellcare MGG,Wellcare MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Bright Health - commercial,Bright Health - commercial,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
PRAVASTATIN 20 MG TABLET      ,92129257,CDM,250,RC,,,,,,Inpatient,1,EA,9.75,9.75,Bright Health MGG,Bright Health MGG,9.75,,,,,,,case rate,9.75,9.75,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Aetna,Aetna,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Aetna MGG,Aetna MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,BCBS,BCBS,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,BCBS MGG,BCBS MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Cigna,Cigna,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Cigna MGG,Cigna MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Humana,Humana,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Humana MGG,Humana MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Optum VA,Optum VA,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,UHC,UHC,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,UHC MGG,UHC MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,VA,VA,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Wellcare MGG,Wellcare MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Bright Health - commercial,Bright Health - commercial,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 4.6 MG/24 HO     ,92129271,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Bright Health MGG,Bright Health MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Aetna,Aetna,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Aetna MGG,Aetna MGG,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,BCBS,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS MGG,BCBS MGG,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Cigna,Cigna,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Cigna MGG,Cigna MGG,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Humana,Humana,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Humana MGG,Humana MGG,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Optum VA,Optum VA,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,UHC,UHC,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,UHC MGG,UHC MGG,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,VA,VA,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Wellcare MGG,Wellcare MGG,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Bright Health - commercial,Bright Health - commercial,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,Bright Health MGG,Bright Health MGG,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES 8.6 MG TABLET      ,92129278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Aetna,Aetna,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Aetna MGG,Aetna MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,BCBS,BCBS,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,BCBS MGG,BCBS MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Cigna,Cigna,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Cigna MGG,Cigna MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Humana,Humana,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Humana MGG,Humana MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Optum VA,Optum VA,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,UHC,UHC,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,UHC MGG,UHC MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,VA,VA,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Wellcare MGG,Wellcare MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Bright Health - commercial,Bright Health - commercial,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 10 MG TABLET       ,92129295,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Bright Health MGG,Bright Health MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Aetna,Aetna,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Aetna MGG,Aetna MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,BCBS,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS MGG,BCBS MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Cigna,Cigna,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Cigna MGG,Cigna MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Humana,Humana,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Humana MGG,Humana MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Optum VA,Optum VA,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UHC,UHC,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UHC MGG,UHC MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,VA,VA,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Wellcare MGG,Wellcare MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Bright Health - commercial,Bright Health - commercial,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,Bright Health MGG,Bright Health MGG,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna,Aetna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna MGG,Aetna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,BCBS,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS MGG,BCBS MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna,Cigna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna MGG,Cigna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana,Humana,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana MGG,Humana MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Optum VA,Optum VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC,UHC,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC MGG,UHC MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,VA,VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Wellcare MGG,Wellcare MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health - commercial,Bright Health - commercial,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 PCT INT   ,92129315,CDM,636,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health MGG,Bright Health MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE 400 MG-T     ,92129321,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Aetna,Aetna,97.59,,,,,,,per diem,97.59,97.59,"Per diem rate, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Aetna MGG,Aetna MGG,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,BCBS,BCBS,97.59,,,,,,,per diem,97.59,97.59,"Per diem rate, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,BCBS MGG,BCBS MGG,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Cigna,Cigna,97.59,,,,,,,per diem,97.59,97.59,"Per diem rate, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Cigna MGG,Cigna MGG,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Humana,Humana,97.59,,,,,,,per diem,97.59,97.59,"Per diem rate, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Humana MGG,Humana MGG,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Optum VA,Optum VA,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,UHC,UHC,97.59,,,,,,,per diem,97.59,97.59,"Per diem rate, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,UHC MGG,UHC MGG,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,VA,VA,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Wellcare MGG,Wellcare MGG,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Bright Health - commercial,Bright Health - commercial,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
VALPROIC ACID AS SODIUM       ,92129328,CDM,250,RC,,,,,,Inpatient,1,EA,97.59,97.59,Bright Health MGG,Bright Health MGG,97.59,,,,,,,case rate,97.59,97.59,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Aetna,Aetna,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Aetna MGG,Aetna MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,BCBS,BCBS,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,BCBS MGG,BCBS MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Cigna,Cigna,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Cigna MGG,Cigna MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Humana,Humana,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Humana MGG,Humana MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Optum VA,Optum VA,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,UHC,UHC,13.4,,,,,,,per diem,13.4,13.4,"Per diem rate, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,UHC MGG,UHC MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,VA,VA,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Wellcare MGG,Wellcare MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Bright Health - commercial,Bright Health - commercial,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
MEGESTROL ACE 400MG-10ML SUS 1,92129357,CDM,250,RC,,,,,,Inpatient,1,EA,13.4,13.4,Bright Health MGG,Bright Health MGG,13.4,,,,,,,case rate,13.4,13.4,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Aetna,Aetna,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Aetna MGG,Aetna MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,BCBS,BCBS,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,BCBS MGG,BCBS MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Cigna,Cigna,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Cigna MGG,Cigna MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Humana,Humana,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Humana MGG,Humana MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Optum VA,Optum VA,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,UHC,UHC,71.07,,,,,,,per diem,71.07,71.07,"Per diem rate, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,UHC MGG,UHC MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,VA,VA,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Wellcare MGG,Wellcare MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Bright Health - commercial,Bright Health - commercial,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
DAPTOMYCIN 500 MG-10ML VL     ,92129374,CDM,250,RC,,,,,,Inpatient,1,EA,71.07,71.07,Bright Health MGG,Bright Health MGG,71.07,,,,,,,case rate,71.07,71.07,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Aetna,Aetna,71.57,,,,,,,per diem,71.57,71.57,"Per diem rate, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Aetna MGG,Aetna MGG,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,BCBS,BCBS,71.57,,,,,,,per diem,71.57,71.57,"Per diem rate, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,BCBS MGG,BCBS MGG,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Cigna,Cigna,71.57,,,,,,,per diem,71.57,71.57,"Per diem rate, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Cigna MGG,Cigna MGG,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Humana,Humana,71.57,,,,,,,per diem,71.57,71.57,"Per diem rate, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Humana MGG,Humana MGG,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Optum VA,Optum VA,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,UHC,UHC,71.57,,,,,,,per diem,71.57,71.57,"Per diem rate, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,UHC MGG,UHC MGG,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,VA,VA,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Wellcare MGG,Wellcare MGG,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Bright Health - commercial,Bright Health - commercial,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
ENOXAPARIN SOD 100 MG-ML SYG 1,92129408,CDM,250,RC,,,,,,Inpatient,1,EA,71.57,71.57,Bright Health MGG,Bright Health MGG,71.57,,,,,,,case rate,71.57,71.57,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE-ACETAM 10-325MG TA,92129414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Aetna,Aetna,61.78,,,,,,,per diem,61.78,61.78,"Per diem rate, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Aetna MGG,Aetna MGG,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,BCBS,BCBS,61.78,,,,,,,per diem,61.78,61.78,"Per diem rate, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,BCBS MGG,BCBS MGG,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Cigna,Cigna,61.78,,,,,,,per diem,61.78,61.78,"Per diem rate, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Cigna MGG,Cigna MGG,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Humana,Humana,61.78,,,,,,,per diem,61.78,61.78,"Per diem rate, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Humana MGG,Humana MGG,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Optum VA,Optum VA,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,UHC,UHC,61.78,,,,,,,per diem,61.78,61.78,"Per diem rate, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,UHC MGG,UHC MGG,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,VA,VA,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Wellcare MGG,Wellcare MGG,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Bright Health - commercial,Bright Health - commercial,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
FENTANYL TRANSDERM SYS 12MCG-H,92129468,CDM,250,RC,,,,,,Inpatient,1,EA,61.78,61.78,Bright Health MGG,Bright Health MGG,61.78,,,,,,,case rate,61.78,61.78,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Aetna,Aetna,20.86,,,,,,,per diem,20.86,20.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Aetna MGG,Aetna MGG,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,BCBS,BCBS,20.86,,,,,,,per diem,20.86,20.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,BCBS MGG,BCBS MGG,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Cigna,Cigna,20.86,,,,,,,per diem,20.86,20.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Cigna MGG,Cigna MGG,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Humana,Humana,20.86,,,,,,,per diem,20.86,20.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Humana MGG,Humana MGG,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Optum VA,Optum VA,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,UHC,UHC,20.86,,,,,,,per diem,20.86,20.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,UHC MGG,UHC MGG,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,VA,VA,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Wellcare MGG,Wellcare MGG,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Bright Health - commercial,Bright Health - commercial,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETA     ,92129487,CDM,250,RC,,,,,,Inpatient,1,EA,20.86,20.86,Bright Health MGG,Bright Health MGG,20.86,,,,,,,case rate,20.86,20.86,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Aetna,Aetna,24.84,,,,,,,per diem,24.84,24.84,"Per diem rate, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Aetna MGG,Aetna MGG,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,BCBS,BCBS,24.84,,,,,,,per diem,24.84,24.84,"Per diem rate, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,BCBS MGG,BCBS MGG,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Cigna,Cigna,24.84,,,,,,,per diem,24.84,24.84,"Per diem rate, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Cigna MGG,Cigna MGG,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Humana,Humana,24.84,,,,,,,per diem,24.84,24.84,"Per diem rate, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Humana MGG,Humana MGG,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Optum VA,Optum VA,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,UHC,UHC,24.84,,,,,,,per diem,24.84,24.84,"Per diem rate, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,UHC MGG,UHC MGG,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,VA,VA,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Wellcare MGG,Wellcare MGG,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Bright Health - commercial,Bright Health - commercial,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
CEFDINIR 250 MG/5ML PO SU     ,92129494,CDM,250,RC,,,,,,Inpatient,1,EA,24.84,24.84,Bright Health MGG,Bright Health MGG,24.84,,,,,,,case rate,24.84,24.84,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Aetna,Aetna,10.91,,,,,,,per diem,10.91,10.91,"Per diem rate, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Aetna MGG,Aetna MGG,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,BCBS,BCBS,10.91,,,,,,,per diem,10.91,10.91,"Per diem rate, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,BCBS MGG,BCBS MGG,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Cigna,Cigna,10.91,,,,,,,per diem,10.91,10.91,"Per diem rate, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Cigna MGG,Cigna MGG,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Humana,Humana,10.91,,,,,,,per diem,10.91,10.91,"Per diem rate, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Humana MGG,Humana MGG,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Optum VA,Optum VA,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,UHC,UHC,10.91,,,,,,,per diem,10.91,10.91,"Per diem rate, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,UHC MGG,UHC MGG,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,VA,VA,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Wellcare MGG,Wellcare MGG,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Bright Health - commercial,Bright Health - commercial,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
MUSCLE RUB 10-15 PCT EXTERN   ,92129548,CDM,250,RC,,,,,,Inpatient,1,EA,10.91,10.91,Bright Health MGG,Bright Health MGG,10.91,,,,,,,case rate,10.91,10.91,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Aetna,Aetna,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Aetna MGG,Aetna MGG,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,BCBS,BCBS,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,BCBS MGG,BCBS MGG,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Cigna,Cigna,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Cigna MGG,Cigna MGG,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Humana,Humana,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Humana MGG,Humana MGG,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Optum VA,Optum VA,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,UHC,UHC,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,UHC MGG,UHC MGG,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,VA,VA,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Wellcare MGG,Wellcare MGG,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Bright Health - commercial,Bright Health - commercial,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
SACUBITRIL/VALSARTIN 24/26 TAB,92129605,CDM,250,RC,,,,,,Inpatient,1,EA,37.42,37.42,Bright Health MGG,Bright Health MGG,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Aetna,Aetna,925.68,,,,,,,per diem,925.68,925.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Aetna MGG,Aetna MGG,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,BCBS,BCBS,925.68,,,,,,,per diem,925.68,925.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,BCBS MGG,BCBS MGG,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Cigna,Cigna,925.68,,,,,,,per diem,925.68,925.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Cigna MGG,Cigna MGG,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Humana,Humana,925.68,,,,,,,per diem,925.68,925.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Humana MGG,Humana MGG,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Optum VA,Optum VA,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,UHC,UHC,925.68,,,,,,,per diem,925.68,925.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,UHC MGG,UHC MGG,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,VA,VA,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Wellcare MGG,Wellcare MGG,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Bright Health - commercial,Bright Health - commercial,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE 5 MCG/HOUR      ,92129619,CDM,250,RC,,,,,,Inpatient,1,EA,925.68,925.68,Bright Health MGG,Bright Health MGG,925.68,,,,,,,case rate,925.68,925.68,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Aetna,Aetna,53.89,,,,,,,per diem,53.89,53.89,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Aetna MGG,Aetna MGG,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,BCBS,BCBS,53.89,,,,,,,per diem,53.89,53.89,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,BCBS MGG,BCBS MGG,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Cigna,Cigna,53.89,,,,,,,per diem,53.89,53.89,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Cigna MGG,Cigna MGG,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Humana,Humana,53.89,,,,,,,per diem,53.89,53.89,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Humana MGG,Humana MGG,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Optum VA,Optum VA,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,UHC,UHC,53.89,,,,,,,per diem,53.89,53.89,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,UHC MGG,UHC MGG,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,VA,VA,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Wellcare MGG,Wellcare MGG,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Bright Health - commercial,Bright Health - commercial,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,53.89,53.89,Bright Health MGG,Bright Health MGG,53.89,,,,,,,case rate,53.89,53.89,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Aetna,Aetna,1660.5,,,,,,,per diem,1660.5,1660.5,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Aetna MGG,Aetna MGG,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,BCBS,BCBS,1660.5,,,,,,,per diem,1660.5,1660.5,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,BCBS MGG,BCBS MGG,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Cigna,Cigna,1660.5,,,,,,,per diem,1660.5,1660.5,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Cigna MGG,Cigna MGG,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Humana,Humana,1660.5,,,,,,,per diem,1660.5,1660.5,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Humana MGG,Humana MGG,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Optum VA,Optum VA,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,UHC,UHC,1660.5,,,,,,,per diem,1660.5,1660.5,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,UHC MGG,UHC MGG,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,VA,VA,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Wellcare MGG,Wellcare MGG,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Bright Health - commercial,Bright Health - commercial,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUTEROL 20-     ,92129648,CDM,250,RC,,,,,,Inpatient,1,EA,1660.5,1660.5,Bright Health MGG,Bright Health MGG,1660.5,,,,,,,case rate,1660.5,1660.5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN 750 MG 24 H TAB     ,92129662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Aetna,Aetna,18.61,,,,,,,per diem,18.61,18.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Aetna MGG,Aetna MGG,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,BCBS,BCBS,18.61,,,,,,,per diem,18.61,18.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,BCBS MGG,BCBS MGG,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Cigna,Cigna,18.61,,,,,,,per diem,18.61,18.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Cigna MGG,Cigna MGG,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Humana,Humana,18.61,,,,,,,per diem,18.61,18.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Humana MGG,Humana MGG,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Optum VA,Optum VA,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,UHC,UHC,18.61,,,,,,,per diem,18.61,18.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,UHC MGG,UHC MGG,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,VA,VA,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Wellcare MGG,Wellcare MGG,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Bright Health - commercial,Bright Health - commercial,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 50 MG 24 H TAB     ,92129672,CDM,250,RC,,,,,,Inpatient,1,EA,18.61,18.61,Bright Health MGG,Bright Health MGG,18.61,,,,,,,case rate,18.61,18.61,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Aetna,Aetna,7.19,,,,,,,per diem,7.19,7.19,"Per diem rate, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Aetna MGG,Aetna MGG,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,BCBS,BCBS,7.19,,,,,,,per diem,7.19,7.19,"Per diem rate, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,BCBS MGG,BCBS MGG,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Cigna,Cigna,7.19,,,,,,,per diem,7.19,7.19,"Per diem rate, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Cigna MGG,Cigna MGG,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Humana,Humana,7.19,,,,,,,per diem,7.19,7.19,"Per diem rate, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Humana MGG,Humana MGG,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Optum VA,Optum VA,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,UHC,UHC,7.19,,,,,,,per diem,7.19,7.19,"Per diem rate, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,UHC MGG,UHC MGG,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,VA,VA,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Wellcare MGG,Wellcare MGG,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Bright Health - commercial,Bright Health - commercial,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 1 MG TAB 100 EAC     ,92129691,CDM,250,RC,,,,,,Inpatient,1,EA,7.19,7.19,Bright Health MGG,Bright Health MGG,7.19,,,,,,,case rate,7.19,7.19,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Aetna,Aetna,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Aetna MGG,Aetna MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,BCBS,BCBS,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,BCBS MGG,BCBS MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Cigna,Cigna,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Cigna MGG,Cigna MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Humana,Humana,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Humana MGG,Humana MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Optum VA,Optum VA,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,UHC,UHC,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,UHC MGG,UHC MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,VA,VA,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Wellcare MGG,Wellcare MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Bright Health - commercial,Bright Health - commercial,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN 3 MG TAB 100 EAC     ,92129695,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Bright Health MGG,Bright Health MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Aetna,Aetna,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Aetna MGG,Aetna MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,BCBS,BCBS,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,BCBS MGG,BCBS MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Cigna,Cigna,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Cigna MGG,Cigna MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Humana,Humana,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Humana MGG,Humana MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Optum VA,Optum VA,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,UHC,UHC,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,UHC MGG,UHC MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,VA,VA,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Wellcare MGG,Wellcare MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Bright Health - commercial,Bright Health - commercial,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
MEROPENEM 1000 MG IN 100      ,92129763,CDM,636,RC,,,,,,Inpatient,1,EA,17.1,17.1,Bright Health MGG,Bright Health MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Aetna,Aetna,17.62,,,,,,,per diem,17.62,17.62,"Per diem rate, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Aetna MGG,Aetna MGG,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,BCBS,BCBS,17.62,,,,,,,per diem,17.62,17.62,"Per diem rate, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,BCBS MGG,BCBS MGG,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Cigna,Cigna,17.62,,,,,,,per diem,17.62,17.62,"Per diem rate, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Cigna MGG,Cigna MGG,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Humana,Humana,17.62,,,,,,,per diem,17.62,17.62,"Per diem rate, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Humana MGG,Humana MGG,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Optum VA,Optum VA,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,UHC,UHC,17.62,,,,,,,per diem,17.62,17.62,"Per diem rate, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,UHC MGG,UHC MGG,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,VA,VA,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Wellcare MGG,Wellcare MGG,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Bright Health - commercial,Bright Health - commercial,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
ALUMINUM & MAGNESIUM HYDR     ,92129787,CDM,250,RC,,,,,,Inpatient,1,EA,17.62,17.62,Bright Health MGG,Bright Health MGG,17.62,,,,,,,case rate,17.62,17.62,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Aetna,Aetna,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Aetna MGG,Aetna MGG,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,BCBS,BCBS,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,BCBS MGG,BCBS MGG,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Cigna,Cigna,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Cigna MGG,Cigna MGG,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Humana,Humana,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Humana MGG,Humana MGG,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Optum VA,Optum VA,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,UHC,UHC,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,UHC MGG,UHC MGG,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,VA,VA,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Wellcare MGG,Wellcare MGG,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Bright Health - commercial,Bright Health - commercial,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 2.5 MG TAB         ,92129789,CDM,250,RC,,,,,,Inpatient,1,EA,5.23,5.23,Bright Health MGG,Bright Health MGG,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Aetna,Aetna,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Aetna MGG,Aetna MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,BCBS,BCBS,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,BCBS MGG,BCBS MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Cigna,Cigna,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Cigna MGG,Cigna MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Humana,Humana,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Humana MGG,Humana MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Optum VA,Optum VA,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,UHC,UHC,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,UHC MGG,UHC MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,VA,VA,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Wellcare MGG,Wellcare MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Bright Health - commercial,Bright Health - commercial,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TAB           ,92129790,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Bright Health MGG,Bright Health MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TABLET           ,92129829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Aetna,Aetna,54.92,,,,,,,per diem,54.92,54.92,"Per diem rate, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Aetna MGG,Aetna MGG,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,BCBS,BCBS,54.92,,,,,,,per diem,54.92,54.92,"Per diem rate, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,BCBS MGG,BCBS MGG,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Cigna,Cigna,54.92,,,,,,,per diem,54.92,54.92,"Per diem rate, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Cigna MGG,Cigna MGG,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Humana,Humana,54.92,,,,,,,per diem,54.92,54.92,"Per diem rate, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Humana MGG,Humana MGG,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Optum VA,Optum VA,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,UHC,UHC,54.92,,,,,,,per diem,54.92,54.92,"Per diem rate, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,UHC MGG,UHC MGG,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,VA,VA,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Wellcare MGG,Wellcare MGG,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Bright Health - commercial,Bright Health - commercial,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
OXYCODONE ER 40 MG TABLET     ,92129832,CDM,250,RC,,,,,,Inpatient,1,EA,54.92,54.92,Bright Health MGG,Bright Health MGG,54.92,,,,,,,case rate,54.92,54.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN 100 MG CAP          ,92129836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Aetna,Aetna,36.52,,,,,,,per diem,36.52,36.52,"Per diem rate, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Aetna MGG,Aetna MGG,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,BCBS,BCBS,36.52,,,,,,,per diem,36.52,36.52,"Per diem rate, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,BCBS MGG,BCBS MGG,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Cigna,Cigna,36.52,,,,,,,per diem,36.52,36.52,"Per diem rate, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Cigna MGG,Cigna MGG,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Humana,Humana,36.52,,,,,,,per diem,36.52,36.52,"Per diem rate, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Humana MGG,Humana MGG,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Optum VA,Optum VA,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,UHC,UHC,36.52,,,,,,,per diem,36.52,36.52,"Per diem rate, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,UHC MGG,UHC MGG,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,VA,VA,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Wellcare MGG,Wellcare MGG,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Bright Health - commercial,Bright Health - commercial,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
QUETIAPINE 200 MG TAB         ,92129840,CDM,250,RC,,,,,,Inpatient,1,EA,36.52,36.52,Bright Health MGG,Bright Health MGG,36.52,,,,,,,case rate,36.52,36.52,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna,Aetna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna MGG,Aetna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS,BCBS,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS MGG,BCBS MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna,Cigna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna MGG,Cigna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana,Humana,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana MGG,Humana MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Optum VA,Optum VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC,UHC,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC MGG,UHC MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,VA,VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Wellcare MGG,Wellcare MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health - commercial,Bright Health - commercial,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SERTRALINE 25 MG TAB          ,92129842,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health MGG,Bright Health MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Aetna,Aetna,8.72,,,,,,,per diem,8.72,8.72,"Per diem rate, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Aetna MGG,Aetna MGG,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,BCBS,BCBS,8.72,,,,,,,per diem,8.72,8.72,"Per diem rate, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,BCBS MGG,BCBS MGG,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Cigna,Cigna,8.72,,,,,,,per diem,8.72,8.72,"Per diem rate, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Cigna MGG,Cigna MGG,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Humana,Humana,8.72,,,,,,,per diem,8.72,8.72,"Per diem rate, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Humana MGG,Humana MGG,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Optum VA,Optum VA,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,UHC,UHC,8.72,,,,,,,per diem,8.72,8.72,"Per diem rate, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,UHC MGG,UHC MGG,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,VA,VA,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Wellcare MGG,Wellcare MGG,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Bright Health - commercial,Bright Health - commercial,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
SOD CHL 0.9PCT KCL 40 NACL    ,92129846,CDM,258,RC,,,,,,Inpatient,1,EA,8.72,8.72,Bright Health MGG,Bright Health MGG,8.72,,,,,,,case rate,8.72,8.72,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Aetna,Aetna,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Aetna MGG,Aetna MGG,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,BCBS,BCBS,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,BCBS MGG,BCBS MGG,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Cigna,Cigna,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Cigna MGG,Cigna MGG,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Humana,Humana,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Humana MGG,Humana MGG,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Optum VA,Optum VA,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,UHC,UHC,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,UHC MGG,UHC MGG,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,VA,VA,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Wellcare MGG,Wellcare MGG,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Bright Health - commercial,Bright Health - commercial,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
WARFARIN 10 MG TAB 100 EA     ,92129856,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,Bright Health MGG,Bright Health MGG,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Aetna,Aetna,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Aetna MGG,Aetna MGG,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,BCBS,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS MGG,BCBS MGG,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Cigna,Cigna,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Cigna MGG,Cigna MGG,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Humana,Humana,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Humana MGG,Humana MGG,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Optum VA,Optum VA,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,UHC,UHC,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,UHC MGG,UHC MGG,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,VA,VA,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Wellcare MGG,Wellcare MGG,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Bright Health - commercial,Bright Health - commercial,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
FINASTERIDE 1 MG TAB          ,92129875,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,Bright Health MGG,Bright Health MGG,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTINE 5 MG TABLET         ,92129879,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS CHEWABLE TA     ,92129903,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Aetna,Aetna,12.88,,,,,,,per diem,12.88,12.88,"Per diem rate, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Aetna MGG,Aetna MGG,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,BCBS,BCBS,12.88,,,,,,,per diem,12.88,12.88,"Per diem rate, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,BCBS MGG,BCBS MGG,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Cigna,Cigna,12.88,,,,,,,per diem,12.88,12.88,"Per diem rate, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Cigna MGG,Cigna MGG,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Humana,Humana,12.88,,,,,,,per diem,12.88,12.88,"Per diem rate, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Humana MGG,Humana MGG,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Optum VA,Optum VA,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,UHC,UHC,12.88,,,,,,,per diem,12.88,12.88,"Per diem rate, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,UHC MGG,UHC MGG,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,VA,VA,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Wellcare MGG,Wellcare MGG,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Bright Health - commercial,Bright Health - commercial,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
PRAVASTATIN 40MG TAB          ,92129935,CDM,250,RC,,,,,,Inpatient,1,EA,12.88,12.88,Bright Health MGG,Bright Health MGG,12.88,,,,,,,case rate,12.88,12.88,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Aetna,Aetna,30.78,,,,,,,per diem,30.78,30.78,"Per diem rate, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Aetna MGG,Aetna MGG,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,BCBS,BCBS,30.78,,,,,,,per diem,30.78,30.78,"Per diem rate, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,BCBS MGG,BCBS MGG,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Cigna,Cigna,30.78,,,,,,,per diem,30.78,30.78,"Per diem rate, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Cigna MGG,Cigna MGG,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Humana,Humana,30.78,,,,,,,per diem,30.78,30.78,"Per diem rate, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Humana MGG,Humana MGG,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Optum VA,Optum VA,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,UHC,UHC,30.78,,,,,,,per diem,30.78,30.78,"Per diem rate, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,UHC MGG,UHC MGG,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,VA,VA,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Wellcare MGG,Wellcare MGG,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Bright Health - commercial,Bright Health - commercial,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DICLOFENAC 1% 100GM GEL       ,92129948,CDM,250,RC,,,,,,Inpatient,1,EA,30.78,30.78,Bright Health MGG,Bright Health MGG,30.78,,,,,,,case rate,30.78,30.78,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Aetna,Aetna,30.82,,,,,,,per diem,30.82,30.82,"Per diem rate, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Aetna MGG,Aetna MGG,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,BCBS,BCBS,30.82,,,,,,,per diem,30.82,30.82,"Per diem rate, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,BCBS MGG,BCBS MGG,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Cigna,Cigna,30.82,,,,,,,per diem,30.82,30.82,"Per diem rate, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Cigna MGG,Cigna MGG,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Humana,Humana,30.82,,,,,,,per diem,30.82,30.82,"Per diem rate, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Humana MGG,Humana MGG,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Optum VA,Optum VA,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,UHC,UHC,30.82,,,,,,,per diem,30.82,30.82,"Per diem rate, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,UHC MGG,UHC MGG,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,VA,VA,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Wellcare MGG,Wellcare MGG,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Bright Health - commercial,Bright Health - commercial,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
LACTULOSE 30ML SOL            ,92129950,CDM,250,RC,,,,,,Inpatient,1,EA,30.82,30.82,Bright Health MGG,Bright Health MGG,30.82,,,,,,,case rate,30.82,30.82,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOCAINE MENTH 15MG-3.6MG L ,92129966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Aetna,Aetna,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Aetna MGG,Aetna MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,BCBS,BCBS,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,BCBS MGG,BCBS MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Cigna,Cigna,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Cigna MGG,Cigna MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Humana,Humana,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Humana MGG,Humana MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Optum VA,Optum VA,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,UHC,UHC,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,UHC MGG,UHC MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,VA,VA,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Wellcare MGG,Wellcare MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Bright Health - commercial,Bright Health - commercial,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 30GM OINT    ,92129977,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Bright Health MGG,Bright Health MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Aetna,Aetna,68.4,,,,,,,per diem,68.4,68.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Aetna MGG,Aetna MGG,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,BCBS,BCBS,68.4,,,,,,,per diem,68.4,68.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,BCBS MGG,BCBS MGG,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Cigna,Cigna,68.4,,,,,,,per diem,68.4,68.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Cigna MGG,Cigna MGG,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Humana,Humana,68.4,,,,,,,per diem,68.4,68.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Humana MGG,Humana MGG,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Optum VA,Optum VA,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,UHC,UHC,68.4,,,,,,,per diem,68.4,68.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,UHC MGG,UHC MGG,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,VA,VA,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Wellcare MGG,Wellcare MGG,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Bright Health - commercial,Bright Health - commercial,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1250MG/250ML IVPB  ,92129979,CDM,250,RC,,,,,,Inpatient,1,EA,68.4,68.4,Bright Health MGG,Bright Health MGG,68.4,,,,,,,case rate,68.4,68.4,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Aetna,Aetna,67.54,,,,,,,per diem,67.54,67.54,"Per diem rate, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Aetna MGG,Aetna MGG,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,BCBS,BCBS,67.54,,,,,,,per diem,67.54,67.54,"Per diem rate, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,BCBS MGG,BCBS MGG,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Cigna,Cigna,67.54,,,,,,,per diem,67.54,67.54,"Per diem rate, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Cigna MGG,Cigna MGG,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Humana,Humana,67.54,,,,,,,per diem,67.54,67.54,"Per diem rate, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Humana MGG,Humana MGG,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Optum VA,Optum VA,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,UHC,UHC,67.54,,,,,,,per diem,67.54,67.54,"Per diem rate, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,UHC MGG,UHC MGG,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,VA,VA,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Wellcare MGG,Wellcare MGG,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Bright Health - commercial,Bright Health - commercial,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
ARFORMOTEROL 15MCG/2ML SOL    ,92130021,CDM,250,RC,,,,,,Inpatient,1,EA,67.54,67.54,Bright Health MGG,Bright Health MGG,67.54,,,,,,,case rate,67.54,67.54,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Aetna,Aetna,74.95,,,,,,,per diem,74.95,74.95,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Aetna MGG,Aetna MGG,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,BCBS,BCBS,74.95,,,,,,,per diem,74.95,74.95,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,BCBS MGG,BCBS MGG,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Cigna,Cigna,74.95,,,,,,,per diem,74.95,74.95,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Cigna MGG,Cigna MGG,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Humana,Humana,74.95,,,,,,,per diem,74.95,74.95,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Humana MGG,Humana MGG,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Optum VA,Optum VA,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,UHC,UHC,74.95,,,,,,,per diem,74.95,74.95,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,UHC MGG,UHC MGG,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,VA,VA,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Wellcare MGG,Wellcare MGG,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Bright Health - commercial,Bright Health - commercial,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,74.95,74.95,Bright Health MGG,Bright Health MGG,74.95,,,,,,,case rate,74.95,74.95,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Aetna,Aetna,12.02,,,,,,,per diem,12.02,12.02,"Per diem rate, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Aetna MGG,Aetna MGG,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,BCBS,BCBS,12.02,,,,,,,per diem,12.02,12.02,"Per diem rate, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,BCBS MGG,BCBS MGG,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Cigna,Cigna,12.02,,,,,,,per diem,12.02,12.02,"Per diem rate, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Cigna MGG,Cigna MGG,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Humana,Humana,12.02,,,,,,,per diem,12.02,12.02,"Per diem rate, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Humana MGG,Humana MGG,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Optum VA,Optum VA,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,UHC,UHC,12.02,,,,,,,per diem,12.02,12.02,"Per diem rate, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,UHC MGG,UHC MGG,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,VA,VA,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Wellcare MGG,Wellcare MGG,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Bright Health - commercial,Bright Health - commercial,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
SODIUM CHL 0.9% ADV BAG 50x100,92130038,CDM,250,RC,,,,,,Inpatient,1,EA,12.02,12.02,Bright Health MGG,Bright Health MGG,12.02,,,,,,,case rate,12.02,12.02,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SUL 0.63 MG INH 30X3,92130039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Aetna,Aetna,138.21,,,,,,,per diem,138.21,138.21,"Per diem rate, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Aetna MGG,Aetna MGG,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,BCBS,BCBS,138.21,,,,,,,per diem,138.21,138.21,"Per diem rate, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,BCBS MGG,BCBS MGG,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Cigna,Cigna,138.21,,,,,,,per diem,138.21,138.21,"Per diem rate, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Cigna MGG,Cigna MGG,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Humana,Humana,138.21,,,,,,,per diem,138.21,138.21,"Per diem rate, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Humana MGG,Humana MGG,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Optum VA,Optum VA,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,UHC,UHC,138.21,,,,,,,per diem,138.21,138.21,"Per diem rate, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,UHC MGG,UHC MGG,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,VA,VA,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Wellcare MGG,Wellcare MGG,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Bright Health - commercial,Bright Health - commercial,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
LIDOCAINE-PRILO 2.5-2.5% W-DRS,92130048,CDM,250,RC,,,,,,Inpatient,1,EA,138.21,138.21,Bright Health MGG,Bright Health MGG,138.21,,,,,,,case rate,138.21,138.21,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Aetna,Aetna,2927.07,,,,,,,per diem,2927.07,2927.07,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Aetna MGG,Aetna MGG,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,BCBS,BCBS,2927.07,,,,,,,per diem,2927.07,2927.07,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,BCBS MGG,BCBS MGG,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Cigna,Cigna,2927.07,,,,,,,per diem,2927.07,2927.07,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Cigna MGG,Cigna MGG,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Humana,Humana,2927.07,,,,,,,per diem,2927.07,2927.07,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Humana MGG,Humana MGG,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Optum VA,Optum VA,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,UHC,UHC,2927.07,,,,,,,per diem,2927.07,2927.07,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,UHC MGG,UHC MGG,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,VA,VA,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Wellcare MGG,Wellcare MGG,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Bright Health - commercial,Bright Health - commercial,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR (RECOMB),92130100,CDM,250,RC,,,,,,Inpatient,1,EA,2927.07,2927.07,Bright Health MGG,Bright Health MGG,2927.07,,,,,,,case rate,2927.07,2927.07,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Aetna,Aetna,3135,,,,,,,per diem,3135,3135,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Aetna MGG,Aetna MGG,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,BCBS,BCBS,3135,,,,,,,per diem,3135,3135,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,BCBS MGG,BCBS MGG,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Cigna,Cigna,3135,,,,,,,per diem,3135,3135,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Cigna MGG,Cigna MGG,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Humana,Humana,3135,,,,,,,per diem,3135,3135,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Humana MGG,Humana MGG,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Optum VA,Optum VA,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,UHC,UHC,3135,,,,,,,per diem,3135,3135,"Per diem rate, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,UHC MGG,UHC MGG,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,VA,VA,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Wellcare MGG,Wellcare MGG,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Bright Health - commercial,Bright Health - commercial,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTIHEMOPHILIC FACTOR-VWF IV S,92130102,CDM,250,RC,,,,,,Inpatient,1,EA,3135,3135,Bright Health MGG,Bright Health MGG,3135,,,,,,,case rate,3135,3135,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Aetna,Aetna,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Aetna MGG,Aetna MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,BCBS,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS MGG,BCBS MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Cigna,Cigna,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Cigna MGG,Cigna MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Humana,Humana,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Humana MGG,Humana MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Optum VA,Optum VA,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UHC,UHC,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UHC MGG,UHC MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA,VA,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Wellcare MGG,Wellcare MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Bright Health - commercial,Bright Health - commercial,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III (HUMAN) 500 U,92130103,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Bright Health MGG,Bright Health MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Aetna,Aetna,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Aetna MGG,Aetna MGG,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,BCBS,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS MGG,BCBS MGG,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Cigna,Cigna,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Cigna MGG,Cigna MGG,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Humana,Humana,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Humana MGG,Humana MGG,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Optum VA,Optum VA,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UHC,UHC,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UHC MGG,UHC MGG,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA,VA,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Wellcare MGG,Wellcare MGG,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Bright Health - commercial,Bright Health - commercial,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10 MG/ML INJ SOLN 2,92130278,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,Bright Health MGG,Bright Health MGG,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna,Aetna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna MGG,Aetna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS,BCBS,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS MGG,BCBS MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna,Cigna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna MGG,Cigna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana,Humana,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana MGG,Humana MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Optum VA,Optum VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC,UHC,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC MGG,UHC MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,VA,VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Wellcare MGG,Wellcare MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health - commercial,Bright Health - commercial,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METHADONE HCL 1 MG/ML UD INJ (,92130378,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health MGG,Bright Health MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG/ML INJ,92130388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Aetna,Aetna,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Aetna MGG,Aetna MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,BCBS,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS MGG,BCBS MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Cigna,Cigna,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Cigna MGG,Cigna MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Humana,Humana,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Humana MGG,Humana MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Optum VA,Optum VA,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,UHC,UHC,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,UHC MGG,UHC MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,VA,VA,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Wellcare MGG,Wellcare MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Bright Health - commercial,Bright Health - commercial,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
VALSARTAN 80 MG TAB           ,92130600,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Bright Health MGG,Bright Health MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Aetna,Aetna,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Aetna MGG,Aetna MGG,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,BCBS,BCBS,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,BCBS MGG,BCBS MGG,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Cigna,Cigna,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Cigna MGG,Cigna MGG,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Humana,Humana,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Humana MGG,Humana MGG,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Optum VA,Optum VA,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,UHC,UHC,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,UHC MGG,UHC MGG,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,VA,VA,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Wellcare MGG,Wellcare MGG,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Bright Health - commercial,Bright Health - commercial,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
QUETIAPINE 400MG TAB          ,92130615,CDM,250,RC,,,,,,Inpatient,1,EA,63.01,63.01,Bright Health MGG,Bright Health MGG,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Aetna,Aetna,22.94,,,,,,,per diem,22.94,22.94,"Per diem rate, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Aetna MGG,Aetna MGG,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,BCBS,BCBS,22.94,,,,,,,per diem,22.94,22.94,"Per diem rate, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,BCBS MGG,BCBS MGG,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Cigna,Cigna,22.94,,,,,,,per diem,22.94,22.94,"Per diem rate, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Cigna MGG,Cigna MGG,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Humana,Humana,22.94,,,,,,,per diem,22.94,22.94,"Per diem rate, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Humana MGG,Humana MGG,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Optum VA,Optum VA,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,UHC,UHC,22.94,,,,,,,per diem,22.94,22.94,"Per diem rate, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,UHC MGG,UHC MGG,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,VA,VA,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Wellcare MGG,Wellcare MGG,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Bright Health - commercial,Bright Health - commercial,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
OXYCODONE ER 9MG CAPSULE SP EX,92130624,CDM,250,RC,,,,,,Inpatient,1,EA,22.94,22.94,Bright Health MGG,Bright Health MGG,22.94,,,,,,,case rate,22.94,22.94,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Aetna,Aetna,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Aetna MGG,Aetna MGG,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,BCBS,BCBS,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,BCBS MGG,BCBS MGG,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Cigna,Cigna,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Cigna MGG,Cigna MGG,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Humana,Humana,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Humana MGG,Humana MGG,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Optum VA,Optum VA,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,UHC,UHC,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,UHC MGG,UHC MGG,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,VA,VA,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Wellcare MGG,Wellcare MGG,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Bright Health - commercial,Bright Health - commercial,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,6.16,6.16,Bright Health MGG,Bright Health MGG,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna,Aetna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna MGG,Aetna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS,BCBS,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS MGG,BCBS MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna,Cigna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna MGG,Cigna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana,Humana,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana MGG,Humana MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Optum VA,Optum VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC,UHC,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC MGG,UHC MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,VA,VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Wellcare MGG,Wellcare MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health - commercial,Bright Health - commercial,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE 50 MG TAB         ,92130626,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health MGG,Bright Health MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE 10 MG TABLET        ,92130632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Aetna,Aetna,14.21,,,,,,,per diem,14.21,14.21,"Per diem rate, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Aetna MGG,Aetna MGG,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,BCBS,BCBS,14.21,,,,,,,per diem,14.21,14.21,"Per diem rate, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,BCBS MGG,BCBS MGG,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Cigna,Cigna,14.21,,,,,,,per diem,14.21,14.21,"Per diem rate, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Cigna MGG,Cigna MGG,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Humana,Humana,14.21,,,,,,,per diem,14.21,14.21,"Per diem rate, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Humana MGG,Humana MGG,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Optum VA,Optum VA,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,UHC,UHC,14.21,,,,,,,per diem,14.21,14.21,"Per diem rate, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,UHC MGG,UHC MGG,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,VA,VA,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Wellcare MGG,Wellcare MGG,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Bright Health - commercial,Bright Health - commercial,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
NEBIVOLOL 20MG TAB            ,92130647,CDM,250,RC,,,,,,Inpatient,1,EA,14.21,14.21,Bright Health MGG,Bright Health MGG,14.21,,,,,,,case rate,14.21,14.21,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Aetna,Aetna,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Aetna MGG,Aetna MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,BCBS,BCBS,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,BCBS MGG,BCBS MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Cigna,Cigna,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Cigna MGG,Cigna MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Humana,Humana,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Humana MGG,Humana MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Optum VA,Optum VA,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,UHC,UHC,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,UHC MGG,UHC MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,VA,VA,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Wellcare MGG,Wellcare MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Bright Health - commercial,Bright Health - commercial,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
AMPICILLIN INJECTABLE 2 G PWDI,92130659,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Bright Health MGG,Bright Health MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Aetna,Aetna,136.07,,,,,,,per diem,136.07,136.07,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Aetna MGG,Aetna MGG,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,BCBS,BCBS,136.07,,,,,,,per diem,136.07,136.07,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,BCBS MGG,BCBS MGG,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Cigna,Cigna,136.07,,,,,,,per diem,136.07,136.07,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Cigna MGG,Cigna MGG,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Humana,Humana,136.07,,,,,,,per diem,136.07,136.07,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Humana MGG,Humana MGG,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Optum VA,Optum VA,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,UHC,UHC,136.07,,,,,,,per diem,136.07,136.07,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,UHC MGG,UHC MGG,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,VA,VA,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Wellcare MGG,Wellcare MGG,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Bright Health - commercial,Bright Health - commercial,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 30 MG TAB        ,92130661,CDM,250,RC,,,,,,Inpatient,1,EA,136.07,136.07,Bright Health MGG,Bright Health MGG,136.07,,,,,,,case rate,136.07,136.07,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL 10 MG TAB           ,92130691,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Aetna,Aetna,95.67,,,,,,,per diem,95.67,95.67,"Per diem rate, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Aetna MGG,Aetna MGG,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,BCBS,BCBS,95.67,,,,,,,per diem,95.67,95.67,"Per diem rate, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,BCBS MGG,BCBS MGG,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Cigna,Cigna,95.67,,,,,,,per diem,95.67,95.67,"Per diem rate, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Cigna MGG,Cigna MGG,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Humana,Humana,95.67,,,,,,,per diem,95.67,95.67,"Per diem rate, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Humana MGG,Humana MGG,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Optum VA,Optum VA,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,UHC,UHC,95.67,,,,,,,per diem,95.67,95.67,"Per diem rate, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,UHC MGG,UHC MGG,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,VA,VA,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Wellcare MGG,Wellcare MGG,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Bright Health - commercial,Bright Health - commercial,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
LINEZOLID 100 MG/5 ML PWDR    ,92130701,CDM,250,RC,,,,,,Inpatient,1,EA,95.67,95.67,Bright Health MGG,Bright Health MGG,95.67,,,,,,,case rate,95.67,95.67,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.75 MG TAB       ,92130707,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Aetna,Aetna,50.89,,,,,,,per diem,50.89,50.89,"Per diem rate, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Aetna MGG,Aetna MGG,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,BCBS,BCBS,50.89,,,,,,,per diem,50.89,50.89,"Per diem rate, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,BCBS MGG,BCBS MGG,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Cigna,Cigna,50.89,,,,,,,per diem,50.89,50.89,"Per diem rate, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Cigna MGG,Cigna MGG,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Humana,Humana,50.89,,,,,,,per diem,50.89,50.89,"Per diem rate, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Humana MGG,Humana MGG,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Optum VA,Optum VA,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,UHC,UHC,50.89,,,,,,,per diem,50.89,50.89,"Per diem rate, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,UHC MGG,UHC MGG,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,VA,VA,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Wellcare MGG,Wellcare MGG,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Bright Health - commercial,Bright Health - commercial,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
QUETIAPINE 300 MG TAB         ,92130714,CDM,250,RC,,,,,,Inpatient,1,EA,50.89,50.89,Bright Health MGG,Bright Health MGG,50.89,,,,,,,case rate,50.89,50.89,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Aetna,Aetna,62.57,,,,,,,per diem,62.57,62.57,"Per diem rate, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Aetna MGG,Aetna MGG,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,BCBS,BCBS,62.57,,,,,,,per diem,62.57,62.57,"Per diem rate, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,BCBS MGG,BCBS MGG,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Cigna,Cigna,62.57,,,,,,,per diem,62.57,62.57,"Per diem rate, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Cigna MGG,Cigna MGG,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Humana,Humana,62.57,,,,,,,per diem,62.57,62.57,"Per diem rate, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Humana MGG,Humana MGG,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Optum VA,Optum VA,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,UHC,UHC,62.57,,,,,,,per diem,62.57,62.57,"Per diem rate, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,UHC MGG,UHC MGG,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,VA,VA,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Wellcare MGG,Wellcare MGG,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Bright Health - commercial,Bright Health - commercial,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
SITAGLIPTIN 100 MG TAB        ,92130722,CDM,250,RC,,,,,,Inpatient,1,EA,62.57,62.57,Bright Health MGG,Bright Health MGG,62.57,,,,,,,case rate,62.57,62.57,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Aetna,Aetna,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Aetna MGG,Aetna MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,BCBS,BCBS,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,BCBS MGG,BCBS MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Cigna,Cigna,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Cigna MGG,Cigna MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Humana,Humana,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Humana MGG,Humana MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Optum VA,Optum VA,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,UHC,UHC,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,UHC MGG,UHC MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,VA,VA,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Wellcare MGG,Wellcare MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Bright Health - commercial,Bright Health - commercial,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULB 1-0.5G INJ SOL,92130758,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Bright Health MGG,Bright Health MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE-DIPH 0.025 MG TAB    ,92130765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Aetna,Aetna,23.19,,,,,,,per diem,23.19,23.19,"Per diem rate, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Aetna MGG,Aetna MGG,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,BCBS,BCBS,23.19,,,,,,,per diem,23.19,23.19,"Per diem rate, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,BCBS MGG,BCBS MGG,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Cigna,Cigna,23.19,,,,,,,per diem,23.19,23.19,"Per diem rate, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Cigna MGG,Cigna MGG,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Humana,Humana,23.19,,,,,,,per diem,23.19,23.19,"Per diem rate, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Humana MGG,Humana MGG,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Optum VA,Optum VA,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,UHC,UHC,23.19,,,,,,,per diem,23.19,23.19,"Per diem rate, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,UHC MGG,UHC MGG,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,VA,VA,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Wellcare MGG,Wellcare MGG,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Bright Health - commercial,Bright Health - commercial,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BACITRACIN-NEO-POLY 400U      ,92130771,CDM,250,RC,,,,,,Inpatient,1,EA,23.19,23.19,Bright Health MGG,Bright Health MGG,23.19,,,,,,,case rate,23.19,23.19,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Aetna,Aetna,9.22,,,,,,,per diem,9.22,9.22,"Per diem rate, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Aetna MGG,Aetna MGG,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,BCBS,BCBS,9.22,,,,,,,per diem,9.22,9.22,"Per diem rate, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,BCBS MGG,BCBS MGG,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Cigna,Cigna,9.22,,,,,,,per diem,9.22,9.22,"Per diem rate, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Cigna MGG,Cigna MGG,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Humana,Humana,9.22,,,,,,,per diem,9.22,9.22,"Per diem rate, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Humana MGG,Humana MGG,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Optum VA,Optum VA,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,UHC,UHC,9.22,,,,,,,per diem,9.22,9.22,"Per diem rate, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,UHC MGG,UHC MGG,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,VA,VA,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Wellcare MGG,Wellcare MGG,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Bright Health - commercial,Bright Health - commercial,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
"CALCIUM CARB 1,250 MG/5 ML SUS",92130793,CDM,250,RC,,,,,,Inpatient,1,EA,9.22,9.22,Bright Health MGG,Bright Health MGG,9.22,,,,,,,case rate,9.22,9.22,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Aetna,Aetna,31.02,,,,,,,per diem,31.02,31.02,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Aetna MGG,Aetna MGG,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,BCBS,BCBS,31.02,,,,,,,per diem,31.02,31.02,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,BCBS MGG,BCBS MGG,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Cigna,Cigna,31.02,,,,,,,per diem,31.02,31.02,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Cigna MGG,Cigna MGG,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Humana,Humana,31.02,,,,,,,per diem,31.02,31.02,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Humana MGG,Humana MGG,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Optum VA,Optum VA,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,UHC,UHC,31.02,,,,,,,per diem,31.02,31.02,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,UHC MGG,UHC MGG,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,VA,VA,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Wellcare MGG,Wellcare MGG,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Bright Health - commercial,Bright Health - commercial,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,31.02,31.02,Bright Health MGG,Bright Health MGG,31.02,,,,,,,case rate,31.02,31.02,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Aetna,Aetna,8.65,,,,,,,per diem,8.65,8.65,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Aetna MGG,Aetna MGG,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,BCBS,BCBS,8.65,,,,,,,per diem,8.65,8.65,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,BCBS MGG,BCBS MGG,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Cigna,Cigna,8.65,,,,,,,per diem,8.65,8.65,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Cigna MGG,Cigna MGG,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Humana,Humana,8.65,,,,,,,per diem,8.65,8.65,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Humana MGG,Humana MGG,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Optum VA,Optum VA,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,UHC,UHC,8.65,,,,,,,per diem,8.65,8.65,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,UHC MGG,UHC MGG,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,VA,VA,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Wellcare MGG,Wellcare MGG,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Bright Health - commercial,Bright Health - commercial,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIF 20-200M,92130821,CDM,250,RC,,,,,,Inpatient,1,EA,8.65,8.65,Bright Health MGG,Bright Health MGG,8.65,,,,,,,case rate,8.65,8.65,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Aetna,Aetna,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Aetna MGG,Aetna MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,BCBS,BCBS,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,BCBS MGG,BCBS MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Cigna,Cigna,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Cigna MGG,Cigna MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Humana,Humana,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Humana MGG,Humana MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Optum VA,Optum VA,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,UHC,UHC,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,UHC MGG,UHC MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,VA,VA,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Wellcare MGG,Wellcare MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Bright Health - commercial,Bright Health - commercial,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HOMATROPINE-HYDRO 1.5-5MG SYR ,92130857,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Bright Health MGG,Bright Health MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOR-TRIAM 50-75MG TAB  ,92130860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Aetna,Aetna,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Aetna MGG,Aetna MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,BCBS,BCBS,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,BCBS MGG,BCBS MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Cigna,Cigna,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Cigna MGG,Cigna MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Humana,Humana,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Humana MGG,Humana MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Optum VA,Optum VA,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,UHC,UHC,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,UHC MGG,UHC MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,VA,VA,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Wellcare MGG,Wellcare MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Bright Health - commercial,Bright Health - commercial,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130862,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Bright Health MGG,Bright Health MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Aetna,Aetna,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Aetna MGG,Aetna MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,BCBS,BCBS,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,BCBS MGG,BCBS MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Cigna,Cigna,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Cigna MGG,Cigna MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Humana,Humana,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Humana MGG,Humana MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Optum VA,Optum VA,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,UHC,UHC,314.64,,,,,,,per diem,314.64,314.64,"Per diem rate, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,UHC MGG,UHC MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,VA,VA,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Wellcare MGG,Wellcare MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Bright Health - commercial,Bright Health - commercial,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
HYDROCORT-NEO-POLYMYC B 1PCT  ,92130863,CDM,250,RC,,,,,,Inpatient,1,EA,314.64,314.64,Bright Health MGG,Bright Health MGG,314.64,,,,,,,case rate,314.64,314.64,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Aetna,Aetna,20.7,,,,,,,per diem,20.7,20.7,"Per diem rate, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Aetna MGG,Aetna MGG,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,BCBS,BCBS,20.7,,,,,,,per diem,20.7,20.7,"Per diem rate, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,BCBS MGG,BCBS MGG,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Cigna,Cigna,20.7,,,,,,,per diem,20.7,20.7,"Per diem rate, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Cigna MGG,Cigna MGG,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Humana,Humana,20.7,,,,,,,per diem,20.7,20.7,"Per diem rate, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Humana MGG,Humana MGG,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Optum VA,Optum VA,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,UHC,UHC,20.7,,,,,,,per diem,20.7,20.7,"Per diem rate, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,UHC MGG,UHC MGG,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,VA,VA,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Wellcare MGG,Wellcare MGG,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Bright Health - commercial,Bright Health - commercial,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
LIDOCAINE TOPICAL 2PCT JEL    ,92130878,CDM,250,RC,,,,,,Inpatient,1,EA,20.7,20.7,Bright Health MGG,Bright Health MGG,20.7,,,,,,,case rate,20.7,20.7,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVIT WITH MINERALS TAB    ,92130895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Aetna,Aetna,101.59,,,,,,,per diem,101.59,101.59,"Per diem rate, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Aetna MGG,Aetna MGG,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,BCBS,BCBS,101.59,,,,,,,per diem,101.59,101.59,"Per diem rate, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,BCBS MGG,BCBS MGG,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Cigna,Cigna,101.59,,,,,,,per diem,101.59,101.59,"Per diem rate, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Cigna MGG,Cigna MGG,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Humana,Humana,101.59,,,,,,,per diem,101.59,101.59,"Per diem rate, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Humana MGG,Humana MGG,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Optum VA,Optum VA,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,UHC,UHC,101.59,,,,,,,per diem,101.59,101.59,"Per diem rate, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,UHC MGG,UHC MGG,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,VA,VA,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Wellcare MGG,Wellcare MGG,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Bright Health - commercial,Bright Health - commercial,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
ROPIVACAINE 0.5PCT INJ SOL    ,92130912,CDM,250,RC,,,,,,Inpatient,1,EA,101.59,101.59,Bright Health MGG,Bright Health MGG,101.59,,,,,,,case rate,101.59,101.59,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Aetna,Aetna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Aetna MGG,Aetna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS,BCBS,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS MGG,BCBS MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Cigna,Cigna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Cigna MGG,Cigna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Humana,Humana,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Humana MGG,Humana MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Optum VA,Optum VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,UHC,UHC,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,UHC MGG,UHC MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,VA,VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Wellcare MGG,Wellcare MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Bright Health - commercial,Bright Health - commercial,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
DEXTROSE 5% WITH 0.45% NACL   ,92130926,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Bright Health MGG,Bright Health MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Aetna,Aetna,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Aetna MGG,Aetna MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,BCBS,BCBS,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,BCBS MGG,BCBS MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Cigna,Cigna,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Cigna MGG,Cigna MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Humana,Humana,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Humana MGG,Humana MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Optum VA,Optum VA,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,UHC,UHC,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,UHC MGG,UHC MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,VA,VA,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Wellcare MGG,Wellcare MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Bright Health - commercial,Bright Health - commercial,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92130939,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Bright Health MGG,Bright Health MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Aetna,Aetna,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Aetna MGG,Aetna MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,BCBS,BCBS,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,BCBS MGG,BCBS MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Cigna,Cigna,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Cigna MGG,Cigna MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Humana,Humana,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Humana MGG,Humana MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Optum VA,Optum VA,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,UHC,UHC,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,UHC MGG,UHC MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,VA,VA,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Wellcare MGG,Wellcare MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Bright Health - commercial,Bright Health - commercial,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
ARIPIPRAZOLE 2 MG TAB         ,92130943,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Bright Health MGG,Bright Health MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Aetna,Aetna,11.71,,,,,,,per diem,11.71,11.71,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Aetna MGG,Aetna MGG,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,BCBS,BCBS,11.71,,,,,,,per diem,11.71,11.71,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,BCBS MGG,BCBS MGG,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Cigna,Cigna,11.71,,,,,,,per diem,11.71,11.71,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Cigna MGG,Cigna MGG,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Humana,Humana,11.71,,,,,,,per diem,11.71,11.71,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Humana MGG,Humana MGG,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Optum VA,Optum VA,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,UHC,UHC,11.71,,,,,,,per diem,11.71,11.71,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,UHC MGG,UHC MGG,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,VA,VA,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Wellcare MGG,Wellcare MGG,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Bright Health - commercial,Bright Health - commercial,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 4MEQ/ML 50PCT   ,92130945,CDM,250,RC,,,,,,Inpatient,1,EA,11.71,11.71,Bright Health MGG,Bright Health MGG,11.71,,,,,,,case rate,11.71,11.71,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Aetna,Aetna,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Aetna MGG,Aetna MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,BCBS,BCBS,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,BCBS MGG,BCBS MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Cigna,Cigna,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Cigna MGG,Cigna MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Humana,Humana,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Humana MGG,Humana MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Optum VA,Optum VA,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,UHC,UHC,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,UHC MGG,UHC MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,VA,VA,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Wellcare MGG,Wellcare MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Bright Health - commercial,Bright Health - commercial,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 10MG TAB         ,92130949,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Bright Health MGG,Bright Health MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Aetna,Aetna,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Aetna MGG,Aetna MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,BCBS,BCBS,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,BCBS MGG,BCBS MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Cigna,Cigna,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Cigna MGG,Cigna MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Humana,Humana,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Humana MGG,Humana MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Optum VA,Optum VA,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,UHC,UHC,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,UHC MGG,UHC MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,VA,VA,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Wellcare MGG,Wellcare MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Bright Health - commercial,Bright Health - commercial,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
METHOTREXATE SOD 2.5MG TAB    ,92130956,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,Bright Health MGG,Bright Health MGG,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Aetna,Aetna,24.49,,,,,,,per diem,24.49,24.49,"Per diem rate, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Aetna MGG,Aetna MGG,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,BCBS,BCBS,24.49,,,,,,,per diem,24.49,24.49,"Per diem rate, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,BCBS MGG,BCBS MGG,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Cigna,Cigna,24.49,,,,,,,per diem,24.49,24.49,"Per diem rate, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Cigna MGG,Cigna MGG,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Humana,Humana,24.49,,,,,,,per diem,24.49,24.49,"Per diem rate, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Humana MGG,Humana MGG,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Optum VA,Optum VA,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,UHC,UHC,24.49,,,,,,,per diem,24.49,24.49,"Per diem rate, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,UHC MGG,UHC MGG,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,VA,VA,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Wellcare MGG,Wellcare MGG,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Bright Health - commercial,Bright Health - commercial,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
DULOXETINE 20MG CAP DR        ,92130961,CDM,250,RC,,,,,,Inpatient,1,EA,24.49,24.49,Bright Health MGG,Bright Health MGG,24.49,,,,,,,case rate,24.49,24.49,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Aetna,Aetna,32.12,,,,,,,per diem,32.12,32.12,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Aetna MGG,Aetna MGG,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,BCBS,BCBS,32.12,,,,,,,per diem,32.12,32.12,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,BCBS MGG,BCBS MGG,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Cigna,Cigna,32.12,,,,,,,per diem,32.12,32.12,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Cigna MGG,Cigna MGG,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Humana,Humana,32.12,,,,,,,per diem,32.12,32.12,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Humana MGG,Humana MGG,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Optum VA,Optum VA,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,UHC,UHC,32.12,,,,,,,per diem,32.12,32.12,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,UHC MGG,UHC MGG,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,VA,VA,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Wellcare MGG,Wellcare MGG,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Bright Health - commercial,Bright Health - commercial,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,32.12,32.12,Bright Health MGG,Bright Health MGG,32.12,,,,,,,case rate,32.12,32.12,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Aetna,Aetna,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Aetna MGG,Aetna MGG,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,BCBS,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS MGG,BCBS MGG,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Cigna,Cigna,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Cigna MGG,Cigna MGG,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Humana,Humana,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Humana MGG,Humana MGG,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Optum VA,Optum VA,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,UHC,UHC,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,UHC MGG,UHC MGG,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,VA,VA,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Wellcare MGG,Wellcare MGG,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Bright Health - commercial,Bright Health - commercial,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
"LACTO, ACID BULG 100 MIL      ",92130963,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,Bright Health MGG,Bright Health MGG,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUT-IPRAT 2.5 MG-0.5MG/3ML S,92130974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Aetna,Aetna,14.32,,,,,,,per diem,14.32,14.32,"Per diem rate, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Aetna MGG,Aetna MGG,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,BCBS,BCBS,14.32,,,,,,,per diem,14.32,14.32,"Per diem rate, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,BCBS MGG,BCBS MGG,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Cigna,Cigna,14.32,,,,,,,per diem,14.32,14.32,"Per diem rate, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Cigna MGG,Cigna MGG,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Humana,Humana,14.32,,,,,,,per diem,14.32,14.32,"Per diem rate, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Humana MGG,Humana MGG,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Optum VA,Optum VA,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,UHC,UHC,14.32,,,,,,,per diem,14.32,14.32,"Per diem rate, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,UHC MGG,UHC MGG,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,VA,VA,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Wellcare MGG,Wellcare MGG,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Bright Health - commercial,Bright Health - commercial,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
BUPROPION XL                  ,92130987,CDM,250,RC,,,,,,Inpatient,1,EA,14.32,14.32,Bright Health MGG,Bright Health MGG,14.32,,,,,,,case rate,14.32,14.32,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Aetna,Aetna,93.75,,,,,,,per diem,93.75,93.75,"Per diem rate, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Aetna MGG,Aetna MGG,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,BCBS,BCBS,93.75,,,,,,,per diem,93.75,93.75,"Per diem rate, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,BCBS MGG,BCBS MGG,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Cigna,Cigna,93.75,,,,,,,per diem,93.75,93.75,"Per diem rate, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Cigna MGG,Cigna MGG,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Humana,Humana,93.75,,,,,,,per diem,93.75,93.75,"Per diem rate, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Humana MGG,Humana MGG,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Optum VA,Optum VA,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,UHC,UHC,93.75,,,,,,,per diem,93.75,93.75,"Per diem rate, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,UHC MGG,UHC MGG,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,VA,VA,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Wellcare MGG,Wellcare MGG,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Bright Health - commercial,Bright Health - commercial,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
CEFTRIAXONE                   ,92130992,CDM,250,RC,,,,,,Inpatient,1,EA,93.75,93.75,Bright Health MGG,Bright Health MGG,93.75,,,,,,,case rate,93.75,93.75,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Aetna,Aetna,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Aetna MGG,Aetna MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,BCBS,BCBS,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,BCBS MGG,BCBS MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Cigna,Cigna,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Cigna MGG,Cigna MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Humana,Humana,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Humana MGG,Humana MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Optum VA,Optum VA,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,UHC,UHC,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,UHC MGG,UHC MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,VA,VA,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Wellcare MGG,Wellcare MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Bright Health - commercial,Bright Health - commercial,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN OPHTHALMIC 0.025PCT ,92131021,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Bright Health MGG,Bright Health MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE VISCOUS 2PCT LIQ UD ,92131031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Aetna,Aetna,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Aetna MGG,Aetna MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,BCBS,BCBS,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,BCBS MGG,BCBS MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Cigna,Cigna,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Cigna MGG,Cigna MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Humana,Humana,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Humana MGG,Humana MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Optum VA,Optum VA,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,UHC,UHC,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,UHC MGG,UHC MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,VA,VA,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Wellcare MGG,Wellcare MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Bright Health - commercial,Bright Health - commercial,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE UD        ,92131034,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Bright Health MGG,Bright Health MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL - CHERRY 1.4PCT        ,92131063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Aetna,Aetna,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Aetna MGG,Aetna MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,BCBS,BCBS,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,BCBS MGG,BCBS MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Cigna,Cigna,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Cigna MGG,Cigna MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Humana,Humana,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Humana MGG,Humana MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Optum VA,Optum VA,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,UHC,UHC,14.22,,,,,,,per diem,14.22,14.22,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,UHC MGG,UHC MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,VA,VA,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Wellcare MGG,Wellcare MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Bright Health - commercial,Bright Health - commercial,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE *PREMIX*   ,92131068,CDM,250,RC,,,,,,Inpatient,1,EA,14.22,14.22,Bright Health MGG,Bright Health MGG,14.22,,,,,,,case rate,14.22,14.22,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Aetna,Aetna,18.29,,,,,,,per diem,18.29,18.29,"Per diem rate, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Aetna MGG,Aetna MGG,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,BCBS,BCBS,18.29,,,,,,,per diem,18.29,18.29,"Per diem rate, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,BCBS MGG,BCBS MGG,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Cigna,Cigna,18.29,,,,,,,per diem,18.29,18.29,"Per diem rate, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Cigna MGG,Cigna MGG,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Humana,Humana,18.29,,,,,,,per diem,18.29,18.29,"Per diem rate, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Humana MGG,Humana MGG,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Optum VA,Optum VA,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,UHC,UHC,18.29,,,,,,,per diem,18.29,18.29,"Per diem rate, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,UHC MGG,UHC MGG,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,VA,VA,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Wellcare MGG,Wellcare MGG,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Bright Health - commercial,Bright Health - commercial,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
SEVELAMER                     ,92131073,CDM,250,RC,,,,,,Inpatient,1,EA,18.29,18.29,Bright Health MGG,Bright Health MGG,18.29,,,,,,,case rate,18.29,18.29,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92131098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna,Aetna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna MGG,Aetna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,BCBS,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS MGG,BCBS MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna,Cigna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna MGG,Cigna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana,Humana,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana MGG,Humana MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Optum VA,Optum VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC,UHC,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC MGG,UHC MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,VA,VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Wellcare MGG,Wellcare MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health - commercial,Bright Health - commercial,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 10-100M,92131117,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health MGG,Bright Health MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETH-GUAIFENESIN 30-600M,92131119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Aetna,Aetna,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Aetna MGG,Aetna MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,BCBS,BCBS,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,BCBS MGG,BCBS MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Cigna,Cigna,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Cigna MGG,Cigna MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Humana,Humana,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Humana MGG,Humana MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Optum VA,Optum VA,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,UHC,UHC,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,UHC MGG,UHC MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,VA,VA,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Wellcare MGG,Wellcare MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Bright Health - commercial,Bright Health - commercial,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-SALMETEROL 100-50 MCG,92131127,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Bright Health MGG,Bright Health MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Aetna,Aetna,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Aetna MGG,Aetna MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,BCBS,BCBS,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,BCBS MGG,BCBS MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Cigna,Cigna,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Cigna MGG,Cigna MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Humana,Humana,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Humana MGG,Humana MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Optum VA,Optum VA,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,UHC,UHC,274.16,,,,,,,per diem,274.16,274.16,"Per diem rate, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,UHC MGG,UHC MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,VA,VA,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Wellcare MGG,Wellcare MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Bright Health - commercial,Bright Health - commercial,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
FLUTICAS-VILANTEROL 200-25 MCG,92131128,CDM,250,RC,,,,,,Inpatient,1,EA,274.16,274.16,Bright Health MGG,Bright Health MGG,274.16,,,,,,,case rate,274.16,274.16,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYC-WITCH HAZEL 12.5-50  TOP ,92131129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Aetna,Aetna,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Aetna MGG,Aetna MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,BCBS,BCBS,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,BCBS MGG,BCBS MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Cigna,Cigna,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Cigna MGG,Cigna MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Humana,Humana,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Humana MGG,Humana MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Optum VA,Optum VA,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,UHC,UHC,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,UHC MGG,UHC MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,VA,VA,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Wellcare MGG,Wellcare MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Bright Health - commercial,Bright Health - commercial,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000 MG IV SOLR    ,92131154,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Bright Health MGG,Bright Health MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Aetna,Aetna,5.59,,,,,,,per diem,5.59,5.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Aetna MGG,Aetna MGG,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,BCBS,BCBS,5.59,,,,,,,per diem,5.59,5.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,BCBS MGG,BCBS MGG,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Cigna,Cigna,5.59,,,,,,,per diem,5.59,5.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Cigna MGG,Cigna MGG,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Humana,Humana,5.59,,,,,,,per diem,5.59,5.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Humana MGG,Humana MGG,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Optum VA,Optum VA,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,UHC,UHC,5.59,,,,,,,per diem,5.59,5.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,UHC MGG,UHC MGG,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,VA,VA,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Wellcare MGG,Wellcare MGG,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Bright Health - commercial,Bright Health - commercial,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE MONOHYDRATE 100 MG,92131160,CDM,250,RC,,,,,,Inpatient,1,EA,5.59,5.59,Bright Health MGG,Bright Health MGG,5.59,,,,,,,case rate,5.59,5.59,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA 25-100 MG O,92131182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Aetna,Aetna,167.3,,,,,,,per diem,167.3,167.3,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Aetna MGG,Aetna MGG,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,BCBS,BCBS,167.3,,,,,,,per diem,167.3,167.3,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,BCBS MGG,BCBS MGG,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Cigna,Cigna,167.3,,,,,,,per diem,167.3,167.3,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Cigna MGG,Cigna MGG,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Humana,Humana,167.3,,,,,,,per diem,167.3,167.3,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Humana MGG,Humana MGG,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Optum VA,Optum VA,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,UHC,UHC,167.3,,,,,,,per diem,167.3,167.3,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,UHC MGG,UHC MGG,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,VA,VA,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Wellcare MGG,Wellcare MGG,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Bright Health - commercial,Bright Health - commercial,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2 MG/24 HR TD PTWK,92131185,CDM,250,RC,,,,,,Inpatient,1,EA,167.3,167.3,Bright Health MGG,Bright Health MGG,167.3,,,,,,,case rate,167.3,167.3,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180 MG ORAL CP24,92131194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Aetna,Aetna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Aetna MGG,Aetna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,BCBS,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS MGG,BCBS MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Cigna,Cigna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Cigna MGG,Cigna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Humana,Humana,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Humana MGG,Humana MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Optum VA,Optum VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UHC,UHC,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UHC MGG,UHC MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,VA,VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Wellcare MGG,Wellcare MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Bright Health - commercial,Bright Health - commercial,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FENTANYL  50 MCG/HR TD PT72   ,92131205,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Bright Health MGG,Bright Health MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Aetna,Aetna,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Aetna MGG,Aetna MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,BCBS,BCBS,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,BCBS MGG,BCBS MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Cigna,Cigna,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Cigna MGG,Cigna MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Humana,Humana,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Humana MGG,Humana MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Optum VA,Optum VA,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,UHC,UHC,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,UHC MGG,UHC MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,VA,VA,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Wellcare MGG,Wellcare MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Bright Health - commercial,Bright Health - commercial,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Bright Health MGG,Bright Health MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TAB      ,92131219,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE  5 MG ORAL TR24     ,92131220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Aetna,Aetna,5.03,,,,,,,per diem,5.03,5.03,"Per diem rate, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Aetna MGG,Aetna MGG,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,BCBS,BCBS,5.03,,,,,,,per diem,5.03,5.03,"Per diem rate, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,BCBS MGG,BCBS MGG,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Cigna,Cigna,5.03,,,,,,,per diem,5.03,5.03,"Per diem rate, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Cigna MGG,Cigna MGG,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Humana,Humana,5.03,,,,,,,per diem,5.03,5.03,"Per diem rate, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Humana MGG,Humana MGG,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Optum VA,Optum VA,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,UHC,UHC,5.03,,,,,,,per diem,5.03,5.03,"Per diem rate, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,UHC MGG,UHC MGG,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,VA,VA,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Wellcare MGG,Wellcare MGG,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Bright Health - commercial,Bright Health - commercial,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
ISOSORBIDE MONONITRATE  30 MG ,92131229,CDM,250,RC,,,,,,Inpatient,1,EA,5.03,5.03,Bright Health MGG,Bright Health MGG,5.03,,,,,,,case rate,5.03,5.03,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  25 MCG ORAL TAB,92131231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Aetna,Aetna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Aetna MGG,Aetna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,BCBS,BCBS,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,BCBS MGG,BCBS MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Cigna,Cigna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Cigna MGG,Cigna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Humana,Humana,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Humana MGG,Humana MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Optum VA,Optum VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,UHC,UHC,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,UHC MGG,UHC MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,VA,VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Wellcare MGG,Wellcare MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Bright Health - commercial,Bright Health - commercial,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Bright Health MGG,Bright Health MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
LORAZEPAM 2 MG/ML INJ SOLN    ,92131237,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Aetna,Aetna,49.2,,,,,,,per diem,49.2,49.2,"Per diem rate, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Aetna MGG,Aetna MGG,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,BCBS,BCBS,49.2,,,,,,,per diem,49.2,49.2,"Per diem rate, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,BCBS MGG,BCBS MGG,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Cigna,Cigna,49.2,,,,,,,per diem,49.2,49.2,"Per diem rate, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Cigna MGG,Cigna MGG,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Humana,Humana,49.2,,,,,,,per diem,49.2,49.2,"Per diem rate, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Humana MGG,Humana MGG,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Optum VA,Optum VA,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,UHC,UHC,49.2,,,,,,,per diem,49.2,49.2,"Per diem rate, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,UHC MGG,UHC MGG,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,VA,VA,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Wellcare MGG,Wellcare MGG,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Bright Health - commercial,Bright Health - commercial,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
MESALAMINE  800 MG ORAL TBEC  ,92131241,CDM,250,RC,,,,,,Inpatient,1,EA,49.2,49.2,Bright Health MGG,Bright Health MGG,49.2,,,,,,,case rate,49.2,49.2,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN  850 MG ORAL TAB    ,92131243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG ORAL TAB ,92131248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Aetna,Aetna,128.25,,,,,,,per diem,128.25,128.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Aetna MGG,Aetna MGG,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,BCBS,BCBS,128.25,,,,,,,per diem,128.25,128.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,BCBS MGG,BCBS MGG,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Cigna,Cigna,128.25,,,,,,,per diem,128.25,128.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Cigna MGG,Cigna MGG,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Humana,Humana,128.25,,,,,,,per diem,128.25,128.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Humana MGG,Humana MGG,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Optum VA,Optum VA,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,UHC,UHC,128.25,,,,,,,per diem,128.25,128.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,UHC MGG,UHC MGG,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,VA,VA,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Wellcare MGG,Wellcare MGG,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Bright Health - commercial,Bright Health - commercial,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2  TOP OINT         ,92131251,CDM,250,RC,,,,,,Inpatient,1,EA,128.25,128.25,Bright Health MGG,Bright Health MGG,128.25,,,,,,,case rate,128.25,128.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30 MG ORAL TR24    ,92131253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Aetna,Aetna,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Aetna MGG,Aetna MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,BCBS,BCBS,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,BCBS MGG,BCBS MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Cigna,Cigna,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Cigna MGG,Cigna MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Humana,Humana,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Humana MGG,Humana MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Optum VA,Optum VA,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,UHC,UHC,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,UHC MGG,UHC MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,VA,VA,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Wellcare MGG,Wellcare MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Bright Health - commercial,Bright Health - commercial,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
OLANZAPINE  5 MG ORAL TAB RHOW,92131255,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Bright Health MGG,Bright Health MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20 MG ORAL TAB     ,92131267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Aetna,Aetna,35.67,,,,,,,per diem,35.67,35.67,"Per diem rate, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Aetna MGG,Aetna MGG,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,BCBS,BCBS,35.67,,,,,,,per diem,35.67,35.67,"Per diem rate, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,BCBS MGG,BCBS MGG,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Cigna,Cigna,35.67,,,,,,,per diem,35.67,35.67,"Per diem rate, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Cigna MGG,Cigna MGG,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Humana,Humana,35.67,,,,,,,per diem,35.67,35.67,"Per diem rate, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Humana MGG,Humana MGG,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Optum VA,Optum VA,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,UHC,UHC,35.67,,,,,,,per diem,35.67,35.67,"Per diem rate, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,UHC MGG,UHC MGG,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,VA,VA,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Wellcare MGG,Wellcare MGG,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Bright Health - commercial,Bright Health - commercial,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
PREGABALIN  75 MG ORAL CAP    ,92131268,CDM,250,RC,,,,,,Inpatient,1,EA,35.67,35.67,Bright Health MGG,Bright Health MGG,35.67,,,,,,,case rate,35.67,35.67,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500 MG ORAL TAB ,92131273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Aetna,Aetna,29.56,,,,,,,per diem,29.56,29.56,"Per diem rate, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Aetna MGG,Aetna MGG,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,BCBS,BCBS,29.56,,,,,,,per diem,29.56,29.56,"Per diem rate, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,BCBS MGG,BCBS MGG,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Cigna,Cigna,29.56,,,,,,,per diem,29.56,29.56,"Per diem rate, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Cigna MGG,Cigna MGG,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Humana,Humana,29.56,,,,,,,per diem,29.56,29.56,"Per diem rate, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Humana MGG,Humana MGG,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Optum VA,Optum VA,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,UHC,UHC,29.56,,,,,,,per diem,29.56,29.56,"Per diem rate, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,UHC MGG,UHC MGG,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,VA,VA,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Wellcare MGG,Wellcare MGG,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Bright Health - commercial,Bright Health - commercial,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
QUETIAPINE 50MG ORAL TAB      ,92131280,CDM,250,RC,,,,,,Inpatient,1,EA,29.56,29.56,Bright Health MGG,Bright Health MGG,29.56,,,,,,,case rate,29.56,29.56,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASPIRIN 325 MG TABLET,DELAYED ",92131294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN 5 MG TABLET          ,92131312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500 MG TABLET   ,92131322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Aetna,Aetna,74.47,,,,,,,per diem,74.47,74.47,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Aetna MGG,Aetna MGG,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,BCBS,BCBS,74.47,,,,,,,per diem,74.47,74.47,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,BCBS MGG,BCBS MGG,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Cigna,Cigna,74.47,,,,,,,per diem,74.47,74.47,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Cigna MGG,Cigna MGG,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Humana,Humana,74.47,,,,,,,per diem,74.47,74.47,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Humana MGG,Humana MGG,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Optum VA,Optum VA,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,UHC,UHC,74.47,,,,,,,per diem,74.47,74.47,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,UHC MGG,UHC MGG,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,VA,VA,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Wellcare MGG,Wellcare MGG,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Bright Health - commercial,Bright Health - commercial,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1 MG/24 HR WEEKLY ,92131327,CDM,250,RC,,,,,,Inpatient,1,EA,74.47,74.47,Bright Health MGG,Bright Health MGG,74.47,,,,,,,case rate,74.47,74.47,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Aetna,Aetna,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Aetna MGG,Aetna MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,BCBS,BCBS,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,BCBS MGG,BCBS MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Cigna,Cigna,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Cigna MGG,Cigna MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Humana,Humana,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Humana MGG,Humana MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Optum VA,Optum VA,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,UHC,UHC,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,UHC MGG,UHC MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,VA,VA,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Wellcare MGG,Wellcare MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Bright Health - commercial,Bright Health - commercial,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DICLOFENAC 1  TOPICAL GEL     ,92131354,CDM,250,RC,,,,,,Inpatient,1,EA,44.1,44.1,Bright Health MGG,Bright Health MGG,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM ER XR/XT 120 MG CA  ,92131355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Aetna,Aetna,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Aetna MGG,Aetna MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,BCBS,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS MGG,BCBS MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Cigna,Cigna,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Cigna MGG,Cigna MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Humana,Humana,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Humana MGG,Humana MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Optum VA,Optum VA,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UHC,UHC,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UHC MGG,UHC MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,VA,VA,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Wellcare MGG,Wellcare MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Bright Health - commercial,Bright Health - commercial,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25 MG CAPSULE ,92131359,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Bright Health MGG,Bright Health MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE SODIUM 100 MG CAPSULE,92131367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Aetna,Aetna,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Aetna MGG,Aetna MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,BCBS,BCBS,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,BCBS MGG,BCBS MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Cigna,Cigna,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Cigna MGG,Cigna MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Humana,Humana,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Humana MGG,Humana MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Optum VA,Optum VA,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,UHC,UHC,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,UHC MGG,UHC MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,VA,VA,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Wellcare MGG,Wellcare MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Bright Health - commercial,Bright Health - commercial,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100 MG CAP,92131370,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Bright Health MGG,Bright Health MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Aetna,Aetna,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Aetna MGG,Aetna MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,BCBS,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS MGG,BCBS MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Cigna,Cigna,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Cigna MGG,Cigna MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Humana,Humana,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Humana MGG,Humana MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Optum VA,Optum VA,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,UHC,UHC,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,UHC MGG,UHC MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,VA,VA,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Wellcare MGG,Wellcare MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Bright Health - commercial,Bright Health - commercial,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
"DULOXETINE 60 MG CAPSULE,DELAY",92131377,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Bright Health MGG,Bright Health MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Aetna,Aetna,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Aetna MGG,Aetna MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,BCBS,BCBS,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,BCBS MGG,BCBS MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Cigna,Cigna,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Cigna MGG,Cigna MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Humana,Humana,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Humana MGG,Humana MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Optum VA,Optum VA,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,UHC,UHC,33.49,,,,,,,per diem,33.49,33.49,"Per diem rate, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,UHC MGG,UHC MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,VA,VA,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Wellcare MGG,Wellcare MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Bright Health - commercial,Bright Health - commercial,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
ENOXAPARIN 40 MG/0.4 ML SUBCUT,92131380,CDM,250,RC,,,,,,Inpatient,1,EA,33.49,33.49,Bright Health MGG,Bright Health MGG,33.49,,,,,,,case rate,33.49,33.49,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna,Aetna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna MGG,Aetna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS,BCBS,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS MGG,BCBS MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna,Cigna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna MGG,Cigna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana,Humana,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana MGG,Humana MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Optum VA,Optum VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC,UHC,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC MGG,UHC MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,VA,VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Wellcare MGG,Wellcare MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health - commercial,Bright Health - commercial,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE 1 MG/ML 1 ML INJ  ,92131387,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health MGG,Bright Health MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Aetna,Aetna,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Aetna MGG,Aetna MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,BCBS,BCBS,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,BCBS MGG,BCBS MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Cigna,Cigna,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Cigna MGG,Cigna MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Humana,Humana,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Humana MGG,Humana MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Optum VA,Optum VA,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,UHC,UHC,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,UHC MGG,UHC MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,VA,VA,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Wellcare MGG,Wellcare MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Bright Health - commercial,Bright Health - commercial,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ESCITALOPRAM 10 MG TABLET     ,92131397,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Bright Health MGG,Bright Health MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE PF 20 MG/2 ML INT  ,92131398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Aetna,Aetna,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Aetna MGG,Aetna MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,BCBS,BCBS,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,BCBS MGG,BCBS MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Cigna,Cigna,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Cigna MGG,Cigna MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Humana,Humana,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Humana MGG,Humana MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Optum VA,Optum VA,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,UHC,UHC,43.26,,,,,,,per diem,43.26,43.26,"Per diem rate, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,UHC MGG,UHC MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,VA,VA,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Wellcare MGG,Wellcare MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Bright Health - commercial,Bright Health - commercial,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FENTANYL 25 MCG/HR TRANSDERMAL,92131406,CDM,250,RC,,,,,,Inpatient,1,EA,43.26,43.26,Bright Health MGG,Bright Health MGG,43.26,,,,,,,case rate,43.26,43.26,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna,Aetna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna MGG,Aetna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS,BCBS,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS MGG,BCBS MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna,Cigna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna MGG,Cigna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana,Humana,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana MGG,Humana MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Optum VA,Optum VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC,UHC,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC MGG,UHC MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,VA,VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Wellcare MGG,Wellcare MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health - commercial,Bright Health - commercial,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FLUOXETINE 20 MG CAPSULE      ,92131408,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health MGG,Bright Health MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna,Aetna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna MGG,Aetna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS,BCBS,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS MGG,BCBS MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna,Cigna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna MGG,Cigna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana,Humana,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana MGG,Humana MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Optum VA,Optum VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC,UHC,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC MGG,UHC MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,VA,VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Wellcare MGG,Wellcare MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health - commercial,Bright Health - commercial,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131410,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health MGG,Bright Health MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Aetna,Aetna,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Aetna MGG,Aetna MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,BCBS,BCBS,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,BCBS MGG,BCBS MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Cigna,Cigna,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Cigna MGG,Cigna MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Humana,Humana,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Humana MGG,Humana MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Optum VA,Optum VA,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,UHC,UHC,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,UHC MGG,UHC MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,VA,VA,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Wellcare MGG,Wellcare MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Bright Health - commercial,Bright Health - commercial,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
FOLIC ACID 1 MG TABLET        ,92131411,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Bright Health MGG,Bright Health MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 100 MG CAPSULE     ,92131417,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92131427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Aetna,Aetna,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Aetna MGG,Aetna MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,BCBS,BCBS,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,BCBS MGG,BCBS MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Cigna,Cigna,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Cigna MGG,Cigna MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Humana,Humana,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Humana MGG,Humana MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Optum VA,Optum VA,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,UHC,UHC,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,UHC MGG,UHC MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,VA,VA,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Wellcare MGG,Wellcare MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Bright Health - commercial,Bright Health - commercial,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
"HEPARIN PORCINE 5,000 UNIT/M  ",92131437,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Bright Health MGG,Bright Health MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TABLET      ,92131439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 12.5 MG CA,92131441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN GLARGINE U-100 100 U  ,92131472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Aetna,Aetna,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Aetna MGG,Aetna MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,BCBS,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS MGG,BCBS MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Cigna,Cigna,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Cigna MGG,Cigna MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Humana,Humana,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Humana MGG,Humana MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Optum VA,Optum VA,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UHC,UHC,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UHC MGG,UHC MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,VA,VA,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Wellcare MGG,Wellcare MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Bright Health - commercial,Bright Health - commercial,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOPERAMIDE 2 MG CAPSULE       ,92131482,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Bright Health MGG,Bright Health MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5 MG TABLET       ,92131490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Aetna,Aetna,16.96,,,,,,,per diem,16.96,16.96,"Per diem rate, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Aetna MGG,Aetna MGG,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,BCBS,BCBS,16.96,,,,,,,per diem,16.96,16.96,"Per diem rate, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,BCBS MGG,BCBS MGG,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Cigna,Cigna,16.96,,,,,,,per diem,16.96,16.96,"Per diem rate, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Cigna MGG,Cigna MGG,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Humana,Humana,16.96,,,,,,,per diem,16.96,16.96,"Per diem rate, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Humana MGG,Humana MGG,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Optum VA,Optum VA,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,UHC,UHC,16.96,,,,,,,per diem,16.96,16.96,"Per diem rate, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,UHC MGG,UHC MGG,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,VA,VA,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Wellcare MGG,Wellcare MGG,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Bright Health - commercial,Bright Health - commercial,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MONTELUKAST 10 MG TABLET      ,92131536,CDM,250,RC,,,,,,Inpatient,1,EA,16.96,16.96,Bright Health MGG,Bright Health MGG,16.96,,,,,,,case rate,16.96,16.96,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN DROPS PEDIATRIC 0,92131554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Aetna,Aetna,26.84,,,,,,,per diem,26.84,26.84,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Aetna MGG,Aetna MGG,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,BCBS,BCBS,26.84,,,,,,,per diem,26.84,26.84,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,BCBS MGG,BCBS MGG,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Cigna,Cigna,26.84,,,,,,,per diem,26.84,26.84,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Cigna MGG,Cigna MGG,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Humana,Humana,26.84,,,,,,,per diem,26.84,26.84,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Humana MGG,Humana MGG,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Optum VA,Optum VA,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,UHC,UHC,26.84,,,,,,,per diem,26.84,26.84,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,UHC MGG,UHC MGG,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,VA,VA,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Wellcare MGG,Wellcare MGG,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Bright Health - commercial,Bright Health - commercial,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 UNIT/GRAM TOP",92131566,CDM,250,RC,,,,,,Inpatient,1,EA,26.84,26.84,Bright Health MGG,Bright Health MGG,26.84,,,,,,,case rate,26.84,26.84,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Aetna,Aetna,22.13,,,,,,,per diem,22.13,22.13,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Aetna MGG,Aetna MGG,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,BCBS,BCBS,22.13,,,,,,,per diem,22.13,22.13,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,BCBS MGG,BCBS MGG,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Cigna,Cigna,22.13,,,,,,,per diem,22.13,22.13,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Cigna MGG,Cigna MGG,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Humana,Humana,22.13,,,,,,,per diem,22.13,22.13,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Humana MGG,Humana MGG,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Optum VA,Optum VA,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,UHC,UHC,22.13,,,,,,,per diem,22.13,22.13,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,UHC MGG,UHC MGG,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,VA,VA,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Wellcare MGG,Wellcare MGG,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Bright Health - commercial,Bright Health - commercial,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131603,CDM,250,RC,,,,,,Inpatient,1,EA,22.13,22.13,Bright Health MGG,Bright Health MGG,22.13,,,,,,,case rate,22.13,22.13,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Aetna,Aetna,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Aetna MGG,Aetna MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,BCBS,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS MGG,BCBS MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Cigna,Cigna,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Cigna MGG,Cigna MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Humana,Humana,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Humana MGG,Humana MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Optum VA,Optum VA,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UHC,UHC,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UHC MGG,UHC MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,VA,VA,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Wellcare MGG,Wellcare MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Bright Health - commercial,Bright Health - commercial,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
OXYCODONE-ACETAMINOPHEN 10 MG-,92131608,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Bright Health MGG,Bright Health MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Aetna,Aetna,14.75,,,,,,,per diem,14.75,14.75,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Aetna MGG,Aetna MGG,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,BCBS,BCBS,14.75,,,,,,,per diem,14.75,14.75,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,BCBS MGG,BCBS MGG,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Cigna,Cigna,14.75,,,,,,,per diem,14.75,14.75,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Cigna MGG,Cigna MGG,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Humana,Humana,14.75,,,,,,,per diem,14.75,14.75,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Humana MGG,Humana MGG,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Optum VA,Optum VA,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,UHC,UHC,14.75,,,,,,,per diem,14.75,14.75,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,UHC MGG,UHC MGG,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,VA,VA,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Wellcare MGG,Wellcare MGG,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Bright Health - commercial,Bright Health - commercial,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG DISINTEGRAT,92131639,CDM,250,RC,,,,,,Inpatient,1,EA,14.75,14.75,Bright Health MGG,Bright Health MGG,14.75,,,,,,,case rate,14.75,14.75,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Aetna,Aetna,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Aetna MGG,Aetna MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,BCBS,BCBS,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,BCBS MGG,BCBS MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Cigna,Cigna,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Cigna MGG,Cigna MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Humana,Humana,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Humana MGG,Humana MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Optum VA,Optum VA,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,UHC,UHC,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,UHC MGG,UHC MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,VA,VA,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Wellcare MGG,Wellcare MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Bright Health - commercial,Bright Health - commercial,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
RISPERIDONE 0.5 MG TABLET     ,92131641,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Bright Health MGG,Bright Health MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125 MG TABLET    ,92131682,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TABL,92131694,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Aetna,Aetna,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Aetna MGG,Aetna MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,BCBS,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS MGG,BCBS MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Cigna,Cigna,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Cigna MGG,Cigna MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Humana,Humana,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Humana MGG,Humana MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Optum VA,Optum VA,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UHC,UHC,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UHC MGG,UHC MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,VA,VA,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Wellcare MGG,Wellcare MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Bright Health - commercial,Bright Health - commercial,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HRTD PT24     ,92131731,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,Bright Health MGG,Bright Health MGG,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Aetna,Aetna,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Aetna MGG,Aetna MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,BCBS,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS MGG,BCBS MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Cigna,Cigna,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Cigna MGG,Cigna MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Humana,Humana,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Humana MGG,Humana MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Optum VA,Optum VA,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UHC,UHC,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UHC MGG,UHC MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,VA,VA,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Wellcare MGG,Wellcare MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Bright Health - commercial,Bright Health - commercial,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MAC 50MG CAP   ,92131734,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Bright Health MGG,Bright Health MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML ORAL LIQ,92131742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN V POT 500MG ORAL TA,92131748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Aetna,Aetna,54.16,,,,,,,per diem,54.16,54.16,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Aetna MGG,Aetna MGG,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,BCBS,BCBS,54.16,,,,,,,per diem,54.16,54.16,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,BCBS MGG,BCBS MGG,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Cigna,Cigna,54.16,,,,,,,per diem,54.16,54.16,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Cigna MGG,Cigna MGG,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Humana,Humana,54.16,,,,,,,per diem,54.16,54.16,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Humana MGG,Humana MGG,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Optum VA,Optum VA,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,UHC,UHC,54.16,,,,,,,per diem,54.16,54.16,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,UHC MGG,UHC MGG,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,VA,VA,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Wellcare MGG,Wellcare MGG,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Bright Health - commercial,Bright Health - commercial,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,54.16,54.16,Bright Health MGG,Bright Health MGG,54.16,,,,,,,case rate,54.16,54.16,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Aetna,Aetna,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Aetna MGG,Aetna MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,BCBS,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS MGG,BCBS MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Cigna,Cigna,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Cigna MGG,Cigna MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Humana,Humana,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Humana MGG,Humana MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Optum VA,Optum VA,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,UHC,UHC,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,UHC MGG,UHC MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,VA,VA,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Wellcare MGG,Wellcare MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Bright Health - commercial,Bright Health - commercial,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DULOXETINE HCL 30MG CAP       ,92131761,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,Bright Health MGG,Bright Health MGG,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Aetna,Aetna,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Aetna MGG,Aetna MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,BCBS,BCBS,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,BCBS MGG,BCBS MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Cigna,Cigna,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Cigna MGG,Cigna MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Humana,Humana,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Humana MGG,Humana MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Optum VA,Optum VA,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,UHC,UHC,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,UHC MGG,UHC MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,VA,VA,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Wellcare MGG,Wellcare MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Bright Health - commercial,Bright Health - commercial,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92131776,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Bright Health MGG,Bright Health MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Aetna,Aetna,4.46,,,,,,,per diem,4.46,4.46,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Aetna MGG,Aetna MGG,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,BCBS,BCBS,4.46,,,,,,,per diem,4.46,4.46,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,BCBS MGG,BCBS MGG,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Cigna,Cigna,4.46,,,,,,,per diem,4.46,4.46,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Cigna MGG,Cigna MGG,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Humana,Humana,4.46,,,,,,,per diem,4.46,4.46,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Humana MGG,Humana MGG,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Optum VA,Optum VA,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,UHC,UHC,4.46,,,,,,,per diem,4.46,4.46,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,UHC MGG,UHC MGG,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,VA,VA,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Wellcare MGG,Wellcare MGG,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Bright Health - commercial,Bright Health - commercial,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE HCL 5 MG TAB 10,92131778,CDM,250,RC,,,,,,Inpatient,1,EA,4.46,4.46,Bright Health MGG,Bright Health MGG,4.46,,,,,,,case rate,4.46,4.46,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92131783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92131786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Aetna,Aetna,23.54,,,,,,,per diem,23.54,23.54,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Aetna MGG,Aetna MGG,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,BCBS,BCBS,23.54,,,,,,,per diem,23.54,23.54,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,BCBS MGG,BCBS MGG,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Cigna,Cigna,23.54,,,,,,,per diem,23.54,23.54,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Cigna MGG,Cigna MGG,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Humana,Humana,23.54,,,,,,,per diem,23.54,23.54,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Humana MGG,Humana MGG,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Optum VA,Optum VA,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,UHC,UHC,23.54,,,,,,,per diem,23.54,23.54,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,UHC MGG,UHC MGG,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,VA,VA,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Wellcare MGG,Wellcare MGG,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Bright Health - commercial,Bright Health - commercial,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOF 500 MG TAB  ,92131798,CDM,250,RC,,,,,,Inpatient,1,EA,23.54,23.54,Bright Health MGG,Bright Health MGG,23.54,,,,,,,case rate,23.54,23.54,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750 MG PO TABS     ,92131807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Aetna,Aetna,958.14,,,,,,,per diem,958.14,958.14,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Aetna MGG,Aetna MGG,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,BCBS,BCBS,958.14,,,,,,,per diem,958.14,958.14,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,BCBS MGG,BCBS MGG,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Cigna,Cigna,958.14,,,,,,,per diem,958.14,958.14,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Cigna MGG,Cigna MGG,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Humana,Humana,958.14,,,,,,,per diem,958.14,958.14,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Humana MGG,Humana MGG,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Optum VA,Optum VA,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,UHC,UHC,958.14,,,,,,,per diem,958.14,958.14,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,UHC MGG,UHC MGG,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,VA,VA,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Wellcare MGG,Wellcare MGG,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Bright Health - commercial,Bright Health - commercial,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75 % EXT CRM  ,92131816,CDM,250,RC,,,,,,Inpatient,1,EA,958.14,958.14,Bright Health MGG,Bright Health MGG,958.14,,,,,,,case rate,958.14,958.14,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Aetna,Aetna,962.03,,,,,,,per diem,962.03,962.03,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Aetna MGG,Aetna MGG,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,BCBS,BCBS,962.03,,,,,,,per diem,962.03,962.03,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,BCBS MGG,BCBS MGG,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Cigna,Cigna,962.03,,,,,,,per diem,962.03,962.03,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Cigna MGG,Cigna MGG,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Humana,Humana,962.03,,,,,,,per diem,962.03,962.03,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Humana MGG,Humana MGG,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Optum VA,Optum VA,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,UHC,UHC,962.03,,,,,,,per diem,962.03,962.03,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,UHC MGG,UHC MGG,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,VA,VA,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Wellcare MGG,Wellcare MGG,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Bright Health - commercial,Bright Health - commercial,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG PO TABS     ,92131817,CDM,250,RC,,,,,,Inpatient,1,EA,962.03,962.03,Bright Health MGG,Bright Health MGG,962.03,,,,,,,case rate,962.03,962.03,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500 MG PO TABS     ,92131820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250 MG PO TABS  ,92131827,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna,Aetna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna MGG,Aetna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,BCBS,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS MGG,BCBS MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna,Cigna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna MGG,Cigna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana,Humana,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana MGG,Humana MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Optum VA,Optum VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC,UHC,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC MGG,UHC MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,VA,VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Wellcare MGG,Wellcare MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health - commercial,Bright Health - commercial,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SALINE NASAL SPRAY 0.65 % SOLN,92131840,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health MGG,Bright Health MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Aetna,Aetna,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Aetna MGG,Aetna MGG,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,BCBS,BCBS,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,BCBS MGG,BCBS MGG,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Cigna,Cigna,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Cigna MGG,Cigna MGG,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Humana,Humana,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Humana MGG,Humana MGG,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Optum VA,Optum VA,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,UHC,UHC,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,UHC MGG,UHC MGG,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,VA,VA,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Wellcare MGG,Wellcare MGG,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Bright Health - commercial,Bright Health - commercial,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
MISOPROSTOL 200 MCG PO TABS   ,92131866,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,Bright Health MGG,Bright Health MGG,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Aetna,Aetna,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Aetna MGG,Aetna MGG,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,BCBS,BCBS,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,BCBS MGG,BCBS MGG,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Cigna,Cigna,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Cigna MGG,Cigna MGG,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Humana,Humana,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Humana MGG,Humana MGG,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Optum VA,Optum VA,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,UHC,UHC,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,UHC MGG,UHC MGG,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,VA,VA,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Wellcare MGG,Wellcare MGG,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Bright Health - commercial,Bright Health - commercial,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
CLOPIDOGREL BISULFATE 75 MG PO,92131893,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,Bright Health MGG,Bright Health MGG,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITRATE 1.745 GM/30M,92131924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Aetna,Aetna,60.95,,,,,,,per diem,60.95,60.95,"Per diem rate, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Aetna MGG,Aetna MGG,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,BCBS,BCBS,60.95,,,,,,,per diem,60.95,60.95,"Per diem rate, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,BCBS MGG,BCBS MGG,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Cigna,Cigna,60.95,,,,,,,per diem,60.95,60.95,"Per diem rate, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Cigna MGG,Cigna MGG,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Humana,Humana,60.95,,,,,,,per diem,60.95,60.95,"Per diem rate, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Humana MGG,Humana MGG,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Optum VA,Optum VA,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,UHC,UHC,60.95,,,,,,,per diem,60.95,60.95,"Per diem rate, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,UHC MGG,UHC MGG,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,VA,VA,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Wellcare MGG,Wellcare MGG,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Bright Health - commercial,Bright Health - commercial,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
OLANZAPINE 10 MG PO TABS      ,92131942,CDM,250,RC,,,,,,Inpatient,1,EA,60.95,60.95,Bright Health MGG,Bright Health MGG,60.95,,,,,,,case rate,60.95,60.95,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10 MG PO TABS     ,92131959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Aetna,Aetna,7.34,,,,,,,per diem,7.34,7.34,"Per diem rate, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Aetna MGG,Aetna MGG,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,BCBS,BCBS,7.34,,,,,,,per diem,7.34,7.34,"Per diem rate, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,BCBS MGG,BCBS MGG,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Cigna,Cigna,7.34,,,,,,,per diem,7.34,7.34,"Per diem rate, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Cigna MGG,Cigna MGG,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Humana,Humana,7.34,,,,,,,per diem,7.34,7.34,"Per diem rate, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Humana MGG,Humana MGG,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Optum VA,Optum VA,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,UHC,UHC,7.34,,,,,,,per diem,7.34,7.34,"Per diem rate, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,UHC MGG,UHC MGG,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,VA,VA,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Wellcare MGG,Wellcare MGG,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Bright Health - commercial,Bright Health - commercial,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
DIVALPROEX SODIUM 250 TBDR    ,92131993,CDM,250,RC,,,,,,Inpatient,1,EA,7.34,7.34,Bright Health MGG,Bright Health MGG,7.34,,,,,,,case rate,7.34,7.34,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5 TAB     ,92132012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Aetna,Aetna,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Aetna MGG,Aetna MGG,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,BCBS,BCBS,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,BCBS MGG,BCBS MGG,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Cigna,Cigna,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Cigna MGG,Cigna MGG,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Humana,Humana,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Humana MGG,Humana MGG,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Optum VA,Optum VA,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,UHC,UHC,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,UHC MGG,UHC MGG,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,VA,VA,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Wellcare MGG,Wellcare MGG,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Bright Health - commercial,Bright Health - commercial,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHYDRO 1.5MG TAB ,92132014,CDM,250,RC,,,,,,Inpatient,1,EA,12.98,12.98,Bright Health MGG,Bright Health MGG,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Aetna,Aetna,12.59,,,,,,,per diem,12.59,12.59,"Per diem rate, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Aetna MGG,Aetna MGG,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,BCBS,BCBS,12.59,,,,,,,per diem,12.59,12.59,"Per diem rate, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,BCBS MGG,BCBS MGG,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Cigna,Cigna,12.59,,,,,,,per diem,12.59,12.59,"Per diem rate, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Cigna MGG,Cigna MGG,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Humana,Humana,12.59,,,,,,,per diem,12.59,12.59,"Per diem rate, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Humana MGG,Humana MGG,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Optum VA,Optum VA,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,UHC,UHC,12.59,,,,,,,per diem,12.59,12.59,"Per diem rate, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,UHC MGG,UHC MGG,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,VA,VA,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Wellcare MGG,Wellcare MGG,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Bright Health - commercial,Bright Health - commercial,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
UREA 15GM                     ,92132021,CDM,250,RC,,,,,,Inpatient,1,EA,12.59,12.59,Bright Health MGG,Bright Health MGG,12.59,,,,,,,case rate,12.59,12.59,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Aetna,Aetna,12.42,,,,,,,per diem,12.42,12.42,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Aetna MGG,Aetna MGG,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,BCBS,BCBS,12.42,,,,,,,per diem,12.42,12.42,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,BCBS MGG,BCBS MGG,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Cigna,Cigna,12.42,,,,,,,per diem,12.42,12.42,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Cigna MGG,Cigna MGG,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Humana,Humana,12.42,,,,,,,per diem,12.42,12.42,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Humana MGG,Humana MGG,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Optum VA,Optum VA,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,UHC,UHC,12.42,,,,,,,per diem,12.42,12.42,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,UHC MGG,UHC MGG,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,VA,VA,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Wellcare MGG,Wellcare MGG,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Bright Health - commercial,Bright Health - commercial,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 2MG SUB TAB ,92132039,CDM,250,RC,,,,,,Inpatient,1,EA,12.42,12.42,Bright Health MGG,Bright Health MGG,12.42,,,,,,,case rate,12.42,12.42,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Aetna,Aetna,157.45,,,,,,,per diem,157.45,157.45,"Per diem rate, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Aetna MGG,Aetna MGG,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,BCBS,BCBS,157.45,,,,,,,per diem,157.45,157.45,"Per diem rate, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,BCBS MGG,BCBS MGG,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Cigna,Cigna,157.45,,,,,,,per diem,157.45,157.45,"Per diem rate, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Cigna MGG,Cigna MGG,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Humana,Humana,157.45,,,,,,,per diem,157.45,157.45,"Per diem rate, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Humana MGG,Humana MGG,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Optum VA,Optum VA,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,UHC,UHC,157.45,,,,,,,per diem,157.45,157.45,"Per diem rate, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,UHC MGG,UHC MGG,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,VA,VA,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Wellcare MGG,Wellcare MGG,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Bright Health - commercial,Bright Health - commercial,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
CARIPRAZINE 1.5 MG CAP        ,92132040,CDM,250,RC,,,,,,Inpatient,1,EA,157.45,157.45,Bright Health MGG,Bright Health MGG,157.45,,,,,,,case rate,157.45,157.45,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Aetna,Aetna,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Aetna MGG,Aetna MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,BCBS,BCBS,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,BCBS MGG,BCBS MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Cigna,Cigna,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Cigna MGG,Cigna MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Humana,Humana,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Humana MGG,Humana MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Optum VA,Optum VA,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,UHC,UHC,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,UHC MGG,UHC MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,VA,VA,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Wellcare MGG,Wellcare MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Bright Health - commercial,Bright Health - commercial,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN-POLY B 500-1000 EXT,92132064,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Bright Health MGG,Bright Health MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Aetna,Aetna,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Aetna MGG,Aetna MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,BCBS,BCBS,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,BCBS MGG,BCBS MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Cigna,Cigna,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Cigna MGG,Cigna MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Humana,Humana,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Humana MGG,Humana MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Optum VA,Optum VA,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,UHC,UHC,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,UHC MGG,UHC MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,VA,VA,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Wellcare MGG,Wellcare MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Bright Health - commercial,Bright Health - commercial,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEV-ENT 37.5MG TAB  ,92132073,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,Bright Health MGG,Bright Health MGG,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Aetna,Aetna,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Aetna MGG,Aetna MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,BCBS,BCBS,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,BCBS MGG,BCBS MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Cigna,Cigna,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Cigna MGG,Cigna MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Humana,Humana,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Humana MGG,Humana MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Optum VA,Optum VA,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,UHC,UHC,366,,,,,,,per diem,366,366,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,UHC MGG,UHC MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,VA,VA,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Wellcare MGG,Wellcare MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Bright Health - commercial,Bright Health - commercial,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOL 22.3-6,92132095,CDM,250,RC,,,,,,Inpatient,1,EA,366,366,Bright Health MGG,Bright Health MGG,366,,,,,,,case rate,366,366,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Aetna,Aetna,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Aetna MGG,Aetna MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,BCBS,BCBS,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,BCBS MGG,BCBS MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Cigna,Cigna,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Cigna MGG,Cigna MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Humana,Humana,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Humana MGG,Humana MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Optum VA,Optum VA,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,UHC,UHC,336.6,,,,,,,per diem,336.6,336.6,"Per diem rate, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,UHC MGG,UHC MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,VA,VA,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Wellcare MGG,Wellcare MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Bright Health - commercial,Bright Health - commercial,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
MICAFUNGIN INFUSION           ,92132130,CDM,250,RC,,,,,,Inpatient,1,EA,336.6,336.6,Bright Health MGG,Bright Health MGG,336.6,,,,,,,case rate,336.6,336.6,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Aetna,Aetna,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Aetna MGG,Aetna MGG,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,BCBS,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS MGG,BCBS MGG,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Cigna,Cigna,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Cigna MGG,Cigna MGG,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Humana,Humana,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Humana MGG,Humana MGG,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Optum VA,Optum VA,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,UHC,UHC,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,UHC MGG,UHC MGG,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,VA,VA,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Wellcare MGG,Wellcare MGG,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Bright Health - commercial,Bright Health - commercial,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PANCRELIPASE 5000-24000 ORAL C,92132144,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,Bright Health MGG,Bright Health MGG,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Aetna,Aetna,126.4,,,,,,,per diem,126.4,126.4,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Aetna MGG,Aetna MGG,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,BCBS,BCBS,126.4,,,,,,,per diem,126.4,126.4,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,BCBS MGG,BCBS MGG,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Cigna,Cigna,126.4,,,,,,,per diem,126.4,126.4,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Cigna MGG,Cigna MGG,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Humana,Humana,126.4,,,,,,,per diem,126.4,126.4,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Humana MGG,Humana MGG,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Optum VA,Optum VA,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,UHC,UHC,126.4,,,,,,,per diem,126.4,126.4,"Per diem rate, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,UHC MGG,UHC MGG,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,VA,VA,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Wellcare MGG,Wellcare MGG,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Bright Health - commercial,Bright Health - commercial,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
PYRIDOSTIGMINE BROMIDE ER 180 ,92132158,CDM,250,RC,,,,,,Inpatient,1,EA,126.4,126.4,Bright Health MGG,Bright Health MGG,126.4,,,,,,,case rate,126.4,126.4,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Aetna,Aetna,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Aetna MGG,Aetna MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,BCBS,BCBS,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,BCBS MGG,BCBS MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Cigna,Cigna,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Cigna MGG,Cigna MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Humana,Humana,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Humana MGG,Humana MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Optum VA,Optum VA,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,UHC,UHC,53.3,,,,,,,per diem,53.3,53.3,"Per diem rate, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,UHC MGG,UHC MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,VA,VA,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Wellcare MGG,Wellcare MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Bright Health - commercial,Bright Health - commercial,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
VORTIOXETINE 20 MG TABLET     ,92132179,CDM,250,RC,,,,,,Inpatient,1,EA,53.3,53.3,Bright Health MGG,Bright Health MGG,53.3,,,,,,,case rate,53.3,53.3,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Aetna,Aetna,20.57,,,,,,,per diem,20.57,20.57,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Aetna MGG,Aetna MGG,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,BCBS,BCBS,20.57,,,,,,,per diem,20.57,20.57,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,BCBS MGG,BCBS MGG,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Cigna,Cigna,20.57,,,,,,,per diem,20.57,20.57,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Cigna MGG,Cigna MGG,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Humana,Humana,20.57,,,,,,,per diem,20.57,20.57,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Humana MGG,Humana MGG,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Optum VA,Optum VA,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,UHC,UHC,20.57,,,,,,,per diem,20.57,20.57,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,UHC MGG,UHC MGG,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,VA,VA,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Wellcare MGG,Wellcare MGG,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Bright Health - commercial,Bright Health - commercial,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG ORAL TAB    ,92132185,CDM,250,RC,,,,,,Inpatient,1,EA,20.57,20.57,Bright Health MGG,Bright Health MGG,20.57,,,,,,,case rate,20.57,20.57,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Aetna,Aetna,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Aetna MGG,Aetna MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,BCBS,BCBS,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,BCBS MGG,BCBS MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Cigna,Cigna,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Cigna MGG,Cigna MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Humana,Humana,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Humana MGG,Humana MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Optum VA,Optum VA,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,UHC,UHC,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,UHC MGG,UHC MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,VA,VA,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Wellcare MGG,Wellcare MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Bright Health - commercial,Bright Health - commercial,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100 MG ORAL TABS  ,92132188,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Bright Health MGG,Bright Health MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Aetna,Aetna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Aetna MGG,Aetna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,BCBS,BCBS,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,BCBS MGG,BCBS MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Cigna,Cigna,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Cigna MGG,Cigna MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Humana,Humana,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Humana MGG,Humana MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Optum VA,Optum VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,UHC,UHC,31,,,,,,,per diem,31,31,"Per diem rate, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,UHC MGG,UHC MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,VA,VA,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Wellcare MGG,Wellcare MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Bright Health - commercial,Bright Health - commercial,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
RIVAROXABAN 2.5MG TAB         ,92132193,CDM,250,RC,,,,,,Inpatient,1,EA,31,31,Bright Health MGG,Bright Health MGG,31,,,,,,,case rate,31,31,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Aetna,Aetna,13.15,,,,,,,per diem,13.15,13.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Aetna MGG,Aetna MGG,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,BCBS,BCBS,13.15,,,,,,,per diem,13.15,13.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,BCBS MGG,BCBS MGG,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Cigna,Cigna,13.15,,,,,,,per diem,13.15,13.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Cigna MGG,Cigna MGG,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Humana,Humana,13.15,,,,,,,per diem,13.15,13.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Humana MGG,Humana MGG,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Optum VA,Optum VA,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,UHC,UHC,13.15,,,,,,,per diem,13.15,13.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,UHC MGG,UHC MGG,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,VA,VA,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Wellcare MGG,Wellcare MGG,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Bright Health - commercial,Bright Health - commercial,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 25MG TABS      ,92132253,CDM,250,RC,,,,,,Inpatient,1,EA,13.15,13.15,Bright Health MGG,Bright Health MGG,13.15,,,,,,,case rate,13.15,13.15,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Aetna,Aetna,33.92,,,,,,,per diem,33.92,33.92,"Per diem rate, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Aetna MGG,Aetna MGG,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,BCBS,BCBS,33.92,,,,,,,per diem,33.92,33.92,"Per diem rate, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,BCBS MGG,BCBS MGG,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Cigna,Cigna,33.92,,,,,,,per diem,33.92,33.92,"Per diem rate, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Cigna MGG,Cigna MGG,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Humana,Humana,33.92,,,,,,,per diem,33.92,33.92,"Per diem rate, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Humana MGG,Humana MGG,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Optum VA,Optum VA,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,UHC,UHC,33.92,,,,,,,per diem,33.92,33.92,"Per diem rate, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,UHC MGG,UHC MGG,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,VA,VA,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Wellcare MGG,Wellcare MGG,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Bright Health - commercial,Bright Health - commercial,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
TUBERCULIN PPD 5 TUB UN/0.1   ,92132284,CDM,250,RC,,,,,,Inpatient,1,EA,33.92,33.92,Bright Health MGG,Bright Health MGG,33.92,,,,,,,case rate,33.92,33.92,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Aetna,Aetna,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Aetna MGG,Aetna MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,BCBS,BCBS,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,BCBS MGG,BCBS MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Cigna,Cigna,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Cigna MGG,Cigna MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Humana,Humana,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Humana MGG,Humana MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Optum VA,Optum VA,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,UHC,UHC,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,UHC MGG,UHC MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,VA,VA,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Wellcare MGG,Wellcare MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Bright Health - commercial,Bright Health - commercial,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEX 5 MG TAB      ,92132322,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Bright Health MGG,Bright Health MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Aetna,Aetna,32.01,,,,,,,per diem,32.01,32.01,"Per diem rate, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Aetna MGG,Aetna MGG,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,BCBS,BCBS,32.01,,,,,,,per diem,32.01,32.01,"Per diem rate, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,BCBS MGG,BCBS MGG,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Cigna,Cigna,32.01,,,,,,,per diem,32.01,32.01,"Per diem rate, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Cigna MGG,Cigna MGG,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Humana,Humana,32.01,,,,,,,per diem,32.01,32.01,"Per diem rate, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Humana MGG,Humana MGG,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Optum VA,Optum VA,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,UHC,UHC,32.01,,,,,,,per diem,32.01,32.01,"Per diem rate, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,UHC MGG,UHC MGG,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,VA,VA,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Wellcare MGG,Wellcare MGG,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Bright Health - commercial,Bright Health - commercial,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
MESALAMINE 1.2 GM TAB DELAY   ,92132335,CDM,250,RC,,,,,,Inpatient,1,EA,32.01,32.01,Bright Health MGG,Bright Health MGG,32.01,,,,,,,case rate,32.01,32.01,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Aetna,Aetna,69.98,,,,,,,per diem,69.98,69.98,"Per diem rate, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Aetna MGG,Aetna MGG,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,BCBS,BCBS,69.98,,,,,,,per diem,69.98,69.98,"Per diem rate, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,BCBS MGG,BCBS MGG,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Cigna,Cigna,69.98,,,,,,,per diem,69.98,69.98,"Per diem rate, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Cigna MGG,Cigna MGG,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Humana,Humana,69.98,,,,,,,per diem,69.98,69.98,"Per diem rate, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Humana MGG,Humana MGG,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Optum VA,Optum VA,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,UHC,UHC,69.98,,,,,,,per diem,69.98,69.98,"Per diem rate, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,UHC MGG,UHC MGG,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,VA,VA,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Wellcare MGG,Wellcare MGG,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Bright Health - commercial,Bright Health - commercial,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
DROXIDOPA 100 MG ORAL CAP     ,92132347,CDM,250,RC,,,,,,Inpatient,1,EA,69.98,69.98,Bright Health MGG,Bright Health MGG,69.98,,,,,,,case rate,69.98,69.98,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Aetna,Aetna,12.4,,,,,,,per diem,12.4,12.4,"Per diem rate, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Aetna MGG,Aetna MGG,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,BCBS,BCBS,12.4,,,,,,,per diem,12.4,12.4,"Per diem rate, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,BCBS MGG,BCBS MGG,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Cigna,Cigna,12.4,,,,,,,per diem,12.4,12.4,"Per diem rate, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Cigna MGG,Cigna MGG,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Humana,Humana,12.4,,,,,,,per diem,12.4,12.4,"Per diem rate, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Humana MGG,Humana MGG,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Optum VA,Optum VA,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,UHC,UHC,12.4,,,,,,,per diem,12.4,12.4,"Per diem rate, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,UHC MGG,UHC MGG,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,VA,VA,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Wellcare MGG,Wellcare MGG,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Bright Health - commercial,Bright Health - commercial,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
MESALAMINE ER 0.375G CER      ,92132349,CDM,250,RC,,,,,,Inpatient,1,EA,12.4,12.4,Bright Health MGG,Bright Health MGG,12.4,,,,,,,case rate,12.4,12.4,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Aetna,Aetna,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Aetna MGG,Aetna MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,BCBS,BCBS,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,BCBS MGG,BCBS MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Cigna,Cigna,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Cigna MGG,Cigna MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Humana,Humana,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Humana MGG,Humana MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Optum VA,Optum VA,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,UHC,UHC,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,UHC MGG,UHC MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,VA,VA,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Wellcare MGG,Wellcare MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Bright Health - commercial,Bright Health - commercial,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
PILOCARPINE NITRATE           ,92132384,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Bright Health MGG,Bright Health MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTROAMPHETAMINE ,92132391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Aetna,Aetna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Aetna MGG,Aetna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,BCBS,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS MGG,BCBS MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Cigna,Cigna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Cigna MGG,Cigna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Humana,Humana,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Humana MGG,Humana MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Optum VA,Optum VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UHC,UHC,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UHC MGG,UHC MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,VA,VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Wellcare MGG,Wellcare MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Bright Health - commercial,Bright Health - commercial,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Bright Health MGG,Bright Health MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Aetna,Aetna,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Aetna MGG,Aetna MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,BCBS,BCBS,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,BCBS MGG,BCBS MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Cigna,Cigna,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Cigna MGG,Cigna MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Humana,Humana,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Humana MGG,Humana MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Optum VA,Optum VA,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,UHC,UHC,28.3,,,,,,,per diem,28.3,28.3,"Per diem rate, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,UHC MGG,UHC MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,VA,VA,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Wellcare MGG,Wellcare MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Bright Health - commercial,Bright Health - commercial,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
PANCRELIPASE 24000-76000 UNITS,92132423,CDM,250,RC,,,,,,Inpatient,1,EA,28.3,28.3,Bright Health MGG,Bright Health MGG,28.3,,,,,,,case rate,28.3,28.3,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCOD-ACET 5-325MG TAB     ,92132445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN 0.025PCT DROP BTL   ,92132446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE/DEXTR/MALTOSE ORAL   ,92132463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Aetna,Aetna,39.41,,,,,,,per diem,39.41,39.41,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Aetna MGG,Aetna MGG,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,BCBS,BCBS,39.41,,,,,,,per diem,39.41,39.41,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,BCBS MGG,BCBS MGG,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Cigna,Cigna,39.41,,,,,,,per diem,39.41,39.41,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Cigna MGG,Cigna MGG,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Humana,Humana,39.41,,,,,,,per diem,39.41,39.41,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Humana MGG,Humana MGG,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Optum VA,Optum VA,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,UHC,UHC,39.41,,,,,,,per diem,39.41,39.41,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,UHC MGG,UHC MGG,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,VA,VA,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Wellcare MGG,Wellcare MGG,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Bright Health - commercial,Bright Health - commercial,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 1,92132475,CDM,250,RC,,,,,,Inpatient,1,EA,39.41,39.41,Bright Health MGG,Bright Health MGG,39.41,,,,,,,case rate,39.41,39.41,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Aetna,Aetna,114.48,,,,,,,per diem,114.48,114.48,"Per diem rate, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Aetna MGG,Aetna MGG,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,BCBS,BCBS,114.48,,,,,,,per diem,114.48,114.48,"Per diem rate, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,BCBS MGG,BCBS MGG,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Cigna,Cigna,114.48,,,,,,,per diem,114.48,114.48,"Per diem rate, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Cigna MGG,Cigna MGG,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Humana,Humana,114.48,,,,,,,per diem,114.48,114.48,"Per diem rate, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Humana MGG,Humana MGG,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Optum VA,Optum VA,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,UHC,UHC,114.48,,,,,,,per diem,114.48,114.48,"Per diem rate, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,UHC MGG,UHC MGG,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,VA,VA,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Wellcare MGG,Wellcare MGG,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Bright Health - commercial,Bright Health - commercial,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
SODIUM FERR GLUC COM 62.5MG SO,92132496,CDM,250,RC,,,,,,Inpatient,1,EA,114.48,114.48,Bright Health MGG,Bright Health MGG,114.48,,,,,,,case rate,114.48,114.48,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Aetna,Aetna,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Aetna MGG,Aetna MGG,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,BCBS,BCBS,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,BCBS MGG,BCBS MGG,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Cigna,Cigna,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Cigna MGG,Cigna MGG,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Humana,Humana,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Humana MGG,Humana MGG,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Optum VA,Optum VA,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,UHC,UHC,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,UHC MGG,UHC MGG,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,VA,VA,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Wellcare MGG,Wellcare MGG,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Bright Health - commercial,Bright Health - commercial,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 150 MG CP24       ,92132504,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,Bright Health MGG,Bright Health MGG,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Aetna,Aetna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Aetna MGG,Aetna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,BCBS,BCBS,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,BCBS MGG,BCBS MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Cigna,Cigna,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Cigna MGG,Cigna MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Humana,Humana,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Humana MGG,Humana MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Optum VA,Optum VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,UHC,UHC,22,,,,,,,per diem,22,22,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,UHC MGG,UHC MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,VA,VA,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Wellcare MGG,Wellcare MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Bright Health - commercial,Bright Health - commercial,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,22,22,Bright Health MGG,Bright Health MGG,22,,,,,,,case rate,22,22,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CODEINE-GUAIFENESIN 10-100 MG/,92132525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Aetna,Aetna,41.65,,,,,,,per diem,41.65,41.65,"Per diem rate, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Aetna MGG,Aetna MGG,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,BCBS,BCBS,41.65,,,,,,,per diem,41.65,41.65,"Per diem rate, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,BCBS MGG,BCBS MGG,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Cigna,Cigna,41.65,,,,,,,per diem,41.65,41.65,"Per diem rate, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Cigna MGG,Cigna MGG,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Humana,Humana,41.65,,,,,,,per diem,41.65,41.65,"Per diem rate, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Humana MGG,Humana MGG,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Optum VA,Optum VA,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,UHC,UHC,41.65,,,,,,,per diem,41.65,41.65,"Per diem rate, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,UHC MGG,UHC MGG,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,VA,VA,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Wellcare MGG,Wellcare MGG,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Bright Health - commercial,Bright Health - commercial,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
ENOXAPARIN 60 MG/0.6 ML SYRG  ,92132528,CDM,250,RC,,,,,,Inpatient,1,EA,41.65,41.65,Bright Health MGG,Bright Health MGG,41.65,,,,,,,case rate,41.65,41.65,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Aetna,Aetna,9.97,,,,,,,per diem,9.97,9.97,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Aetna MGG,Aetna MGG,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,BCBS,BCBS,9.97,,,,,,,per diem,9.97,9.97,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,BCBS MGG,BCBS MGG,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Cigna,Cigna,9.97,,,,,,,per diem,9.97,9.97,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Cigna MGG,Cigna MGG,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Humana,Humana,9.97,,,,,,,per diem,9.97,9.97,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Humana MGG,Humana MGG,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Optum VA,Optum VA,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,UHC,UHC,9.97,,,,,,,per diem,9.97,9.97,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,UHC MGG,UHC MGG,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,VA,VA,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Wellcare MGG,Wellcare MGG,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Bright Health - commercial,Bright Health - commercial,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,9.97,9.97,Bright Health MGG,Bright Health MGG,9.97,,,,,,,case rate,9.97,9.97,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Aetna,Aetna,7.87,,,,,,,per diem,7.87,7.87,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Aetna MGG,Aetna MGG,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,BCBS,BCBS,7.87,,,,,,,per diem,7.87,7.87,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,BCBS MGG,BCBS MGG,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Cigna,Cigna,7.87,,,,,,,per diem,7.87,7.87,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Cigna MGG,Cigna MGG,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Humana,Humana,7.87,,,,,,,per diem,7.87,7.87,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Humana MGG,Humana MGG,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Optum VA,Optum VA,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,UHC,UHC,7.87,,,,,,,per diem,7.87,7.87,"Per diem rate, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,UHC MGG,UHC MGG,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,VA,VA,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Wellcare MGG,Wellcare MGG,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Bright Health - commercial,Bright Health - commercial,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
OXYCODONE 15 MG TAB           ,92132531,CDM,250,RC,,,,,,Inpatient,1,EA,7.87,7.87,Bright Health MGG,Bright Health MGG,7.87,,,,,,,case rate,7.87,7.87,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Aetna,Aetna,6.32,,,,,,,per diem,6.32,6.32,"Per diem rate, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Aetna MGG,Aetna MGG,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,BCBS,BCBS,6.32,,,,,,,per diem,6.32,6.32,"Per diem rate, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,BCBS MGG,BCBS MGG,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Cigna,Cigna,6.32,,,,,,,per diem,6.32,6.32,"Per diem rate, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Cigna MGG,Cigna MGG,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Humana,Humana,6.32,,,,,,,per diem,6.32,6.32,"Per diem rate, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Humana MGG,Humana MGG,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Optum VA,Optum VA,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,UHC,UHC,6.32,,,,,,,per diem,6.32,6.32,"Per diem rate, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,UHC MGG,UHC MGG,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,VA,VA,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Wellcare MGG,Wellcare MGG,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Bright Health - commercial,Bright Health - commercial,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
PANCRELIPASE (LIP-PROT-AMUL) 3,92132561,CDM,250,RC,,,,,,Inpatient,1,EA,6.32,6.32,Bright Health MGG,Bright Health MGG,6.32,,,,,,,case rate,6.32,6.32,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Aetna,Aetna,44.76,,,,,,,per diem,44.76,44.76,"Per diem rate, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Aetna MGG,Aetna MGG,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,BCBS,BCBS,44.76,,,,,,,per diem,44.76,44.76,"Per diem rate, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,BCBS MGG,BCBS MGG,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Cigna,Cigna,44.76,,,,,,,per diem,44.76,44.76,"Per diem rate, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Cigna MGG,Cigna MGG,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Humana,Humana,44.76,,,,,,,per diem,44.76,44.76,"Per diem rate, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Humana MGG,Humana MGG,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Optum VA,Optum VA,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,UHC,UHC,44.76,,,,,,,per diem,44.76,44.76,"Per diem rate, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,UHC MGG,UHC MGG,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,VA,VA,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Wellcare MGG,Wellcare MGG,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Bright Health - commercial,Bright Health - commercial,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
DICLOFENAC EPOLAMINE 1.3% PT12,92132593,CDM,250,RC,,,,,,Inpatient,1,EA,44.76,44.76,Bright Health MGG,Bright Health MGG,44.76,,,,,,,case rate,44.76,44.76,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE MOFETIL 250MG CA,92132605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Aetna,Aetna,55.77,,,,,,,per diem,55.77,55.77,"Per diem rate, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Aetna MGG,Aetna MGG,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,BCBS,BCBS,55.77,,,,,,,per diem,55.77,55.77,"Per diem rate, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,BCBS MGG,BCBS MGG,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Cigna,Cigna,55.77,,,,,,,per diem,55.77,55.77,"Per diem rate, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Cigna MGG,Cigna MGG,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Humana,Humana,55.77,,,,,,,per diem,55.77,55.77,"Per diem rate, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Humana MGG,Humana MGG,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Optum VA,Optum VA,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,UHC,UHC,55.77,,,,,,,per diem,55.77,55.77,"Per diem rate, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,UHC MGG,UHC MGG,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,VA,VA,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Wellcare MGG,Wellcare MGG,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Bright Health - commercial,Bright Health - commercial,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
MEMANTIME 7MG CAP SPR EXT     ,92132623,CDM,250,RC,,,,,,Inpatient,1,EA,55.77,55.77,Bright Health MGG,Bright Health MGG,55.77,,,,,,,case rate,55.77,55.77,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Aetna,Aetna,20.04,,,,,,,per diem,20.04,20.04,"Per diem rate, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Aetna MGG,Aetna MGG,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,BCBS,BCBS,20.04,,,,,,,per diem,20.04,20.04,"Per diem rate, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,BCBS MGG,BCBS MGG,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Cigna,Cigna,20.04,,,,,,,per diem,20.04,20.04,"Per diem rate, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Cigna MGG,Cigna MGG,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Humana,Humana,20.04,,,,,,,per diem,20.04,20.04,"Per diem rate, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Humana MGG,Humana MGG,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Optum VA,Optum VA,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,UHC,UHC,20.04,,,,,,,per diem,20.04,20.04,"Per diem rate, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,UHC MGG,UHC MGG,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,VA,VA,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Wellcare MGG,Wellcare MGG,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Bright Health - commercial,Bright Health - commercial,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
DUTASTERIDE 0.5MG CAP         ,92132655,CDM,250,RC,,,,,,Inpatient,1,EA,20.04,20.04,Bright Health MGG,Bright Health MGG,20.04,,,,,,,case rate,20.04,20.04,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNA-DOCUSATE 8.6-50MG TAB   ,92132679,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Aetna,Aetna,381.89,,,,,,,per diem,381.89,381.89,"Per diem rate, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Aetna MGG,Aetna MGG,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,BCBS,BCBS,381.89,,,,,,,per diem,381.89,381.89,"Per diem rate, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,BCBS MGG,BCBS MGG,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Cigna,Cigna,381.89,,,,,,,per diem,381.89,381.89,"Per diem rate, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Cigna MGG,Cigna MGG,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Humana,Humana,381.89,,,,,,,per diem,381.89,381.89,"Per diem rate, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Humana MGG,Humana MGG,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Optum VA,Optum VA,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,UHC,UHC,381.89,,,,,,,per diem,381.89,381.89,"Per diem rate, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,UHC MGG,UHC MGG,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,VA,VA,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Wellcare MGG,Wellcare MGG,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Bright Health - commercial,Bright Health - commercial,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
INSULIN LISPRO 100UNIT/ML SC  ,92132710,CDM,250,RC,,,,,,Inpatient,1,EA,381.89,381.89,Bright Health MGG,Bright Health MGG,381.89,,,,,,,case rate,381.89,381.89,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Aetna,Aetna,11.85,,,,,,,per diem,11.85,11.85,"Per diem rate, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Aetna MGG,Aetna MGG,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,BCBS,BCBS,11.85,,,,,,,per diem,11.85,11.85,"Per diem rate, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,BCBS MGG,BCBS MGG,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Cigna,Cigna,11.85,,,,,,,per diem,11.85,11.85,"Per diem rate, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Cigna MGG,Cigna MGG,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Humana,Humana,11.85,,,,,,,per diem,11.85,11.85,"Per diem rate, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Humana MGG,Humana MGG,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Optum VA,Optum VA,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,UHC,UHC,11.85,,,,,,,per diem,11.85,11.85,"Per diem rate, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,UHC MGG,UHC MGG,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,VA,VA,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Wellcare MGG,Wellcare MGG,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Bright Health - commercial,Bright Health - commercial,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
GLUCOSE 40% ORAL GEL          ,92132719,CDM,250,RC,,,,,,Inpatient,1,EA,11.85,11.85,Bright Health MGG,Bright Health MGG,11.85,,,,,,,case rate,11.85,11.85,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna,Aetna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna MGG,Aetna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS,BCBS,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS MGG,BCBS MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna,Cigna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna MGG,Cigna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana,Humana,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana MGG,Humana MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Optum VA,Optum VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC,UHC,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC MGG,UHC MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,VA,VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Wellcare MGG,Wellcare MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health - commercial,Bright Health - commercial,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE 37.5MG TAB        ,92132733,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health MGG,Bright Health MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Aetna,Aetna,65.59,,,,,,,per diem,65.59,65.59,"Per diem rate, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Aetna MGG,Aetna MGG,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,BCBS,BCBS,65.59,,,,,,,per diem,65.59,65.59,"Per diem rate, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,BCBS MGG,BCBS MGG,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Cigna,Cigna,65.59,,,,,,,per diem,65.59,65.59,"Per diem rate, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Cigna MGG,Cigna MGG,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Humana,Humana,65.59,,,,,,,per diem,65.59,65.59,"Per diem rate, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Humana MGG,Humana MGG,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Optum VA,Optum VA,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,UHC,UHC,65.59,,,,,,,per diem,65.59,65.59,"Per diem rate, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,UHC MGG,UHC MGG,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,VA,VA,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Wellcare MGG,Wellcare MGG,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Bright Health - commercial,Bright Health - commercial,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ARMODAFINIL 150MG TAB         ,92132734,CDM,250,RC,,,,,,Inpatient,1,EA,65.59,65.59,Bright Health MGG,Bright Health MGG,65.59,,,,,,,case rate,65.59,65.59,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Aetna,Aetna,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Aetna MGG,Aetna MGG,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,BCBS,BCBS,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,BCBS MGG,BCBS MGG,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Cigna,Cigna,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Cigna MGG,Cigna MGG,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Humana,Humana,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Humana MGG,Humana MGG,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Optum VA,Optum VA,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,UHC,UHC,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,UHC MGG,UHC MGG,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,VA,VA,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Wellcare MGG,Wellcare MGG,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Bright Health - commercial,Bright Health - commercial,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ENOXAPARIN 120MG/0.8ML SYRG   ,92132736,CDM,250,RC,,,,,,Inpatient,1,EA,83.27,83.27,Bright Health MGG,Bright Health MGG,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Aetna,Aetna,36.44,,,,,,,per diem,36.44,36.44,"Per diem rate, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Aetna MGG,Aetna MGG,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,BCBS,BCBS,36.44,,,,,,,per diem,36.44,36.44,"Per diem rate, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,BCBS MGG,BCBS MGG,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Cigna,Cigna,36.44,,,,,,,per diem,36.44,36.44,"Per diem rate, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Cigna MGG,Cigna MGG,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Humana,Humana,36.44,,,,,,,per diem,36.44,36.44,"Per diem rate, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Humana MGG,Humana MGG,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Optum VA,Optum VA,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,UHC,UHC,36.44,,,,,,,per diem,36.44,36.44,"Per diem rate, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,UHC MGG,UHC MGG,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,VA,VA,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Wellcare MGG,Wellcare MGG,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Bright Health - commercial,Bright Health - commercial,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
ESZOPICLONE 3 MG TABLET       ,92132894,CDM,250,RC,,,,,,Inpatient,1,EA,36.44,36.44,Bright Health MGG,Bright Health MGG,36.44,,,,,,,case rate,36.44,36.44,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Aetna,Aetna,28.82,,,,,,,per diem,28.82,28.82,"Per diem rate, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Aetna MGG,Aetna MGG,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,BCBS,BCBS,28.82,,,,,,,per diem,28.82,28.82,"Per diem rate, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,BCBS MGG,BCBS MGG,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Cigna,Cigna,28.82,,,,,,,per diem,28.82,28.82,"Per diem rate, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Cigna MGG,Cigna MGG,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Humana,Humana,28.82,,,,,,,per diem,28.82,28.82,"Per diem rate, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Humana MGG,Humana MGG,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Optum VA,Optum VA,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,UHC,UHC,28.82,,,,,,,per diem,28.82,28.82,"Per diem rate, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,UHC MGG,UHC MGG,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,VA,VA,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Wellcare MGG,Wellcare MGG,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Bright Health - commercial,Bright Health - commercial,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OLMESARTAN 40 MG-HYDROCHLOROTH,92132895,CDM,250,RC,,,,,,Inpatient,1,EA,28.82,28.82,Bright Health MGG,Bright Health MGG,28.82,,,,,,,case rate,28.82,28.82,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Aetna,Aetna,33.77,,,,,,,per diem,33.77,33.77,"Per diem rate, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Aetna MGG,Aetna MGG,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,BCBS,BCBS,33.77,,,,,,,per diem,33.77,33.77,"Per diem rate, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,BCBS MGG,BCBS MGG,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Cigna,Cigna,33.77,,,,,,,per diem,33.77,33.77,"Per diem rate, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Cigna MGG,Cigna MGG,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Humana,Humana,33.77,,,,,,,per diem,33.77,33.77,"Per diem rate, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Humana MGG,Humana MGG,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Optum VA,Optum VA,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,UHC,UHC,33.77,,,,,,,per diem,33.77,33.77,"Per diem rate, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,UHC MGG,UHC MGG,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,VA,VA,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Wellcare MGG,Wellcare MGG,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Bright Health - commercial,Bright Health - commercial,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
OXYCODONE ER 13.5 MG CSPT     ,92132915,CDM,250,RC,,,,,,Inpatient,1,EA,33.77,33.77,Bright Health MGG,Bright Health MGG,33.77,,,,,,,case rate,33.77,33.77,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Aetna,Aetna,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Aetna MGG,Aetna MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,BCBS,BCBS,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,BCBS MGG,BCBS MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Cigna,Cigna,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Cigna MGG,Cigna MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Humana,Humana,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Humana MGG,Humana MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Optum VA,Optum VA,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,UHC,UHC,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,UHC MGG,UHC MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,VA,VA,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Wellcare MGG,Wellcare MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Bright Health - commercial,Bright Health - commercial,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
VERAPAMIL 100MG CPCT          ,92132921,CDM,250,RC,,,,,,Inpatient,1,EA,14.03,14.03,Bright Health MGG,Bright Health MGG,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Aetna,Aetna,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Aetna MGG,Aetna MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,BCBS,BCBS,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,BCBS MGG,BCBS MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Cigna,Cigna,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Cigna MGG,Cigna MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Humana,Humana,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Humana MGG,Humana MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Optum VA,Optum VA,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,UHC,UHC,5.14,,,,,,,per diem,5.14,5.14,"Per diem rate, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,UHC MGG,UHC MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,VA,VA,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Wellcare MGG,Wellcare MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Bright Health - commercial,Bright Health - commercial,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
AMPHETAMINE-DEXTRO 10MG TAB   ,92132922,CDM,250,RC,,,,,,Inpatient,1,EA,5.14,5.14,Bright Health MGG,Bright Health MGG,5.14,,,,,,,case rate,5.14,5.14,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Aetna,Aetna,5.15,,,,,,,per diem,5.15,5.15,"Per diem rate, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Aetna MGG,Aetna MGG,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,BCBS,BCBS,5.15,,,,,,,per diem,5.15,5.15,"Per diem rate, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,BCBS MGG,BCBS MGG,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Cigna,Cigna,5.15,,,,,,,per diem,5.15,5.15,"Per diem rate, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Cigna MGG,Cigna MGG,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Humana,Humana,5.15,,,,,,,per diem,5.15,5.15,"Per diem rate, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Humana MGG,Humana MGG,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Optum VA,Optum VA,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,UHC,UHC,5.15,,,,,,,per diem,5.15,5.15,"Per diem rate, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,UHC MGG,UHC MGG,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,VA,VA,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Wellcare MGG,Wellcare MGG,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Bright Health - commercial,Bright Health - commercial,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
METOPROLOL TART 40MG TAB      ,92132923,CDM,250,RC,,,,,,Inpatient,1,EA,5.15,5.15,Bright Health MGG,Bright Health MGG,5.15,,,,,,,case rate,5.15,5.15,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Aetna,Aetna,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Aetna MGG,Aetna MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,BCBS,BCBS,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,BCBS MGG,BCBS MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Cigna,Cigna,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Cigna MGG,Cigna MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Humana,Humana,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Humana MGG,Humana MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Optum VA,Optum VA,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,UHC,UHC,50.69,,,,,,,per diem,50.69,50.69,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,UHC MGG,UHC MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,VA,VA,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Wellcare MGG,Wellcare MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Bright Health - commercial,Bright Health - commercial,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 13.3 MG/24HR TRD ,92133055,CDM,250,RC,,,,,,Inpatient,1,EA,50.69,50.69,Bright Health MGG,Bright Health MGG,50.69,,,,,,,case rate,50.69,50.69,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Aetna,Aetna,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Aetna MGG,Aetna MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,BCBS,BCBS,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,BCBS MGG,BCBS MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Cigna,Cigna,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Cigna MGG,Cigna MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Humana,Humana,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Humana MGG,Humana MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Optum VA,Optum VA,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,UHC,UHC,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,UHC MGG,UHC MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,VA,VA,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Wellcare MGG,Wellcare MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Bright Health - commercial,Bright Health - commercial,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,24.48,24.48,Bright Health MGG,Bright Health MGG,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Aetna,Aetna,222.02,,,,,,,per diem,222.02,222.02,"Per diem rate, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Aetna MGG,Aetna MGG,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,BCBS,BCBS,222.02,,,,,,,per diem,222.02,222.02,"Per diem rate, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,BCBS MGG,BCBS MGG,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Cigna,Cigna,222.02,,,,,,,per diem,222.02,222.02,"Per diem rate, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Cigna MGG,Cigna MGG,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Humana,Humana,222.02,,,,,,,per diem,222.02,222.02,"Per diem rate, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Humana MGG,Humana MGG,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Optum VA,Optum VA,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,UHC,UHC,222.02,,,,,,,per diem,222.02,222.02,"Per diem rate, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,UHC MGG,UHC MGG,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,VA,VA,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Wellcare MGG,Wellcare MGG,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Bright Health - commercial,Bright Health - commercial,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
POSACONAZOLE 100 MG DEL REL TA,92133102,CDM,250,RC,,,,,,Inpatient,1,EA,222.02,222.02,Bright Health MGG,Bright Health MGG,222.02,,,,,,,case rate,222.02,222.02,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Aetna,Aetna,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Aetna MGG,Aetna MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,BCBS,BCBS,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,BCBS MGG,BCBS MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Cigna,Cigna,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Cigna MGG,Cigna MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Humana,Humana,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Humana MGG,Humana MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Optum VA,Optum VA,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,UHC,UHC,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,UHC MGG,UHC MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,VA,VA,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Wellcare MGG,Wellcare MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Bright Health - commercial,Bright Health - commercial,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
TACROLIMUS PER 1 MG           ,92133103,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Bright Health MGG,Bright Health MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Aetna,Aetna,52.33,,,,,,,per diem,52.33,52.33,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Aetna MGG,Aetna MGG,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,BCBS,BCBS,52.33,,,,,,,per diem,52.33,52.33,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,BCBS MGG,BCBS MGG,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Cigna,Cigna,52.33,,,,,,,per diem,52.33,52.33,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Cigna MGG,Cigna MGG,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Humana,Humana,52.33,,,,,,,per diem,52.33,52.33,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Humana MGG,Humana MGG,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Optum VA,Optum VA,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,UHC,UHC,52.33,,,,,,,per diem,52.33,52.33,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,UHC MGG,UHC MGG,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,VA,VA,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Wellcare MGG,Wellcare MGG,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Bright Health - commercial,Bright Health - commercial,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG TAB        ,92133141,CDM,250,RC,,,,,,Inpatient,1,EA,52.33,52.33,Bright Health MGG,Bright Health MGG,52.33,,,,,,,case rate,52.33,52.33,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Aetna,Aetna,87.56,,,,,,,per diem,87.56,87.56,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Aetna MGG,Aetna MGG,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,BCBS,BCBS,87.56,,,,,,,per diem,87.56,87.56,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,BCBS MGG,BCBS MGG,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Cigna,Cigna,87.56,,,,,,,per diem,87.56,87.56,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Cigna MGG,Cigna MGG,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Humana,Humana,87.56,,,,,,,per diem,87.56,87.56,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Humana MGG,Humana MGG,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Optum VA,Optum VA,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,UHC,UHC,87.56,,,,,,,per diem,87.56,87.56,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,UHC MGG,UHC MGG,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,VA,VA,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Wellcare MGG,Wellcare MGG,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Bright Health - commercial,Bright Health - commercial,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,87.56,87.56,Bright Health MGG,Bright Health MGG,87.56,,,,,,,case rate,87.56,87.56,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Aetna,Aetna,737.27,,,,,,,per diem,737.27,737.27,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Aetna MGG,Aetna MGG,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,BCBS,BCBS,737.27,,,,,,,per diem,737.27,737.27,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,BCBS MGG,BCBS MGG,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Cigna,Cigna,737.27,,,,,,,per diem,737.27,737.27,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Cigna MGG,Cigna MGG,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Humana,Humana,737.27,,,,,,,per diem,737.27,737.27,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Humana MGG,Humana MGG,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Optum VA,Optum VA,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,UHC,UHC,737.27,,,,,,,per diem,737.27,737.27,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,UHC MGG,UHC MGG,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,VA,VA,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Wellcare MGG,Wellcare MGG,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Bright Health - commercial,Bright Health - commercial,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,737.27,737.27,Bright Health MGG,Bright Health MGG,737.27,,,,,,,case rate,737.27,737.27,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna,Aetna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna MGG,Aetna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,BCBS,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS MGG,BCBS MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna,Cigna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna MGG,Cigna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana,Humana,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana MGG,Humana MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Optum VA,Optum VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC,UHC,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC MGG,UHC MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Wellcare MGG,Wellcare MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health - commercial,Bright Health - commercial,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92133162,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health MGG,Bright Health MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Aetna,Aetna,39.46,,,,,,,per diem,39.46,39.46,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Aetna MGG,Aetna MGG,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,BCBS,BCBS,39.46,,,,,,,per diem,39.46,39.46,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,BCBS MGG,BCBS MGG,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Cigna,Cigna,39.46,,,,,,,per diem,39.46,39.46,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Cigna MGG,Cigna MGG,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Humana,Humana,39.46,,,,,,,per diem,39.46,39.46,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Humana MGG,Humana MGG,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Optum VA,Optum VA,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,UHC,UHC,39.46,,,,,,,per diem,39.46,39.46,"Per diem rate, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,UHC MGG,UHC MGG,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,VA,VA,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Wellcare MGG,Wellcare MGG,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Bright Health - commercial,Bright Health - commercial,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
FLUTICASONE-UMECLIDIN-VILANT 2,92133254,CDM,250,RC,,,,,,Inpatient,1,EA,39.46,39.46,Bright Health MGG,Bright Health MGG,39.46,,,,,,,case rate,39.46,39.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Aetna,Aetna,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Aetna MGG,Aetna MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,BCBS,BCBS,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,BCBS MGG,BCBS MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Cigna,Cigna,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Cigna MGG,Cigna MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Humana,Humana,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Humana MGG,Humana MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Optum VA,Optum VA,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,UHC,UHC,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,UHC MGG,UHC MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,VA,VA,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Wellcare MGG,Wellcare MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Bright Health - commercial,Bright Health - commercial,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75GM/350ML WATER ,92133285,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Bright Health MGG,Bright Health MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Aetna,Aetna,31.38,,,,,,,per diem,31.38,31.38,"Per diem rate, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Aetna MGG,Aetna MGG,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,BCBS,BCBS,31.38,,,,,,,per diem,31.38,31.38,"Per diem rate, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,BCBS MGG,BCBS MGG,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Cigna,Cigna,31.38,,,,,,,per diem,31.38,31.38,"Per diem rate, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Cigna MGG,Cigna MGG,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Humana,Humana,31.38,,,,,,,per diem,31.38,31.38,"Per diem rate, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Humana MGG,Humana MGG,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Optum VA,Optum VA,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,UHC,UHC,31.38,,,,,,,per diem,31.38,31.38,"Per diem rate, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,UHC MGG,UHC MGG,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,VA,VA,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Wellcare MGG,Wellcare MGG,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Bright Health - commercial,Bright Health - commercial,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
SILODOSIN 4MG CAP             ,92133345,CDM,250,RC,,,,,,Inpatient,1,EA,31.38,31.38,Bright Health MGG,Bright Health MGG,31.38,,,,,,,case rate,31.38,31.38,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Aetna,Aetna,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Aetna MGG,Aetna MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS,BCBS,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS MGG,BCBS MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Cigna,Cigna,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Cigna MGG,Cigna MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Humana,Humana,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Humana MGG,Humana MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Optum VA,Optum VA,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,UHC,UHC,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,UHC MGG,UHC MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,VA,VA,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Wellcare MGG,Wellcare MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Bright Health - commercial,Bright Health - commercial,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Bright Health MGG,Bright Health MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ER 650 MG TABLET,92133355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL 40 MG TABLET      ,92133371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Aetna,Aetna,94.02,,,,,,,per diem,94.02,94.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Aetna MGG,Aetna MGG,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,BCBS,BCBS,94.02,,,,,,,per diem,94.02,94.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,BCBS MGG,BCBS MGG,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Cigna,Cigna,94.02,,,,,,,per diem,94.02,94.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Cigna MGG,Cigna MGG,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Humana,Humana,94.02,,,,,,,per diem,94.02,94.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Humana MGG,Humana MGG,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Optum VA,Optum VA,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,UHC,UHC,94.02,,,,,,,per diem,94.02,94.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,UHC MGG,UHC MGG,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,VA,VA,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Wellcare MGG,Wellcare MGG,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Bright Health - commercial,Bright Health - commercial,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN  125 MG ORAL CAP   ,92133387,CDM,250,RC,,,,,,Inpatient,1,EA,94.02,94.02,Bright Health MGG,Bright Health MGG,94.02,,,,,,,case rate,94.02,94.02,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Aetna,Aetna,65.86,,,,,,,per diem,65.86,65.86,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Aetna MGG,Aetna MGG,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,BCBS,BCBS,65.86,,,,,,,per diem,65.86,65.86,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,BCBS MGG,BCBS MGG,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Cigna,Cigna,65.86,,,,,,,per diem,65.86,65.86,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Cigna MGG,Cigna MGG,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Humana,Humana,65.86,,,,,,,per diem,65.86,65.86,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Humana MGG,Humana MGG,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Optum VA,Optum VA,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,UHC,UHC,65.86,,,,,,,per diem,65.86,65.86,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,UHC MGG,UHC MGG,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,VA,VA,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Wellcare MGG,Wellcare MGG,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Bright Health - commercial,Bright Health - commercial,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,65.86,65.86,Bright Health MGG,Bright Health MGG,65.86,,,,,,,case rate,65.86,65.86,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Aetna,Aetna,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Aetna MGG,Aetna MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,BCBS,BCBS,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,BCBS MGG,BCBS MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Cigna,Cigna,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Cigna MGG,Cigna MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Humana,Humana,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Humana MGG,Humana MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Optum VA,Optum VA,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,UHC,UHC,24.62,,,,,,,per diem,24.62,24.62,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,UHC MGG,UHC MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,VA,VA,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Wellcare MGG,Wellcare MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Bright Health - commercial,Bright Health - commercial,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 6 MG TABLET     ,92133400,CDM,250,RC,,,,,,Inpatient,1,EA,24.62,24.62,Bright Health MGG,Bright Health MGG,24.62,,,,,,,case rate,24.62,24.62,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 10 MG/5 ML ORAL SOLUT,92133406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Aetna,Aetna,12.74,,,,,,,per diem,12.74,12.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Aetna MGG,Aetna MGG,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,BCBS,BCBS,12.74,,,,,,,per diem,12.74,12.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,BCBS MGG,BCBS MGG,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Cigna,Cigna,12.74,,,,,,,per diem,12.74,12.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Cigna MGG,Cigna MGG,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Humana,Humana,12.74,,,,,,,per diem,12.74,12.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Humana MGG,Humana MGG,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Optum VA,Optum VA,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,UHC,UHC,12.74,,,,,,,per diem,12.74,12.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,UHC MGG,UHC MGG,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,VA,VA,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Wellcare MGG,Wellcare MGG,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Bright Health - commercial,Bright Health - commercial,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 100MG TAB          ,92133425,CDM,250,RC,,,,,,Inpatient,1,EA,12.74,12.74,Bright Health MGG,Bright Health MGG,12.74,,,,,,,case rate,12.74,12.74,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Aetna,Aetna,24.47,,,,,,,per diem,24.47,24.47,"Per diem rate, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Aetna MGG,Aetna MGG,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,BCBS,BCBS,24.47,,,,,,,per diem,24.47,24.47,"Per diem rate, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,BCBS MGG,BCBS MGG,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Cigna,Cigna,24.47,,,,,,,per diem,24.47,24.47,"Per diem rate, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Cigna MGG,Cigna MGG,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Humana,Humana,24.47,,,,,,,per diem,24.47,24.47,"Per diem rate, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Humana MGG,Humana MGG,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Optum VA,Optum VA,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,UHC,UHC,24.47,,,,,,,per diem,24.47,24.47,"Per diem rate, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,UHC MGG,UHC MGG,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,VA,VA,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Wellcare MGG,Wellcare MGG,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Bright Health - commercial,Bright Health - commercial,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
DOFETILIDE 250 MCG ORAL CAP   ,92133436,CDM,250,RC,,,,,,Inpatient,1,EA,24.47,24.47,Bright Health MGG,Bright Health MGG,24.47,,,,,,,case rate,24.47,24.47,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Aetna,Aetna,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Aetna MGG,Aetna MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,BCBS,BCBS,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,BCBS MGG,BCBS MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Cigna,Cigna,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Cigna MGG,Cigna MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Humana,Humana,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Humana MGG,Humana MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Optum VA,Optum VA,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,UHC,UHC,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,UHC MGG,UHC MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,VA,VA,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Wellcare MGG,Wellcare MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Bright Health - commercial,Bright Health - commercial,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
MIRTAZAPINE  7.5 MG ORAL TAB  ,92133439,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Bright Health MGG,Bright Health MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Aetna,Aetna,31.24,,,,,,,per diem,31.24,31.24,"Per diem rate, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Aetna MGG,Aetna MGG,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,BCBS,BCBS,31.24,,,,,,,per diem,31.24,31.24,"Per diem rate, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,BCBS MGG,BCBS MGG,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Cigna,Cigna,31.24,,,,,,,per diem,31.24,31.24,"Per diem rate, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Cigna MGG,Cigna MGG,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Humana,Humana,31.24,,,,,,,per diem,31.24,31.24,"Per diem rate, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Humana MGG,Humana MGG,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Optum VA,Optum VA,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,UHC,UHC,31.24,,,,,,,per diem,31.24,31.24,"Per diem rate, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,UHC MGG,UHC MGG,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,VA,VA,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Wellcare MGG,Wellcare MGG,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Bright Health - commercial,Bright Health - commercial,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
DONEPEZIL 23 MG TABLET        ,92133448,CDM,250,RC,,,,,,Inpatient,1,EA,31.24,31.24,Bright Health MGG,Bright Health MGG,31.24,,,,,,,case rate,31.24,31.24,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Aetna,Aetna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Aetna MGG,Aetna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,BCBS,BCBS,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,BCBS MGG,BCBS MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Cigna,Cigna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Cigna MGG,Cigna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Humana,Humana,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Humana MGG,Humana MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Optum VA,Optum VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,UHC,UHC,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,UHC MGG,UHC MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,VA,VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Wellcare MGG,Wellcare MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Bright Health - commercial,Bright Health - commercial,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TIOTROPIUM 2.5 MCG-OLODATEROL ,92133457,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Bright Health MGG,Bright Health MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Aetna,Aetna,14.5,,,,,,,per diem,14.5,14.5,"Per diem rate, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Aetna MGG,Aetna MGG,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,BCBS,BCBS,14.5,,,,,,,per diem,14.5,14.5,"Per diem rate, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,BCBS MGG,BCBS MGG,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Cigna,Cigna,14.5,,,,,,,per diem,14.5,14.5,"Per diem rate, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Cigna MGG,Cigna MGG,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Humana,Humana,14.5,,,,,,,per diem,14.5,14.5,"Per diem rate, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Humana MGG,Humana MGG,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Optum VA,Optum VA,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,UHC,UHC,14.5,,,,,,,per diem,14.5,14.5,"Per diem rate, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,UHC MGG,UHC MGG,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,VA,VA,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Wellcare MGG,Wellcare MGG,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Bright Health - commercial,Bright Health - commercial,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
FONDAPARINUX 10 MG/0.8 ML SUBC,92133475,CDM,250,RC,,,,,,Inpatient,1,EA,14.5,14.5,Bright Health MGG,Bright Health MGG,14.5,,,,,,,case rate,14.5,14.5,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Aetna,Aetna,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Aetna MGG,Aetna MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,BCBS,BCBS,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,BCBS MGG,BCBS MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Cigna,Cigna,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Cigna MGG,Cigna MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Humana,Humana,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Humana MGG,Humana MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Optum VA,Optum VA,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,UHC,UHC,37.82,,,,,,,per diem,37.82,37.82,"Per diem rate, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,UHC MGG,UHC MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,VA,VA,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Wellcare MGG,Wellcare MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Bright Health - commercial,Bright Health - commercial,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
VILAZODONE 40 MG TAB          ,92133479,CDM,250,RC,,,,,,Inpatient,1,EA,37.82,37.82,Bright Health MGG,Bright Health MGG,37.82,,,,,,,case rate,37.82,37.82,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Aetna,Aetna,15.19,,,,,,,per diem,15.19,15.19,"Per diem rate, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Aetna MGG,Aetna MGG,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,BCBS,BCBS,15.19,,,,,,,per diem,15.19,15.19,"Per diem rate, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,BCBS MGG,BCBS MGG,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Cigna,Cigna,15.19,,,,,,,per diem,15.19,15.19,"Per diem rate, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Cigna MGG,Cigna MGG,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Humana,Humana,15.19,,,,,,,per diem,15.19,15.19,"Per diem rate, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Humana MGG,Humana MGG,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Optum VA,Optum VA,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,UHC,UHC,15.19,,,,,,,per diem,15.19,15.19,"Per diem rate, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,UHC MGG,UHC MGG,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,VA,VA,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Wellcare MGG,Wellcare MGG,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Bright Health - commercial,Bright Health - commercial,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
MYCOPHENOLIC ACID 180MG DR TAB,92133492,CDM,250,RC,,,,,,Inpatient,1,EA,15.19,15.19,Bright Health MGG,Bright Health MGG,15.19,,,,,,,case rate,15.19,15.19,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Aetna,Aetna,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Aetna MGG,Aetna MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,BCBS,BCBS,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,BCBS MGG,BCBS MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Cigna,Cigna,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Cigna MGG,Cigna MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Humana,Humana,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Humana MGG,Humana MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Optum VA,Optum VA,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,UHC,UHC,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,UHC MGG,UHC MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,VA,VA,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Wellcare MGG,Wellcare MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Bright Health - commercial,Bright Health - commercial,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
PHENYTOIN 25MG/ML ORAL SUSP   ,92133494,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,Bright Health MGG,Bright Health MGG,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Aetna,Aetna,52.58,,,,,,,per diem,52.58,52.58,"Per diem rate, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Aetna MGG,Aetna MGG,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,BCBS,BCBS,52.58,,,,,,,per diem,52.58,52.58,"Per diem rate, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,BCBS MGG,BCBS MGG,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Cigna,Cigna,52.58,,,,,,,per diem,52.58,52.58,"Per diem rate, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Cigna MGG,Cigna MGG,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Humana,Humana,52.58,,,,,,,per diem,52.58,52.58,"Per diem rate, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Humana MGG,Humana MGG,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Optum VA,Optum VA,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,UHC,UHC,52.58,,,,,,,per diem,52.58,52.58,"Per diem rate, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,UHC MGG,UHC MGG,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,VA,VA,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Wellcare MGG,Wellcare MGG,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Bright Health - commercial,Bright Health - commercial,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 200MG ER TAB       ,92133496,CDM,250,RC,,,,,,Inpatient,1,EA,52.58,52.58,Bright Health MGG,Bright Health MGG,52.58,,,,,,,case rate,52.58,52.58,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Aetna,Aetna,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Aetna MGG,Aetna MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,BCBS,BCBS,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,BCBS MGG,BCBS MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Cigna,Cigna,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Cigna MGG,Cigna MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Humana,Humana,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Humana MGG,Humana MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Optum VA,Optum VA,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,UHC,UHC,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,UHC MGG,UHC MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,VA,VA,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Wellcare MGG,Wellcare MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Bright Health - commercial,Bright Health - commercial,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
QUETIAPINE 300MG ER TAB       ,92133497,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Bright Health MGG,Bright Health MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna,Aetna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna MGG,Aetna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS,BCBS,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS MGG,BCBS MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna,Cigna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna MGG,Cigna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana,Humana,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana MGG,Humana MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Optum VA,Optum VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC,UHC,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC MGG,UHC MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,VA,VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Wellcare MGG,Wellcare MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health - commercial,Bright Health - commercial,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM CHEMO       ,92133498,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health MGG,Bright Health MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMPLATE NON-FORM INTERMITT   ,92133500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Aetna,Aetna,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Aetna MGG,Aetna MGG,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,BCBS,BCBS,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,BCBS MGG,BCBS MGG,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Cigna,Cigna,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Cigna MGG,Cigna MGG,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Humana,Humana,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Humana MGG,Humana MGG,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Optum VA,Optum VA,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,UHC,UHC,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,UHC MGG,UHC MGG,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,VA,VA,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Wellcare MGG,Wellcare MGG,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Bright Health - commercial,Bright Health - commercial,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN 2000MG IN WATER    ,92133504,CDM,250,RC,,,,,,Inpatient,1,EA,100.8,100.8,Bright Health MGG,Bright Health MGG,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Aetna,Aetna,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Aetna MGG,Aetna MGG,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,BCBS,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS MGG,BCBS MGG,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Cigna,Cigna,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Cigna MGG,Cigna MGG,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Humana,Humana,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Humana MGG,Humana MGG,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Optum VA,Optum VA,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,UHC,UHC,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,UHC MGG,UHC MGG,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,VA,VA,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Wellcare MGG,Wellcare MGG,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Bright Health - commercial,Bright Health - commercial,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CITALOPRAM 10MG TAB           ,92133506,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,Bright Health MGG,Bright Health MGG,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CHL-POT CHL 450MG-30MG    ,92133540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OCULAR MULTIPLE VIT AND MIN   ,92133544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Aetna,Aetna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Aetna MGG,Aetna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,BCBS,BCBS,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,BCBS MGG,BCBS MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Cigna,Cigna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Cigna MGG,Cigna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Humana,Humana,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Humana MGG,Humana MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Optum VA,Optum VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,UHC,UHC,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,UHC MGG,UHC MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,VA,VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Wellcare MGG,Wellcare MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Bright Health - commercial,Bright Health - commercial,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DIPH-LIDO-ALOH-MGOH-SIMETH    ,92133547,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Bright Health MGG,Bright Health MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN 30MG/5ML ORAL,92133661,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Aetna,Aetna,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Aetna MGG,Aetna MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,BCBS,BCBS,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,BCBS MGG,BCBS MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Cigna,Cigna,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Cigna MGG,Cigna MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Humana,Humana,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Humana MGG,Humana MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Optum VA,Optum VA,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,UHC,UHC,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,UHC MGG,UHC MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,VA,VA,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Wellcare MGG,Wellcare MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Bright Health - commercial,Bright Health - commercial,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
INSULIN ISOPH 70U SUBCUT PEN  ,92133670,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Bright Health MGG,Bright Health MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Aetna,Aetna,4.67,,,,,,,per diem,4.67,4.67,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Aetna MGG,Aetna MGG,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,BCBS,BCBS,4.67,,,,,,,per diem,4.67,4.67,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,BCBS MGG,BCBS MGG,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Cigna,Cigna,4.67,,,,,,,per diem,4.67,4.67,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Cigna MGG,Cigna MGG,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Humana,Humana,4.67,,,,,,,per diem,4.67,4.67,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Humana MGG,Humana MGG,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Optum VA,Optum VA,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,UHC,UHC,4.67,,,,,,,per diem,4.67,4.67,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,UHC MGG,UHC MGG,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,VA,VA,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Wellcare MGG,Wellcare MGG,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Bright Health - commercial,Bright Health - commercial,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.67,4.67,Bright Health MGG,Bright Health MGG,4.67,,,,,,,case rate,4.67,4.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Aetna,Aetna,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Aetna MGG,Aetna MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,BCBS,BCBS,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,BCBS MGG,BCBS MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Cigna,Cigna,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Cigna MGG,Cigna MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Humana,Humana,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Humana MGG,Humana MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Optum VA,Optum VA,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,UHC,UHC,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,UHC MGG,UHC MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,VA,VA,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Wellcare MGG,Wellcare MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Bright Health - commercial,Bright Health - commercial,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,Bright Health MGG,Bright Health MGG,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Aetna,Aetna,9.82,,,,,,,per diem,9.82,9.82,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Aetna MGG,Aetna MGG,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,BCBS,BCBS,9.82,,,,,,,per diem,9.82,9.82,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,BCBS MGG,BCBS MGG,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Cigna,Cigna,9.82,,,,,,,per diem,9.82,9.82,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Cigna MGG,Cigna MGG,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Humana,Humana,9.82,,,,,,,per diem,9.82,9.82,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Humana MGG,Humana MGG,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Optum VA,Optum VA,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,UHC,UHC,9.82,,,,,,,per diem,9.82,9.82,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,UHC MGG,UHC MGG,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,VA,VA,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Wellcare MGG,Wellcare MGG,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Bright Health - commercial,Bright Health - commercial,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,9.82,9.82,Bright Health MGG,Bright Health MGG,9.82,,,,,,,case rate,9.82,9.82,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Aetna,Aetna,4.49,,,,,,,per diem,4.49,4.49,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Aetna MGG,Aetna MGG,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,BCBS,BCBS,4.49,,,,,,,per diem,4.49,4.49,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,BCBS MGG,BCBS MGG,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Cigna,Cigna,4.49,,,,,,,per diem,4.49,4.49,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Cigna MGG,Cigna MGG,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Humana,Humana,4.49,,,,,,,per diem,4.49,4.49,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Humana MGG,Humana MGG,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Optum VA,Optum VA,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,UHC,UHC,4.49,,,,,,,per diem,4.49,4.49,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,UHC MGG,UHC MGG,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,VA,VA,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Wellcare MGG,Wellcare MGG,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Bright Health - commercial,Bright Health - commercial,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.49,4.49,Bright Health MGG,Bright Health MGG,4.49,,,,,,,case rate,4.49,4.49,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Aetna,Aetna,44.84,,,,,,,per diem,44.84,44.84,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Aetna MGG,Aetna MGG,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,BCBS,BCBS,44.84,,,,,,,per diem,44.84,44.84,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,BCBS MGG,BCBS MGG,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Cigna,Cigna,44.84,,,,,,,per diem,44.84,44.84,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Cigna MGG,Cigna MGG,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Humana,Humana,44.84,,,,,,,per diem,44.84,44.84,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Humana MGG,Humana MGG,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Optum VA,Optum VA,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,UHC,UHC,44.84,,,,,,,per diem,44.84,44.84,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,UHC MGG,UHC MGG,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,VA,VA,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Wellcare MGG,Wellcare MGG,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Bright Health - commercial,Bright Health - commercial,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,44.84,44.84,Bright Health MGG,Bright Health MGG,44.84,,,,,,,case rate,44.84,44.84,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Aetna,Aetna,224.1,,,,,,,per diem,224.1,224.1,"Per diem rate, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Aetna MGG,Aetna MGG,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,BCBS,BCBS,224.1,,,,,,,per diem,224.1,224.1,"Per diem rate, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,BCBS MGG,BCBS MGG,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Cigna,Cigna,224.1,,,,,,,per diem,224.1,224.1,"Per diem rate, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Cigna MGG,Cigna MGG,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Humana,Humana,224.1,,,,,,,per diem,224.1,224.1,"Per diem rate, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Humana MGG,Humana MGG,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Optum VA,Optum VA,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,UHC,UHC,224.1,,,,,,,per diem,224.1,224.1,"Per diem rate, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,UHC MGG,UHC MGG,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,VA,VA,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Wellcare MGG,Wellcare MGG,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Bright Health - commercial,Bright Health - commercial,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
GADOBUTROL 604.72 MG/ML (1 MMO,92133807,CDM,250,RC,,,,,,Inpatient,1,EA,224.1,224.1,Bright Health MGG,Bright Health MGG,224.1,,,,,,,case rate,224.1,224.1,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN-DIPHENHYDRAMINE ,92133808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Aetna,Aetna,32.05,,,,,,,per diem,32.05,32.05,"Per diem rate, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Aetna MGG,Aetna MGG,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,BCBS,BCBS,32.05,,,,,,,per diem,32.05,32.05,"Per diem rate, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,BCBS MGG,BCBS MGG,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Cigna,Cigna,32.05,,,,,,,per diem,32.05,32.05,"Per diem rate, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Cigna MGG,Cigna MGG,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Humana,Humana,32.05,,,,,,,per diem,32.05,32.05,"Per diem rate, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Humana MGG,Humana MGG,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Optum VA,Optum VA,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,UHC,UHC,32.05,,,,,,,per diem,32.05,32.05,"Per diem rate, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,UHC MGG,UHC MGG,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,VA,VA,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Wellcare MGG,Wellcare MGG,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Bright Health - commercial,Bright Health - commercial,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
ATROPINE/HYOSCYAMINE/PHENOBARB,92133809,CDM,250,RC,,,,,,Inpatient,1,EA,32.05,32.05,Bright Health MGG,Bright Health MGG,32.05,,,,,,,case rate,32.05,32.05,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEGA-3 POLYUNSATURATED FATTY ,92133810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Aetna,Aetna,58.83,,,,,,,per diem,58.83,58.83,"Per diem rate, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Aetna MGG,Aetna MGG,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,BCBS,BCBS,58.83,,,,,,,per diem,58.83,58.83,"Per diem rate, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,BCBS MGG,BCBS MGG,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Cigna,Cigna,58.83,,,,,,,per diem,58.83,58.83,"Per diem rate, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Cigna MGG,Cigna MGG,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Humana,Humana,58.83,,,,,,,per diem,58.83,58.83,"Per diem rate, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Humana MGG,Humana MGG,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Optum VA,Optum VA,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,UHC,UHC,58.83,,,,,,,per diem,58.83,58.83,"Per diem rate, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,UHC MGG,UHC MGG,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,VA,VA,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Wellcare MGG,Wellcare MGG,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Bright Health - commercial,Bright Health - commercial,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
OXYMORPHONE 20MG ER TAB       ,92133811,CDM,250,RC,,,,,,Inpatient,1,EA,58.83,58.83,Bright Health MGG,Bright Health MGG,58.83,,,,,,,case rate,58.83,58.83,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Aetna,Aetna,10.81,,,,,,,per diem,10.81,10.81,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Aetna MGG,Aetna MGG,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,BCBS,BCBS,10.81,,,,,,,per diem,10.81,10.81,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,BCBS MGG,BCBS MGG,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Cigna,Cigna,10.81,,,,,,,per diem,10.81,10.81,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Cigna MGG,Cigna MGG,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Humana,Humana,10.81,,,,,,,per diem,10.81,10.81,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Humana MGG,Humana MGG,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Optum VA,Optum VA,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,UHC,UHC,10.81,,,,,,,per diem,10.81,10.81,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,UHC MGG,UHC MGG,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,VA,VA,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Wellcare MGG,Wellcare MGG,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Bright Health - commercial,Bright Health - commercial,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 10,500/35,500/61,",92133812,CDM,250,RC,,,,,,Inpatient,1,EA,10.81,10.81,Bright Health MGG,Bright Health MGG,10.81,,,,,,,case rate,10.81,10.81,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Aetna,Aetna,22.7,,,,,,,per diem,22.7,22.7,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Aetna MGG,Aetna MGG,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,BCBS,BCBS,22.7,,,,,,,per diem,22.7,22.7,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,BCBS MGG,BCBS MGG,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Cigna,Cigna,22.7,,,,,,,per diem,22.7,22.7,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Cigna MGG,Cigna MGG,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Humana,Humana,22.7,,,,,,,per diem,22.7,22.7,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Humana MGG,Humana MGG,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Optum VA,Optum VA,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,UHC,UHC,22.7,,,,,,,per diem,22.7,22.7,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,UHC MGG,UHC MGG,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,VA,VA,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Wellcare MGG,Wellcare MGG,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Bright Health - commercial,Bright Health - commercial,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 21,000-83,900-54,",92133813,CDM,250,RC,,,,,,Inpatient,1,EA,22.7,22.7,Bright Health MGG,Bright Health MGG,22.7,,,,,,,case rate,22.7,22.7,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Aetna,Aetna,16.61,,,,,,,per diem,16.61,16.61,"Per diem rate, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Aetna MGG,Aetna MGG,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,BCBS,BCBS,16.61,,,,,,,per diem,16.61,16.61,"Per diem rate, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,BCBS MGG,BCBS MGG,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Cigna,Cigna,16.61,,,,,,,per diem,16.61,16.61,"Per diem rate, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Cigna MGG,Cigna MGG,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Humana,Humana,16.61,,,,,,,per diem,16.61,16.61,"Per diem rate, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Humana MGG,Humana MGG,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Optum VA,Optum VA,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,UHC,UHC,16.61,,,,,,,per diem,16.61,16.61,"Per diem rate, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,UHC MGG,UHC MGG,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,VA,VA,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Wellcare MGG,Wellcare MGG,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Bright Health - commercial,Bright Health - commercial,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
SODIUM CITRATE-CITRIC ACID 500,92133814,CDM,250,RC,,,,,,Inpatient,1,EA,16.61,16.61,Bright Health MGG,Bright Health MGG,16.61,,,,,,,case rate,16.61,16.61,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Aetna,Aetna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Aetna MGG,Aetna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,BCBS,BCBS,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,BCBS MGG,BCBS MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Cigna,Cigna,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Cigna MGG,Cigna MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Humana,Humana,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Humana MGG,Humana MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Optum VA,Optum VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,UHC,UHC,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,UHC MGG,UHC MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,VA,VA,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Wellcare MGG,Wellcare MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Bright Health - commercial,Bright Health - commercial,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% TOPICAL GEL WITH ,92133949,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,Bright Health MGG,Bright Health MGG,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Aetna,Aetna,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Aetna MGG,Aetna MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,BCBS,BCBS,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,BCBS MGG,BCBS MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Cigna,Cigna,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Cigna MGG,Cigna MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Humana,Humana,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Humana MGG,Humana MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Optum VA,Optum VA,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,UHC,UHC,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,UHC MGG,UHC MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,VA,VA,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Wellcare MGG,Wellcare MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Bright Health - commercial,Bright Health - commercial,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Bright Health MGG,Bright Health MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Aetna,Aetna,26.23,,,,,,,per diem,26.23,26.23,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Aetna MGG,Aetna MGG,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,BCBS,BCBS,26.23,,,,,,,per diem,26.23,26.23,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,BCBS MGG,BCBS MGG,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Cigna,Cigna,26.23,,,,,,,per diem,26.23,26.23,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Cigna MGG,Cigna MGG,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Humana,Humana,26.23,,,,,,,per diem,26.23,26.23,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Humana MGG,Humana MGG,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Optum VA,Optum VA,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,UHC,UHC,26.23,,,,,,,per diem,26.23,26.23,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,UHC MGG,UHC MGG,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,VA,VA,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Wellcare MGG,Wellcare MGG,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Bright Health - commercial,Bright Health - commercial,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,26.23,26.23,Bright Health MGG,Bright Health MGG,26.23,,,,,,,case rate,26.23,26.23,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Aetna,Aetna,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Aetna MGG,Aetna MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,BCBS,BCBS,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,BCBS MGG,BCBS MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Cigna,Cigna,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Cigna MGG,Cigna MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Humana,Humana,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Humana MGG,Humana MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Optum VA,Optum VA,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,UHC,UHC,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,UHC MGG,UHC MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,VA,VA,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Wellcare MGG,Wellcare MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Bright Health - commercial,Bright Health - commercial,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Bright Health MGG,Bright Health MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Aetna,Aetna,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Aetna MGG,Aetna MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,BCBS,BCBS,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,BCBS MGG,BCBS MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Cigna,Cigna,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Cigna MGG,Cigna MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Humana,Humana,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Humana MGG,Humana MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Optum VA,Optum VA,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,UHC,UHC,0.25,,,,,,,per diem,0.25,0.25,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,UHC MGG,UHC MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,VA,VA,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Wellcare MGG,Wellcare MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Bright Health - commercial,Bright Health - commercial,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.25,0.25,Bright Health MGG,Bright Health MGG,0.25,,,,,,,case rate,0.25,0.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Aetna,Aetna,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Aetna MGG,Aetna MGG,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,BCBS,BCBS,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,BCBS MGG,BCBS MGG,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Cigna,Cigna,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Cigna MGG,Cigna MGG,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Humana,Humana,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Humana MGG,Humana MGG,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Optum VA,Optum VA,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,UHC,UHC,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,UHC MGG,UHC MGG,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,VA,VA,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Wellcare MGG,Wellcare MGG,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Bright Health - commercial,Bright Health - commercial,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,525,525,Bright Health MGG,Bright Health MGG,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Aetna,Aetna,12.05,,,,,,,per diem,12.05,12.05,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Aetna MGG,Aetna MGG,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,BCBS,BCBS,12.05,,,,,,,per diem,12.05,12.05,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,BCBS MGG,BCBS MGG,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Cigna,Cigna,12.05,,,,,,,per diem,12.05,12.05,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Cigna MGG,Cigna MGG,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Humana,Humana,12.05,,,,,,,per diem,12.05,12.05,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Humana MGG,Humana MGG,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Optum VA,Optum VA,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,UHC,UHC,12.05,,,,,,,per diem,12.05,12.05,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,UHC MGG,UHC MGG,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,VA,VA,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Wellcare MGG,Wellcare MGG,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Bright Health - commercial,Bright Health - commercial,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.05,12.05,Bright Health MGG,Bright Health MGG,12.05,,,,,,,case rate,12.05,12.05,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Aetna,Aetna,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Aetna MGG,Aetna MGG,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,BCBS,BCBS,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,BCBS MGG,BCBS MGG,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Cigna,Cigna,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Cigna MGG,Cigna MGG,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Humana,Humana,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Humana MGG,Humana MGG,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Optum VA,Optum VA,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,UHC,UHC,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,UHC MGG,UHC MGG,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,VA,VA,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Wellcare MGG,Wellcare MGG,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Bright Health - commercial,Bright Health - commercial,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
NRB 5 (UPDATE DESC)           ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,Bright Health MGG,Bright Health MGG,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Aetna,Aetna,82.08,,,,,,,per diem,82.08,82.08,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Aetna MGG,Aetna MGG,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,BCBS,BCBS,82.08,,,,,,,per diem,82.08,82.08,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,BCBS MGG,BCBS MGG,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Cigna,Cigna,82.08,,,,,,,per diem,82.08,82.08,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Cigna MGG,Cigna MGG,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Humana,Humana,82.08,,,,,,,per diem,82.08,82.08,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Humana MGG,Humana MGG,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Optum VA,Optum VA,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,UHC,UHC,82.08,,,,,,,per diem,82.08,82.08,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,UHC MGG,UHC MGG,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,VA,VA,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Wellcare MGG,Wellcare MGG,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Bright Health - commercial,Bright Health - commercial,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,82.08,82.08,Bright Health MGG,Bright Health MGG,82.08,,,,,,,case rate,82.08,82.08,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Aetna,Aetna,47.77,,,,,,,per diem,47.77,47.77,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Aetna MGG,Aetna MGG,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,BCBS,BCBS,47.77,,,,,,,per diem,47.77,47.77,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,BCBS MGG,BCBS MGG,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Cigna,Cigna,47.77,,,,,,,per diem,47.77,47.77,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Cigna MGG,Cigna MGG,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Humana,Humana,47.77,,,,,,,per diem,47.77,47.77,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Humana MGG,Humana MGG,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Optum VA,Optum VA,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,UHC,UHC,47.77,,,,,,,per diem,47.77,47.77,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,UHC MGG,UHC MGG,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,VA,VA,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Wellcare MGG,Wellcare MGG,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Bright Health - commercial,Bright Health - commercial,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,47.77,47.77,Bright Health MGG,Bright Health MGG,47.77,,,,,,,case rate,47.77,47.77,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Aetna,Aetna,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Aetna MGG,Aetna MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,BCBS,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS MGG,BCBS MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Cigna,Cigna,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Cigna MGG,Cigna MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Humana,Humana,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Humana MGG,Humana MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Optum VA,Optum VA,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UHC,UHC,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UHC MGG,UHC MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,VA,VA,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Wellcare MGG,Wellcare MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Bright Health - commercial,Bright Health - commercial,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Bright Health MGG,Bright Health MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Aetna,Aetna,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Aetna MGG,Aetna MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,BCBS,BCBS,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,BCBS MGG,BCBS MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Cigna,Cigna,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Cigna MGG,Cigna MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Humana,Humana,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Humana MGG,Humana MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Optum VA,Optum VA,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,UHC,UHC,29.58,,,,,,,per diem,29.58,29.58,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,UHC MGG,UHC MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,VA,VA,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Wellcare MGG,Wellcare MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Bright Health - commercial,Bright Health - commercial,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,29.58,29.58,Bright Health MGG,Bright Health MGG,29.58,,,,,,,case rate,29.58,29.58,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna,Aetna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna MGG,Aetna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS,BCBS,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS MGG,BCBS MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna,Cigna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna MGG,Cigna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana,Humana,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana MGG,Humana MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Optum VA,Optum VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC,UHC,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC MGG,UHC MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,VA,VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Wellcare MGG,Wellcare MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health - commercial,Bright Health - commercial,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health MGG,Bright Health MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Aetna,Aetna,207.75,,,,,,,per diem,207.75,207.75,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Aetna MGG,Aetna MGG,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,BCBS,BCBS,207.75,,,,,,,per diem,207.75,207.75,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,BCBS MGG,BCBS MGG,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Cigna,Cigna,207.75,,,,,,,per diem,207.75,207.75,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Cigna MGG,Cigna MGG,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Humana,Humana,207.75,,,,,,,per diem,207.75,207.75,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Humana MGG,Humana MGG,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Optum VA,Optum VA,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,UHC,UHC,207.75,,,,,,,per diem,207.75,207.75,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,UHC MGG,UHC MGG,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,VA,VA,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Wellcare MGG,Wellcare MGG,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Bright Health - commercial,Bright Health - commercial,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,207.75,207.75,Bright Health MGG,Bright Health MGG,207.75,,,,,,,case rate,207.75,207.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Aetna,Aetna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Aetna MGG,Aetna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,BCBS,BCBS,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,BCBS MGG,BCBS MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Cigna,Cigna,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Cigna MGG,Cigna MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Humana,Humana,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Humana MGG,Humana MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Optum VA,Optum VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,UHC,UHC,135,,,,,,,per diem,135,135,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,UHC MGG,UHC MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,VA,VA,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Wellcare MGG,Wellcare MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Bright Health - commercial,Bright Health - commercial,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,135,135,Bright Health MGG,Bright Health MGG,135,,,,,,,case rate,135,135,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Aetna,Aetna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Aetna MGG,Aetna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,BCBS,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS MGG,BCBS MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Cigna,Cigna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Cigna MGG,Cigna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Humana,Humana,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Humana MGG,Humana MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Optum VA,Optum VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,UHC,UHC,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,UHC MGG,UHC MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,VA,VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Wellcare MGG,Wellcare MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Bright Health - commercial,Bright Health - commercial,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Bright Health MGG,Bright Health MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Aetna,Aetna,62.67,,,,,,,per diem,62.67,62.67,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Aetna MGG,Aetna MGG,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,BCBS,BCBS,62.67,,,,,,,per diem,62.67,62.67,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,BCBS MGG,BCBS MGG,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Cigna,Cigna,62.67,,,,,,,per diem,62.67,62.67,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Cigna MGG,Cigna MGG,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Humana,Humana,62.67,,,,,,,per diem,62.67,62.67,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Humana MGG,Humana MGG,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Optum VA,Optum VA,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,UHC,UHC,62.67,,,,,,,per diem,62.67,62.67,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,UHC MGG,UHC MGG,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,VA,VA,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Wellcare MGG,Wellcare MGG,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Bright Health - commercial,Bright Health - commercial,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,62.67,62.67,Bright Health MGG,Bright Health MGG,62.67,,,,,,,case rate,62.67,62.67,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Aetna,Aetna,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Aetna MGG,Aetna MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,BCBS,BCBS,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,BCBS MGG,BCBS MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Cigna,Cigna,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Cigna MGG,Cigna MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Humana,Humana,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Humana MGG,Humana MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Optum VA,Optum VA,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,UHC,UHC,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,UHC MGG,UHC MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,VA,VA,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Wellcare MGG,Wellcare MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Bright Health - commercial,Bright Health - commercial,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Bright Health MGG,Bright Health MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Aetna,Aetna,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Aetna MGG,Aetna MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,BCBS,BCBS,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,BCBS MGG,BCBS MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Cigna,Cigna,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Cigna MGG,Cigna MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Humana,Humana,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Humana MGG,Humana MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Optum VA,Optum VA,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,UHC,UHC,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,UHC MGG,UHC MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,VA,VA,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Wellcare MGG,Wellcare MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Bright Health - commercial,Bright Health - commercial,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Bright Health MGG,Bright Health MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Aetna,Aetna,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Aetna MGG,Aetna MGG,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,BCBS,BCBS,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,BCBS MGG,BCBS MGG,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Cigna,Cigna,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Cigna MGG,Cigna MGG,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Humana,Humana,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Humana MGG,Humana MGG,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Optum VA,Optum VA,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,UHC,UHC,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,UHC MGG,UHC MGG,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,VA,VA,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Wellcare MGG,Wellcare MGG,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Bright Health - commercial,Bright Health - commercial,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,Bright Health MGG,Bright Health MGG,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Aetna,Aetna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Aetna MGG,Aetna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,BCBS,BCBS,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,BCBS MGG,BCBS MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Cigna,Cigna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Cigna MGG,Cigna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Humana,Humana,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Humana MGG,Humana MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Optum VA,Optum VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,UHC,UHC,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,UHC MGG,UHC MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,VA,VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Wellcare MGG,Wellcare MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Bright Health - commercial,Bright Health - commercial,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Bright Health MGG,Bright Health MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Aetna,Aetna,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Aetna MGG,Aetna MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,BCBS,BCBS,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,BCBS MGG,BCBS MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Cigna,Cigna,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Cigna MGG,Cigna MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Humana,Humana,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Humana MGG,Humana MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Optum VA,Optum VA,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,UHC,UHC,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,UHC MGG,UHC MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,VA,VA,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Wellcare MGG,Wellcare MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Bright Health - commercial,Bright Health - commercial,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Bright Health MGG,Bright Health MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Aetna,Aetna,34.02,,,,,,,per diem,34.02,34.02,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Aetna MGG,Aetna MGG,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,BCBS,BCBS,34.02,,,,,,,per diem,34.02,34.02,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,BCBS MGG,BCBS MGG,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Cigna,Cigna,34.02,,,,,,,per diem,34.02,34.02,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Cigna MGG,Cigna MGG,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Humana,Humana,34.02,,,,,,,per diem,34.02,34.02,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Humana MGG,Humana MGG,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Optum VA,Optum VA,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,UHC,UHC,34.02,,,,,,,per diem,34.02,34.02,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,UHC MGG,UHC MGG,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,VA,VA,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Wellcare MGG,Wellcare MGG,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Bright Health - commercial,Bright Health - commercial,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,34.02,34.02,Bright Health MGG,Bright Health MGG,34.02,,,,,,,case rate,34.02,34.02,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Aetna,Aetna,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Aetna MGG,Aetna MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,BCBS,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS MGG,BCBS MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Cigna,Cigna,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Cigna MGG,Cigna MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Humana,Humana,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Humana MGG,Humana MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Optum VA,Optum VA,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,UHC,UHC,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,UHC MGG,UHC MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,VA,VA,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Wellcare MGG,Wellcare MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Bright Health - commercial,Bright Health - commercial,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,Bright Health MGG,Bright Health MGG,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Aetna,Aetna,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Aetna MGG,Aetna MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,BCBS,BCBS,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,BCBS MGG,BCBS MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Cigna,Cigna,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Cigna MGG,Cigna MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Humana,Humana,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Humana MGG,Humana MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Optum VA,Optum VA,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,UHC,UHC,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,UHC MGG,UHC MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,VA,VA,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Wellcare MGG,Wellcare MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Bright Health - commercial,Bright Health - commercial,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Bright Health MGG,Bright Health MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Aetna,Aetna,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Aetna MGG,Aetna MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,BCBS,BCBS,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,BCBS MGG,BCBS MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Cigna,Cigna,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Cigna MGG,Cigna MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Humana,Humana,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Humana MGG,Humana MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Optum VA,Optum VA,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,UHC,UHC,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,UHC MGG,UHC MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,VA,VA,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Wellcare MGG,Wellcare MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Bright Health - commercial,Bright Health - commercial,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,81.54,81.54,Bright Health MGG,Bright Health MGG,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna,Aetna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna MGG,Aetna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,BCBS,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS MGG,BCBS MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna,Cigna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna MGG,Cigna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana,Humana,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana MGG,Humana MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Optum VA,Optum VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC,UHC,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC MGG,UHC MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,VA,VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Wellcare MGG,Wellcare MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health - commercial,Bright Health - commercial,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health MGG,Bright Health MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Aetna,Aetna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Aetna MGG,Aetna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,BCBS,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS MGG,BCBS MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Cigna,Cigna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Cigna MGG,Cigna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Humana,Humana,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Humana MGG,Humana MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Optum VA,Optum VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,UHC,UHC,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,UHC MGG,UHC MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,VA,VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Wellcare MGG,Wellcare MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Bright Health - commercial,Bright Health - commercial,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Bright Health MGG,Bright Health MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna,Aetna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna MGG,Aetna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,BCBS,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS MGG,BCBS MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna,Cigna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna MGG,Cigna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana,Humana,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana MGG,Humana MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Optum VA,Optum VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC,UHC,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC MGG,UHC MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Wellcare MGG,Wellcare MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health - commercial,Bright Health - commercial,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health MGG,Bright Health MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Aetna,Aetna,29.1,,,,,,,per diem,29.1,29.1,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Aetna MGG,Aetna MGG,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,BCBS,BCBS,29.1,,,,,,,per diem,29.1,29.1,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,BCBS MGG,BCBS MGG,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Cigna,Cigna,29.1,,,,,,,per diem,29.1,29.1,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Cigna MGG,Cigna MGG,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Humana,Humana,29.1,,,,,,,per diem,29.1,29.1,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Humana MGG,Humana MGG,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Optum VA,Optum VA,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,UHC,UHC,29.1,,,,,,,per diem,29.1,29.1,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,UHC MGG,UHC MGG,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,VA,VA,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Wellcare MGG,Wellcare MGG,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Bright Health - commercial,Bright Health - commercial,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,29.1,29.1,Bright Health MGG,Bright Health MGG,29.1,,,,,,,case rate,29.1,29.1,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Aetna,Aetna,45.18,,,,,,,per diem,45.18,45.18,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Aetna MGG,Aetna MGG,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,BCBS,BCBS,45.18,,,,,,,per diem,45.18,45.18,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,BCBS MGG,BCBS MGG,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Cigna,Cigna,45.18,,,,,,,per diem,45.18,45.18,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Cigna MGG,Cigna MGG,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Humana,Humana,45.18,,,,,,,per diem,45.18,45.18,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Humana MGG,Humana MGG,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Optum VA,Optum VA,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,UHC,UHC,45.18,,,,,,,per diem,45.18,45.18,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,UHC MGG,UHC MGG,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,VA,VA,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Wellcare MGG,Wellcare MGG,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Bright Health - commercial,Bright Health - commercial,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,45.18,45.18,Bright Health MGG,Bright Health MGG,45.18,,,,,,,case rate,45.18,45.18,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Aetna,Aetna,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Aetna MGG,Aetna MGG,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,BCBS,BCBS,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,BCBS MGG,BCBS MGG,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Cigna,Cigna,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Cigna MGG,Cigna MGG,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Humana,Humana,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Humana MGG,Humana MGG,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Optum VA,Optum VA,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,UHC,UHC,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,UHC MGG,UHC MGG,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,VA,VA,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Wellcare MGG,Wellcare MGG,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Bright Health - commercial,Bright Health - commercial,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,Bright Health MGG,Bright Health MGG,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Aetna,Aetna,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Aetna MGG,Aetna MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,BCBS,BCBS,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,BCBS MGG,BCBS MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Cigna,Cigna,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Cigna MGG,Cigna MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Humana,Humana,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Humana MGG,Humana MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Optum VA,Optum VA,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,UHC,UHC,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,UHC MGG,UHC MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,VA,VA,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Wellcare MGG,Wellcare MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Bright Health - commercial,Bright Health - commercial,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Bright Health MGG,Bright Health MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna,Aetna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna MGG,Aetna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,BCBS,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS MGG,BCBS MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna,Cigna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna MGG,Cigna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana,Humana,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana MGG,Humana MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Optum VA,Optum VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC,UHC,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC MGG,UHC MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Wellcare MGG,Wellcare MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health - commercial,Bright Health - commercial,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health MGG,Bright Health MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Aetna,Aetna,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Aetna MGG,Aetna MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,BCBS,BCBS,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,BCBS MGG,BCBS MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Cigna,Cigna,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Cigna MGG,Cigna MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Humana,Humana,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Humana MGG,Humana MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Optum VA,Optum VA,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,UHC,UHC,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,UHC MGG,UHC MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,VA,VA,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Wellcare MGG,Wellcare MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Bright Health - commercial,Bright Health - commercial,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Bright Health MGG,Bright Health MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Aetna,Aetna,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Aetna MGG,Aetna MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,BCBS,BCBS,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,BCBS MGG,BCBS MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Cigna,Cigna,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Cigna MGG,Cigna MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Humana,Humana,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Humana MGG,Humana MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Optum VA,Optum VA,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,UHC,UHC,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,UHC MGG,UHC MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,VA,VA,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Wellcare MGG,Wellcare MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Bright Health - commercial,Bright Health - commercial,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Bright Health MGG,Bright Health MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Aetna,Aetna,190.23,,,,,,,per diem,190.23,190.23,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Aetna MGG,Aetna MGG,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,BCBS,BCBS,190.23,,,,,,,per diem,190.23,190.23,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,BCBS MGG,BCBS MGG,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Cigna,Cigna,190.23,,,,,,,per diem,190.23,190.23,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Cigna MGG,Cigna MGG,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Humana,Humana,190.23,,,,,,,per diem,190.23,190.23,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Humana MGG,Humana MGG,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Optum VA,Optum VA,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,UHC,UHC,190.23,,,,,,,per diem,190.23,190.23,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,UHC MGG,UHC MGG,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,VA,VA,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Wellcare MGG,Wellcare MGG,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Bright Health - commercial,Bright Health - commercial,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,190.23,190.23,Bright Health MGG,Bright Health MGG,190.23,,,,,,,case rate,190.23,190.23,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Aetna,Aetna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Aetna MGG,Aetna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,BCBS,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS MGG,BCBS MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Cigna,Cigna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Cigna MGG,Cigna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Humana,Humana,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Humana MGG,Humana MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Optum VA,Optum VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UHC,UHC,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UHC MGG,UHC MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,VA,VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Wellcare MGG,Wellcare MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Bright Health - commercial,Bright Health - commercial,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Bright Health MGG,Bright Health MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Aetna,Aetna,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Aetna MGG,Aetna MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,BCBS,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS MGG,BCBS MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Cigna,Cigna,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Cigna MGG,Cigna MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Humana,Humana,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Humana MGG,Humana MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Optum VA,Optum VA,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,UHC,UHC,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,UHC MGG,UHC MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,VA,VA,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Wellcare MGG,Wellcare MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Bright Health - commercial,Bright Health - commercial,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,Bright Health MGG,Bright Health MGG,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Aetna,Aetna,638.94,,,,,,,per diem,638.94,638.94,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Aetna MGG,Aetna MGG,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,BCBS,BCBS,638.94,,,,,,,per diem,638.94,638.94,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,BCBS MGG,BCBS MGG,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Cigna,Cigna,638.94,,,,,,,per diem,638.94,638.94,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Cigna MGG,Cigna MGG,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Humana,Humana,638.94,,,,,,,per diem,638.94,638.94,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Humana MGG,Humana MGG,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Optum VA,Optum VA,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,UHC,UHC,638.94,,,,,,,per diem,638.94,638.94,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,UHC MGG,UHC MGG,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,VA,VA,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Wellcare MGG,Wellcare MGG,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Bright Health - commercial,Bright Health - commercial,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,638.94,638.94,Bright Health MGG,Bright Health MGG,638.94,,,,,,,case rate,638.94,638.94,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Aetna,Aetna,125.43,,,,,,,per diem,125.43,125.43,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Aetna MGG,Aetna MGG,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,BCBS,BCBS,125.43,,,,,,,per diem,125.43,125.43,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,BCBS MGG,BCBS MGG,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Cigna,Cigna,125.43,,,,,,,per diem,125.43,125.43,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Cigna MGG,Cigna MGG,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Humana,Humana,125.43,,,,,,,per diem,125.43,125.43,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Humana MGG,Humana MGG,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Optum VA,Optum VA,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,UHC,UHC,125.43,,,,,,,per diem,125.43,125.43,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,UHC MGG,UHC MGG,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,VA,VA,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Wellcare MGG,Wellcare MGG,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Bright Health - commercial,Bright Health - commercial,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,125.43,125.43,Bright Health MGG,Bright Health MGG,125.43,,,,,,,case rate,125.43,125.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Aetna,Aetna,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Aetna MGG,Aetna MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,BCBS,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS MGG,BCBS MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Cigna,Cigna,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Cigna MGG,Cigna MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Humana,Humana,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Humana MGG,Humana MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Optum VA,Optum VA,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UHC,UHC,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UHC MGG,UHC MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,VA,VA,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Wellcare MGG,Wellcare MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Bright Health - commercial,Bright Health - commercial,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Bright Health MGG,Bright Health MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna,Aetna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna MGG,Aetna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS,BCBS,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS MGG,BCBS MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna,Cigna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna MGG,Cigna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana,Humana,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana MGG,Humana MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Optum VA,Optum VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC,UHC,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC MGG,UHC MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,VA,VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Wellcare MGG,Wellcare MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health - commercial,Bright Health - commercial,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health MGG,Bright Health MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Aetna,Aetna,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Aetna MGG,Aetna MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,BCBS,BCBS,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,BCBS MGG,BCBS MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Cigna,Cigna,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Cigna MGG,Cigna MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Humana,Humana,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Humana MGG,Humana MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Optum VA,Optum VA,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,UHC,UHC,42.12,,,,,,,per diem,42.12,42.12,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,UHC MGG,UHC MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,VA,VA,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Wellcare MGG,Wellcare MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Bright Health - commercial,Bright Health - commercial,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,42.12,42.12,Bright Health MGG,Bright Health MGG,42.12,,,,,,,case rate,42.12,42.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Aetna,Aetna,97.05,,,,,,,per diem,97.05,97.05,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Aetna MGG,Aetna MGG,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,BCBS,BCBS,97.05,,,,,,,per diem,97.05,97.05,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,BCBS MGG,BCBS MGG,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Cigna,Cigna,97.05,,,,,,,per diem,97.05,97.05,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Cigna MGG,Cigna MGG,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Humana,Humana,97.05,,,,,,,per diem,97.05,97.05,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Humana MGG,Humana MGG,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Optum VA,Optum VA,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,UHC,UHC,97.05,,,,,,,per diem,97.05,97.05,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,UHC MGG,UHC MGG,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,VA,VA,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Wellcare MGG,Wellcare MGG,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Bright Health - commercial,Bright Health - commercial,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,97.05,97.05,Bright Health MGG,Bright Health MGG,97.05,,,,,,,case rate,97.05,97.05,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Aetna,Aetna,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Aetna MGG,Aetna MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,BCBS,BCBS,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,BCBS MGG,BCBS MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Cigna,Cigna,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Cigna MGG,Cigna MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Humana,Humana,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Humana MGG,Humana MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Optum VA,Optum VA,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,UHC,UHC,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,UHC MGG,UHC MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,VA,VA,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Wellcare MGG,Wellcare MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Bright Health - commercial,Bright Health - commercial,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Bright Health MGG,Bright Health MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Aetna,Aetna,175.08,,,,,,,per diem,175.08,175.08,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Aetna MGG,Aetna MGG,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,BCBS,BCBS,175.08,,,,,,,per diem,175.08,175.08,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,BCBS MGG,BCBS MGG,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Cigna,Cigna,175.08,,,,,,,per diem,175.08,175.08,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Cigna MGG,Cigna MGG,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Humana,Humana,175.08,,,,,,,per diem,175.08,175.08,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Humana MGG,Humana MGG,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Optum VA,Optum VA,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,UHC,UHC,175.08,,,,,,,per diem,175.08,175.08,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,UHC MGG,UHC MGG,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,VA,VA,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Wellcare MGG,Wellcare MGG,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Bright Health - commercial,Bright Health - commercial,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,175.08,175.08,Bright Health MGG,Bright Health MGG,175.08,,,,,,,case rate,175.08,175.08,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Aetna,Aetna,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Aetna MGG,Aetna MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,BCBS,BCBS,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,BCBS MGG,BCBS MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Cigna,Cigna,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Cigna MGG,Cigna MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Humana,Humana,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Humana MGG,Humana MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Optum VA,Optum VA,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,UHC,UHC,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,UHC MGG,UHC MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,VA,VA,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Wellcare MGG,Wellcare MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Bright Health - commercial,Bright Health - commercial,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Bright Health MGG,Bright Health MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna,Aetna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna MGG,Aetna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,BCBS,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS MGG,BCBS MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna,Cigna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna MGG,Cigna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana,Humana,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana MGG,Humana MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Optum VA,Optum VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC,UHC,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC MGG,UHC MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,VA,VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Wellcare MGG,Wellcare MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health - commercial,Bright Health - commercial,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health MGG,Bright Health MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Aetna,Aetna,36.96,,,,,,,per diem,36.96,36.96,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Aetna MGG,Aetna MGG,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,BCBS,BCBS,36.96,,,,,,,per diem,36.96,36.96,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,BCBS MGG,BCBS MGG,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Cigna,Cigna,36.96,,,,,,,per diem,36.96,36.96,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Cigna MGG,Cigna MGG,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Humana,Humana,36.96,,,,,,,per diem,36.96,36.96,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Humana MGG,Humana MGG,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Optum VA,Optum VA,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,UHC,UHC,36.96,,,,,,,per diem,36.96,36.96,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,UHC MGG,UHC MGG,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,VA,VA,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Wellcare MGG,Wellcare MGG,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Bright Health - commercial,Bright Health - commercial,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,36.96,36.96,Bright Health MGG,Bright Health MGG,36.96,,,,,,,case rate,36.96,36.96,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna,Aetna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna MGG,Aetna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS,BCBS,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS MGG,BCBS MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna,Cigna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna MGG,Cigna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana,Humana,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana MGG,Humana MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Optum VA,Optum VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC,UHC,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC MGG,UHC MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,VA,VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Wellcare MGG,Wellcare MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health - commercial,Bright Health - commercial,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health MGG,Bright Health MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Aetna,Aetna,83.88,,,,,,,per diem,83.88,83.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Aetna MGG,Aetna MGG,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,BCBS,BCBS,83.88,,,,,,,per diem,83.88,83.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,BCBS MGG,BCBS MGG,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Cigna,Cigna,83.88,,,,,,,per diem,83.88,83.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Cigna MGG,Cigna MGG,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Humana,Humana,83.88,,,,,,,per diem,83.88,83.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Humana MGG,Humana MGG,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Optum VA,Optum VA,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,UHC,UHC,83.88,,,,,,,per diem,83.88,83.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,UHC MGG,UHC MGG,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,VA,VA,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Wellcare MGG,Wellcare MGG,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Bright Health - commercial,Bright Health - commercial,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,83.88,83.88,Bright Health MGG,Bright Health MGG,83.88,,,,,,,case rate,83.88,83.88,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Aetna,Aetna,84.48,,,,,,,per diem,84.48,84.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Aetna MGG,Aetna MGG,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,BCBS,BCBS,84.48,,,,,,,per diem,84.48,84.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,BCBS MGG,BCBS MGG,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Cigna,Cigna,84.48,,,,,,,per diem,84.48,84.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Cigna MGG,Cigna MGG,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Humana,Humana,84.48,,,,,,,per diem,84.48,84.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Humana MGG,Humana MGG,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Optum VA,Optum VA,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,UHC,UHC,84.48,,,,,,,per diem,84.48,84.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,UHC MGG,UHC MGG,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,VA,VA,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Wellcare MGG,Wellcare MGG,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Bright Health - commercial,Bright Health - commercial,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,84.48,84.48,Bright Health MGG,Bright Health MGG,84.48,,,,,,,case rate,84.48,84.48,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Aetna,Aetna,5074.02,,,,,,,per diem,5074.02,5074.02,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Aetna MGG,Aetna MGG,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,BCBS,BCBS,5074.02,,,,,,,per diem,5074.02,5074.02,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,BCBS MGG,BCBS MGG,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Cigna,Cigna,5074.02,,,,,,,per diem,5074.02,5074.02,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Cigna MGG,Cigna MGG,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Humana,Humana,5074.02,,,,,,,per diem,5074.02,5074.02,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Humana MGG,Humana MGG,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Optum VA,Optum VA,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,UHC,UHC,5074.02,,,,,,,per diem,5074.02,5074.02,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,UHC MGG,UHC MGG,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,VA,VA,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Wellcare MGG,Wellcare MGG,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Bright Health - commercial,Bright Health - commercial,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5074.02,5074.02,Bright Health MGG,Bright Health MGG,5074.02,,,,,,,case rate,5074.02,5074.02,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Aetna,Aetna,62.58,,,,,,,per diem,62.58,62.58,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Aetna MGG,Aetna MGG,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,BCBS,BCBS,62.58,,,,,,,per diem,62.58,62.58,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,BCBS MGG,BCBS MGG,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Cigna,Cigna,62.58,,,,,,,per diem,62.58,62.58,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Cigna MGG,Cigna MGG,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Humana,Humana,62.58,,,,,,,per diem,62.58,62.58,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Humana MGG,Humana MGG,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Optum VA,Optum VA,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,UHC,UHC,62.58,,,,,,,per diem,62.58,62.58,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,UHC MGG,UHC MGG,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,VA,VA,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Wellcare MGG,Wellcare MGG,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Bright Health - commercial,Bright Health - commercial,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,62.58,62.58,Bright Health MGG,Bright Health MGG,62.58,,,,,,,case rate,62.58,62.58,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Aetna,Aetna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Aetna MGG,Aetna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,BCBS,BCBS,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,BCBS MGG,BCBS MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Cigna,Cigna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Cigna MGG,Cigna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Humana,Humana,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Humana MGG,Humana MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Optum VA,Optum VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,UHC,UHC,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,UHC MGG,UHC MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,VA,VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Wellcare MGG,Wellcare MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Bright Health - commercial,Bright Health - commercial,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Bright Health MGG,Bright Health MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Aetna,Aetna,478.56,,,,,,,per diem,478.56,478.56,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Aetna MGG,Aetna MGG,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,BCBS,BCBS,478.56,,,,,,,per diem,478.56,478.56,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,BCBS MGG,BCBS MGG,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Cigna,Cigna,478.56,,,,,,,per diem,478.56,478.56,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Cigna MGG,Cigna MGG,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Humana,Humana,478.56,,,,,,,per diem,478.56,478.56,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Humana MGG,Humana MGG,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Optum VA,Optum VA,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,UHC,UHC,478.56,,,,,,,per diem,478.56,478.56,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,UHC MGG,UHC MGG,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,VA,VA,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Wellcare MGG,Wellcare MGG,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Bright Health - commercial,Bright Health - commercial,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,478.56,478.56,Bright Health MGG,Bright Health MGG,478.56,,,,,,,case rate,478.56,478.56,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Aetna,Aetna,17.94,,,,,,,per diem,17.94,17.94,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Aetna MGG,Aetna MGG,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,BCBS,BCBS,17.94,,,,,,,per diem,17.94,17.94,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,BCBS MGG,BCBS MGG,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Cigna,Cigna,17.94,,,,,,,per diem,17.94,17.94,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Cigna MGG,Cigna MGG,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Humana,Humana,17.94,,,,,,,per diem,17.94,17.94,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Humana MGG,Humana MGG,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Optum VA,Optum VA,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,UHC,UHC,17.94,,,,,,,per diem,17.94,17.94,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,UHC MGG,UHC MGG,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,VA,VA,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Wellcare MGG,Wellcare MGG,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Bright Health - commercial,Bright Health - commercial,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,17.94,17.94,Bright Health MGG,Bright Health MGG,17.94,,,,,,,case rate,17.94,17.94,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Aetna,Aetna,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Aetna MGG,Aetna MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,BCBS,BCBS,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,BCBS MGG,BCBS MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Cigna,Cigna,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Cigna MGG,Cigna MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Humana,Humana,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Humana MGG,Humana MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Optum VA,Optum VA,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,UHC,UHC,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,UHC MGG,UHC MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,VA,VA,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Wellcare MGG,Wellcare MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Bright Health - commercial,Bright Health - commercial,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Bright Health MGG,Bright Health MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Aetna,Aetna,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Aetna MGG,Aetna MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,BCBS,BCBS,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,BCBS MGG,BCBS MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Cigna,Cigna,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Cigna MGG,Cigna MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Humana,Humana,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Humana MGG,Humana MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Optum VA,Optum VA,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,UHC,UHC,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,UHC MGG,UHC MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,VA,VA,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Wellcare MGG,Wellcare MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Bright Health - commercial,Bright Health - commercial,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Bright Health MGG,Bright Health MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Aetna,Aetna,22.47,,,,,,,per diem,22.47,22.47,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Aetna MGG,Aetna MGG,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,BCBS,BCBS,22.47,,,,,,,per diem,22.47,22.47,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,BCBS MGG,BCBS MGG,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Cigna,Cigna,22.47,,,,,,,per diem,22.47,22.47,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Cigna MGG,Cigna MGG,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Humana,Humana,22.47,,,,,,,per diem,22.47,22.47,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Humana MGG,Humana MGG,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Optum VA,Optum VA,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,UHC,UHC,22.47,,,,,,,per diem,22.47,22.47,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,UHC MGG,UHC MGG,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,VA,VA,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Wellcare MGG,Wellcare MGG,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Bright Health - commercial,Bright Health - commercial,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,22.47,22.47,Bright Health MGG,Bright Health MGG,22.47,,,,,,,case rate,22.47,22.47,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Aetna,Aetna,361.59,,,,,,,per diem,361.59,361.59,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Aetna MGG,Aetna MGG,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,BCBS,BCBS,361.59,,,,,,,per diem,361.59,361.59,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,BCBS MGG,BCBS MGG,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Cigna,Cigna,361.59,,,,,,,per diem,361.59,361.59,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Cigna MGG,Cigna MGG,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Humana,Humana,361.59,,,,,,,per diem,361.59,361.59,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Humana MGG,Humana MGG,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Optum VA,Optum VA,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,UHC,UHC,361.59,,,,,,,per diem,361.59,361.59,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,UHC MGG,UHC MGG,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,VA,VA,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Wellcare MGG,Wellcare MGG,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Bright Health - commercial,Bright Health - commercial,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,361.59,361.59,Bright Health MGG,Bright Health MGG,361.59,,,,,,,case rate,361.59,361.59,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Aetna,Aetna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Aetna MGG,Aetna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,BCBS,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS MGG,BCBS MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Cigna,Cigna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Cigna MGG,Cigna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Humana,Humana,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Humana MGG,Humana MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Optum VA,Optum VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UHC,UHC,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UHC MGG,UHC MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Wellcare MGG,Wellcare MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Bright Health - commercial,Bright Health - commercial,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Bright Health MGG,Bright Health MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Aetna,Aetna,24.66,,,,,,,per diem,24.66,24.66,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Aetna MGG,Aetna MGG,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,BCBS,BCBS,24.66,,,,,,,per diem,24.66,24.66,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,BCBS MGG,BCBS MGG,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Cigna,Cigna,24.66,,,,,,,per diem,24.66,24.66,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Cigna MGG,Cigna MGG,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Humana,Humana,24.66,,,,,,,per diem,24.66,24.66,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Humana MGG,Humana MGG,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Optum VA,Optum VA,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,UHC,UHC,24.66,,,,,,,per diem,24.66,24.66,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,UHC MGG,UHC MGG,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,VA,VA,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Wellcare MGG,Wellcare MGG,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Bright Health - commercial,Bright Health - commercial,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,24.66,24.66,Bright Health MGG,Bright Health MGG,24.66,,,,,,,case rate,24.66,24.66,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Aetna,Aetna,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Aetna MGG,Aetna MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,BCBS,BCBS,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,BCBS MGG,BCBS MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Cigna,Cigna,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Cigna MGG,Cigna MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Humana,Humana,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Humana MGG,Humana MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Optum VA,Optum VA,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,UHC,UHC,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,UHC MGG,UHC MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,VA,VA,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Wellcare MGG,Wellcare MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Bright Health - commercial,Bright Health - commercial,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Bright Health MGG,Bright Health MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Aetna,Aetna,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Aetna MGG,Aetna MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,BCBS,BCBS,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,BCBS MGG,BCBS MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Cigna,Cigna,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Cigna MGG,Cigna MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Humana,Humana,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Humana MGG,Humana MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Optum VA,Optum VA,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,UHC,UHC,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,UHC MGG,UHC MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,VA,VA,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Wellcare MGG,Wellcare MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Bright Health - commercial,Bright Health - commercial,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Bright Health MGG,Bright Health MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Aetna,Aetna,34.2,,,,,,,per diem,34.2,34.2,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Aetna MGG,Aetna MGG,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,BCBS,BCBS,34.2,,,,,,,per diem,34.2,34.2,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,BCBS MGG,BCBS MGG,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Cigna,Cigna,34.2,,,,,,,per diem,34.2,34.2,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Cigna MGG,Cigna MGG,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Humana,Humana,34.2,,,,,,,per diem,34.2,34.2,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Humana MGG,Humana MGG,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Optum VA,Optum VA,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,UHC,UHC,34.2,,,,,,,per diem,34.2,34.2,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,UHC MGG,UHC MGG,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,VA,VA,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Wellcare MGG,Wellcare MGG,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Bright Health - commercial,Bright Health - commercial,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,34.2,34.2,Bright Health MGG,Bright Health MGG,34.2,,,,,,,case rate,34.2,34.2,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Aetna,Aetna,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Aetna MGG,Aetna MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,BCBS,BCBS,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,BCBS MGG,BCBS MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Cigna,Cigna,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Cigna MGG,Cigna MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Humana,Humana,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Humana MGG,Humana MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Optum VA,Optum VA,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,UHC,UHC,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,UHC MGG,UHC MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,VA,VA,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Wellcare MGG,Wellcare MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Bright Health - commercial,Bright Health - commercial,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Bright Health MGG,Bright Health MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Aetna,Aetna,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Aetna MGG,Aetna MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,BCBS,BCBS,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,BCBS MGG,BCBS MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Cigna,Cigna,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Cigna MGG,Cigna MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Humana,Humana,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Humana MGG,Humana MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Optum VA,Optum VA,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,UHC,UHC,45.84,,,,,,,per diem,45.84,45.84,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,UHC MGG,UHC MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,VA,VA,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Wellcare MGG,Wellcare MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Bright Health - commercial,Bright Health - commercial,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,45.84,45.84,Bright Health MGG,Bright Health MGG,45.84,,,,,,,case rate,45.84,45.84,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Aetna,Aetna,104.43,,,,,,,per diem,104.43,104.43,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Aetna MGG,Aetna MGG,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,BCBS,BCBS,104.43,,,,,,,per diem,104.43,104.43,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,BCBS MGG,BCBS MGG,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Cigna,Cigna,104.43,,,,,,,per diem,104.43,104.43,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Cigna MGG,Cigna MGG,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Humana,Humana,104.43,,,,,,,per diem,104.43,104.43,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Humana MGG,Humana MGG,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Optum VA,Optum VA,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,UHC,UHC,104.43,,,,,,,per diem,104.43,104.43,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,UHC MGG,UHC MGG,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,VA,VA,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Wellcare MGG,Wellcare MGG,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Bright Health - commercial,Bright Health - commercial,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,104.43,104.43,Bright Health MGG,Bright Health MGG,104.43,,,,,,,case rate,104.43,104.43,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Aetna,Aetna,67.95,,,,,,,per diem,67.95,67.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Aetna MGG,Aetna MGG,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,BCBS,BCBS,67.95,,,,,,,per diem,67.95,67.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,BCBS MGG,BCBS MGG,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Cigna,Cigna,67.95,,,,,,,per diem,67.95,67.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Cigna MGG,Cigna MGG,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Humana,Humana,67.95,,,,,,,per diem,67.95,67.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Humana MGG,Humana MGG,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Optum VA,Optum VA,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,UHC,UHC,67.95,,,,,,,per diem,67.95,67.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,UHC MGG,UHC MGG,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,VA,VA,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Wellcare MGG,Wellcare MGG,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Bright Health - commercial,Bright Health - commercial,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,67.95,67.95,Bright Health MGG,Bright Health MGG,67.95,,,,,,,case rate,67.95,67.95,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Aetna,Aetna,93.06,,,,,,,per diem,93.06,93.06,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Aetna MGG,Aetna MGG,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,BCBS,BCBS,93.06,,,,,,,per diem,93.06,93.06,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,BCBS MGG,BCBS MGG,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Cigna,Cigna,93.06,,,,,,,per diem,93.06,93.06,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Cigna MGG,Cigna MGG,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Humana,Humana,93.06,,,,,,,per diem,93.06,93.06,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Humana MGG,Humana MGG,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Optum VA,Optum VA,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,UHC,UHC,93.06,,,,,,,per diem,93.06,93.06,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,UHC MGG,UHC MGG,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,VA,VA,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Wellcare MGG,Wellcare MGG,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Bright Health - commercial,Bright Health - commercial,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,93.06,93.06,Bright Health MGG,Bright Health MGG,93.06,,,,,,,case rate,93.06,93.06,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Aetna,Aetna,21.33,,,,,,,per diem,21.33,21.33,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Aetna MGG,Aetna MGG,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,BCBS,BCBS,21.33,,,,,,,per diem,21.33,21.33,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,BCBS MGG,BCBS MGG,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Cigna,Cigna,21.33,,,,,,,per diem,21.33,21.33,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Cigna MGG,Cigna MGG,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Humana,Humana,21.33,,,,,,,per diem,21.33,21.33,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Humana MGG,Humana MGG,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Optum VA,Optum VA,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,UHC,UHC,21.33,,,,,,,per diem,21.33,21.33,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,UHC MGG,UHC MGG,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,VA,VA,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Wellcare MGG,Wellcare MGG,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Bright Health - commercial,Bright Health - commercial,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,21.33,21.33,Bright Health MGG,Bright Health MGG,21.33,,,,,,,case rate,21.33,21.33,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Aetna,Aetna,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Aetna MGG,Aetna MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,BCBS,BCBS,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,BCBS MGG,BCBS MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Cigna,Cigna,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Cigna MGG,Cigna MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Humana,Humana,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Humana MGG,Humana MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Optum VA,Optum VA,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,UHC,UHC,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,UHC MGG,UHC MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,VA,VA,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Wellcare MGG,Wellcare MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Bright Health - commercial,Bright Health - commercial,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Bright Health MGG,Bright Health MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna,Aetna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna MGG,Aetna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,BCBS,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS MGG,BCBS MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna,Cigna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna MGG,Cigna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana,Humana,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana MGG,Humana MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Optum VA,Optum VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC,UHC,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC MGG,UHC MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA,VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Wellcare MGG,Wellcare MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health - commercial,Bright Health - commercial,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health MGG,Bright Health MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Aetna,Aetna,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Aetna MGG,Aetna MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,BCBS,BCBS,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,BCBS MGG,BCBS MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Cigna,Cigna,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Cigna MGG,Cigna MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Humana,Humana,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Humana MGG,Humana MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Optum VA,Optum VA,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,UHC,UHC,10.29,,,,,,,per diem,10.29,10.29,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,UHC MGG,UHC MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,VA,VA,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Wellcare MGG,Wellcare MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Bright Health - commercial,Bright Health - commercial,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.29,10.29,Bright Health MGG,Bright Health MGG,10.29,,,,,,,case rate,10.29,10.29,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Aetna,Aetna,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Aetna MGG,Aetna MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,BCBS,BCBS,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,BCBS MGG,BCBS MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Cigna,Cigna,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Cigna MGG,Cigna MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Humana,Humana,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Humana MGG,Humana MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Optum VA,Optum VA,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,UHC,UHC,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,UHC MGG,UHC MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,VA,VA,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Wellcare MGG,Wellcare MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Bright Health - commercial,Bright Health - commercial,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Bright Health MGG,Bright Health MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Aetna,Aetna,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Aetna MGG,Aetna MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,BCBS,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS MGG,BCBS MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Cigna,Cigna,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Cigna MGG,Cigna MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Humana,Humana,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Humana MGG,Humana MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Optum VA,Optum VA,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UHC,UHC,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UHC MGG,UHC MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,VA,VA,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Wellcare MGG,Wellcare MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Bright Health - commercial,Bright Health - commercial,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Bright Health MGG,Bright Health MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Aetna,Aetna,135.42,,,,,,,per diem,135.42,135.42,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Aetna MGG,Aetna MGG,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,BCBS,BCBS,135.42,,,,,,,per diem,135.42,135.42,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,BCBS MGG,BCBS MGG,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Cigna,Cigna,135.42,,,,,,,per diem,135.42,135.42,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Cigna MGG,Cigna MGG,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Humana,Humana,135.42,,,,,,,per diem,135.42,135.42,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Humana MGG,Humana MGG,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Optum VA,Optum VA,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,UHC,UHC,135.42,,,,,,,per diem,135.42,135.42,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,UHC MGG,UHC MGG,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,VA,VA,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Wellcare MGG,Wellcare MGG,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Bright Health - commercial,Bright Health - commercial,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,135.42,135.42,Bright Health MGG,Bright Health MGG,135.42,,,,,,,case rate,135.42,135.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Aetna,Aetna,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Aetna MGG,Aetna MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,BCBS,BCBS,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,BCBS MGG,BCBS MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Cigna,Cigna,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Cigna MGG,Cigna MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Humana,Humana,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Humana MGG,Humana MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Optum VA,Optum VA,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,UHC,UHC,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,UHC MGG,UHC MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,VA,VA,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Wellcare MGG,Wellcare MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Bright Health - commercial,Bright Health - commercial,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Bright Health MGG,Bright Health MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Aetna,Aetna,327.87,,,,,,,per diem,327.87,327.87,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Aetna MGG,Aetna MGG,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,BCBS,BCBS,327.87,,,,,,,per diem,327.87,327.87,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,BCBS MGG,BCBS MGG,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Cigna,Cigna,327.87,,,,,,,per diem,327.87,327.87,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Cigna MGG,Cigna MGG,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Humana,Humana,327.87,,,,,,,per diem,327.87,327.87,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Humana MGG,Humana MGG,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Optum VA,Optum VA,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,UHC,UHC,327.87,,,,,,,per diem,327.87,327.87,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,UHC MGG,UHC MGG,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,VA,VA,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Wellcare MGG,Wellcare MGG,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Bright Health - commercial,Bright Health - commercial,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,327.87,327.87,Bright Health MGG,Bright Health MGG,327.87,,,,,,,case rate,327.87,327.87,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Aetna,Aetna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Aetna MGG,Aetna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,BCBS,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS MGG,BCBS MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Cigna,Cigna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Cigna MGG,Cigna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Humana,Humana,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Humana MGG,Humana MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Optum VA,Optum VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UHC,UHC,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UHC MGG,UHC MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,VA,VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Wellcare MGG,Wellcare MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Bright Health - commercial,Bright Health - commercial,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Bright Health MGG,Bright Health MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Aetna,Aetna,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Aetna MGG,Aetna MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,BCBS,BCBS,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,BCBS MGG,BCBS MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Cigna,Cigna,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Cigna MGG,Cigna MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Humana,Humana,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Humana MGG,Humana MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Optum VA,Optum VA,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,UHC,UHC,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,UHC MGG,UHC MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,VA,VA,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Wellcare MGG,Wellcare MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Bright Health - commercial,Bright Health - commercial,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Bright Health MGG,Bright Health MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Aetna,Aetna,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Aetna MGG,Aetna MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,BCBS,BCBS,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,BCBS MGG,BCBS MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Cigna,Cigna,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Cigna MGG,Cigna MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Humana,Humana,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Humana MGG,Humana MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Optum VA,Optum VA,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,UHC,UHC,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,UHC MGG,UHC MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,VA,VA,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Wellcare MGG,Wellcare MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Bright Health - commercial,Bright Health - commercial,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Bright Health MGG,Bright Health MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Aetna,Aetna,687.06,,,,,,,per diem,687.06,687.06,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Aetna MGG,Aetna MGG,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,BCBS,BCBS,687.06,,,,,,,per diem,687.06,687.06,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,BCBS MGG,BCBS MGG,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Cigna,Cigna,687.06,,,,,,,per diem,687.06,687.06,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Cigna MGG,Cigna MGG,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Humana,Humana,687.06,,,,,,,per diem,687.06,687.06,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Humana MGG,Humana MGG,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Optum VA,Optum VA,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,UHC,UHC,687.06,,,,,,,per diem,687.06,687.06,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,UHC MGG,UHC MGG,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,VA,VA,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Wellcare MGG,Wellcare MGG,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Bright Health - commercial,Bright Health - commercial,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,687.06,687.06,Bright Health MGG,Bright Health MGG,687.06,,,,,,,case rate,687.06,687.06,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Aetna,Aetna,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Aetna MGG,Aetna MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,BCBS,BCBS,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,BCBS MGG,BCBS MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Cigna,Cigna,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Cigna MGG,Cigna MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Humana,Humana,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Humana MGG,Humana MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Optum VA,Optum VA,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,UHC,UHC,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,UHC MGG,UHC MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,VA,VA,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Wellcare MGG,Wellcare MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Bright Health - commercial,Bright Health - commercial,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Bright Health MGG,Bright Health MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna,Aetna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna MGG,Aetna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS,BCBS,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS MGG,BCBS MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna,Cigna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna MGG,Cigna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana,Humana,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana MGG,Humana MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Optum VA,Optum VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC,UHC,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC MGG,UHC MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,VA,VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Wellcare MGG,Wellcare MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health - commercial,Bright Health - commercial,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health MGG,Bright Health MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Aetna,Aetna,817.62,,,,,,,per diem,817.62,817.62,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Aetna MGG,Aetna MGG,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,BCBS,BCBS,817.62,,,,,,,per diem,817.62,817.62,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,BCBS MGG,BCBS MGG,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Cigna,Cigna,817.62,,,,,,,per diem,817.62,817.62,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Cigna MGG,Cigna MGG,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Humana,Humana,817.62,,,,,,,per diem,817.62,817.62,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Humana MGG,Humana MGG,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Optum VA,Optum VA,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,UHC,UHC,817.62,,,,,,,per diem,817.62,817.62,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,UHC MGG,UHC MGG,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,VA,VA,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Wellcare MGG,Wellcare MGG,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Bright Health - commercial,Bright Health - commercial,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,817.62,817.62,Bright Health MGG,Bright Health MGG,817.62,,,,,,,case rate,817.62,817.62,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Aetna,Aetna,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Aetna MGG,Aetna MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,BCBS,BCBS,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,BCBS MGG,BCBS MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Cigna,Cigna,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Cigna MGG,Cigna MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Humana,Humana,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Humana MGG,Humana MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Optum VA,Optum VA,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,UHC,UHC,35.1,,,,,,,per diem,35.1,35.1,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,UHC MGG,UHC MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,VA,VA,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Wellcare MGG,Wellcare MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Bright Health - commercial,Bright Health - commercial,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,35.1,35.1,Bright Health MGG,Bright Health MGG,35.1,,,,,,,case rate,35.1,35.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Aetna,Aetna,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Aetna MGG,Aetna MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,BCBS,BCBS,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,BCBS MGG,BCBS MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Cigna,Cigna,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Cigna MGG,Cigna MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Humana,Humana,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Humana MGG,Humana MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Optum VA,Optum VA,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,UHC,UHC,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,UHC MGG,UHC MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,VA,VA,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Wellcare MGG,Wellcare MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Bright Health - commercial,Bright Health - commercial,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Bright Health MGG,Bright Health MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna,Aetna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna MGG,Aetna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS,BCBS,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS MGG,BCBS MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna,Cigna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna MGG,Cigna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana,Humana,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana MGG,Humana MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Optum VA,Optum VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC,UHC,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC MGG,UHC MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,VA,VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Wellcare MGG,Wellcare MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health - commercial,Bright Health - commercial,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health MGG,Bright Health MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Aetna,Aetna,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Aetna MGG,Aetna MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,BCBS,BCBS,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,BCBS MGG,BCBS MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Cigna,Cigna,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Cigna MGG,Cigna MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Humana,Humana,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Humana MGG,Humana MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Optum VA,Optum VA,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,UHC,UHC,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,UHC MGG,UHC MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,VA,VA,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Wellcare MGG,Wellcare MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Bright Health - commercial,Bright Health - commercial,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Bright Health MGG,Bright Health MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Aetna,Aetna,18.54,,,,,,,per diem,18.54,18.54,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Aetna MGG,Aetna MGG,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,BCBS,BCBS,18.54,,,,,,,per diem,18.54,18.54,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,BCBS MGG,BCBS MGG,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Cigna,Cigna,18.54,,,,,,,per diem,18.54,18.54,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Cigna MGG,Cigna MGG,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Humana,Humana,18.54,,,,,,,per diem,18.54,18.54,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Humana MGG,Humana MGG,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Optum VA,Optum VA,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,UHC,UHC,18.54,,,,,,,per diem,18.54,18.54,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,UHC MGG,UHC MGG,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,VA,VA,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Wellcare MGG,Wellcare MGG,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Bright Health - commercial,Bright Health - commercial,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,18.54,18.54,Bright Health MGG,Bright Health MGG,18.54,,,,,,,case rate,18.54,18.54,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Aetna,Aetna,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Aetna MGG,Aetna MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,BCBS,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS MGG,BCBS MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Cigna,Cigna,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Cigna MGG,Cigna MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Humana,Humana,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Humana MGG,Humana MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Optum VA,Optum VA,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UHC,UHC,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UHC MGG,UHC MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,VA,VA,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Wellcare MGG,Wellcare MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Bright Health - commercial,Bright Health - commercial,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Bright Health MGG,Bright Health MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna,Aetna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna MGG,Aetna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,BCBS,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS MGG,BCBS MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna,Cigna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna MGG,Cigna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana,Humana,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana MGG,Humana MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Optum VA,Optum VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC,UHC,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC MGG,UHC MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,VA,VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Wellcare MGG,Wellcare MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health - commercial,Bright Health - commercial,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health MGG,Bright Health MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna,Aetna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna MGG,Aetna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,BCBS,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS MGG,BCBS MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna,Cigna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna MGG,Cigna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana,Humana,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana MGG,Humana MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Optum VA,Optum VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC,UHC,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC MGG,UHC MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,VA,VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Wellcare MGG,Wellcare MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health - commercial,Bright Health - commercial,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health MGG,Bright Health MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Aetna,Aetna,167.25,,,,,,,per diem,167.25,167.25,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Aetna MGG,Aetna MGG,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,BCBS,BCBS,167.25,,,,,,,per diem,167.25,167.25,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,BCBS MGG,BCBS MGG,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Cigna,Cigna,167.25,,,,,,,per diem,167.25,167.25,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Cigna MGG,Cigna MGG,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Humana,Humana,167.25,,,,,,,per diem,167.25,167.25,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Humana MGG,Humana MGG,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Optum VA,Optum VA,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,UHC,UHC,167.25,,,,,,,per diem,167.25,167.25,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,UHC MGG,UHC MGG,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,VA,VA,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Wellcare MGG,Wellcare MGG,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Bright Health - commercial,Bright Health - commercial,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,167.25,167.25,Bright Health MGG,Bright Health MGG,167.25,,,,,,,case rate,167.25,167.25,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Aetna,Aetna,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Aetna MGG,Aetna MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,BCBS,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS MGG,BCBS MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Cigna,Cigna,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Cigna MGG,Cigna MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Humana,Humana,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Humana MGG,Humana MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Optum VA,Optum VA,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UHC,UHC,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UHC MGG,UHC MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA,VA,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Wellcare MGG,Wellcare MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Bright Health - commercial,Bright Health - commercial,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Bright Health MGG,Bright Health MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Aetna,Aetna,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Aetna MGG,Aetna MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,BCBS,BCBS,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,BCBS MGG,BCBS MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Cigna,Cigna,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Cigna MGG,Cigna MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Humana,Humana,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Humana MGG,Humana MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Optum VA,Optum VA,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,UHC,UHC,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,UHC MGG,UHC MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,VA,VA,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Wellcare MGG,Wellcare MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Bright Health - commercial,Bright Health - commercial,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Bright Health MGG,Bright Health MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Aetna,Aetna,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Aetna MGG,Aetna MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,BCBS,BCBS,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,BCBS MGG,BCBS MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Cigna,Cigna,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Cigna MGG,Cigna MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Humana,Humana,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Humana MGG,Humana MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Optum VA,Optum VA,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,UHC,UHC,18.81,,,,,,,per diem,18.81,18.81,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,UHC MGG,UHC MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,VA,VA,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Wellcare MGG,Wellcare MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Bright Health - commercial,Bright Health - commercial,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,18.81,18.81,Bright Health MGG,Bright Health MGG,18.81,,,,,,,case rate,18.81,18.81,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Aetna,Aetna,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Aetna MGG,Aetna MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,BCBS,BCBS,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,BCBS MGG,BCBS MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Cigna,Cigna,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Cigna MGG,Cigna MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Humana,Humana,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Humana MGG,Humana MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Optum VA,Optum VA,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,UHC,UHC,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,UHC MGG,UHC MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,VA,VA,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Wellcare MGG,Wellcare MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Bright Health - commercial,Bright Health - commercial,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Bright Health MGG,Bright Health MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Aetna,Aetna,7.68,,,,,,,per diem,7.68,7.68,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Aetna MGG,Aetna MGG,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,BCBS,BCBS,7.68,,,,,,,per diem,7.68,7.68,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,BCBS MGG,BCBS MGG,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Cigna,Cigna,7.68,,,,,,,per diem,7.68,7.68,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Cigna MGG,Cigna MGG,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Humana,Humana,7.68,,,,,,,per diem,7.68,7.68,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Humana MGG,Humana MGG,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Optum VA,Optum VA,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,UHC,UHC,7.68,,,,,,,per diem,7.68,7.68,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,UHC MGG,UHC MGG,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,VA,VA,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Wellcare MGG,Wellcare MGG,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Bright Health - commercial,Bright Health - commercial,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,7.68,7.68,Bright Health MGG,Bright Health MGG,7.68,,,,,,,case rate,7.68,7.68,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Aetna,Aetna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Aetna MGG,Aetna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,BCBS,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS MGG,BCBS MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Cigna,Cigna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Cigna MGG,Cigna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Humana,Humana,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Humana MGG,Humana MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Optum VA,Optum VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UHC,UHC,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UHC MGG,UHC MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Wellcare MGG,Wellcare MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Bright Health - commercial,Bright Health - commercial,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Bright Health MGG,Bright Health MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Aetna,Aetna,19.23,,,,,,,per diem,19.23,19.23,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Aetna MGG,Aetna MGG,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,BCBS,BCBS,19.23,,,,,,,per diem,19.23,19.23,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,BCBS MGG,BCBS MGG,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Cigna,Cigna,19.23,,,,,,,per diem,19.23,19.23,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Cigna MGG,Cigna MGG,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Humana,Humana,19.23,,,,,,,per diem,19.23,19.23,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Humana MGG,Humana MGG,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Optum VA,Optum VA,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,UHC,UHC,19.23,,,,,,,per diem,19.23,19.23,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,UHC MGG,UHC MGG,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,VA,VA,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Wellcare MGG,Wellcare MGG,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Bright Health - commercial,Bright Health - commercial,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,19.23,19.23,Bright Health MGG,Bright Health MGG,19.23,,,,,,,case rate,19.23,19.23,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Aetna,Aetna,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Aetna MGG,Aetna MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,BCBS,BCBS,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,BCBS MGG,BCBS MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Cigna,Cigna,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Cigna MGG,Cigna MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Humana,Humana,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Humana MGG,Humana MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Optum VA,Optum VA,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,UHC,UHC,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,UHC MGG,UHC MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,VA,VA,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Wellcare MGG,Wellcare MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Bright Health - commercial,Bright Health - commercial,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Bright Health MGG,Bright Health MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Aetna,Aetna,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Aetna MGG,Aetna MGG,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,BCBS,BCBS,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,BCBS MGG,BCBS MGG,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Cigna,Cigna,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Cigna MGG,Cigna MGG,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Humana,Humana,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Humana MGG,Humana MGG,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Optum VA,Optum VA,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,UHC,UHC,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,UHC MGG,UHC MGG,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,VA,VA,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Wellcare MGG,Wellcare MGG,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Bright Health - commercial,Bright Health - commercial,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,Bright Health MGG,Bright Health MGG,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Aetna,Aetna,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Aetna MGG,Aetna MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,BCBS,BCBS,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,BCBS MGG,BCBS MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Cigna,Cigna,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Cigna MGG,Cigna MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Humana,Humana,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Humana MGG,Humana MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Optum VA,Optum VA,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,UHC,UHC,57.6,,,,,,,per diem,57.6,57.6,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,UHC MGG,UHC MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,VA,VA,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Wellcare MGG,Wellcare MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Bright Health - commercial,Bright Health - commercial,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,57.6,57.6,Bright Health MGG,Bright Health MGG,57.6,,,,,,,case rate,57.6,57.6,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Aetna,Aetna,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Aetna MGG,Aetna MGG,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,BCBS,BCBS,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,BCBS MGG,BCBS MGG,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Cigna,Cigna,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Cigna MGG,Cigna MGG,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Humana,Humana,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Humana MGG,Humana MGG,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Optum VA,Optum VA,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,UHC,UHC,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,UHC MGG,UHC MGG,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,VA,VA,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Wellcare MGG,Wellcare MGG,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Bright Health - commercial,Bright Health - commercial,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,Bright Health MGG,Bright Health MGG,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Aetna,Aetna,58.02,,,,,,,per diem,58.02,58.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Aetna MGG,Aetna MGG,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,BCBS,BCBS,58.02,,,,,,,per diem,58.02,58.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,BCBS MGG,BCBS MGG,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Cigna,Cigna,58.02,,,,,,,per diem,58.02,58.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Cigna MGG,Cigna MGG,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Humana,Humana,58.02,,,,,,,per diem,58.02,58.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Humana MGG,Humana MGG,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Optum VA,Optum VA,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,UHC,UHC,58.02,,,,,,,per diem,58.02,58.02,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,UHC MGG,UHC MGG,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,VA,VA,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Wellcare MGG,Wellcare MGG,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Bright Health - commercial,Bright Health - commercial,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,58.02,58.02,Bright Health MGG,Bright Health MGG,58.02,,,,,,,case rate,58.02,58.02,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Aetna,Aetna,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Aetna MGG,Aetna MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,BCBS,BCBS,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,BCBS MGG,BCBS MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Cigna,Cigna,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Cigna MGG,Cigna MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Humana,Humana,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Humana MGG,Humana MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Optum VA,Optum VA,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,UHC,UHC,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,UHC MGG,UHC MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,VA,VA,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Wellcare MGG,Wellcare MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Bright Health - commercial,Bright Health - commercial,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Bright Health MGG,Bright Health MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Aetna,Aetna,218.88,,,,,,,per diem,218.88,218.88,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Aetna MGG,Aetna MGG,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,BCBS,BCBS,218.88,,,,,,,per diem,218.88,218.88,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,BCBS MGG,BCBS MGG,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Cigna,Cigna,218.88,,,,,,,per diem,218.88,218.88,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Cigna MGG,Cigna MGG,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Humana,Humana,218.88,,,,,,,per diem,218.88,218.88,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Humana MGG,Humana MGG,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Optum VA,Optum VA,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,UHC,UHC,218.88,,,,,,,per diem,218.88,218.88,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,UHC MGG,UHC MGG,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,VA,VA,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Wellcare MGG,Wellcare MGG,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Bright Health - commercial,Bright Health - commercial,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,218.88,218.88,Bright Health MGG,Bright Health MGG,218.88,,,,,,,case rate,218.88,218.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Aetna,Aetna,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Aetna MGG,Aetna MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,BCBS,BCBS,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,BCBS MGG,BCBS MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Cigna,Cigna,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Cigna MGG,Cigna MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Humana,Humana,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Humana MGG,Humana MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Optum VA,Optum VA,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,UHC,UHC,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,UHC MGG,UHC MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,VA,VA,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Wellcare MGG,Wellcare MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Bright Health - commercial,Bright Health - commercial,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Bright Health MGG,Bright Health MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Aetna,Aetna,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Aetna MGG,Aetna MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,BCBS,BCBS,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,BCBS MGG,BCBS MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Cigna,Cigna,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Cigna MGG,Cigna MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Humana,Humana,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Humana MGG,Humana MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Optum VA,Optum VA,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,UHC,UHC,163.68,,,,,,,per diem,163.68,163.68,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,UHC MGG,UHC MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,VA,VA,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Wellcare MGG,Wellcare MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Bright Health - commercial,Bright Health - commercial,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,163.68,163.68,Bright Health MGG,Bright Health MGG,163.68,,,,,,,case rate,163.68,163.68,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Aetna,Aetna,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Aetna MGG,Aetna MGG,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,BCBS,BCBS,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,BCBS MGG,BCBS MGG,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Cigna,Cigna,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Cigna MGG,Cigna MGG,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Humana,Humana,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Humana MGG,Humana MGG,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Optum VA,Optum VA,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,UHC,UHC,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,UHC MGG,UHC MGG,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,VA,VA,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Wellcare MGG,Wellcare MGG,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Bright Health - commercial,Bright Health - commercial,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,78.41,78.41,Bright Health MGG,Bright Health MGG,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Aetna,Aetna,171.3,,,,,,,per diem,171.3,171.3,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Aetna MGG,Aetna MGG,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,BCBS,BCBS,171.3,,,,,,,per diem,171.3,171.3,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,BCBS MGG,BCBS MGG,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Cigna,Cigna,171.3,,,,,,,per diem,171.3,171.3,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Cigna MGG,Cigna MGG,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Humana,Humana,171.3,,,,,,,per diem,171.3,171.3,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Humana MGG,Humana MGG,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Optum VA,Optum VA,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,UHC,UHC,171.3,,,,,,,per diem,171.3,171.3,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,UHC MGG,UHC MGG,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,VA,VA,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Wellcare MGG,Wellcare MGG,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Bright Health - commercial,Bright Health - commercial,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,171.3,171.3,Bright Health MGG,Bright Health MGG,171.3,,,,,,,case rate,171.3,171.3,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Aetna,Aetna,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Aetna MGG,Aetna MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,BCBS,BCBS,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,BCBS MGG,BCBS MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Cigna,Cigna,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Cigna MGG,Cigna MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Humana,Humana,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Humana MGG,Humana MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Optum VA,Optum VA,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,UHC,UHC,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,UHC MGG,UHC MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,VA,VA,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Wellcare MGG,Wellcare MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Bright Health - commercial,Bright Health - commercial,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Bright Health MGG,Bright Health MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Aetna,Aetna,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Aetna MGG,Aetna MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,BCBS,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS MGG,BCBS MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Cigna,Cigna,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Cigna MGG,Cigna MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Humana,Humana,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Humana MGG,Humana MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Optum VA,Optum VA,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UHC,UHC,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UHC MGG,UHC MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA,VA,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Wellcare MGG,Wellcare MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Bright Health - commercial,Bright Health - commercial,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Bright Health MGG,Bright Health MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Aetna,Aetna,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Aetna MGG,Aetna MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,BCBS,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS MGG,BCBS MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Cigna,Cigna,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Cigna MGG,Cigna MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Humana,Humana,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Humana MGG,Humana MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Optum VA,Optum VA,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,UHC,UHC,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,UHC MGG,UHC MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,VA,VA,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Wellcare MGG,Wellcare MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Bright Health - commercial,Bright Health - commercial,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Bright Health MGG,Bright Health MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Aetna,Aetna,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Aetna MGG,Aetna MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,BCBS,BCBS,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,BCBS MGG,BCBS MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Cigna,Cigna,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Cigna MGG,Cigna MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Humana,Humana,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Humana MGG,Humana MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Optum VA,Optum VA,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,UHC,UHC,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,UHC MGG,UHC MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,VA,VA,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Wellcare MGG,Wellcare MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Bright Health - commercial,Bright Health - commercial,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Bright Health MGG,Bright Health MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Aetna,Aetna,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Aetna MGG,Aetna MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,BCBS,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS MGG,BCBS MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Cigna,Cigna,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Cigna MGG,Cigna MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Humana,Humana,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Humana MGG,Humana MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Optum VA,Optum VA,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UHC,UHC,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UHC MGG,UHC MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,VA,VA,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Wellcare MGG,Wellcare MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Bright Health - commercial,Bright Health - commercial,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Bright Health MGG,Bright Health MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Aetna,Aetna,320.15,,,,,,,per diem,320.15,320.15,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Aetna MGG,Aetna MGG,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,BCBS,BCBS,320.15,,,,,,,per diem,320.15,320.15,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,BCBS MGG,BCBS MGG,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Cigna,Cigna,320.15,,,,,,,per diem,320.15,320.15,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Cigna MGG,Cigna MGG,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Humana,Humana,320.15,,,,,,,per diem,320.15,320.15,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Humana MGG,Humana MGG,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Optum VA,Optum VA,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,UHC,UHC,320.15,,,,,,,per diem,320.15,320.15,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,UHC MGG,UHC MGG,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,VA,VA,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Wellcare MGG,Wellcare MGG,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Bright Health - commercial,Bright Health - commercial,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,320.15,320.15,Bright Health MGG,Bright Health MGG,320.15,,,,,,,case rate,320.15,320.15,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna,Aetna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna MGG,Aetna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS,BCBS,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS MGG,BCBS MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna,Cigna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna MGG,Cigna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana,Humana,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana MGG,Humana MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Optum VA,Optum VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC,UHC,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC MGG,UHC MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,VA,VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Wellcare MGG,Wellcare MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health - commercial,Bright Health - commercial,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health MGG,Bright Health MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Aetna,Aetna,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Aetna MGG,Aetna MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,BCBS,BCBS,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,BCBS MGG,BCBS MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Cigna,Cigna,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Cigna MGG,Cigna MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Humana,Humana,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Humana MGG,Humana MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Optum VA,Optum VA,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,UHC,UHC,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,UHC MGG,UHC MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,VA,VA,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Wellcare MGG,Wellcare MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Bright Health - commercial,Bright Health - commercial,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,46.2,46.2,Bright Health MGG,Bright Health MGG,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Aetna,Aetna,13.44,,,,,,,per diem,13.44,13.44,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Aetna MGG,Aetna MGG,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,BCBS,BCBS,13.44,,,,,,,per diem,13.44,13.44,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,BCBS MGG,BCBS MGG,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Cigna,Cigna,13.44,,,,,,,per diem,13.44,13.44,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Cigna MGG,Cigna MGG,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Humana,Humana,13.44,,,,,,,per diem,13.44,13.44,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Humana MGG,Humana MGG,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Optum VA,Optum VA,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,UHC,UHC,13.44,,,,,,,per diem,13.44,13.44,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,UHC MGG,UHC MGG,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,VA,VA,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Wellcare MGG,Wellcare MGG,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Bright Health - commercial,Bright Health - commercial,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,13.44,13.44,Bright Health MGG,Bright Health MGG,13.44,,,,,,,case rate,13.44,13.44,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Aetna,Aetna,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Aetna MGG,Aetna MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,BCBS,BCBS,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,BCBS MGG,BCBS MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Cigna,Cigna,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Cigna MGG,Cigna MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Humana,Humana,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Humana MGG,Humana MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Optum VA,Optum VA,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,UHC,UHC,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,UHC MGG,UHC MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,VA,VA,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Wellcare MGG,Wellcare MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Bright Health - commercial,Bright Health - commercial,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Bright Health MGG,Bright Health MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Aetna,Aetna,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Aetna MGG,Aetna MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,BCBS,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS MGG,BCBS MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Cigna,Cigna,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Cigna MGG,Cigna MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Humana,Humana,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Humana MGG,Humana MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Optum VA,Optum VA,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,UHC,UHC,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,UHC MGG,UHC MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,VA,VA,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Wellcare MGG,Wellcare MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Bright Health - commercial,Bright Health - commercial,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Bright Health MGG,Bright Health MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Aetna,Aetna,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Aetna MGG,Aetna MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,BCBS,BCBS,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,BCBS MGG,BCBS MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Cigna,Cigna,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Cigna MGG,Cigna MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Humana,Humana,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Humana MGG,Humana MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Optum VA,Optum VA,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,UHC,UHC,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,UHC MGG,UHC MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,VA,VA,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Wellcare MGG,Wellcare MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Bright Health - commercial,Bright Health - commercial,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Bright Health MGG,Bright Health MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Aetna,Aetna,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Aetna MGG,Aetna MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,BCBS,BCBS,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,BCBS MGG,BCBS MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Cigna,Cigna,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Cigna MGG,Cigna MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Humana,Humana,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Humana MGG,Humana MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Optum VA,Optum VA,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,UHC,UHC,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,UHC MGG,UHC MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,VA,VA,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Wellcare MGG,Wellcare MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Bright Health - commercial,Bright Health - commercial,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Bright Health MGG,Bright Health MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna,Aetna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna MGG,Aetna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS,BCBS,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS MGG,BCBS MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna,Cigna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna MGG,Cigna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana,Humana,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana MGG,Humana MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Optum VA,Optum VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC,UHC,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC MGG,UHC MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,VA,VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Wellcare MGG,Wellcare MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health - commercial,Bright Health - commercial,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health MGG,Bright Health MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Aetna,Aetna,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Aetna MGG,Aetna MGG,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,BCBS,BCBS,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,BCBS MGG,BCBS MGG,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Cigna,Cigna,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Cigna MGG,Cigna MGG,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Humana,Humana,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Humana MGG,Humana MGG,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Optum VA,Optum VA,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,UHC,UHC,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,UHC MGG,UHC MGG,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,VA,VA,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Wellcare MGG,Wellcare MGG,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Bright Health - commercial,Bright Health - commercial,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,Bright Health MGG,Bright Health MGG,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Aetna,Aetna,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Aetna MGG,Aetna MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,BCBS,BCBS,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,BCBS MGG,BCBS MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Cigna,Cigna,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Cigna MGG,Cigna MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Humana,Humana,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Humana MGG,Humana MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Optum VA,Optum VA,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,UHC,UHC,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,UHC MGG,UHC MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,VA,VA,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Wellcare MGG,Wellcare MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Bright Health - commercial,Bright Health - commercial,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Bright Health MGG,Bright Health MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Aetna,Aetna,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Aetna MGG,Aetna MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,BCBS,BCBS,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,BCBS MGG,BCBS MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Cigna,Cigna,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Cigna MGG,Cigna MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Humana,Humana,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Humana MGG,Humana MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Optum VA,Optum VA,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,UHC,UHC,10.1,,,,,,,per diem,10.1,10.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,UHC MGG,UHC MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,VA,VA,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Wellcare MGG,Wellcare MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Bright Health - commercial,Bright Health - commercial,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,10.1,10.1,Bright Health MGG,Bright Health MGG,10.1,,,,,,,case rate,10.1,10.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Aetna,Aetna,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Aetna MGG,Aetna MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,BCBS,BCBS,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,BCBS MGG,BCBS MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Cigna,Cigna,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Cigna MGG,Cigna MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Humana,Humana,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Humana MGG,Humana MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Optum VA,Optum VA,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,UHC,UHC,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,UHC MGG,UHC MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,VA,VA,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Wellcare MGG,Wellcare MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Bright Health - commercial,Bright Health - commercial,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Bright Health MGG,Bright Health MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Aetna,Aetna,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Aetna MGG,Aetna MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,BCBS,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS MGG,BCBS MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Cigna,Cigna,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Cigna MGG,Cigna MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Humana,Humana,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Humana MGG,Humana MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Optum VA,Optum VA,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UHC,UHC,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UHC MGG,UHC MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,VA,VA,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Wellcare MGG,Wellcare MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Bright Health - commercial,Bright Health - commercial,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Bright Health MGG,Bright Health MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Aetna,Aetna,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Aetna MGG,Aetna MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,BCBS,BCBS,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,BCBS MGG,BCBS MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Cigna,Cigna,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Cigna MGG,Cigna MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Humana,Humana,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Humana MGG,Humana MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Optum VA,Optum VA,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,UHC,UHC,86.25,,,,,,,per diem,86.25,86.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,UHC MGG,UHC MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,VA,VA,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Wellcare MGG,Wellcare MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Bright Health - commercial,Bright Health - commercial,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,86.25,86.25,Bright Health MGG,Bright Health MGG,86.25,,,,,,,case rate,86.25,86.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Aetna,Aetna,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Aetna MGG,Aetna MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,BCBS,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS MGG,BCBS MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Cigna,Cigna,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Cigna MGG,Cigna MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Humana,Humana,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Humana MGG,Humana MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Optum VA,Optum VA,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,UHC,UHC,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,UHC MGG,UHC MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,VA,VA,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Wellcare MGG,Wellcare MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Bright Health - commercial,Bright Health - commercial,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Bright Health MGG,Bright Health MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna,Aetna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna MGG,Aetna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,BCBS,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS MGG,BCBS MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna,Cigna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna MGG,Cigna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana,Humana,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana MGG,Humana MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Optum VA,Optum VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC,UHC,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC MGG,UHC MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA,VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Wellcare MGG,Wellcare MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health - commercial,Bright Health - commercial,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health MGG,Bright Health MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Aetna,Aetna,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Aetna MGG,Aetna MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,BCBS,BCBS,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,BCBS MGG,BCBS MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Cigna,Cigna,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Cigna MGG,Cigna MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Humana,Humana,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Humana MGG,Humana MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Optum VA,Optum VA,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,UHC,UHC,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,UHC MGG,UHC MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,VA,VA,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Wellcare MGG,Wellcare MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Bright Health - commercial,Bright Health - commercial,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Bright Health MGG,Bright Health MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Aetna,Aetna,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Aetna MGG,Aetna MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,BCBS,BCBS,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,BCBS MGG,BCBS MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Cigna,Cigna,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Cigna MGG,Cigna MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Humana,Humana,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Humana MGG,Humana MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Optum VA,Optum VA,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,UHC,UHC,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,UHC MGG,UHC MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,VA,VA,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Wellcare MGG,Wellcare MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Bright Health - commercial,Bright Health - commercial,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Bright Health MGG,Bright Health MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Aetna,Aetna,479.67,,,,,,,per diem,479.67,479.67,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Aetna MGG,Aetna MGG,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,BCBS,BCBS,479.67,,,,,,,per diem,479.67,479.67,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,BCBS MGG,BCBS MGG,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Cigna,Cigna,479.67,,,,,,,per diem,479.67,479.67,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Cigna MGG,Cigna MGG,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Humana,Humana,479.67,,,,,,,per diem,479.67,479.67,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Humana MGG,Humana MGG,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Optum VA,Optum VA,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,UHC,UHC,479.67,,,,,,,per diem,479.67,479.67,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,UHC MGG,UHC MGG,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,VA,VA,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Wellcare MGG,Wellcare MGG,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Bright Health - commercial,Bright Health - commercial,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,479.67,479.67,Bright Health MGG,Bright Health MGG,479.67,,,,,,,case rate,479.67,479.67,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Aetna,Aetna,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Aetna MGG,Aetna MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,BCBS,BCBS,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,BCBS MGG,BCBS MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Cigna,Cigna,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Cigna MGG,Cigna MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Humana,Humana,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Humana MGG,Humana MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Optum VA,Optum VA,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,UHC,UHC,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,UHC MGG,UHC MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,VA,VA,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Wellcare MGG,Wellcare MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Bright Health - commercial,Bright Health - commercial,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,35.85,35.85,Bright Health MGG,Bright Health MGG,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Aetna,Aetna,15.81,,,,,,,per diem,15.81,15.81,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Aetna MGG,Aetna MGG,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,BCBS,BCBS,15.81,,,,,,,per diem,15.81,15.81,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,BCBS MGG,BCBS MGG,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Cigna,Cigna,15.81,,,,,,,per diem,15.81,15.81,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Cigna MGG,Cigna MGG,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Humana,Humana,15.81,,,,,,,per diem,15.81,15.81,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Humana MGG,Humana MGG,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Optum VA,Optum VA,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,UHC,UHC,15.81,,,,,,,per diem,15.81,15.81,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,UHC MGG,UHC MGG,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,VA,VA,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Wellcare MGG,Wellcare MGG,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Bright Health - commercial,Bright Health - commercial,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,15.81,15.81,Bright Health MGG,Bright Health MGG,15.81,,,,,,,case rate,15.81,15.81,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Aetna,Aetna,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Aetna MGG,Aetna MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,BCBS,BCBS,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,BCBS MGG,BCBS MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Cigna,Cigna,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Cigna MGG,Cigna MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Humana,Humana,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Humana MGG,Humana MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Optum VA,Optum VA,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,UHC,UHC,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,UHC MGG,UHC MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,VA,VA,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Wellcare MGG,Wellcare MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Bright Health - commercial,Bright Health - commercial,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Bright Health MGG,Bright Health MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Aetna,Aetna,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Aetna MGG,Aetna MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS,BCBS,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS MGG,BCBS MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Cigna,Cigna,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Cigna MGG,Cigna MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Humana,Humana,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Humana MGG,Humana MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Optum VA,Optum VA,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,UHC,UHC,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,UHC MGG,UHC MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,VA,VA,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Wellcare MGG,Wellcare MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Bright Health - commercial,Bright Health - commercial,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Bright Health MGG,Bright Health MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Aetna,Aetna,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Aetna MGG,Aetna MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,BCBS,BCBS,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,BCBS MGG,BCBS MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Cigna,Cigna,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Cigna MGG,Cigna MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Humana,Humana,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Humana MGG,Humana MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Optum VA,Optum VA,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,UHC,UHC,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,UHC MGG,UHC MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,VA,VA,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Wellcare MGG,Wellcare MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Bright Health - commercial,Bright Health - commercial,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Bright Health MGG,Bright Health MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Aetna,Aetna,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Aetna MGG,Aetna MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,BCBS,BCBS,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,BCBS MGG,BCBS MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Cigna,Cigna,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Cigna MGG,Cigna MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Humana,Humana,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Humana MGG,Humana MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Optum VA,Optum VA,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,UHC,UHC,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,UHC MGG,UHC MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,VA,VA,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Wellcare MGG,Wellcare MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Bright Health - commercial,Bright Health - commercial,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Bright Health MGG,Bright Health MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Aetna,Aetna,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Aetna MGG,Aetna MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,BCBS,BCBS,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,BCBS MGG,BCBS MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Cigna,Cigna,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Cigna MGG,Cigna MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Humana,Humana,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Humana MGG,Humana MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Optum VA,Optum VA,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,UHC,UHC,13.98,,,,,,,per diem,13.98,13.98,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,UHC MGG,UHC MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,VA,VA,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Wellcare MGG,Wellcare MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Bright Health - commercial,Bright Health - commercial,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,13.98,13.98,Bright Health MGG,Bright Health MGG,13.98,,,,,,,case rate,13.98,13.98,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Aetna,Aetna,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Aetna MGG,Aetna MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,BCBS,BCBS,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,BCBS MGG,BCBS MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Cigna,Cigna,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Cigna MGG,Cigna MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Humana,Humana,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Humana MGG,Humana MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Optum VA,Optum VA,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,UHC,UHC,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,UHC MGG,UHC MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,VA,VA,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Wellcare MGG,Wellcare MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Bright Health - commercial,Bright Health - commercial,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Bright Health MGG,Bright Health MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Aetna,Aetna,143.97,,,,,,,per diem,143.97,143.97,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Aetna MGG,Aetna MGG,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,BCBS,BCBS,143.97,,,,,,,per diem,143.97,143.97,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,BCBS MGG,BCBS MGG,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Cigna,Cigna,143.97,,,,,,,per diem,143.97,143.97,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Cigna MGG,Cigna MGG,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Humana,Humana,143.97,,,,,,,per diem,143.97,143.97,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Humana MGG,Humana MGG,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Optum VA,Optum VA,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,UHC,UHC,143.97,,,,,,,per diem,143.97,143.97,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,UHC MGG,UHC MGG,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,VA,VA,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Wellcare MGG,Wellcare MGG,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Bright Health - commercial,Bright Health - commercial,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,143.97,143.97,Bright Health MGG,Bright Health MGG,143.97,,,,,,,case rate,143.97,143.97,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Aetna,Aetna,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Aetna MGG,Aetna MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,BCBS,BCBS,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,BCBS MGG,BCBS MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Cigna,Cigna,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Cigna MGG,Cigna MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Humana,Humana,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Humana MGG,Humana MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Optum VA,Optum VA,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,UHC,UHC,14.13,,,,,,,per diem,14.13,14.13,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,UHC MGG,UHC MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,VA,VA,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Wellcare MGG,Wellcare MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Bright Health - commercial,Bright Health - commercial,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.13,14.13,Bright Health MGG,Bright Health MGG,14.13,,,,,,,case rate,14.13,14.13,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Aetna,Aetna,136.8,,,,,,,per diem,136.8,136.8,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Aetna MGG,Aetna MGG,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,BCBS,BCBS,136.8,,,,,,,per diem,136.8,136.8,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,BCBS MGG,BCBS MGG,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Cigna,Cigna,136.8,,,,,,,per diem,136.8,136.8,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Cigna MGG,Cigna MGG,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Humana,Humana,136.8,,,,,,,per diem,136.8,136.8,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Humana MGG,Humana MGG,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Optum VA,Optum VA,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,UHC,UHC,136.8,,,,,,,per diem,136.8,136.8,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,UHC MGG,UHC MGG,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,VA,VA,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Wellcare MGG,Wellcare MGG,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Bright Health - commercial,Bright Health - commercial,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,136.8,136.8,Bright Health MGG,Bright Health MGG,136.8,,,,,,,case rate,136.8,136.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Aetna,Aetna,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Aetna MGG,Aetna MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,BCBS,BCBS,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,BCBS MGG,BCBS MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Cigna,Cigna,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Cigna MGG,Cigna MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Humana,Humana,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Humana MGG,Humana MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Optum VA,Optum VA,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,UHC,UHC,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,UHC MGG,UHC MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,VA,VA,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Wellcare MGG,Wellcare MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Bright Health - commercial,Bright Health - commercial,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Bright Health MGG,Bright Health MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Aetna,Aetna,114.09,,,,,,,per diem,114.09,114.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Aetna MGG,Aetna MGG,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,BCBS,BCBS,114.09,,,,,,,per diem,114.09,114.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,BCBS MGG,BCBS MGG,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Cigna,Cigna,114.09,,,,,,,per diem,114.09,114.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Cigna MGG,Cigna MGG,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Humana,Humana,114.09,,,,,,,per diem,114.09,114.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Humana MGG,Humana MGG,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Optum VA,Optum VA,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,UHC,UHC,114.09,,,,,,,per diem,114.09,114.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,UHC MGG,UHC MGG,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,VA,VA,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Wellcare MGG,Wellcare MGG,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Bright Health - commercial,Bright Health - commercial,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,114.09,114.09,Bright Health MGG,Bright Health MGG,114.09,,,,,,,case rate,114.09,114.09,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Aetna,Aetna,66.36,,,,,,,per diem,66.36,66.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Aetna MGG,Aetna MGG,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,BCBS,BCBS,66.36,,,,,,,per diem,66.36,66.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,BCBS MGG,BCBS MGG,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Cigna,Cigna,66.36,,,,,,,per diem,66.36,66.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Cigna MGG,Cigna MGG,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Humana,Humana,66.36,,,,,,,per diem,66.36,66.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Humana MGG,Humana MGG,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Optum VA,Optum VA,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,UHC,UHC,66.36,,,,,,,per diem,66.36,66.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,UHC MGG,UHC MGG,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,VA,VA,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Wellcare MGG,Wellcare MGG,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Bright Health - commercial,Bright Health - commercial,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,66.36,66.36,Bright Health MGG,Bright Health MGG,66.36,,,,,,,case rate,66.36,66.36,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Aetna,Aetna,155.4,,,,,,,per diem,155.4,155.4,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Aetna MGG,Aetna MGG,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,BCBS,BCBS,155.4,,,,,,,per diem,155.4,155.4,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,BCBS MGG,BCBS MGG,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Cigna,Cigna,155.4,,,,,,,per diem,155.4,155.4,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Cigna MGG,Cigna MGG,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Humana,Humana,155.4,,,,,,,per diem,155.4,155.4,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Humana MGG,Humana MGG,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Optum VA,Optum VA,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,UHC,UHC,155.4,,,,,,,per diem,155.4,155.4,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,UHC MGG,UHC MGG,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,VA,VA,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Wellcare MGG,Wellcare MGG,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Bright Health - commercial,Bright Health - commercial,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,155.4,155.4,Bright Health MGG,Bright Health MGG,155.4,,,,,,,case rate,155.4,155.4,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Aetna,Aetna,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Aetna MGG,Aetna MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,BCBS,BCBS,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,BCBS MGG,BCBS MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Cigna,Cigna,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Cigna MGG,Cigna MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Humana,Humana,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Humana MGG,Humana MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Optum VA,Optum VA,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,UHC,UHC,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,UHC MGG,UHC MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,VA,VA,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Wellcare MGG,Wellcare MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Bright Health - commercial,Bright Health - commercial,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Bright Health MGG,Bright Health MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Aetna,Aetna,17.46,,,,,,,per diem,17.46,17.46,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Aetna MGG,Aetna MGG,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,BCBS,BCBS,17.46,,,,,,,per diem,17.46,17.46,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,BCBS MGG,BCBS MGG,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Cigna,Cigna,17.46,,,,,,,per diem,17.46,17.46,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Cigna MGG,Cigna MGG,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Humana,Humana,17.46,,,,,,,per diem,17.46,17.46,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Humana MGG,Humana MGG,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Optum VA,Optum VA,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,UHC,UHC,17.46,,,,,,,per diem,17.46,17.46,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,UHC MGG,UHC MGG,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,VA,VA,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Wellcare MGG,Wellcare MGG,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Bright Health - commercial,Bright Health - commercial,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,17.46,17.46,Bright Health MGG,Bright Health MGG,17.46,,,,,,,case rate,17.46,17.46,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Aetna,Aetna,292.5,,,,,,,per diem,292.5,292.5,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Aetna MGG,Aetna MGG,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,BCBS,BCBS,292.5,,,,,,,per diem,292.5,292.5,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,BCBS MGG,BCBS MGG,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Cigna,Cigna,292.5,,,,,,,per diem,292.5,292.5,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Cigna MGG,Cigna MGG,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Humana,Humana,292.5,,,,,,,per diem,292.5,292.5,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Humana MGG,Humana MGG,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Optum VA,Optum VA,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,UHC,UHC,292.5,,,,,,,per diem,292.5,292.5,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,UHC MGG,UHC MGG,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,VA,VA,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Wellcare MGG,Wellcare MGG,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Bright Health - commercial,Bright Health - commercial,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,292.5,292.5,Bright Health MGG,Bright Health MGG,292.5,,,,,,,case rate,292.5,292.5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Aetna,Aetna,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Aetna MGG,Aetna MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,BCBS,BCBS,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,BCBS MGG,BCBS MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Cigna,Cigna,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Cigna MGG,Cigna MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Humana,Humana,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Humana MGG,Humana MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Optum VA,Optum VA,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,UHC,UHC,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,UHC MGG,UHC MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,VA,VA,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Wellcare MGG,Wellcare MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Bright Health - commercial,Bright Health - commercial,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Bright Health MGG,Bright Health MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Aetna,Aetna,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Aetna MGG,Aetna MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,BCBS,BCBS,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,BCBS MGG,BCBS MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Cigna,Cigna,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Cigna MGG,Cigna MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Humana,Humana,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Humana MGG,Humana MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Optum VA,Optum VA,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,UHC,UHC,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,UHC MGG,UHC MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,VA,VA,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Wellcare MGG,Wellcare MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Bright Health - commercial,Bright Health - commercial,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Bright Health MGG,Bright Health MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Aetna,Aetna,103.92,,,,,,,per diem,103.92,103.92,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Aetna MGG,Aetna MGG,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,BCBS,BCBS,103.92,,,,,,,per diem,103.92,103.92,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,BCBS MGG,BCBS MGG,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Cigna,Cigna,103.92,,,,,,,per diem,103.92,103.92,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Cigna MGG,Cigna MGG,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Humana,Humana,103.92,,,,,,,per diem,103.92,103.92,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Humana MGG,Humana MGG,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Optum VA,Optum VA,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,UHC,UHC,103.92,,,,,,,per diem,103.92,103.92,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,UHC MGG,UHC MGG,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,VA,VA,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Wellcare MGG,Wellcare MGG,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Bright Health - commercial,Bright Health - commercial,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,103.92,103.92,Bright Health MGG,Bright Health MGG,103.92,,,,,,,case rate,103.92,103.92,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Aetna,Aetna,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Aetna MGG,Aetna MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,BCBS,BCBS,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,BCBS MGG,BCBS MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Cigna,Cigna,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Cigna MGG,Cigna MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Humana,Humana,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Humana MGG,Humana MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Optum VA,Optum VA,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,UHC,UHC,16.74,,,,,,,per diem,16.74,16.74,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,UHC MGG,UHC MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,VA,VA,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Wellcare MGG,Wellcare MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Bright Health - commercial,Bright Health - commercial,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,16.74,16.74,Bright Health MGG,Bright Health MGG,16.74,,,,,,,case rate,16.74,16.74,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Aetna,Aetna,313.95,,,,,,,per diem,313.95,313.95,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Aetna MGG,Aetna MGG,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,BCBS,BCBS,313.95,,,,,,,per diem,313.95,313.95,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,BCBS MGG,BCBS MGG,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Cigna,Cigna,313.95,,,,,,,per diem,313.95,313.95,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Cigna MGG,Cigna MGG,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Humana,Humana,313.95,,,,,,,per diem,313.95,313.95,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Humana MGG,Humana MGG,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Optum VA,Optum VA,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,UHC,UHC,313.95,,,,,,,per diem,313.95,313.95,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,UHC MGG,UHC MGG,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,VA,VA,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Wellcare MGG,Wellcare MGG,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Bright Health - commercial,Bright Health - commercial,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,313.95,313.95,Bright Health MGG,Bright Health MGG,313.95,,,,,,,case rate,313.95,313.95,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Aetna,Aetna,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Aetna MGG,Aetna MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,BCBS,BCBS,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,BCBS MGG,BCBS MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Cigna,Cigna,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Cigna MGG,Cigna MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Humana,Humana,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Humana MGG,Humana MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Optum VA,Optum VA,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,UHC,UHC,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,UHC MGG,UHC MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,VA,VA,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Wellcare MGG,Wellcare MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Bright Health - commercial,Bright Health - commercial,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,9.12,9.12,Bright Health MGG,Bright Health MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Aetna,Aetna,21.09,,,,,,,per diem,21.09,21.09,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Aetna MGG,Aetna MGG,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,BCBS,BCBS,21.09,,,,,,,per diem,21.09,21.09,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,BCBS MGG,BCBS MGG,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Cigna,Cigna,21.09,,,,,,,per diem,21.09,21.09,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Cigna MGG,Cigna MGG,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Humana,Humana,21.09,,,,,,,per diem,21.09,21.09,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Humana MGG,Humana MGG,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Optum VA,Optum VA,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,UHC,UHC,21.09,,,,,,,per diem,21.09,21.09,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,UHC MGG,UHC MGG,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,VA,VA,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Wellcare MGG,Wellcare MGG,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Bright Health - commercial,Bright Health - commercial,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,21.09,21.09,Bright Health MGG,Bright Health MGG,21.09,,,,,,,case rate,21.09,21.09,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Aetna,Aetna,565.38,,,,,,,per diem,565.38,565.38,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Aetna MGG,Aetna MGG,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,BCBS,BCBS,565.38,,,,,,,per diem,565.38,565.38,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,BCBS MGG,BCBS MGG,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Cigna,Cigna,565.38,,,,,,,per diem,565.38,565.38,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Cigna MGG,Cigna MGG,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Humana,Humana,565.38,,,,,,,per diem,565.38,565.38,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Humana MGG,Humana MGG,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Optum VA,Optum VA,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,UHC,UHC,565.38,,,,,,,per diem,565.38,565.38,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,UHC MGG,UHC MGG,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,VA,VA,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Wellcare MGG,Wellcare MGG,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Bright Health - commercial,Bright Health - commercial,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,565.38,565.38,Bright Health MGG,Bright Health MGG,565.38,,,,,,,case rate,565.38,565.38,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Aetna,Aetna,56.58,,,,,,,per diem,56.58,56.58,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Aetna MGG,Aetna MGG,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,BCBS,BCBS,56.58,,,,,,,per diem,56.58,56.58,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,BCBS MGG,BCBS MGG,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Cigna,Cigna,56.58,,,,,,,per diem,56.58,56.58,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Cigna MGG,Cigna MGG,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Humana,Humana,56.58,,,,,,,per diem,56.58,56.58,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Humana MGG,Humana MGG,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Optum VA,Optum VA,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,UHC,UHC,56.58,,,,,,,per diem,56.58,56.58,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,UHC MGG,UHC MGG,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,VA,VA,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Wellcare MGG,Wellcare MGG,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Bright Health - commercial,Bright Health - commercial,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,56.58,56.58,Bright Health MGG,Bright Health MGG,56.58,,,,,,,case rate,56.58,56.58,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Aetna,Aetna,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Aetna MGG,Aetna MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,BCBS,BCBS,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,BCBS MGG,BCBS MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Cigna,Cigna,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Cigna MGG,Cigna MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Humana,Humana,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Humana MGG,Humana MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Optum VA,Optum VA,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,UHC,UHC,85.95,,,,,,,per diem,85.95,85.95,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,UHC MGG,UHC MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,VA,VA,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Wellcare MGG,Wellcare MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Bright Health - commercial,Bright Health - commercial,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,85.95,85.95,Bright Health MGG,Bright Health MGG,85.95,,,,,,,case rate,85.95,85.95,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Aetna,Aetna,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Aetna MGG,Aetna MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS,BCBS,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS MGG,BCBS MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Cigna,Cigna,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Cigna MGG,Cigna MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Humana,Humana,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Humana MGG,Humana MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Optum VA,Optum VA,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,UHC,UHC,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,UHC MGG,UHC MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,VA,VA,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Wellcare MGG,Wellcare MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Bright Health - commercial,Bright Health - commercial,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Bright Health MGG,Bright Health MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Aetna,Aetna,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Aetna MGG,Aetna MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,BCBS,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS MGG,BCBS MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Cigna,Cigna,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Cigna MGG,Cigna MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Humana,Humana,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Humana MGG,Humana MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Optum VA,Optum VA,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UHC,UHC,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UHC MGG,UHC MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,VA,VA,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Wellcare MGG,Wellcare MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Bright Health - commercial,Bright Health - commercial,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,Bright Health MGG,Bright Health MGG,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Aetna,Aetna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Aetna MGG,Aetna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,BCBS,BCBS,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,BCBS MGG,BCBS MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Cigna,Cigna,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Cigna MGG,Cigna MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Humana,Humana,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Humana MGG,Humana MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Optum VA,Optum VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,UHC,UHC,270,,,,,,,per diem,270,270,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,UHC MGG,UHC MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,VA,VA,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Wellcare MGG,Wellcare MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Bright Health - commercial,Bright Health - commercial,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,270,270,Bright Health MGG,Bright Health MGG,270,,,,,,,case rate,270,270,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Aetna,Aetna,184.47,,,,,,,per diem,184.47,184.47,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Aetna MGG,Aetna MGG,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,BCBS,BCBS,184.47,,,,,,,per diem,184.47,184.47,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,BCBS MGG,BCBS MGG,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Cigna,Cigna,184.47,,,,,,,per diem,184.47,184.47,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Cigna MGG,Cigna MGG,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Humana,Humana,184.47,,,,,,,per diem,184.47,184.47,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Humana MGG,Humana MGG,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Optum VA,Optum VA,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,UHC,UHC,184.47,,,,,,,per diem,184.47,184.47,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,UHC MGG,UHC MGG,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,VA,VA,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Wellcare MGG,Wellcare MGG,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Bright Health - commercial,Bright Health - commercial,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,184.47,184.47,Bright Health MGG,Bright Health MGG,184.47,,,,,,,case rate,184.47,184.47,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Aetna,Aetna,1512,,,,,,,per diem,1512,1512,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Aetna MGG,Aetna MGG,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,BCBS,BCBS,1512,,,,,,,per diem,1512,1512,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,BCBS MGG,BCBS MGG,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Cigna,Cigna,1512,,,,,,,per diem,1512,1512,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Cigna MGG,Cigna MGG,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Humana,Humana,1512,,,,,,,per diem,1512,1512,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Humana MGG,Humana MGG,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Optum VA,Optum VA,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,UHC,UHC,1512,,,,,,,per diem,1512,1512,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,UHC MGG,UHC MGG,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,VA,VA,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Wellcare MGG,Wellcare MGG,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Bright Health - commercial,Bright Health - commercial,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1512,1512,Bright Health MGG,Bright Health MGG,1512,,,,,,,case rate,1512,1512,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Aetna,Aetna,57.69,,,,,,,per diem,57.69,57.69,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Aetna MGG,Aetna MGG,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,BCBS,BCBS,57.69,,,,,,,per diem,57.69,57.69,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,BCBS MGG,BCBS MGG,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Cigna,Cigna,57.69,,,,,,,per diem,57.69,57.69,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Cigna MGG,Cigna MGG,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Humana,Humana,57.69,,,,,,,per diem,57.69,57.69,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Humana MGG,Humana MGG,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Optum VA,Optum VA,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,UHC,UHC,57.69,,,,,,,per diem,57.69,57.69,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,UHC MGG,UHC MGG,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,VA,VA,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Wellcare MGG,Wellcare MGG,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Bright Health - commercial,Bright Health - commercial,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,57.69,57.69,Bright Health MGG,Bright Health MGG,57.69,,,,,,,case rate,57.69,57.69,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Aetna,Aetna,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Aetna MGG,Aetna MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,BCBS,BCBS,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,BCBS MGG,BCBS MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Cigna,Cigna,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Cigna MGG,Cigna MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Humana,Humana,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Humana MGG,Humana MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Optum VA,Optum VA,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,UHC,UHC,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,UHC MGG,UHC MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,VA,VA,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Wellcare MGG,Wellcare MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Bright Health - commercial,Bright Health - commercial,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Bright Health MGG,Bright Health MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Aetna,Aetna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Aetna MGG,Aetna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,BCBS,BCBS,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,BCBS MGG,BCBS MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Cigna,Cigna,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Cigna MGG,Cigna MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Humana,Humana,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Humana MGG,Humana MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Optum VA,Optum VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,UHC,UHC,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,UHC MGG,UHC MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,VA,VA,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Wellcare MGG,Wellcare MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Bright Health - commercial,Bright Health - commercial,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,78.18,78.18,Bright Health MGG,Bright Health MGG,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Aetna,Aetna,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Aetna MGG,Aetna MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,BCBS,BCBS,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,BCBS MGG,BCBS MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Cigna,Cigna,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Cigna MGG,Cigna MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Humana,Humana,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Humana MGG,Humana MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Optum VA,Optum VA,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,UHC,UHC,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,UHC MGG,UHC MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,VA,VA,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Wellcare MGG,Wellcare MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Bright Health - commercial,Bright Health - commercial,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Bright Health MGG,Bright Health MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Aetna,Aetna,338.01,,,,,,,per diem,338.01,338.01,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Aetna MGG,Aetna MGG,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,BCBS,BCBS,338.01,,,,,,,per diem,338.01,338.01,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,BCBS MGG,BCBS MGG,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Cigna,Cigna,338.01,,,,,,,per diem,338.01,338.01,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Cigna MGG,Cigna MGG,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Humana,Humana,338.01,,,,,,,per diem,338.01,338.01,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Humana MGG,Humana MGG,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Optum VA,Optum VA,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,UHC,UHC,338.01,,,,,,,per diem,338.01,338.01,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,UHC MGG,UHC MGG,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,VA,VA,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Wellcare MGG,Wellcare MGG,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Bright Health - commercial,Bright Health - commercial,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,338.01,338.01,Bright Health MGG,Bright Health MGG,338.01,,,,,,,case rate,338.01,338.01,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Aetna,Aetna,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Aetna MGG,Aetna MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,BCBS,BCBS,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,BCBS MGG,BCBS MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Cigna,Cigna,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Cigna MGG,Cigna MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Humana,Humana,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Humana MGG,Humana MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Optum VA,Optum VA,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,UHC,UHC,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,UHC MGG,UHC MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,VA,VA,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Wellcare MGG,Wellcare MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Bright Health - commercial,Bright Health - commercial,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Bright Health MGG,Bright Health MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna,Aetna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna MGG,Aetna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS,BCBS,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS MGG,BCBS MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna,Cigna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna MGG,Cigna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana,Humana,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana MGG,Humana MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Optum VA,Optum VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC,UHC,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC MGG,UHC MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,VA,VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Wellcare MGG,Wellcare MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health - commercial,Bright Health - commercial,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health MGG,Bright Health MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna,Aetna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna MGG,Aetna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,BCBS,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS MGG,BCBS MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna,Cigna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna MGG,Cigna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana,Humana,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana MGG,Humana MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Optum VA,Optum VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC,UHC,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC MGG,UHC MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,VA,VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Wellcare MGG,Wellcare MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health - commercial,Bright Health - commercial,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health MGG,Bright Health MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Aetna,Aetna,20.25,,,,,,,per diem,20.25,20.25,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Aetna MGG,Aetna MGG,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,BCBS,BCBS,20.25,,,,,,,per diem,20.25,20.25,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,BCBS MGG,BCBS MGG,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Cigna,Cigna,20.25,,,,,,,per diem,20.25,20.25,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Cigna MGG,Cigna MGG,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Humana,Humana,20.25,,,,,,,per diem,20.25,20.25,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Humana MGG,Humana MGG,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Optum VA,Optum VA,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,UHC,UHC,20.25,,,,,,,per diem,20.25,20.25,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,UHC MGG,UHC MGG,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,VA,VA,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Wellcare MGG,Wellcare MGG,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Bright Health - commercial,Bright Health - commercial,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,20.25,20.25,Bright Health MGG,Bright Health MGG,20.25,,,,,,,case rate,20.25,20.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Aetna,Aetna,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Aetna MGG,Aetna MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,BCBS,BCBS,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,BCBS MGG,BCBS MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Cigna,Cigna,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Cigna MGG,Cigna MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Humana,Humana,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Humana MGG,Humana MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Optum VA,Optum VA,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,UHC,UHC,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,UHC MGG,UHC MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,VA,VA,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Wellcare MGG,Wellcare MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Bright Health - commercial,Bright Health - commercial,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Bright Health MGG,Bright Health MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Aetna,Aetna,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Aetna MGG,Aetna MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,BCBS,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS MGG,BCBS MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Cigna,Cigna,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Cigna MGG,Cigna MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Humana,Humana,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Humana MGG,Humana MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Optum VA,Optum VA,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UHC,UHC,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UHC MGG,UHC MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA,VA,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Wellcare MGG,Wellcare MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Bright Health - commercial,Bright Health - commercial,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Bright Health MGG,Bright Health MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Aetna,Aetna,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Aetna MGG,Aetna MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,BCBS,BCBS,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,BCBS MGG,BCBS MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Cigna,Cigna,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Cigna MGG,Cigna MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Humana,Humana,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Humana MGG,Humana MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Optum VA,Optum VA,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,UHC,UHC,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,UHC MGG,UHC MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,VA,VA,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Wellcare MGG,Wellcare MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Bright Health - commercial,Bright Health - commercial,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Bright Health MGG,Bright Health MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Aetna,Aetna,249.09,,,,,,,per diem,249.09,249.09,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Aetna MGG,Aetna MGG,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,BCBS,BCBS,249.09,,,,,,,per diem,249.09,249.09,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,BCBS MGG,BCBS MGG,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Cigna,Cigna,249.09,,,,,,,per diem,249.09,249.09,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Cigna MGG,Cigna MGG,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Humana,Humana,249.09,,,,,,,per diem,249.09,249.09,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Humana MGG,Humana MGG,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Optum VA,Optum VA,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,UHC,UHC,249.09,,,,,,,per diem,249.09,249.09,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,UHC MGG,UHC MGG,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,VA,VA,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Wellcare MGG,Wellcare MGG,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Bright Health - commercial,Bright Health - commercial,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,249.09,249.09,Bright Health MGG,Bright Health MGG,249.09,,,,,,,case rate,249.09,249.09,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Aetna,Aetna,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Aetna MGG,Aetna MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,BCBS,BCBS,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,BCBS MGG,BCBS MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Cigna,Cigna,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Cigna MGG,Cigna MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Humana,Humana,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Humana MGG,Humana MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Optum VA,Optum VA,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,UHC,UHC,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,UHC MGG,UHC MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,VA,VA,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Wellcare MGG,Wellcare MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Bright Health - commercial,Bright Health - commercial,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Bright Health MGG,Bright Health MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Aetna,Aetna,237.78,,,,,,,per diem,237.78,237.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Aetna MGG,Aetna MGG,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,BCBS,BCBS,237.78,,,,,,,per diem,237.78,237.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,BCBS MGG,BCBS MGG,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Cigna,Cigna,237.78,,,,,,,per diem,237.78,237.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Cigna MGG,Cigna MGG,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Humana,Humana,237.78,,,,,,,per diem,237.78,237.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Humana MGG,Humana MGG,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Optum VA,Optum VA,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,UHC,UHC,237.78,,,,,,,per diem,237.78,237.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,UHC MGG,UHC MGG,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,VA,VA,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Wellcare MGG,Wellcare MGG,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Bright Health - commercial,Bright Health - commercial,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,237.78,237.78,Bright Health MGG,Bright Health MGG,237.78,,,,,,,case rate,237.78,237.78,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Aetna,Aetna,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Aetna MGG,Aetna MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,BCBS,BCBS,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,BCBS MGG,BCBS MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Cigna,Cigna,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Cigna MGG,Cigna MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Humana,Humana,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Humana MGG,Humana MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Optum VA,Optum VA,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,UHC,UHC,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,UHC MGG,UHC MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,VA,VA,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Wellcare MGG,Wellcare MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Bright Health - commercial,Bright Health - commercial,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.77,7.77,Bright Health MGG,Bright Health MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Aetna,Aetna,414.69,,,,,,,per diem,414.69,414.69,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Aetna MGG,Aetna MGG,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,BCBS,BCBS,414.69,,,,,,,per diem,414.69,414.69,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,BCBS MGG,BCBS MGG,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Cigna,Cigna,414.69,,,,,,,per diem,414.69,414.69,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Cigna MGG,Cigna MGG,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Humana,Humana,414.69,,,,,,,per diem,414.69,414.69,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Humana MGG,Humana MGG,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Optum VA,Optum VA,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,UHC,UHC,414.69,,,,,,,per diem,414.69,414.69,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,UHC MGG,UHC MGG,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,VA,VA,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Wellcare MGG,Wellcare MGG,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Bright Health - commercial,Bright Health - commercial,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,414.69,414.69,Bright Health MGG,Bright Health MGG,414.69,,,,,,,case rate,414.69,414.69,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna,Aetna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna MGG,Aetna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS,BCBS,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS MGG,BCBS MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna,Cigna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna MGG,Cigna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana,Humana,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana MGG,Humana MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Optum VA,Optum VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC,UHC,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC MGG,UHC MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,VA,VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Wellcare MGG,Wellcare MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health - commercial,Bright Health - commercial,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health MGG,Bright Health MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Aetna,Aetna,64.47,,,,,,,per diem,64.47,64.47,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Aetna MGG,Aetna MGG,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,BCBS,BCBS,64.47,,,,,,,per diem,64.47,64.47,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,BCBS MGG,BCBS MGG,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Cigna,Cigna,64.47,,,,,,,per diem,64.47,64.47,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Cigna MGG,Cigna MGG,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Humana,Humana,64.47,,,,,,,per diem,64.47,64.47,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Humana MGG,Humana MGG,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Optum VA,Optum VA,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,UHC,UHC,64.47,,,,,,,per diem,64.47,64.47,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,UHC MGG,UHC MGG,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,VA,VA,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Wellcare MGG,Wellcare MGG,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Bright Health - commercial,Bright Health - commercial,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,64.47,64.47,Bright Health MGG,Bright Health MGG,64.47,,,,,,,case rate,64.47,64.47,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna,Aetna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna MGG,Aetna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,BCBS,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS MGG,BCBS MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna,Cigna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna MGG,Cigna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana,Humana,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana MGG,Humana MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Optum VA,Optum VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC,UHC,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC MGG,UHC MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,VA,VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Wellcare MGG,Wellcare MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health - commercial,Bright Health - commercial,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health MGG,Bright Health MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Aetna,Aetna,290.91,,,,,,,per diem,290.91,290.91,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Aetna MGG,Aetna MGG,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,BCBS,BCBS,290.91,,,,,,,per diem,290.91,290.91,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,BCBS MGG,BCBS MGG,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Cigna,Cigna,290.91,,,,,,,per diem,290.91,290.91,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Cigna MGG,Cigna MGG,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Humana,Humana,290.91,,,,,,,per diem,290.91,290.91,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Humana MGG,Humana MGG,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Optum VA,Optum VA,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,UHC,UHC,290.91,,,,,,,per diem,290.91,290.91,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,UHC MGG,UHC MGG,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,VA,VA,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Wellcare MGG,Wellcare MGG,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Bright Health - commercial,Bright Health - commercial,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,290.91,290.91,Bright Health MGG,Bright Health MGG,290.91,,,,,,,case rate,290.91,290.91,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Aetna,Aetna,891.39,,,,,,,per diem,891.39,891.39,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Aetna MGG,Aetna MGG,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,BCBS,BCBS,891.39,,,,,,,per diem,891.39,891.39,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,BCBS MGG,BCBS MGG,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Cigna,Cigna,891.39,,,,,,,per diem,891.39,891.39,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Cigna MGG,Cigna MGG,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Humana,Humana,891.39,,,,,,,per diem,891.39,891.39,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Humana MGG,Humana MGG,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Optum VA,Optum VA,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,UHC,UHC,891.39,,,,,,,per diem,891.39,891.39,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,UHC MGG,UHC MGG,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,VA,VA,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Wellcare MGG,Wellcare MGG,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Bright Health - commercial,Bright Health - commercial,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,891.39,891.39,Bright Health MGG,Bright Health MGG,891.39,,,,,,,case rate,891.39,891.39,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Aetna,Aetna,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Aetna MGG,Aetna MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,BCBS,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS MGG,BCBS MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Cigna,Cigna,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Cigna MGG,Cigna MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Humana,Humana,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Humana MGG,Humana MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Optum VA,Optum VA,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UHC,UHC,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UHC MGG,UHC MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,VA,VA,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Wellcare MGG,Wellcare MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Bright Health - commercial,Bright Health - commercial,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Bright Health MGG,Bright Health MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Aetna,Aetna,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Aetna MGG,Aetna MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,BCBS,BCBS,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,BCBS MGG,BCBS MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Cigna,Cigna,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Cigna MGG,Cigna MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Humana,Humana,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Humana MGG,Humana MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Optum VA,Optum VA,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,UHC,UHC,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,UHC MGG,UHC MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,VA,VA,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Wellcare MGG,Wellcare MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Bright Health - commercial,Bright Health - commercial,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Bright Health MGG,Bright Health MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Aetna,Aetna,122.43,,,,,,,per diem,122.43,122.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Aetna MGG,Aetna MGG,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,BCBS,BCBS,122.43,,,,,,,per diem,122.43,122.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,BCBS MGG,BCBS MGG,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Cigna,Cigna,122.43,,,,,,,per diem,122.43,122.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Cigna MGG,Cigna MGG,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Humana,Humana,122.43,,,,,,,per diem,122.43,122.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Humana MGG,Humana MGG,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Optum VA,Optum VA,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,UHC,UHC,122.43,,,,,,,per diem,122.43,122.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,UHC MGG,UHC MGG,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,VA,VA,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Wellcare MGG,Wellcare MGG,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Bright Health - commercial,Bright Health - commercial,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,122.43,122.43,Bright Health MGG,Bright Health MGG,122.43,,,,,,,case rate,122.43,122.43,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Aetna,Aetna,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Aetna MGG,Aetna MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,BCBS,BCBS,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,BCBS MGG,BCBS MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Cigna,Cigna,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Cigna MGG,Cigna MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Humana,Humana,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Humana MGG,Humana MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Optum VA,Optum VA,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,UHC,UHC,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,UHC MGG,UHC MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,VA,VA,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Wellcare MGG,Wellcare MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Bright Health - commercial,Bright Health - commercial,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Bright Health MGG,Bright Health MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Aetna,Aetna,9.09,,,,,,,per diem,9.09,9.09,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Aetna MGG,Aetna MGG,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,BCBS,BCBS,9.09,,,,,,,per diem,9.09,9.09,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,BCBS MGG,BCBS MGG,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Cigna,Cigna,9.09,,,,,,,per diem,9.09,9.09,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Cigna MGG,Cigna MGG,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Humana,Humana,9.09,,,,,,,per diem,9.09,9.09,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Humana MGG,Humana MGG,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Optum VA,Optum VA,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,UHC,UHC,9.09,,,,,,,per diem,9.09,9.09,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,UHC MGG,UHC MGG,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,VA,VA,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Wellcare MGG,Wellcare MGG,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Bright Health - commercial,Bright Health - commercial,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.09,9.09,Bright Health MGG,Bright Health MGG,9.09,,,,,,,case rate,9.09,9.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Aetna,Aetna,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Aetna MGG,Aetna MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,BCBS,BCBS,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,BCBS MGG,BCBS MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Cigna,Cigna,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Cigna MGG,Cigna MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Humana,Humana,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Humana MGG,Humana MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Optum VA,Optum VA,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,UHC,UHC,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,UHC MGG,UHC MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,VA,VA,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Wellcare MGG,Wellcare MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Bright Health - commercial,Bright Health - commercial,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,Bright Health MGG,Bright Health MGG,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Aetna,Aetna,30.39,,,,,,,per diem,30.39,30.39,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Aetna MGG,Aetna MGG,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,BCBS,BCBS,30.39,,,,,,,per diem,30.39,30.39,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,BCBS MGG,BCBS MGG,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Cigna,Cigna,30.39,,,,,,,per diem,30.39,30.39,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Cigna MGG,Cigna MGG,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Humana,Humana,30.39,,,,,,,per diem,30.39,30.39,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Humana MGG,Humana MGG,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Optum VA,Optum VA,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,UHC,UHC,30.39,,,,,,,per diem,30.39,30.39,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,UHC MGG,UHC MGG,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,VA,VA,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Wellcare MGG,Wellcare MGG,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Bright Health - commercial,Bright Health - commercial,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,30.39,30.39,Bright Health MGG,Bright Health MGG,30.39,,,,,,,case rate,30.39,30.39,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Aetna,Aetna,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Aetna MGG,Aetna MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,BCBS,BCBS,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,BCBS MGG,BCBS MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Cigna,Cigna,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Cigna MGG,Cigna MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Humana,Humana,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Humana MGG,Humana MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Optum VA,Optum VA,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,UHC,UHC,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,UHC MGG,UHC MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,VA,VA,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Wellcare MGG,Wellcare MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Bright Health - commercial,Bright Health - commercial,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Bright Health MGG,Bright Health MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Aetna,Aetna,10.59,,,,,,,per diem,10.59,10.59,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Aetna MGG,Aetna MGG,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,BCBS,BCBS,10.59,,,,,,,per diem,10.59,10.59,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,BCBS MGG,BCBS MGG,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Cigna,Cigna,10.59,,,,,,,per diem,10.59,10.59,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Cigna MGG,Cigna MGG,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Humana,Humana,10.59,,,,,,,per diem,10.59,10.59,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Humana MGG,Humana MGG,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Optum VA,Optum VA,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,UHC,UHC,10.59,,,,,,,per diem,10.59,10.59,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,UHC MGG,UHC MGG,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,VA,VA,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Wellcare MGG,Wellcare MGG,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Bright Health - commercial,Bright Health - commercial,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,10.59,10.59,Bright Health MGG,Bright Health MGG,10.59,,,,,,,case rate,10.59,10.59,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna,Aetna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna MGG,Aetna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS,BCBS,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS MGG,BCBS MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna,Cigna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna MGG,Cigna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana,Humana,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana MGG,Humana MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Optum VA,Optum VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC,UHC,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC MGG,UHC MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,VA,VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Wellcare MGG,Wellcare MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health - commercial,Bright Health - commercial,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health MGG,Bright Health MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Aetna,Aetna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Aetna MGG,Aetna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,BCBS,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS MGG,BCBS MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Cigna,Cigna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Cigna MGG,Cigna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Humana,Humana,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Humana MGG,Humana MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Optum VA,Optum VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,UHC,UHC,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,UHC MGG,UHC MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,VA,VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Wellcare MGG,Wellcare MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Bright Health - commercial,Bright Health - commercial,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Bright Health MGG,Bright Health MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Aetna,Aetna,31.14,,,,,,,per diem,31.14,31.14,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Aetna MGG,Aetna MGG,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,BCBS,BCBS,31.14,,,,,,,per diem,31.14,31.14,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,BCBS MGG,BCBS MGG,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Cigna,Cigna,31.14,,,,,,,per diem,31.14,31.14,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Cigna MGG,Cigna MGG,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Humana,Humana,31.14,,,,,,,per diem,31.14,31.14,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Humana MGG,Humana MGG,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Optum VA,Optum VA,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,UHC,UHC,31.14,,,,,,,per diem,31.14,31.14,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,UHC MGG,UHC MGG,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,VA,VA,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Wellcare MGG,Wellcare MGG,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Bright Health - commercial,Bright Health - commercial,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,31.14,31.14,Bright Health MGG,Bright Health MGG,31.14,,,,,,,case rate,31.14,31.14,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Aetna,Aetna,6.72,,,,,,,per diem,6.72,6.72,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Aetna MGG,Aetna MGG,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,BCBS,BCBS,6.72,,,,,,,per diem,6.72,6.72,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,BCBS MGG,BCBS MGG,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Cigna,Cigna,6.72,,,,,,,per diem,6.72,6.72,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Cigna MGG,Cigna MGG,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Humana,Humana,6.72,,,,,,,per diem,6.72,6.72,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Humana MGG,Humana MGG,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Optum VA,Optum VA,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,UHC,UHC,6.72,,,,,,,per diem,6.72,6.72,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,UHC MGG,UHC MGG,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,VA,VA,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Wellcare MGG,Wellcare MGG,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Bright Health - commercial,Bright Health - commercial,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,6.72,6.72,Bright Health MGG,Bright Health MGG,6.72,,,,,,,case rate,6.72,6.72,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Aetna,Aetna,42.24,,,,,,,per diem,42.24,42.24,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Aetna MGG,Aetna MGG,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,BCBS,BCBS,42.24,,,,,,,per diem,42.24,42.24,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,BCBS MGG,BCBS MGG,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Cigna,Cigna,42.24,,,,,,,per diem,42.24,42.24,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Cigna MGG,Cigna MGG,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Humana,Humana,42.24,,,,,,,per diem,42.24,42.24,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Humana MGG,Humana MGG,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Optum VA,Optum VA,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,UHC,UHC,42.24,,,,,,,per diem,42.24,42.24,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,UHC MGG,UHC MGG,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,VA,VA,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Wellcare MGG,Wellcare MGG,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Bright Health - commercial,Bright Health - commercial,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,42.24,42.24,Bright Health MGG,Bright Health MGG,42.24,,,,,,,case rate,42.24,42.24,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Aetna,Aetna,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Aetna MGG,Aetna MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,BCBS,BCBS,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,BCBS MGG,BCBS MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Cigna,Cigna,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Cigna MGG,Cigna MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Humana,Humana,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Humana MGG,Humana MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Optum VA,Optum VA,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,UHC,UHC,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,UHC MGG,UHC MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,VA,VA,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Wellcare MGG,Wellcare MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Bright Health - commercial,Bright Health - commercial,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Bright Health MGG,Bright Health MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Aetna,Aetna,1160.34,,,,,,,per diem,1160.34,1160.34,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Aetna MGG,Aetna MGG,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,BCBS,BCBS,1160.34,,,,,,,per diem,1160.34,1160.34,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,BCBS MGG,BCBS MGG,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Cigna,Cigna,1160.34,,,,,,,per diem,1160.34,1160.34,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Cigna MGG,Cigna MGG,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Humana,Humana,1160.34,,,,,,,per diem,1160.34,1160.34,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Humana MGG,Humana MGG,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Optum VA,Optum VA,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,UHC,UHC,1160.34,,,,,,,per diem,1160.34,1160.34,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,UHC MGG,UHC MGG,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,VA,VA,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Wellcare MGG,Wellcare MGG,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Bright Health - commercial,Bright Health - commercial,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1160.34,1160.34,Bright Health MGG,Bright Health MGG,1160.34,,,,,,,case rate,1160.34,1160.34,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Aetna,Aetna,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Aetna MGG,Aetna MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,BCBS,BCBS,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,BCBS MGG,BCBS MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Cigna,Cigna,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Cigna MGG,Cigna MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Humana,Humana,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Humana MGG,Humana MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Optum VA,Optum VA,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,UHC,UHC,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,UHC MGG,UHC MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,VA,VA,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Wellcare MGG,Wellcare MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Bright Health - commercial,Bright Health - commercial,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Bright Health MGG,Bright Health MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Aetna,Aetna,224.19,,,,,,,per diem,224.19,224.19,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Aetna MGG,Aetna MGG,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,BCBS,BCBS,224.19,,,,,,,per diem,224.19,224.19,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,BCBS MGG,BCBS MGG,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Cigna,Cigna,224.19,,,,,,,per diem,224.19,224.19,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Cigna MGG,Cigna MGG,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Humana,Humana,224.19,,,,,,,per diem,224.19,224.19,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Humana MGG,Humana MGG,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Optum VA,Optum VA,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,UHC,UHC,224.19,,,,,,,per diem,224.19,224.19,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,UHC MGG,UHC MGG,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,VA,VA,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Wellcare MGG,Wellcare MGG,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Bright Health - commercial,Bright Health - commercial,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,224.19,224.19,Bright Health MGG,Bright Health MGG,224.19,,,,,,,case rate,224.19,224.19,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Aetna,Aetna,238.74,,,,,,,per diem,238.74,238.74,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Aetna MGG,Aetna MGG,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,BCBS,BCBS,238.74,,,,,,,per diem,238.74,238.74,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,BCBS MGG,BCBS MGG,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Cigna,Cigna,238.74,,,,,,,per diem,238.74,238.74,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Cigna MGG,Cigna MGG,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Humana,Humana,238.74,,,,,,,per diem,238.74,238.74,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Humana MGG,Humana MGG,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Optum VA,Optum VA,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,UHC,UHC,238.74,,,,,,,per diem,238.74,238.74,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,UHC MGG,UHC MGG,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,VA,VA,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Wellcare MGG,Wellcare MGG,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Bright Health - commercial,Bright Health - commercial,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,238.74,238.74,Bright Health MGG,Bright Health MGG,238.74,,,,,,,case rate,238.74,238.74,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna,Aetna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna MGG,Aetna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,BCBS,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS MGG,BCBS MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna,Cigna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna MGG,Cigna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana,Humana,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana MGG,Humana MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Optum VA,Optum VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC,UHC,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC MGG,UHC MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,VA,VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Wellcare MGG,Wellcare MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health - commercial,Bright Health - commercial,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health MGG,Bright Health MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Aetna,Aetna,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Aetna MGG,Aetna MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,BCBS,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS MGG,BCBS MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Cigna,Cigna,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Cigna MGG,Cigna MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Humana,Humana,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Humana MGG,Humana MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Optum VA,Optum VA,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UHC,UHC,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UHC MGG,UHC MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,VA,VA,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Wellcare MGG,Wellcare MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Bright Health - commercial,Bright Health - commercial,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Bright Health MGG,Bright Health MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna,Aetna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna MGG,Aetna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,BCBS,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS MGG,BCBS MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna,Cigna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna MGG,Cigna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana,Humana,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana MGG,Humana MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Optum VA,Optum VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC,UHC,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC MGG,UHC MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,VA,VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Wellcare MGG,Wellcare MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health - commercial,Bright Health - commercial,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health MGG,Bright Health MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Aetna,Aetna,152.43,,,,,,,per diem,152.43,152.43,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Aetna MGG,Aetna MGG,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,BCBS,BCBS,152.43,,,,,,,per diem,152.43,152.43,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,BCBS MGG,BCBS MGG,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Cigna,Cigna,152.43,,,,,,,per diem,152.43,152.43,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Cigna MGG,Cigna MGG,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Humana,Humana,152.43,,,,,,,per diem,152.43,152.43,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Humana MGG,Humana MGG,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Optum VA,Optum VA,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,UHC,UHC,152.43,,,,,,,per diem,152.43,152.43,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,UHC MGG,UHC MGG,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,VA,VA,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Wellcare MGG,Wellcare MGG,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Bright Health - commercial,Bright Health - commercial,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,152.43,152.43,Bright Health MGG,Bright Health MGG,152.43,,,,,,,case rate,152.43,152.43,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Aetna,Aetna,72.3,,,,,,,per diem,72.3,72.3,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Aetna MGG,Aetna MGG,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,BCBS,BCBS,72.3,,,,,,,per diem,72.3,72.3,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,BCBS MGG,BCBS MGG,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Cigna,Cigna,72.3,,,,,,,per diem,72.3,72.3,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Cigna MGG,Cigna MGG,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Humana,Humana,72.3,,,,,,,per diem,72.3,72.3,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Humana MGG,Humana MGG,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Optum VA,Optum VA,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,UHC,UHC,72.3,,,,,,,per diem,72.3,72.3,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,UHC MGG,UHC MGG,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,VA,VA,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Wellcare MGG,Wellcare MGG,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Bright Health - commercial,Bright Health - commercial,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,72.3,72.3,Bright Health MGG,Bright Health MGG,72.3,,,,,,,case rate,72.3,72.3,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Aetna,Aetna,1753.92,,,,,,,per diem,1753.92,1753.92,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Aetna MGG,Aetna MGG,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,BCBS,BCBS,1753.92,,,,,,,per diem,1753.92,1753.92,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,BCBS MGG,BCBS MGG,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Cigna,Cigna,1753.92,,,,,,,per diem,1753.92,1753.92,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Cigna MGG,Cigna MGG,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Humana,Humana,1753.92,,,,,,,per diem,1753.92,1753.92,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Humana MGG,Humana MGG,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Optum VA,Optum VA,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,UHC,UHC,1753.92,,,,,,,per diem,1753.92,1753.92,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,UHC MGG,UHC MGG,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,VA,VA,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Wellcare MGG,Wellcare MGG,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Bright Health - commercial,Bright Health - commercial,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1753.92,1753.92,Bright Health MGG,Bright Health MGG,1753.92,,,,,,,case rate,1753.92,1753.92,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna,Aetna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna MGG,Aetna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS,BCBS,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS MGG,BCBS MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna,Cigna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna MGG,Cigna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana,Humana,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana MGG,Humana MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Optum VA,Optum VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC,UHC,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC MGG,UHC MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,VA,VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Wellcare MGG,Wellcare MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health - commercial,Bright Health - commercial,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health MGG,Bright Health MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Aetna,Aetna,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Aetna MGG,Aetna MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,BCBS,BCBS,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,BCBS MGG,BCBS MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Cigna,Cigna,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Cigna MGG,Cigna MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Humana,Humana,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Humana MGG,Humana MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Optum VA,Optum VA,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,UHC,UHC,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,UHC MGG,UHC MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,VA,VA,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Wellcare MGG,Wellcare MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Bright Health - commercial,Bright Health - commercial,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Bright Health MGG,Bright Health MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Aetna,Aetna,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Aetna MGG,Aetna MGG,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,BCBS,BCBS,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,BCBS MGG,BCBS MGG,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Cigna,Cigna,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Cigna MGG,Cigna MGG,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Humana,Humana,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Humana MGG,Humana MGG,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Optum VA,Optum VA,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,UHC,UHC,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,UHC MGG,UHC MGG,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,VA,VA,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Wellcare MGG,Wellcare MGG,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Bright Health - commercial,Bright Health - commercial,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,Bright Health MGG,Bright Health MGG,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Aetna,Aetna,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Aetna MGG,Aetna MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,BCBS,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS MGG,BCBS MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Cigna,Cigna,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Cigna MGG,Cigna MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Humana,Humana,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Humana MGG,Humana MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Optum VA,Optum VA,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UHC,UHC,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UHC MGG,UHC MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA,VA,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Wellcare MGG,Wellcare MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Bright Health - commercial,Bright Health - commercial,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Bright Health MGG,Bright Health MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Aetna,Aetna,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Aetna MGG,Aetna MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,BCBS,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS MGG,BCBS MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Cigna,Cigna,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Cigna MGG,Cigna MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Humana,Humana,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Humana MGG,Humana MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Optum VA,Optum VA,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UHC,UHC,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UHC MGG,UHC MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,VA,VA,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Wellcare MGG,Wellcare MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Bright Health - commercial,Bright Health - commercial,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Bright Health MGG,Bright Health MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Aetna,Aetna,56.43,,,,,,,per diem,56.43,56.43,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Aetna MGG,Aetna MGG,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,BCBS,BCBS,56.43,,,,,,,per diem,56.43,56.43,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,BCBS MGG,BCBS MGG,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Cigna,Cigna,56.43,,,,,,,per diem,56.43,56.43,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Cigna MGG,Cigna MGG,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Humana,Humana,56.43,,,,,,,per diem,56.43,56.43,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Humana MGG,Humana MGG,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Optum VA,Optum VA,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,UHC,UHC,56.43,,,,,,,per diem,56.43,56.43,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,UHC MGG,UHC MGG,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,VA,VA,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Wellcare MGG,Wellcare MGG,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Bright Health - commercial,Bright Health - commercial,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,56.43,56.43,Bright Health MGG,Bright Health MGG,56.43,,,,,,,case rate,56.43,56.43,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna,Aetna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna MGG,Aetna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS,BCBS,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS MGG,BCBS MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna,Cigna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna MGG,Cigna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana,Humana,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana MGG,Humana MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Optum VA,Optum VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC,UHC,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC MGG,UHC MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,VA,VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Wellcare MGG,Wellcare MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health - commercial,Bright Health - commercial,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health MGG,Bright Health MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Aetna,Aetna,57,,,,,,,per diem,57,57,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Aetna MGG,Aetna MGG,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,BCBS,BCBS,57,,,,,,,per diem,57,57,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,BCBS MGG,BCBS MGG,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Cigna,Cigna,57,,,,,,,per diem,57,57,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Cigna MGG,Cigna MGG,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Humana,Humana,57,,,,,,,per diem,57,57,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Humana MGG,Humana MGG,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Optum VA,Optum VA,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,UHC,UHC,57,,,,,,,per diem,57,57,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,UHC MGG,UHC MGG,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,VA,VA,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Wellcare MGG,Wellcare MGG,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Bright Health - commercial,Bright Health - commercial,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,57,57,Bright Health MGG,Bright Health MGG,57,,,,,,,case rate,57,57,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Aetna,Aetna,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Aetna MGG,Aetna MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,BCBS,BCBS,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,BCBS MGG,BCBS MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Cigna,Cigna,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Cigna MGG,Cigna MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Humana,Humana,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Humana MGG,Humana MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Optum VA,Optum VA,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,UHC,UHC,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,UHC MGG,UHC MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,VA,VA,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Wellcare MGG,Wellcare MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Bright Health - commercial,Bright Health - commercial,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Bright Health MGG,Bright Health MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Aetna,Aetna,75.15,,,,,,,per diem,75.15,75.15,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Aetna MGG,Aetna MGG,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,BCBS,BCBS,75.15,,,,,,,per diem,75.15,75.15,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,BCBS MGG,BCBS MGG,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Cigna,Cigna,75.15,,,,,,,per diem,75.15,75.15,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Cigna MGG,Cigna MGG,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Humana,Humana,75.15,,,,,,,per diem,75.15,75.15,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Humana MGG,Humana MGG,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Optum VA,Optum VA,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,UHC,UHC,75.15,,,,,,,per diem,75.15,75.15,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,UHC MGG,UHC MGG,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,VA,VA,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Wellcare MGG,Wellcare MGG,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Bright Health - commercial,Bright Health - commercial,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,75.15,75.15,Bright Health MGG,Bright Health MGG,75.15,,,,,,,case rate,75.15,75.15,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Aetna,Aetna,104.7,,,,,,,per diem,104.7,104.7,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Aetna MGG,Aetna MGG,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,BCBS,BCBS,104.7,,,,,,,per diem,104.7,104.7,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,BCBS MGG,BCBS MGG,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Cigna,Cigna,104.7,,,,,,,per diem,104.7,104.7,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Cigna MGG,Cigna MGG,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Humana,Humana,104.7,,,,,,,per diem,104.7,104.7,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Humana MGG,Humana MGG,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Optum VA,Optum VA,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,UHC,UHC,104.7,,,,,,,per diem,104.7,104.7,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,UHC MGG,UHC MGG,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,VA,VA,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Wellcare MGG,Wellcare MGG,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Bright Health - commercial,Bright Health - commercial,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,104.7,104.7,Bright Health MGG,Bright Health MGG,104.7,,,,,,,case rate,104.7,104.7,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Aetna,Aetna,10.17,,,,,,,per diem,10.17,10.17,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Aetna MGG,Aetna MGG,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,BCBS,BCBS,10.17,,,,,,,per diem,10.17,10.17,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,BCBS MGG,BCBS MGG,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Cigna,Cigna,10.17,,,,,,,per diem,10.17,10.17,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Cigna MGG,Cigna MGG,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Humana,Humana,10.17,,,,,,,per diem,10.17,10.17,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Humana MGG,Humana MGG,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Optum VA,Optum VA,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,UHC,UHC,10.17,,,,,,,per diem,10.17,10.17,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,UHC MGG,UHC MGG,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,VA,VA,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Wellcare MGG,Wellcare MGG,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Bright Health - commercial,Bright Health - commercial,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.17,10.17,Bright Health MGG,Bright Health MGG,10.17,,,,,,,case rate,10.17,10.17,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Aetna,Aetna,32.25,,,,,,,per diem,32.25,32.25,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Aetna MGG,Aetna MGG,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,BCBS,BCBS,32.25,,,,,,,per diem,32.25,32.25,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,BCBS MGG,BCBS MGG,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Cigna,Cigna,32.25,,,,,,,per diem,32.25,32.25,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Cigna MGG,Cigna MGG,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Humana,Humana,32.25,,,,,,,per diem,32.25,32.25,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Humana MGG,Humana MGG,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Optum VA,Optum VA,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,UHC,UHC,32.25,,,,,,,per diem,32.25,32.25,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,UHC MGG,UHC MGG,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,VA,VA,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Wellcare MGG,Wellcare MGG,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Bright Health - commercial,Bright Health - commercial,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,32.25,32.25,Bright Health MGG,Bright Health MGG,32.25,,,,,,,case rate,32.25,32.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Aetna,Aetna,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Aetna MGG,Aetna MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,BCBS,BCBS,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,BCBS MGG,BCBS MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Cigna,Cigna,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Cigna MGG,Cigna MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Humana,Humana,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Humana MGG,Humana MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Optum VA,Optum VA,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,UHC,UHC,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,UHC MGG,UHC MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,VA,VA,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Wellcare MGG,Wellcare MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Bright Health - commercial,Bright Health - commercial,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Bright Health MGG,Bright Health MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Aetna,Aetna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Aetna MGG,Aetna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,BCBS,BCBS,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,BCBS MGG,BCBS MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Cigna,Cigna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Cigna MGG,Cigna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Humana,Humana,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Humana MGG,Humana MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Optum VA,Optum VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,UHC,UHC,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,UHC MGG,UHC MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,VA,VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Wellcare MGG,Wellcare MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Bright Health - commercial,Bright Health - commercial,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Bright Health MGG,Bright Health MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Aetna,Aetna,272.52,,,,,,,per diem,272.52,272.52,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Aetna MGG,Aetna MGG,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,BCBS,BCBS,272.52,,,,,,,per diem,272.52,272.52,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,BCBS MGG,BCBS MGG,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Cigna,Cigna,272.52,,,,,,,per diem,272.52,272.52,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Cigna MGG,Cigna MGG,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Humana,Humana,272.52,,,,,,,per diem,272.52,272.52,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Humana MGG,Humana MGG,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Optum VA,Optum VA,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,UHC,UHC,272.52,,,,,,,per diem,272.52,272.52,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,UHC MGG,UHC MGG,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,VA,VA,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Wellcare MGG,Wellcare MGG,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Bright Health - commercial,Bright Health - commercial,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,272.52,272.52,Bright Health MGG,Bright Health MGG,272.52,,,,,,,case rate,272.52,272.52,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Aetna,Aetna,52.26,,,,,,,per diem,52.26,52.26,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Aetna MGG,Aetna MGG,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,BCBS,BCBS,52.26,,,,,,,per diem,52.26,52.26,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,BCBS MGG,BCBS MGG,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Cigna,Cigna,52.26,,,,,,,per diem,52.26,52.26,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Cigna MGG,Cigna MGG,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Humana,Humana,52.26,,,,,,,per diem,52.26,52.26,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Humana MGG,Humana MGG,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Optum VA,Optum VA,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,UHC,UHC,52.26,,,,,,,per diem,52.26,52.26,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,UHC MGG,UHC MGG,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,VA,VA,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Wellcare MGG,Wellcare MGG,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Bright Health - commercial,Bright Health - commercial,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,52.26,52.26,Bright Health MGG,Bright Health MGG,52.26,,,,,,,case rate,52.26,52.26,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Aetna,Aetna,369.84,,,,,,,per diem,369.84,369.84,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Aetna MGG,Aetna MGG,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,BCBS,BCBS,369.84,,,,,,,per diem,369.84,369.84,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,BCBS MGG,BCBS MGG,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Cigna,Cigna,369.84,,,,,,,per diem,369.84,369.84,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Cigna MGG,Cigna MGG,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Humana,Humana,369.84,,,,,,,per diem,369.84,369.84,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Humana MGG,Humana MGG,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Optum VA,Optum VA,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,UHC,UHC,369.84,,,,,,,per diem,369.84,369.84,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,UHC MGG,UHC MGG,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,VA,VA,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Wellcare MGG,Wellcare MGG,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Bright Health - commercial,Bright Health - commercial,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,369.84,369.84,Bright Health MGG,Bright Health MGG,369.84,,,,,,,case rate,369.84,369.84,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Aetna,Aetna,701.61,,,,,,,per diem,701.61,701.61,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Aetna MGG,Aetna MGG,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,BCBS,BCBS,701.61,,,,,,,per diem,701.61,701.61,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,BCBS MGG,BCBS MGG,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Cigna,Cigna,701.61,,,,,,,per diem,701.61,701.61,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Cigna MGG,Cigna MGG,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Humana,Humana,701.61,,,,,,,per diem,701.61,701.61,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Humana MGG,Humana MGG,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Optum VA,Optum VA,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,UHC,UHC,701.61,,,,,,,per diem,701.61,701.61,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,UHC MGG,UHC MGG,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,VA,VA,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Wellcare MGG,Wellcare MGG,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Bright Health - commercial,Bright Health - commercial,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,701.61,701.61,Bright Health MGG,Bright Health MGG,701.61,,,,,,,case rate,701.61,701.61,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Aetna,Aetna,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Aetna MGG,Aetna MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,BCBS,BCBS,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,BCBS MGG,BCBS MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Cigna,Cigna,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Cigna MGG,Cigna MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Humana,Humana,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Humana MGG,Humana MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Optum VA,Optum VA,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,UHC,UHC,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,UHC MGG,UHC MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,VA,VA,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Wellcare MGG,Wellcare MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Bright Health - commercial,Bright Health - commercial,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Bright Health MGG,Bright Health MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Aetna,Aetna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Aetna MGG,Aetna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS,BCBS,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS MGG,BCBS MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Cigna,Cigna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Cigna MGG,Cigna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Humana,Humana,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Humana MGG,Humana MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Optum VA,Optum VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,UHC,UHC,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,UHC MGG,UHC MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,VA,VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Wellcare MGG,Wellcare MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Bright Health - commercial,Bright Health - commercial,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Bright Health MGG,Bright Health MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Aetna,Aetna,25.26,,,,,,,per diem,25.26,25.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Aetna MGG,Aetna MGG,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,BCBS,BCBS,25.26,,,,,,,per diem,25.26,25.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,BCBS MGG,BCBS MGG,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Cigna,Cigna,25.26,,,,,,,per diem,25.26,25.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Cigna MGG,Cigna MGG,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Humana,Humana,25.26,,,,,,,per diem,25.26,25.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Humana MGG,Humana MGG,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Optum VA,Optum VA,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,UHC,UHC,25.26,,,,,,,per diem,25.26,25.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,UHC MGG,UHC MGG,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,VA,VA,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Wellcare MGG,Wellcare MGG,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Bright Health - commercial,Bright Health - commercial,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,25.26,25.26,Bright Health MGG,Bright Health MGG,25.26,,,,,,,case rate,25.26,25.26,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Aetna,Aetna,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Aetna MGG,Aetna MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,BCBS,BCBS,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,BCBS MGG,BCBS MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Cigna,Cigna,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Cigna MGG,Cigna MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Humana,Humana,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Humana MGG,Humana MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Optum VA,Optum VA,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,UHC,UHC,22.74,,,,,,,per diem,22.74,22.74,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,UHC MGG,UHC MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,VA,VA,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Wellcare MGG,Wellcare MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Bright Health - commercial,Bright Health - commercial,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,22.74,22.74,Bright Health MGG,Bright Health MGG,22.74,,,,,,,case rate,22.74,22.74,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Aetna,Aetna,640.23,,,,,,,per diem,640.23,640.23,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Aetna MGG,Aetna MGG,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,BCBS,BCBS,640.23,,,,,,,per diem,640.23,640.23,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,BCBS MGG,BCBS MGG,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Cigna,Cigna,640.23,,,,,,,per diem,640.23,640.23,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Cigna MGG,Cigna MGG,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Humana,Humana,640.23,,,,,,,per diem,640.23,640.23,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Humana MGG,Humana MGG,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Optum VA,Optum VA,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,UHC,UHC,640.23,,,,,,,per diem,640.23,640.23,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,UHC MGG,UHC MGG,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,VA,VA,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Wellcare MGG,Wellcare MGG,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Bright Health - commercial,Bright Health - commercial,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,640.23,640.23,Bright Health MGG,Bright Health MGG,640.23,,,,,,,case rate,640.23,640.23,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna,Aetna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna MGG,Aetna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS,BCBS,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS MGG,BCBS MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna,Cigna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna MGG,Cigna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana,Humana,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana MGG,Humana MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Optum VA,Optum VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC,UHC,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC MGG,UHC MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,VA,VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Wellcare MGG,Wellcare MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health - commercial,Bright Health - commercial,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health MGG,Bright Health MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna,Aetna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna MGG,Aetna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS,BCBS,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS MGG,BCBS MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna,Cigna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna MGG,Cigna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana,Humana,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana MGG,Humana MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Optum VA,Optum VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC,UHC,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC MGG,UHC MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,VA,VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Wellcare MGG,Wellcare MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health - commercial,Bright Health - commercial,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health MGG,Bright Health MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Aetna,Aetna,74.1,,,,,,,per diem,74.1,74.1,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Aetna MGG,Aetna MGG,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,BCBS,BCBS,74.1,,,,,,,per diem,74.1,74.1,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,BCBS MGG,BCBS MGG,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Cigna,Cigna,74.1,,,,,,,per diem,74.1,74.1,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Cigna MGG,Cigna MGG,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Humana,Humana,74.1,,,,,,,per diem,74.1,74.1,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Humana MGG,Humana MGG,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Optum VA,Optum VA,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,UHC,UHC,74.1,,,,,,,per diem,74.1,74.1,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,UHC MGG,UHC MGG,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,VA,VA,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Wellcare MGG,Wellcare MGG,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Bright Health - commercial,Bright Health - commercial,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,74.1,74.1,Bright Health MGG,Bright Health MGG,74.1,,,,,,,case rate,74.1,74.1,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Aetna,Aetna,304.83,,,,,,,per diem,304.83,304.83,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Aetna MGG,Aetna MGG,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,BCBS,BCBS,304.83,,,,,,,per diem,304.83,304.83,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,BCBS MGG,BCBS MGG,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Cigna,Cigna,304.83,,,,,,,per diem,304.83,304.83,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Cigna MGG,Cigna MGG,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Humana,Humana,304.83,,,,,,,per diem,304.83,304.83,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Humana MGG,Humana MGG,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Optum VA,Optum VA,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,UHC,UHC,304.83,,,,,,,per diem,304.83,304.83,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,UHC MGG,UHC MGG,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,VA,VA,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Wellcare MGG,Wellcare MGG,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Bright Health - commercial,Bright Health - commercial,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,304.83,304.83,Bright Health MGG,Bright Health MGG,304.83,,,,,,,case rate,304.83,304.83,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Aetna,Aetna,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Aetna MGG,Aetna MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS,BCBS,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS MGG,BCBS MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Cigna,Cigna,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Cigna MGG,Cigna MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Humana,Humana,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Humana MGG,Humana MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Optum VA,Optum VA,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,UHC,UHC,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,UHC MGG,UHC MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,VA,VA,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Wellcare MGG,Wellcare MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Bright Health - commercial,Bright Health - commercial,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Bright Health MGG,Bright Health MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Aetna,Aetna,1265.88,,,,,,,per diem,1265.88,1265.88,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Aetna MGG,Aetna MGG,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,BCBS,BCBS,1265.88,,,,,,,per diem,1265.88,1265.88,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,BCBS MGG,BCBS MGG,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Cigna,Cigna,1265.88,,,,,,,per diem,1265.88,1265.88,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Cigna MGG,Cigna MGG,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Humana,Humana,1265.88,,,,,,,per diem,1265.88,1265.88,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Humana MGG,Humana MGG,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Optum VA,Optum VA,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,UHC,UHC,1265.88,,,,,,,per diem,1265.88,1265.88,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,UHC MGG,UHC MGG,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,VA,VA,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Wellcare MGG,Wellcare MGG,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Bright Health - commercial,Bright Health - commercial,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1265.88,1265.88,Bright Health MGG,Bright Health MGG,1265.88,,,,,,,case rate,1265.88,1265.88,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Aetna,Aetna,133.71,,,,,,,per diem,133.71,133.71,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Aetna MGG,Aetna MGG,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,BCBS,BCBS,133.71,,,,,,,per diem,133.71,133.71,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,BCBS MGG,BCBS MGG,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Cigna,Cigna,133.71,,,,,,,per diem,133.71,133.71,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Cigna MGG,Cigna MGG,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Humana,Humana,133.71,,,,,,,per diem,133.71,133.71,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Humana MGG,Humana MGG,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Optum VA,Optum VA,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,UHC,UHC,133.71,,,,,,,per diem,133.71,133.71,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,UHC MGG,UHC MGG,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,VA,VA,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Wellcare MGG,Wellcare MGG,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Bright Health - commercial,Bright Health - commercial,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,133.71,133.71,Bright Health MGG,Bright Health MGG,133.71,,,,,,,case rate,133.71,133.71,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Aetna,Aetna,13.68,,,,,,,per diem,13.68,13.68,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Aetna MGG,Aetna MGG,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,BCBS,BCBS,13.68,,,,,,,per diem,13.68,13.68,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,BCBS MGG,BCBS MGG,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Cigna,Cigna,13.68,,,,,,,per diem,13.68,13.68,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Cigna MGG,Cigna MGG,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Humana,Humana,13.68,,,,,,,per diem,13.68,13.68,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Humana MGG,Humana MGG,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Optum VA,Optum VA,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,UHC,UHC,13.68,,,,,,,per diem,13.68,13.68,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,UHC MGG,UHC MGG,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,VA,VA,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Wellcare MGG,Wellcare MGG,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Bright Health - commercial,Bright Health - commercial,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,13.68,13.68,Bright Health MGG,Bright Health MGG,13.68,,,,,,,case rate,13.68,13.68,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Aetna,Aetna,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Aetna MGG,Aetna MGG,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,BCBS,BCBS,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,BCBS MGG,BCBS MGG,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Cigna,Cigna,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Cigna MGG,Cigna MGG,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Humana,Humana,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Humana MGG,Humana MGG,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Optum VA,Optum VA,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,UHC,UHC,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,UHC MGG,UHC MGG,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,VA,VA,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Wellcare MGG,Wellcare MGG,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Bright Health - commercial,Bright Health - commercial,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,79.41,79.41,Bright Health MGG,Bright Health MGG,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Aetna,Aetna,821.55,,,,,,,per diem,821.55,821.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Aetna MGG,Aetna MGG,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,BCBS,BCBS,821.55,,,,,,,per diem,821.55,821.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,BCBS MGG,BCBS MGG,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Cigna,Cigna,821.55,,,,,,,per diem,821.55,821.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Cigna MGG,Cigna MGG,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Humana,Humana,821.55,,,,,,,per diem,821.55,821.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Humana MGG,Humana MGG,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Optum VA,Optum VA,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,UHC,UHC,821.55,,,,,,,per diem,821.55,821.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,UHC MGG,UHC MGG,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,VA,VA,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Wellcare MGG,Wellcare MGG,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Bright Health - commercial,Bright Health - commercial,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,821.55,821.55,Bright Health MGG,Bright Health MGG,821.55,,,,,,,case rate,821.55,821.55,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Aetna,Aetna,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Aetna MGG,Aetna MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,BCBS,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS MGG,BCBS MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Cigna,Cigna,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Cigna MGG,Cigna MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Humana,Humana,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Humana MGG,Humana MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Optum VA,Optum VA,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UHC,UHC,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UHC MGG,UHC MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA,VA,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Wellcare MGG,Wellcare MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Bright Health - commercial,Bright Health - commercial,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,Bright Health MGG,Bright Health MGG,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Aetna,Aetna,16.65,,,,,,,per diem,16.65,16.65,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Aetna MGG,Aetna MGG,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,BCBS,BCBS,16.65,,,,,,,per diem,16.65,16.65,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,BCBS MGG,BCBS MGG,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Cigna,Cigna,16.65,,,,,,,per diem,16.65,16.65,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Cigna MGG,Cigna MGG,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Humana,Humana,16.65,,,,,,,per diem,16.65,16.65,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Humana MGG,Humana MGG,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Optum VA,Optum VA,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,UHC,UHC,16.65,,,,,,,per diem,16.65,16.65,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,UHC MGG,UHC MGG,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,VA,VA,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Wellcare MGG,Wellcare MGG,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Bright Health - commercial,Bright Health - commercial,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,16.65,16.65,Bright Health MGG,Bright Health MGG,16.65,,,,,,,case rate,16.65,16.65,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Aetna,Aetna,1245.6,,,,,,,per diem,1245.6,1245.6,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Aetna MGG,Aetna MGG,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,BCBS,BCBS,1245.6,,,,,,,per diem,1245.6,1245.6,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,BCBS MGG,BCBS MGG,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Cigna,Cigna,1245.6,,,,,,,per diem,1245.6,1245.6,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Cigna MGG,Cigna MGG,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Humana,Humana,1245.6,,,,,,,per diem,1245.6,1245.6,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Humana MGG,Humana MGG,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Optum VA,Optum VA,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,UHC,UHC,1245.6,,,,,,,per diem,1245.6,1245.6,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,UHC MGG,UHC MGG,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,VA,VA,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Wellcare MGG,Wellcare MGG,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Bright Health - commercial,Bright Health - commercial,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1245.6,1245.6,Bright Health MGG,Bright Health MGG,1245.6,,,,,,,case rate,1245.6,1245.6,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Aetna,Aetna,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Aetna MGG,Aetna MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,BCBS,BCBS,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,BCBS MGG,BCBS MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Cigna,Cigna,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Cigna MGG,Cigna MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Humana,Humana,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Humana MGG,Humana MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Optum VA,Optum VA,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,UHC,UHC,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,UHC MGG,UHC MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,VA,VA,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Wellcare MGG,Wellcare MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Bright Health - commercial,Bright Health - commercial,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Bright Health MGG,Bright Health MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Aetna,Aetna,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Aetna MGG,Aetna MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,BCBS,BCBS,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,BCBS MGG,BCBS MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Cigna,Cigna,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Cigna MGG,Cigna MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Humana,Humana,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Humana MGG,Humana MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Optum VA,Optum VA,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,UHC,UHC,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,UHC MGG,UHC MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,VA,VA,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Wellcare MGG,Wellcare MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Bright Health - commercial,Bright Health - commercial,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Bright Health MGG,Bright Health MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Aetna,Aetna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Aetna MGG,Aetna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,BCBS,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS MGG,BCBS MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Cigna,Cigna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Cigna MGG,Cigna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Humana,Humana,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Humana MGG,Humana MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Optum VA,Optum VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UHC,UHC,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UHC MGG,UHC MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,VA,VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Wellcare MGG,Wellcare MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Bright Health - commercial,Bright Health - commercial,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Bright Health MGG,Bright Health MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Aetna,Aetna,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Aetna MGG,Aetna MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,BCBS,BCBS,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,BCBS MGG,BCBS MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Cigna,Cigna,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Cigna MGG,Cigna MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Humana,Humana,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Humana MGG,Humana MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Optum VA,Optum VA,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,UHC,UHC,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,UHC MGG,UHC MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,VA,VA,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Wellcare MGG,Wellcare MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Bright Health - commercial,Bright Health - commercial,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Bright Health MGG,Bright Health MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna,Aetna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna MGG,Aetna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,BCBS,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS MGG,BCBS MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna,Cigna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna MGG,Cigna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana,Humana,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana MGG,Humana MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Optum VA,Optum VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC,UHC,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC MGG,UHC MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,VA,VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Wellcare MGG,Wellcare MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health - commercial,Bright Health - commercial,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health MGG,Bright Health MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Aetna,Aetna,21.36,,,,,,,per diem,21.36,21.36,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Aetna MGG,Aetna MGG,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,BCBS,BCBS,21.36,,,,,,,per diem,21.36,21.36,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,BCBS MGG,BCBS MGG,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Cigna,Cigna,21.36,,,,,,,per diem,21.36,21.36,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Cigna MGG,Cigna MGG,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Humana,Humana,21.36,,,,,,,per diem,21.36,21.36,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Humana MGG,Humana MGG,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Optum VA,Optum VA,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,UHC,UHC,21.36,,,,,,,per diem,21.36,21.36,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,UHC MGG,UHC MGG,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,VA,VA,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Wellcare MGG,Wellcare MGG,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Bright Health - commercial,Bright Health - commercial,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,21.36,21.36,Bright Health MGG,Bright Health MGG,21.36,,,,,,,case rate,21.36,21.36,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Aetna,Aetna,23.25,,,,,,,per diem,23.25,23.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Aetna MGG,Aetna MGG,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,BCBS,BCBS,23.25,,,,,,,per diem,23.25,23.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,BCBS MGG,BCBS MGG,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Cigna,Cigna,23.25,,,,,,,per diem,23.25,23.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Cigna MGG,Cigna MGG,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Humana,Humana,23.25,,,,,,,per diem,23.25,23.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Humana MGG,Humana MGG,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Optum VA,Optum VA,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,UHC,UHC,23.25,,,,,,,per diem,23.25,23.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,UHC MGG,UHC MGG,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,VA,VA,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Wellcare MGG,Wellcare MGG,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Bright Health - commercial,Bright Health - commercial,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,23.25,23.25,Bright Health MGG,Bright Health MGG,23.25,,,,,,,case rate,23.25,23.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Aetna,Aetna,22.59,,,,,,,per diem,22.59,22.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Aetna MGG,Aetna MGG,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,BCBS,BCBS,22.59,,,,,,,per diem,22.59,22.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,BCBS MGG,BCBS MGG,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Cigna,Cigna,22.59,,,,,,,per diem,22.59,22.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Cigna MGG,Cigna MGG,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Humana,Humana,22.59,,,,,,,per diem,22.59,22.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Humana MGG,Humana MGG,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Optum VA,Optum VA,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,UHC,UHC,22.59,,,,,,,per diem,22.59,22.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,UHC MGG,UHC MGG,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,VA,VA,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Wellcare MGG,Wellcare MGG,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Bright Health - commercial,Bright Health - commercial,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,22.59,22.59,Bright Health MGG,Bright Health MGG,22.59,,,,,,,case rate,22.59,22.59,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Aetna,Aetna,249,,,,,,,per diem,249,249,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Aetna MGG,Aetna MGG,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,BCBS,BCBS,249,,,,,,,per diem,249,249,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,BCBS MGG,BCBS MGG,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Cigna,Cigna,249,,,,,,,per diem,249,249,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Cigna MGG,Cigna MGG,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Humana,Humana,249,,,,,,,per diem,249,249,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Humana MGG,Humana MGG,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Optum VA,Optum VA,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,UHC,UHC,249,,,,,,,per diem,249,249,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,UHC MGG,UHC MGG,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,VA,VA,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Wellcare MGG,Wellcare MGG,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Bright Health - commercial,Bright Health - commercial,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,249,249,Bright Health MGG,Bright Health MGG,249,,,,,,,case rate,249,249,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Aetna,Aetna,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Aetna MGG,Aetna MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,BCBS,BCBS,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,BCBS MGG,BCBS MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Cigna,Cigna,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Cigna MGG,Cigna MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Humana,Humana,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Humana MGG,Humana MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Optum VA,Optum VA,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,UHC,UHC,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,UHC MGG,UHC MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,VA,VA,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Wellcare MGG,Wellcare MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Bright Health - commercial,Bright Health - commercial,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Bright Health MGG,Bright Health MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Aetna,Aetna,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Aetna MGG,Aetna MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,BCBS,BCBS,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,BCBS MGG,BCBS MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Cigna,Cigna,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Cigna MGG,Cigna MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Humana,Humana,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Humana MGG,Humana MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Optum VA,Optum VA,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,UHC,UHC,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,UHC MGG,UHC MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,VA,VA,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Wellcare MGG,Wellcare MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Bright Health - commercial,Bright Health - commercial,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Bright Health MGG,Bright Health MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Aetna,Aetna,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Aetna MGG,Aetna MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,BCBS,BCBS,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,BCBS MGG,BCBS MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Cigna,Cigna,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Cigna MGG,Cigna MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Humana,Humana,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Humana MGG,Humana MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Optum VA,Optum VA,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,UHC,UHC,18.36,,,,,,,per diem,18.36,18.36,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,UHC MGG,UHC MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,VA,VA,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Wellcare MGG,Wellcare MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Bright Health - commercial,Bright Health - commercial,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,18.36,18.36,Bright Health MGG,Bright Health MGG,18.36,,,,,,,case rate,18.36,18.36,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna,Aetna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna MGG,Aetna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS,BCBS,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS MGG,BCBS MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna,Cigna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna MGG,Cigna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana,Humana,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana MGG,Humana MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Optum VA,Optum VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC,UHC,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC MGG,UHC MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,VA,VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Wellcare MGG,Wellcare MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health - commercial,Bright Health - commercial,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health MGG,Bright Health MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Aetna,Aetna,112.98,,,,,,,per diem,112.98,112.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Aetna MGG,Aetna MGG,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,BCBS,BCBS,112.98,,,,,,,per diem,112.98,112.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,BCBS MGG,BCBS MGG,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Cigna,Cigna,112.98,,,,,,,per diem,112.98,112.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Cigna MGG,Cigna MGG,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Humana,Humana,112.98,,,,,,,per diem,112.98,112.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Humana MGG,Humana MGG,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Optum VA,Optum VA,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,UHC,UHC,112.98,,,,,,,per diem,112.98,112.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,UHC MGG,UHC MGG,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,VA,VA,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Wellcare MGG,Wellcare MGG,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Bright Health - commercial,Bright Health - commercial,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,112.98,112.98,Bright Health MGG,Bright Health MGG,112.98,,,,,,,case rate,112.98,112.98,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Aetna,Aetna,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Aetna MGG,Aetna MGG,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,BCBS,BCBS,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,BCBS MGG,BCBS MGG,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Cigna,Cigna,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Cigna MGG,Cigna MGG,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Humana,Humana,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Humana MGG,Humana MGG,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Optum VA,Optum VA,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,UHC,UHC,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,UHC MGG,UHC MGG,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,VA,VA,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Wellcare MGG,Wellcare MGG,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Bright Health - commercial,Bright Health - commercial,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,Bright Health MGG,Bright Health MGG,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Aetna,Aetna,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Aetna MGG,Aetna MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,BCBS,BCBS,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,BCBS MGG,BCBS MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Cigna,Cigna,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Cigna MGG,Cigna MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Humana,Humana,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Humana MGG,Humana MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Optum VA,Optum VA,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,UHC,UHC,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,UHC MGG,UHC MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,VA,VA,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Wellcare MGG,Wellcare MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Bright Health - commercial,Bright Health - commercial,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Bright Health MGG,Bright Health MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Aetna,Aetna,24.93,,,,,,,per diem,24.93,24.93,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Aetna MGG,Aetna MGG,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,BCBS,BCBS,24.93,,,,,,,per diem,24.93,24.93,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,BCBS MGG,BCBS MGG,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Cigna,Cigna,24.93,,,,,,,per diem,24.93,24.93,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Cigna MGG,Cigna MGG,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Humana,Humana,24.93,,,,,,,per diem,24.93,24.93,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Humana MGG,Humana MGG,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Optum VA,Optum VA,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,UHC,UHC,24.93,,,,,,,per diem,24.93,24.93,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,UHC MGG,UHC MGG,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,VA,VA,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Wellcare MGG,Wellcare MGG,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Bright Health - commercial,Bright Health - commercial,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,24.93,24.93,Bright Health MGG,Bright Health MGG,24.93,,,,,,,case rate,24.93,24.93,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Aetna,Aetna,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Aetna MGG,Aetna MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,BCBS,BCBS,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,BCBS MGG,BCBS MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Cigna,Cigna,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Cigna MGG,Cigna MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Humana,Humana,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Humana MGG,Humana MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Optum VA,Optum VA,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,UHC,UHC,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,UHC MGG,UHC MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,VA,VA,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Wellcare MGG,Wellcare MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Bright Health - commercial,Bright Health - commercial,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Bright Health MGG,Bright Health MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Aetna,Aetna,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Aetna MGG,Aetna MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,BCBS,BCBS,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,BCBS MGG,BCBS MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Cigna,Cigna,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Cigna MGG,Cigna MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Humana,Humana,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Humana MGG,Humana MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Optum VA,Optum VA,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,UHC,UHC,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,UHC MGG,UHC MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,VA,VA,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Wellcare MGG,Wellcare MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Bright Health - commercial,Bright Health - commercial,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Bright Health MGG,Bright Health MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Aetna,Aetna,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Aetna MGG,Aetna MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,BCBS,BCBS,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,BCBS MGG,BCBS MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Cigna,Cigna,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Cigna MGG,Cigna MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Humana,Humana,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Humana MGG,Humana MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Optum VA,Optum VA,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,UHC,UHC,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,UHC MGG,UHC MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,VA,VA,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Wellcare MGG,Wellcare MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Bright Health - commercial,Bright Health - commercial,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Bright Health MGG,Bright Health MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Aetna,Aetna,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Aetna MGG,Aetna MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,BCBS,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS MGG,BCBS MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Cigna,Cigna,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Cigna MGG,Cigna MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Humana,Humana,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Humana MGG,Humana MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Optum VA,Optum VA,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,UHC,UHC,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,UHC MGG,UHC MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,VA,VA,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Wellcare MGG,Wellcare MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Bright Health - commercial,Bright Health - commercial,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Bright Health MGG,Bright Health MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Aetna,Aetna,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Aetna MGG,Aetna MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,BCBS,BCBS,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,BCBS MGG,BCBS MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Cigna,Cigna,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Cigna MGG,Cigna MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Humana,Humana,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Humana MGG,Humana MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Optum VA,Optum VA,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,UHC,UHC,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,UHC MGG,UHC MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,VA,VA,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Wellcare MGG,Wellcare MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Bright Health - commercial,Bright Health - commercial,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Bright Health MGG,Bright Health MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Aetna,Aetna,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Aetna MGG,Aetna MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,BCBS,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS MGG,BCBS MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Cigna,Cigna,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Cigna MGG,Cigna MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Humana,Humana,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Humana MGG,Humana MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Optum VA,Optum VA,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,UHC,UHC,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,UHC MGG,UHC MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,VA,VA,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Wellcare MGG,Wellcare MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Bright Health - commercial,Bright Health - commercial,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Bright Health MGG,Bright Health MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Aetna,Aetna,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Aetna MGG,Aetna MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,BCBS,BCBS,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,BCBS MGG,BCBS MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Cigna,Cigna,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Cigna MGG,Cigna MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Humana,Humana,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Humana MGG,Humana MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Optum VA,Optum VA,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,UHC,UHC,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,UHC MGG,UHC MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,VA,VA,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Wellcare MGG,Wellcare MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Bright Health - commercial,Bright Health - commercial,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,Bright Health MGG,Bright Health MGG,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Aetna,Aetna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Aetna MGG,Aetna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,BCBS,BCBS,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,BCBS MGG,BCBS MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Cigna,Cigna,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Cigna MGG,Cigna MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Humana,Humana,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Humana MGG,Humana MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Optum VA,Optum VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,UHC,UHC,48,,,,,,,per diem,48,48,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,UHC MGG,UHC MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,VA,VA,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Wellcare MGG,Wellcare MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Bright Health - commercial,Bright Health - commercial,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,48,48,Bright Health MGG,Bright Health MGG,48,,,,,,,case rate,48,48,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Aetna,Aetna,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Aetna MGG,Aetna MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,BCBS,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS MGG,BCBS MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Cigna,Cigna,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Cigna MGG,Cigna MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Humana,Humana,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Humana MGG,Humana MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Optum VA,Optum VA,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UHC,UHC,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UHC MGG,UHC MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,VA,VA,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Wellcare MGG,Wellcare MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Bright Health - commercial,Bright Health - commercial,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Bright Health MGG,Bright Health MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Aetna,Aetna,194.19,,,,,,,per diem,194.19,194.19,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Aetna MGG,Aetna MGG,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,BCBS,BCBS,194.19,,,,,,,per diem,194.19,194.19,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,BCBS MGG,BCBS MGG,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Cigna,Cigna,194.19,,,,,,,per diem,194.19,194.19,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Cigna MGG,Cigna MGG,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Humana,Humana,194.19,,,,,,,per diem,194.19,194.19,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Humana MGG,Humana MGG,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Optum VA,Optum VA,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,UHC,UHC,194.19,,,,,,,per diem,194.19,194.19,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,UHC MGG,UHC MGG,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,VA,VA,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Wellcare MGG,Wellcare MGG,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Bright Health - commercial,Bright Health - commercial,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,194.19,194.19,Bright Health MGG,Bright Health MGG,194.19,,,,,,,case rate,194.19,194.19,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Aetna,Aetna,64.87,,,,,,,per diem,64.87,64.87,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Aetna MGG,Aetna MGG,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,BCBS,BCBS,64.87,,,,,,,per diem,64.87,64.87,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,BCBS MGG,BCBS MGG,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Cigna,Cigna,64.87,,,,,,,per diem,64.87,64.87,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Cigna MGG,Cigna MGG,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Humana,Humana,64.87,,,,,,,per diem,64.87,64.87,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Humana MGG,Humana MGG,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Optum VA,Optum VA,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,UHC,UHC,64.87,,,,,,,per diem,64.87,64.87,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,UHC MGG,UHC MGG,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,VA,VA,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Wellcare MGG,Wellcare MGG,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Bright Health - commercial,Bright Health - commercial,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,64.87,64.87,Bright Health MGG,Bright Health MGG,64.87,,,,,,,case rate,64.87,64.87,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Aetna,Aetna,21.57,,,,,,,per diem,21.57,21.57,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Aetna MGG,Aetna MGG,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,BCBS,BCBS,21.57,,,,,,,per diem,21.57,21.57,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,BCBS MGG,BCBS MGG,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Cigna,Cigna,21.57,,,,,,,per diem,21.57,21.57,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Cigna MGG,Cigna MGG,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Humana,Humana,21.57,,,,,,,per diem,21.57,21.57,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Humana MGG,Humana MGG,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Optum VA,Optum VA,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,UHC,UHC,21.57,,,,,,,per diem,21.57,21.57,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,UHC MGG,UHC MGG,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,VA,VA,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Wellcare MGG,Wellcare MGG,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Bright Health - commercial,Bright Health - commercial,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,21.57,21.57,Bright Health MGG,Bright Health MGG,21.57,,,,,,,case rate,21.57,21.57,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Aetna,Aetna,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Aetna MGG,Aetna MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,BCBS,BCBS,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,BCBS MGG,BCBS MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Cigna,Cigna,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Cigna MGG,Cigna MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Humana,Humana,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Humana MGG,Humana MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Optum VA,Optum VA,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,UHC,UHC,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,UHC MGG,UHC MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,VA,VA,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Wellcare MGG,Wellcare MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Bright Health - commercial,Bright Health - commercial,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Bright Health MGG,Bright Health MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Aetna,Aetna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Aetna MGG,Aetna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS,BCBS,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS MGG,BCBS MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Cigna,Cigna,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Cigna MGG,Cigna MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Humana,Humana,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Humana MGG,Humana MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Optum VA,Optum VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,UHC,UHC,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,UHC MGG,UHC MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,VA,VA,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Wellcare MGG,Wellcare MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Bright Health - commercial,Bright Health - commercial,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,Bright Health MGG,Bright Health MGG,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Aetna,Aetna,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Aetna MGG,Aetna MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,BCBS,BCBS,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,BCBS MGG,BCBS MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Cigna,Cigna,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Cigna MGG,Cigna MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Humana,Humana,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Humana MGG,Humana MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Optum VA,Optum VA,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,UHC,UHC,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,UHC MGG,UHC MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,VA,VA,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Wellcare MGG,Wellcare MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Bright Health - commercial,Bright Health - commercial,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Bright Health MGG,Bright Health MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Aetna,Aetna,124.8,,,,,,,per diem,124.8,124.8,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Aetna MGG,Aetna MGG,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,BCBS,BCBS,124.8,,,,,,,per diem,124.8,124.8,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,BCBS MGG,BCBS MGG,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Cigna,Cigna,124.8,,,,,,,per diem,124.8,124.8,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Cigna MGG,Cigna MGG,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Humana,Humana,124.8,,,,,,,per diem,124.8,124.8,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Humana MGG,Humana MGG,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Optum VA,Optum VA,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,UHC,UHC,124.8,,,,,,,per diem,124.8,124.8,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,UHC MGG,UHC MGG,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,VA,VA,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Wellcare MGG,Wellcare MGG,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Bright Health - commercial,Bright Health - commercial,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,124.8,124.8,Bright Health MGG,Bright Health MGG,124.8,,,,,,,case rate,124.8,124.8,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Aetna,Aetna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Aetna MGG,Aetna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,BCBS,BCBS,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,BCBS MGG,BCBS MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Cigna,Cigna,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Cigna MGG,Cigna MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Humana,Humana,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Humana MGG,Humana MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Optum VA,Optum VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,UHC,UHC,90,,,,,,,per diem,90,90,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,UHC MGG,UHC MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,VA,VA,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Wellcare MGG,Wellcare MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Bright Health - commercial,Bright Health - commercial,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,90,90,Bright Health MGG,Bright Health MGG,90,,,,,,,case rate,90,90,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Aetna,Aetna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Aetna MGG,Aetna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,BCBS,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS MGG,BCBS MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Cigna,Cigna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Cigna MGG,Cigna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Humana,Humana,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Humana MGG,Humana MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Optum VA,Optum VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,UHC,UHC,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,UHC MGG,UHC MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA,VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Wellcare MGG,Wellcare MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Bright Health - commercial,Bright Health - commercial,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.47,7.47,Bright Health MGG,Bright Health MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Aetna,Aetna,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Aetna MGG,Aetna MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,BCBS,BCBS,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,BCBS MGG,BCBS MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Cigna,Cigna,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Cigna MGG,Cigna MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Humana,Humana,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Humana MGG,Humana MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Optum VA,Optum VA,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,UHC,UHC,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,UHC MGG,UHC MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,VA,VA,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Wellcare MGG,Wellcare MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Bright Health - commercial,Bright Health - commercial,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Bright Health MGG,Bright Health MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Aetna,Aetna,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Aetna MGG,Aetna MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,BCBS,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS MGG,BCBS MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Cigna,Cigna,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Cigna MGG,Cigna MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Humana,Humana,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Humana MGG,Humana MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Optum VA,Optum VA,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,UHC,UHC,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,UHC MGG,UHC MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,VA,VA,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Wellcare MGG,Wellcare MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Bright Health - commercial,Bright Health - commercial,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Bright Health MGG,Bright Health MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Aetna,Aetna,178.38,,,,,,,per diem,178.38,178.38,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Aetna MGG,Aetna MGG,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,BCBS,BCBS,178.38,,,,,,,per diem,178.38,178.38,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,BCBS MGG,BCBS MGG,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Cigna,Cigna,178.38,,,,,,,per diem,178.38,178.38,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Cigna MGG,Cigna MGG,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Humana,Humana,178.38,,,,,,,per diem,178.38,178.38,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Humana MGG,Humana MGG,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Optum VA,Optum VA,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,UHC,UHC,178.38,,,,,,,per diem,178.38,178.38,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,UHC MGG,UHC MGG,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,VA,VA,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Wellcare MGG,Wellcare MGG,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Bright Health - commercial,Bright Health - commercial,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,178.38,178.38,Bright Health MGG,Bright Health MGG,178.38,,,,,,,case rate,178.38,178.38,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Aetna,Aetna,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Aetna MGG,Aetna MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,BCBS,BCBS,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,BCBS MGG,BCBS MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Cigna,Cigna,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Cigna MGG,Cigna MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Humana,Humana,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Humana MGG,Humana MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Optum VA,Optum VA,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,UHC,UHC,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,UHC MGG,UHC MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,VA,VA,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Wellcare MGG,Wellcare MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Bright Health - commercial,Bright Health - commercial,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Bright Health MGG,Bright Health MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Aetna,Aetna,68.73,,,,,,,per diem,68.73,68.73,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Aetna MGG,Aetna MGG,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,BCBS,BCBS,68.73,,,,,,,per diem,68.73,68.73,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,BCBS MGG,BCBS MGG,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Cigna,Cigna,68.73,,,,,,,per diem,68.73,68.73,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Cigna MGG,Cigna MGG,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Humana,Humana,68.73,,,,,,,per diem,68.73,68.73,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Humana MGG,Humana MGG,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Optum VA,Optum VA,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,UHC,UHC,68.73,,,,,,,per diem,68.73,68.73,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,UHC MGG,UHC MGG,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,VA,VA,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Wellcare MGG,Wellcare MGG,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Bright Health - commercial,Bright Health - commercial,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,68.73,68.73,Bright Health MGG,Bright Health MGG,68.73,,,,,,,case rate,68.73,68.73,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Aetna,Aetna,38.25,,,,,,,per diem,38.25,38.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Aetna MGG,Aetna MGG,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,BCBS,BCBS,38.25,,,,,,,per diem,38.25,38.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,BCBS MGG,BCBS MGG,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Cigna,Cigna,38.25,,,,,,,per diem,38.25,38.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Cigna MGG,Cigna MGG,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Humana,Humana,38.25,,,,,,,per diem,38.25,38.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Humana MGG,Humana MGG,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Optum VA,Optum VA,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,UHC,UHC,38.25,,,,,,,per diem,38.25,38.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,UHC MGG,UHC MGG,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,VA,VA,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Wellcare MGG,Wellcare MGG,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Bright Health - commercial,Bright Health - commercial,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,38.25,38.25,Bright Health MGG,Bright Health MGG,38.25,,,,,,,case rate,38.25,38.25,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna,Aetna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna MGG,Aetna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,BCBS,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS MGG,BCBS MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna,Cigna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna MGG,Cigna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana,Humana,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana MGG,Humana MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Optum VA,Optum VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC,UHC,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC MGG,UHC MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,VA,VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Wellcare MGG,Wellcare MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health - commercial,Bright Health - commercial,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health MGG,Bright Health MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Aetna,Aetna,24.12,,,,,,,per diem,24.12,24.12,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Aetna MGG,Aetna MGG,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,BCBS,BCBS,24.12,,,,,,,per diem,24.12,24.12,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,BCBS MGG,BCBS MGG,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Cigna,Cigna,24.12,,,,,,,per diem,24.12,24.12,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Cigna MGG,Cigna MGG,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Humana,Humana,24.12,,,,,,,per diem,24.12,24.12,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Humana MGG,Humana MGG,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Optum VA,Optum VA,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,UHC,UHC,24.12,,,,,,,per diem,24.12,24.12,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,UHC MGG,UHC MGG,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,VA,VA,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Wellcare MGG,Wellcare MGG,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Bright Health - commercial,Bright Health - commercial,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,24.12,24.12,Bright Health MGG,Bright Health MGG,24.12,,,,,,,case rate,24.12,24.12,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Aetna,Aetna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Aetna MGG,Aetna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,BCBS,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS MGG,BCBS MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Cigna,Cigna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Cigna MGG,Cigna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Humana,Humana,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Humana MGG,Humana MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Optum VA,Optum VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,UHC,UHC,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,UHC MGG,UHC MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,VA,VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Wellcare MGG,Wellcare MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Bright Health - commercial,Bright Health - commercial,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Bright Health MGG,Bright Health MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Aetna,Aetna,832.83,,,,,,,per diem,832.83,832.83,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Aetna MGG,Aetna MGG,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,BCBS,BCBS,832.83,,,,,,,per diem,832.83,832.83,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,BCBS MGG,BCBS MGG,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Cigna,Cigna,832.83,,,,,,,per diem,832.83,832.83,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Cigna MGG,Cigna MGG,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Humana,Humana,832.83,,,,,,,per diem,832.83,832.83,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Humana MGG,Humana MGG,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Optum VA,Optum VA,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,UHC,UHC,832.83,,,,,,,per diem,832.83,832.83,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,UHC MGG,UHC MGG,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,VA,VA,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Wellcare MGG,Wellcare MGG,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Bright Health - commercial,Bright Health - commercial,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,832.83,832.83,Bright Health MGG,Bright Health MGG,832.83,,,,,,,case rate,832.83,832.83,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Aetna,Aetna,99.78,,,,,,,per diem,99.78,99.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Aetna MGG,Aetna MGG,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,BCBS,BCBS,99.78,,,,,,,per diem,99.78,99.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,BCBS MGG,BCBS MGG,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Cigna,Cigna,99.78,,,,,,,per diem,99.78,99.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Cigna MGG,Cigna MGG,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Humana,Humana,99.78,,,,,,,per diem,99.78,99.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Humana MGG,Humana MGG,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Optum VA,Optum VA,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,UHC,UHC,99.78,,,,,,,per diem,99.78,99.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,UHC MGG,UHC MGG,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,VA,VA,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Wellcare MGG,Wellcare MGG,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Bright Health - commercial,Bright Health - commercial,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,99.78,99.78,Bright Health MGG,Bright Health MGG,99.78,,,,,,,case rate,99.78,99.78,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Aetna,Aetna,128.55,,,,,,,per diem,128.55,128.55,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Aetna MGG,Aetna MGG,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,BCBS,BCBS,128.55,,,,,,,per diem,128.55,128.55,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,BCBS MGG,BCBS MGG,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Cigna,Cigna,128.55,,,,,,,per diem,128.55,128.55,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Cigna MGG,Cigna MGG,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Humana,Humana,128.55,,,,,,,per diem,128.55,128.55,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Humana MGG,Humana MGG,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Optum VA,Optum VA,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,UHC,UHC,128.55,,,,,,,per diem,128.55,128.55,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,UHC MGG,UHC MGG,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,VA,VA,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Wellcare MGG,Wellcare MGG,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Bright Health - commercial,Bright Health - commercial,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,128.55,128.55,Bright Health MGG,Bright Health MGG,128.55,,,,,,,case rate,128.55,128.55,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Aetna,Aetna,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Aetna MGG,Aetna MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,BCBS,BCBS,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,BCBS MGG,BCBS MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Cigna,Cigna,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Cigna MGG,Cigna MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Humana,Humana,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Humana MGG,Humana MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Optum VA,Optum VA,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,UHC,UHC,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,UHC MGG,UHC MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,VA,VA,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Wellcare MGG,Wellcare MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Bright Health - commercial,Bright Health - commercial,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Bright Health MGG,Bright Health MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Aetna,Aetna,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Aetna MGG,Aetna MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,BCBS,BCBS,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,BCBS MGG,BCBS MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Cigna,Cigna,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Cigna MGG,Cigna MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Humana,Humana,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Humana MGG,Humana MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Optum VA,Optum VA,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,UHC,UHC,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,UHC MGG,UHC MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,VA,VA,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Wellcare MGG,Wellcare MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Bright Health - commercial,Bright Health - commercial,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Bright Health MGG,Bright Health MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Aetna,Aetna,29.89,,,,,,,per diem,29.89,29.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Aetna MGG,Aetna MGG,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,BCBS,BCBS,29.89,,,,,,,per diem,29.89,29.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,BCBS MGG,BCBS MGG,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Cigna,Cigna,29.89,,,,,,,per diem,29.89,29.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Cigna MGG,Cigna MGG,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Humana,Humana,29.89,,,,,,,per diem,29.89,29.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Humana MGG,Humana MGG,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Optum VA,Optum VA,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,UHC,UHC,29.89,,,,,,,per diem,29.89,29.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,UHC MGG,UHC MGG,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,VA,VA,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Wellcare MGG,Wellcare MGG,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Bright Health - commercial,Bright Health - commercial,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,29.89,29.89,Bright Health MGG,Bright Health MGG,29.89,,,,,,,case rate,29.89,29.89,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Aetna,Aetna,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Aetna MGG,Aetna MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,BCBS,BCBS,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,BCBS MGG,BCBS MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Cigna,Cigna,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Cigna MGG,Cigna MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Humana,Humana,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Humana MGG,Humana MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Optum VA,Optum VA,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,UHC,UHC,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,UHC MGG,UHC MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,VA,VA,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Wellcare MGG,Wellcare MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Bright Health - commercial,Bright Health - commercial,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Bright Health MGG,Bright Health MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Aetna,Aetna,541.47,,,,,,,per diem,541.47,541.47,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Aetna MGG,Aetna MGG,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,BCBS,BCBS,541.47,,,,,,,per diem,541.47,541.47,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,BCBS MGG,BCBS MGG,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Cigna,Cigna,541.47,,,,,,,per diem,541.47,541.47,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Cigna MGG,Cigna MGG,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Humana,Humana,541.47,,,,,,,per diem,541.47,541.47,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Humana MGG,Humana MGG,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Optum VA,Optum VA,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,UHC,UHC,541.47,,,,,,,per diem,541.47,541.47,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,UHC MGG,UHC MGG,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,VA,VA,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Wellcare MGG,Wellcare MGG,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Bright Health - commercial,Bright Health - commercial,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,541.47,541.47,Bright Health MGG,Bright Health MGG,541.47,,,,,,,case rate,541.47,541.47,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Aetna,Aetna,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Aetna MGG,Aetna MGG,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,BCBS,BCBS,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,BCBS MGG,BCBS MGG,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Cigna,Cigna,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Cigna MGG,Cigna MGG,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Humana,Humana,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Humana MGG,Humana MGG,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Optum VA,Optum VA,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,UHC,UHC,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,UHC MGG,UHC MGG,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,VA,VA,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Wellcare MGG,Wellcare MGG,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Bright Health - commercial,Bright Health - commercial,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,Bright Health MGG,Bright Health MGG,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Aetna,Aetna,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Aetna MGG,Aetna MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,BCBS,BCBS,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,BCBS MGG,BCBS MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Cigna,Cigna,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Cigna MGG,Cigna MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Humana,Humana,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Humana MGG,Humana MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Optum VA,Optum VA,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,UHC,UHC,174.03,,,,,,,per diem,174.03,174.03,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,UHC MGG,UHC MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,VA,VA,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Wellcare MGG,Wellcare MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Bright Health - commercial,Bright Health - commercial,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,174.03,174.03,Bright Health MGG,Bright Health MGG,174.03,,,,,,,case rate,174.03,174.03,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Aetna,Aetna,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Aetna MGG,Aetna MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,BCBS,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS MGG,BCBS MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Cigna,Cigna,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Cigna MGG,Cigna MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Humana,Humana,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Humana MGG,Humana MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Optum VA,Optum VA,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UHC,UHC,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UHC MGG,UHC MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,VA,VA,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Wellcare MGG,Wellcare MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Bright Health - commercial,Bright Health - commercial,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Bright Health MGG,Bright Health MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Aetna,Aetna,6.48,,,,,,,per diem,6.48,6.48,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Aetna MGG,Aetna MGG,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,BCBS,BCBS,6.48,,,,,,,per diem,6.48,6.48,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,BCBS MGG,BCBS MGG,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Cigna,Cigna,6.48,,,,,,,per diem,6.48,6.48,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Cigna MGG,Cigna MGG,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Humana,Humana,6.48,,,,,,,per diem,6.48,6.48,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Humana MGG,Humana MGG,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Optum VA,Optum VA,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,UHC,UHC,6.48,,,,,,,per diem,6.48,6.48,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,UHC MGG,UHC MGG,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,VA,VA,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Wellcare MGG,Wellcare MGG,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Bright Health - commercial,Bright Health - commercial,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.48,6.48,Bright Health MGG,Bright Health MGG,6.48,,,,,,,case rate,6.48,6.48,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Aetna,Aetna,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Aetna MGG,Aetna MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,BCBS,BCBS,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,BCBS MGG,BCBS MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Cigna,Cigna,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Cigna MGG,Cigna MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Humana,Humana,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Humana MGG,Humana MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Optum VA,Optum VA,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,UHC,UHC,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,UHC MGG,UHC MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,VA,VA,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Wellcare MGG,Wellcare MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Bright Health - commercial,Bright Health - commercial,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Bright Health MGG,Bright Health MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Aetna,Aetna,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Aetna MGG,Aetna MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,BCBS,BCBS,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,BCBS MGG,BCBS MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Cigna,Cigna,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Cigna MGG,Cigna MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Humana,Humana,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Humana MGG,Humana MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Optum VA,Optum VA,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,UHC,UHC,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,UHC MGG,UHC MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,VA,VA,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Wellcare MGG,Wellcare MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Bright Health - commercial,Bright Health - commercial,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Bright Health MGG,Bright Health MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Aetna,Aetna,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Aetna MGG,Aetna MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,BCBS,BCBS,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,BCBS MGG,BCBS MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Cigna,Cigna,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Cigna MGG,Cigna MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Humana,Humana,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Humana MGG,Humana MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Optum VA,Optum VA,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,UHC,UHC,52.14,,,,,,,per diem,52.14,52.14,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,UHC MGG,UHC MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,VA,VA,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Wellcare MGG,Wellcare MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Bright Health - commercial,Bright Health - commercial,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,52.14,52.14,Bright Health MGG,Bright Health MGG,52.14,,,,,,,case rate,52.14,52.14,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Aetna,Aetna,28.32,,,,,,,per diem,28.32,28.32,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Aetna MGG,Aetna MGG,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,BCBS,BCBS,28.32,,,,,,,per diem,28.32,28.32,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,BCBS MGG,BCBS MGG,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Cigna,Cigna,28.32,,,,,,,per diem,28.32,28.32,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Cigna MGG,Cigna MGG,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Humana,Humana,28.32,,,,,,,per diem,28.32,28.32,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Humana MGG,Humana MGG,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Optum VA,Optum VA,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,UHC,UHC,28.32,,,,,,,per diem,28.32,28.32,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,UHC MGG,UHC MGG,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,VA,VA,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Wellcare MGG,Wellcare MGG,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Bright Health - commercial,Bright Health - commercial,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,28.32,28.32,Bright Health MGG,Bright Health MGG,28.32,,,,,,,case rate,28.32,28.32,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Aetna,Aetna,83.91,,,,,,,per diem,83.91,83.91,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Aetna MGG,Aetna MGG,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,BCBS,BCBS,83.91,,,,,,,per diem,83.91,83.91,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,BCBS MGG,BCBS MGG,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Cigna,Cigna,83.91,,,,,,,per diem,83.91,83.91,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Cigna MGG,Cigna MGG,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Humana,Humana,83.91,,,,,,,per diem,83.91,83.91,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Humana MGG,Humana MGG,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Optum VA,Optum VA,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,UHC,UHC,83.91,,,,,,,per diem,83.91,83.91,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,UHC MGG,UHC MGG,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,VA,VA,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Wellcare MGG,Wellcare MGG,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Bright Health - commercial,Bright Health - commercial,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,83.91,83.91,Bright Health MGG,Bright Health MGG,83.91,,,,,,,case rate,83.91,83.91,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Aetna,Aetna,406.92,,,,,,,per diem,406.92,406.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Aetna MGG,Aetna MGG,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,BCBS,BCBS,406.92,,,,,,,per diem,406.92,406.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,BCBS MGG,BCBS MGG,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Cigna,Cigna,406.92,,,,,,,per diem,406.92,406.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Cigna MGG,Cigna MGG,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Humana,Humana,406.92,,,,,,,per diem,406.92,406.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Humana MGG,Humana MGG,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Optum VA,Optum VA,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,UHC,UHC,406.92,,,,,,,per diem,406.92,406.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,UHC MGG,UHC MGG,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,VA,VA,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Wellcare MGG,Wellcare MGG,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Bright Health - commercial,Bright Health - commercial,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,406.92,406.92,Bright Health MGG,Bright Health MGG,406.92,,,,,,,case rate,406.92,406.92,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Aetna,Aetna,60.42,,,,,,,per diem,60.42,60.42,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Aetna MGG,Aetna MGG,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,BCBS,BCBS,60.42,,,,,,,per diem,60.42,60.42,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,BCBS MGG,BCBS MGG,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Cigna,Cigna,60.42,,,,,,,per diem,60.42,60.42,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Cigna MGG,Cigna MGG,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Humana,Humana,60.42,,,,,,,per diem,60.42,60.42,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Humana MGG,Humana MGG,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Optum VA,Optum VA,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,UHC,UHC,60.42,,,,,,,per diem,60.42,60.42,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,UHC MGG,UHC MGG,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,VA,VA,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Wellcare MGG,Wellcare MGG,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Bright Health - commercial,Bright Health - commercial,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,60.42,60.42,Bright Health MGG,Bright Health MGG,60.42,,,,,,,case rate,60.42,60.42,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Aetna,Aetna,10.56,,,,,,,per diem,10.56,10.56,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Aetna MGG,Aetna MGG,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,BCBS,BCBS,10.56,,,,,,,per diem,10.56,10.56,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,BCBS MGG,BCBS MGG,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Cigna,Cigna,10.56,,,,,,,per diem,10.56,10.56,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Cigna MGG,Cigna MGG,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Humana,Humana,10.56,,,,,,,per diem,10.56,10.56,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Humana MGG,Humana MGG,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Optum VA,Optum VA,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,UHC,UHC,10.56,,,,,,,per diem,10.56,10.56,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,UHC MGG,UHC MGG,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,VA,VA,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Wellcare MGG,Wellcare MGG,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Bright Health - commercial,Bright Health - commercial,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,10.56,10.56,Bright Health MGG,Bright Health MGG,10.56,,,,,,,case rate,10.56,10.56,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna,Aetna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna MGG,Aetna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,BCBS,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS MGG,BCBS MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna,Cigna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna MGG,Cigna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana,Humana,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana MGG,Humana MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Optum VA,Optum VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC,UHC,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC MGG,UHC MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,VA,VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Wellcare MGG,Wellcare MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health - commercial,Bright Health - commercial,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health MGG,Bright Health MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Aetna,Aetna,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Aetna MGG,Aetna MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,BCBS,BCBS,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,BCBS MGG,BCBS MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Cigna,Cigna,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Cigna MGG,Cigna MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Humana,Humana,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Humana MGG,Humana MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Optum VA,Optum VA,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,UHC,UHC,384.69,,,,,,,per diem,384.69,384.69,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,UHC MGG,UHC MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,VA,VA,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Wellcare MGG,Wellcare MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Bright Health - commercial,Bright Health - commercial,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,384.69,384.69,Bright Health MGG,Bright Health MGG,384.69,,,,,,,case rate,384.69,384.69,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Aetna,Aetna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Aetna MGG,Aetna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,BCBS,BCBS,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,BCBS MGG,BCBS MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Cigna,Cigna,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Cigna MGG,Cigna MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Humana,Humana,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Humana MGG,Humana MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Optum VA,Optum VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,UHC,UHC,120,,,,,,,per diem,120,120,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,UHC MGG,UHC MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,VA,VA,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Wellcare MGG,Wellcare MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Bright Health - commercial,Bright Health - commercial,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,120,120,Bright Health MGG,Bright Health MGG,120,,,,,,,case rate,120,120,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Aetna,Aetna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Aetna MGG,Aetna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,BCBS,BCBS,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,BCBS MGG,BCBS MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Cigna,Cigna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Cigna MGG,Cigna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Humana,Humana,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Humana MGG,Humana MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Optum VA,Optum VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,UHC,UHC,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,UHC MGG,UHC MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,VA,VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Wellcare MGG,Wellcare MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Bright Health - commercial,Bright Health - commercial,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Bright Health MGG,Bright Health MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Aetna,Aetna,175.5,,,,,,,per diem,175.5,175.5,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Aetna MGG,Aetna MGG,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,BCBS,BCBS,175.5,,,,,,,per diem,175.5,175.5,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,BCBS MGG,BCBS MGG,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Cigna,Cigna,175.5,,,,,,,per diem,175.5,175.5,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Cigna MGG,Cigna MGG,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Humana,Humana,175.5,,,,,,,per diem,175.5,175.5,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Humana MGG,Humana MGG,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Optum VA,Optum VA,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,UHC,UHC,175.5,,,,,,,per diem,175.5,175.5,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,UHC MGG,UHC MGG,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,VA,VA,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Wellcare MGG,Wellcare MGG,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Bright Health - commercial,Bright Health - commercial,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,175.5,175.5,Bright Health MGG,Bright Health MGG,175.5,,,,,,,case rate,175.5,175.5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Aetna,Aetna,240.87,,,,,,,per diem,240.87,240.87,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Aetna MGG,Aetna MGG,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,BCBS,BCBS,240.87,,,,,,,per diem,240.87,240.87,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,BCBS MGG,BCBS MGG,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Cigna,Cigna,240.87,,,,,,,per diem,240.87,240.87,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Cigna MGG,Cigna MGG,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Humana,Humana,240.87,,,,,,,per diem,240.87,240.87,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Humana MGG,Humana MGG,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Optum VA,Optum VA,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,UHC,UHC,240.87,,,,,,,per diem,240.87,240.87,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,UHC MGG,UHC MGG,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,VA,VA,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Wellcare MGG,Wellcare MGG,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Bright Health - commercial,Bright Health - commercial,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,240.87,240.87,Bright Health MGG,Bright Health MGG,240.87,,,,,,,case rate,240.87,240.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Aetna,Aetna,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Aetna MGG,Aetna MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,BCBS,BCBS,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,BCBS MGG,BCBS MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Cigna,Cigna,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Cigna MGG,Cigna MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Humana,Humana,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Humana MGG,Humana MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Optum VA,Optum VA,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,UHC,UHC,17.04,,,,,,,per diem,17.04,17.04,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,UHC MGG,UHC MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,VA,VA,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Wellcare MGG,Wellcare MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Bright Health - commercial,Bright Health - commercial,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.04,17.04,Bright Health MGG,Bright Health MGG,17.04,,,,,,,case rate,17.04,17.04,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Aetna,Aetna,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Aetna MGG,Aetna MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,BCBS,BCBS,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,BCBS MGG,BCBS MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Cigna,Cigna,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Cigna MGG,Cigna MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Humana,Humana,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Humana MGG,Humana MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Optum VA,Optum VA,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,UHC,UHC,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,UHC MGG,UHC MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,VA,VA,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Wellcare MGG,Wellcare MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Bright Health - commercial,Bright Health - commercial,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Bright Health MGG,Bright Health MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Aetna,Aetna,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Aetna MGG,Aetna MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,BCBS,BCBS,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,BCBS MGG,BCBS MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Cigna,Cigna,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Cigna MGG,Cigna MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Humana,Humana,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Humana MGG,Humana MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Optum VA,Optum VA,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,UHC,UHC,96.45,,,,,,,per diem,96.45,96.45,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,UHC MGG,UHC MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,VA,VA,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Wellcare MGG,Wellcare MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Bright Health - commercial,Bright Health - commercial,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,96.45,96.45,Bright Health MGG,Bright Health MGG,96.45,,,,,,,case rate,96.45,96.45,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Aetna,Aetna,72.75,,,,,,,per diem,72.75,72.75,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Aetna MGG,Aetna MGG,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,BCBS,BCBS,72.75,,,,,,,per diem,72.75,72.75,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,BCBS MGG,BCBS MGG,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Cigna,Cigna,72.75,,,,,,,per diem,72.75,72.75,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Cigna MGG,Cigna MGG,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Humana,Humana,72.75,,,,,,,per diem,72.75,72.75,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Humana MGG,Humana MGG,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Optum VA,Optum VA,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,UHC,UHC,72.75,,,,,,,per diem,72.75,72.75,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,UHC MGG,UHC MGG,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,VA,VA,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Wellcare MGG,Wellcare MGG,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Bright Health - commercial,Bright Health - commercial,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,72.75,72.75,Bright Health MGG,Bright Health MGG,72.75,,,,,,,case rate,72.75,72.75,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Aetna,Aetna,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Aetna MGG,Aetna MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,BCBS,BCBS,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,BCBS MGG,BCBS MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Cigna,Cigna,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Cigna MGG,Cigna MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Humana,Humana,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Humana MGG,Humana MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Optum VA,Optum VA,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,UHC,UHC,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,UHC MGG,UHC MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,VA,VA,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Wellcare MGG,Wellcare MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Bright Health - commercial,Bright Health - commercial,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Bright Health MGG,Bright Health MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Aetna,Aetna,56.25,,,,,,,per diem,56.25,56.25,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Aetna MGG,Aetna MGG,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,BCBS,BCBS,56.25,,,,,,,per diem,56.25,56.25,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,BCBS MGG,BCBS MGG,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Cigna,Cigna,56.25,,,,,,,per diem,56.25,56.25,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Cigna MGG,Cigna MGG,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Humana,Humana,56.25,,,,,,,per diem,56.25,56.25,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Humana MGG,Humana MGG,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Optum VA,Optum VA,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,UHC,UHC,56.25,,,,,,,per diem,56.25,56.25,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,UHC MGG,UHC MGG,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,VA,VA,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Wellcare MGG,Wellcare MGG,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Bright Health - commercial,Bright Health - commercial,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,56.25,56.25,Bright Health MGG,Bright Health MGG,56.25,,,,,,,case rate,56.25,56.25,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Aetna,Aetna,40.14,,,,,,,per diem,40.14,40.14,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Aetna MGG,Aetna MGG,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,BCBS,BCBS,40.14,,,,,,,per diem,40.14,40.14,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,BCBS MGG,BCBS MGG,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Cigna,Cigna,40.14,,,,,,,per diem,40.14,40.14,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Cigna MGG,Cigna MGG,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Humana,Humana,40.14,,,,,,,per diem,40.14,40.14,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Humana MGG,Humana MGG,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Optum VA,Optum VA,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,UHC,UHC,40.14,,,,,,,per diem,40.14,40.14,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,UHC MGG,UHC MGG,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,VA,VA,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Wellcare MGG,Wellcare MGG,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Bright Health - commercial,Bright Health - commercial,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,40.14,40.14,Bright Health MGG,Bright Health MGG,40.14,,,,,,,case rate,40.14,40.14,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Aetna,Aetna,55.5,,,,,,,per diem,55.5,55.5,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Aetna MGG,Aetna MGG,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,BCBS,BCBS,55.5,,,,,,,per diem,55.5,55.5,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,BCBS MGG,BCBS MGG,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Cigna,Cigna,55.5,,,,,,,per diem,55.5,55.5,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Cigna MGG,Cigna MGG,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Humana,Humana,55.5,,,,,,,per diem,55.5,55.5,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Humana MGG,Humana MGG,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Optum VA,Optum VA,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,UHC,UHC,55.5,,,,,,,per diem,55.5,55.5,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,UHC MGG,UHC MGG,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,VA,VA,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Wellcare MGG,Wellcare MGG,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Bright Health - commercial,Bright Health - commercial,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,55.5,55.5,Bright Health MGG,Bright Health MGG,55.5,,,,,,,case rate,55.5,55.5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Aetna,Aetna,355.32,,,,,,,per diem,355.32,355.32,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Aetna MGG,Aetna MGG,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,BCBS,BCBS,355.32,,,,,,,per diem,355.32,355.32,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,BCBS MGG,BCBS MGG,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Cigna,Cigna,355.32,,,,,,,per diem,355.32,355.32,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Cigna MGG,Cigna MGG,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Humana,Humana,355.32,,,,,,,per diem,355.32,355.32,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Humana MGG,Humana MGG,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Optum VA,Optum VA,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,UHC,UHC,355.32,,,,,,,per diem,355.32,355.32,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,UHC MGG,UHC MGG,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,VA,VA,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Wellcare MGG,Wellcare MGG,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Bright Health - commercial,Bright Health - commercial,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,355.32,355.32,Bright Health MGG,Bright Health MGG,355.32,,,,,,,case rate,355.32,355.32,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Aetna,Aetna,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Aetna MGG,Aetna MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,BCBS,BCBS,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,BCBS MGG,BCBS MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Cigna,Cigna,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Cigna MGG,Cigna MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Humana,Humana,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Humana MGG,Humana MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Optum VA,Optum VA,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,UHC,UHC,35.16,,,,,,,per diem,35.16,35.16,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,UHC MGG,UHC MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,VA,VA,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Wellcare MGG,Wellcare MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Bright Health - commercial,Bright Health - commercial,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,35.16,35.16,Bright Health MGG,Bright Health MGG,35.16,,,,,,,case rate,35.16,35.16,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Aetna,Aetna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Aetna MGG,Aetna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,BCBS,BCBS,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,BCBS MGG,BCBS MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Cigna,Cigna,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Cigna MGG,Cigna MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Humana,Humana,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Humana MGG,Humana MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Optum VA,Optum VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,UHC,UHC,15,,,,,,,per diem,15,15,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,UHC MGG,UHC MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,VA,VA,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Wellcare MGG,Wellcare MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Bright Health - commercial,Bright Health - commercial,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15,15,Bright Health MGG,Bright Health MGG,15,,,,,,,case rate,15,15,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Aetna,Aetna,206.25,,,,,,,per diem,206.25,206.25,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Aetna MGG,Aetna MGG,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,BCBS,BCBS,206.25,,,,,,,per diem,206.25,206.25,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,BCBS MGG,BCBS MGG,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Cigna,Cigna,206.25,,,,,,,per diem,206.25,206.25,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Cigna MGG,Cigna MGG,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Humana,Humana,206.25,,,,,,,per diem,206.25,206.25,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Humana MGG,Humana MGG,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Optum VA,Optum VA,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,UHC,UHC,206.25,,,,,,,per diem,206.25,206.25,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,UHC MGG,UHC MGG,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,VA,VA,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Wellcare MGG,Wellcare MGG,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Bright Health - commercial,Bright Health - commercial,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,206.25,206.25,Bright Health MGG,Bright Health MGG,206.25,,,,,,,case rate,206.25,206.25,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Aetna,Aetna,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Aetna MGG,Aetna MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,BCBS,BCBS,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,BCBS MGG,BCBS MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Cigna,Cigna,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Cigna MGG,Cigna MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Humana,Humana,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Humana MGG,Humana MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Optum VA,Optum VA,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,UHC,UHC,109.98,,,,,,,per diem,109.98,109.98,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,UHC MGG,UHC MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,VA,VA,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Wellcare MGG,Wellcare MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Bright Health - commercial,Bright Health - commercial,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,109.98,109.98,Bright Health MGG,Bright Health MGG,109.98,,,,,,,case rate,109.98,109.98,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna,Aetna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna MGG,Aetna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS,BCBS,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS MGG,BCBS MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna,Cigna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna MGG,Cigna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana,Humana,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana MGG,Humana MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Optum VA,Optum VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC,UHC,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC MGG,UHC MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,VA,VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Wellcare MGG,Wellcare MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health - commercial,Bright Health - commercial,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health MGG,Bright Health MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Aetna,Aetna,323.31,,,,,,,per diem,323.31,323.31,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Aetna MGG,Aetna MGG,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,BCBS,BCBS,323.31,,,,,,,per diem,323.31,323.31,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,BCBS MGG,BCBS MGG,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Cigna,Cigna,323.31,,,,,,,per diem,323.31,323.31,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Cigna MGG,Cigna MGG,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Humana,Humana,323.31,,,,,,,per diem,323.31,323.31,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Humana MGG,Humana MGG,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Optum VA,Optum VA,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,UHC,UHC,323.31,,,,,,,per diem,323.31,323.31,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,UHC MGG,UHC MGG,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,VA,VA,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Wellcare MGG,Wellcare MGG,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Bright Health - commercial,Bright Health - commercial,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,323.31,323.31,Bright Health MGG,Bright Health MGG,323.31,,,,,,,case rate,323.31,323.31,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Aetna,Aetna,13.63,,,,,,,per diem,13.63,13.63,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Aetna MGG,Aetna MGG,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,BCBS,BCBS,13.63,,,,,,,per diem,13.63,13.63,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,BCBS MGG,BCBS MGG,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Cigna,Cigna,13.63,,,,,,,per diem,13.63,13.63,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Cigna MGG,Cigna MGG,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Humana,Humana,13.63,,,,,,,per diem,13.63,13.63,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Humana MGG,Humana MGG,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Optum VA,Optum VA,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,UHC,UHC,13.63,,,,,,,per diem,13.63,13.63,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,UHC MGG,UHC MGG,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,VA,VA,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Wellcare MGG,Wellcare MGG,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Bright Health - commercial,Bright Health - commercial,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,13.63,13.63,Bright Health MGG,Bright Health MGG,13.63,,,,,,,case rate,13.63,13.63,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Aetna,Aetna,75.02,,,,,,,per diem,75.02,75.02,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Aetna MGG,Aetna MGG,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,BCBS,BCBS,75.02,,,,,,,per diem,75.02,75.02,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,BCBS MGG,BCBS MGG,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Cigna,Cigna,75.02,,,,,,,per diem,75.02,75.02,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Cigna MGG,Cigna MGG,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Humana,Humana,75.02,,,,,,,per diem,75.02,75.02,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Humana MGG,Humana MGG,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Optum VA,Optum VA,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,UHC,UHC,75.02,,,,,,,per diem,75.02,75.02,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,UHC MGG,UHC MGG,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,VA,VA,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Wellcare MGG,Wellcare MGG,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Bright Health - commercial,Bright Health - commercial,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,75.02,75.02,Bright Health MGG,Bright Health MGG,75.02,,,,,,,case rate,75.02,75.02,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Aetna,Aetna,59.34,,,,,,,per diem,59.34,59.34,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Aetna MGG,Aetna MGG,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,BCBS,BCBS,59.34,,,,,,,per diem,59.34,59.34,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,BCBS MGG,BCBS MGG,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Cigna,Cigna,59.34,,,,,,,per diem,59.34,59.34,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Cigna MGG,Cigna MGG,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Humana,Humana,59.34,,,,,,,per diem,59.34,59.34,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Humana MGG,Humana MGG,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Optum VA,Optum VA,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,UHC,UHC,59.34,,,,,,,per diem,59.34,59.34,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,UHC MGG,UHC MGG,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,VA,VA,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Wellcare MGG,Wellcare MGG,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Bright Health - commercial,Bright Health - commercial,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,59.34,59.34,Bright Health MGG,Bright Health MGG,59.34,,,,,,,case rate,59.34,59.34,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna,Aetna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna MGG,Aetna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS,BCBS,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS MGG,BCBS MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna,Cigna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna MGG,Cigna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana,Humana,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana MGG,Humana MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Optum VA,Optum VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC,UHC,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC MGG,UHC MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,VA,VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Wellcare MGG,Wellcare MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health - commercial,Bright Health - commercial,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health MGG,Bright Health MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna,Aetna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna MGG,Aetna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS,BCBS,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS MGG,BCBS MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna,Cigna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna MGG,Cigna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana,Humana,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana MGG,Humana MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Optum VA,Optum VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC,UHC,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC MGG,UHC MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,VA,VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Wellcare MGG,Wellcare MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health - commercial,Bright Health - commercial,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health MGG,Bright Health MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Aetna,Aetna,963.42,,,,,,,per diem,963.42,963.42,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Aetna MGG,Aetna MGG,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,BCBS,BCBS,963.42,,,,,,,per diem,963.42,963.42,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,BCBS MGG,BCBS MGG,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Cigna,Cigna,963.42,,,,,,,per diem,963.42,963.42,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Cigna MGG,Cigna MGG,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Humana,Humana,963.42,,,,,,,per diem,963.42,963.42,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Humana MGG,Humana MGG,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Optum VA,Optum VA,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,UHC,UHC,963.42,,,,,,,per diem,963.42,963.42,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,UHC MGG,UHC MGG,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,VA,VA,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Wellcare MGG,Wellcare MGG,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Bright Health - commercial,Bright Health - commercial,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,963.42,963.42,Bright Health MGG,Bright Health MGG,963.42,,,,,,,case rate,963.42,963.42,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Aetna,Aetna,127.26,,,,,,,per diem,127.26,127.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Aetna MGG,Aetna MGG,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,BCBS,BCBS,127.26,,,,,,,per diem,127.26,127.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,BCBS MGG,BCBS MGG,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Cigna,Cigna,127.26,,,,,,,per diem,127.26,127.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Cigna MGG,Cigna MGG,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Humana,Humana,127.26,,,,,,,per diem,127.26,127.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Humana MGG,Humana MGG,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Optum VA,Optum VA,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,UHC,UHC,127.26,,,,,,,per diem,127.26,127.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,UHC MGG,UHC MGG,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,VA,VA,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Wellcare MGG,Wellcare MGG,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Bright Health - commercial,Bright Health - commercial,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,127.26,127.26,Bright Health MGG,Bright Health MGG,127.26,,,,,,,case rate,127.26,127.26,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna,Aetna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna MGG,Aetna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS,BCBS,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS MGG,BCBS MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna,Cigna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna MGG,Cigna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana,Humana,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana MGG,Humana MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Optum VA,Optum VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC,UHC,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC MGG,UHC MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,VA,VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Wellcare MGG,Wellcare MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health - commercial,Bright Health - commercial,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health MGG,Bright Health MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Aetna,Aetna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Aetna MGG,Aetna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,BCBS,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS MGG,BCBS MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Cigna,Cigna,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Cigna MGG,Cigna MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Humana,Humana,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Humana MGG,Humana MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Optum VA,Optum VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,UHC,UHC,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,UHC MGG,UHC MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,VA,VA,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Wellcare MGG,Wellcare MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Bright Health - commercial,Bright Health - commercial,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,Bright Health MGG,Bright Health MGG,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Aetna,Aetna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Aetna MGG,Aetna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,BCBS,BCBS,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,BCBS MGG,BCBS MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Cigna,Cigna,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Cigna MGG,Cigna MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Humana,Humana,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Humana MGG,Humana MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Optum VA,Optum VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,UHC,UHC,37.77,,,,,,,per diem,37.77,37.77,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,UHC MGG,UHC MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,VA,VA,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Wellcare MGG,Wellcare MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Bright Health - commercial,Bright Health - commercial,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,37.77,37.77,Bright Health MGG,Bright Health MGG,37.77,,,,,,,case rate,37.77,37.77,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Aetna,Aetna,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Aetna MGG,Aetna MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,BCBS,BCBS,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,BCBS MGG,BCBS MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Cigna,Cigna,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Cigna MGG,Cigna MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Humana,Humana,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Humana MGG,Humana MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Optum VA,Optum VA,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,UHC,UHC,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,UHC MGG,UHC MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,VA,VA,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Wellcare MGG,Wellcare MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Bright Health - commercial,Bright Health - commercial,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Bright Health MGG,Bright Health MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Aetna,Aetna,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Aetna MGG,Aetna MGG,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,BCBS,BCBS,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,BCBS MGG,BCBS MGG,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Cigna,Cigna,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Cigna MGG,Cigna MGG,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Humana,Humana,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Humana MGG,Humana MGG,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Optum VA,Optum VA,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,UHC,UHC,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,UHC MGG,UHC MGG,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,VA,VA,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Wellcare MGG,Wellcare MGG,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Bright Health - commercial,Bright Health - commercial,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,Bright Health MGG,Bright Health MGG,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Aetna,Aetna,402.84,,,,,,,per diem,402.84,402.84,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Aetna MGG,Aetna MGG,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,BCBS,BCBS,402.84,,,,,,,per diem,402.84,402.84,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,BCBS MGG,BCBS MGG,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Cigna,Cigna,402.84,,,,,,,per diem,402.84,402.84,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Cigna MGG,Cigna MGG,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Humana,Humana,402.84,,,,,,,per diem,402.84,402.84,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Humana MGG,Humana MGG,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Optum VA,Optum VA,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,UHC,UHC,402.84,,,,,,,per diem,402.84,402.84,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,UHC MGG,UHC MGG,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,VA,VA,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Wellcare MGG,Wellcare MGG,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Bright Health - commercial,Bright Health - commercial,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,402.84,402.84,Bright Health MGG,Bright Health MGG,402.84,,,,,,,case rate,402.84,402.84,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Aetna,Aetna,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Aetna MGG,Aetna MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,BCBS,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS MGG,BCBS MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Cigna,Cigna,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Cigna MGG,Cigna MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Humana,Humana,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Humana MGG,Humana MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Optum VA,Optum VA,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UHC,UHC,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UHC MGG,UHC MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,VA,VA,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Wellcare MGG,Wellcare MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Bright Health - commercial,Bright Health - commercial,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Bright Health MGG,Bright Health MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Aetna,Aetna,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Aetna MGG,Aetna MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,BCBS,BCBS,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,BCBS MGG,BCBS MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Cigna,Cigna,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Cigna MGG,Cigna MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Humana,Humana,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Humana MGG,Humana MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Optum VA,Optum VA,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,UHC,UHC,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,UHC MGG,UHC MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,VA,VA,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Wellcare MGG,Wellcare MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Bright Health - commercial,Bright Health - commercial,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,255.78,255.78,Bright Health MGG,Bright Health MGG,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Aetna,Aetna,246,,,,,,,per diem,246,246,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Aetna MGG,Aetna MGG,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,BCBS,BCBS,246,,,,,,,per diem,246,246,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,BCBS MGG,BCBS MGG,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Cigna,Cigna,246,,,,,,,per diem,246,246,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Cigna MGG,Cigna MGG,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Humana,Humana,246,,,,,,,per diem,246,246,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Humana MGG,Humana MGG,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Optum VA,Optum VA,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,UHC,UHC,246,,,,,,,per diem,246,246,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,UHC MGG,UHC MGG,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,VA,VA,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Wellcare MGG,Wellcare MGG,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Bright Health - commercial,Bright Health - commercial,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,246,246,Bright Health MGG,Bright Health MGG,246,,,,,,,case rate,246,246,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Aetna,Aetna,466.26,,,,,,,per diem,466.26,466.26,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Aetna MGG,Aetna MGG,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,BCBS,BCBS,466.26,,,,,,,per diem,466.26,466.26,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,BCBS MGG,BCBS MGG,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Cigna,Cigna,466.26,,,,,,,per diem,466.26,466.26,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Cigna MGG,Cigna MGG,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Humana,Humana,466.26,,,,,,,per diem,466.26,466.26,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Humana MGG,Humana MGG,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Optum VA,Optum VA,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,UHC,UHC,466.26,,,,,,,per diem,466.26,466.26,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,UHC MGG,UHC MGG,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,VA,VA,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Wellcare MGG,Wellcare MGG,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Bright Health - commercial,Bright Health - commercial,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,466.26,466.26,Bright Health MGG,Bright Health MGG,466.26,,,,,,,case rate,466.26,466.26,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Aetna,Aetna,401.01,,,,,,,per diem,401.01,401.01,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Aetna MGG,Aetna MGG,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,BCBS,BCBS,401.01,,,,,,,per diem,401.01,401.01,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,BCBS MGG,BCBS MGG,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Cigna,Cigna,401.01,,,,,,,per diem,401.01,401.01,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Cigna MGG,Cigna MGG,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Humana,Humana,401.01,,,,,,,per diem,401.01,401.01,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Humana MGG,Humana MGG,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Optum VA,Optum VA,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,UHC,UHC,401.01,,,,,,,per diem,401.01,401.01,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,UHC MGG,UHC MGG,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,VA,VA,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Wellcare MGG,Wellcare MGG,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Bright Health - commercial,Bright Health - commercial,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,401.01,401.01,Bright Health MGG,Bright Health MGG,401.01,,,,,,,case rate,401.01,401.01,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Aetna,Aetna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Aetna MGG,Aetna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS,BCBS,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS MGG,BCBS MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Cigna,Cigna,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Cigna MGG,Cigna MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Humana,Humana,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Humana MGG,Humana MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Optum VA,Optum VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,UHC,UHC,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,UHC MGG,UHC MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,VA,VA,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Wellcare MGG,Wellcare MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Bright Health - commercial,Bright Health - commercial,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,Bright Health MGG,Bright Health MGG,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Aetna,Aetna,10.35,,,,,,,per diem,10.35,10.35,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Aetna MGG,Aetna MGG,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,BCBS,BCBS,10.35,,,,,,,per diem,10.35,10.35,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,BCBS MGG,BCBS MGG,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Cigna,Cigna,10.35,,,,,,,per diem,10.35,10.35,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Cigna MGG,Cigna MGG,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Humana,Humana,10.35,,,,,,,per diem,10.35,10.35,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Humana MGG,Humana MGG,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Optum VA,Optum VA,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,UHC,UHC,10.35,,,,,,,per diem,10.35,10.35,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,UHC MGG,UHC MGG,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,VA,VA,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Wellcare MGG,Wellcare MGG,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Bright Health - commercial,Bright Health - commercial,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.35,10.35,Bright Health MGG,Bright Health MGG,10.35,,,,,,,case rate,10.35,10.35,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna,Aetna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna MGG,Aetna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,BCBS,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS MGG,BCBS MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna,Cigna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna MGG,Cigna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana,Humana,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana MGG,Humana MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Optum VA,Optum VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC,UHC,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC MGG,UHC MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,VA,VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Wellcare MGG,Wellcare MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health - commercial,Bright Health - commercial,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health MGG,Bright Health MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Aetna,Aetna,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Aetna MGG,Aetna MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,BCBS,BCBS,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,BCBS MGG,BCBS MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Cigna,Cigna,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Cigna MGG,Cigna MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Humana,Humana,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Humana MGG,Humana MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Optum VA,Optum VA,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,UHC,UHC,37.2,,,,,,,per diem,37.2,37.2,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,UHC MGG,UHC MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,VA,VA,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Wellcare MGG,Wellcare MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Bright Health - commercial,Bright Health - commercial,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,37.2,37.2,Bright Health MGG,Bright Health MGG,37.2,,,,,,,case rate,37.2,37.2,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Aetna,Aetna,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Aetna MGG,Aetna MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,BCBS,BCBS,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,BCBS MGG,BCBS MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Cigna,Cigna,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Cigna MGG,Cigna MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Humana,Humana,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Humana MGG,Humana MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Optum VA,Optum VA,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,UHC,UHC,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,UHC MGG,UHC MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,VA,VA,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Wellcare MGG,Wellcare MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Bright Health - commercial,Bright Health - commercial,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Bright Health MGG,Bright Health MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Aetna,Aetna,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Aetna MGG,Aetna MGG,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,BCBS,BCBS,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,BCBS MGG,BCBS MGG,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Cigna,Cigna,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Cigna MGG,Cigna MGG,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Humana,Humana,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Humana MGG,Humana MGG,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Optum VA,Optum VA,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,UHC,UHC,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,UHC MGG,UHC MGG,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,VA,VA,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Wellcare MGG,Wellcare MGG,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Bright Health - commercial,Bright Health - commercial,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,81.9,81.9,Bright Health MGG,Bright Health MGG,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Aetna,Aetna,520.86,,,,,,,per diem,520.86,520.86,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Aetna MGG,Aetna MGG,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,BCBS,BCBS,520.86,,,,,,,per diem,520.86,520.86,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,BCBS MGG,BCBS MGG,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Cigna,Cigna,520.86,,,,,,,per diem,520.86,520.86,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Cigna MGG,Cigna MGG,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Humana,Humana,520.86,,,,,,,per diem,520.86,520.86,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Humana MGG,Humana MGG,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Optum VA,Optum VA,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,UHC,UHC,520.86,,,,,,,per diem,520.86,520.86,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,UHC MGG,UHC MGG,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,VA,VA,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Wellcare MGG,Wellcare MGG,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Bright Health - commercial,Bright Health - commercial,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,520.86,520.86,Bright Health MGG,Bright Health MGG,520.86,,,,,,,case rate,520.86,520.86,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Aetna,Aetna,7.29,,,,,,,per diem,7.29,7.29,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Aetna MGG,Aetna MGG,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,BCBS,BCBS,7.29,,,,,,,per diem,7.29,7.29,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,BCBS MGG,BCBS MGG,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Cigna,Cigna,7.29,,,,,,,per diem,7.29,7.29,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Cigna MGG,Cigna MGG,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Humana,Humana,7.29,,,,,,,per diem,7.29,7.29,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Humana MGG,Humana MGG,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Optum VA,Optum VA,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,UHC,UHC,7.29,,,,,,,per diem,7.29,7.29,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,UHC MGG,UHC MGG,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,VA,VA,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Wellcare MGG,Wellcare MGG,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Bright Health - commercial,Bright Health - commercial,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,7.29,7.29,Bright Health MGG,Bright Health MGG,7.29,,,,,,,case rate,7.29,7.29,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Aetna,Aetna,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Aetna MGG,Aetna MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,BCBS,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS MGG,BCBS MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Cigna,Cigna,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Cigna MGG,Cigna MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Humana,Humana,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Humana MGG,Humana MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Optum VA,Optum VA,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,UHC,UHC,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,UHC MGG,UHC MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,VA,VA,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Wellcare MGG,Wellcare MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Bright Health - commercial,Bright Health - commercial,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,Bright Health MGG,Bright Health MGG,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna,Aetna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna MGG,Aetna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS,BCBS,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS MGG,BCBS MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna,Cigna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna MGG,Cigna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana,Humana,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana MGG,Humana MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Optum VA,Optum VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC,UHC,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC MGG,UHC MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,VA,VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Wellcare MGG,Wellcare MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health - commercial,Bright Health - commercial,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health MGG,Bright Health MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Aetna,Aetna,254.97,,,,,,,per diem,254.97,254.97,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Aetna MGG,Aetna MGG,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,BCBS,BCBS,254.97,,,,,,,per diem,254.97,254.97,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,BCBS MGG,BCBS MGG,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Cigna,Cigna,254.97,,,,,,,per diem,254.97,254.97,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Cigna MGG,Cigna MGG,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Humana,Humana,254.97,,,,,,,per diem,254.97,254.97,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Humana MGG,Humana MGG,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Optum VA,Optum VA,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,UHC,UHC,254.97,,,,,,,per diem,254.97,254.97,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,UHC MGG,UHC MGG,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,VA,VA,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Wellcare MGG,Wellcare MGG,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Bright Health - commercial,Bright Health - commercial,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,254.97,254.97,Bright Health MGG,Bright Health MGG,254.97,,,,,,,case rate,254.97,254.97,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Aetna,Aetna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Aetna MGG,Aetna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,BCBS,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS MGG,BCBS MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Cigna,Cigna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Cigna MGG,Cigna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Humana,Humana,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Humana MGG,Humana MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Optum VA,Optum VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,UHC,UHC,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,UHC MGG,UHC MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Wellcare MGG,Wellcare MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Bright Health - commercial,Bright Health - commercial,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.4,8.4,Bright Health MGG,Bright Health MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Aetna,Aetna,604.08,,,,,,,per diem,604.08,604.08,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Aetna MGG,Aetna MGG,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,BCBS,BCBS,604.08,,,,,,,per diem,604.08,604.08,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,BCBS MGG,BCBS MGG,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Cigna,Cigna,604.08,,,,,,,per diem,604.08,604.08,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Cigna MGG,Cigna MGG,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Humana,Humana,604.08,,,,,,,per diem,604.08,604.08,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Humana MGG,Humana MGG,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Optum VA,Optum VA,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,UHC,UHC,604.08,,,,,,,per diem,604.08,604.08,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,UHC MGG,UHC MGG,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,VA,VA,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Wellcare MGG,Wellcare MGG,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Bright Health - commercial,Bright Health - commercial,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,604.08,604.08,Bright Health MGG,Bright Health MGG,604.08,,,,,,,case rate,604.08,604.08,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Aetna,Aetna,2073.6,,,,,,,per diem,2073.6,2073.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Aetna MGG,Aetna MGG,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,BCBS,BCBS,2073.6,,,,,,,per diem,2073.6,2073.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,BCBS MGG,BCBS MGG,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Cigna,Cigna,2073.6,,,,,,,per diem,2073.6,2073.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Cigna MGG,Cigna MGG,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Humana,Humana,2073.6,,,,,,,per diem,2073.6,2073.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Humana MGG,Humana MGG,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Optum VA,Optum VA,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,UHC,UHC,2073.6,,,,,,,per diem,2073.6,2073.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,UHC MGG,UHC MGG,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,VA,VA,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Wellcare MGG,Wellcare MGG,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Bright Health - commercial,Bright Health - commercial,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2073.6,2073.6,Bright Health MGG,Bright Health MGG,2073.6,,,,,,,case rate,2073.6,2073.6,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Aetna,Aetna,1083,,,,,,,per diem,1083,1083,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Aetna MGG,Aetna MGG,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,BCBS,BCBS,1083,,,,,,,per diem,1083,1083,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,BCBS MGG,BCBS MGG,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Cigna,Cigna,1083,,,,,,,per diem,1083,1083,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Cigna MGG,Cigna MGG,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Humana,Humana,1083,,,,,,,per diem,1083,1083,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Humana MGG,Humana MGG,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Optum VA,Optum VA,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,UHC,UHC,1083,,,,,,,per diem,1083,1083,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,UHC MGG,UHC MGG,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,VA,VA,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Wellcare MGG,Wellcare MGG,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Bright Health - commercial,Bright Health - commercial,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1083,1083,Bright Health MGG,Bright Health MGG,1083,,,,,,,case rate,1083,1083,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Aetna,Aetna,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Aetna MGG,Aetna MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,BCBS,BCBS,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,BCBS MGG,BCBS MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Cigna,Cigna,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Cigna MGG,Cigna MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Humana,Humana,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Humana MGG,Humana MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Optum VA,Optum VA,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,UHC,UHC,33.3,,,,,,,per diem,33.3,33.3,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,UHC MGG,UHC MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,VA,VA,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Wellcare MGG,Wellcare MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Bright Health - commercial,Bright Health - commercial,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,33.3,33.3,Bright Health MGG,Bright Health MGG,33.3,,,,,,,case rate,33.3,33.3,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Aetna,Aetna,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Aetna MGG,Aetna MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,BCBS,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS MGG,BCBS MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Cigna,Cigna,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Cigna MGG,Cigna MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Humana,Humana,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Humana MGG,Humana MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Optum VA,Optum VA,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UHC,UHC,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UHC MGG,UHC MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,VA,VA,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Wellcare MGG,Wellcare MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Bright Health - commercial,Bright Health - commercial,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Bright Health MGG,Bright Health MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Aetna,Aetna,16.6,,,,,,,per diem,16.6,16.6,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Aetna MGG,Aetna MGG,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,BCBS,BCBS,16.6,,,,,,,per diem,16.6,16.6,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,BCBS MGG,BCBS MGG,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Cigna,Cigna,16.6,,,,,,,per diem,16.6,16.6,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Cigna MGG,Cigna MGG,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Humana,Humana,16.6,,,,,,,per diem,16.6,16.6,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Humana MGG,Humana MGG,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Optum VA,Optum VA,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,UHC,UHC,16.6,,,,,,,per diem,16.6,16.6,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,UHC MGG,UHC MGG,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,VA,VA,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Wellcare MGG,Wellcare MGG,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Bright Health - commercial,Bright Health - commercial,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,16.6,16.6,Bright Health MGG,Bright Health MGG,16.6,,,,,,,case rate,16.6,16.6,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Aetna,Aetna,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Aetna MGG,Aetna MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,BCBS,BCBS,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,BCBS MGG,BCBS MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Cigna,Cigna,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Cigna MGG,Cigna MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Humana,Humana,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Humana MGG,Humana MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Optum VA,Optum VA,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,UHC,UHC,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,UHC MGG,UHC MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,VA,VA,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Wellcare MGG,Wellcare MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Bright Health - commercial,Bright Health - commercial,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Bright Health MGG,Bright Health MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna,Aetna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna MGG,Aetna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS,BCBS,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS MGG,BCBS MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna,Cigna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna MGG,Cigna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana,Humana,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana MGG,Humana MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Optum VA,Optum VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC,UHC,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC MGG,UHC MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,VA,VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Wellcare MGG,Wellcare MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health - commercial,Bright Health - commercial,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health MGG,Bright Health MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Aetna,Aetna,19.17,,,,,,,per diem,19.17,19.17,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Aetna MGG,Aetna MGG,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,BCBS,BCBS,19.17,,,,,,,per diem,19.17,19.17,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,BCBS MGG,BCBS MGG,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Cigna,Cigna,19.17,,,,,,,per diem,19.17,19.17,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Cigna MGG,Cigna MGG,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Humana,Humana,19.17,,,,,,,per diem,19.17,19.17,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Humana MGG,Humana MGG,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Optum VA,Optum VA,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,UHC,UHC,19.17,,,,,,,per diem,19.17,19.17,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,UHC MGG,UHC MGG,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,VA,VA,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Wellcare MGG,Wellcare MGG,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Bright Health - commercial,Bright Health - commercial,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,19.17,19.17,Bright Health MGG,Bright Health MGG,19.17,,,,,,,case rate,19.17,19.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Aetna,Aetna,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Aetna MGG,Aetna MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,BCBS,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS MGG,BCBS MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Cigna,Cigna,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Cigna MGG,Cigna MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Humana,Humana,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Humana MGG,Humana MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Optum VA,Optum VA,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UHC,UHC,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UHC MGG,UHC MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,VA,VA,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Wellcare MGG,Wellcare MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Bright Health - commercial,Bright Health - commercial,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Bright Health MGG,Bright Health MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Aetna,Aetna,48.27,,,,,,,per diem,48.27,48.27,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Aetna MGG,Aetna MGG,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,BCBS,BCBS,48.27,,,,,,,per diem,48.27,48.27,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,BCBS MGG,BCBS MGG,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Cigna,Cigna,48.27,,,,,,,per diem,48.27,48.27,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Cigna MGG,Cigna MGG,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Humana,Humana,48.27,,,,,,,per diem,48.27,48.27,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Humana MGG,Humana MGG,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Optum VA,Optum VA,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,UHC,UHC,48.27,,,,,,,per diem,48.27,48.27,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,UHC MGG,UHC MGG,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,VA,VA,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Wellcare MGG,Wellcare MGG,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Bright Health - commercial,Bright Health - commercial,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.27,48.27,Bright Health MGG,Bright Health MGG,48.27,,,,,,,case rate,48.27,48.27,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Aetna,Aetna,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Aetna MGG,Aetna MGG,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,BCBS,BCBS,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,BCBS MGG,BCBS MGG,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Cigna,Cigna,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Cigna MGG,Cigna MGG,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Humana,Humana,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Humana MGG,Humana MGG,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Optum VA,Optum VA,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,UHC,UHC,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,UHC MGG,UHC MGG,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,VA,VA,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Wellcare MGG,Wellcare MGG,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Bright Health - commercial,Bright Health - commercial,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,Bright Health MGG,Bright Health MGG,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Aetna,Aetna,294.09,,,,,,,per diem,294.09,294.09,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Aetna MGG,Aetna MGG,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,BCBS,BCBS,294.09,,,,,,,per diem,294.09,294.09,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,BCBS MGG,BCBS MGG,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Cigna,Cigna,294.09,,,,,,,per diem,294.09,294.09,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Cigna MGG,Cigna MGG,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Humana,Humana,294.09,,,,,,,per diem,294.09,294.09,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Humana MGG,Humana MGG,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Optum VA,Optum VA,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,UHC,UHC,294.09,,,,,,,per diem,294.09,294.09,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,UHC MGG,UHC MGG,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,VA,VA,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Wellcare MGG,Wellcare MGG,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Bright Health - commercial,Bright Health - commercial,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,294.09,294.09,Bright Health MGG,Bright Health MGG,294.09,,,,,,,case rate,294.09,294.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Aetna,Aetna,4647.6,,,,,,,per diem,4647.6,4647.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Aetna MGG,Aetna MGG,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,BCBS,BCBS,4647.6,,,,,,,per diem,4647.6,4647.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,BCBS MGG,BCBS MGG,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Cigna,Cigna,4647.6,,,,,,,per diem,4647.6,4647.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Cigna MGG,Cigna MGG,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Humana,Humana,4647.6,,,,,,,per diem,4647.6,4647.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Humana MGG,Humana MGG,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Optum VA,Optum VA,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,UHC,UHC,4647.6,,,,,,,per diem,4647.6,4647.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,UHC MGG,UHC MGG,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,VA,VA,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Wellcare MGG,Wellcare MGG,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Bright Health - commercial,Bright Health - commercial,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4647.6,4647.6,Bright Health MGG,Bright Health MGG,4647.6,,,,,,,case rate,4647.6,4647.6,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Aetna,Aetna,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Aetna MGG,Aetna MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,BCBS,BCBS,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,BCBS MGG,BCBS MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Cigna,Cigna,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Cigna MGG,Cigna MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Humana,Humana,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Humana MGG,Humana MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Optum VA,Optum VA,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,UHC,UHC,64.2,,,,,,,per diem,64.2,64.2,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,UHC MGG,UHC MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,VA,VA,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Wellcare MGG,Wellcare MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Bright Health - commercial,Bright Health - commercial,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,64.2,64.2,Bright Health MGG,Bright Health MGG,64.2,,,,,,,case rate,64.2,64.2,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Aetna,Aetna,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Aetna MGG,Aetna MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,BCBS,BCBS,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,BCBS MGG,BCBS MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Cigna,Cigna,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Cigna MGG,Cigna MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Humana,Humana,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Humana MGG,Humana MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Optum VA,Optum VA,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,UHC,UHC,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,UHC MGG,UHC MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,VA,VA,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Wellcare MGG,Wellcare MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Bright Health - commercial,Bright Health - commercial,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Bright Health MGG,Bright Health MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Aetna,Aetna,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Aetna MGG,Aetna MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,BCBS,BCBS,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,BCBS MGG,BCBS MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Cigna,Cigna,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Cigna MGG,Cigna MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Humana,Humana,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Humana MGG,Humana MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Optum VA,Optum VA,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,UHC,UHC,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,UHC MGG,UHC MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,VA,VA,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Wellcare MGG,Wellcare MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Bright Health - commercial,Bright Health - commercial,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Bright Health MGG,Bright Health MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Aetna,Aetna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Aetna MGG,Aetna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,BCBS,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS MGG,BCBS MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Cigna,Cigna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Cigna MGG,Cigna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Humana,Humana,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Humana MGG,Humana MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Optum VA,Optum VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UHC,UHC,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UHC MGG,UHC MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,VA,VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Wellcare MGG,Wellcare MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Bright Health - commercial,Bright Health - commercial,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Bright Health MGG,Bright Health MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Aetna,Aetna,129,,,,,,,per diem,129,129,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Aetna MGG,Aetna MGG,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,BCBS,BCBS,129,,,,,,,per diem,129,129,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,BCBS MGG,BCBS MGG,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Cigna,Cigna,129,,,,,,,per diem,129,129,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Cigna MGG,Cigna MGG,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Humana,Humana,129,,,,,,,per diem,129,129,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Humana MGG,Humana MGG,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Optum VA,Optum VA,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,UHC,UHC,129,,,,,,,per diem,129,129,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,UHC MGG,UHC MGG,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,VA,VA,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Wellcare MGG,Wellcare MGG,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Bright Health - commercial,Bright Health - commercial,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,129,129,Bright Health MGG,Bright Health MGG,129,,,,,,,case rate,129,129,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Aetna,Aetna,254.16,,,,,,,per diem,254.16,254.16,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Aetna MGG,Aetna MGG,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,BCBS,BCBS,254.16,,,,,,,per diem,254.16,254.16,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,BCBS MGG,BCBS MGG,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Cigna,Cigna,254.16,,,,,,,per diem,254.16,254.16,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Cigna MGG,Cigna MGG,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Humana,Humana,254.16,,,,,,,per diem,254.16,254.16,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Humana MGG,Humana MGG,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Optum VA,Optum VA,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,UHC,UHC,254.16,,,,,,,per diem,254.16,254.16,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,UHC MGG,UHC MGG,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,VA,VA,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Wellcare MGG,Wellcare MGG,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Bright Health - commercial,Bright Health - commercial,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,254.16,254.16,Bright Health MGG,Bright Health MGG,254.16,,,,,,,case rate,254.16,254.16,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Aetna,Aetna,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Aetna MGG,Aetna MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,BCBS,BCBS,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,BCBS MGG,BCBS MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Cigna,Cigna,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Cigna MGG,Cigna MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Humana,Humana,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Humana MGG,Humana MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Optum VA,Optum VA,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,UHC,UHC,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,UHC MGG,UHC MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,VA,VA,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Wellcare MGG,Wellcare MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Bright Health - commercial,Bright Health - commercial,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Bright Health MGG,Bright Health MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna,Aetna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna MGG,Aetna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS,BCBS,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS MGG,BCBS MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna,Cigna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna MGG,Cigna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana,Humana,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana MGG,Humana MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Optum VA,Optum VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC,UHC,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC MGG,UHC MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,VA,VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Wellcare MGG,Wellcare MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health - commercial,Bright Health - commercial,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health MGG,Bright Health MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Aetna,Aetna,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Aetna MGG,Aetna MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,BCBS,BCBS,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,BCBS MGG,BCBS MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Cigna,Cigna,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Cigna MGG,Cigna MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Humana,Humana,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Humana MGG,Humana MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Optum VA,Optum VA,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,UHC,UHC,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,UHC MGG,UHC MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,VA,VA,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Wellcare MGG,Wellcare MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Bright Health - commercial,Bright Health - commercial,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Bright Health MGG,Bright Health MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Aetna,Aetna,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Aetna MGG,Aetna MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,BCBS,BCBS,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,BCBS MGG,BCBS MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Cigna,Cigna,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Cigna MGG,Cigna MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Humana,Humana,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Humana MGG,Humana MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Optum VA,Optum VA,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,UHC,UHC,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,UHC MGG,UHC MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,VA,VA,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Wellcare MGG,Wellcare MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Bright Health - commercial,Bright Health - commercial,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Bright Health MGG,Bright Health MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Aetna,Aetna,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Aetna MGG,Aetna MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,BCBS,BCBS,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,BCBS MGG,BCBS MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Cigna,Cigna,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Cigna MGG,Cigna MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Humana,Humana,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Humana MGG,Humana MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Optum VA,Optum VA,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,UHC,UHC,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,UHC MGG,UHC MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,VA,VA,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Wellcare MGG,Wellcare MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Bright Health - commercial,Bright Health - commercial,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Bright Health MGG,Bright Health MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Aetna,Aetna,50.52,,,,,,,per diem,50.52,50.52,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Aetna MGG,Aetna MGG,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,BCBS,BCBS,50.52,,,,,,,per diem,50.52,50.52,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,BCBS MGG,BCBS MGG,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Cigna,Cigna,50.52,,,,,,,per diem,50.52,50.52,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Cigna MGG,Cigna MGG,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Humana,Humana,50.52,,,,,,,per diem,50.52,50.52,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Humana MGG,Humana MGG,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Optum VA,Optum VA,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,UHC,UHC,50.52,,,,,,,per diem,50.52,50.52,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,UHC MGG,UHC MGG,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,VA,VA,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Wellcare MGG,Wellcare MGG,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Bright Health - commercial,Bright Health - commercial,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,50.52,50.52,Bright Health MGG,Bright Health MGG,50.52,,,,,,,case rate,50.52,50.52,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Aetna,Aetna,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Aetna MGG,Aetna MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,BCBS,BCBS,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,BCBS MGG,BCBS MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Cigna,Cigna,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Cigna MGG,Cigna MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Humana,Humana,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Humana MGG,Humana MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Optum VA,Optum VA,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,UHC,UHC,48.93,,,,,,,per diem,48.93,48.93,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,UHC MGG,UHC MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,VA,VA,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Wellcare MGG,Wellcare MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Bright Health - commercial,Bright Health - commercial,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,48.93,48.93,Bright Health MGG,Bright Health MGG,48.93,,,,,,,case rate,48.93,48.93,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Aetna,Aetna,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Aetna MGG,Aetna MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,BCBS,BCBS,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,BCBS MGG,BCBS MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Cigna,Cigna,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Cigna MGG,Cigna MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Humana,Humana,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Humana MGG,Humana MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Optum VA,Optum VA,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,UHC,UHC,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,UHC MGG,UHC MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,VA,VA,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Wellcare MGG,Wellcare MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Bright Health - commercial,Bright Health - commercial,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Bright Health MGG,Bright Health MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna,Aetna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna MGG,Aetna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS,BCBS,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS MGG,BCBS MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna,Cigna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna MGG,Cigna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana,Humana,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana MGG,Humana MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Optum VA,Optum VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC,UHC,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC MGG,UHC MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,VA,VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Wellcare MGG,Wellcare MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health - commercial,Bright Health - commercial,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health MGG,Bright Health MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Aetna,Aetna,474.63,,,,,,,per diem,474.63,474.63,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Aetna MGG,Aetna MGG,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,BCBS,BCBS,474.63,,,,,,,per diem,474.63,474.63,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,BCBS MGG,BCBS MGG,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Cigna,Cigna,474.63,,,,,,,per diem,474.63,474.63,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Cigna MGG,Cigna MGG,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Humana,Humana,474.63,,,,,,,per diem,474.63,474.63,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Humana MGG,Humana MGG,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Optum VA,Optum VA,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,UHC,UHC,474.63,,,,,,,per diem,474.63,474.63,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,UHC MGG,UHC MGG,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,VA,VA,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Wellcare MGG,Wellcare MGG,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Bright Health - commercial,Bright Health - commercial,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,474.63,474.63,Bright Health MGG,Bright Health MGG,474.63,,,,,,,case rate,474.63,474.63,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Aetna,Aetna,15.51,,,,,,,per diem,15.51,15.51,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Aetna MGG,Aetna MGG,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,BCBS,BCBS,15.51,,,,,,,per diem,15.51,15.51,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,BCBS MGG,BCBS MGG,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Cigna,Cigna,15.51,,,,,,,per diem,15.51,15.51,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Cigna MGG,Cigna MGG,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Humana,Humana,15.51,,,,,,,per diem,15.51,15.51,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Humana MGG,Humana MGG,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Optum VA,Optum VA,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,UHC,UHC,15.51,,,,,,,per diem,15.51,15.51,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,UHC MGG,UHC MGG,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,VA,VA,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Wellcare MGG,Wellcare MGG,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Bright Health - commercial,Bright Health - commercial,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,15.51,15.51,Bright Health MGG,Bright Health MGG,15.51,,,,,,,case rate,15.51,15.51,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna,Aetna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna MGG,Aetna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,BCBS,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS MGG,BCBS MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna,Cigna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna MGG,Cigna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana,Humana,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana MGG,Humana MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Optum VA,Optum VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC,UHC,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC MGG,UHC MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,VA,VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Wellcare MGG,Wellcare MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health - commercial,Bright Health - commercial,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health MGG,Bright Health MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Aetna,Aetna,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Aetna MGG,Aetna MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,BCBS,BCBS,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,BCBS MGG,BCBS MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Cigna,Cigna,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Cigna MGG,Cigna MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Humana,Humana,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Humana MGG,Humana MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Optum VA,Optum VA,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,UHC,UHC,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,UHC MGG,UHC MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,VA,VA,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Wellcare MGG,Wellcare MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Bright Health - commercial,Bright Health - commercial,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Bright Health MGG,Bright Health MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Aetna,Aetna,440.7,,,,,,,per diem,440.7,440.7,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Aetna MGG,Aetna MGG,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,BCBS,BCBS,440.7,,,,,,,per diem,440.7,440.7,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,BCBS MGG,BCBS MGG,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Cigna,Cigna,440.7,,,,,,,per diem,440.7,440.7,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Cigna MGG,Cigna MGG,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Humana,Humana,440.7,,,,,,,per diem,440.7,440.7,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Humana MGG,Humana MGG,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Optum VA,Optum VA,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,UHC,UHC,440.7,,,,,,,per diem,440.7,440.7,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,UHC MGG,UHC MGG,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,VA,VA,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Wellcare MGG,Wellcare MGG,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Bright Health - commercial,Bright Health - commercial,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,440.7,440.7,Bright Health MGG,Bright Health MGG,440.7,,,,,,,case rate,440.7,440.7,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Aetna,Aetna,130.8,,,,,,,per diem,130.8,130.8,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Aetna MGG,Aetna MGG,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,BCBS,BCBS,130.8,,,,,,,per diem,130.8,130.8,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,BCBS MGG,BCBS MGG,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Cigna,Cigna,130.8,,,,,,,per diem,130.8,130.8,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Cigna MGG,Cigna MGG,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Humana,Humana,130.8,,,,,,,per diem,130.8,130.8,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Humana MGG,Humana MGG,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Optum VA,Optum VA,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,UHC,UHC,130.8,,,,,,,per diem,130.8,130.8,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,UHC MGG,UHC MGG,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,VA,VA,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Wellcare MGG,Wellcare MGG,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Bright Health - commercial,Bright Health - commercial,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,130.8,130.8,Bright Health MGG,Bright Health MGG,130.8,,,,,,,case rate,130.8,130.8,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Aetna,Aetna,180.9,,,,,,,per diem,180.9,180.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Aetna MGG,Aetna MGG,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,BCBS,BCBS,180.9,,,,,,,per diem,180.9,180.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,BCBS MGG,BCBS MGG,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Cigna,Cigna,180.9,,,,,,,per diem,180.9,180.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Cigna MGG,Cigna MGG,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Humana,Humana,180.9,,,,,,,per diem,180.9,180.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Humana MGG,Humana MGG,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Optum VA,Optum VA,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,UHC,UHC,180.9,,,,,,,per diem,180.9,180.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,UHC MGG,UHC MGG,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,VA,VA,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Wellcare MGG,Wellcare MGG,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Bright Health - commercial,Bright Health - commercial,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,180.9,180.9,Bright Health MGG,Bright Health MGG,180.9,,,,,,,case rate,180.9,180.9,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna,Aetna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna MGG,Aetna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,BCBS,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS MGG,BCBS MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna,Cigna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna MGG,Cigna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana,Humana,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana MGG,Humana MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Optum VA,Optum VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC,UHC,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC MGG,UHC MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,VA,VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Wellcare MGG,Wellcare MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health - commercial,Bright Health - commercial,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health MGG,Bright Health MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Aetna,Aetna,185.91,,,,,,,per diem,185.91,185.91,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Aetna MGG,Aetna MGG,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,BCBS,BCBS,185.91,,,,,,,per diem,185.91,185.91,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,BCBS MGG,BCBS MGG,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Cigna,Cigna,185.91,,,,,,,per diem,185.91,185.91,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Cigna MGG,Cigna MGG,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Humana,Humana,185.91,,,,,,,per diem,185.91,185.91,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Humana MGG,Humana MGG,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Optum VA,Optum VA,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,UHC,UHC,185.91,,,,,,,per diem,185.91,185.91,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,UHC MGG,UHC MGG,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,VA,VA,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Wellcare MGG,Wellcare MGG,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Bright Health - commercial,Bright Health - commercial,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,185.91,185.91,Bright Health MGG,Bright Health MGG,185.91,,,,,,,case rate,185.91,185.91,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Aetna,Aetna,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Aetna MGG,Aetna MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,BCBS,BCBS,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,BCBS MGG,BCBS MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Cigna,Cigna,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Cigna MGG,Cigna MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Humana,Humana,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Humana MGG,Humana MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Optum VA,Optum VA,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,UHC,UHC,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,UHC MGG,UHC MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,VA,VA,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Wellcare MGG,Wellcare MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Bright Health - commercial,Bright Health - commercial,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Bright Health MGG,Bright Health MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Aetna,Aetna,84.72,,,,,,,per diem,84.72,84.72,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Aetna MGG,Aetna MGG,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,BCBS,BCBS,84.72,,,,,,,per diem,84.72,84.72,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,BCBS MGG,BCBS MGG,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Cigna,Cigna,84.72,,,,,,,per diem,84.72,84.72,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Cigna MGG,Cigna MGG,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Humana,Humana,84.72,,,,,,,per diem,84.72,84.72,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Humana MGG,Humana MGG,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Optum VA,Optum VA,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,UHC,UHC,84.72,,,,,,,per diem,84.72,84.72,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,UHC MGG,UHC MGG,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,VA,VA,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Wellcare MGG,Wellcare MGG,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Bright Health - commercial,Bright Health - commercial,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,84.72,84.72,Bright Health MGG,Bright Health MGG,84.72,,,,,,,case rate,84.72,84.72,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Aetna,Aetna,308.46,,,,,,,per diem,308.46,308.46,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Aetna MGG,Aetna MGG,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,BCBS,BCBS,308.46,,,,,,,per diem,308.46,308.46,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,BCBS MGG,BCBS MGG,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Cigna,Cigna,308.46,,,,,,,per diem,308.46,308.46,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Cigna MGG,Cigna MGG,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Humana,Humana,308.46,,,,,,,per diem,308.46,308.46,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Humana MGG,Humana MGG,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Optum VA,Optum VA,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,UHC,UHC,308.46,,,,,,,per diem,308.46,308.46,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,UHC MGG,UHC MGG,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,VA,VA,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Wellcare MGG,Wellcare MGG,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Bright Health - commercial,Bright Health - commercial,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,308.46,308.46,Bright Health MGG,Bright Health MGG,308.46,,,,,,,case rate,308.46,308.46,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Aetna,Aetna,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Aetna MGG,Aetna MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,BCBS,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS MGG,BCBS MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Cigna,Cigna,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Cigna MGG,Cigna MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Humana,Humana,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Humana MGG,Humana MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Optum VA,Optum VA,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UHC,UHC,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UHC MGG,UHC MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA,VA,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Wellcare MGG,Wellcare MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Bright Health - commercial,Bright Health - commercial,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Bright Health MGG,Bright Health MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Aetna,Aetna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Aetna MGG,Aetna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,BCBS,BCBS,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,BCBS MGG,BCBS MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Cigna,Cigna,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Cigna MGG,Cigna MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Humana,Humana,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Humana MGG,Humana MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Optum VA,Optum VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,UHC,UHC,45,,,,,,,per diem,45,45,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,UHC MGG,UHC MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,VA,VA,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Wellcare MGG,Wellcare MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Bright Health - commercial,Bright Health - commercial,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,45,45,Bright Health MGG,Bright Health MGG,45,,,,,,,case rate,45,45,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Aetna,Aetna,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Aetna MGG,Aetna MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,BCBS,BCBS,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,BCBS MGG,BCBS MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Cigna,Cigna,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Cigna MGG,Cigna MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Humana,Humana,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Humana MGG,Humana MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Optum VA,Optum VA,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,UHC,UHC,26.04,,,,,,,per diem,26.04,26.04,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,UHC MGG,UHC MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,VA,VA,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Wellcare MGG,Wellcare MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Bright Health - commercial,Bright Health - commercial,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,26.04,26.04,Bright Health MGG,Bright Health MGG,26.04,,,,,,,case rate,26.04,26.04,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Aetna,Aetna,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Aetna MGG,Aetna MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,BCBS,BCBS,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,BCBS MGG,BCBS MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Cigna,Cigna,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Cigna MGG,Cigna MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Humana,Humana,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Humana MGG,Humana MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Optum VA,Optum VA,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,UHC,UHC,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,UHC MGG,UHC MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,VA,VA,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Wellcare MGG,Wellcare MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Bright Health - commercial,Bright Health - commercial,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Bright Health MGG,Bright Health MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Aetna,Aetna,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Aetna MGG,Aetna MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,BCBS,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS MGG,BCBS MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Cigna,Cigna,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Cigna MGG,Cigna MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Humana,Humana,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Humana MGG,Humana MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Optum VA,Optum VA,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UHC,UHC,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UHC MGG,UHC MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,VA,VA,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Wellcare MGG,Wellcare MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Bright Health - commercial,Bright Health - commercial,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Bright Health MGG,Bright Health MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Aetna,Aetna,12.27,,,,,,,per diem,12.27,12.27,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Aetna MGG,Aetna MGG,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,BCBS,BCBS,12.27,,,,,,,per diem,12.27,12.27,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,BCBS MGG,BCBS MGG,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Cigna,Cigna,12.27,,,,,,,per diem,12.27,12.27,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Cigna MGG,Cigna MGG,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Humana,Humana,12.27,,,,,,,per diem,12.27,12.27,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Humana MGG,Humana MGG,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Optum VA,Optum VA,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,UHC,UHC,12.27,,,,,,,per diem,12.27,12.27,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,UHC MGG,UHC MGG,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,VA,VA,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Wellcare MGG,Wellcare MGG,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Bright Health - commercial,Bright Health - commercial,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,12.27,12.27,Bright Health MGG,Bright Health MGG,12.27,,,,,,,case rate,12.27,12.27,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Aetna,Aetna,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Aetna MGG,Aetna MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,BCBS,BCBS,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,BCBS MGG,BCBS MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Cigna,Cigna,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Cigna MGG,Cigna MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Humana,Humana,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Humana MGG,Humana MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Optum VA,Optum VA,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,UHC,UHC,779.25,,,,,,,per diem,779.25,779.25,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,UHC MGG,UHC MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,VA,VA,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Wellcare MGG,Wellcare MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Bright Health - commercial,Bright Health - commercial,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,779.25,779.25,Bright Health MGG,Bright Health MGG,779.25,,,,,,,case rate,779.25,779.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Aetna,Aetna,51.51,,,,,,,per diem,51.51,51.51,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Aetna MGG,Aetna MGG,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,BCBS,BCBS,51.51,,,,,,,per diem,51.51,51.51,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,BCBS MGG,BCBS MGG,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Cigna,Cigna,51.51,,,,,,,per diem,51.51,51.51,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Cigna MGG,Cigna MGG,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Humana,Humana,51.51,,,,,,,per diem,51.51,51.51,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Humana MGG,Humana MGG,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Optum VA,Optum VA,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,UHC,UHC,51.51,,,,,,,per diem,51.51,51.51,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,UHC MGG,UHC MGG,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,VA,VA,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Wellcare MGG,Wellcare MGG,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Bright Health - commercial,Bright Health - commercial,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,51.51,51.51,Bright Health MGG,Bright Health MGG,51.51,,,,,,,case rate,51.51,51.51,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Aetna,Aetna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Aetna MGG,Aetna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,BCBS,BCBS,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,BCBS MGG,BCBS MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Cigna,Cigna,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Cigna MGG,Cigna MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Humana,Humana,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Humana MGG,Humana MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Optum VA,Optum VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,UHC,UHC,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,UHC MGG,UHC MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,VA,VA,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Wellcare MGG,Wellcare MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Bright Health - commercial,Bright Health - commercial,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,39.63,39.63,Bright Health MGG,Bright Health MGG,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Aetna,Aetna,27.27,,,,,,,per diem,27.27,27.27,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Aetna MGG,Aetna MGG,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,BCBS,BCBS,27.27,,,,,,,per diem,27.27,27.27,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,BCBS MGG,BCBS MGG,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Cigna,Cigna,27.27,,,,,,,per diem,27.27,27.27,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Cigna MGG,Cigna MGG,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Humana,Humana,27.27,,,,,,,per diem,27.27,27.27,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Humana MGG,Humana MGG,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Optum VA,Optum VA,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,UHC,UHC,27.27,,,,,,,per diem,27.27,27.27,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,UHC MGG,UHC MGG,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,VA,VA,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Wellcare MGG,Wellcare MGG,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Bright Health - commercial,Bright Health - commercial,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,27.27,27.27,Bright Health MGG,Bright Health MGG,27.27,,,,,,,case rate,27.27,27.27,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Aetna,Aetna,265.68,,,,,,,per diem,265.68,265.68,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Aetna MGG,Aetna MGG,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,BCBS,BCBS,265.68,,,,,,,per diem,265.68,265.68,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,BCBS MGG,BCBS MGG,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Cigna,Cigna,265.68,,,,,,,per diem,265.68,265.68,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Cigna MGG,Cigna MGG,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Humana,Humana,265.68,,,,,,,per diem,265.68,265.68,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Humana MGG,Humana MGG,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Optum VA,Optum VA,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,UHC,UHC,265.68,,,,,,,per diem,265.68,265.68,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,UHC MGG,UHC MGG,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,VA,VA,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Wellcare MGG,Wellcare MGG,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Bright Health - commercial,Bright Health - commercial,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,265.68,265.68,Bright Health MGG,Bright Health MGG,265.68,,,,,,,case rate,265.68,265.68,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Aetna,Aetna,268.62,,,,,,,per diem,268.62,268.62,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Aetna MGG,Aetna MGG,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,BCBS,BCBS,268.62,,,,,,,per diem,268.62,268.62,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,BCBS MGG,BCBS MGG,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Cigna,Cigna,268.62,,,,,,,per diem,268.62,268.62,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Cigna MGG,Cigna MGG,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Humana,Humana,268.62,,,,,,,per diem,268.62,268.62,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Humana MGG,Humana MGG,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Optum VA,Optum VA,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,UHC,UHC,268.62,,,,,,,per diem,268.62,268.62,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,UHC MGG,UHC MGG,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,VA,VA,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Wellcare MGG,Wellcare MGG,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Bright Health - commercial,Bright Health - commercial,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,268.62,268.62,Bright Health MGG,Bright Health MGG,268.62,,,,,,,case rate,268.62,268.62,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Aetna,Aetna,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Aetna MGG,Aetna MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,BCBS,BCBS,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,BCBS MGG,BCBS MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Cigna,Cigna,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Cigna MGG,Cigna MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Humana,Humana,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Humana MGG,Humana MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Optum VA,Optum VA,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,UHC,UHC,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,UHC MGG,UHC MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,VA,VA,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Wellcare MGG,Wellcare MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Bright Health - commercial,Bright Health - commercial,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Bright Health MGG,Bright Health MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Aetna,Aetna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Aetna MGG,Aetna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,BCBS,BCBS,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,BCBS MGG,BCBS MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Cigna,Cigna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Cigna MGG,Cigna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Humana,Humana,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Humana MGG,Humana MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Optum VA,Optum VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,UHC,UHC,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,UHC MGG,UHC MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,VA,VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Wellcare MGG,Wellcare MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Bright Health - commercial,Bright Health - commercial,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Bright Health MGG,Bright Health MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Aetna,Aetna,14.01,,,,,,,per diem,14.01,14.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Aetna MGG,Aetna MGG,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,BCBS,BCBS,14.01,,,,,,,per diem,14.01,14.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,BCBS MGG,BCBS MGG,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Cigna,Cigna,14.01,,,,,,,per diem,14.01,14.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Cigna MGG,Cigna MGG,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Humana,Humana,14.01,,,,,,,per diem,14.01,14.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Humana MGG,Humana MGG,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Optum VA,Optum VA,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,UHC,UHC,14.01,,,,,,,per diem,14.01,14.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,UHC MGG,UHC MGG,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,VA,VA,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Wellcare MGG,Wellcare MGG,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Bright Health - commercial,Bright Health - commercial,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.01,14.01,Bright Health MGG,Bright Health MGG,14.01,,,,,,,case rate,14.01,14.01,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Aetna,Aetna,19.59,,,,,,,per diem,19.59,19.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Aetna MGG,Aetna MGG,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,BCBS,BCBS,19.59,,,,,,,per diem,19.59,19.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,BCBS MGG,BCBS MGG,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Cigna,Cigna,19.59,,,,,,,per diem,19.59,19.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Cigna MGG,Cigna MGG,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Humana,Humana,19.59,,,,,,,per diem,19.59,19.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Humana MGG,Humana MGG,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Optum VA,Optum VA,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,UHC,UHC,19.59,,,,,,,per diem,19.59,19.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,UHC MGG,UHC MGG,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,VA,VA,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Wellcare MGG,Wellcare MGG,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Bright Health - commercial,Bright Health - commercial,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,19.59,19.59,Bright Health MGG,Bright Health MGG,19.59,,,,,,,case rate,19.59,19.59,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Aetna,Aetna,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Aetna MGG,Aetna MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,BCBS,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS MGG,BCBS MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Cigna,Cigna,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Cigna MGG,Cigna MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Humana,Humana,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Humana MGG,Humana MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Optum VA,Optum VA,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UHC,UHC,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UHC MGG,UHC MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,VA,VA,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Wellcare MGG,Wellcare MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Bright Health - commercial,Bright Health - commercial,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Bright Health MGG,Bright Health MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna,Aetna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna MGG,Aetna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS,BCBS,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS MGG,BCBS MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna,Cigna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna MGG,Cigna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana,Humana,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana MGG,Humana MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Optum VA,Optum VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC,UHC,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC MGG,UHC MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,VA,VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Wellcare MGG,Wellcare MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health - commercial,Bright Health - commercial,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health MGG,Bright Health MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Aetna,Aetna,13.32,,,,,,,per diem,13.32,13.32,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Aetna MGG,Aetna MGG,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,BCBS,BCBS,13.32,,,,,,,per diem,13.32,13.32,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,BCBS MGG,BCBS MGG,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Cigna,Cigna,13.32,,,,,,,per diem,13.32,13.32,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Cigna MGG,Cigna MGG,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Humana,Humana,13.32,,,,,,,per diem,13.32,13.32,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Humana MGG,Humana MGG,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Optum VA,Optum VA,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,UHC,UHC,13.32,,,,,,,per diem,13.32,13.32,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,UHC MGG,UHC MGG,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,VA,VA,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Wellcare MGG,Wellcare MGG,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Bright Health - commercial,Bright Health - commercial,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.32,13.32,Bright Health MGG,Bright Health MGG,13.32,,,,,,,case rate,13.32,13.32,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Aetna,Aetna,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Aetna MGG,Aetna MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,BCBS,BCBS,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,BCBS MGG,BCBS MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Cigna,Cigna,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Cigna MGG,Cigna MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Humana,Humana,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Humana MGG,Humana MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Optum VA,Optum VA,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,UHC,UHC,69.57,,,,,,,per diem,69.57,69.57,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,UHC MGG,UHC MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,VA,VA,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Wellcare MGG,Wellcare MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Bright Health - commercial,Bright Health - commercial,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,69.57,69.57,Bright Health MGG,Bright Health MGG,69.57,,,,,,,case rate,69.57,69.57,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Aetna,Aetna,171.87,,,,,,,per diem,171.87,171.87,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Aetna MGG,Aetna MGG,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,BCBS,BCBS,171.87,,,,,,,per diem,171.87,171.87,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,BCBS MGG,BCBS MGG,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Cigna,Cigna,171.87,,,,,,,per diem,171.87,171.87,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Cigna MGG,Cigna MGG,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Humana,Humana,171.87,,,,,,,per diem,171.87,171.87,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Humana MGG,Humana MGG,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Optum VA,Optum VA,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,UHC,UHC,171.87,,,,,,,per diem,171.87,171.87,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,UHC MGG,UHC MGG,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,VA,VA,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Wellcare MGG,Wellcare MGG,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Bright Health - commercial,Bright Health - commercial,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,171.87,171.87,Bright Health MGG,Bright Health MGG,171.87,,,,,,,case rate,171.87,171.87,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna,Aetna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna MGG,Aetna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,BCBS,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS MGG,BCBS MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna,Cigna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna MGG,Cigna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana,Humana,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana MGG,Humana MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Optum VA,Optum VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC,UHC,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC MGG,UHC MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,VA,VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Wellcare MGG,Wellcare MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health - commercial,Bright Health - commercial,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health MGG,Bright Health MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna,Aetna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna MGG,Aetna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,BCBS,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS MGG,BCBS MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna,Cigna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna MGG,Cigna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana,Humana,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana MGG,Humana MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Optum VA,Optum VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC,UHC,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC MGG,UHC MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Wellcare MGG,Wellcare MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health - commercial,Bright Health - commercial,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health MGG,Bright Health MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Aetna,Aetna,25.41,,,,,,,per diem,25.41,25.41,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Aetna MGG,Aetna MGG,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,BCBS,BCBS,25.41,,,,,,,per diem,25.41,25.41,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,BCBS MGG,BCBS MGG,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Cigna,Cigna,25.41,,,,,,,per diem,25.41,25.41,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Cigna MGG,Cigna MGG,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Humana,Humana,25.41,,,,,,,per diem,25.41,25.41,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Humana MGG,Humana MGG,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Optum VA,Optum VA,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,UHC,UHC,25.41,,,,,,,per diem,25.41,25.41,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,UHC MGG,UHC MGG,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,VA,VA,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Wellcare MGG,Wellcare MGG,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Bright Health - commercial,Bright Health - commercial,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,25.41,25.41,Bright Health MGG,Bright Health MGG,25.41,,,,,,,case rate,25.41,25.41,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Aetna,Aetna,68.31,,,,,,,per diem,68.31,68.31,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Aetna MGG,Aetna MGG,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,BCBS,BCBS,68.31,,,,,,,per diem,68.31,68.31,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,BCBS MGG,BCBS MGG,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Cigna,Cigna,68.31,,,,,,,per diem,68.31,68.31,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Cigna MGG,Cigna MGG,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Humana,Humana,68.31,,,,,,,per diem,68.31,68.31,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Humana MGG,Humana MGG,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Optum VA,Optum VA,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,UHC,UHC,68.31,,,,,,,per diem,68.31,68.31,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,UHC MGG,UHC MGG,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,VA,VA,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Wellcare MGG,Wellcare MGG,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Bright Health - commercial,Bright Health - commercial,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,68.31,68.31,Bright Health MGG,Bright Health MGG,68.31,,,,,,,case rate,68.31,68.31,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna,Aetna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna MGG,Aetna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS,BCBS,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS MGG,BCBS MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna,Cigna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna MGG,Cigna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana,Humana,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana MGG,Humana MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Optum VA,Optum VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC,UHC,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC MGG,UHC MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,VA,VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Wellcare MGG,Wellcare MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health - commercial,Bright Health - commercial,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health MGG,Bright Health MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Aetna,Aetna,12.93,,,,,,,per diem,12.93,12.93,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Aetna MGG,Aetna MGG,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,BCBS,BCBS,12.93,,,,,,,per diem,12.93,12.93,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,BCBS MGG,BCBS MGG,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Cigna,Cigna,12.93,,,,,,,per diem,12.93,12.93,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Cigna MGG,Cigna MGG,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Humana,Humana,12.93,,,,,,,per diem,12.93,12.93,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Humana MGG,Humana MGG,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Optum VA,Optum VA,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,UHC,UHC,12.93,,,,,,,per diem,12.93,12.93,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,UHC MGG,UHC MGG,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,VA,VA,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Wellcare MGG,Wellcare MGG,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Bright Health - commercial,Bright Health - commercial,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,12.93,12.93,Bright Health MGG,Bright Health MGG,12.93,,,,,,,case rate,12.93,12.93,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Aetna,Aetna,15.99,,,,,,,per diem,15.99,15.99,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Aetna MGG,Aetna MGG,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,BCBS,BCBS,15.99,,,,,,,per diem,15.99,15.99,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,BCBS MGG,BCBS MGG,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Cigna,Cigna,15.99,,,,,,,per diem,15.99,15.99,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Cigna MGG,Cigna MGG,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Humana,Humana,15.99,,,,,,,per diem,15.99,15.99,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Humana MGG,Humana MGG,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Optum VA,Optum VA,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,UHC,UHC,15.99,,,,,,,per diem,15.99,15.99,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,UHC MGG,UHC MGG,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,VA,VA,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Wellcare MGG,Wellcare MGG,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Bright Health - commercial,Bright Health - commercial,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,15.99,15.99,Bright Health MGG,Bright Health MGG,15.99,,,,,,,case rate,15.99,15.99,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Aetna,Aetna,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Aetna MGG,Aetna MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,BCBS,BCBS,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,BCBS MGG,BCBS MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Cigna,Cigna,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Cigna MGG,Cigna MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Humana,Humana,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Humana MGG,Humana MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Optum VA,Optum VA,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,UHC,UHC,29.94,,,,,,,per diem,29.94,29.94,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,UHC MGG,UHC MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,VA,VA,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Wellcare MGG,Wellcare MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Bright Health - commercial,Bright Health - commercial,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,29.94,29.94,Bright Health MGG,Bright Health MGG,29.94,,,,,,,case rate,29.94,29.94,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Aetna,Aetna,37.95,,,,,,,per diem,37.95,37.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Aetna MGG,Aetna MGG,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,BCBS,BCBS,37.95,,,,,,,per diem,37.95,37.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,BCBS MGG,BCBS MGG,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Cigna,Cigna,37.95,,,,,,,per diem,37.95,37.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Cigna MGG,Cigna MGG,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Humana,Humana,37.95,,,,,,,per diem,37.95,37.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Humana MGG,Humana MGG,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Optum VA,Optum VA,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,UHC,UHC,37.95,,,,,,,per diem,37.95,37.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,UHC MGG,UHC MGG,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,VA,VA,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Wellcare MGG,Wellcare MGG,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Bright Health - commercial,Bright Health - commercial,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,37.95,37.95,Bright Health MGG,Bright Health MGG,37.95,,,,,,,case rate,37.95,37.95,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Aetna,Aetna,24.45,,,,,,,per diem,24.45,24.45,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Aetna MGG,Aetna MGG,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,BCBS,BCBS,24.45,,,,,,,per diem,24.45,24.45,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,BCBS MGG,BCBS MGG,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Cigna,Cigna,24.45,,,,,,,per diem,24.45,24.45,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Cigna MGG,Cigna MGG,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Humana,Humana,24.45,,,,,,,per diem,24.45,24.45,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Humana MGG,Humana MGG,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Optum VA,Optum VA,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,UHC,UHC,24.45,,,,,,,per diem,24.45,24.45,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,UHC MGG,UHC MGG,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,VA,VA,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Wellcare MGG,Wellcare MGG,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Bright Health - commercial,Bright Health - commercial,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,24.45,24.45,Bright Health MGG,Bright Health MGG,24.45,,,,,,,case rate,24.45,24.45,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Aetna,Aetna,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Aetna MGG,Aetna MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,BCBS,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS MGG,BCBS MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Cigna,Cigna,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Cigna MGG,Cigna MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Humana,Humana,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Humana MGG,Humana MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Optum VA,Optum VA,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UHC,UHC,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UHC MGG,UHC MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,VA,VA,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Wellcare MGG,Wellcare MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Bright Health - commercial,Bright Health - commercial,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Bright Health MGG,Bright Health MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Aetna,Aetna,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Aetna MGG,Aetna MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,BCBS,BCBS,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,BCBS MGG,BCBS MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Cigna,Cigna,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Cigna MGG,Cigna MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Humana,Humana,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Humana MGG,Humana MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Optum VA,Optum VA,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,UHC,UHC,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,UHC MGG,UHC MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,VA,VA,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Wellcare MGG,Wellcare MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Bright Health - commercial,Bright Health - commercial,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Bright Health MGG,Bright Health MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Aetna,Aetna,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Aetna MGG,Aetna MGG,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,BCBS,BCBS,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,BCBS MGG,BCBS MGG,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Cigna,Cigna,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Cigna MGG,Cigna MGG,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Humana,Humana,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Humana MGG,Humana MGG,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Optum VA,Optum VA,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,UHC,UHC,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,UHC MGG,UHC MGG,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,VA,VA,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Wellcare MGG,Wellcare MGG,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Bright Health - commercial,Bright Health - commercial,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,24.9,24.9,Bright Health MGG,Bright Health MGG,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Aetna,Aetna,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Aetna MGG,Aetna MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,BCBS,BCBS,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,BCBS MGG,BCBS MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Cigna,Cigna,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Cigna MGG,Cigna MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Humana,Humana,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Humana MGG,Humana MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Optum VA,Optum VA,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,UHC,UHC,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,UHC MGG,UHC MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,VA,VA,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Wellcare MGG,Wellcare MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Bright Health - commercial,Bright Health - commercial,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Bright Health MGG,Bright Health MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Aetna,Aetna,61.26,,,,,,,per diem,61.26,61.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Aetna MGG,Aetna MGG,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,BCBS,BCBS,61.26,,,,,,,per diem,61.26,61.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,BCBS MGG,BCBS MGG,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Cigna,Cigna,61.26,,,,,,,per diem,61.26,61.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Cigna MGG,Cigna MGG,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Humana,Humana,61.26,,,,,,,per diem,61.26,61.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Humana MGG,Humana MGG,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Optum VA,Optum VA,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,UHC,UHC,61.26,,,,,,,per diem,61.26,61.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,UHC MGG,UHC MGG,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,VA,VA,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Wellcare MGG,Wellcare MGG,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Bright Health - commercial,Bright Health - commercial,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,61.26,61.26,Bright Health MGG,Bright Health MGG,61.26,,,,,,,case rate,61.26,61.26,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Aetna,Aetna,36.78,,,,,,,per diem,36.78,36.78,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Aetna MGG,Aetna MGG,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,BCBS,BCBS,36.78,,,,,,,per diem,36.78,36.78,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,BCBS MGG,BCBS MGG,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Cigna,Cigna,36.78,,,,,,,per diem,36.78,36.78,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Cigna MGG,Cigna MGG,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Humana,Humana,36.78,,,,,,,per diem,36.78,36.78,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Humana MGG,Humana MGG,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Optum VA,Optum VA,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,UHC,UHC,36.78,,,,,,,per diem,36.78,36.78,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,UHC MGG,UHC MGG,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,VA,VA,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Wellcare MGG,Wellcare MGG,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Bright Health - commercial,Bright Health - commercial,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,36.78,36.78,Bright Health MGG,Bright Health MGG,36.78,,,,,,,case rate,36.78,36.78,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Aetna,Aetna,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Aetna MGG,Aetna MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,BCBS,BCBS,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,BCBS MGG,BCBS MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Cigna,Cigna,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Cigna MGG,Cigna MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Humana,Humana,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Humana MGG,Humana MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Optum VA,Optum VA,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,UHC,UHC,303.81,,,,,,,per diem,303.81,303.81,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,UHC MGG,UHC MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,VA,VA,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Wellcare MGG,Wellcare MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Bright Health - commercial,Bright Health - commercial,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,303.81,303.81,Bright Health MGG,Bright Health MGG,303.81,,,,,,,case rate,303.81,303.81,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Aetna,Aetna,117.27,,,,,,,per diem,117.27,117.27,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Aetna MGG,Aetna MGG,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,BCBS,BCBS,117.27,,,,,,,per diem,117.27,117.27,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,BCBS MGG,BCBS MGG,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Cigna,Cigna,117.27,,,,,,,per diem,117.27,117.27,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Cigna MGG,Cigna MGG,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Humana,Humana,117.27,,,,,,,per diem,117.27,117.27,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Humana MGG,Humana MGG,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Optum VA,Optum VA,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,UHC,UHC,117.27,,,,,,,per diem,117.27,117.27,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,UHC MGG,UHC MGG,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,VA,VA,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Wellcare MGG,Wellcare MGG,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Bright Health - commercial,Bright Health - commercial,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,117.27,117.27,Bright Health MGG,Bright Health MGG,117.27,,,,,,,case rate,117.27,117.27,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Aetna,Aetna,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Aetna MGG,Aetna MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,BCBS,BCBS,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,BCBS MGG,BCBS MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Cigna,Cigna,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Cigna MGG,Cigna MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Humana,Humana,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Humana MGG,Humana MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Optum VA,Optum VA,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,UHC,UHC,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,UHC MGG,UHC MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,VA,VA,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Wellcare MGG,Wellcare MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Bright Health - commercial,Bright Health - commercial,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Bright Health MGG,Bright Health MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Aetna,Aetna,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Aetna MGG,Aetna MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,BCBS,BCBS,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,BCBS MGG,BCBS MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Cigna,Cigna,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Cigna MGG,Cigna MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Humana,Humana,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Humana MGG,Humana MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Optum VA,Optum VA,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,UHC,UHC,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,UHC MGG,UHC MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,VA,VA,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Wellcare MGG,Wellcare MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Bright Health - commercial,Bright Health - commercial,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Bright Health MGG,Bright Health MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Aetna,Aetna,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Aetna MGG,Aetna MGG,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,BCBS,BCBS,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,BCBS MGG,BCBS MGG,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Cigna,Cigna,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Cigna MGG,Cigna MGG,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Humana,Humana,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Humana MGG,Humana MGG,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Optum VA,Optum VA,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,UHC,UHC,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,UHC MGG,UHC MGG,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,VA,VA,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Wellcare MGG,Wellcare MGG,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Bright Health - commercial,Bright Health - commercial,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,Bright Health MGG,Bright Health MGG,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Aetna,Aetna,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Aetna MGG,Aetna MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,BCBS,BCBS,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,BCBS MGG,BCBS MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Cigna,Cigna,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Cigna MGG,Cigna MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Humana,Humana,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Humana MGG,Humana MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Optum VA,Optum VA,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,UHC,UHC,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,UHC MGG,UHC MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,VA,VA,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Wellcare MGG,Wellcare MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Bright Health - commercial,Bright Health - commercial,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,Bright Health MGG,Bright Health MGG,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Aetna,Aetna,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Aetna MGG,Aetna MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,BCBS,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS MGG,BCBS MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Cigna,Cigna,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Cigna MGG,Cigna MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Humana,Humana,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Humana MGG,Humana MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Optum VA,Optum VA,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UHC,UHC,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UHC MGG,UHC MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,VA,VA,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Wellcare MGG,Wellcare MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Bright Health - commercial,Bright Health - commercial,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Bright Health MGG,Bright Health MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Aetna,Aetna,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Aetna MGG,Aetna MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,BCBS,BCBS,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,BCBS MGG,BCBS MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Cigna,Cigna,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Cigna MGG,Cigna MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Humana,Humana,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Humana MGG,Humana MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Optum VA,Optum VA,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,UHC,UHC,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,UHC MGG,UHC MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,VA,VA,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Wellcare MGG,Wellcare MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Bright Health - commercial,Bright Health - commercial,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Bright Health MGG,Bright Health MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Aetna,Aetna,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Aetna MGG,Aetna MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,BCBS,BCBS,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,BCBS MGG,BCBS MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Cigna,Cigna,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Cigna MGG,Cigna MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Humana,Humana,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Humana MGG,Humana MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Optum VA,Optum VA,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,UHC,UHC,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,UHC MGG,UHC MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,VA,VA,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Wellcare MGG,Wellcare MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Bright Health - commercial,Bright Health - commercial,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Bright Health MGG,Bright Health MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Aetna,Aetna,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Aetna MGG,Aetna MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,BCBS,BCBS,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,BCBS MGG,BCBS MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Cigna,Cigna,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Cigna MGG,Cigna MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Humana,Humana,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Humana MGG,Humana MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Optum VA,Optum VA,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,UHC,UHC,59.7,,,,,,,per diem,59.7,59.7,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,UHC MGG,UHC MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,VA,VA,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Wellcare MGG,Wellcare MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Bright Health - commercial,Bright Health - commercial,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,59.7,59.7,Bright Health MGG,Bright Health MGG,59.7,,,,,,,case rate,59.7,59.7,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Aetna,Aetna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Aetna MGG,Aetna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,BCBS,BCBS,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,BCBS MGG,BCBS MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Cigna,Cigna,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Cigna MGG,Cigna MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Humana,Humana,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Humana MGG,Humana MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Optum VA,Optum VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,UHC,UHC,41.82,,,,,,,per diem,41.82,41.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,UHC MGG,UHC MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,VA,VA,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Wellcare MGG,Wellcare MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Bright Health - commercial,Bright Health - commercial,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,41.82,41.82,Bright Health MGG,Bright Health MGG,41.82,,,,,,,case rate,41.82,41.82,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Aetna,Aetna,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Aetna MGG,Aetna MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,BCBS,BCBS,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,BCBS MGG,BCBS MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Cigna,Cigna,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Cigna MGG,Cigna MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Humana,Humana,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Humana MGG,Humana MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Optum VA,Optum VA,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,UHC,UHC,17.1,,,,,,,per diem,17.1,17.1,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,UHC MGG,UHC MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,VA,VA,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Wellcare MGG,Wellcare MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Bright Health - commercial,Bright Health - commercial,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.1,17.1,Bright Health MGG,Bright Health MGG,17.1,,,,,,,case rate,17.1,17.1,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Aetna,Aetna,183.78,,,,,,,per diem,183.78,183.78,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Aetna MGG,Aetna MGG,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,BCBS,BCBS,183.78,,,,,,,per diem,183.78,183.78,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,BCBS MGG,BCBS MGG,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Cigna,Cigna,183.78,,,,,,,per diem,183.78,183.78,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Cigna MGG,Cigna MGG,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Humana,Humana,183.78,,,,,,,per diem,183.78,183.78,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Humana MGG,Humana MGG,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Optum VA,Optum VA,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,UHC,UHC,183.78,,,,,,,per diem,183.78,183.78,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,UHC MGG,UHC MGG,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,VA,VA,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Wellcare MGG,Wellcare MGG,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Bright Health - commercial,Bright Health - commercial,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,183.78,183.78,Bright Health MGG,Bright Health MGG,183.78,,,,,,,case rate,183.78,183.78,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Aetna,Aetna,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Aetna MGG,Aetna MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,BCBS,BCBS,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,BCBS MGG,BCBS MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Cigna,Cigna,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Cigna MGG,Cigna MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Humana,Humana,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Humana MGG,Humana MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Optum VA,Optum VA,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,UHC,UHC,291.72,,,,,,,per diem,291.72,291.72,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,UHC MGG,UHC MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,VA,VA,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Wellcare MGG,Wellcare MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Bright Health - commercial,Bright Health - commercial,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,291.72,291.72,Bright Health MGG,Bright Health MGG,291.72,,,,,,,case rate,291.72,291.72,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna,Aetna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna MGG,Aetna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS,BCBS,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS MGG,BCBS MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna,Cigna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna MGG,Cigna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana,Humana,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana MGG,Humana MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Optum VA,Optum VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC,UHC,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC MGG,UHC MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,VA,VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Wellcare MGG,Wellcare MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health - commercial,Bright Health - commercial,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health MGG,Bright Health MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Aetna,Aetna,220.53,,,,,,,per diem,220.53,220.53,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Aetna MGG,Aetna MGG,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,BCBS,BCBS,220.53,,,,,,,per diem,220.53,220.53,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,BCBS MGG,BCBS MGG,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Cigna,Cigna,220.53,,,,,,,per diem,220.53,220.53,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Cigna MGG,Cigna MGG,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Humana,Humana,220.53,,,,,,,per diem,220.53,220.53,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Humana MGG,Humana MGG,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Optum VA,Optum VA,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,UHC,UHC,220.53,,,,,,,per diem,220.53,220.53,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,UHC MGG,UHC MGG,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,VA,VA,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Wellcare MGG,Wellcare MGG,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Bright Health - commercial,Bright Health - commercial,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,220.53,220.53,Bright Health MGG,Bright Health MGG,220.53,,,,,,,case rate,220.53,220.53,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Aetna,Aetna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Aetna MGG,Aetna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,BCBS,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS MGG,BCBS MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Cigna,Cigna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Cigna MGG,Cigna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Humana,Humana,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Humana MGG,Humana MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Optum VA,Optum VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UHC,UHC,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UHC MGG,UHC MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA,VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Wellcare MGG,Wellcare MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Bright Health - commercial,Bright Health - commercial,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Bright Health MGG,Bright Health MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Aetna,Aetna,72.66,,,,,,,per diem,72.66,72.66,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Aetna MGG,Aetna MGG,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,BCBS,BCBS,72.66,,,,,,,per diem,72.66,72.66,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,BCBS MGG,BCBS MGG,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Cigna,Cigna,72.66,,,,,,,per diem,72.66,72.66,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Cigna MGG,Cigna MGG,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Humana,Humana,72.66,,,,,,,per diem,72.66,72.66,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Humana MGG,Humana MGG,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Optum VA,Optum VA,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,UHC,UHC,72.66,,,,,,,per diem,72.66,72.66,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,UHC MGG,UHC MGG,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,VA,VA,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Wellcare MGG,Wellcare MGG,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Bright Health - commercial,Bright Health - commercial,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,72.66,72.66,Bright Health MGG,Bright Health MGG,72.66,,,,,,,case rate,72.66,72.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Aetna,Aetna,34.98,,,,,,,per diem,34.98,34.98,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Aetna MGG,Aetna MGG,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,BCBS,BCBS,34.98,,,,,,,per diem,34.98,34.98,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,BCBS MGG,BCBS MGG,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Cigna,Cigna,34.98,,,,,,,per diem,34.98,34.98,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Cigna MGG,Cigna MGG,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Humana,Humana,34.98,,,,,,,per diem,34.98,34.98,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Humana MGG,Humana MGG,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Optum VA,Optum VA,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,UHC,UHC,34.98,,,,,,,per diem,34.98,34.98,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,UHC MGG,UHC MGG,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,VA,VA,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Wellcare MGG,Wellcare MGG,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Bright Health - commercial,Bright Health - commercial,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,34.98,34.98,Bright Health MGG,Bright Health MGG,34.98,,,,,,,case rate,34.98,34.98,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Aetna,Aetna,212.22,,,,,,,per diem,212.22,212.22,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Aetna MGG,Aetna MGG,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,BCBS,BCBS,212.22,,,,,,,per diem,212.22,212.22,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,BCBS MGG,BCBS MGG,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Cigna,Cigna,212.22,,,,,,,per diem,212.22,212.22,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Cigna MGG,Cigna MGG,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Humana,Humana,212.22,,,,,,,per diem,212.22,212.22,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Humana MGG,Humana MGG,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Optum VA,Optum VA,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,UHC,UHC,212.22,,,,,,,per diem,212.22,212.22,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,UHC MGG,UHC MGG,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,VA,VA,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Wellcare MGG,Wellcare MGG,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Bright Health - commercial,Bright Health - commercial,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,212.22,212.22,Bright Health MGG,Bright Health MGG,212.22,,,,,,,case rate,212.22,212.22,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Aetna,Aetna,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Aetna MGG,Aetna MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,BCBS,BCBS,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,BCBS MGG,BCBS MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Cigna,Cigna,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Cigna MGG,Cigna MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Humana,Humana,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Humana MGG,Humana MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Optum VA,Optum VA,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,UHC,UHC,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,UHC MGG,UHC MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,VA,VA,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Wellcare MGG,Wellcare MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Bright Health - commercial,Bright Health - commercial,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Bright Health MGG,Bright Health MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Aetna,Aetna,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Aetna MGG,Aetna MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,BCBS,BCBS,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,BCBS MGG,BCBS MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Cigna,Cigna,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Cigna MGG,Cigna MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Humana,Humana,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Humana MGG,Humana MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Optum VA,Optum VA,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,UHC,UHC,225,,,,,,,per diem,225,225,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,UHC MGG,UHC MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,VA,VA,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Wellcare MGG,Wellcare MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Bright Health - commercial,Bright Health - commercial,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,225,225,Bright Health MGG,Bright Health MGG,225,,,,,,,case rate,225,225,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Aetna,Aetna,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Aetna MGG,Aetna MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,BCBS,BCBS,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,BCBS MGG,BCBS MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Cigna,Cigna,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Cigna MGG,Cigna MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Humana,Humana,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Humana MGG,Humana MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Optum VA,Optum VA,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,UHC,UHC,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,UHC MGG,UHC MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,VA,VA,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Wellcare MGG,Wellcare MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Bright Health - commercial,Bright Health - commercial,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Bright Health MGG,Bright Health MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Aetna,Aetna,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Aetna MGG,Aetna MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,BCBS,BCBS,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,BCBS MGG,BCBS MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Cigna,Cigna,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Cigna MGG,Cigna MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Humana,Humana,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Humana MGG,Humana MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Optum VA,Optum VA,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,UHC,UHC,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,UHC MGG,UHC MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,VA,VA,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Wellcare MGG,Wellcare MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Bright Health - commercial,Bright Health - commercial,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,18.12,18.12,Bright Health MGG,Bright Health MGG,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Aetna,Aetna,15.42,,,,,,,per diem,15.42,15.42,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Aetna MGG,Aetna MGG,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,BCBS,BCBS,15.42,,,,,,,per diem,15.42,15.42,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,BCBS MGG,BCBS MGG,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Cigna,Cigna,15.42,,,,,,,per diem,15.42,15.42,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Cigna MGG,Cigna MGG,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Humana,Humana,15.42,,,,,,,per diem,15.42,15.42,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Humana MGG,Humana MGG,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Optum VA,Optum VA,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,UHC,UHC,15.42,,,,,,,per diem,15.42,15.42,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,UHC MGG,UHC MGG,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,VA,VA,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Wellcare MGG,Wellcare MGG,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Bright Health - commercial,Bright Health - commercial,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.42,15.42,Bright Health MGG,Bright Health MGG,15.42,,,,,,,case rate,15.42,15.42,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna,Aetna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna MGG,Aetna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,BCBS,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS MGG,BCBS MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna,Cigna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna MGG,Cigna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana,Humana,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana MGG,Humana MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Optum VA,Optum VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC,UHC,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC MGG,UHC MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,VA,VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Wellcare MGG,Wellcare MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health - commercial,Bright Health - commercial,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health MGG,Bright Health MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Aetna,Aetna,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Aetna MGG,Aetna MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,BCBS,BCBS,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,BCBS MGG,BCBS MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Cigna,Cigna,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Cigna MGG,Cigna MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Humana,Humana,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Humana MGG,Humana MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Optum VA,Optum VA,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,UHC,UHC,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,UHC MGG,UHC MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,VA,VA,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Wellcare MGG,Wellcare MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Bright Health - commercial,Bright Health - commercial,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Bright Health MGG,Bright Health MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Aetna,Aetna,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Aetna MGG,Aetna MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,BCBS,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS MGG,BCBS MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Cigna,Cigna,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Cigna MGG,Cigna MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Humana,Humana,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Humana MGG,Humana MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Optum VA,Optum VA,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UHC,UHC,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UHC MGG,UHC MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA,VA,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Wellcare MGG,Wellcare MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Bright Health - commercial,Bright Health - commercial,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Bright Health MGG,Bright Health MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Aetna,Aetna,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Aetna MGG,Aetna MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,BCBS,BCBS,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,BCBS MGG,BCBS MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Cigna,Cigna,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Cigna MGG,Cigna MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Humana,Humana,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Humana MGG,Humana MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Optum VA,Optum VA,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,UHC,UHC,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,UHC MGG,UHC MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,VA,VA,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Wellcare MGG,Wellcare MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Bright Health - commercial,Bright Health - commercial,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Bright Health MGG,Bright Health MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Aetna,Aetna,2563.17,,,,,,,per diem,2563.17,2563.17,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Aetna MGG,Aetna MGG,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,BCBS,BCBS,2563.17,,,,,,,per diem,2563.17,2563.17,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,BCBS MGG,BCBS MGG,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Cigna,Cigna,2563.17,,,,,,,per diem,2563.17,2563.17,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Cigna MGG,Cigna MGG,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Humana,Humana,2563.17,,,,,,,per diem,2563.17,2563.17,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Humana MGG,Humana MGG,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Optum VA,Optum VA,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,UHC,UHC,2563.17,,,,,,,per diem,2563.17,2563.17,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,UHC MGG,UHC MGG,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,VA,VA,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Wellcare MGG,Wellcare MGG,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Bright Health - commercial,Bright Health - commercial,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2563.17,2563.17,Bright Health MGG,Bright Health MGG,2563.17,,,,,,,case rate,2563.17,2563.17,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Aetna,Aetna,33.18,,,,,,,per diem,33.18,33.18,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Aetna MGG,Aetna MGG,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,BCBS,BCBS,33.18,,,,,,,per diem,33.18,33.18,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,BCBS MGG,BCBS MGG,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Cigna,Cigna,33.18,,,,,,,per diem,33.18,33.18,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Cigna MGG,Cigna MGG,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Humana,Humana,33.18,,,,,,,per diem,33.18,33.18,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Humana MGG,Humana MGG,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Optum VA,Optum VA,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,UHC,UHC,33.18,,,,,,,per diem,33.18,33.18,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,UHC MGG,UHC MGG,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,VA,VA,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Wellcare MGG,Wellcare MGG,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Bright Health - commercial,Bright Health - commercial,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,33.18,33.18,Bright Health MGG,Bright Health MGG,33.18,,,,,,,case rate,33.18,33.18,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Aetna,Aetna,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Aetna MGG,Aetna MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,BCBS,BCBS,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,BCBS MGG,BCBS MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Cigna,Cigna,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Cigna MGG,Cigna MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Humana,Humana,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Humana MGG,Humana MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Optum VA,Optum VA,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,UHC,UHC,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,UHC MGG,UHC MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,VA,VA,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Wellcare MGG,Wellcare MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Bright Health - commercial,Bright Health - commercial,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Bright Health MGG,Bright Health MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Aetna,Aetna,460.98,,,,,,,per diem,460.98,460.98,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Aetna MGG,Aetna MGG,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,BCBS,BCBS,460.98,,,,,,,per diem,460.98,460.98,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,BCBS MGG,BCBS MGG,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Cigna,Cigna,460.98,,,,,,,per diem,460.98,460.98,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Cigna MGG,Cigna MGG,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Humana,Humana,460.98,,,,,,,per diem,460.98,460.98,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Humana MGG,Humana MGG,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Optum VA,Optum VA,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,UHC,UHC,460.98,,,,,,,per diem,460.98,460.98,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,UHC MGG,UHC MGG,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,VA,VA,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Wellcare MGG,Wellcare MGG,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Bright Health - commercial,Bright Health - commercial,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,460.98,460.98,Bright Health MGG,Bright Health MGG,460.98,,,,,,,case rate,460.98,460.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Aetna,Aetna,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Aetna MGG,Aetna MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,BCBS,BCBS,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,BCBS MGG,BCBS MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Cigna,Cigna,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Cigna MGG,Cigna MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Humana,Humana,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Humana MGG,Humana MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Optum VA,Optum VA,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,UHC,UHC,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,UHC MGG,UHC MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,VA,VA,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Wellcare MGG,Wellcare MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Bright Health - commercial,Bright Health - commercial,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Bright Health MGG,Bright Health MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Aetna,Aetna,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Aetna MGG,Aetna MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,BCBS,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS MGG,BCBS MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Cigna,Cigna,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Cigna MGG,Cigna MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Humana,Humana,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Humana MGG,Humana MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Optum VA,Optum VA,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UHC,UHC,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UHC MGG,UHC MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA,VA,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Wellcare MGG,Wellcare MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Bright Health - commercial,Bright Health - commercial,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Bright Health MGG,Bright Health MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Aetna,Aetna,595.53,,,,,,,per diem,595.53,595.53,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Aetna MGG,Aetna MGG,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,BCBS,BCBS,595.53,,,,,,,per diem,595.53,595.53,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,BCBS MGG,BCBS MGG,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Cigna,Cigna,595.53,,,,,,,per diem,595.53,595.53,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Cigna MGG,Cigna MGG,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Humana,Humana,595.53,,,,,,,per diem,595.53,595.53,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Humana MGG,Humana MGG,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Optum VA,Optum VA,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,UHC,UHC,595.53,,,,,,,per diem,595.53,595.53,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,UHC MGG,UHC MGG,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,VA,VA,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Wellcare MGG,Wellcare MGG,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Bright Health - commercial,Bright Health - commercial,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,595.53,595.53,Bright Health MGG,Bright Health MGG,595.53,,,,,,,case rate,595.53,595.53,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna,Aetna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna MGG,Aetna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS,BCBS,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS MGG,BCBS MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna,Cigna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna MGG,Cigna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana,Humana,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana MGG,Humana MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Optum VA,Optum VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC,UHC,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC MGG,UHC MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,VA,VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Wellcare MGG,Wellcare MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health - commercial,Bright Health - commercial,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health MGG,Bright Health MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Aetna,Aetna,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Aetna MGG,Aetna MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,BCBS,BCBS,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,BCBS MGG,BCBS MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Cigna,Cigna,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Cigna MGG,Cigna MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Humana,Humana,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Humana MGG,Humana MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Optum VA,Optum VA,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,UHC,UHC,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,UHC MGG,UHC MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,VA,VA,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Wellcare MGG,Wellcare MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Bright Health - commercial,Bright Health - commercial,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Bright Health MGG,Bright Health MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Aetna,Aetna,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Aetna MGG,Aetna MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,BCBS,BCBS,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,BCBS MGG,BCBS MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Cigna,Cigna,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Cigna MGG,Cigna MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Humana,Humana,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Humana MGG,Humana MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Optum VA,Optum VA,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,UHC,UHC,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,UHC MGG,UHC MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,VA,VA,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Wellcare MGG,Wellcare MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Bright Health - commercial,Bright Health - commercial,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Bright Health MGG,Bright Health MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Aetna,Aetna,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Aetna MGG,Aetna MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,BCBS,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS MGG,BCBS MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Cigna,Cigna,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Cigna MGG,Cigna MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Humana,Humana,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Humana MGG,Humana MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Optum VA,Optum VA,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,UHC,UHC,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,UHC MGG,UHC MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,VA,VA,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Wellcare MGG,Wellcare MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Bright Health - commercial,Bright Health - commercial,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Bright Health MGG,Bright Health MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Aetna,Aetna,41.07,,,,,,,per diem,41.07,41.07,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Aetna MGG,Aetna MGG,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,BCBS,BCBS,41.07,,,,,,,per diem,41.07,41.07,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,BCBS MGG,BCBS MGG,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Cigna,Cigna,41.07,,,,,,,per diem,41.07,41.07,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Cigna MGG,Cigna MGG,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Humana,Humana,41.07,,,,,,,per diem,41.07,41.07,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Humana MGG,Humana MGG,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Optum VA,Optum VA,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,UHC,UHC,41.07,,,,,,,per diem,41.07,41.07,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,UHC MGG,UHC MGG,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,VA,VA,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Wellcare MGG,Wellcare MGG,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Bright Health - commercial,Bright Health - commercial,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,41.07,41.07,Bright Health MGG,Bright Health MGG,41.07,,,,,,,case rate,41.07,41.07,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Aetna,Aetna,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Aetna MGG,Aetna MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,BCBS,BCBS,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,BCBS MGG,BCBS MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Cigna,Cigna,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Cigna MGG,Cigna MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Humana,Humana,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Humana MGG,Humana MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Optum VA,Optum VA,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,UHC,UHC,41.97,,,,,,,per diem,41.97,41.97,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,UHC MGG,UHC MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,VA,VA,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Wellcare MGG,Wellcare MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Bright Health - commercial,Bright Health - commercial,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,41.97,41.97,Bright Health MGG,Bright Health MGG,41.97,,,,,,,case rate,41.97,41.97,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Aetna,Aetna,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Aetna MGG,Aetna MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,BCBS,BCBS,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,BCBS MGG,BCBS MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Cigna,Cigna,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Cigna MGG,Cigna MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Humana,Humana,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Humana MGG,Humana MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Optum VA,Optum VA,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,UHC,UHC,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,UHC MGG,UHC MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,VA,VA,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Wellcare MGG,Wellcare MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Bright Health - commercial,Bright Health - commercial,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Bright Health MGG,Bright Health MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Aetna,Aetna,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Aetna MGG,Aetna MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,BCBS,BCBS,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,BCBS MGG,BCBS MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Cigna,Cigna,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Cigna MGG,Cigna MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Humana,Humana,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Humana MGG,Humana MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Optum VA,Optum VA,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,UHC,UHC,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,UHC MGG,UHC MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,VA,VA,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Wellcare MGG,Wellcare MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Bright Health - commercial,Bright Health - commercial,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,16.35,16.35,Bright Health MGG,Bright Health MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Aetna,Aetna,487.92,,,,,,,per diem,487.92,487.92,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Aetna MGG,Aetna MGG,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,BCBS,BCBS,487.92,,,,,,,per diem,487.92,487.92,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,BCBS MGG,BCBS MGG,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Cigna,Cigna,487.92,,,,,,,per diem,487.92,487.92,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Cigna MGG,Cigna MGG,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Humana,Humana,487.92,,,,,,,per diem,487.92,487.92,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Humana MGG,Humana MGG,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Optum VA,Optum VA,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,UHC,UHC,487.92,,,,,,,per diem,487.92,487.92,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,UHC MGG,UHC MGG,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,VA,VA,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Wellcare MGG,Wellcare MGG,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Bright Health - commercial,Bright Health - commercial,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,487.92,487.92,Bright Health MGG,Bright Health MGG,487.92,,,,,,,case rate,487.92,487.92,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Aetna,Aetna,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Aetna MGG,Aetna MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,BCBS,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS MGG,BCBS MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Cigna,Cigna,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Cigna MGG,Cigna MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Humana,Humana,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Humana MGG,Humana MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Optum VA,Optum VA,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UHC,UHC,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UHC MGG,UHC MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,VA,VA,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Wellcare MGG,Wellcare MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Bright Health - commercial,Bright Health - commercial,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,Bright Health MGG,Bright Health MGG,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Aetna,Aetna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Aetna MGG,Aetna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,BCBS,BCBS,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,BCBS MGG,BCBS MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Cigna,Cigna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Cigna MGG,Cigna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Humana,Humana,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Humana MGG,Humana MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Optum VA,Optum VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,UHC,UHC,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,UHC MGG,UHC MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,VA,VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Wellcare MGG,Wellcare MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Bright Health - commercial,Bright Health - commercial,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Bright Health MGG,Bright Health MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Aetna,Aetna,31.86,,,,,,,per diem,31.86,31.86,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Aetna MGG,Aetna MGG,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,BCBS,BCBS,31.86,,,,,,,per diem,31.86,31.86,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,BCBS MGG,BCBS MGG,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Cigna,Cigna,31.86,,,,,,,per diem,31.86,31.86,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Cigna MGG,Cigna MGG,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Humana,Humana,31.86,,,,,,,per diem,31.86,31.86,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Humana MGG,Humana MGG,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Optum VA,Optum VA,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,UHC,UHC,31.86,,,,,,,per diem,31.86,31.86,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,UHC MGG,UHC MGG,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,VA,VA,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Wellcare MGG,Wellcare MGG,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Bright Health - commercial,Bright Health - commercial,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,31.86,31.86,Bright Health MGG,Bright Health MGG,31.86,,,,,,,case rate,31.86,31.86,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Aetna,Aetna,34.47,,,,,,,per diem,34.47,34.47,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Aetna MGG,Aetna MGG,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,BCBS,BCBS,34.47,,,,,,,per diem,34.47,34.47,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,BCBS MGG,BCBS MGG,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Cigna,Cigna,34.47,,,,,,,per diem,34.47,34.47,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Cigna MGG,Cigna MGG,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Humana,Humana,34.47,,,,,,,per diem,34.47,34.47,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Humana MGG,Humana MGG,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Optum VA,Optum VA,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,UHC,UHC,34.47,,,,,,,per diem,34.47,34.47,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,UHC MGG,UHC MGG,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,VA,VA,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Wellcare MGG,Wellcare MGG,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Bright Health - commercial,Bright Health - commercial,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,34.47,34.47,Bright Health MGG,Bright Health MGG,34.47,,,,,,,case rate,34.47,34.47,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Aetna,Aetna,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Aetna MGG,Aetna MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,BCBS,BCBS,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,BCBS MGG,BCBS MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Cigna,Cigna,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Cigna MGG,Cigna MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Humana,Humana,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Humana MGG,Humana MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Optum VA,Optum VA,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,UHC,UHC,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,UHC MGG,UHC MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,VA,VA,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Wellcare MGG,Wellcare MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Bright Health - commercial,Bright Health - commercial,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Bright Health MGG,Bright Health MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Aetna,Aetna,10252.26,,,,,,,per diem,10252.26,10252.26,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Aetna MGG,Aetna MGG,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,BCBS,BCBS,10252.26,,,,,,,per diem,10252.26,10252.26,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,BCBS MGG,BCBS MGG,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Cigna,Cigna,10252.26,,,,,,,per diem,10252.26,10252.26,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Cigna MGG,Cigna MGG,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Humana,Humana,10252.26,,,,,,,per diem,10252.26,10252.26,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Humana MGG,Humana MGG,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Optum VA,Optum VA,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,UHC,UHC,10252.26,,,,,,,per diem,10252.26,10252.26,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,UHC MGG,UHC MGG,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,VA,VA,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Wellcare MGG,Wellcare MGG,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Bright Health - commercial,Bright Health - commercial,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10252.26,10252.26,Bright Health MGG,Bright Health MGG,10252.26,,,,,,,case rate,10252.26,10252.26,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Aetna,Aetna,153.75,,,,,,,per diem,153.75,153.75,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Aetna MGG,Aetna MGG,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,BCBS,BCBS,153.75,,,,,,,per diem,153.75,153.75,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,BCBS MGG,BCBS MGG,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Cigna,Cigna,153.75,,,,,,,per diem,153.75,153.75,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Cigna MGG,Cigna MGG,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Humana,Humana,153.75,,,,,,,per diem,153.75,153.75,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Humana MGG,Humana MGG,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Optum VA,Optum VA,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,UHC,UHC,153.75,,,,,,,per diem,153.75,153.75,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,UHC MGG,UHC MGG,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,VA,VA,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Wellcare MGG,Wellcare MGG,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Bright Health - commercial,Bright Health - commercial,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,153.75,153.75,Bright Health MGG,Bright Health MGG,153.75,,,,,,,case rate,153.75,153.75,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Aetna,Aetna,27.66,,,,,,,per diem,27.66,27.66,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Aetna MGG,Aetna MGG,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,BCBS,BCBS,27.66,,,,,,,per diem,27.66,27.66,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,BCBS MGG,BCBS MGG,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Cigna,Cigna,27.66,,,,,,,per diem,27.66,27.66,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Cigna MGG,Cigna MGG,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Humana,Humana,27.66,,,,,,,per diem,27.66,27.66,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Humana MGG,Humana MGG,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Optum VA,Optum VA,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,UHC,UHC,27.66,,,,,,,per diem,27.66,27.66,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,UHC MGG,UHC MGG,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,VA,VA,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Wellcare MGG,Wellcare MGG,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Bright Health - commercial,Bright Health - commercial,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,27.66,27.66,Bright Health MGG,Bright Health MGG,27.66,,,,,,,case rate,27.66,27.66,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Aetna,Aetna,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Aetna MGG,Aetna MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,BCBS,BCBS,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,BCBS MGG,BCBS MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Cigna,Cigna,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Cigna MGG,Cigna MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Humana,Humana,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Humana MGG,Humana MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Optum VA,Optum VA,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,UHC,UHC,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,UHC MGG,UHC MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,VA,VA,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Wellcare MGG,Wellcare MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Bright Health - commercial,Bright Health - commercial,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,22.86,22.86,Bright Health MGG,Bright Health MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Aetna,Aetna,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Aetna MGG,Aetna MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,BCBS,BCBS,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,BCBS MGG,BCBS MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Cigna,Cigna,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Cigna MGG,Cigna MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Humana,Humana,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Humana MGG,Humana MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Optum VA,Optum VA,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,UHC,UHC,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,UHC MGG,UHC MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,VA,VA,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Wellcare MGG,Wellcare MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Bright Health - commercial,Bright Health - commercial,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Bright Health MGG,Bright Health MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Aetna,Aetna,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Aetna MGG,Aetna MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,BCBS,BCBS,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,BCBS MGG,BCBS MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Cigna,Cigna,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Cigna MGG,Cigna MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Humana,Humana,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Humana MGG,Humana MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Optum VA,Optum VA,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,UHC,UHC,18.96,,,,,,,per diem,18.96,18.96,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,UHC MGG,UHC MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,VA,VA,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Wellcare MGG,Wellcare MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Bright Health - commercial,Bright Health - commercial,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,18.96,18.96,Bright Health MGG,Bright Health MGG,18.96,,,,,,,case rate,18.96,18.96,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Aetna,Aetna,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Aetna MGG,Aetna MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,BCBS,BCBS,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,BCBS MGG,BCBS MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Cigna,Cigna,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Cigna MGG,Cigna MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Humana,Humana,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Humana MGG,Humana MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Optum VA,Optum VA,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,UHC,UHC,2.34,,,,,,,per diem,2.34,2.34,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,UHC MGG,UHC MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,VA,VA,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Wellcare MGG,Wellcare MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Bright Health - commercial,Bright Health - commercial,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,2.34,2.34,Bright Health MGG,Bright Health MGG,2.34,,,,,,,case rate,2.34,2.34,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Aetna,Aetna,54.21,,,,,,,per diem,54.21,54.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Aetna MGG,Aetna MGG,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,BCBS,BCBS,54.21,,,,,,,per diem,54.21,54.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,BCBS MGG,BCBS MGG,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Cigna,Cigna,54.21,,,,,,,per diem,54.21,54.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Cigna MGG,Cigna MGG,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Humana,Humana,54.21,,,,,,,per diem,54.21,54.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Humana MGG,Humana MGG,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Optum VA,Optum VA,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,UHC,UHC,54.21,,,,,,,per diem,54.21,54.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,UHC MGG,UHC MGG,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,VA,VA,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Wellcare MGG,Wellcare MGG,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Bright Health - commercial,Bright Health - commercial,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,54.21,54.21,Bright Health MGG,Bright Health MGG,54.21,,,,,,,case rate,54.21,54.21,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Aetna,Aetna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Aetna MGG,Aetna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,BCBS,BCBS,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,BCBS MGG,BCBS MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Cigna,Cigna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Cigna MGG,Cigna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Humana,Humana,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Humana MGG,Humana MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Optum VA,Optum VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,UHC,UHC,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,UHC MGG,UHC MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,VA,VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Wellcare MGG,Wellcare MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Bright Health - commercial,Bright Health - commercial,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Bright Health MGG,Bright Health MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Aetna,Aetna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Aetna MGG,Aetna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,BCBS,BCBS,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,BCBS MGG,BCBS MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Cigna,Cigna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Cigna MGG,Cigna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Humana,Humana,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Humana MGG,Humana MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Optum VA,Optum VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,UHC,UHC,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,UHC MGG,UHC MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,VA,VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Wellcare MGG,Wellcare MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Bright Health - commercial,Bright Health - commercial,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Bright Health MGG,Bright Health MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Aetna,Aetna,1154.07,,,,,,,per diem,1154.07,1154.07,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Aetna MGG,Aetna MGG,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,BCBS,BCBS,1154.07,,,,,,,per diem,1154.07,1154.07,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,BCBS MGG,BCBS MGG,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Cigna,Cigna,1154.07,,,,,,,per diem,1154.07,1154.07,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Cigna MGG,Cigna MGG,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Humana,Humana,1154.07,,,,,,,per diem,1154.07,1154.07,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Humana MGG,Humana MGG,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Optum VA,Optum VA,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,UHC,UHC,1154.07,,,,,,,per diem,1154.07,1154.07,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,UHC MGG,UHC MGG,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,VA,VA,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Wellcare MGG,Wellcare MGG,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Bright Health - commercial,Bright Health - commercial,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1154.07,1154.07,Bright Health MGG,Bright Health MGG,1154.07,,,,,,,case rate,1154.07,1154.07,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna,Aetna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna MGG,Aetna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS,BCBS,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS MGG,BCBS MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna,Cigna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna MGG,Cigna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana,Humana,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana MGG,Humana MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Optum VA,Optum VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC,UHC,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC MGG,UHC MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,VA,VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Wellcare MGG,Wellcare MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health - commercial,Bright Health - commercial,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health MGG,Bright Health MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Aetna,Aetna,30.12,,,,,,,per diem,30.12,30.12,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Aetna MGG,Aetna MGG,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,BCBS,BCBS,30.12,,,,,,,per diem,30.12,30.12,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,BCBS MGG,BCBS MGG,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Cigna,Cigna,30.12,,,,,,,per diem,30.12,30.12,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Cigna MGG,Cigna MGG,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Humana,Humana,30.12,,,,,,,per diem,30.12,30.12,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Humana MGG,Humana MGG,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Optum VA,Optum VA,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,UHC,UHC,30.12,,,,,,,per diem,30.12,30.12,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,UHC MGG,UHC MGG,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,VA,VA,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Wellcare MGG,Wellcare MGG,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Bright Health - commercial,Bright Health - commercial,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,30.12,30.12,Bright Health MGG,Bright Health MGG,30.12,,,,,,,case rate,30.12,30.12,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Aetna,Aetna,69.33,,,,,,,per diem,69.33,69.33,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Aetna MGG,Aetna MGG,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,BCBS,BCBS,69.33,,,,,,,per diem,69.33,69.33,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,BCBS MGG,BCBS MGG,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Cigna,Cigna,69.33,,,,,,,per diem,69.33,69.33,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Cigna MGG,Cigna MGG,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Humana,Humana,69.33,,,,,,,per diem,69.33,69.33,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Humana MGG,Humana MGG,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Optum VA,Optum VA,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,UHC,UHC,69.33,,,,,,,per diem,69.33,69.33,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,UHC MGG,UHC MGG,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,VA,VA,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Wellcare MGG,Wellcare MGG,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Bright Health - commercial,Bright Health - commercial,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,69.33,69.33,Bright Health MGG,Bright Health MGG,69.33,,,,,,,case rate,69.33,69.33,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Aetna,Aetna,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Aetna MGG,Aetna MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,BCBS,BCBS,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,BCBS MGG,BCBS MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Cigna,Cigna,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Cigna MGG,Cigna MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Humana,Humana,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Humana MGG,Humana MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Optum VA,Optum VA,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,UHC,UHC,50.58,,,,,,,per diem,50.58,50.58,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,UHC MGG,UHC MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,VA,VA,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Wellcare MGG,Wellcare MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Bright Health - commercial,Bright Health - commercial,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,50.58,50.58,Bright Health MGG,Bright Health MGG,50.58,,,,,,,case rate,50.58,50.58,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Aetna,Aetna,17.75,,,,,,,per diem,17.75,17.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Aetna MGG,Aetna MGG,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,BCBS,BCBS,17.75,,,,,,,per diem,17.75,17.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,BCBS MGG,BCBS MGG,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Cigna,Cigna,17.75,,,,,,,per diem,17.75,17.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Cigna MGG,Cigna MGG,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Humana,Humana,17.75,,,,,,,per diem,17.75,17.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Humana MGG,Humana MGG,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Optum VA,Optum VA,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,UHC,UHC,17.75,,,,,,,per diem,17.75,17.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,UHC MGG,UHC MGG,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,VA,VA,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Wellcare MGG,Wellcare MGG,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Bright Health - commercial,Bright Health - commercial,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,17.75,17.75,Bright Health MGG,Bright Health MGG,17.75,,,,,,,case rate,17.75,17.75,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Aetna,Aetna,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Aetna MGG,Aetna MGG,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,BCBS,BCBS,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,BCBS MGG,BCBS MGG,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Cigna,Cigna,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Cigna MGG,Cigna MGG,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Humana,Humana,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Humana MGG,Humana MGG,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Optum VA,Optum VA,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,UHC,UHC,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,UHC MGG,UHC MGG,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,VA,VA,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Wellcare MGG,Wellcare MGG,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Bright Health - commercial,Bright Health - commercial,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,Bright Health MGG,Bright Health MGG,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Aetna,Aetna,158.37,,,,,,,per diem,158.37,158.37,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Aetna MGG,Aetna MGG,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,BCBS,BCBS,158.37,,,,,,,per diem,158.37,158.37,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,BCBS MGG,BCBS MGG,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Cigna,Cigna,158.37,,,,,,,per diem,158.37,158.37,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Cigna MGG,Cigna MGG,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Humana,Humana,158.37,,,,,,,per diem,158.37,158.37,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Humana MGG,Humana MGG,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Optum VA,Optum VA,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,UHC,UHC,158.37,,,,,,,per diem,158.37,158.37,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,UHC MGG,UHC MGG,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,VA,VA,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Wellcare MGG,Wellcare MGG,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Bright Health - commercial,Bright Health - commercial,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,158.37,158.37,Bright Health MGG,Bright Health MGG,158.37,,,,,,,case rate,158.37,158.37,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Aetna,Aetna,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Aetna MGG,Aetna MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,BCBS,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS MGG,BCBS MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Cigna,Cigna,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Cigna MGG,Cigna MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Humana,Humana,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Humana MGG,Humana MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Optum VA,Optum VA,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UHC,UHC,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UHC MGG,UHC MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,VA,VA,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Wellcare MGG,Wellcare MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Bright Health - commercial,Bright Health - commercial,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Bright Health MGG,Bright Health MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Aetna,Aetna,33.45,,,,,,,per diem,33.45,33.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Aetna MGG,Aetna MGG,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,BCBS,BCBS,33.45,,,,,,,per diem,33.45,33.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,BCBS MGG,BCBS MGG,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Cigna,Cigna,33.45,,,,,,,per diem,33.45,33.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Cigna MGG,Cigna MGG,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Humana,Humana,33.45,,,,,,,per diem,33.45,33.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Humana MGG,Humana MGG,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Optum VA,Optum VA,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,UHC,UHC,33.45,,,,,,,per diem,33.45,33.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,UHC MGG,UHC MGG,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,VA,VA,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Wellcare MGG,Wellcare MGG,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Bright Health - commercial,Bright Health - commercial,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,33.45,33.45,Bright Health MGG,Bright Health MGG,33.45,,,,,,,case rate,33.45,33.45,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Aetna,Aetna,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Aetna MGG,Aetna MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,BCBS,BCBS,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,BCBS MGG,BCBS MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Cigna,Cigna,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Cigna MGG,Cigna MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Humana,Humana,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Humana MGG,Humana MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Optum VA,Optum VA,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,UHC,UHC,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,UHC MGG,UHC MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,VA,VA,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Wellcare MGG,Wellcare MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Bright Health - commercial,Bright Health - commercial,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,14.91,14.91,Bright Health MGG,Bright Health MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Aetna,Aetna,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Aetna MGG,Aetna MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,BCBS,BCBS,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,BCBS MGG,BCBS MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Cigna,Cigna,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Cigna MGG,Cigna MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Humana,Humana,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Humana MGG,Humana MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Optum VA,Optum VA,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,UHC,UHC,302.04,,,,,,,per diem,302.04,302.04,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,UHC MGG,UHC MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,VA,VA,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Wellcare MGG,Wellcare MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Bright Health - commercial,Bright Health - commercial,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,302.04,302.04,Bright Health MGG,Bright Health MGG,302.04,,,,,,,case rate,302.04,302.04,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Aetna,Aetna,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Aetna MGG,Aetna MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,BCBS,BCBS,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,BCBS MGG,BCBS MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Cigna,Cigna,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Cigna MGG,Cigna MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Humana,Humana,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Humana MGG,Humana MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Optum VA,Optum VA,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,UHC,UHC,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,UHC MGG,UHC MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,VA,VA,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Wellcare MGG,Wellcare MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Bright Health - commercial,Bright Health - commercial,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Bright Health MGG,Bright Health MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Aetna,Aetna,366.63,,,,,,,per diem,366.63,366.63,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Aetna MGG,Aetna MGG,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,BCBS,BCBS,366.63,,,,,,,per diem,366.63,366.63,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,BCBS MGG,BCBS MGG,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Cigna,Cigna,366.63,,,,,,,per diem,366.63,366.63,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Cigna MGG,Cigna MGG,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Humana,Humana,366.63,,,,,,,per diem,366.63,366.63,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Humana MGG,Humana MGG,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Optum VA,Optum VA,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,UHC,UHC,366.63,,,,,,,per diem,366.63,366.63,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,UHC MGG,UHC MGG,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,VA,VA,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Wellcare MGG,Wellcare MGG,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Bright Health - commercial,Bright Health - commercial,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,366.63,366.63,Bright Health MGG,Bright Health MGG,366.63,,,,,,,case rate,366.63,366.63,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Aetna,Aetna,80.28,,,,,,,per diem,80.28,80.28,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Aetna MGG,Aetna MGG,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,BCBS,BCBS,80.28,,,,,,,per diem,80.28,80.28,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,BCBS MGG,BCBS MGG,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Cigna,Cigna,80.28,,,,,,,per diem,80.28,80.28,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Cigna MGG,Cigna MGG,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Humana,Humana,80.28,,,,,,,per diem,80.28,80.28,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Humana MGG,Humana MGG,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Optum VA,Optum VA,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,UHC,UHC,80.28,,,,,,,per diem,80.28,80.28,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,UHC MGG,UHC MGG,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,VA,VA,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Wellcare MGG,Wellcare MGG,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Bright Health - commercial,Bright Health - commercial,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,80.28,80.28,Bright Health MGG,Bright Health MGG,80.28,,,,,,,case rate,80.28,80.28,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Aetna,Aetna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Aetna MGG,Aetna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,BCBS,BCBS,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,BCBS MGG,BCBS MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Cigna,Cigna,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Cigna MGG,Cigna MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Humana,Humana,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Humana MGG,Humana MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Optum VA,Optum VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,UHC,UHC,8.46,,,,,,,per diem,8.46,8.46,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,UHC MGG,UHC MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,VA,VA,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Wellcare MGG,Wellcare MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Bright Health - commercial,Bright Health - commercial,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,8.46,8.46,Bright Health MGG,Bright Health MGG,8.46,,,,,,,case rate,8.46,8.46,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Aetna,Aetna,56.46,,,,,,,per diem,56.46,56.46,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Aetna MGG,Aetna MGG,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,BCBS,BCBS,56.46,,,,,,,per diem,56.46,56.46,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,BCBS MGG,BCBS MGG,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Cigna,Cigna,56.46,,,,,,,per diem,56.46,56.46,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Cigna MGG,Cigna MGG,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Humana,Humana,56.46,,,,,,,per diem,56.46,56.46,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Humana MGG,Humana MGG,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Optum VA,Optum VA,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,UHC,UHC,56.46,,,,,,,per diem,56.46,56.46,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,UHC MGG,UHC MGG,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,VA,VA,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Wellcare MGG,Wellcare MGG,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Bright Health - commercial,Bright Health - commercial,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,56.46,56.46,Bright Health MGG,Bright Health MGG,56.46,,,,,,,case rate,56.46,56.46,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Aetna,Aetna,252,,,,,,,per diem,252,252,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Aetna MGG,Aetna MGG,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,BCBS,BCBS,252,,,,,,,per diem,252,252,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,BCBS MGG,BCBS MGG,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Cigna,Cigna,252,,,,,,,per diem,252,252,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Cigna MGG,Cigna MGG,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Humana,Humana,252,,,,,,,per diem,252,252,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Humana MGG,Humana MGG,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Optum VA,Optum VA,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,UHC,UHC,252,,,,,,,per diem,252,252,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,UHC MGG,UHC MGG,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,VA,VA,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Wellcare MGG,Wellcare MGG,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Bright Health - commercial,Bright Health - commercial,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,252,252,Bright Health MGG,Bright Health MGG,252,,,,,,,case rate,252,252,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Aetna,Aetna,512.19,,,,,,,per diem,512.19,512.19,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Aetna MGG,Aetna MGG,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,BCBS,BCBS,512.19,,,,,,,per diem,512.19,512.19,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,BCBS MGG,BCBS MGG,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Cigna,Cigna,512.19,,,,,,,per diem,512.19,512.19,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Cigna MGG,Cigna MGG,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Humana,Humana,512.19,,,,,,,per diem,512.19,512.19,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Humana MGG,Humana MGG,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Optum VA,Optum VA,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,UHC,UHC,512.19,,,,,,,per diem,512.19,512.19,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,UHC MGG,UHC MGG,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,VA,VA,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Wellcare MGG,Wellcare MGG,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Bright Health - commercial,Bright Health - commercial,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,512.19,512.19,Bright Health MGG,Bright Health MGG,512.19,,,,,,,case rate,512.19,512.19,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Aetna,Aetna,54.39,,,,,,,per diem,54.39,54.39,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Aetna MGG,Aetna MGG,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,BCBS,BCBS,54.39,,,,,,,per diem,54.39,54.39,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,BCBS MGG,BCBS MGG,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Cigna,Cigna,54.39,,,,,,,per diem,54.39,54.39,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Cigna MGG,Cigna MGG,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Humana,Humana,54.39,,,,,,,per diem,54.39,54.39,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Humana MGG,Humana MGG,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Optum VA,Optum VA,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,UHC,UHC,54.39,,,,,,,per diem,54.39,54.39,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,UHC MGG,UHC MGG,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,VA,VA,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Wellcare MGG,Wellcare MGG,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Bright Health - commercial,Bright Health - commercial,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,54.39,54.39,Bright Health MGG,Bright Health MGG,54.39,,,,,,,case rate,54.39,54.39,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Aetna,Aetna,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Aetna MGG,Aetna MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,BCBS,BCBS,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,BCBS MGG,BCBS MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Cigna,Cigna,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Cigna MGG,Cigna MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Humana,Humana,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Humana MGG,Humana MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Optum VA,Optum VA,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,UHC,UHC,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,UHC MGG,UHC MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,VA,VA,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Wellcare MGG,Wellcare MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Bright Health - commercial,Bright Health - commercial,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Bright Health MGG,Bright Health MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Aetna,Aetna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Aetna MGG,Aetna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,BCBS,BCBS,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,BCBS MGG,BCBS MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Cigna,Cigna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Cigna MGG,Cigna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Humana,Humana,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Humana MGG,Humana MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Optum VA,Optum VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,UHC,UHC,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,UHC MGG,UHC MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,VA,VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Wellcare MGG,Wellcare MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Bright Health - commercial,Bright Health - commercial,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Bright Health MGG,Bright Health MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Aetna,Aetna,54.3,,,,,,,per diem,54.3,54.3,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Aetna MGG,Aetna MGG,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,BCBS,BCBS,54.3,,,,,,,per diem,54.3,54.3,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,BCBS MGG,BCBS MGG,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Cigna,Cigna,54.3,,,,,,,per diem,54.3,54.3,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Cigna MGG,Cigna MGG,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Humana,Humana,54.3,,,,,,,per diem,54.3,54.3,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Humana MGG,Humana MGG,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Optum VA,Optum VA,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,UHC,UHC,54.3,,,,,,,per diem,54.3,54.3,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,UHC MGG,UHC MGG,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,VA,VA,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Wellcare MGG,Wellcare MGG,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Bright Health - commercial,Bright Health - commercial,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,54.3,54.3,Bright Health MGG,Bright Health MGG,54.3,,,,,,,case rate,54.3,54.3,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Aetna,Aetna,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Aetna MGG,Aetna MGG,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,BCBS,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS MGG,BCBS MGG,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Cigna,Cigna,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Cigna MGG,Cigna MGG,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Humana,Humana,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Humana MGG,Humana MGG,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Optum VA,Optum VA,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,UHC,UHC,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,UHC MGG,UHC MGG,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,VA,VA,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Wellcare MGG,Wellcare MGG,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Bright Health - commercial,Bright Health - commercial,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,Bright Health MGG,Bright Health MGG,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Aetna,Aetna,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Aetna MGG,Aetna MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,BCBS,BCBS,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,BCBS MGG,BCBS MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Cigna,Cigna,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Cigna MGG,Cigna MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Humana,Humana,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Humana MGG,Humana MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Optum VA,Optum VA,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,UHC,UHC,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,UHC MGG,UHC MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,VA,VA,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Wellcare MGG,Wellcare MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Bright Health - commercial,Bright Health - commercial,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Bright Health MGG,Bright Health MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Aetna,Aetna,393.99,,,,,,,per diem,393.99,393.99,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Aetna MGG,Aetna MGG,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,BCBS,BCBS,393.99,,,,,,,per diem,393.99,393.99,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,BCBS MGG,BCBS MGG,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Cigna,Cigna,393.99,,,,,,,per diem,393.99,393.99,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Cigna MGG,Cigna MGG,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Humana,Humana,393.99,,,,,,,per diem,393.99,393.99,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Humana MGG,Humana MGG,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Optum VA,Optum VA,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,UHC,UHC,393.99,,,,,,,per diem,393.99,393.99,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,UHC MGG,UHC MGG,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,VA,VA,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Wellcare MGG,Wellcare MGG,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Bright Health - commercial,Bright Health - commercial,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,393.99,393.99,Bright Health MGG,Bright Health MGG,393.99,,,,,,,case rate,393.99,393.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Aetna,Aetna,30.72,,,,,,,per diem,30.72,30.72,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Aetna MGG,Aetna MGG,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,BCBS,BCBS,30.72,,,,,,,per diem,30.72,30.72,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,BCBS MGG,BCBS MGG,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Cigna,Cigna,30.72,,,,,,,per diem,30.72,30.72,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Cigna MGG,Cigna MGG,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Humana,Humana,30.72,,,,,,,per diem,30.72,30.72,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Humana MGG,Humana MGG,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Optum VA,Optum VA,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,UHC,UHC,30.72,,,,,,,per diem,30.72,30.72,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,UHC MGG,UHC MGG,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,VA,VA,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Wellcare MGG,Wellcare MGG,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Bright Health - commercial,Bright Health - commercial,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,30.72,30.72,Bright Health MGG,Bright Health MGG,30.72,,,,,,,case rate,30.72,30.72,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Aetna,Aetna,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Aetna MGG,Aetna MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,BCBS,BCBS,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,BCBS MGG,BCBS MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Cigna,Cigna,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Cigna MGG,Cigna MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Humana,Humana,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Humana MGG,Humana MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Optum VA,Optum VA,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,UHC,UHC,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,UHC MGG,UHC MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,VA,VA,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Wellcare MGG,Wellcare MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Bright Health - commercial,Bright Health - commercial,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Bright Health MGG,Bright Health MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Aetna,Aetna,106.32,,,,,,,per diem,106.32,106.32,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Aetna MGG,Aetna MGG,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,BCBS,BCBS,106.32,,,,,,,per diem,106.32,106.32,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,BCBS MGG,BCBS MGG,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Cigna,Cigna,106.32,,,,,,,per diem,106.32,106.32,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Cigna MGG,Cigna MGG,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Humana,Humana,106.32,,,,,,,per diem,106.32,106.32,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Humana MGG,Humana MGG,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Optum VA,Optum VA,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,UHC,UHC,106.32,,,,,,,per diem,106.32,106.32,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,UHC MGG,UHC MGG,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,VA,VA,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Wellcare MGG,Wellcare MGG,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Bright Health - commercial,Bright Health - commercial,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,106.32,106.32,Bright Health MGG,Bright Health MGG,106.32,,,,,,,case rate,106.32,106.32,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Aetna,Aetna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Aetna MGG,Aetna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,BCBS,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS MGG,BCBS MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Cigna,Cigna,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Cigna MGG,Cigna MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Humana,Humana,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Humana MGG,Humana MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Optum VA,Optum VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,UHC,UHC,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,UHC MGG,UHC MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,VA,VA,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Wellcare MGG,Wellcare MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Bright Health - commercial,Bright Health - commercial,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,Bright Health MGG,Bright Health MGG,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna,Aetna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna MGG,Aetna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS,BCBS,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS MGG,BCBS MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna,Cigna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna MGG,Cigna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana,Humana,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana MGG,Humana MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Optum VA,Optum VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC,UHC,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC MGG,UHC MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,VA,VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Wellcare MGG,Wellcare MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health - commercial,Bright Health - commercial,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health MGG,Bright Health MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Aetna,Aetna,33.27,,,,,,,per diem,33.27,33.27,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Aetna MGG,Aetna MGG,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,BCBS,BCBS,33.27,,,,,,,per diem,33.27,33.27,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,BCBS MGG,BCBS MGG,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Cigna,Cigna,33.27,,,,,,,per diem,33.27,33.27,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Cigna MGG,Cigna MGG,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Humana,Humana,33.27,,,,,,,per diem,33.27,33.27,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Humana MGG,Humana MGG,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Optum VA,Optum VA,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,UHC,UHC,33.27,,,,,,,per diem,33.27,33.27,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,UHC MGG,UHC MGG,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,VA,VA,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Wellcare MGG,Wellcare MGG,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Bright Health - commercial,Bright Health - commercial,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,33.27,33.27,Bright Health MGG,Bright Health MGG,33.27,,,,,,,case rate,33.27,33.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Aetna,Aetna,116.1,,,,,,,per diem,116.1,116.1,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Aetna MGG,Aetna MGG,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,BCBS,BCBS,116.1,,,,,,,per diem,116.1,116.1,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,BCBS MGG,BCBS MGG,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Cigna,Cigna,116.1,,,,,,,per diem,116.1,116.1,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Cigna MGG,Cigna MGG,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Humana,Humana,116.1,,,,,,,per diem,116.1,116.1,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Humana MGG,Humana MGG,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Optum VA,Optum VA,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,UHC,UHC,116.1,,,,,,,per diem,116.1,116.1,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,UHC MGG,UHC MGG,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,VA,VA,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Wellcare MGG,Wellcare MGG,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Bright Health - commercial,Bright Health - commercial,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,116.1,116.1,Bright Health MGG,Bright Health MGG,116.1,,,,,,,case rate,116.1,116.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Aetna,Aetna,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Aetna MGG,Aetna MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,BCBS,BCBS,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,BCBS MGG,BCBS MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Cigna,Cigna,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Cigna MGG,Cigna MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Humana,Humana,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Humana MGG,Humana MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Optum VA,Optum VA,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,UHC,UHC,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,UHC MGG,UHC MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,VA,VA,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Wellcare MGG,Wellcare MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Bright Health - commercial,Bright Health - commercial,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Bright Health MGG,Bright Health MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Aetna,Aetna,1649.85,,,,,,,per diem,1649.85,1649.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Aetna MGG,Aetna MGG,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,BCBS,BCBS,1649.85,,,,,,,per diem,1649.85,1649.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,BCBS MGG,BCBS MGG,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Cigna,Cigna,1649.85,,,,,,,per diem,1649.85,1649.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Cigna MGG,Cigna MGG,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Humana,Humana,1649.85,,,,,,,per diem,1649.85,1649.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Humana MGG,Humana MGG,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Optum VA,Optum VA,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,UHC,UHC,1649.85,,,,,,,per diem,1649.85,1649.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,UHC MGG,UHC MGG,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,VA,VA,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Wellcare MGG,Wellcare MGG,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Bright Health - commercial,Bright Health - commercial,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,1649.85,1649.85,Bright Health MGG,Bright Health MGG,1649.85,,,,,,,case rate,1649.85,1649.85,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Aetna,Aetna,174.54,,,,,,,per diem,174.54,174.54,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Aetna MGG,Aetna MGG,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,BCBS,BCBS,174.54,,,,,,,per diem,174.54,174.54,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,BCBS MGG,BCBS MGG,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Cigna,Cigna,174.54,,,,,,,per diem,174.54,174.54,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Cigna MGG,Cigna MGG,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Humana,Humana,174.54,,,,,,,per diem,174.54,174.54,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Humana MGG,Humana MGG,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Optum VA,Optum VA,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,UHC,UHC,174.54,,,,,,,per diem,174.54,174.54,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,UHC MGG,UHC MGG,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,VA,VA,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Wellcare MGG,Wellcare MGG,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Bright Health - commercial,Bright Health - commercial,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,174.54,174.54,Bright Health MGG,Bright Health MGG,174.54,,,,,,,case rate,174.54,174.54,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Aetna,Aetna,164.04,,,,,,,per diem,164.04,164.04,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Aetna MGG,Aetna MGG,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,BCBS,BCBS,164.04,,,,,,,per diem,164.04,164.04,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,BCBS MGG,BCBS MGG,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Cigna,Cigna,164.04,,,,,,,per diem,164.04,164.04,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Cigna MGG,Cigna MGG,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Humana,Humana,164.04,,,,,,,per diem,164.04,164.04,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Humana MGG,Humana MGG,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Optum VA,Optum VA,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,UHC,UHC,164.04,,,,,,,per diem,164.04,164.04,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,UHC MGG,UHC MGG,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,VA,VA,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Wellcare MGG,Wellcare MGG,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Bright Health - commercial,Bright Health - commercial,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,164.04,164.04,Bright Health MGG,Bright Health MGG,164.04,,,,,,,case rate,164.04,164.04,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Aetna,Aetna,53.58,,,,,,,per diem,53.58,53.58,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Aetna MGG,Aetna MGG,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,BCBS,BCBS,53.58,,,,,,,per diem,53.58,53.58,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,BCBS MGG,BCBS MGG,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Cigna,Cigna,53.58,,,,,,,per diem,53.58,53.58,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Cigna MGG,Cigna MGG,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Humana,Humana,53.58,,,,,,,per diem,53.58,53.58,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Humana MGG,Humana MGG,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Optum VA,Optum VA,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,UHC,UHC,53.58,,,,,,,per diem,53.58,53.58,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,UHC MGG,UHC MGG,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,VA,VA,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Wellcare MGG,Wellcare MGG,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Bright Health - commercial,Bright Health - commercial,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,53.58,53.58,Bright Health MGG,Bright Health MGG,53.58,,,,,,,case rate,53.58,53.58,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Aetna,Aetna,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Aetna MGG,Aetna MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,BCBS,BCBS,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,BCBS MGG,BCBS MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Cigna,Cigna,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Cigna MGG,Cigna MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Humana,Humana,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Humana MGG,Humana MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Optum VA,Optum VA,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,UHC,UHC,27.15,,,,,,,per diem,27.15,27.15,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,UHC MGG,UHC MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,VA,VA,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Wellcare MGG,Wellcare MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Bright Health - commercial,Bright Health - commercial,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,27.15,27.15,Bright Health MGG,Bright Health MGG,27.15,,,,,,,case rate,27.15,27.15,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Aetna,Aetna,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Aetna MGG,Aetna MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,BCBS,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS MGG,BCBS MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Cigna,Cigna,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Cigna MGG,Cigna MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Humana,Humana,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Humana MGG,Humana MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Optum VA,Optum VA,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,UHC,UHC,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,UHC MGG,UHC MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,VA,VA,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Wellcare MGG,Wellcare MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Bright Health - commercial,Bright Health - commercial,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Bright Health MGG,Bright Health MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Aetna,Aetna,23.79,,,,,,,per diem,23.79,23.79,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Aetna MGG,Aetna MGG,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,BCBS,BCBS,23.79,,,,,,,per diem,23.79,23.79,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,BCBS MGG,BCBS MGG,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Cigna,Cigna,23.79,,,,,,,per diem,23.79,23.79,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Cigna MGG,Cigna MGG,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Humana,Humana,23.79,,,,,,,per diem,23.79,23.79,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Humana MGG,Humana MGG,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Optum VA,Optum VA,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,UHC,UHC,23.79,,,,,,,per diem,23.79,23.79,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,UHC MGG,UHC MGG,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,VA,VA,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Wellcare MGG,Wellcare MGG,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Bright Health - commercial,Bright Health - commercial,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,23.79,23.79,Bright Health MGG,Bright Health MGG,23.79,,,,,,,case rate,23.79,23.79,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Aetna,Aetna,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Aetna MGG,Aetna MGG,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,BCBS,BCBS,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,BCBS MGG,BCBS MGG,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Cigna,Cigna,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Cigna MGG,Cigna MGG,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Humana,Humana,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Humana MGG,Humana MGG,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Optum VA,Optum VA,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,UHC,UHC,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,UHC MGG,UHC MGG,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,VA,VA,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Wellcare MGG,Wellcare MGG,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Bright Health - commercial,Bright Health - commercial,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,Bright Health MGG,Bright Health MGG,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna,Aetna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna MGG,Aetna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,BCBS,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS MGG,BCBS MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna,Cigna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna MGG,Cigna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana,Humana,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana MGG,Humana MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Optum VA,Optum VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC,UHC,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC MGG,UHC MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA,VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Wellcare MGG,Wellcare MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health - commercial,Bright Health - commercial,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health MGG,Bright Health MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Aetna,Aetna,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Aetna MGG,Aetna MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,BCBS,BCBS,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,BCBS MGG,BCBS MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Cigna,Cigna,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Cigna MGG,Cigna MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Humana,Humana,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Humana MGG,Humana MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Optum VA,Optum VA,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,UHC,UHC,27.21,,,,,,,per diem,27.21,27.21,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,UHC MGG,UHC MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,VA,VA,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Wellcare MGG,Wellcare MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Bright Health - commercial,Bright Health - commercial,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,27.21,27.21,Bright Health MGG,Bright Health MGG,27.21,,,,,,,case rate,27.21,27.21,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Aetna,Aetna,120.6,,,,,,,per diem,120.6,120.6,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Aetna MGG,Aetna MGG,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,BCBS,BCBS,120.6,,,,,,,per diem,120.6,120.6,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,BCBS MGG,BCBS MGG,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Cigna,Cigna,120.6,,,,,,,per diem,120.6,120.6,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Cigna MGG,Cigna MGG,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Humana,Humana,120.6,,,,,,,per diem,120.6,120.6,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Humana MGG,Humana MGG,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Optum VA,Optum VA,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,UHC,UHC,120.6,,,,,,,per diem,120.6,120.6,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,UHC MGG,UHC MGG,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,VA,VA,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Wellcare MGG,Wellcare MGG,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Bright Health - commercial,Bright Health - commercial,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,120.6,120.6,Bright Health MGG,Bright Health MGG,120.6,,,,,,,case rate,120.6,120.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Aetna,Aetna,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Aetna MGG,Aetna MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,BCBS,BCBS,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,BCBS MGG,BCBS MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Cigna,Cigna,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Cigna MGG,Cigna MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Humana,Humana,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Humana MGG,Humana MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Optum VA,Optum VA,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,UHC,UHC,57.42,,,,,,,per diem,57.42,57.42,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,UHC MGG,UHC MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,VA,VA,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Wellcare MGG,Wellcare MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Bright Health - commercial,Bright Health - commercial,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,57.42,57.42,Bright Health MGG,Bright Health MGG,57.42,,,,,,,case rate,57.42,57.42,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Aetna,Aetna,196.98,,,,,,,per diem,196.98,196.98,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Aetna MGG,Aetna MGG,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,BCBS,BCBS,196.98,,,,,,,per diem,196.98,196.98,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,BCBS MGG,BCBS MGG,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Cigna,Cigna,196.98,,,,,,,per diem,196.98,196.98,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Cigna MGG,Cigna MGG,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Humana,Humana,196.98,,,,,,,per diem,196.98,196.98,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Humana MGG,Humana MGG,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Optum VA,Optum VA,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,UHC,UHC,196.98,,,,,,,per diem,196.98,196.98,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,UHC MGG,UHC MGG,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,VA,VA,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Wellcare MGG,Wellcare MGG,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Bright Health - commercial,Bright Health - commercial,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,196.98,196.98,Bright Health MGG,Bright Health MGG,196.98,,,,,,,case rate,196.98,196.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Aetna,Aetna,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Aetna MGG,Aetna MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,BCBS,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS MGG,BCBS MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Cigna,Cigna,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Cigna MGG,Cigna MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Humana,Humana,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Humana MGG,Humana MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Optum VA,Optum VA,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UHC,UHC,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UHC MGG,UHC MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,VA,VA,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Wellcare MGG,Wellcare MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Bright Health - commercial,Bright Health - commercial,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,Bright Health MGG,Bright Health MGG,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Aetna,Aetna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Aetna MGG,Aetna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,BCBS,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS MGG,BCBS MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Cigna,Cigna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Cigna MGG,Cigna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Humana,Humana,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Humana MGG,Humana MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Optum VA,Optum VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,UHC,UHC,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,UHC MGG,UHC MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,VA,VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Wellcare MGG,Wellcare MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Bright Health - commercial,Bright Health - commercial,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Bright Health MGG,Bright Health MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Aetna,Aetna,104.89,,,,,,,per diem,104.89,104.89,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Aetna MGG,Aetna MGG,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,BCBS,BCBS,104.89,,,,,,,per diem,104.89,104.89,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,BCBS MGG,BCBS MGG,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Cigna,Cigna,104.89,,,,,,,per diem,104.89,104.89,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Cigna MGG,Cigna MGG,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Humana,Humana,104.89,,,,,,,per diem,104.89,104.89,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Humana MGG,Humana MGG,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Optum VA,Optum VA,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,UHC,UHC,104.89,,,,,,,per diem,104.89,104.89,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,UHC MGG,UHC MGG,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,VA,VA,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Wellcare MGG,Wellcare MGG,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Bright Health - commercial,Bright Health - commercial,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,104.89,104.89,Bright Health MGG,Bright Health MGG,104.89,,,,,,,case rate,104.89,104.89,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Aetna,Aetna,19.98,,,,,,,per diem,19.98,19.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Aetna MGG,Aetna MGG,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,BCBS,BCBS,19.98,,,,,,,per diem,19.98,19.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,BCBS MGG,BCBS MGG,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Cigna,Cigna,19.98,,,,,,,per diem,19.98,19.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Cigna MGG,Cigna MGG,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Humana,Humana,19.98,,,,,,,per diem,19.98,19.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Humana MGG,Humana MGG,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Optum VA,Optum VA,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,UHC,UHC,19.98,,,,,,,per diem,19.98,19.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,UHC MGG,UHC MGG,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,VA,VA,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Wellcare MGG,Wellcare MGG,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Bright Health - commercial,Bright Health - commercial,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,19.98,19.98,Bright Health MGG,Bright Health MGG,19.98,,,,,,,case rate,19.98,19.98,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Aetna,Aetna,114,,,,,,,per diem,114,114,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Aetna MGG,Aetna MGG,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,BCBS,BCBS,114,,,,,,,per diem,114,114,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,BCBS MGG,BCBS MGG,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Cigna,Cigna,114,,,,,,,per diem,114,114,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Cigna MGG,Cigna MGG,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Humana,Humana,114,,,,,,,per diem,114,114,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Humana MGG,Humana MGG,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Optum VA,Optum VA,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,UHC,UHC,114,,,,,,,per diem,114,114,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,UHC MGG,UHC MGG,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,VA,VA,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Wellcare MGG,Wellcare MGG,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Bright Health - commercial,Bright Health - commercial,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,114,114,Bright Health MGG,Bright Health MGG,114,,,,,,,case rate,114,114,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Aetna,Aetna,24.78,,,,,,,per diem,24.78,24.78,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Aetna MGG,Aetna MGG,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,BCBS,BCBS,24.78,,,,,,,per diem,24.78,24.78,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,BCBS MGG,BCBS MGG,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Cigna,Cigna,24.78,,,,,,,per diem,24.78,24.78,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Cigna MGG,Cigna MGG,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Humana,Humana,24.78,,,,,,,per diem,24.78,24.78,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Humana MGG,Humana MGG,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Optum VA,Optum VA,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,UHC,UHC,24.78,,,,,,,per diem,24.78,24.78,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,UHC MGG,UHC MGG,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,VA,VA,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Wellcare MGG,Wellcare MGG,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Bright Health - commercial,Bright Health - commercial,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,24.78,24.78,Bright Health MGG,Bright Health MGG,24.78,,,,,,,case rate,24.78,24.78,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Aetna,Aetna,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Aetna MGG,Aetna MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,BCBS,BCBS,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,BCBS MGG,BCBS MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Cigna,Cigna,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Cigna MGG,Cigna MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Humana,Humana,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Humana MGG,Humana MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Optum VA,Optum VA,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,UHC,UHC,5.37,,,,,,,per diem,5.37,5.37,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,UHC MGG,UHC MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,VA,VA,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Wellcare MGG,Wellcare MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Bright Health - commercial,Bright Health - commercial,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.37,5.37,Bright Health MGG,Bright Health MGG,5.37,,,,,,,case rate,5.37,5.37,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Aetna,Aetna,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Aetna MGG,Aetna MGG,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,BCBS,BCBS,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,BCBS MGG,BCBS MGG,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Cigna,Cigna,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Cigna MGG,Cigna MGG,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Humana,Humana,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Humana MGG,Humana MGG,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Optum VA,Optum VA,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,UHC,UHC,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,UHC MGG,UHC MGG,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,VA,VA,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Wellcare MGG,Wellcare MGG,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Bright Health - commercial,Bright Health - commercial,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,15.39,15.39,Bright Health MGG,Bright Health MGG,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna,Aetna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna MGG,Aetna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS,BCBS,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS MGG,BCBS MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna,Cigna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna MGG,Cigna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana,Humana,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana MGG,Humana MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Optum VA,Optum VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC,UHC,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC MGG,UHC MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,VA,VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Wellcare MGG,Wellcare MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health - commercial,Bright Health - commercial,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health MGG,Bright Health MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Aetna,Aetna,7293.27,,,,,,,per diem,7293.27,7293.27,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Aetna MGG,Aetna MGG,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,BCBS,BCBS,7293.27,,,,,,,per diem,7293.27,7293.27,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,BCBS MGG,BCBS MGG,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Cigna,Cigna,7293.27,,,,,,,per diem,7293.27,7293.27,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Cigna MGG,Cigna MGG,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Humana,Humana,7293.27,,,,,,,per diem,7293.27,7293.27,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Humana MGG,Humana MGG,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Optum VA,Optum VA,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,UHC,UHC,7293.27,,,,,,,per diem,7293.27,7293.27,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,UHC MGG,UHC MGG,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,VA,VA,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Wellcare MGG,Wellcare MGG,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Bright Health - commercial,Bright Health - commercial,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7293.27,7293.27,Bright Health MGG,Bright Health MGG,7293.27,,,,,,,case rate,7293.27,7293.27,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Aetna,Aetna,19.05,,,,,,,per diem,19.05,19.05,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Aetna MGG,Aetna MGG,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,BCBS,BCBS,19.05,,,,,,,per diem,19.05,19.05,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,BCBS MGG,BCBS MGG,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Cigna,Cigna,19.05,,,,,,,per diem,19.05,19.05,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Cigna MGG,Cigna MGG,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Humana,Humana,19.05,,,,,,,per diem,19.05,19.05,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Humana MGG,Humana MGG,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Optum VA,Optum VA,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,UHC,UHC,19.05,,,,,,,per diem,19.05,19.05,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,UHC MGG,UHC MGG,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,VA,VA,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Wellcare MGG,Wellcare MGG,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Bright Health - commercial,Bright Health - commercial,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,19.05,19.05,Bright Health MGG,Bright Health MGG,19.05,,,,,,,case rate,19.05,19.05,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Aetna,Aetna,110.67,,,,,,,per diem,110.67,110.67,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Aetna MGG,Aetna MGG,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,BCBS,BCBS,110.67,,,,,,,per diem,110.67,110.67,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,BCBS MGG,BCBS MGG,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Cigna,Cigna,110.67,,,,,,,per diem,110.67,110.67,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Cigna MGG,Cigna MGG,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Humana,Humana,110.67,,,,,,,per diem,110.67,110.67,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Humana MGG,Humana MGG,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Optum VA,Optum VA,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,UHC,UHC,110.67,,,,,,,per diem,110.67,110.67,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,UHC MGG,UHC MGG,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,VA,VA,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Wellcare MGG,Wellcare MGG,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Bright Health - commercial,Bright Health - commercial,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,110.67,110.67,Bright Health MGG,Bright Health MGG,110.67,,,,,,,case rate,110.67,110.67,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Aetna,Aetna,306.9,,,,,,,per diem,306.9,306.9,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Aetna MGG,Aetna MGG,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,BCBS,BCBS,306.9,,,,,,,per diem,306.9,306.9,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,BCBS MGG,BCBS MGG,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Cigna,Cigna,306.9,,,,,,,per diem,306.9,306.9,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Cigna MGG,Cigna MGG,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Humana,Humana,306.9,,,,,,,per diem,306.9,306.9,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Humana MGG,Humana MGG,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Optum VA,Optum VA,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,UHC,UHC,306.9,,,,,,,per diem,306.9,306.9,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,UHC MGG,UHC MGG,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,VA,VA,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Wellcare MGG,Wellcare MGG,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Bright Health - commercial,Bright Health - commercial,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,306.9,306.9,Bright Health MGG,Bright Health MGG,306.9,,,,,,,case rate,306.9,306.9,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Aetna,Aetna,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Aetna MGG,Aetna MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS,BCBS,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS MGG,BCBS MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Cigna,Cigna,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Cigna MGG,Cigna MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Humana,Humana,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Humana MGG,Humana MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Optum VA,Optum VA,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,UHC,UHC,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,UHC MGG,UHC MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,VA,VA,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Wellcare MGG,Wellcare MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Bright Health - commercial,Bright Health - commercial,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Bright Health MGG,Bright Health MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Aetna,Aetna,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Aetna MGG,Aetna MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,BCBS,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS MGG,BCBS MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Cigna,Cigna,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Cigna MGG,Cigna MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Humana,Humana,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Humana MGG,Humana MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Optum VA,Optum VA,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UHC,UHC,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UHC MGG,UHC MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,VA,VA,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Wellcare MGG,Wellcare MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Bright Health - commercial,Bright Health - commercial,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Bright Health MGG,Bright Health MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Aetna,Aetna,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Aetna MGG,Aetna MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,BCBS,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS MGG,BCBS MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Cigna,Cigna,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Cigna MGG,Cigna MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Humana,Humana,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Humana MGG,Humana MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Optum VA,Optum VA,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UHC,UHC,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UHC MGG,UHC MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,VA,VA,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Wellcare MGG,Wellcare MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Bright Health - commercial,Bright Health - commercial,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Bright Health MGG,Bright Health MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Aetna,Aetna,312.36,,,,,,,per diem,312.36,312.36,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Aetna MGG,Aetna MGG,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,BCBS,BCBS,312.36,,,,,,,per diem,312.36,312.36,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,BCBS MGG,BCBS MGG,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Cigna,Cigna,312.36,,,,,,,per diem,312.36,312.36,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Cigna MGG,Cigna MGG,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Humana,Humana,312.36,,,,,,,per diem,312.36,312.36,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Humana MGG,Humana MGG,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Optum VA,Optum VA,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,UHC,UHC,312.36,,,,,,,per diem,312.36,312.36,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,UHC MGG,UHC MGG,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,VA,VA,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Wellcare MGG,Wellcare MGG,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Bright Health - commercial,Bright Health - commercial,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,312.36,312.36,Bright Health MGG,Bright Health MGG,312.36,,,,,,,case rate,312.36,312.36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Aetna,Aetna,58.11,,,,,,,per diem,58.11,58.11,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Aetna MGG,Aetna MGG,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,BCBS,BCBS,58.11,,,,,,,per diem,58.11,58.11,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,BCBS MGG,BCBS MGG,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Cigna,Cigna,58.11,,,,,,,per diem,58.11,58.11,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Cigna MGG,Cigna MGG,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Humana,Humana,58.11,,,,,,,per diem,58.11,58.11,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Humana MGG,Humana MGG,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Optum VA,Optum VA,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,UHC,UHC,58.11,,,,,,,per diem,58.11,58.11,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,UHC MGG,UHC MGG,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,VA,VA,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Wellcare MGG,Wellcare MGG,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Bright Health - commercial,Bright Health - commercial,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,58.11,58.11,Bright Health MGG,Bright Health MGG,58.11,,,,,,,case rate,58.11,58.11,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Aetna,Aetna,175.95,,,,,,,per diem,175.95,175.95,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Aetna MGG,Aetna MGG,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,BCBS,BCBS,175.95,,,,,,,per diem,175.95,175.95,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,BCBS MGG,BCBS MGG,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Cigna,Cigna,175.95,,,,,,,per diem,175.95,175.95,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Cigna MGG,Cigna MGG,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Humana,Humana,175.95,,,,,,,per diem,175.95,175.95,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Humana MGG,Humana MGG,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Optum VA,Optum VA,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,UHC,UHC,175.95,,,,,,,per diem,175.95,175.95,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,UHC MGG,UHC MGG,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,VA,VA,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Wellcare MGG,Wellcare MGG,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Bright Health - commercial,Bright Health - commercial,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,175.95,175.95,Bright Health MGG,Bright Health MGG,175.95,,,,,,,case rate,175.95,175.95,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Aetna,Aetna,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Aetna MGG,Aetna MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,BCBS,BCBS,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,BCBS MGG,BCBS MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Cigna,Cigna,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Cigna MGG,Cigna MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Humana,Humana,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Humana MGG,Humana MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Optum VA,Optum VA,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,UHC,UHC,10.2,,,,,,,per diem,10.2,10.2,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,UHC MGG,UHC MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,VA,VA,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Wellcare MGG,Wellcare MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Bright Health - commercial,Bright Health - commercial,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.2,10.2,Bright Health MGG,Bright Health MGG,10.2,,,,,,,case rate,10.2,10.2,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Aetna,Aetna,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Aetna MGG,Aetna MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,BCBS,BCBS,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,BCBS MGG,BCBS MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Cigna,Cigna,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Cigna MGG,Cigna MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Humana,Humana,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Humana MGG,Humana MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Optum VA,Optum VA,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,UHC,UHC,293.76,,,,,,,per diem,293.76,293.76,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,UHC MGG,UHC MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,VA,VA,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Wellcare MGG,Wellcare MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Bright Health - commercial,Bright Health - commercial,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,293.76,293.76,Bright Health MGG,Bright Health MGG,293.76,,,,,,,case rate,293.76,293.76,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Aetna,Aetna,14.1,,,,,,,per diem,14.1,14.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Aetna MGG,Aetna MGG,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,BCBS,BCBS,14.1,,,,,,,per diem,14.1,14.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,BCBS MGG,BCBS MGG,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Cigna,Cigna,14.1,,,,,,,per diem,14.1,14.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Cigna MGG,Cigna MGG,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Humana,Humana,14.1,,,,,,,per diem,14.1,14.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Humana MGG,Humana MGG,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Optum VA,Optum VA,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,UHC,UHC,14.1,,,,,,,per diem,14.1,14.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,UHC MGG,UHC MGG,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,VA,VA,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Wellcare MGG,Wellcare MGG,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Bright Health - commercial,Bright Health - commercial,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.1,14.1,Bright Health MGG,Bright Health MGG,14.1,,,,,,,case rate,14.1,14.1,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna,Aetna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna MGG,Aetna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,BCBS,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS MGG,BCBS MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna,Cigna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna MGG,Cigna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana,Humana,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana MGG,Humana MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Optum VA,Optum VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC,UHC,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC MGG,UHC MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA,VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Wellcare MGG,Wellcare MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health - commercial,Bright Health - commercial,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health MGG,Bright Health MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Aetna,Aetna,52.47,,,,,,,per diem,52.47,52.47,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Aetna MGG,Aetna MGG,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,BCBS,BCBS,52.47,,,,,,,per diem,52.47,52.47,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,BCBS MGG,BCBS MGG,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Cigna,Cigna,52.47,,,,,,,per diem,52.47,52.47,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Cigna MGG,Cigna MGG,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Humana,Humana,52.47,,,,,,,per diem,52.47,52.47,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Humana MGG,Humana MGG,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Optum VA,Optum VA,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,UHC,UHC,52.47,,,,,,,per diem,52.47,52.47,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,UHC MGG,UHC MGG,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,VA,VA,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Wellcare MGG,Wellcare MGG,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Bright Health - commercial,Bright Health - commercial,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,52.47,52.47,Bright Health MGG,Bright Health MGG,52.47,,,,,,,case rate,52.47,52.47,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna,Aetna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna MGG,Aetna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS,BCBS,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS MGG,BCBS MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna,Cigna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna MGG,Cigna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana,Humana,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana MGG,Humana MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Optum VA,Optum VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC,UHC,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC MGG,UHC MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,VA,VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Wellcare MGG,Wellcare MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health - commercial,Bright Health - commercial,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health MGG,Bright Health MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Aetna,Aetna,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Aetna MGG,Aetna MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,BCBS,BCBS,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,BCBS MGG,BCBS MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Cigna,Cigna,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Cigna MGG,Cigna MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Humana,Humana,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Humana MGG,Humana MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Optum VA,Optum VA,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,UHC,UHC,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,UHC MGG,UHC MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,VA,VA,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Wellcare MGG,Wellcare MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Bright Health - commercial,Bright Health - commercial,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Bright Health MGG,Bright Health MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Aetna,Aetna,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Aetna MGG,Aetna MGG,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,BCBS,BCBS,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,BCBS MGG,BCBS MGG,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Cigna,Cigna,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Cigna MGG,Cigna MGG,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Humana,Humana,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Humana MGG,Humana MGG,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Optum VA,Optum VA,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,UHC,UHC,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,UHC MGG,UHC MGG,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,VA,VA,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Wellcare MGG,Wellcare MGG,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Bright Health - commercial,Bright Health - commercial,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,Bright Health MGG,Bright Health MGG,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Aetna,Aetna,1117.92,,,,,,,per diem,1117.92,1117.92,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Aetna MGG,Aetna MGG,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,BCBS,BCBS,1117.92,,,,,,,per diem,1117.92,1117.92,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,BCBS MGG,BCBS MGG,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Cigna,Cigna,1117.92,,,,,,,per diem,1117.92,1117.92,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Cigna MGG,Cigna MGG,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Humana,Humana,1117.92,,,,,,,per diem,1117.92,1117.92,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Humana MGG,Humana MGG,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Optum VA,Optum VA,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,UHC,UHC,1117.92,,,,,,,per diem,1117.92,1117.92,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,UHC MGG,UHC MGG,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,VA,VA,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Wellcare MGG,Wellcare MGG,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Bright Health - commercial,Bright Health - commercial,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1117.92,1117.92,Bright Health MGG,Bright Health MGG,1117.92,,,,,,,case rate,1117.92,1117.92,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Aetna,Aetna,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Aetna MGG,Aetna MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,BCBS,BCBS,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,BCBS MGG,BCBS MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Cigna,Cigna,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Cigna MGG,Cigna MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Humana,Humana,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Humana MGG,Humana MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Optum VA,Optum VA,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,UHC,UHC,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,UHC MGG,UHC MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,VA,VA,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Wellcare MGG,Wellcare MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Bright Health - commercial,Bright Health - commercial,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Bright Health MGG,Bright Health MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Aetna,Aetna,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Aetna MGG,Aetna MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,BCBS,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS MGG,BCBS MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Cigna,Cigna,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Cigna MGG,Cigna MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Humana,Humana,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Humana MGG,Humana MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Optum VA,Optum VA,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UHC,UHC,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UHC MGG,UHC MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,VA,VA,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Wellcare MGG,Wellcare MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Bright Health - commercial,Bright Health - commercial,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Bright Health MGG,Bright Health MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Aetna,Aetna,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Aetna MGG,Aetna MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,BCBS,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS MGG,BCBS MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Cigna,Cigna,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Cigna MGG,Cigna MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Humana,Humana,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Humana MGG,Humana MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Optum VA,Optum VA,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UHC,UHC,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UHC MGG,UHC MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,VA,VA,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Wellcare MGG,Wellcare MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Bright Health - commercial,Bright Health - commercial,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Bright Health MGG,Bright Health MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Aetna,Aetna,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Aetna MGG,Aetna MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,BCBS,BCBS,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,BCBS MGG,BCBS MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Cigna,Cigna,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Cigna MGG,Cigna MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Humana,Humana,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Humana MGG,Humana MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Optum VA,Optum VA,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,UHC,UHC,14.37,,,,,,,per diem,14.37,14.37,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,UHC MGG,UHC MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,VA,VA,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Wellcare MGG,Wellcare MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Bright Health - commercial,Bright Health - commercial,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,14.37,14.37,Bright Health MGG,Bright Health MGG,14.37,,,,,,,case rate,14.37,14.37,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Aetna,Aetna,61.86,,,,,,,per diem,61.86,61.86,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Aetna MGG,Aetna MGG,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,BCBS,BCBS,61.86,,,,,,,per diem,61.86,61.86,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,BCBS MGG,BCBS MGG,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Cigna,Cigna,61.86,,,,,,,per diem,61.86,61.86,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Cigna MGG,Cigna MGG,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Humana,Humana,61.86,,,,,,,per diem,61.86,61.86,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Humana MGG,Humana MGG,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Optum VA,Optum VA,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,UHC,UHC,61.86,,,,,,,per diem,61.86,61.86,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,UHC MGG,UHC MGG,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,VA,VA,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Wellcare MGG,Wellcare MGG,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Bright Health - commercial,Bright Health - commercial,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,61.86,61.86,Bright Health MGG,Bright Health MGG,61.86,,,,,,,case rate,61.86,61.86,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Aetna,Aetna,5.52,,,,,,,per diem,5.52,5.52,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Aetna MGG,Aetna MGG,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,BCBS,BCBS,5.52,,,,,,,per diem,5.52,5.52,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,BCBS MGG,BCBS MGG,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Cigna,Cigna,5.52,,,,,,,per diem,5.52,5.52,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Cigna MGG,Cigna MGG,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Humana,Humana,5.52,,,,,,,per diem,5.52,5.52,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Humana MGG,Humana MGG,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Optum VA,Optum VA,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,UHC,UHC,5.52,,,,,,,per diem,5.52,5.52,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,UHC MGG,UHC MGG,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,VA,VA,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Wellcare MGG,Wellcare MGG,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Bright Health - commercial,Bright Health - commercial,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.52,5.52,Bright Health MGG,Bright Health MGG,5.52,,,,,,,case rate,5.52,5.52,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Aetna,Aetna,162,,,,,,,per diem,162,162,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Aetna MGG,Aetna MGG,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,BCBS,BCBS,162,,,,,,,per diem,162,162,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,BCBS MGG,BCBS MGG,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Cigna,Cigna,162,,,,,,,per diem,162,162,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Cigna MGG,Cigna MGG,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Humana,Humana,162,,,,,,,per diem,162,162,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Humana MGG,Humana MGG,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Optum VA,Optum VA,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,UHC,UHC,162,,,,,,,per diem,162,162,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,UHC MGG,UHC MGG,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,VA,VA,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Wellcare MGG,Wellcare MGG,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Bright Health - commercial,Bright Health - commercial,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,162,162,Bright Health MGG,Bright Health MGG,162,,,,,,,case rate,162,162,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Aetna,Aetna,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Aetna MGG,Aetna MGG,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,BCBS,BCBS,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,BCBS MGG,BCBS MGG,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Cigna,Cigna,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Cigna MGG,Cigna MGG,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Humana,Humana,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Humana MGG,Humana MGG,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Optum VA,Optum VA,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,UHC,UHC,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,UHC MGG,UHC MGG,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,VA,VA,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Wellcare MGG,Wellcare MGG,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Bright Health - commercial,Bright Health - commercial,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,Bright Health MGG,Bright Health MGG,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Aetna,Aetna,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Aetna MGG,Aetna MGG,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,BCBS,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS MGG,BCBS MGG,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Cigna,Cigna,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Cigna MGG,Cigna MGG,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Humana,Humana,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Humana MGG,Humana MGG,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Optum VA,Optum VA,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,UHC,UHC,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,UHC MGG,UHC MGG,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,VA,VA,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Wellcare MGG,Wellcare MGG,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Bright Health - commercial,Bright Health - commercial,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,Bright Health MGG,Bright Health MGG,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Aetna,Aetna,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Aetna MGG,Aetna MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,BCBS,BCBS,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,BCBS MGG,BCBS MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Cigna,Cigna,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Cigna MGG,Cigna MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Humana,Humana,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Humana MGG,Humana MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Optum VA,Optum VA,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,UHC,UHC,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,UHC MGG,UHC MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,VA,VA,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Wellcare MGG,Wellcare MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Bright Health - commercial,Bright Health - commercial,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Bright Health MGG,Bright Health MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Aetna,Aetna,506.61,,,,,,,per diem,506.61,506.61,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Aetna MGG,Aetna MGG,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,BCBS,BCBS,506.61,,,,,,,per diem,506.61,506.61,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,BCBS MGG,BCBS MGG,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Cigna,Cigna,506.61,,,,,,,per diem,506.61,506.61,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Cigna MGG,Cigna MGG,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Humana,Humana,506.61,,,,,,,per diem,506.61,506.61,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Humana MGG,Humana MGG,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Optum VA,Optum VA,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,UHC,UHC,506.61,,,,,,,per diem,506.61,506.61,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,UHC MGG,UHC MGG,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,VA,VA,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Wellcare MGG,Wellcare MGG,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Bright Health - commercial,Bright Health - commercial,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,506.61,506.61,Bright Health MGG,Bright Health MGG,506.61,,,,,,,case rate,506.61,506.61,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Aetna,Aetna,26.22,,,,,,,per diem,26.22,26.22,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Aetna MGG,Aetna MGG,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,BCBS,BCBS,26.22,,,,,,,per diem,26.22,26.22,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,BCBS MGG,BCBS MGG,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Cigna,Cigna,26.22,,,,,,,per diem,26.22,26.22,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Cigna MGG,Cigna MGG,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Humana,Humana,26.22,,,,,,,per diem,26.22,26.22,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Humana MGG,Humana MGG,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Optum VA,Optum VA,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,UHC,UHC,26.22,,,,,,,per diem,26.22,26.22,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,UHC MGG,UHC MGG,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,VA,VA,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Wellcare MGG,Wellcare MGG,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Bright Health - commercial,Bright Health - commercial,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,26.22,26.22,Bright Health MGG,Bright Health MGG,26.22,,,,,,,case rate,26.22,26.22,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Aetna,Aetna,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Aetna MGG,Aetna MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,BCBS,BCBS,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,BCBS MGG,BCBS MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Cigna,Cigna,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Cigna MGG,Cigna MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Humana,Humana,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Humana MGG,Humana MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Optum VA,Optum VA,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,UHC,UHC,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,UHC MGG,UHC MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,VA,VA,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Wellcare MGG,Wellcare MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Bright Health - commercial,Bright Health - commercial,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Bright Health MGG,Bright Health MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Aetna,Aetna,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Aetna MGG,Aetna MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,BCBS,BCBS,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,BCBS MGG,BCBS MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Cigna,Cigna,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Cigna MGG,Cigna MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Humana,Humana,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Humana MGG,Humana MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Optum VA,Optum VA,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,UHC,UHC,8.07,,,,,,,per diem,8.07,8.07,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,UHC MGG,UHC MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,VA,VA,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Wellcare MGG,Wellcare MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Bright Health - commercial,Bright Health - commercial,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.07,8.07,Bright Health MGG,Bright Health MGG,8.07,,,,,,,case rate,8.07,8.07,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Aetna,Aetna,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Aetna MGG,Aetna MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,BCBS,BCBS,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,BCBS MGG,BCBS MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Cigna,Cigna,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Cigna MGG,Cigna MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Humana,Humana,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Humana MGG,Humana MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Optum VA,Optum VA,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,UHC,UHC,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,UHC MGG,UHC MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,VA,VA,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Wellcare MGG,Wellcare MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Bright Health - commercial,Bright Health - commercial,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Bright Health MGG,Bright Health MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Aetna,Aetna,43.8,,,,,,,per diem,43.8,43.8,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Aetna MGG,Aetna MGG,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,BCBS,BCBS,43.8,,,,,,,per diem,43.8,43.8,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,BCBS MGG,BCBS MGG,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Cigna,Cigna,43.8,,,,,,,per diem,43.8,43.8,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Cigna MGG,Cigna MGG,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Humana,Humana,43.8,,,,,,,per diem,43.8,43.8,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Humana MGG,Humana MGG,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Optum VA,Optum VA,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,UHC,UHC,43.8,,,,,,,per diem,43.8,43.8,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,UHC MGG,UHC MGG,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,VA,VA,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Wellcare MGG,Wellcare MGG,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Bright Health - commercial,Bright Health - commercial,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,43.8,43.8,Bright Health MGG,Bright Health MGG,43.8,,,,,,,case rate,43.8,43.8,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna,Aetna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna MGG,Aetna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS,BCBS,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS MGG,BCBS MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna,Cigna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna MGG,Cigna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana,Humana,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana MGG,Humana MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Optum VA,Optum VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC,UHC,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC MGG,UHC MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,VA,VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Wellcare MGG,Wellcare MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health - commercial,Bright Health - commercial,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health MGG,Bright Health MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Aetna,Aetna,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Aetna MGG,Aetna MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,BCBS,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS MGG,BCBS MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Cigna,Cigna,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Cigna MGG,Cigna MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Humana,Humana,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Humana MGG,Humana MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Optum VA,Optum VA,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UHC,UHC,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UHC MGG,UHC MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA,VA,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Wellcare MGG,Wellcare MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Bright Health - commercial,Bright Health - commercial,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Bright Health MGG,Bright Health MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Aetna,Aetna,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Aetna MGG,Aetna MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,BCBS,BCBS,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,BCBS MGG,BCBS MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Cigna,Cigna,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Cigna MGG,Cigna MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Humana,Humana,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Humana MGG,Humana MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Optum VA,Optum VA,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,UHC,UHC,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,UHC MGG,UHC MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,VA,VA,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Wellcare MGG,Wellcare MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Bright Health - commercial,Bright Health - commercial,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Bright Health MGG,Bright Health MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Aetna,Aetna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Aetna MGG,Aetna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,BCBS,BCBS,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,BCBS MGG,BCBS MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Cigna,Cigna,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Cigna MGG,Cigna MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Humana,Humana,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Humana MGG,Humana MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Optum VA,Optum VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,UHC,UHC,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,UHC MGG,UHC MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,VA,VA,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Wellcare MGG,Wellcare MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Bright Health - commercial,Bright Health - commercial,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,35.34,35.34,Bright Health MGG,Bright Health MGG,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Aetna,Aetna,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Aetna MGG,Aetna MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,BCBS,BCBS,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,BCBS MGG,BCBS MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Cigna,Cigna,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Cigna MGG,Cigna MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Humana,Humana,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Humana MGG,Humana MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Optum VA,Optum VA,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,UHC,UHC,7.77,,,,,,,per diem,7.77,7.77,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,UHC MGG,UHC MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,VA,VA,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Wellcare MGG,Wellcare MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Bright Health - commercial,Bright Health - commercial,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,7.77,7.77,Bright Health MGG,Bright Health MGG,7.77,,,,,,,case rate,7.77,7.77,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Aetna,Aetna,196.2,,,,,,,per diem,196.2,196.2,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Aetna MGG,Aetna MGG,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,BCBS,BCBS,196.2,,,,,,,per diem,196.2,196.2,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,BCBS MGG,BCBS MGG,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Cigna,Cigna,196.2,,,,,,,per diem,196.2,196.2,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Cigna MGG,Cigna MGG,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Humana,Humana,196.2,,,,,,,per diem,196.2,196.2,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Humana MGG,Humana MGG,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Optum VA,Optum VA,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,UHC,UHC,196.2,,,,,,,per diem,196.2,196.2,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,UHC MGG,UHC MGG,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,VA,VA,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Wellcare MGG,Wellcare MGG,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Bright Health - commercial,Bright Health - commercial,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,196.2,196.2,Bright Health MGG,Bright Health MGG,196.2,,,,,,,case rate,196.2,196.2,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Aetna,Aetna,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Aetna MGG,Aetna MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,BCBS,BCBS,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,BCBS MGG,BCBS MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Cigna,Cigna,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Cigna MGG,Cigna MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Humana,Humana,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Humana MGG,Humana MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Optum VA,Optum VA,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,UHC,UHC,19.56,,,,,,,per diem,19.56,19.56,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,UHC MGG,UHC MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,VA,VA,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Wellcare MGG,Wellcare MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Bright Health - commercial,Bright Health - commercial,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,19.56,19.56,Bright Health MGG,Bright Health MGG,19.56,,,,,,,case rate,19.56,19.56,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna,Aetna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna MGG,Aetna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS,BCBS,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS MGG,BCBS MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna,Cigna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna MGG,Cigna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana,Humana,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana MGG,Humana MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Optum VA,Optum VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC,UHC,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC MGG,UHC MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,VA,VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Wellcare MGG,Wellcare MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health - commercial,Bright Health - commercial,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health MGG,Bright Health MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Aetna,Aetna,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Aetna MGG,Aetna MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,BCBS,BCBS,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,BCBS MGG,BCBS MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Cigna,Cigna,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Cigna MGG,Cigna MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Humana,Humana,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Humana MGG,Humana MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Optum VA,Optum VA,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,UHC,UHC,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,UHC MGG,UHC MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,VA,VA,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Wellcare MGG,Wellcare MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Bright Health - commercial,Bright Health - commercial,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,11.73,11.73,Bright Health MGG,Bright Health MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna,Aetna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna MGG,Aetna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS,BCBS,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS MGG,BCBS MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna,Cigna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna MGG,Cigna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana,Humana,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana MGG,Humana MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Optum VA,Optum VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC,UHC,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC MGG,UHC MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,VA,VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Wellcare MGG,Wellcare MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health - commercial,Bright Health - commercial,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health MGG,Bright Health MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Aetna,Aetna,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Aetna MGG,Aetna MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,BCBS,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS MGG,BCBS MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Cigna,Cigna,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Cigna MGG,Cigna MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Humana,Humana,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Humana MGG,Humana MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Optum VA,Optum VA,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UHC,UHC,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UHC MGG,UHC MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,VA,VA,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Wellcare MGG,Wellcare MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Bright Health - commercial,Bright Health - commercial,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Bright Health MGG,Bright Health MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Aetna,Aetna,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Aetna MGG,Aetna MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,BCBS,BCBS,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,BCBS MGG,BCBS MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Cigna,Cigna,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Cigna MGG,Cigna MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Humana,Humana,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Humana MGG,Humana MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Optum VA,Optum VA,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,UHC,UHC,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,UHC MGG,UHC MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,VA,VA,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Wellcare MGG,Wellcare MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Bright Health - commercial,Bright Health - commercial,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Bright Health MGG,Bright Health MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna,Aetna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna MGG,Aetna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS,BCBS,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS MGG,BCBS MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna,Cigna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna MGG,Cigna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana,Humana,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana MGG,Humana MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Optum VA,Optum VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC,UHC,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC MGG,UHC MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,VA,VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Wellcare MGG,Wellcare MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health - commercial,Bright Health - commercial,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health MGG,Bright Health MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Aetna,Aetna,158.34,,,,,,,per diem,158.34,158.34,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Aetna MGG,Aetna MGG,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,BCBS,BCBS,158.34,,,,,,,per diem,158.34,158.34,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,BCBS MGG,BCBS MGG,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Cigna,Cigna,158.34,,,,,,,per diem,158.34,158.34,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Cigna MGG,Cigna MGG,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Humana,Humana,158.34,,,,,,,per diem,158.34,158.34,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Humana MGG,Humana MGG,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Optum VA,Optum VA,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,UHC,UHC,158.34,,,,,,,per diem,158.34,158.34,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,UHC MGG,UHC MGG,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,VA,VA,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Wellcare MGG,Wellcare MGG,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Bright Health - commercial,Bright Health - commercial,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,158.34,158.34,Bright Health MGG,Bright Health MGG,158.34,,,,,,,case rate,158.34,158.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Aetna,Aetna,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Aetna MGG,Aetna MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,BCBS,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS MGG,BCBS MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Cigna,Cigna,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Cigna MGG,Cigna MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Humana,Humana,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Humana MGG,Humana MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Optum VA,Optum VA,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UHC,UHC,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UHC MGG,UHC MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA,VA,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Wellcare MGG,Wellcare MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Bright Health - commercial,Bright Health - commercial,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Bright Health MGG,Bright Health MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Aetna,Aetna,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Aetna MGG,Aetna MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,BCBS,BCBS,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,BCBS MGG,BCBS MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Cigna,Cigna,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Cigna MGG,Cigna MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Humana,Humana,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Humana MGG,Humana MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Optum VA,Optum VA,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,UHC,UHC,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,UHC MGG,UHC MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,VA,VA,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Wellcare MGG,Wellcare MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Bright Health - commercial,Bright Health - commercial,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Bright Health MGG,Bright Health MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Aetna,Aetna,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Aetna MGG,Aetna MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,BCBS,BCBS,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,BCBS MGG,BCBS MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Cigna,Cigna,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Cigna MGG,Cigna MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Humana,Humana,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Humana MGG,Humana MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Optum VA,Optum VA,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,UHC,UHC,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,UHC MGG,UHC MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,VA,VA,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Wellcare MGG,Wellcare MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Bright Health - commercial,Bright Health - commercial,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Bright Health MGG,Bright Health MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Aetna,Aetna,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Aetna MGG,Aetna MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,BCBS,BCBS,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,BCBS MGG,BCBS MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Cigna,Cigna,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Cigna MGG,Cigna MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Humana,Humana,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Humana MGG,Humana MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Optum VA,Optum VA,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,UHC,UHC,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,UHC MGG,UHC MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,VA,VA,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Wellcare MGG,Wellcare MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Bright Health - commercial,Bright Health - commercial,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,99.15,99.15,Bright Health MGG,Bright Health MGG,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Aetna,Aetna,1649.61,,,,,,,per diem,1649.61,1649.61,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Aetna MGG,Aetna MGG,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,BCBS,BCBS,1649.61,,,,,,,per diem,1649.61,1649.61,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,BCBS MGG,BCBS MGG,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Cigna,Cigna,1649.61,,,,,,,per diem,1649.61,1649.61,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Cigna MGG,Cigna MGG,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Humana,Humana,1649.61,,,,,,,per diem,1649.61,1649.61,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Humana MGG,Humana MGG,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Optum VA,Optum VA,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,UHC,UHC,1649.61,,,,,,,per diem,1649.61,1649.61,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,UHC MGG,UHC MGG,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,VA,VA,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Wellcare MGG,Wellcare MGG,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Bright Health - commercial,Bright Health - commercial,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,1649.61,1649.61,Bright Health MGG,Bright Health MGG,1649.61,,,,,,,case rate,1649.61,1649.61,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna,Aetna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna MGG,Aetna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,BCBS,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS MGG,BCBS MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna,Cigna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna MGG,Cigna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana,Humana,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana MGG,Humana MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Optum VA,Optum VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC,UHC,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC MGG,UHC MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,VA,VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Wellcare MGG,Wellcare MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health - commercial,Bright Health - commercial,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health MGG,Bright Health MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Aetna,Aetna,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Aetna MGG,Aetna MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,BCBS,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS MGG,BCBS MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Cigna,Cigna,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Cigna MGG,Cigna MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Humana,Humana,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Humana MGG,Humana MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Optum VA,Optum VA,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UHC,UHC,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UHC MGG,UHC MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,VA,VA,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Wellcare MGG,Wellcare MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Bright Health - commercial,Bright Health - commercial,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Bright Health MGG,Bright Health MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Aetna,Aetna,25.44,,,,,,,per diem,25.44,25.44,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Aetna MGG,Aetna MGG,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,BCBS,BCBS,25.44,,,,,,,per diem,25.44,25.44,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,BCBS MGG,BCBS MGG,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Cigna,Cigna,25.44,,,,,,,per diem,25.44,25.44,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Cigna MGG,Cigna MGG,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Humana,Humana,25.44,,,,,,,per diem,25.44,25.44,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Humana MGG,Humana MGG,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Optum VA,Optum VA,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,UHC,UHC,25.44,,,,,,,per diem,25.44,25.44,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,UHC MGG,UHC MGG,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,VA,VA,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Wellcare MGG,Wellcare MGG,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Bright Health - commercial,Bright Health - commercial,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,25.44,25.44,Bright Health MGG,Bright Health MGG,25.44,,,,,,,case rate,25.44,25.44,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Aetna,Aetna,29.16,,,,,,,per diem,29.16,29.16,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Aetna MGG,Aetna MGG,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,BCBS,BCBS,29.16,,,,,,,per diem,29.16,29.16,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,BCBS MGG,BCBS MGG,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Cigna,Cigna,29.16,,,,,,,per diem,29.16,29.16,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Cigna MGG,Cigna MGG,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Humana,Humana,29.16,,,,,,,per diem,29.16,29.16,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Humana MGG,Humana MGG,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Optum VA,Optum VA,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,UHC,UHC,29.16,,,,,,,per diem,29.16,29.16,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,UHC MGG,UHC MGG,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,VA,VA,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Wellcare MGG,Wellcare MGG,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Bright Health - commercial,Bright Health - commercial,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,29.16,29.16,Bright Health MGG,Bright Health MGG,29.16,,,,,,,case rate,29.16,29.16,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Aetna,Aetna,104.04,,,,,,,per diem,104.04,104.04,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Aetna MGG,Aetna MGG,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,BCBS,BCBS,104.04,,,,,,,per diem,104.04,104.04,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,BCBS MGG,BCBS MGG,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Cigna,Cigna,104.04,,,,,,,per diem,104.04,104.04,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Cigna MGG,Cigna MGG,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Humana,Humana,104.04,,,,,,,per diem,104.04,104.04,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Humana MGG,Humana MGG,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Optum VA,Optum VA,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,UHC,UHC,104.04,,,,,,,per diem,104.04,104.04,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,UHC MGG,UHC MGG,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,VA,VA,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Wellcare MGG,Wellcare MGG,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Bright Health - commercial,Bright Health - commercial,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,104.04,104.04,Bright Health MGG,Bright Health MGG,104.04,,,,,,,case rate,104.04,104.04,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Aetna,Aetna,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Aetna MGG,Aetna MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,BCBS,BCBS,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,BCBS MGG,BCBS MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Cigna,Cigna,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Cigna MGG,Cigna MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Humana,Humana,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Humana MGG,Humana MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Optum VA,Optum VA,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,UHC,UHC,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,UHC MGG,UHC MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,VA,VA,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Wellcare MGG,Wellcare MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Bright Health - commercial,Bright Health - commercial,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,Bright Health MGG,Bright Health MGG,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Aetna,Aetna,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Aetna MGG,Aetna MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,BCBS,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS MGG,BCBS MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Cigna,Cigna,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Cigna MGG,Cigna MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Humana,Humana,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Humana MGG,Humana MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Optum VA,Optum VA,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UHC,UHC,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UHC MGG,UHC MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,VA,VA,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Wellcare MGG,Wellcare MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Bright Health - commercial,Bright Health - commercial,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Bright Health MGG,Bright Health MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Aetna,Aetna,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Aetna MGG,Aetna MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,BCBS,BCBS,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,BCBS MGG,BCBS MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Cigna,Cigna,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Cigna MGG,Cigna MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Humana,Humana,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Humana MGG,Humana MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Optum VA,Optum VA,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,UHC,UHC,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,UHC MGG,UHC MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,VA,VA,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Wellcare MGG,Wellcare MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Bright Health - commercial,Bright Health - commercial,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,136.71,136.71,Bright Health MGG,Bright Health MGG,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Aetna,Aetna,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Aetna MGG,Aetna MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,BCBS,BCBS,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,BCBS MGG,BCBS MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Cigna,Cigna,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Cigna MGG,Cigna MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Humana,Humana,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Humana MGG,Humana MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Optum VA,Optum VA,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,UHC,UHC,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,UHC MGG,UHC MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,VA,VA,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Wellcare MGG,Wellcare MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Bright Health - commercial,Bright Health - commercial,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Bright Health MGG,Bright Health MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Aetna,Aetna,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Aetna MGG,Aetna MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,BCBS,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS MGG,BCBS MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Cigna,Cigna,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Cigna MGG,Cigna MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Humana,Humana,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Humana MGG,Humana MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Optum VA,Optum VA,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UHC,UHC,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UHC MGG,UHC MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,VA,VA,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Wellcare MGG,Wellcare MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Bright Health - commercial,Bright Health - commercial,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Bright Health MGG,Bright Health MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna,Aetna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna MGG,Aetna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS,BCBS,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS MGG,BCBS MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna,Cigna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna MGG,Cigna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana,Humana,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana MGG,Humana MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Optum VA,Optum VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC,UHC,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC MGG,UHC MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,VA,VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Wellcare MGG,Wellcare MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health - commercial,Bright Health - commercial,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health MGG,Bright Health MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Aetna,Aetna,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Aetna MGG,Aetna MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,BCBS,BCBS,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,BCBS MGG,BCBS MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Cigna,Cigna,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Cigna MGG,Cigna MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Humana,Humana,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Humana MGG,Humana MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Optum VA,Optum VA,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,UHC,UHC,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,UHC MGG,UHC MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,VA,VA,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Wellcare MGG,Wellcare MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Bright Health - commercial,Bright Health - commercial,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Bright Health MGG,Bright Health MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Aetna,Aetna,127.47,,,,,,,per diem,127.47,127.47,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Aetna MGG,Aetna MGG,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,BCBS,BCBS,127.47,,,,,,,per diem,127.47,127.47,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,BCBS MGG,BCBS MGG,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Cigna,Cigna,127.47,,,,,,,per diem,127.47,127.47,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Cigna MGG,Cigna MGG,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Humana,Humana,127.47,,,,,,,per diem,127.47,127.47,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Humana MGG,Humana MGG,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Optum VA,Optum VA,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,UHC,UHC,127.47,,,,,,,per diem,127.47,127.47,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,UHC MGG,UHC MGG,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,VA,VA,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Wellcare MGG,Wellcare MGG,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Bright Health - commercial,Bright Health - commercial,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,127.47,127.47,Bright Health MGG,Bright Health MGG,127.47,,,,,,,case rate,127.47,127.47,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Aetna,Aetna,19.89,,,,,,,per diem,19.89,19.89,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Aetna MGG,Aetna MGG,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,BCBS,BCBS,19.89,,,,,,,per diem,19.89,19.89,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,BCBS MGG,BCBS MGG,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Cigna,Cigna,19.89,,,,,,,per diem,19.89,19.89,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Cigna MGG,Cigna MGG,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Humana,Humana,19.89,,,,,,,per diem,19.89,19.89,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Humana MGG,Humana MGG,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Optum VA,Optum VA,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,UHC,UHC,19.89,,,,,,,per diem,19.89,19.89,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,UHC MGG,UHC MGG,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,VA,VA,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Wellcare MGG,Wellcare MGG,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Bright Health - commercial,Bright Health - commercial,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,19.89,19.89,Bright Health MGG,Bright Health MGG,19.89,,,,,,,case rate,19.89,19.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Aetna,Aetna,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Aetna MGG,Aetna MGG,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,BCBS,BCBS,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,BCBS MGG,BCBS MGG,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Cigna,Cigna,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Cigna MGG,Cigna MGG,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Humana,Humana,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Humana MGG,Humana MGG,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Optum VA,Optum VA,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,UHC,UHC,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,UHC MGG,UHC MGG,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,VA,VA,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Wellcare MGG,Wellcare MGG,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Bright Health - commercial,Bright Health - commercial,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.07,14.07,Bright Health MGG,Bright Health MGG,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna,Aetna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna MGG,Aetna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS,BCBS,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS MGG,BCBS MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna,Cigna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna MGG,Cigna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana,Humana,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana MGG,Humana MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Optum VA,Optum VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC,UHC,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC MGG,UHC MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,VA,VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Wellcare MGG,Wellcare MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health - commercial,Bright Health - commercial,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health MGG,Bright Health MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Aetna,Aetna,19.65,,,,,,,per diem,19.65,19.65,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Aetna MGG,Aetna MGG,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,BCBS,BCBS,19.65,,,,,,,per diem,19.65,19.65,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,BCBS MGG,BCBS MGG,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Cigna,Cigna,19.65,,,,,,,per diem,19.65,19.65,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Cigna MGG,Cigna MGG,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Humana,Humana,19.65,,,,,,,per diem,19.65,19.65,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Humana MGG,Humana MGG,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Optum VA,Optum VA,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,UHC,UHC,19.65,,,,,,,per diem,19.65,19.65,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,UHC MGG,UHC MGG,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,VA,VA,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Wellcare MGG,Wellcare MGG,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Bright Health - commercial,Bright Health - commercial,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,19.65,19.65,Bright Health MGG,Bright Health MGG,19.65,,,,,,,case rate,19.65,19.65,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Aetna,Aetna,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Aetna MGG,Aetna MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,BCBS,BCBS,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,BCBS MGG,BCBS MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Cigna,Cigna,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Cigna MGG,Cigna MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Humana,Humana,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Humana MGG,Humana MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Optum VA,Optum VA,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,UHC,UHC,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,UHC MGG,UHC MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,VA,VA,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Wellcare MGG,Wellcare MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Bright Health - commercial,Bright Health - commercial,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.38,10.38,Bright Health MGG,Bright Health MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Aetna,Aetna,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Aetna MGG,Aetna MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,BCBS,BCBS,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,BCBS MGG,BCBS MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Cigna,Cigna,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Cigna MGG,Cigna MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Humana,Humana,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Humana MGG,Humana MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Optum VA,Optum VA,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,UHC,UHC,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,UHC MGG,UHC MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,VA,VA,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Wellcare MGG,Wellcare MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Bright Health - commercial,Bright Health - commercial,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Bright Health MGG,Bright Health MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Aetna,Aetna,251.07,,,,,,,per diem,251.07,251.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Aetna MGG,Aetna MGG,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,BCBS,BCBS,251.07,,,,,,,per diem,251.07,251.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,BCBS MGG,BCBS MGG,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Cigna,Cigna,251.07,,,,,,,per diem,251.07,251.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Cigna MGG,Cigna MGG,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Humana,Humana,251.07,,,,,,,per diem,251.07,251.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Humana MGG,Humana MGG,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Optum VA,Optum VA,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,UHC,UHC,251.07,,,,,,,per diem,251.07,251.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,UHC MGG,UHC MGG,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,VA,VA,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Wellcare MGG,Wellcare MGG,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Bright Health - commercial,Bright Health - commercial,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,251.07,251.07,Bright Health MGG,Bright Health MGG,251.07,,,,,,,case rate,251.07,251.07,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Aetna,Aetna,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Aetna MGG,Aetna MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,BCBS,BCBS,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,BCBS MGG,BCBS MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Cigna,Cigna,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Cigna MGG,Cigna MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Humana,Humana,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Humana MGG,Humana MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Optum VA,Optum VA,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,UHC,UHC,36.57,,,,,,,per diem,36.57,36.57,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,UHC MGG,UHC MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,VA,VA,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Wellcare MGG,Wellcare MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Bright Health - commercial,Bright Health - commercial,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,36.57,36.57,Bright Health MGG,Bright Health MGG,36.57,,,,,,,case rate,36.57,36.57,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Aetna,Aetna,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Aetna MGG,Aetna MGG,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,BCBS,BCBS,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,BCBS MGG,BCBS MGG,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Cigna,Cigna,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Cigna MGG,Cigna MGG,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Humana,Humana,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Humana MGG,Humana MGG,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Optum VA,Optum VA,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,UHC,UHC,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,UHC MGG,UHC MGG,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,VA,VA,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Wellcare MGG,Wellcare MGG,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Bright Health - commercial,Bright Health - commercial,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,Bright Health MGG,Bright Health MGG,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Aetna,Aetna,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Aetna MGG,Aetna MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,BCBS,BCBS,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,BCBS MGG,BCBS MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Cigna,Cigna,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Cigna MGG,Cigna MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Humana,Humana,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Humana MGG,Humana MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Optum VA,Optum VA,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,UHC,UHC,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,UHC MGG,UHC MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,VA,VA,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Wellcare MGG,Wellcare MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Bright Health - commercial,Bright Health - commercial,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Bright Health MGG,Bright Health MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Aetna,Aetna,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Aetna MGG,Aetna MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,BCBS,BCBS,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,BCBS MGG,BCBS MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Cigna,Cigna,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Cigna MGG,Cigna MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Humana,Humana,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Humana MGG,Humana MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Optum VA,Optum VA,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,UHC,UHC,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,UHC MGG,UHC MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,VA,VA,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Wellcare MGG,Wellcare MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Bright Health - commercial,Bright Health - commercial,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Bright Health MGG,Bright Health MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Aetna,Aetna,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Aetna MGG,Aetna MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,BCBS,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS MGG,BCBS MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Cigna,Cigna,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Cigna MGG,Cigna MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Humana,Humana,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Humana MGG,Humana MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Optum VA,Optum VA,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UHC,UHC,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UHC MGG,UHC MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,VA,VA,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Wellcare MGG,Wellcare MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Bright Health - commercial,Bright Health - commercial,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Bright Health MGG,Bright Health MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Aetna,Aetna,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Aetna MGG,Aetna MGG,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,BCBS,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS MGG,BCBS MGG,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Cigna,Cigna,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Cigna MGG,Cigna MGG,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Humana,Humana,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Humana MGG,Humana MGG,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Optum VA,Optum VA,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,UHC,UHC,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,UHC MGG,UHC MGG,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,VA,VA,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Wellcare MGG,Wellcare MGG,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Bright Health - commercial,Bright Health - commercial,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,Bright Health MGG,Bright Health MGG,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Aetna,Aetna,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Aetna MGG,Aetna MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,BCBS,BCBS,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,BCBS MGG,BCBS MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Cigna,Cigna,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Cigna MGG,Cigna MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Humana,Humana,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Humana MGG,Humana MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Optum VA,Optum VA,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,UHC,UHC,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,UHC MGG,UHC MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,VA,VA,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Wellcare MGG,Wellcare MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Bright Health - commercial,Bright Health - commercial,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Bright Health MGG,Bright Health MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Aetna,Aetna,41.4,,,,,,,per diem,41.4,41.4,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Aetna MGG,Aetna MGG,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,BCBS,BCBS,41.4,,,,,,,per diem,41.4,41.4,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,BCBS MGG,BCBS MGG,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Cigna,Cigna,41.4,,,,,,,per diem,41.4,41.4,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Cigna MGG,Cigna MGG,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Humana,Humana,41.4,,,,,,,per diem,41.4,41.4,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Humana MGG,Humana MGG,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Optum VA,Optum VA,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,UHC,UHC,41.4,,,,,,,per diem,41.4,41.4,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,UHC MGG,UHC MGG,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,VA,VA,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Wellcare MGG,Wellcare MGG,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Bright Health - commercial,Bright Health - commercial,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,41.4,41.4,Bright Health MGG,Bright Health MGG,41.4,,,,,,,case rate,41.4,41.4,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Aetna,Aetna,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Aetna MGG,Aetna MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,BCBS,BCBS,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,BCBS MGG,BCBS MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Cigna,Cigna,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Cigna MGG,Cigna MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Humana,Humana,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Humana MGG,Humana MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Optum VA,Optum VA,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,UHC,UHC,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,UHC MGG,UHC MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,VA,VA,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Wellcare MGG,Wellcare MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Bright Health - commercial,Bright Health - commercial,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,8.34,8.34,Bright Health MGG,Bright Health MGG,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Aetna,Aetna,14.2,,,,,,,per diem,14.2,14.2,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Aetna MGG,Aetna MGG,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,BCBS,BCBS,14.2,,,,,,,per diem,14.2,14.2,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,BCBS MGG,BCBS MGG,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Cigna,Cigna,14.2,,,,,,,per diem,14.2,14.2,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Cigna MGG,Cigna MGG,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Humana,Humana,14.2,,,,,,,per diem,14.2,14.2,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Humana MGG,Humana MGG,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Optum VA,Optum VA,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,UHC,UHC,14.2,,,,,,,per diem,14.2,14.2,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,UHC MGG,UHC MGG,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,VA,VA,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Wellcare MGG,Wellcare MGG,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Bright Health - commercial,Bright Health - commercial,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,14.2,14.2,Bright Health MGG,Bright Health MGG,14.2,,,,,,,case rate,14.2,14.2,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Aetna,Aetna,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Aetna MGG,Aetna MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,BCBS,BCBS,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,BCBS MGG,BCBS MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Cigna,Cigna,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Cigna MGG,Cigna MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Humana,Humana,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Humana MGG,Humana MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Optum VA,Optum VA,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,UHC,UHC,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,UHC MGG,UHC MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,VA,VA,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Wellcare MGG,Wellcare MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Bright Health - commercial,Bright Health - commercial,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Bright Health MGG,Bright Health MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Aetna,Aetna,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Aetna MGG,Aetna MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,BCBS,BCBS,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,BCBS MGG,BCBS MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Cigna,Cigna,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Cigna MGG,Cigna MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Humana,Humana,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Humana MGG,Humana MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Optum VA,Optum VA,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,UHC,UHC,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,UHC MGG,UHC MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,VA,VA,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Wellcare MGG,Wellcare MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Bright Health - commercial,Bright Health - commercial,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Bright Health MGG,Bright Health MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Aetna,Aetna,47.1,,,,,,,per diem,47.1,47.1,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Aetna MGG,Aetna MGG,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,BCBS,BCBS,47.1,,,,,,,per diem,47.1,47.1,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,BCBS MGG,BCBS MGG,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Cigna,Cigna,47.1,,,,,,,per diem,47.1,47.1,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Cigna MGG,Cigna MGG,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Humana,Humana,47.1,,,,,,,per diem,47.1,47.1,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Humana MGG,Humana MGG,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Optum VA,Optum VA,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,UHC,UHC,47.1,,,,,,,per diem,47.1,47.1,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,UHC MGG,UHC MGG,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,VA,VA,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Wellcare MGG,Wellcare MGG,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Bright Health - commercial,Bright Health - commercial,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,47.1,47.1,Bright Health MGG,Bright Health MGG,47.1,,,,,,,case rate,47.1,47.1,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Aetna,Aetna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Aetna MGG,Aetna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,BCBS,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS MGG,BCBS MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Cigna,Cigna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Cigna MGG,Cigna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Humana,Humana,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Humana MGG,Humana MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Optum VA,Optum VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UHC,UHC,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UHC MGG,UHC MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,VA,VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Wellcare MGG,Wellcare MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Bright Health - commercial,Bright Health - commercial,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Bright Health MGG,Bright Health MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Aetna,Aetna,60.81,,,,,,,per diem,60.81,60.81,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Aetna MGG,Aetna MGG,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,BCBS,BCBS,60.81,,,,,,,per diem,60.81,60.81,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,BCBS MGG,BCBS MGG,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Cigna,Cigna,60.81,,,,,,,per diem,60.81,60.81,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Cigna MGG,Cigna MGG,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Humana,Humana,60.81,,,,,,,per diem,60.81,60.81,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Humana MGG,Humana MGG,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Optum VA,Optum VA,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,UHC,UHC,60.81,,,,,,,per diem,60.81,60.81,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,UHC MGG,UHC MGG,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,VA,VA,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Wellcare MGG,Wellcare MGG,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Bright Health - commercial,Bright Health - commercial,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,60.81,60.81,Bright Health MGG,Bright Health MGG,60.81,,,,,,,case rate,60.81,60.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Aetna,Aetna,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Aetna MGG,Aetna MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,BCBS,BCBS,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,BCBS MGG,BCBS MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Cigna,Cigna,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Cigna MGG,Cigna MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Humana,Humana,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Humana MGG,Humana MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Optum VA,Optum VA,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,UHC,UHC,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,UHC MGG,UHC MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,VA,VA,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Wellcare MGG,Wellcare MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Bright Health - commercial,Bright Health - commercial,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Bright Health MGG,Bright Health MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Aetna,Aetna,56.82,,,,,,,per diem,56.82,56.82,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Aetna MGG,Aetna MGG,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,BCBS,BCBS,56.82,,,,,,,per diem,56.82,56.82,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,BCBS MGG,BCBS MGG,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Cigna,Cigna,56.82,,,,,,,per diem,56.82,56.82,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Cigna MGG,Cigna MGG,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Humana,Humana,56.82,,,,,,,per diem,56.82,56.82,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Humana MGG,Humana MGG,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Optum VA,Optum VA,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,UHC,UHC,56.82,,,,,,,per diem,56.82,56.82,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,UHC MGG,UHC MGG,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,VA,VA,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Wellcare MGG,Wellcare MGG,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Bright Health - commercial,Bright Health - commercial,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,56.82,56.82,Bright Health MGG,Bright Health MGG,56.82,,,,,,,case rate,56.82,56.82,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Aetna,Aetna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Aetna MGG,Aetna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,BCBS,BCBS,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,BCBS MGG,BCBS MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Cigna,Cigna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Cigna MGG,Cigna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Humana,Humana,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Humana MGG,Humana MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Optum VA,Optum VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,UHC,UHC,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,UHC MGG,UHC MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,VA,VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Wellcare MGG,Wellcare MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Bright Health - commercial,Bright Health - commercial,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Bright Health MGG,Bright Health MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna,Aetna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna MGG,Aetna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,BCBS,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS MGG,BCBS MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna,Cigna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna MGG,Cigna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana,Humana,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana MGG,Humana MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Optum VA,Optum VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC,UHC,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC MGG,UHC MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,VA,VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Wellcare MGG,Wellcare MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health - commercial,Bright Health - commercial,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health MGG,Bright Health MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Aetna,Aetna,124.26,,,,,,,per diem,124.26,124.26,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Aetna MGG,Aetna MGG,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,BCBS,BCBS,124.26,,,,,,,per diem,124.26,124.26,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,BCBS MGG,BCBS MGG,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Cigna,Cigna,124.26,,,,,,,per diem,124.26,124.26,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Cigna MGG,Cigna MGG,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Humana,Humana,124.26,,,,,,,per diem,124.26,124.26,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Humana MGG,Humana MGG,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Optum VA,Optum VA,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,UHC,UHC,124.26,,,,,,,per diem,124.26,124.26,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,UHC MGG,UHC MGG,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,VA,VA,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Wellcare MGG,Wellcare MGG,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Bright Health - commercial,Bright Health - commercial,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,124.26,124.26,Bright Health MGG,Bright Health MGG,124.26,,,,,,,case rate,124.26,124.26,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Aetna,Aetna,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Aetna MGG,Aetna MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,BCBS,BCBS,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,BCBS MGG,BCBS MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Cigna,Cigna,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Cigna MGG,Cigna MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Humana,Humana,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Humana MGG,Humana MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Optum VA,Optum VA,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,UHC,UHC,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,UHC MGG,UHC MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,VA,VA,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Wellcare MGG,Wellcare MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Bright Health - commercial,Bright Health - commercial,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Bright Health MGG,Bright Health MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Aetna,Aetna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Aetna MGG,Aetna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,BCBS,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS MGG,BCBS MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Cigna,Cigna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Cigna MGG,Cigna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Humana,Humana,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Humana MGG,Humana MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Optum VA,Optum VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UHC,UHC,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UHC MGG,UHC MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,VA,VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Wellcare MGG,Wellcare MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Bright Health - commercial,Bright Health - commercial,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Bright Health MGG,Bright Health MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Aetna,Aetna,2037.42,,,,,,,per diem,2037.42,2037.42,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Aetna MGG,Aetna MGG,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,BCBS,BCBS,2037.42,,,,,,,per diem,2037.42,2037.42,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,BCBS MGG,BCBS MGG,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Cigna,Cigna,2037.42,,,,,,,per diem,2037.42,2037.42,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Cigna MGG,Cigna MGG,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Humana,Humana,2037.42,,,,,,,per diem,2037.42,2037.42,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Humana MGG,Humana MGG,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Optum VA,Optum VA,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,UHC,UHC,2037.42,,,,,,,per diem,2037.42,2037.42,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,UHC MGG,UHC MGG,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,VA,VA,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Wellcare MGG,Wellcare MGG,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Bright Health - commercial,Bright Health - commercial,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2037.42,2037.42,Bright Health MGG,Bright Health MGG,2037.42,,,,,,,case rate,2037.42,2037.42,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Aetna,Aetna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Aetna MGG,Aetna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,BCBS,BCBS,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,BCBS MGG,BCBS MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Cigna,Cigna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Cigna MGG,Cigna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Humana,Humana,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Humana MGG,Humana MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Optum VA,Optum VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,UHC,UHC,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,UHC MGG,UHC MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,VA,VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Wellcare MGG,Wellcare MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Bright Health - commercial,Bright Health - commercial,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Bright Health MGG,Bright Health MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna,Aetna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna MGG,Aetna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS,BCBS,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS MGG,BCBS MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna,Cigna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna MGG,Cigna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana,Humana,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana MGG,Humana MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Optum VA,Optum VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC,UHC,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC MGG,UHC MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,VA,VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Wellcare MGG,Wellcare MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health - commercial,Bright Health - commercial,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health MGG,Bright Health MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Aetna,Aetna,1287.87,,,,,,,per diem,1287.87,1287.87,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Aetna MGG,Aetna MGG,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,BCBS,BCBS,1287.87,,,,,,,per diem,1287.87,1287.87,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,BCBS MGG,BCBS MGG,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Cigna,Cigna,1287.87,,,,,,,per diem,1287.87,1287.87,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Cigna MGG,Cigna MGG,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Humana,Humana,1287.87,,,,,,,per diem,1287.87,1287.87,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Humana MGG,Humana MGG,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Optum VA,Optum VA,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,UHC,UHC,1287.87,,,,,,,per diem,1287.87,1287.87,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,UHC MGG,UHC MGG,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,VA,VA,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Wellcare MGG,Wellcare MGG,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Bright Health - commercial,Bright Health - commercial,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1287.87,1287.87,Bright Health MGG,Bright Health MGG,1287.87,,,,,,,case rate,1287.87,1287.87,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Aetna,Aetna,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Aetna MGG,Aetna MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,BCBS,BCBS,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,BCBS MGG,BCBS MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Cigna,Cigna,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Cigna MGG,Cigna MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Humana,Humana,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Humana MGG,Humana MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Optum VA,Optum VA,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,UHC,UHC,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,UHC MGG,UHC MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,VA,VA,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Wellcare MGG,Wellcare MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Bright Health - commercial,Bright Health - commercial,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,30.24,30.24,Bright Health MGG,Bright Health MGG,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Aetna,Aetna,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Aetna MGG,Aetna MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,BCBS,BCBS,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,BCBS MGG,BCBS MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Cigna,Cigna,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Cigna MGG,Cigna MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Humana,Humana,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Humana MGG,Humana MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Optum VA,Optum VA,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,UHC,UHC,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,UHC MGG,UHC MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,VA,VA,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Wellcare MGG,Wellcare MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Bright Health - commercial,Bright Health - commercial,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Bright Health MGG,Bright Health MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna,Aetna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna MGG,Aetna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS,BCBS,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS MGG,BCBS MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna,Cigna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna MGG,Cigna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana,Humana,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana MGG,Humana MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Optum VA,Optum VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC,UHC,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC MGG,UHC MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,VA,VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Wellcare MGG,Wellcare MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health - commercial,Bright Health - commercial,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health MGG,Bright Health MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Aetna,Aetna,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Aetna MGG,Aetna MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,BCBS,BCBS,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,BCBS MGG,BCBS MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Cigna,Cigna,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Cigna MGG,Cigna MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Humana,Humana,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Humana MGG,Humana MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Optum VA,Optum VA,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,UHC,UHC,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,UHC MGG,UHC MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,VA,VA,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Wellcare MGG,Wellcare MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Bright Health - commercial,Bright Health - commercial,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,20.61,20.61,Bright Health MGG,Bright Health MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Aetna,Aetna,1472.22,,,,,,,per diem,1472.22,1472.22,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Aetna MGG,Aetna MGG,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,BCBS,BCBS,1472.22,,,,,,,per diem,1472.22,1472.22,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,BCBS MGG,BCBS MGG,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Cigna,Cigna,1472.22,,,,,,,per diem,1472.22,1472.22,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Cigna MGG,Cigna MGG,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Humana,Humana,1472.22,,,,,,,per diem,1472.22,1472.22,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Humana MGG,Humana MGG,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Optum VA,Optum VA,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,UHC,UHC,1472.22,,,,,,,per diem,1472.22,1472.22,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,UHC MGG,UHC MGG,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,VA,VA,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Wellcare MGG,Wellcare MGG,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Bright Health - commercial,Bright Health - commercial,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1472.22,1472.22,Bright Health MGG,Bright Health MGG,1472.22,,,,,,,case rate,1472.22,1472.22,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Aetna,Aetna,179.94,,,,,,,per diem,179.94,179.94,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Aetna MGG,Aetna MGG,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,BCBS,BCBS,179.94,,,,,,,per diem,179.94,179.94,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,BCBS MGG,BCBS MGG,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Cigna,Cigna,179.94,,,,,,,per diem,179.94,179.94,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Cigna MGG,Cigna MGG,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Humana,Humana,179.94,,,,,,,per diem,179.94,179.94,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Humana MGG,Humana MGG,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Optum VA,Optum VA,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,UHC,UHC,179.94,,,,,,,per diem,179.94,179.94,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,UHC MGG,UHC MGG,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,VA,VA,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Wellcare MGG,Wellcare MGG,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Bright Health - commercial,Bright Health - commercial,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,179.94,179.94,Bright Health MGG,Bright Health MGG,179.94,,,,,,,case rate,179.94,179.94,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Aetna,Aetna,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Aetna MGG,Aetna MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,BCBS,BCBS,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,BCBS MGG,BCBS MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Cigna,Cigna,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Cigna MGG,Cigna MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Humana,Humana,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Humana MGG,Humana MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Optum VA,Optum VA,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,UHC,UHC,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,UHC MGG,UHC MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,VA,VA,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Wellcare MGG,Wellcare MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Bright Health - commercial,Bright Health - commercial,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,Bright Health MGG,Bright Health MGG,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Aetna,Aetna,258.51,,,,,,,per diem,258.51,258.51,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Aetna MGG,Aetna MGG,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,BCBS,BCBS,258.51,,,,,,,per diem,258.51,258.51,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,BCBS MGG,BCBS MGG,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Cigna,Cigna,258.51,,,,,,,per diem,258.51,258.51,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Cigna MGG,Cigna MGG,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Humana,Humana,258.51,,,,,,,per diem,258.51,258.51,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Humana MGG,Humana MGG,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Optum VA,Optum VA,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,UHC,UHC,258.51,,,,,,,per diem,258.51,258.51,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,UHC MGG,UHC MGG,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,VA,VA,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Wellcare MGG,Wellcare MGG,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Bright Health - commercial,Bright Health - commercial,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,258.51,258.51,Bright Health MGG,Bright Health MGG,258.51,,,,,,,case rate,258.51,258.51,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Aetna,Aetna,16.72,,,,,,,per diem,16.72,16.72,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Aetna MGG,Aetna MGG,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,BCBS,BCBS,16.72,,,,,,,per diem,16.72,16.72,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,BCBS MGG,BCBS MGG,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Cigna,Cigna,16.72,,,,,,,per diem,16.72,16.72,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Cigna MGG,Cigna MGG,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Humana,Humana,16.72,,,,,,,per diem,16.72,16.72,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Humana MGG,Humana MGG,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Optum VA,Optum VA,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,UHC,UHC,16.72,,,,,,,per diem,16.72,16.72,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,UHC MGG,UHC MGG,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,VA,VA,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Wellcare MGG,Wellcare MGG,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Bright Health - commercial,Bright Health - commercial,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,16.72,16.72,Bright Health MGG,Bright Health MGG,16.72,,,,,,,case rate,16.72,16.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna,Aetna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna MGG,Aetna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS,BCBS,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS MGG,BCBS MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna,Cigna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna MGG,Cigna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana,Humana,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana MGG,Humana MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Optum VA,Optum VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC,UHC,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC MGG,UHC MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,VA,VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Wellcare MGG,Wellcare MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health - commercial,Bright Health - commercial,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health MGG,Bright Health MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Aetna,Aetna,27.75,,,,,,,per diem,27.75,27.75,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Aetna MGG,Aetna MGG,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,BCBS,BCBS,27.75,,,,,,,per diem,27.75,27.75,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,BCBS MGG,BCBS MGG,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Cigna,Cigna,27.75,,,,,,,per diem,27.75,27.75,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Cigna MGG,Cigna MGG,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Humana,Humana,27.75,,,,,,,per diem,27.75,27.75,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Humana MGG,Humana MGG,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Optum VA,Optum VA,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,UHC,UHC,27.75,,,,,,,per diem,27.75,27.75,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,UHC MGG,UHC MGG,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,VA,VA,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Wellcare MGG,Wellcare MGG,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Bright Health - commercial,Bright Health - commercial,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,27.75,27.75,Bright Health MGG,Bright Health MGG,27.75,,,,,,,case rate,27.75,27.75,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Aetna,Aetna,320.64,,,,,,,per diem,320.64,320.64,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Aetna MGG,Aetna MGG,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,BCBS,BCBS,320.64,,,,,,,per diem,320.64,320.64,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,BCBS MGG,BCBS MGG,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Cigna,Cigna,320.64,,,,,,,per diem,320.64,320.64,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Cigna MGG,Cigna MGG,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Humana,Humana,320.64,,,,,,,per diem,320.64,320.64,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Humana MGG,Humana MGG,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Optum VA,Optum VA,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,UHC,UHC,320.64,,,,,,,per diem,320.64,320.64,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,UHC MGG,UHC MGG,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,VA,VA,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Wellcare MGG,Wellcare MGG,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Bright Health - commercial,Bright Health - commercial,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,320.64,320.64,Bright Health MGG,Bright Health MGG,320.64,,,,,,,case rate,320.64,320.64,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Aetna,Aetna,10.44,,,,,,,per diem,10.44,10.44,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Aetna MGG,Aetna MGG,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,BCBS,BCBS,10.44,,,,,,,per diem,10.44,10.44,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,BCBS MGG,BCBS MGG,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Cigna,Cigna,10.44,,,,,,,per diem,10.44,10.44,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Cigna MGG,Cigna MGG,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Humana,Humana,10.44,,,,,,,per diem,10.44,10.44,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Humana MGG,Humana MGG,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Optum VA,Optum VA,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,UHC,UHC,10.44,,,,,,,per diem,10.44,10.44,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,UHC MGG,UHC MGG,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,VA,VA,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Wellcare MGG,Wellcare MGG,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Bright Health - commercial,Bright Health - commercial,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.44,10.44,Bright Health MGG,Bright Health MGG,10.44,,,,,,,case rate,10.44,10.44,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Aetna,Aetna,194.04,,,,,,,per diem,194.04,194.04,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Aetna MGG,Aetna MGG,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,BCBS,BCBS,194.04,,,,,,,per diem,194.04,194.04,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,BCBS MGG,BCBS MGG,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Cigna,Cigna,194.04,,,,,,,per diem,194.04,194.04,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Cigna MGG,Cigna MGG,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Humana,Humana,194.04,,,,,,,per diem,194.04,194.04,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Humana MGG,Humana MGG,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Optum VA,Optum VA,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,UHC,UHC,194.04,,,,,,,per diem,194.04,194.04,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,UHC MGG,UHC MGG,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,VA,VA,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Wellcare MGG,Wellcare MGG,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Bright Health - commercial,Bright Health - commercial,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,194.04,194.04,Bright Health MGG,Bright Health MGG,194.04,,,,,,,case rate,194.04,194.04,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Aetna,Aetna,170.57,,,,,,,per diem,170.57,170.57,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Aetna MGG,Aetna MGG,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,BCBS,BCBS,170.57,,,,,,,per diem,170.57,170.57,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,BCBS MGG,BCBS MGG,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Cigna,Cigna,170.57,,,,,,,per diem,170.57,170.57,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Cigna MGG,Cigna MGG,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Humana,Humana,170.57,,,,,,,per diem,170.57,170.57,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Humana MGG,Humana MGG,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Optum VA,Optum VA,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,UHC,UHC,170.57,,,,,,,per diem,170.57,170.57,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,UHC MGG,UHC MGG,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,VA,VA,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Wellcare MGG,Wellcare MGG,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Bright Health - commercial,Bright Health - commercial,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,170.57,170.57,Bright Health MGG,Bright Health MGG,170.57,,,,,,,case rate,170.57,170.57,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Aetna,Aetna,83.37,,,,,,,per diem,83.37,83.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Aetna MGG,Aetna MGG,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,BCBS,BCBS,83.37,,,,,,,per diem,83.37,83.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,BCBS MGG,BCBS MGG,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Cigna,Cigna,83.37,,,,,,,per diem,83.37,83.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Cigna MGG,Cigna MGG,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Humana,Humana,83.37,,,,,,,per diem,83.37,83.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Humana MGG,Humana MGG,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Optum VA,Optum VA,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,UHC,UHC,83.37,,,,,,,per diem,83.37,83.37,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,UHC MGG,UHC MGG,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,VA,VA,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Wellcare MGG,Wellcare MGG,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Bright Health - commercial,Bright Health - commercial,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,83.37,83.37,Bright Health MGG,Bright Health MGG,83.37,,,,,,,case rate,83.37,83.37,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Aetna,Aetna,12.03,,,,,,,per diem,12.03,12.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Aetna MGG,Aetna MGG,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,BCBS,BCBS,12.03,,,,,,,per diem,12.03,12.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,BCBS MGG,BCBS MGG,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Cigna,Cigna,12.03,,,,,,,per diem,12.03,12.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Cigna MGG,Cigna MGG,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Humana,Humana,12.03,,,,,,,per diem,12.03,12.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Humana MGG,Humana MGG,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Optum VA,Optum VA,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,UHC,UHC,12.03,,,,,,,per diem,12.03,12.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,UHC MGG,UHC MGG,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,VA,VA,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Wellcare MGG,Wellcare MGG,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Bright Health - commercial,Bright Health - commercial,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,12.03,12.03,Bright Health MGG,Bright Health MGG,12.03,,,,,,,case rate,12.03,12.03,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Aetna,Aetna,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Aetna MGG,Aetna MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,BCBS,BCBS,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,BCBS MGG,BCBS MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Cigna,Cigna,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Cigna MGG,Cigna MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Humana,Humana,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Humana MGG,Humana MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Optum VA,Optum VA,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,UHC,UHC,7.95,,,,,,,per diem,7.95,7.95,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,UHC MGG,UHC MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,VA,VA,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Wellcare MGG,Wellcare MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Bright Health - commercial,Bright Health - commercial,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,7.95,7.95,Bright Health MGG,Bright Health MGG,7.95,,,,,,,case rate,7.95,7.95,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Aetna,Aetna,45.21,,,,,,,per diem,45.21,45.21,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Aetna MGG,Aetna MGG,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,BCBS,BCBS,45.21,,,,,,,per diem,45.21,45.21,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,BCBS MGG,BCBS MGG,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Cigna,Cigna,45.21,,,,,,,per diem,45.21,45.21,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Cigna MGG,Cigna MGG,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Humana,Humana,45.21,,,,,,,per diem,45.21,45.21,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Humana MGG,Humana MGG,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Optum VA,Optum VA,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,UHC,UHC,45.21,,,,,,,per diem,45.21,45.21,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,UHC MGG,UHC MGG,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,VA,VA,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Wellcare MGG,Wellcare MGG,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Bright Health - commercial,Bright Health - commercial,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,45.21,45.21,Bright Health MGG,Bright Health MGG,45.21,,,,,,,case rate,45.21,45.21,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Aetna,Aetna,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Aetna MGG,Aetna MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,BCBS,BCBS,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,BCBS MGG,BCBS MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Cigna,Cigna,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Cigna MGG,Cigna MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Humana,Humana,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Humana MGG,Humana MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Optum VA,Optum VA,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,UHC,UHC,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,UHC MGG,UHC MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,VA,VA,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Wellcare MGG,Wellcare MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Bright Health - commercial,Bright Health - commercial,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Bright Health MGG,Bright Health MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna,Aetna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna MGG,Aetna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS,BCBS,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS MGG,BCBS MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna,Cigna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna MGG,Cigna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana,Humana,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana MGG,Humana MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Optum VA,Optum VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC,UHC,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC MGG,UHC MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,VA,VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Wellcare MGG,Wellcare MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health - commercial,Bright Health - commercial,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health MGG,Bright Health MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Aetna,Aetna,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Aetna MGG,Aetna MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,BCBS,BCBS,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,BCBS MGG,BCBS MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Cigna,Cigna,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Cigna MGG,Cigna MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Humana,Humana,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Humana MGG,Humana MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Optum VA,Optum VA,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,UHC,UHC,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,UHC MGG,UHC MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,VA,VA,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Wellcare MGG,Wellcare MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Bright Health - commercial,Bright Health - commercial,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Bright Health MGG,Bright Health MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Aetna,Aetna,47.67,,,,,,,per diem,47.67,47.67,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Aetna MGG,Aetna MGG,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,BCBS,BCBS,47.67,,,,,,,per diem,47.67,47.67,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,BCBS MGG,BCBS MGG,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Cigna,Cigna,47.67,,,,,,,per diem,47.67,47.67,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Cigna MGG,Cigna MGG,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Humana,Humana,47.67,,,,,,,per diem,47.67,47.67,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Humana MGG,Humana MGG,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Optum VA,Optum VA,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,UHC,UHC,47.67,,,,,,,per diem,47.67,47.67,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,UHC MGG,UHC MGG,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,VA,VA,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Wellcare MGG,Wellcare MGG,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Bright Health - commercial,Bright Health - commercial,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,47.67,47.67,Bright Health MGG,Bright Health MGG,47.67,,,,,,,case rate,47.67,47.67,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Aetna,Aetna,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Aetna MGG,Aetna MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,BCBS,BCBS,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,BCBS MGG,BCBS MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Cigna,Cigna,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Cigna MGG,Cigna MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Humana,Humana,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Humana MGG,Humana MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Optum VA,Optum VA,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,UHC,UHC,108,,,,,,,per diem,108,108,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,UHC MGG,UHC MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,VA,VA,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Wellcare MGG,Wellcare MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Bright Health - commercial,Bright Health - commercial,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,108,108,Bright Health MGG,Bright Health MGG,108,,,,,,,case rate,108,108,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Aetna,Aetna,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Aetna MGG,Aetna MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,BCBS,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS MGG,BCBS MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Cigna,Cigna,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Cigna MGG,Cigna MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Humana,Humana,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Humana MGG,Humana MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Optum VA,Optum VA,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,UHC,UHC,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,UHC MGG,UHC MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,VA,VA,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Wellcare MGG,Wellcare MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Bright Health - commercial,Bright Health - commercial,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Bright Health MGG,Bright Health MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Aetna,Aetna,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Aetna MGG,Aetna MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,BCBS,BCBS,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,BCBS MGG,BCBS MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Cigna,Cigna,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Cigna MGG,Cigna MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Humana,Humana,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Humana MGG,Humana MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Optum VA,Optum VA,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,UHC,UHC,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,UHC MGG,UHC MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,VA,VA,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Wellcare MGG,Wellcare MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Bright Health - commercial,Bright Health - commercial,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Bright Health MGG,Bright Health MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Aetna,Aetna,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Aetna MGG,Aetna MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,BCBS,BCBS,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,BCBS MGG,BCBS MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Cigna,Cigna,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Cigna MGG,Cigna MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Humana,Humana,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Humana MGG,Humana MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Optum VA,Optum VA,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,UHC,UHC,50.1,,,,,,,per diem,50.1,50.1,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,UHC MGG,UHC MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,VA,VA,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Wellcare MGG,Wellcare MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Bright Health - commercial,Bright Health - commercial,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,50.1,50.1,Bright Health MGG,Bright Health MGG,50.1,,,,,,,case rate,50.1,50.1,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Aetna,Aetna,82.56,,,,,,,per diem,82.56,82.56,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Aetna MGG,Aetna MGG,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,BCBS,BCBS,82.56,,,,,,,per diem,82.56,82.56,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,BCBS MGG,BCBS MGG,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Cigna,Cigna,82.56,,,,,,,per diem,82.56,82.56,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Cigna MGG,Cigna MGG,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Humana,Humana,82.56,,,,,,,per diem,82.56,82.56,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Humana MGG,Humana MGG,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Optum VA,Optum VA,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,UHC,UHC,82.56,,,,,,,per diem,82.56,82.56,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,UHC MGG,UHC MGG,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,VA,VA,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Wellcare MGG,Wellcare MGG,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Bright Health - commercial,Bright Health - commercial,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,82.56,82.56,Bright Health MGG,Bright Health MGG,82.56,,,,,,,case rate,82.56,82.56,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Aetna,Aetna,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Aetna MGG,Aetna MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,BCBS,BCBS,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,BCBS MGG,BCBS MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Cigna,Cigna,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Cigna MGG,Cigna MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Humana,Humana,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Humana MGG,Humana MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Optum VA,Optum VA,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,UHC,UHC,84.09,,,,,,,per diem,84.09,84.09,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,UHC MGG,UHC MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,VA,VA,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Wellcare MGG,Wellcare MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Bright Health - commercial,Bright Health - commercial,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,84.09,84.09,Bright Health MGG,Bright Health MGG,84.09,,,,,,,case rate,84.09,84.09,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Aetna,Aetna,52.11,,,,,,,per diem,52.11,52.11,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Aetna MGG,Aetna MGG,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,BCBS,BCBS,52.11,,,,,,,per diem,52.11,52.11,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,BCBS MGG,BCBS MGG,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Cigna,Cigna,52.11,,,,,,,per diem,52.11,52.11,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Cigna MGG,Cigna MGG,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Humana,Humana,52.11,,,,,,,per diem,52.11,52.11,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Humana MGG,Humana MGG,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Optum VA,Optum VA,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,UHC,UHC,52.11,,,,,,,per diem,52.11,52.11,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,UHC MGG,UHC MGG,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,VA,VA,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Wellcare MGG,Wellcare MGG,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Bright Health - commercial,Bright Health - commercial,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,52.11,52.11,Bright Health MGG,Bright Health MGG,52.11,,,,,,,case rate,52.11,52.11,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Aetna,Aetna,10.25,,,,,,,per diem,10.25,10.25,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Aetna MGG,Aetna MGG,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,BCBS,BCBS,10.25,,,,,,,per diem,10.25,10.25,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,BCBS MGG,BCBS MGG,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Cigna,Cigna,10.25,,,,,,,per diem,10.25,10.25,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Cigna MGG,Cigna MGG,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Humana,Humana,10.25,,,,,,,per diem,10.25,10.25,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Humana MGG,Humana MGG,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Optum VA,Optum VA,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,UHC,UHC,10.25,,,,,,,per diem,10.25,10.25,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,UHC MGG,UHC MGG,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,VA,VA,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Wellcare MGG,Wellcare MGG,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Bright Health - commercial,Bright Health - commercial,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,10.25,10.25,Bright Health MGG,Bright Health MGG,10.25,,,,,,,case rate,10.25,10.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Aetna,Aetna,14.02,,,,,,,per diem,14.02,14.02,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Aetna MGG,Aetna MGG,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,BCBS,BCBS,14.02,,,,,,,per diem,14.02,14.02,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,BCBS MGG,BCBS MGG,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Cigna,Cigna,14.02,,,,,,,per diem,14.02,14.02,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Cigna MGG,Cigna MGG,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Humana,Humana,14.02,,,,,,,per diem,14.02,14.02,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Humana MGG,Humana MGG,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Optum VA,Optum VA,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,UHC,UHC,14.02,,,,,,,per diem,14.02,14.02,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,UHC MGG,UHC MGG,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,VA,VA,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Wellcare MGG,Wellcare MGG,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Bright Health - commercial,Bright Health - commercial,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.02,14.02,Bright Health MGG,Bright Health MGG,14.02,,,,,,,case rate,14.02,14.02,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Aetna,Aetna,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Aetna MGG,Aetna MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,BCBS,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS MGG,BCBS MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Cigna,Cigna,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Cigna MGG,Cigna MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Humana,Humana,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Humana MGG,Humana MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Optum VA,Optum VA,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UHC,UHC,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UHC MGG,UHC MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,VA,VA,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Wellcare MGG,Wellcare MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Bright Health - commercial,Bright Health - commercial,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Bright Health MGG,Bright Health MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Aetna,Aetna,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Aetna MGG,Aetna MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,BCBS,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS MGG,BCBS MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Cigna,Cigna,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Cigna MGG,Cigna MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Humana,Humana,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Humana MGG,Humana MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Optum VA,Optum VA,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UHC,UHC,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UHC MGG,UHC MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,VA,VA,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Wellcare MGG,Wellcare MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Bright Health - commercial,Bright Health - commercial,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Bright Health MGG,Bright Health MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Aetna,Aetna,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Aetna MGG,Aetna MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,BCBS,BCBS,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,BCBS MGG,BCBS MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Cigna,Cigna,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Cigna MGG,Cigna MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Humana,Humana,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Humana MGG,Humana MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Optum VA,Optum VA,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,UHC,UHC,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,UHC MGG,UHC MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,VA,VA,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Wellcare MGG,Wellcare MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Bright Health - commercial,Bright Health - commercial,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Bright Health MGG,Bright Health MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Aetna,Aetna,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Aetna MGG,Aetna MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,BCBS,BCBS,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,BCBS MGG,BCBS MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Cigna,Cigna,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Cigna MGG,Cigna MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Humana,Humana,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Humana MGG,Humana MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Optum VA,Optum VA,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,UHC,UHC,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,UHC MGG,UHC MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,VA,VA,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Wellcare MGG,Wellcare MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Bright Health - commercial,Bright Health - commercial,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Bright Health MGG,Bright Health MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Aetna,Aetna,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Aetna MGG,Aetna MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,BCBS,BCBS,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,BCBS MGG,BCBS MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Cigna,Cigna,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Cigna MGG,Cigna MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Humana,Humana,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Humana MGG,Humana MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Optum VA,Optum VA,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,UHC,UHC,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,UHC MGG,UHC MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,VA,VA,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Wellcare MGG,Wellcare MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Bright Health - commercial,Bright Health - commercial,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Bright Health MGG,Bright Health MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Aetna,Aetna,911.94,,,,,,,per diem,911.94,911.94,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Aetna MGG,Aetna MGG,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,BCBS,BCBS,911.94,,,,,,,per diem,911.94,911.94,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,BCBS MGG,BCBS MGG,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Cigna,Cigna,911.94,,,,,,,per diem,911.94,911.94,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Cigna MGG,Cigna MGG,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Humana,Humana,911.94,,,,,,,per diem,911.94,911.94,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Humana MGG,Humana MGG,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Optum VA,Optum VA,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,UHC,UHC,911.94,,,,,,,per diem,911.94,911.94,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,UHC MGG,UHC MGG,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,VA,VA,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Wellcare MGG,Wellcare MGG,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Bright Health - commercial,Bright Health - commercial,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,911.94,911.94,Bright Health MGG,Bright Health MGG,911.94,,,,,,,case rate,911.94,911.94,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna,Aetna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna MGG,Aetna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS,BCBS,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS MGG,BCBS MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna,Cigna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna MGG,Cigna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana,Humana,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana MGG,Humana MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Optum VA,Optum VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC,UHC,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC MGG,UHC MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,VA,VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Wellcare MGG,Wellcare MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health - commercial,Bright Health - commercial,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health MGG,Bright Health MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna,Aetna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna MGG,Aetna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS,BCBS,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS MGG,BCBS MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna,Cigna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna MGG,Cigna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana,Humana,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana MGG,Humana MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Optum VA,Optum VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC,UHC,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC MGG,UHC MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,VA,VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Wellcare MGG,Wellcare MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health - commercial,Bright Health - commercial,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health MGG,Bright Health MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Aetna,Aetna,425.34,,,,,,,per diem,425.34,425.34,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Aetna MGG,Aetna MGG,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,BCBS,BCBS,425.34,,,,,,,per diem,425.34,425.34,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,BCBS MGG,BCBS MGG,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Cigna,Cigna,425.34,,,,,,,per diem,425.34,425.34,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Cigna MGG,Cigna MGG,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Humana,Humana,425.34,,,,,,,per diem,425.34,425.34,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Humana MGG,Humana MGG,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Optum VA,Optum VA,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,UHC,UHC,425.34,,,,,,,per diem,425.34,425.34,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,UHC MGG,UHC MGG,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,VA,VA,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Wellcare MGG,Wellcare MGG,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Bright Health - commercial,Bright Health - commercial,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,425.34,425.34,Bright Health MGG,Bright Health MGG,425.34,,,,,,,case rate,425.34,425.34,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Aetna,Aetna,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Aetna MGG,Aetna MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS,BCBS,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS MGG,BCBS MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Cigna,Cigna,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Cigna MGG,Cigna MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Humana,Humana,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Humana MGG,Humana MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Optum VA,Optum VA,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,UHC,UHC,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,UHC MGG,UHC MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,VA,VA,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Wellcare MGG,Wellcare MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Bright Health - commercial,Bright Health - commercial,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Bright Health MGG,Bright Health MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Aetna,Aetna,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Aetna MGG,Aetna MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,BCBS,BCBS,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,BCBS MGG,BCBS MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Cigna,Cigna,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Cigna MGG,Cigna MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Humana,Humana,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Humana MGG,Humana MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Optum VA,Optum VA,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,UHC,UHC,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,UHC MGG,UHC MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,VA,VA,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Wellcare MGG,Wellcare MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Bright Health - commercial,Bright Health - commercial,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Bright Health MGG,Bright Health MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Aetna,Aetna,108.9,,,,,,,per diem,108.9,108.9,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Aetna MGG,Aetna MGG,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,BCBS,BCBS,108.9,,,,,,,per diem,108.9,108.9,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,BCBS MGG,BCBS MGG,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Cigna,Cigna,108.9,,,,,,,per diem,108.9,108.9,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Cigna MGG,Cigna MGG,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Humana,Humana,108.9,,,,,,,per diem,108.9,108.9,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Humana MGG,Humana MGG,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Optum VA,Optum VA,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,UHC,UHC,108.9,,,,,,,per diem,108.9,108.9,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,UHC MGG,UHC MGG,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,VA,VA,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Wellcare MGG,Wellcare MGG,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Bright Health - commercial,Bright Health - commercial,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,108.9,108.9,Bright Health MGG,Bright Health MGG,108.9,,,,,,,case rate,108.9,108.9,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Aetna,Aetna,34.05,,,,,,,per diem,34.05,34.05,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Aetna MGG,Aetna MGG,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,BCBS,BCBS,34.05,,,,,,,per diem,34.05,34.05,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,BCBS MGG,BCBS MGG,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Cigna,Cigna,34.05,,,,,,,per diem,34.05,34.05,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Cigna MGG,Cigna MGG,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Humana,Humana,34.05,,,,,,,per diem,34.05,34.05,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Humana MGG,Humana MGG,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Optum VA,Optum VA,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,UHC,UHC,34.05,,,,,,,per diem,34.05,34.05,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,UHC MGG,UHC MGG,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,VA,VA,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Wellcare MGG,Wellcare MGG,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Bright Health - commercial,Bright Health - commercial,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,34.05,34.05,Bright Health MGG,Bright Health MGG,34.05,,,,,,,case rate,34.05,34.05,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Aetna,Aetna,202.5,,,,,,,per diem,202.5,202.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Aetna MGG,Aetna MGG,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,BCBS,BCBS,202.5,,,,,,,per diem,202.5,202.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,BCBS MGG,BCBS MGG,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Cigna,Cigna,202.5,,,,,,,per diem,202.5,202.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Cigna MGG,Cigna MGG,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Humana,Humana,202.5,,,,,,,per diem,202.5,202.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Humana MGG,Humana MGG,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Optum VA,Optum VA,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,UHC,UHC,202.5,,,,,,,per diem,202.5,202.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,UHC MGG,UHC MGG,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,VA,VA,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Wellcare MGG,Wellcare MGG,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Bright Health - commercial,Bright Health - commercial,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,202.5,202.5,Bright Health MGG,Bright Health MGG,202.5,,,,,,,case rate,202.5,202.5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Aetna,Aetna,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Aetna MGG,Aetna MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,BCBS,BCBS,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,BCBS MGG,BCBS MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Cigna,Cigna,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Cigna MGG,Cigna MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Humana,Humana,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Humana MGG,Humana MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Optum VA,Optum VA,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,UHC,UHC,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,UHC MGG,UHC MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,VA,VA,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Wellcare MGG,Wellcare MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Bright Health - commercial,Bright Health - commercial,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Bright Health MGG,Bright Health MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Aetna,Aetna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Aetna MGG,Aetna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,BCBS,BCBS,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,BCBS MGG,BCBS MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Cigna,Cigna,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Cigna MGG,Cigna MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Humana,Humana,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Humana MGG,Humana MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Optum VA,Optum VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,UHC,UHC,9.18,,,,,,,per diem,9.18,9.18,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,UHC MGG,UHC MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,VA,VA,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Wellcare MGG,Wellcare MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Bright Health - commercial,Bright Health - commercial,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.18,9.18,Bright Health MGG,Bright Health MGG,9.18,,,,,,,case rate,9.18,9.18,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Aetna,Aetna,35.07,,,,,,,per diem,35.07,35.07,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Aetna MGG,Aetna MGG,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,BCBS,BCBS,35.07,,,,,,,per diem,35.07,35.07,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,BCBS MGG,BCBS MGG,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Cigna,Cigna,35.07,,,,,,,per diem,35.07,35.07,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Cigna MGG,Cigna MGG,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Humana,Humana,35.07,,,,,,,per diem,35.07,35.07,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Humana MGG,Humana MGG,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Optum VA,Optum VA,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,UHC,UHC,35.07,,,,,,,per diem,35.07,35.07,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,UHC MGG,UHC MGG,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,VA,VA,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Wellcare MGG,Wellcare MGG,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Bright Health - commercial,Bright Health - commercial,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,35.07,35.07,Bright Health MGG,Bright Health MGG,35.07,,,,,,,case rate,35.07,35.07,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Aetna,Aetna,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Aetna MGG,Aetna MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,BCBS,BCBS,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,BCBS MGG,BCBS MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Cigna,Cigna,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Cigna MGG,Cigna MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Humana,Humana,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Humana MGG,Humana MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Optum VA,Optum VA,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,UHC,UHC,16.5,,,,,,,per diem,16.5,16.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,UHC MGG,UHC MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,VA,VA,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Wellcare MGG,Wellcare MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Bright Health - commercial,Bright Health - commercial,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,16.5,16.5,Bright Health MGG,Bright Health MGG,16.5,,,,,,,case rate,16.5,16.5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna,Aetna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna MGG,Aetna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS,BCBS,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS MGG,BCBS MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna,Cigna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna MGG,Cigna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana,Humana,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana MGG,Humana MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Optum VA,Optum VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC,UHC,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC MGG,UHC MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,VA,VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Wellcare MGG,Wellcare MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health - commercial,Bright Health - commercial,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health MGG,Bright Health MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Aetna,Aetna,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Aetna MGG,Aetna MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,BCBS,BCBS,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,BCBS MGG,BCBS MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Cigna,Cigna,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Cigna MGG,Cigna MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Humana,Humana,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Humana MGG,Humana MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Optum VA,Optum VA,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,UHC,UHC,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,UHC MGG,UHC MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,VA,VA,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Wellcare MGG,Wellcare MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Bright Health - commercial,Bright Health - commercial,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Bright Health MGG,Bright Health MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna,Aetna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna MGG,Aetna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS,BCBS,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS MGG,BCBS MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna,Cigna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna MGG,Cigna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana,Humana,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana MGG,Humana MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Optum VA,Optum VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC,UHC,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC MGG,UHC MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,VA,VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Wellcare MGG,Wellcare MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health - commercial,Bright Health - commercial,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health MGG,Bright Health MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Aetna,Aetna,114.87,,,,,,,per diem,114.87,114.87,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Aetna MGG,Aetna MGG,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,BCBS,BCBS,114.87,,,,,,,per diem,114.87,114.87,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,BCBS MGG,BCBS MGG,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Cigna,Cigna,114.87,,,,,,,per diem,114.87,114.87,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Cigna MGG,Cigna MGG,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Humana,Humana,114.87,,,,,,,per diem,114.87,114.87,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Humana MGG,Humana MGG,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Optum VA,Optum VA,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,UHC,UHC,114.87,,,,,,,per diem,114.87,114.87,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,UHC MGG,UHC MGG,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,VA,VA,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Wellcare MGG,Wellcare MGG,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Bright Health - commercial,Bright Health - commercial,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,114.87,114.87,Bright Health MGG,Bright Health MGG,114.87,,,,,,,case rate,114.87,114.87,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Aetna,Aetna,4319.64,,,,,,,per diem,4319.64,4319.64,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Aetna MGG,Aetna MGG,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,BCBS,BCBS,4319.64,,,,,,,per diem,4319.64,4319.64,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,BCBS MGG,BCBS MGG,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Cigna,Cigna,4319.64,,,,,,,per diem,4319.64,4319.64,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Cigna MGG,Cigna MGG,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Humana,Humana,4319.64,,,,,,,per diem,4319.64,4319.64,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Humana MGG,Humana MGG,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Optum VA,Optum VA,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,UHC,UHC,4319.64,,,,,,,per diem,4319.64,4319.64,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,UHC MGG,UHC MGG,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,VA,VA,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Wellcare MGG,Wellcare MGG,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Bright Health - commercial,Bright Health - commercial,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,4319.64,4319.64,Bright Health MGG,Bright Health MGG,4319.64,,,,,,,case rate,4319.64,4319.64,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Aetna,Aetna,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Aetna MGG,Aetna MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,BCBS,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS MGG,BCBS MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Cigna,Cigna,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Cigna MGG,Cigna MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Humana,Humana,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Humana MGG,Humana MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Optum VA,Optum VA,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,UHC,UHC,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,UHC MGG,UHC MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,VA,VA,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Wellcare MGG,Wellcare MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Bright Health - commercial,Bright Health - commercial,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Bright Health MGG,Bright Health MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Aetna,Aetna,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Aetna MGG,Aetna MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,BCBS,BCBS,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,BCBS MGG,BCBS MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Cigna,Cigna,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Cigna MGG,Cigna MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Humana,Humana,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Humana MGG,Humana MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Optum VA,Optum VA,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,UHC,UHC,8.61,,,,,,,per diem,8.61,8.61,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,UHC MGG,UHC MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,VA,VA,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Wellcare MGG,Wellcare MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Bright Health - commercial,Bright Health - commercial,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,8.61,8.61,Bright Health MGG,Bright Health MGG,8.61,,,,,,,case rate,8.61,8.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Aetna,Aetna,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Aetna MGG,Aetna MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,BCBS,BCBS,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,BCBS MGG,BCBS MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Cigna,Cigna,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Cigna MGG,Cigna MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Humana,Humana,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Humana MGG,Humana MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Optum VA,Optum VA,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,UHC,UHC,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,UHC MGG,UHC MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,VA,VA,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Wellcare MGG,Wellcare MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Bright Health - commercial,Bright Health - commercial,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Bright Health MGG,Bright Health MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Aetna,Aetna,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Aetna MGG,Aetna MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,BCBS,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS MGG,BCBS MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Cigna,Cigna,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Cigna MGG,Cigna MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Humana,Humana,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Humana MGG,Humana MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Optum VA,Optum VA,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UHC,UHC,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UHC MGG,UHC MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA,VA,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Wellcare MGG,Wellcare MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Bright Health - commercial,Bright Health - commercial,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Bright Health MGG,Bright Health MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Aetna,Aetna,17.61,,,,,,,per diem,17.61,17.61,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Aetna MGG,Aetna MGG,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,BCBS,BCBS,17.61,,,,,,,per diem,17.61,17.61,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,BCBS MGG,BCBS MGG,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Cigna,Cigna,17.61,,,,,,,per diem,17.61,17.61,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Cigna MGG,Cigna MGG,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Humana,Humana,17.61,,,,,,,per diem,17.61,17.61,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Humana MGG,Humana MGG,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Optum VA,Optum VA,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,UHC,UHC,17.61,,,,,,,per diem,17.61,17.61,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,UHC MGG,UHC MGG,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,VA,VA,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Wellcare MGG,Wellcare MGG,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Bright Health - commercial,Bright Health - commercial,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,17.61,17.61,Bright Health MGG,Bright Health MGG,17.61,,,,,,,case rate,17.61,17.61,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Aetna,Aetna,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Aetna MGG,Aetna MGG,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,BCBS,BCBS,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,BCBS MGG,BCBS MGG,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Cigna,Cigna,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Cigna MGG,Cigna MGG,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Humana,Humana,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Humana MGG,Humana MGG,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Optum VA,Optum VA,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,UHC,UHC,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,UHC MGG,UHC MGG,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,VA,VA,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Wellcare MGG,Wellcare MGG,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Bright Health - commercial,Bright Health - commercial,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,72.54,72.54,Bright Health MGG,Bright Health MGG,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Aetna,Aetna,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Aetna MGG,Aetna MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,BCBS,BCBS,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,BCBS MGG,BCBS MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Cigna,Cigna,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Cigna MGG,Cigna MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Humana,Humana,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Humana MGG,Humana MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Optum VA,Optum VA,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,UHC,UHC,11.28,,,,,,,per diem,11.28,11.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,UHC MGG,UHC MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,VA,VA,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Wellcare MGG,Wellcare MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Bright Health - commercial,Bright Health - commercial,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.28,11.28,Bright Health MGG,Bright Health MGG,11.28,,,,,,,case rate,11.28,11.28,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Aetna,Aetna,69.42,,,,,,,per diem,69.42,69.42,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Aetna MGG,Aetna MGG,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,BCBS,BCBS,69.42,,,,,,,per diem,69.42,69.42,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,BCBS MGG,BCBS MGG,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Cigna,Cigna,69.42,,,,,,,per diem,69.42,69.42,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Cigna MGG,Cigna MGG,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Humana,Humana,69.42,,,,,,,per diem,69.42,69.42,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Humana MGG,Humana MGG,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Optum VA,Optum VA,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,UHC,UHC,69.42,,,,,,,per diem,69.42,69.42,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,UHC MGG,UHC MGG,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,VA,VA,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Wellcare MGG,Wellcare MGG,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Bright Health - commercial,Bright Health - commercial,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,69.42,69.42,Bright Health MGG,Bright Health MGG,69.42,,,,,,,case rate,69.42,69.42,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Aetna,Aetna,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Aetna MGG,Aetna MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,BCBS,BCBS,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,BCBS MGG,BCBS MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Cigna,Cigna,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Cigna MGG,Cigna MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Humana,Humana,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Humana MGG,Humana MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Optum VA,Optum VA,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,UHC,UHC,10.23,,,,,,,per diem,10.23,10.23,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,UHC MGG,UHC MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,VA,VA,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Wellcare MGG,Wellcare MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Bright Health - commercial,Bright Health - commercial,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.23,10.23,Bright Health MGG,Bright Health MGG,10.23,,,,,,,case rate,10.23,10.23,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Aetna,Aetna,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Aetna MGG,Aetna MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,BCBS,BCBS,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,BCBS MGG,BCBS MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Cigna,Cigna,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Cigna MGG,Cigna MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Humana,Humana,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Humana MGG,Humana MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Optum VA,Optum VA,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,UHC,UHC,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,UHC MGG,UHC MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,VA,VA,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Wellcare MGG,Wellcare MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Bright Health - commercial,Bright Health - commercial,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Bright Health MGG,Bright Health MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Aetna,Aetna,11.92,,,,,,,per diem,11.92,11.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Aetna MGG,Aetna MGG,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,BCBS,BCBS,11.92,,,,,,,per diem,11.92,11.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,BCBS MGG,BCBS MGG,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Cigna,Cigna,11.92,,,,,,,per diem,11.92,11.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Cigna MGG,Cigna MGG,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Humana,Humana,11.92,,,,,,,per diem,11.92,11.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Humana MGG,Humana MGG,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Optum VA,Optum VA,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,UHC,UHC,11.92,,,,,,,per diem,11.92,11.92,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,UHC MGG,UHC MGG,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,VA,VA,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Wellcare MGG,Wellcare MGG,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Bright Health - commercial,Bright Health - commercial,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,11.92,11.92,Bright Health MGG,Bright Health MGG,11.92,,,,,,,case rate,11.92,11.92,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Aetna,Aetna,94.53,,,,,,,per diem,94.53,94.53,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Aetna MGG,Aetna MGG,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,BCBS,BCBS,94.53,,,,,,,per diem,94.53,94.53,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,BCBS MGG,BCBS MGG,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Cigna,Cigna,94.53,,,,,,,per diem,94.53,94.53,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Cigna MGG,Cigna MGG,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Humana,Humana,94.53,,,,,,,per diem,94.53,94.53,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Humana MGG,Humana MGG,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Optum VA,Optum VA,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,UHC,UHC,94.53,,,,,,,per diem,94.53,94.53,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,UHC MGG,UHC MGG,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,VA,VA,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Wellcare MGG,Wellcare MGG,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Bright Health - commercial,Bright Health - commercial,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,94.53,94.53,Bright Health MGG,Bright Health MGG,94.53,,,,,,,case rate,94.53,94.53,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Aetna,Aetna,585.75,,,,,,,per diem,585.75,585.75,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Aetna MGG,Aetna MGG,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,BCBS,BCBS,585.75,,,,,,,per diem,585.75,585.75,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,BCBS MGG,BCBS MGG,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Cigna,Cigna,585.75,,,,,,,per diem,585.75,585.75,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Cigna MGG,Cigna MGG,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Humana,Humana,585.75,,,,,,,per diem,585.75,585.75,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Humana MGG,Humana MGG,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Optum VA,Optum VA,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,UHC,UHC,585.75,,,,,,,per diem,585.75,585.75,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,UHC MGG,UHC MGG,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,VA,VA,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Wellcare MGG,Wellcare MGG,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Bright Health - commercial,Bright Health - commercial,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,585.75,585.75,Bright Health MGG,Bright Health MGG,585.75,,,,,,,case rate,585.75,585.75,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Aetna,Aetna,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Aetna MGG,Aetna MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,BCBS,BCBS,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,BCBS MGG,BCBS MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Cigna,Cigna,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Cigna MGG,Cigna MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Humana,Humana,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Humana MGG,Humana MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Optum VA,Optum VA,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,UHC,UHC,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,UHC MGG,UHC MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,VA,VA,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Wellcare MGG,Wellcare MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Bright Health - commercial,Bright Health - commercial,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Bright Health MGG,Bright Health MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Aetna,Aetna,15.48,,,,,,,per diem,15.48,15.48,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Aetna MGG,Aetna MGG,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,BCBS,BCBS,15.48,,,,,,,per diem,15.48,15.48,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,BCBS MGG,BCBS MGG,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Cigna,Cigna,15.48,,,,,,,per diem,15.48,15.48,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Cigna MGG,Cigna MGG,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Humana,Humana,15.48,,,,,,,per diem,15.48,15.48,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Humana MGG,Humana MGG,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Optum VA,Optum VA,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,UHC,UHC,15.48,,,,,,,per diem,15.48,15.48,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,UHC MGG,UHC MGG,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,VA,VA,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Wellcare MGG,Wellcare MGG,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Bright Health - commercial,Bright Health - commercial,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,15.48,15.48,Bright Health MGG,Bright Health MGG,15.48,,,,,,,case rate,15.48,15.48,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Aetna,Aetna,76.62,,,,,,,per diem,76.62,76.62,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Aetna MGG,Aetna MGG,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,BCBS,BCBS,76.62,,,,,,,per diem,76.62,76.62,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,BCBS MGG,BCBS MGG,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Cigna,Cigna,76.62,,,,,,,per diem,76.62,76.62,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Cigna MGG,Cigna MGG,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Humana,Humana,76.62,,,,,,,per diem,76.62,76.62,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Humana MGG,Humana MGG,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Optum VA,Optum VA,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,UHC,UHC,76.62,,,,,,,per diem,76.62,76.62,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,UHC MGG,UHC MGG,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,VA,VA,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Wellcare MGG,Wellcare MGG,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Bright Health - commercial,Bright Health - commercial,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,76.62,76.62,Bright Health MGG,Bright Health MGG,76.62,,,,,,,case rate,76.62,76.62,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Aetna,Aetna,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Aetna MGG,Aetna MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,BCBS,BCBS,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,BCBS MGG,BCBS MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Cigna,Cigna,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Cigna MGG,Cigna MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Humana,Humana,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Humana MGG,Humana MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Optum VA,Optum VA,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,UHC,UHC,410.58,,,,,,,per diem,410.58,410.58,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,UHC MGG,UHC MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,VA,VA,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Wellcare MGG,Wellcare MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Bright Health - commercial,Bright Health - commercial,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,410.58,410.58,Bright Health MGG,Bright Health MGG,410.58,,,,,,,case rate,410.58,410.58,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Aetna,Aetna,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Aetna MGG,Aetna MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS,BCBS,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS MGG,BCBS MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Cigna,Cigna,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Cigna MGG,Cigna MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Humana,Humana,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Humana MGG,Humana MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Optum VA,Optum VA,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,UHC,UHC,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,UHC MGG,UHC MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,VA,VA,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Wellcare MGG,Wellcare MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Bright Health - commercial,Bright Health - commercial,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Bright Health MGG,Bright Health MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna,Aetna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna MGG,Aetna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS,BCBS,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS MGG,BCBS MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna,Cigna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna MGG,Cigna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana,Humana,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana MGG,Humana MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Optum VA,Optum VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC,UHC,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC MGG,UHC MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,VA,VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Wellcare MGG,Wellcare MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health - commercial,Bright Health - commercial,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health MGG,Bright Health MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Aetna,Aetna,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Aetna MGG,Aetna MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,BCBS,BCBS,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,BCBS MGG,BCBS MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Cigna,Cigna,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Cigna MGG,Cigna MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Humana,Humana,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Humana MGG,Humana MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Optum VA,Optum VA,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,UHC,UHC,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,UHC MGG,UHC MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,VA,VA,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Wellcare MGG,Wellcare MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Bright Health - commercial,Bright Health - commercial,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Bright Health MGG,Bright Health MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Aetna,Aetna,193.92,,,,,,,per diem,193.92,193.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Aetna MGG,Aetna MGG,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,BCBS,BCBS,193.92,,,,,,,per diem,193.92,193.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,BCBS MGG,BCBS MGG,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Cigna,Cigna,193.92,,,,,,,per diem,193.92,193.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Cigna MGG,Cigna MGG,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Humana,Humana,193.92,,,,,,,per diem,193.92,193.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Humana MGG,Humana MGG,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Optum VA,Optum VA,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,UHC,UHC,193.92,,,,,,,per diem,193.92,193.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,UHC MGG,UHC MGG,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,VA,VA,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Wellcare MGG,Wellcare MGG,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Bright Health - commercial,Bright Health - commercial,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,193.92,193.92,Bright Health MGG,Bright Health MGG,193.92,,,,,,,case rate,193.92,193.92,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Aetna,Aetna,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Aetna MGG,Aetna MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,BCBS,BCBS,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,BCBS MGG,BCBS MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Cigna,Cigna,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Cigna MGG,Cigna MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Humana,Humana,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Humana MGG,Humana MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Optum VA,Optum VA,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,UHC,UHC,53.61,,,,,,,per diem,53.61,53.61,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,UHC MGG,UHC MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,VA,VA,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Wellcare MGG,Wellcare MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Bright Health - commercial,Bright Health - commercial,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,53.61,53.61,Bright Health MGG,Bright Health MGG,53.61,,,,,,,case rate,53.61,53.61,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Aetna,Aetna,905.16,,,,,,,per diem,905.16,905.16,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Aetna MGG,Aetna MGG,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,BCBS,BCBS,905.16,,,,,,,per diem,905.16,905.16,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,BCBS MGG,BCBS MGG,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Cigna,Cigna,905.16,,,,,,,per diem,905.16,905.16,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Cigna MGG,Cigna MGG,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Humana,Humana,905.16,,,,,,,per diem,905.16,905.16,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Humana MGG,Humana MGG,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Optum VA,Optum VA,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,UHC,UHC,905.16,,,,,,,per diem,905.16,905.16,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,UHC MGG,UHC MGG,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,VA,VA,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Wellcare MGG,Wellcare MGG,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Bright Health - commercial,Bright Health - commercial,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,905.16,905.16,Bright Health MGG,Bright Health MGG,905.16,,,,,,,case rate,905.16,905.16,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Aetna,Aetna,6.45,,,,,,,per diem,6.45,6.45,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Aetna MGG,Aetna MGG,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,BCBS,BCBS,6.45,,,,,,,per diem,6.45,6.45,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,BCBS MGG,BCBS MGG,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Cigna,Cigna,6.45,,,,,,,per diem,6.45,6.45,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Cigna MGG,Cigna MGG,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Humana,Humana,6.45,,,,,,,per diem,6.45,6.45,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Humana MGG,Humana MGG,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Optum VA,Optum VA,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,UHC,UHC,6.45,,,,,,,per diem,6.45,6.45,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,UHC MGG,UHC MGG,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,VA,VA,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Wellcare MGG,Wellcare MGG,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Bright Health - commercial,Bright Health - commercial,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,6.45,6.45,Bright Health MGG,Bright Health MGG,6.45,,,,,,,case rate,6.45,6.45,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Aetna,Aetna,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Aetna MGG,Aetna MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,BCBS,BCBS,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,BCBS MGG,BCBS MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Cigna,Cigna,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Cigna MGG,Cigna MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Humana,Humana,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Humana MGG,Humana MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Optum VA,Optum VA,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,UHC,UHC,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,UHC MGG,UHC MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,VA,VA,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Wellcare MGG,Wellcare MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Bright Health - commercial,Bright Health - commercial,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Bright Health MGG,Bright Health MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Aetna,Aetna,498.96,,,,,,,per diem,498.96,498.96,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Aetna MGG,Aetna MGG,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,BCBS,BCBS,498.96,,,,,,,per diem,498.96,498.96,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,BCBS MGG,BCBS MGG,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Cigna,Cigna,498.96,,,,,,,per diem,498.96,498.96,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Cigna MGG,Cigna MGG,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Humana,Humana,498.96,,,,,,,per diem,498.96,498.96,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Humana MGG,Humana MGG,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Optum VA,Optum VA,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,UHC,UHC,498.96,,,,,,,per diem,498.96,498.96,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,UHC MGG,UHC MGG,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,VA,VA,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Wellcare MGG,Wellcare MGG,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Bright Health - commercial,Bright Health - commercial,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,498.96,498.96,Bright Health MGG,Bright Health MGG,498.96,,,,,,,case rate,498.96,498.96,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Aetna,Aetna,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Aetna MGG,Aetna MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,BCBS,BCBS,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,BCBS MGG,BCBS MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Cigna,Cigna,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Cigna MGG,Cigna MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Humana,Humana,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Humana MGG,Humana MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Optum VA,Optum VA,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,UHC,UHC,46.71,,,,,,,per diem,46.71,46.71,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,UHC MGG,UHC MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,VA,VA,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Wellcare MGG,Wellcare MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Bright Health - commercial,Bright Health - commercial,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,46.71,46.71,Bright Health MGG,Bright Health MGG,46.71,,,,,,,case rate,46.71,46.71,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Aetna,Aetna,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Aetna MGG,Aetna MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,BCBS,BCBS,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,BCBS MGG,BCBS MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Cigna,Cigna,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Cigna MGG,Cigna MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Humana,Humana,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Humana MGG,Humana MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Optum VA,Optum VA,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,UHC,UHC,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,UHC MGG,UHC MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,VA,VA,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Wellcare MGG,Wellcare MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Bright Health - commercial,Bright Health - commercial,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Bright Health MGG,Bright Health MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Aetna,Aetna,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Aetna MGG,Aetna MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,BCBS,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS MGG,BCBS MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Cigna,Cigna,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Cigna MGG,Cigna MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Humana,Humana,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Humana MGG,Humana MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Optum VA,Optum VA,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,UHC,UHC,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,UHC MGG,UHC MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,VA,VA,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Wellcare MGG,Wellcare MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Bright Health - commercial,Bright Health - commercial,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Bright Health MGG,Bright Health MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna,Aetna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna MGG,Aetna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,BCBS,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS MGG,BCBS MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna,Cigna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna MGG,Cigna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana,Humana,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana MGG,Humana MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Optum VA,Optum VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC,UHC,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC MGG,UHC MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,VA,VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Wellcare MGG,Wellcare MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health - commercial,Bright Health - commercial,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health MGG,Bright Health MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Aetna,Aetna,934.2,,,,,,,per diem,934.2,934.2,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Aetna MGG,Aetna MGG,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,BCBS,BCBS,934.2,,,,,,,per diem,934.2,934.2,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,BCBS MGG,BCBS MGG,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Cigna,Cigna,934.2,,,,,,,per diem,934.2,934.2,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Cigna MGG,Cigna MGG,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Humana,Humana,934.2,,,,,,,per diem,934.2,934.2,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Humana MGG,Humana MGG,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Optum VA,Optum VA,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,UHC,UHC,934.2,,,,,,,per diem,934.2,934.2,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,UHC MGG,UHC MGG,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,VA,VA,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Wellcare MGG,Wellcare MGG,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Bright Health - commercial,Bright Health - commercial,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,934.2,934.2,Bright Health MGG,Bright Health MGG,934.2,,,,,,,case rate,934.2,934.2,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Aetna,Aetna,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Aetna MGG,Aetna MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,BCBS,BCBS,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,BCBS MGG,BCBS MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Cigna,Cigna,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Cigna MGG,Cigna MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Humana,Humana,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Humana MGG,Humana MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Optum VA,Optum VA,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,UHC,UHC,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,UHC MGG,UHC MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,VA,VA,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Wellcare MGG,Wellcare MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Bright Health - commercial,Bright Health - commercial,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Bright Health MGG,Bright Health MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Aetna,Aetna,134.64,,,,,,,per diem,134.64,134.64,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Aetna MGG,Aetna MGG,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,BCBS,BCBS,134.64,,,,,,,per diem,134.64,134.64,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,BCBS MGG,BCBS MGG,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Cigna,Cigna,134.64,,,,,,,per diem,134.64,134.64,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Cigna MGG,Cigna MGG,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Humana,Humana,134.64,,,,,,,per diem,134.64,134.64,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Humana MGG,Humana MGG,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Optum VA,Optum VA,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,UHC,UHC,134.64,,,,,,,per diem,134.64,134.64,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,UHC MGG,UHC MGG,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,VA,VA,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Wellcare MGG,Wellcare MGG,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Bright Health - commercial,Bright Health - commercial,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,134.64,134.64,Bright Health MGG,Bright Health MGG,134.64,,,,,,,case rate,134.64,134.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Aetna,Aetna,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Aetna MGG,Aetna MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,BCBS,BCBS,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,BCBS MGG,BCBS MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Cigna,Cigna,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Cigna MGG,Cigna MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Humana,Humana,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Humana MGG,Humana MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Optum VA,Optum VA,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,UHC,UHC,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,UHC MGG,UHC MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,VA,VA,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Wellcare MGG,Wellcare MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Bright Health - commercial,Bright Health - commercial,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Bright Health MGG,Bright Health MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna,Aetna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna MGG,Aetna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS,BCBS,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS MGG,BCBS MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna,Cigna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna MGG,Cigna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana,Humana,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana MGG,Humana MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Optum VA,Optum VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC,UHC,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC MGG,UHC MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,VA,VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Wellcare MGG,Wellcare MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health - commercial,Bright Health - commercial,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health MGG,Bright Health MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Aetna,Aetna,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Aetna MGG,Aetna MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,BCBS,BCBS,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,BCBS MGG,BCBS MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Cigna,Cigna,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Cigna MGG,Cigna MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Humana,Humana,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Humana MGG,Humana MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Optum VA,Optum VA,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,UHC,UHC,16.2,,,,,,,per diem,16.2,16.2,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,UHC MGG,UHC MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,VA,VA,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Wellcare MGG,Wellcare MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Bright Health - commercial,Bright Health - commercial,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,16.2,16.2,Bright Health MGG,Bright Health MGG,16.2,,,,,,,case rate,16.2,16.2,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna,Aetna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Aetna MGG,Aetna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,BCBS,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS MGG,BCBS MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna,Cigna,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Cigna MGG,Cigna MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana,Humana,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Humana MGG,Humana MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Optum VA,Optum VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC,UHC,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UHC MGG,UHC MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA,VA,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Wellcare MGG,Wellcare MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health - commercial,Bright Health - commercial,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,Bright Health MGG,Bright Health MGG,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Aetna,Aetna,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Aetna MGG,Aetna MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,BCBS,BCBS,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,BCBS MGG,BCBS MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Cigna,Cigna,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Cigna MGG,Cigna MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Humana,Humana,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Humana MGG,Humana MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Optum VA,Optum VA,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,UHC,UHC,10.83,,,,,,,per diem,10.83,10.83,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,UHC MGG,UHC MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,VA,VA,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Wellcare MGG,Wellcare MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Bright Health - commercial,Bright Health - commercial,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,10.83,10.83,Bright Health MGG,Bright Health MGG,10.83,,,,,,,case rate,10.83,10.83,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Aetna,Aetna,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Aetna MGG,Aetna MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,BCBS,BCBS,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,BCBS MGG,BCBS MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Cigna,Cigna,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Cigna MGG,Cigna MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Humana,Humana,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Humana MGG,Humana MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Optum VA,Optum VA,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,UHC,UHC,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,UHC MGG,UHC MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,VA,VA,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Wellcare MGG,Wellcare MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Bright Health - commercial,Bright Health - commercial,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Bright Health MGG,Bright Health MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Aetna,Aetna,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Aetna MGG,Aetna MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,BCBS,BCBS,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,BCBS MGG,BCBS MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Cigna,Cigna,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Cigna MGG,Cigna MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Humana,Humana,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Humana MGG,Humana MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Optum VA,Optum VA,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,UHC,UHC,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,UHC MGG,UHC MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,VA,VA,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Wellcare MGG,Wellcare MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Bright Health - commercial,Bright Health - commercial,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Bright Health MGG,Bright Health MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Aetna,Aetna,91.02,,,,,,,per diem,91.02,91.02,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Aetna MGG,Aetna MGG,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,BCBS,BCBS,91.02,,,,,,,per diem,91.02,91.02,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,BCBS MGG,BCBS MGG,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Cigna,Cigna,91.02,,,,,,,per diem,91.02,91.02,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Cigna MGG,Cigna MGG,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Humana,Humana,91.02,,,,,,,per diem,91.02,91.02,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Humana MGG,Humana MGG,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Optum VA,Optum VA,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,UHC,UHC,91.02,,,,,,,per diem,91.02,91.02,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,UHC MGG,UHC MGG,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,VA,VA,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Wellcare MGG,Wellcare MGG,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Bright Health - commercial,Bright Health - commercial,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,91.02,91.02,Bright Health MGG,Bright Health MGG,91.02,,,,,,,case rate,91.02,91.02,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Aetna,Aetna,16.89,,,,,,,per diem,16.89,16.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Aetna MGG,Aetna MGG,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,BCBS,BCBS,16.89,,,,,,,per diem,16.89,16.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,BCBS MGG,BCBS MGG,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Cigna,Cigna,16.89,,,,,,,per diem,16.89,16.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Cigna MGG,Cigna MGG,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Humana,Humana,16.89,,,,,,,per diem,16.89,16.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Humana MGG,Humana MGG,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Optum VA,Optum VA,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,UHC,UHC,16.89,,,,,,,per diem,16.89,16.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,UHC MGG,UHC MGG,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,VA,VA,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Wellcare MGG,Wellcare MGG,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Bright Health - commercial,Bright Health - commercial,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,16.89,16.89,Bright Health MGG,Bright Health MGG,16.89,,,,,,,case rate,16.89,16.89,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Aetna,Aetna,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Aetna MGG,Aetna MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,BCBS,BCBS,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,BCBS MGG,BCBS MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Cigna,Cigna,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Cigna MGG,Cigna MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Humana,Humana,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Humana MGG,Humana MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Optum VA,Optum VA,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,UHC,UHC,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,UHC MGG,UHC MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,VA,VA,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Wellcare MGG,Wellcare MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Bright Health - commercial,Bright Health - commercial,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Bright Health MGG,Bright Health MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Aetna,Aetna,24.39,,,,,,,per diem,24.39,24.39,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Aetna MGG,Aetna MGG,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,BCBS,BCBS,24.39,,,,,,,per diem,24.39,24.39,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,BCBS MGG,BCBS MGG,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Cigna,Cigna,24.39,,,,,,,per diem,24.39,24.39,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Cigna MGG,Cigna MGG,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Humana,Humana,24.39,,,,,,,per diem,24.39,24.39,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Humana MGG,Humana MGG,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Optum VA,Optum VA,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,UHC,UHC,24.39,,,,,,,per diem,24.39,24.39,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,UHC MGG,UHC MGG,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,VA,VA,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Wellcare MGG,Wellcare MGG,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Bright Health - commercial,Bright Health - commercial,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,24.39,24.39,Bright Health MGG,Bright Health MGG,24.39,,,,,,,case rate,24.39,24.39,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Aetna,Aetna,9.47,,,,,,,per diem,9.47,9.47,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Aetna MGG,Aetna MGG,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,BCBS,BCBS,9.47,,,,,,,per diem,9.47,9.47,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,BCBS MGG,BCBS MGG,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Cigna,Cigna,9.47,,,,,,,per diem,9.47,9.47,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Cigna MGG,Cigna MGG,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Humana,Humana,9.47,,,,,,,per diem,9.47,9.47,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Humana MGG,Humana MGG,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Optum VA,Optum VA,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,UHC,UHC,9.47,,,,,,,per diem,9.47,9.47,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,UHC MGG,UHC MGG,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,VA,VA,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Wellcare MGG,Wellcare MGG,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Bright Health - commercial,Bright Health - commercial,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,9.47,9.47,Bright Health MGG,Bright Health MGG,9.47,,,,,,,case rate,9.47,9.47,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna,Aetna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna MGG,Aetna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS,BCBS,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS MGG,BCBS MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna,Cigna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna MGG,Cigna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana,Humana,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana MGG,Humana MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Optum VA,Optum VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC,UHC,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC MGG,UHC MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,VA,VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Wellcare MGG,Wellcare MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health - commercial,Bright Health - commercial,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health MGG,Bright Health MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Aetna,Aetna,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Aetna MGG,Aetna MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,BCBS,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS MGG,BCBS MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Cigna,Cigna,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Cigna MGG,Cigna MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Humana,Humana,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Humana MGG,Humana MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Optum VA,Optum VA,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,UHC,UHC,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,UHC MGG,UHC MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,VA,VA,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Wellcare MGG,Wellcare MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Bright Health - commercial,Bright Health - commercial,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Bright Health MGG,Bright Health MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Aetna,Aetna,898.71,,,,,,,per diem,898.71,898.71,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Aetna MGG,Aetna MGG,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,BCBS,BCBS,898.71,,,,,,,per diem,898.71,898.71,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,BCBS MGG,BCBS MGG,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Cigna,Cigna,898.71,,,,,,,per diem,898.71,898.71,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Cigna MGG,Cigna MGG,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Humana,Humana,898.71,,,,,,,per diem,898.71,898.71,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Humana MGG,Humana MGG,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Optum VA,Optum VA,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,UHC,UHC,898.71,,,,,,,per diem,898.71,898.71,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,UHC MGG,UHC MGG,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,VA,VA,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Wellcare MGG,Wellcare MGG,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Bright Health - commercial,Bright Health - commercial,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,898.71,898.71,Bright Health MGG,Bright Health MGG,898.71,,,,,,,case rate,898.71,898.71,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna,Aetna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Aetna MGG,Aetna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,BCBS,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS MGG,BCBS MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna,Cigna,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Cigna MGG,Cigna MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana,Humana,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Humana MGG,Humana MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Optum VA,Optum VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC,UHC,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UHC MGG,UHC MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,VA,VA,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Wellcare MGG,Wellcare MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health - commercial,Bright Health - commercial,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,Bright Health MGG,Bright Health MGG,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Aetna,Aetna,1193.76,,,,,,,per diem,1193.76,1193.76,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Aetna MGG,Aetna MGG,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,BCBS,BCBS,1193.76,,,,,,,per diem,1193.76,1193.76,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,BCBS MGG,BCBS MGG,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Cigna,Cigna,1193.76,,,,,,,per diem,1193.76,1193.76,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Cigna MGG,Cigna MGG,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Humana,Humana,1193.76,,,,,,,per diem,1193.76,1193.76,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Humana MGG,Humana MGG,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Optum VA,Optum VA,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,UHC,UHC,1193.76,,,,,,,per diem,1193.76,1193.76,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,UHC MGG,UHC MGG,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,VA,VA,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Wellcare MGG,Wellcare MGG,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Bright Health - commercial,Bright Health - commercial,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1193.76,1193.76,Bright Health MGG,Bright Health MGG,1193.76,,,,,,,case rate,1193.76,1193.76,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Aetna,Aetna,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Aetna MGG,Aetna MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,BCBS,BCBS,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,BCBS MGG,BCBS MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Cigna,Cigna,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Cigna MGG,Cigna MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Humana,Humana,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Humana MGG,Humana MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Optum VA,Optum VA,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,UHC,UHC,39.84,,,,,,,per diem,39.84,39.84,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,UHC MGG,UHC MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,VA,VA,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Wellcare MGG,Wellcare MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Bright Health - commercial,Bright Health - commercial,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,39.84,39.84,Bright Health MGG,Bright Health MGG,39.84,,,,,,,case rate,39.84,39.84,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Aetna,Aetna,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Aetna MGG,Aetna MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,BCBS,BCBS,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,BCBS MGG,BCBS MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Cigna,Cigna,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Cigna MGG,Cigna MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Humana,Humana,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Humana MGG,Humana MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Optum VA,Optum VA,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,UHC,UHC,8.55,,,,,,,per diem,8.55,8.55,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,UHC MGG,UHC MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,VA,VA,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Wellcare MGG,Wellcare MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Bright Health - commercial,Bright Health - commercial,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.55,8.55,Bright Health MGG,Bright Health MGG,8.55,,,,,,,case rate,8.55,8.55,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Aetna,Aetna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Aetna MGG,Aetna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,BCBS,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS MGG,BCBS MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Cigna,Cigna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Cigna MGG,Cigna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Humana,Humana,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Humana MGG,Humana MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Optum VA,Optum VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UHC,UHC,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UHC MGG,UHC MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA,VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Wellcare MGG,Wellcare MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Bright Health - commercial,Bright Health - commercial,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Bright Health MGG,Bright Health MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Aetna,Aetna,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Aetna MGG,Aetna MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,BCBS,BCBS,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,BCBS MGG,BCBS MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Cigna,Cigna,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Cigna MGG,Cigna MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Humana,Humana,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Humana MGG,Humana MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Optum VA,Optum VA,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,UHC,UHC,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,UHC MGG,UHC MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,VA,VA,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Wellcare MGG,Wellcare MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Bright Health - commercial,Bright Health - commercial,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Bright Health MGG,Bright Health MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Aetna,Aetna,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Aetna MGG,Aetna MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,BCBS,BCBS,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,BCBS MGG,BCBS MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Cigna,Cigna,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Cigna MGG,Cigna MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Humana,Humana,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Humana MGG,Humana MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Optum VA,Optum VA,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,UHC,UHC,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,UHC MGG,UHC MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,VA,VA,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Wellcare MGG,Wellcare MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Bright Health - commercial,Bright Health - commercial,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Bright Health MGG,Bright Health MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Aetna,Aetna,42.69,,,,,,,per diem,42.69,42.69,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Aetna MGG,Aetna MGG,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,BCBS,BCBS,42.69,,,,,,,per diem,42.69,42.69,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,BCBS MGG,BCBS MGG,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Cigna,Cigna,42.69,,,,,,,per diem,42.69,42.69,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Cigna MGG,Cigna MGG,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Humana,Humana,42.69,,,,,,,per diem,42.69,42.69,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Humana MGG,Humana MGG,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Optum VA,Optum VA,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,UHC,UHC,42.69,,,,,,,per diem,42.69,42.69,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,UHC MGG,UHC MGG,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,VA,VA,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Wellcare MGG,Wellcare MGG,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Bright Health - commercial,Bright Health - commercial,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,42.69,42.69,Bright Health MGG,Bright Health MGG,42.69,,,,,,,case rate,42.69,42.69,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna,Aetna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna MGG,Aetna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS,BCBS,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS MGG,BCBS MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna,Cigna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna MGG,Cigna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana,Humana,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana MGG,Humana MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Optum VA,Optum VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC,UHC,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC MGG,UHC MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,VA,VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Wellcare MGG,Wellcare MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health - commercial,Bright Health - commercial,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health MGG,Bright Health MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna,Aetna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna MGG,Aetna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,BCBS,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS MGG,BCBS MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna,Cigna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna MGG,Cigna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana,Humana,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana MGG,Humana MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Optum VA,Optum VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC,UHC,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC MGG,UHC MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,VA,VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Wellcare MGG,Wellcare MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health - commercial,Bright Health - commercial,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health MGG,Bright Health MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Aetna,Aetna,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Aetna MGG,Aetna MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,BCBS,BCBS,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,BCBS MGG,BCBS MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Cigna,Cigna,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Cigna MGG,Cigna MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Humana,Humana,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Humana MGG,Humana MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Optum VA,Optum VA,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,UHC,UHC,11.7,,,,,,,per diem,11.7,11.7,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,UHC MGG,UHC MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,VA,VA,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Wellcare MGG,Wellcare MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Bright Health - commercial,Bright Health - commercial,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,11.7,11.7,Bright Health MGG,Bright Health MGG,11.7,,,,,,,case rate,11.7,11.7,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Aetna,Aetna,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Aetna MGG,Aetna MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,BCBS,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS MGG,BCBS MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Cigna,Cigna,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Cigna MGG,Cigna MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Humana,Humana,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Humana MGG,Humana MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Optum VA,Optum VA,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,UHC,UHC,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,UHC MGG,UHC MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,VA,VA,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Wellcare MGG,Wellcare MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Bright Health - commercial,Bright Health - commercial,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,Bright Health MGG,Bright Health MGG,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Aetna,Aetna,223.83,,,,,,,per diem,223.83,223.83,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Aetna MGG,Aetna MGG,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,BCBS,BCBS,223.83,,,,,,,per diem,223.83,223.83,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,BCBS MGG,BCBS MGG,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Cigna,Cigna,223.83,,,,,,,per diem,223.83,223.83,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Cigna MGG,Cigna MGG,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Humana,Humana,223.83,,,,,,,per diem,223.83,223.83,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Humana MGG,Humana MGG,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Optum VA,Optum VA,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,UHC,UHC,223.83,,,,,,,per diem,223.83,223.83,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,UHC MGG,UHC MGG,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,VA,VA,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Wellcare MGG,Wellcare MGG,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Bright Health - commercial,Bright Health - commercial,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,223.83,223.83,Bright Health MGG,Bright Health MGG,223.83,,,,,,,case rate,223.83,223.83,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Aetna,Aetna,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Aetna MGG,Aetna MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,BCBS,BCBS,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,BCBS MGG,BCBS MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Cigna,Cigna,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Cigna MGG,Cigna MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Humana,Humana,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Humana MGG,Humana MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Optum VA,Optum VA,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,UHC,UHC,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,UHC MGG,UHC MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,VA,VA,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Wellcare MGG,Wellcare MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Bright Health - commercial,Bright Health - commercial,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Bright Health MGG,Bright Health MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Aetna,Aetna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Aetna MGG,Aetna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,BCBS,BCBS,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,BCBS MGG,BCBS MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Cigna,Cigna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Cigna MGG,Cigna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Humana,Humana,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Humana MGG,Humana MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Optum VA,Optum VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,UHC,UHC,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,UHC MGG,UHC MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,VA,VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Wellcare MGG,Wellcare MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Bright Health - commercial,Bright Health - commercial,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Bright Health MGG,Bright Health MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Aetna,Aetna,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Aetna MGG,Aetna MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,BCBS,BCBS,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,BCBS MGG,BCBS MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Cigna,Cigna,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Cigna MGG,Cigna MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Humana,Humana,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Humana MGG,Humana MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Optum VA,Optum VA,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,UHC,UHC,33.12,,,,,,,per diem,33.12,33.12,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,UHC MGG,UHC MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,VA,VA,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Wellcare MGG,Wellcare MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Bright Health - commercial,Bright Health - commercial,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,33.12,33.12,Bright Health MGG,Bright Health MGG,33.12,,,,,,,case rate,33.12,33.12,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Aetna,Aetna,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Aetna MGG,Aetna MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,BCBS,BCBS,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,BCBS MGG,BCBS MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Cigna,Cigna,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Cigna MGG,Cigna MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Humana,Humana,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Humana MGG,Humana MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Optum VA,Optum VA,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,UHC,UHC,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,UHC MGG,UHC MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,VA,VA,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Wellcare MGG,Wellcare MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Bright Health - commercial,Bright Health - commercial,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Bright Health MGG,Bright Health MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Aetna,Aetna,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Aetna MGG,Aetna MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,BCBS,BCBS,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,BCBS MGG,BCBS MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Cigna,Cigna,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Cigna MGG,Cigna MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Humana,Humana,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Humana MGG,Humana MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Optum VA,Optum VA,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,UHC,UHC,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,UHC MGG,UHC MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,VA,VA,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Wellcare MGG,Wellcare MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Bright Health - commercial,Bright Health - commercial,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Bright Health MGG,Bright Health MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Aetna,Aetna,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Aetna MGG,Aetna MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,BCBS,BCBS,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,BCBS MGG,BCBS MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Cigna,Cigna,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Cigna MGG,Cigna MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Humana,Humana,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Humana MGG,Humana MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Optum VA,Optum VA,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,UHC,UHC,12.9,,,,,,,per diem,12.9,12.9,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,UHC MGG,UHC MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,VA,VA,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Wellcare MGG,Wellcare MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Bright Health - commercial,Bright Health - commercial,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,12.9,12.9,Bright Health MGG,Bright Health MGG,12.9,,,,,,,case rate,12.9,12.9,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Aetna,Aetna,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Aetna MGG,Aetna MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,BCBS,BCBS,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,BCBS MGG,BCBS MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Cigna,Cigna,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Cigna MGG,Cigna MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Humana,Humana,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Humana MGG,Humana MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Optum VA,Optum VA,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,UHC,UHC,102,,,,,,,per diem,102,102,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,UHC MGG,UHC MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,VA,VA,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Wellcare MGG,Wellcare MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Bright Health - commercial,Bright Health - commercial,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,102,102,Bright Health MGG,Bright Health MGG,102,,,,,,,case rate,102,102,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Aetna,Aetna,720,,,,,,,per diem,720,720,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Aetna MGG,Aetna MGG,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,BCBS,BCBS,720,,,,,,,per diem,720,720,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,BCBS MGG,BCBS MGG,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Cigna,Cigna,720,,,,,,,per diem,720,720,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Cigna MGG,Cigna MGG,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Humana,Humana,720,,,,,,,per diem,720,720,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Humana MGG,Humana MGG,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Optum VA,Optum VA,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,UHC,UHC,720,,,,,,,per diem,720,720,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,UHC MGG,UHC MGG,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,VA,VA,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Wellcare MGG,Wellcare MGG,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Bright Health - commercial,Bright Health - commercial,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,720,720,Bright Health MGG,Bright Health MGG,720,,,,,,,case rate,720,720,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna,Aetna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna MGG,Aetna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS,BCBS,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS MGG,BCBS MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna,Cigna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna MGG,Cigna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana,Humana,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana MGG,Humana MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Optum VA,Optum VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC,UHC,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC MGG,UHC MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,VA,VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Wellcare MGG,Wellcare MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health - commercial,Bright Health - commercial,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health MGG,Bright Health MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Aetna,Aetna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Aetna MGG,Aetna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,BCBS,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS MGG,BCBS MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Cigna,Cigna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Cigna MGG,Cigna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Humana,Humana,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Humana MGG,Humana MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Optum VA,Optum VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UHC,UHC,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UHC MGG,UHC MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,VA,VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Wellcare MGG,Wellcare MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Bright Health - commercial,Bright Health - commercial,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Bright Health MGG,Bright Health MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Aetna,Aetna,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Aetna MGG,Aetna MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,BCBS,BCBS,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,BCBS MGG,BCBS MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Cigna,Cigna,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Cigna MGG,Cigna MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Humana,Humana,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Humana MGG,Humana MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Optum VA,Optum VA,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,UHC,UHC,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,UHC MGG,UHC MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,VA,VA,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Wellcare MGG,Wellcare MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Bright Health - commercial,Bright Health - commercial,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Bright Health MGG,Bright Health MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Aetna,Aetna,21.54,,,,,,,per diem,21.54,21.54,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Aetna MGG,Aetna MGG,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,BCBS,BCBS,21.54,,,,,,,per diem,21.54,21.54,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,BCBS MGG,BCBS MGG,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Cigna,Cigna,21.54,,,,,,,per diem,21.54,21.54,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Cigna MGG,Cigna MGG,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Humana,Humana,21.54,,,,,,,per diem,21.54,21.54,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Humana MGG,Humana MGG,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Optum VA,Optum VA,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,UHC,UHC,21.54,,,,,,,per diem,21.54,21.54,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,UHC MGG,UHC MGG,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,VA,VA,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Wellcare MGG,Wellcare MGG,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Bright Health - commercial,Bright Health - commercial,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,21.54,21.54,Bright Health MGG,Bright Health MGG,21.54,,,,,,,case rate,21.54,21.54,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Aetna,Aetna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Aetna MGG,Aetna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,BCBS,BCBS,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,BCBS MGG,BCBS MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Cigna,Cigna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Cigna MGG,Cigna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Humana,Humana,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Humana MGG,Humana MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Optum VA,Optum VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,UHC,UHC,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,UHC MGG,UHC MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,VA,VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Wellcare MGG,Wellcare MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Bright Health - commercial,Bright Health - commercial,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Bright Health MGG,Bright Health MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Aetna,Aetna,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Aetna MGG,Aetna MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,BCBS,BCBS,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,BCBS MGG,BCBS MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Cigna,Cigna,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Cigna MGG,Cigna MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Humana,Humana,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Humana MGG,Humana MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Optum VA,Optum VA,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,UHC,UHC,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,UHC MGG,UHC MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,VA,VA,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Wellcare MGG,Wellcare MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Bright Health - commercial,Bright Health - commercial,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Bright Health MGG,Bright Health MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Aetna,Aetna,107.73,,,,,,,per diem,107.73,107.73,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Aetna MGG,Aetna MGG,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,BCBS,BCBS,107.73,,,,,,,per diem,107.73,107.73,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,BCBS MGG,BCBS MGG,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Cigna,Cigna,107.73,,,,,,,per diem,107.73,107.73,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Cigna MGG,Cigna MGG,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Humana,Humana,107.73,,,,,,,per diem,107.73,107.73,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Humana MGG,Humana MGG,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Optum VA,Optum VA,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,UHC,UHC,107.73,,,,,,,per diem,107.73,107.73,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,UHC MGG,UHC MGG,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,VA,VA,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Wellcare MGG,Wellcare MGG,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Bright Health - commercial,Bright Health - commercial,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,107.73,107.73,Bright Health MGG,Bright Health MGG,107.73,,,,,,,case rate,107.73,107.73,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Aetna,Aetna,24.69,,,,,,,per diem,24.69,24.69,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Aetna MGG,Aetna MGG,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,BCBS,BCBS,24.69,,,,,,,per diem,24.69,24.69,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,BCBS MGG,BCBS MGG,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Cigna,Cigna,24.69,,,,,,,per diem,24.69,24.69,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Cigna MGG,Cigna MGG,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Humana,Humana,24.69,,,,,,,per diem,24.69,24.69,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Humana MGG,Humana MGG,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Optum VA,Optum VA,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,UHC,UHC,24.69,,,,,,,per diem,24.69,24.69,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,UHC MGG,UHC MGG,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,VA,VA,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Wellcare MGG,Wellcare MGG,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Bright Health - commercial,Bright Health - commercial,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,24.69,24.69,Bright Health MGG,Bright Health MGG,24.69,,,,,,,case rate,24.69,24.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Aetna,Aetna,458.79,,,,,,,per diem,458.79,458.79,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Aetna MGG,Aetna MGG,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,BCBS,BCBS,458.79,,,,,,,per diem,458.79,458.79,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,BCBS MGG,BCBS MGG,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Cigna,Cigna,458.79,,,,,,,per diem,458.79,458.79,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Cigna MGG,Cigna MGG,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Humana,Humana,458.79,,,,,,,per diem,458.79,458.79,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Humana MGG,Humana MGG,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Optum VA,Optum VA,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,UHC,UHC,458.79,,,,,,,per diem,458.79,458.79,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,UHC MGG,UHC MGG,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,VA,VA,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Wellcare MGG,Wellcare MGG,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Bright Health - commercial,Bright Health - commercial,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,458.79,458.79,Bright Health MGG,Bright Health MGG,458.79,,,,,,,case rate,458.79,458.79,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Aetna,Aetna,771.69,,,,,,,per diem,771.69,771.69,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Aetna MGG,Aetna MGG,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,BCBS,BCBS,771.69,,,,,,,per diem,771.69,771.69,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,BCBS MGG,BCBS MGG,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Cigna,Cigna,771.69,,,,,,,per diem,771.69,771.69,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Cigna MGG,Cigna MGG,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Humana,Humana,771.69,,,,,,,per diem,771.69,771.69,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Humana MGG,Humana MGG,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Optum VA,Optum VA,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,UHC,UHC,771.69,,,,,,,per diem,771.69,771.69,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,UHC MGG,UHC MGG,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,VA,VA,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Wellcare MGG,Wellcare MGG,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Bright Health - commercial,Bright Health - commercial,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,771.69,771.69,Bright Health MGG,Bright Health MGG,771.69,,,,,,,case rate,771.69,771.69,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Aetna,Aetna,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Aetna MGG,Aetna MGG,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,BCBS,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS MGG,BCBS MGG,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Cigna,Cigna,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Cigna MGG,Cigna MGG,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Humana,Humana,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Humana MGG,Humana MGG,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Optum VA,Optum VA,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,UHC,UHC,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,UHC MGG,UHC MGG,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,VA,VA,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Wellcare MGG,Wellcare MGG,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Bright Health - commercial,Bright Health - commercial,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,Bright Health MGG,Bright Health MGG,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna,Aetna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna MGG,Aetna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,BCBS,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS MGG,BCBS MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna,Cigna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna MGG,Cigna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana,Humana,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana MGG,Humana MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Optum VA,Optum VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC,UHC,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC MGG,UHC MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,VA,VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Wellcare MGG,Wellcare MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health - commercial,Bright Health - commercial,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health MGG,Bright Health MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna,Aetna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna MGG,Aetna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS,BCBS,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS MGG,BCBS MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna,Cigna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna MGG,Cigna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana,Humana,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana MGG,Humana MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Optum VA,Optum VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC,UHC,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC MGG,UHC MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,VA,VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Wellcare MGG,Wellcare MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health - commercial,Bright Health - commercial,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health MGG,Bright Health MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Aetna,Aetna,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Aetna MGG,Aetna MGG,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,BCBS,BCBS,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,BCBS MGG,BCBS MGG,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Cigna,Cigna,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Cigna MGG,Cigna MGG,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Humana,Humana,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Humana MGG,Humana MGG,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Optum VA,Optum VA,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,UHC,UHC,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,UHC MGG,UHC MGG,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,VA,VA,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Wellcare MGG,Wellcare MGG,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Bright Health - commercial,Bright Health - commercial,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,Bright Health MGG,Bright Health MGG,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Aetna,Aetna,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Aetna MGG,Aetna MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,BCBS,BCBS,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,BCBS MGG,BCBS MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Cigna,Cigna,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Cigna MGG,Cigna MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Humana,Humana,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Humana MGG,Humana MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Optum VA,Optum VA,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,UHC,UHC,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,UHC MGG,UHC MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,VA,VA,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Wellcare MGG,Wellcare MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Bright Health - commercial,Bright Health - commercial,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Bright Health MGG,Bright Health MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Aetna,Aetna,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Aetna MGG,Aetna MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,BCBS,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS MGG,BCBS MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Cigna,Cigna,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Cigna MGG,Cigna MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Humana,Humana,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Humana MGG,Humana MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Optum VA,Optum VA,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UHC,UHC,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UHC MGG,UHC MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,VA,VA,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Wellcare MGG,Wellcare MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Bright Health - commercial,Bright Health - commercial,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Bright Health MGG,Bright Health MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Aetna,Aetna,164.97,,,,,,,per diem,164.97,164.97,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Aetna MGG,Aetna MGG,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,BCBS,BCBS,164.97,,,,,,,per diem,164.97,164.97,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,BCBS MGG,BCBS MGG,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Cigna,Cigna,164.97,,,,,,,per diem,164.97,164.97,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Cigna MGG,Cigna MGG,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Humana,Humana,164.97,,,,,,,per diem,164.97,164.97,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Humana MGG,Humana MGG,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Optum VA,Optum VA,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,UHC,UHC,164.97,,,,,,,per diem,164.97,164.97,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,UHC MGG,UHC MGG,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,VA,VA,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Wellcare MGG,Wellcare MGG,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Bright Health - commercial,Bright Health - commercial,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,164.97,164.97,Bright Health MGG,Bright Health MGG,164.97,,,,,,,case rate,164.97,164.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Aetna,Aetna,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Aetna MGG,Aetna MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,BCBS,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS MGG,BCBS MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Cigna,Cigna,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Cigna MGG,Cigna MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Humana,Humana,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Humana MGG,Humana MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Optum VA,Optum VA,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UHC,UHC,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UHC MGG,UHC MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,VA,VA,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Wellcare MGG,Wellcare MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Bright Health - commercial,Bright Health - commercial,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Bright Health MGG,Bright Health MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Aetna,Aetna,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Aetna MGG,Aetna MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,BCBS,BCBS,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,BCBS MGG,BCBS MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Cigna,Cigna,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Cigna MGG,Cigna MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Humana,Humana,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Humana MGG,Humana MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Optum VA,Optum VA,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,UHC,UHC,489.12,,,,,,,per diem,489.12,489.12,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,UHC MGG,UHC MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,VA,VA,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Wellcare MGG,Wellcare MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Bright Health - commercial,Bright Health - commercial,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,489.12,489.12,Bright Health MGG,Bright Health MGG,489.12,,,,,,,case rate,489.12,489.12,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Aetna,Aetna,4626,,,,,,,per diem,4626,4626,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Aetna MGG,Aetna MGG,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,BCBS,BCBS,4626,,,,,,,per diem,4626,4626,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,BCBS MGG,BCBS MGG,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Cigna,Cigna,4626,,,,,,,per diem,4626,4626,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Cigna MGG,Cigna MGG,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Humana,Humana,4626,,,,,,,per diem,4626,4626,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Humana MGG,Humana MGG,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Optum VA,Optum VA,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,UHC,UHC,4626,,,,,,,per diem,4626,4626,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,UHC MGG,UHC MGG,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,VA,VA,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Wellcare MGG,Wellcare MGG,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Bright Health - commercial,Bright Health - commercial,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4626,4626,Bright Health MGG,Bright Health MGG,4626,,,,,,,case rate,4626,4626,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Aetna,Aetna,35.49,,,,,,,per diem,35.49,35.49,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Aetna MGG,Aetna MGG,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,BCBS,BCBS,35.49,,,,,,,per diem,35.49,35.49,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,BCBS MGG,BCBS MGG,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Cigna,Cigna,35.49,,,,,,,per diem,35.49,35.49,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Cigna MGG,Cigna MGG,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Humana,Humana,35.49,,,,,,,per diem,35.49,35.49,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Humana MGG,Humana MGG,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Optum VA,Optum VA,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,UHC,UHC,35.49,,,,,,,per diem,35.49,35.49,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,UHC MGG,UHC MGG,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,VA,VA,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Wellcare MGG,Wellcare MGG,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Bright Health - commercial,Bright Health - commercial,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,35.49,35.49,Bright Health MGG,Bright Health MGG,35.49,,,,,,,case rate,35.49,35.49,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Aetna,Aetna,305.85,,,,,,,per diem,305.85,305.85,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Aetna MGG,Aetna MGG,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,BCBS,BCBS,305.85,,,,,,,per diem,305.85,305.85,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,BCBS MGG,BCBS MGG,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Cigna,Cigna,305.85,,,,,,,per diem,305.85,305.85,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Cigna MGG,Cigna MGG,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Humana,Humana,305.85,,,,,,,per diem,305.85,305.85,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Humana MGG,Humana MGG,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Optum VA,Optum VA,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,UHC,UHC,305.85,,,,,,,per diem,305.85,305.85,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,UHC MGG,UHC MGG,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,VA,VA,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Wellcare MGG,Wellcare MGG,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Bright Health - commercial,Bright Health - commercial,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,305.85,305.85,Bright Health MGG,Bright Health MGG,305.85,,,,,,,case rate,305.85,305.85,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Aetna,Aetna,123.57,,,,,,,per diem,123.57,123.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Aetna MGG,Aetna MGG,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,BCBS,BCBS,123.57,,,,,,,per diem,123.57,123.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,BCBS MGG,BCBS MGG,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Cigna,Cigna,123.57,,,,,,,per diem,123.57,123.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Cigna MGG,Cigna MGG,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Humana,Humana,123.57,,,,,,,per diem,123.57,123.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Humana MGG,Humana MGG,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Optum VA,Optum VA,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,UHC,UHC,123.57,,,,,,,per diem,123.57,123.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,UHC MGG,UHC MGG,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,VA,VA,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Wellcare MGG,Wellcare MGG,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Bright Health - commercial,Bright Health - commercial,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,123.57,123.57,Bright Health MGG,Bright Health MGG,123.57,,,,,,,case rate,123.57,123.57,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Aetna,Aetna,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Aetna MGG,Aetna MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,BCBS,BCBS,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,BCBS MGG,BCBS MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Cigna,Cigna,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Cigna MGG,Cigna MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Humana,Humana,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Humana MGG,Humana MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Optum VA,Optum VA,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,UHC,UHC,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,UHC MGG,UHC MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,VA,VA,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Wellcare MGG,Wellcare MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Bright Health - commercial,Bright Health - commercial,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Bright Health MGG,Bright Health MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Aetna,Aetna,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Aetna MGG,Aetna MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,BCBS,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS MGG,BCBS MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Cigna,Cigna,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Cigna MGG,Cigna MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Humana,Humana,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Humana MGG,Humana MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Optum VA,Optum VA,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,UHC,UHC,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,UHC MGG,UHC MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,VA,VA,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Wellcare MGG,Wellcare MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Bright Health - commercial,Bright Health - commercial,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,Bright Health MGG,Bright Health MGG,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Aetna,Aetna,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Aetna MGG,Aetna MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,BCBS,BCBS,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,BCBS MGG,BCBS MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Cigna,Cigna,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Cigna MGG,Cigna MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Humana,Humana,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Humana MGG,Humana MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Optum VA,Optum VA,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,UHC,UHC,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,UHC MGG,UHC MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,VA,VA,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Wellcare MGG,Wellcare MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Bright Health - commercial,Bright Health - commercial,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Bright Health MGG,Bright Health MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Aetna,Aetna,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Aetna MGG,Aetna MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,BCBS,BCBS,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,BCBS MGG,BCBS MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Cigna,Cigna,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Cigna MGG,Cigna MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Humana,Humana,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Humana MGG,Humana MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Optum VA,Optum VA,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,UHC,UHC,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,UHC MGG,UHC MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,VA,VA,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Wellcare MGG,Wellcare MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Bright Health - commercial,Bright Health - commercial,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Bright Health MGG,Bright Health MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Aetna,Aetna,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Aetna MGG,Aetna MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,BCBS,BCBS,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,BCBS MGG,BCBS MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Cigna,Cigna,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Cigna MGG,Cigna MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Humana,Humana,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Humana MGG,Humana MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Optum VA,Optum VA,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,UHC,UHC,142.2,,,,,,,per diem,142.2,142.2,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,UHC MGG,UHC MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,VA,VA,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Wellcare MGG,Wellcare MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Bright Health - commercial,Bright Health - commercial,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,142.2,142.2,Bright Health MGG,Bright Health MGG,142.2,,,,,,,case rate,142.2,142.2,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Aetna,Aetna,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Aetna MGG,Aetna MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,BCBS,BCBS,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,BCBS MGG,BCBS MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Cigna,Cigna,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Cigna MGG,Cigna MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Humana,Humana,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Humana MGG,Humana MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Optum VA,Optum VA,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,UHC,UHC,18.24,,,,,,,per diem,18.24,18.24,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,UHC MGG,UHC MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,VA,VA,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Wellcare MGG,Wellcare MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Bright Health - commercial,Bright Health - commercial,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,18.24,18.24,Bright Health MGG,Bright Health MGG,18.24,,,,,,,case rate,18.24,18.24,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Aetna,Aetna,116.28,,,,,,,per diem,116.28,116.28,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Aetna MGG,Aetna MGG,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,BCBS,BCBS,116.28,,,,,,,per diem,116.28,116.28,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,BCBS MGG,BCBS MGG,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Cigna,Cigna,116.28,,,,,,,per diem,116.28,116.28,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Cigna MGG,Cigna MGG,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Humana,Humana,116.28,,,,,,,per diem,116.28,116.28,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Humana MGG,Humana MGG,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Optum VA,Optum VA,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,UHC,UHC,116.28,,,,,,,per diem,116.28,116.28,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,UHC MGG,UHC MGG,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,VA,VA,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Wellcare MGG,Wellcare MGG,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Bright Health - commercial,Bright Health - commercial,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,116.28,116.28,Bright Health MGG,Bright Health MGG,116.28,,,,,,,case rate,116.28,116.28,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Aetna,Aetna,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Aetna MGG,Aetna MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,BCBS,BCBS,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,BCBS MGG,BCBS MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Cigna,Cigna,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Cigna MGG,Cigna MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Humana,Humana,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Humana MGG,Humana MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Optum VA,Optum VA,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,UHC,UHC,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,UHC MGG,UHC MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,VA,VA,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Wellcare MGG,Wellcare MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Bright Health - commercial,Bright Health - commercial,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Bright Health MGG,Bright Health MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Aetna,Aetna,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Aetna MGG,Aetna MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,BCBS,BCBS,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,BCBS MGG,BCBS MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Cigna,Cigna,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Cigna MGG,Cigna MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Humana,Humana,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Humana MGG,Humana MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Optum VA,Optum VA,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,UHC,UHC,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,UHC MGG,UHC MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,VA,VA,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Wellcare MGG,Wellcare MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Bright Health - commercial,Bright Health - commercial,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Bright Health MGG,Bright Health MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Aetna,Aetna,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Aetna MGG,Aetna MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,BCBS,BCBS,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,BCBS MGG,BCBS MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Cigna,Cigna,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Cigna MGG,Cigna MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Humana,Humana,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Humana MGG,Humana MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Optum VA,Optum VA,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,UHC,UHC,273.3,,,,,,,per diem,273.3,273.3,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,UHC MGG,UHC MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,VA,VA,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Wellcare MGG,Wellcare MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Bright Health - commercial,Bright Health - commercial,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,273.3,273.3,Bright Health MGG,Bright Health MGG,273.3,,,,,,,case rate,273.3,273.3,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Aetna,Aetna,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Aetna MGG,Aetna MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,BCBS,BCBS,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,BCBS MGG,BCBS MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Cigna,Cigna,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Cigna MGG,Cigna MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Humana,Humana,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Humana MGG,Humana MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Optum VA,Optum VA,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,UHC,UHC,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,UHC MGG,UHC MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,VA,VA,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Wellcare MGG,Wellcare MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Bright Health - commercial,Bright Health - commercial,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Bright Health MGG,Bright Health MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Aetna,Aetna,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Aetna MGG,Aetna MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,BCBS,BCBS,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,BCBS MGG,BCBS MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Cigna,Cigna,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Cigna MGG,Cigna MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Humana,Humana,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Humana MGG,Humana MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Optum VA,Optum VA,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,UHC,UHC,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,UHC MGG,UHC MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,VA,VA,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Wellcare MGG,Wellcare MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Bright Health - commercial,Bright Health - commercial,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Bright Health MGG,Bright Health MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Aetna,Aetna,9.96,,,,,,,per diem,9.96,9.96,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Aetna MGG,Aetna MGG,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,BCBS,BCBS,9.96,,,,,,,per diem,9.96,9.96,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,BCBS MGG,BCBS MGG,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Cigna,Cigna,9.96,,,,,,,per diem,9.96,9.96,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Cigna MGG,Cigna MGG,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Humana,Humana,9.96,,,,,,,per diem,9.96,9.96,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Humana MGG,Humana MGG,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Optum VA,Optum VA,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,UHC,UHC,9.96,,,,,,,per diem,9.96,9.96,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,UHC MGG,UHC MGG,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,VA,VA,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Wellcare MGG,Wellcare MGG,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Bright Health - commercial,Bright Health - commercial,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,9.96,9.96,Bright Health MGG,Bright Health MGG,9.96,,,,,,,case rate,9.96,9.96,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Aetna,Aetna,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Aetna MGG,Aetna MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,BCBS,BCBS,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,BCBS MGG,BCBS MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Cigna,Cigna,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Cigna MGG,Cigna MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Humana,Humana,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Humana MGG,Humana MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Optum VA,Optum VA,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,UHC,UHC,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,UHC MGG,UHC MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,VA,VA,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Wellcare MGG,Wellcare MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Bright Health - commercial,Bright Health - commercial,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,5.79,5.79,Bright Health MGG,Bright Health MGG,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Aetna,Aetna,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Aetna MGG,Aetna MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,BCBS,BCBS,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,BCBS MGG,BCBS MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Cigna,Cigna,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Cigna MGG,Cigna MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Humana,Humana,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Humana MGG,Humana MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Optum VA,Optum VA,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,UHC,UHC,72.45,,,,,,,per diem,72.45,72.45,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,UHC MGG,UHC MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,VA,VA,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Wellcare MGG,Wellcare MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Bright Health - commercial,Bright Health - commercial,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,72.45,72.45,Bright Health MGG,Bright Health MGG,72.45,,,,,,,case rate,72.45,72.45,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Aetna,Aetna,207.69,,,,,,,per diem,207.69,207.69,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Aetna MGG,Aetna MGG,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,BCBS,BCBS,207.69,,,,,,,per diem,207.69,207.69,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,BCBS MGG,BCBS MGG,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Cigna,Cigna,207.69,,,,,,,per diem,207.69,207.69,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Cigna MGG,Cigna MGG,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Humana,Humana,207.69,,,,,,,per diem,207.69,207.69,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Humana MGG,Humana MGG,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Optum VA,Optum VA,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,UHC,UHC,207.69,,,,,,,per diem,207.69,207.69,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,UHC MGG,UHC MGG,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,VA,VA,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Wellcare MGG,Wellcare MGG,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Bright Health - commercial,Bright Health - commercial,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,207.69,207.69,Bright Health MGG,Bright Health MGG,207.69,,,,,,,case rate,207.69,207.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Aetna,Aetna,687.6,,,,,,,per diem,687.6,687.6,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Aetna MGG,Aetna MGG,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,BCBS,BCBS,687.6,,,,,,,per diem,687.6,687.6,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,BCBS MGG,BCBS MGG,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Cigna,Cigna,687.6,,,,,,,per diem,687.6,687.6,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Cigna MGG,Cigna MGG,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Humana,Humana,687.6,,,,,,,per diem,687.6,687.6,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Humana MGG,Humana MGG,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Optum VA,Optum VA,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,UHC,UHC,687.6,,,,,,,per diem,687.6,687.6,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,UHC MGG,UHC MGG,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,VA,VA,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Wellcare MGG,Wellcare MGG,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Bright Health - commercial,Bright Health - commercial,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,687.6,687.6,Bright Health MGG,Bright Health MGG,687.6,,,,,,,case rate,687.6,687.6,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Aetna,Aetna,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Aetna MGG,Aetna MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,BCBS,BCBS,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,BCBS MGG,BCBS MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Cigna,Cigna,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Cigna MGG,Cigna MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Humana,Humana,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Humana MGG,Humana MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Optum VA,Optum VA,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,UHC,UHC,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,UHC MGG,UHC MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,VA,VA,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Wellcare MGG,Wellcare MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Bright Health - commercial,Bright Health - commercial,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Bright Health MGG,Bright Health MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Aetna,Aetna,20.4,,,,,,,per diem,20.4,20.4,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Aetna MGG,Aetna MGG,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,BCBS,BCBS,20.4,,,,,,,per diem,20.4,20.4,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,BCBS MGG,BCBS MGG,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Cigna,Cigna,20.4,,,,,,,per diem,20.4,20.4,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Cigna MGG,Cigna MGG,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Humana,Humana,20.4,,,,,,,per diem,20.4,20.4,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Humana MGG,Humana MGG,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Optum VA,Optum VA,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,UHC,UHC,20.4,,,,,,,per diem,20.4,20.4,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,UHC MGG,UHC MGG,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,VA,VA,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Wellcare MGG,Wellcare MGG,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Bright Health - commercial,Bright Health - commercial,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,20.4,20.4,Bright Health MGG,Bright Health MGG,20.4,,,,,,,case rate,20.4,20.4,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Aetna,Aetna,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Aetna MGG,Aetna MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,BCBS,BCBS,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,BCBS MGG,BCBS MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Cigna,Cigna,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Cigna MGG,Cigna MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Humana,Humana,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Humana MGG,Humana MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Optum VA,Optum VA,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,UHC,UHC,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,UHC MGG,UHC MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,VA,VA,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Wellcare MGG,Wellcare MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Bright Health - commercial,Bright Health - commercial,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Bright Health MGG,Bright Health MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Aetna,Aetna,478.53,,,,,,,per diem,478.53,478.53,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Aetna MGG,Aetna MGG,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,BCBS,BCBS,478.53,,,,,,,per diem,478.53,478.53,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,BCBS MGG,BCBS MGG,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Cigna,Cigna,478.53,,,,,,,per diem,478.53,478.53,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Cigna MGG,Cigna MGG,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Humana,Humana,478.53,,,,,,,per diem,478.53,478.53,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Humana MGG,Humana MGG,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Optum VA,Optum VA,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,UHC,UHC,478.53,,,,,,,per diem,478.53,478.53,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,UHC MGG,UHC MGG,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,VA,VA,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Wellcare MGG,Wellcare MGG,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Bright Health - commercial,Bright Health - commercial,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,478.53,478.53,Bright Health MGG,Bright Health MGG,478.53,,,,,,,case rate,478.53,478.53,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Aetna,Aetna,922.74,,,,,,,per diem,922.74,922.74,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Aetna MGG,Aetna MGG,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,BCBS,BCBS,922.74,,,,,,,per diem,922.74,922.74,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,BCBS MGG,BCBS MGG,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Cigna,Cigna,922.74,,,,,,,per diem,922.74,922.74,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Cigna MGG,Cigna MGG,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Humana,Humana,922.74,,,,,,,per diem,922.74,922.74,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Humana MGG,Humana MGG,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Optum VA,Optum VA,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,UHC,UHC,922.74,,,,,,,per diem,922.74,922.74,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,UHC MGG,UHC MGG,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,VA,VA,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Wellcare MGG,Wellcare MGG,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Bright Health - commercial,Bright Health - commercial,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,922.74,922.74,Bright Health MGG,Bright Health MGG,922.74,,,,,,,case rate,922.74,922.74,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna,Aetna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna MGG,Aetna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS,BCBS,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS MGG,BCBS MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna,Cigna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna MGG,Cigna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana,Humana,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana MGG,Humana MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Optum VA,Optum VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC,UHC,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC MGG,UHC MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,VA,VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Wellcare MGG,Wellcare MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health - commercial,Bright Health - commercial,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health MGG,Bright Health MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Aetna,Aetna,528.69,,,,,,,per diem,528.69,528.69,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Aetna MGG,Aetna MGG,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,BCBS,BCBS,528.69,,,,,,,per diem,528.69,528.69,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,BCBS MGG,BCBS MGG,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Cigna,Cigna,528.69,,,,,,,per diem,528.69,528.69,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Cigna MGG,Cigna MGG,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Humana,Humana,528.69,,,,,,,per diem,528.69,528.69,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Humana MGG,Humana MGG,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Optum VA,Optum VA,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,UHC,UHC,528.69,,,,,,,per diem,528.69,528.69,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,UHC MGG,UHC MGG,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,VA,VA,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Wellcare MGG,Wellcare MGG,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Bright Health - commercial,Bright Health - commercial,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,528.69,528.69,Bright Health MGG,Bright Health MGG,528.69,,,,,,,case rate,528.69,528.69,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Aetna,Aetna,74.85,,,,,,,per diem,74.85,74.85,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Aetna MGG,Aetna MGG,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,BCBS,BCBS,74.85,,,,,,,per diem,74.85,74.85,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,BCBS MGG,BCBS MGG,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Cigna,Cigna,74.85,,,,,,,per diem,74.85,74.85,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Cigna MGG,Cigna MGG,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Humana,Humana,74.85,,,,,,,per diem,74.85,74.85,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Humana MGG,Humana MGG,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Optum VA,Optum VA,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,UHC,UHC,74.85,,,,,,,per diem,74.85,74.85,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,UHC MGG,UHC MGG,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,VA,VA,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Wellcare MGG,Wellcare MGG,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Bright Health - commercial,Bright Health - commercial,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,74.85,74.85,Bright Health MGG,Bright Health MGG,74.85,,,,,,,case rate,74.85,74.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Aetna,Aetna,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Aetna MGG,Aetna MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,BCBS,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS MGG,BCBS MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Cigna,Cigna,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Cigna MGG,Cigna MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Humana,Humana,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Humana MGG,Humana MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Optum VA,Optum VA,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UHC,UHC,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UHC MGG,UHC MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,VA,VA,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Wellcare MGG,Wellcare MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Bright Health - commercial,Bright Health - commercial,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,Bright Health MGG,Bright Health MGG,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Aetna,Aetna,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Aetna MGG,Aetna MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,BCBS,BCBS,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,BCBS MGG,BCBS MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Cigna,Cigna,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Cigna MGG,Cigna MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Humana,Humana,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Humana MGG,Humana MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Optum VA,Optum VA,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,UHC,UHC,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,UHC MGG,UHC MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,VA,VA,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Wellcare MGG,Wellcare MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Bright Health - commercial,Bright Health - commercial,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Bright Health MGG,Bright Health MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Aetna,Aetna,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Aetna MGG,Aetna MGG,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,BCBS,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS MGG,BCBS MGG,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Cigna,Cigna,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Cigna MGG,Cigna MGG,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Humana,Humana,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Humana MGG,Humana MGG,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Optum VA,Optum VA,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,UHC,UHC,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,UHC MGG,UHC MGG,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,VA,VA,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Wellcare MGG,Wellcare MGG,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Bright Health - commercial,Bright Health - commercial,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,Bright Health MGG,Bright Health MGG,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Aetna,Aetna,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Aetna MGG,Aetna MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,BCBS,BCBS,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,BCBS MGG,BCBS MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Cigna,Cigna,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Cigna MGG,Cigna MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Humana,Humana,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Humana MGG,Humana MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Optum VA,Optum VA,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,UHC,UHC,32.04,,,,,,,per diem,32.04,32.04,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,UHC MGG,UHC MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,VA,VA,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Wellcare MGG,Wellcare MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Bright Health - commercial,Bright Health - commercial,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,32.04,32.04,Bright Health MGG,Bright Health MGG,32.04,,,,,,,case rate,32.04,32.04,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Aetna,Aetna,33.21,,,,,,,per diem,33.21,33.21,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Aetna MGG,Aetna MGG,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,BCBS,BCBS,33.21,,,,,,,per diem,33.21,33.21,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,BCBS MGG,BCBS MGG,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Cigna,Cigna,33.21,,,,,,,per diem,33.21,33.21,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Cigna MGG,Cigna MGG,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Humana,Humana,33.21,,,,,,,per diem,33.21,33.21,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Humana MGG,Humana MGG,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Optum VA,Optum VA,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,UHC,UHC,33.21,,,,,,,per diem,33.21,33.21,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,UHC MGG,UHC MGG,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,VA,VA,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Wellcare MGG,Wellcare MGG,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Bright Health - commercial,Bright Health - commercial,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,33.21,33.21,Bright Health MGG,Bright Health MGG,33.21,,,,,,,case rate,33.21,33.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Aetna,Aetna,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Aetna MGG,Aetna MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,BCBS,BCBS,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,BCBS MGG,BCBS MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Cigna,Cigna,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Cigna MGG,Cigna MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Humana,Humana,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Humana MGG,Humana MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Optum VA,Optum VA,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,UHC,UHC,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,UHC MGG,UHC MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,VA,VA,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Wellcare MGG,Wellcare MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Bright Health - commercial,Bright Health - commercial,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,158.4,158.4,Bright Health MGG,Bright Health MGG,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Aetna,Aetna,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Aetna MGG,Aetna MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,BCBS,BCBS,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,BCBS MGG,BCBS MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Cigna,Cigna,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Cigna MGG,Cigna MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Humana,Humana,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Humana MGG,Humana MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Optum VA,Optum VA,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,UHC,UHC,26.55,,,,,,,per diem,26.55,26.55,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,UHC MGG,UHC MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,VA,VA,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Wellcare MGG,Wellcare MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Bright Health - commercial,Bright Health - commercial,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,26.55,26.55,Bright Health MGG,Bright Health MGG,26.55,,,,,,,case rate,26.55,26.55,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Aetna,Aetna,160.6,,,,,,,per diem,160.6,160.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Aetna MGG,Aetna MGG,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,BCBS,BCBS,160.6,,,,,,,per diem,160.6,160.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,BCBS MGG,BCBS MGG,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Cigna,Cigna,160.6,,,,,,,per diem,160.6,160.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Cigna MGG,Cigna MGG,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Humana,Humana,160.6,,,,,,,per diem,160.6,160.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Humana MGG,Humana MGG,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Optum VA,Optum VA,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,UHC,UHC,160.6,,,,,,,per diem,160.6,160.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,UHC MGG,UHC MGG,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,VA,VA,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Wellcare MGG,Wellcare MGG,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Bright Health - commercial,Bright Health - commercial,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,160.6,160.6,Bright Health MGG,Bright Health MGG,160.6,,,,,,,case rate,160.6,160.6,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna,Aetna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna MGG,Aetna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS,BCBS,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS MGG,BCBS MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna,Cigna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna MGG,Cigna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana,Humana,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana MGG,Humana MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Optum VA,Optum VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC,UHC,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC MGG,UHC MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,VA,VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Wellcare MGG,Wellcare MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health - commercial,Bright Health - commercial,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health MGG,Bright Health MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Aetna,Aetna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Aetna MGG,Aetna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,BCBS,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS MGG,BCBS MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Cigna,Cigna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Cigna MGG,Cigna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Humana,Humana,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Humana MGG,Humana MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Optum VA,Optum VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UHC,UHC,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UHC MGG,UHC MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA,VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Wellcare MGG,Wellcare MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Bright Health - commercial,Bright Health - commercial,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Bright Health MGG,Bright Health MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Aetna,Aetna,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Aetna MGG,Aetna MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,BCBS,BCBS,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,BCBS MGG,BCBS MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Cigna,Cigna,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Cigna MGG,Cigna MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Humana,Humana,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Humana MGG,Humana MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Optum VA,Optum VA,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,UHC,UHC,146.25,,,,,,,per diem,146.25,146.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,UHC MGG,UHC MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,VA,VA,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Wellcare MGG,Wellcare MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Bright Health - commercial,Bright Health - commercial,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,146.25,146.25,Bright Health MGG,Bright Health MGG,146.25,,,,,,,case rate,146.25,146.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Aetna,Aetna,18.3,,,,,,,per diem,18.3,18.3,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Aetna MGG,Aetna MGG,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,BCBS,BCBS,18.3,,,,,,,per diem,18.3,18.3,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,BCBS MGG,BCBS MGG,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Cigna,Cigna,18.3,,,,,,,per diem,18.3,18.3,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Cigna MGG,Cigna MGG,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Humana,Humana,18.3,,,,,,,per diem,18.3,18.3,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Humana MGG,Humana MGG,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Optum VA,Optum VA,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,UHC,UHC,18.3,,,,,,,per diem,18.3,18.3,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,UHC MGG,UHC MGG,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,VA,VA,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Wellcare MGG,Wellcare MGG,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Bright Health - commercial,Bright Health - commercial,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,18.3,18.3,Bright Health MGG,Bright Health MGG,18.3,,,,,,,case rate,18.3,18.3,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Aetna,Aetna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Aetna MGG,Aetna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,BCBS,BCBS,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,BCBS MGG,BCBS MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Cigna,Cigna,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Cigna MGG,Cigna MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Humana,Humana,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Humana MGG,Humana MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Optum VA,Optum VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,UHC,UHC,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,UHC MGG,UHC MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,VA,VA,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Wellcare MGG,Wellcare MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Bright Health - commercial,Bright Health - commercial,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12,12,Bright Health MGG,Bright Health MGG,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Aetna,Aetna,77.73,,,,,,,per diem,77.73,77.73,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Aetna MGG,Aetna MGG,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,BCBS,BCBS,77.73,,,,,,,per diem,77.73,77.73,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,BCBS MGG,BCBS MGG,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Cigna,Cigna,77.73,,,,,,,per diem,77.73,77.73,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Cigna MGG,Cigna MGG,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Humana,Humana,77.73,,,,,,,per diem,77.73,77.73,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Humana MGG,Humana MGG,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Optum VA,Optum VA,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,UHC,UHC,77.73,,,,,,,per diem,77.73,77.73,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,UHC MGG,UHC MGG,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,VA,VA,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Wellcare MGG,Wellcare MGG,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Bright Health - commercial,Bright Health - commercial,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,77.73,77.73,Bright Health MGG,Bright Health MGG,77.73,,,,,,,case rate,77.73,77.73,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Aetna,Aetna,83.82,,,,,,,per diem,83.82,83.82,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Aetna MGG,Aetna MGG,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,BCBS,BCBS,83.82,,,,,,,per diem,83.82,83.82,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,BCBS MGG,BCBS MGG,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Cigna,Cigna,83.82,,,,,,,per diem,83.82,83.82,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Cigna MGG,Cigna MGG,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Humana,Humana,83.82,,,,,,,per diem,83.82,83.82,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Humana MGG,Humana MGG,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Optum VA,Optum VA,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,UHC,UHC,83.82,,,,,,,per diem,83.82,83.82,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,UHC MGG,UHC MGG,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,VA,VA,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Wellcare MGG,Wellcare MGG,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Bright Health - commercial,Bright Health - commercial,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,83.82,83.82,Bright Health MGG,Bright Health MGG,83.82,,,,,,,case rate,83.82,83.82,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Aetna,Aetna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Aetna MGG,Aetna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,BCBS,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS MGG,BCBS MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Cigna,Cigna,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Cigna MGG,Cigna MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Humana,Humana,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Humana MGG,Humana MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Optum VA,Optum VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UHC,UHC,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UHC MGG,UHC MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,VA,VA,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Wellcare MGG,Wellcare MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Bright Health - commercial,Bright Health - commercial,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,Bright Health MGG,Bright Health MGG,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Aetna,Aetna,244.2,,,,,,,per diem,244.2,244.2,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Aetna MGG,Aetna MGG,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,BCBS,BCBS,244.2,,,,,,,per diem,244.2,244.2,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,BCBS MGG,BCBS MGG,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Cigna,Cigna,244.2,,,,,,,per diem,244.2,244.2,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Cigna MGG,Cigna MGG,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Humana,Humana,244.2,,,,,,,per diem,244.2,244.2,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Humana MGG,Humana MGG,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Optum VA,Optum VA,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,UHC,UHC,244.2,,,,,,,per diem,244.2,244.2,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,UHC MGG,UHC MGG,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,VA,VA,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Wellcare MGG,Wellcare MGG,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Bright Health - commercial,Bright Health - commercial,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,244.2,244.2,Bright Health MGG,Bright Health MGG,244.2,,,,,,,case rate,244.2,244.2,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Aetna,Aetna,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Aetna MGG,Aetna MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS,BCBS,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS MGG,BCBS MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Cigna,Cigna,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Cigna MGG,Cigna MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Humana,Humana,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Humana MGG,Humana MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Optum VA,Optum VA,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,UHC,UHC,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,UHC MGG,UHC MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,VA,VA,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Wellcare MGG,Wellcare MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Bright Health - commercial,Bright Health - commercial,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Bright Health MGG,Bright Health MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Aetna,Aetna,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Aetna MGG,Aetna MGG,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,BCBS,BCBS,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,BCBS MGG,BCBS MGG,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Cigna,Cigna,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Cigna MGG,Cigna MGG,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Humana,Humana,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Humana MGG,Humana MGG,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Optum VA,Optum VA,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,UHC,UHC,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,UHC MGG,UHC MGG,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,VA,VA,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Wellcare MGG,Wellcare MGG,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Bright Health - commercial,Bright Health - commercial,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,Bright Health MGG,Bright Health MGG,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Aetna,Aetna,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Aetna MGG,Aetna MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,BCBS,BCBS,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,BCBS MGG,BCBS MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Cigna,Cigna,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Cigna MGG,Cigna MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Humana,Humana,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Humana MGG,Humana MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Optum VA,Optum VA,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,UHC,UHC,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,UHC MGG,UHC MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,VA,VA,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Wellcare MGG,Wellcare MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Bright Health - commercial,Bright Health - commercial,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Bright Health MGG,Bright Health MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Aetna,Aetna,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Aetna MGG,Aetna MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,BCBS,BCBS,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,BCBS MGG,BCBS MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Cigna,Cigna,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Cigna MGG,Cigna MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Humana,Humana,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Humana MGG,Humana MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Optum VA,Optum VA,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,UHC,UHC,222.06,,,,,,,per diem,222.06,222.06,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,UHC MGG,UHC MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,VA,VA,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Wellcare MGG,Wellcare MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Bright Health - commercial,Bright Health - commercial,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,222.06,222.06,Bright Health MGG,Bright Health MGG,222.06,,,,,,,case rate,222.06,222.06,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Aetna,Aetna,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Aetna MGG,Aetna MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,BCBS,BCBS,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,BCBS MGG,BCBS MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Cigna,Cigna,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Cigna MGG,Cigna MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Humana,Humana,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Humana MGG,Humana MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Optum VA,Optum VA,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,UHC,UHC,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,UHC MGG,UHC MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,VA,VA,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Wellcare MGG,Wellcare MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Bright Health - commercial,Bright Health - commercial,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Bright Health MGG,Bright Health MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Aetna,Aetna,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Aetna MGG,Aetna MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,BCBS,BCBS,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,BCBS MGG,BCBS MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Cigna,Cigna,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Cigna MGG,Cigna MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Humana,Humana,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Humana MGG,Humana MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Optum VA,Optum VA,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,UHC,UHC,32.91,,,,,,,per diem,32.91,32.91,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,UHC MGG,UHC MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,VA,VA,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Wellcare MGG,Wellcare MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Bright Health - commercial,Bright Health - commercial,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,32.91,32.91,Bright Health MGG,Bright Health MGG,32.91,,,,,,,case rate,32.91,32.91,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Aetna,Aetna,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Aetna MGG,Aetna MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,BCBS,BCBS,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,BCBS MGG,BCBS MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Cigna,Cigna,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Cigna MGG,Cigna MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Humana,Humana,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Humana MGG,Humana MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Optum VA,Optum VA,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,UHC,UHC,6.57,,,,,,,per diem,6.57,6.57,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,UHC MGG,UHC MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,VA,VA,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Wellcare MGG,Wellcare MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Bright Health - commercial,Bright Health - commercial,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.57,6.57,Bright Health MGG,Bright Health MGG,6.57,,,,,,,case rate,6.57,6.57,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Aetna,Aetna,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Aetna MGG,Aetna MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,BCBS,BCBS,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,BCBS MGG,BCBS MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Cigna,Cigna,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Cigna MGG,Cigna MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Humana,Humana,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Humana MGG,Humana MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Optum VA,Optum VA,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,UHC,UHC,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,UHC MGG,UHC MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,VA,VA,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Wellcare MGG,Wellcare MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Bright Health - commercial,Bright Health - commercial,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Bright Health MGG,Bright Health MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Aetna,Aetna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Aetna MGG,Aetna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,BCBS,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS MGG,BCBS MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Cigna,Cigna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Cigna MGG,Cigna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Humana,Humana,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Humana MGG,Humana MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Optum VA,Optum VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UHC,UHC,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UHC MGG,UHC MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,VA,VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Wellcare MGG,Wellcare MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Bright Health - commercial,Bright Health - commercial,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,Bright Health MGG,Bright Health MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Aetna,Aetna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Aetna MGG,Aetna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,BCBS,BCBS,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,BCBS MGG,BCBS MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Cigna,Cigna,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Cigna MGG,Cigna MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Humana,Humana,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Humana MGG,Humana MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Optum VA,Optum VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,UHC,UHC,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,UHC MGG,UHC MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,VA,VA,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Wellcare MGG,Wellcare MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Bright Health - commercial,Bright Health - commercial,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,82.47,82.47,Bright Health MGG,Bright Health MGG,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Aetna,Aetna,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Aetna MGG,Aetna MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,BCBS,BCBS,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,BCBS MGG,BCBS MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Cigna,Cigna,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Cigna MGG,Cigna MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Humana,Humana,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Humana MGG,Humana MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Optum VA,Optum VA,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,UHC,UHC,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,UHC MGG,UHC MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,VA,VA,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Wellcare MGG,Wellcare MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Bright Health - commercial,Bright Health - commercial,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Bright Health MGG,Bright Health MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Aetna,Aetna,17.21,,,,,,,per diem,17.21,17.21,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Aetna MGG,Aetna MGG,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,BCBS,BCBS,17.21,,,,,,,per diem,17.21,17.21,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,BCBS MGG,BCBS MGG,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Cigna,Cigna,17.21,,,,,,,per diem,17.21,17.21,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Cigna MGG,Cigna MGG,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Humana,Humana,17.21,,,,,,,per diem,17.21,17.21,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Humana MGG,Humana MGG,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Optum VA,Optum VA,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,UHC,UHC,17.21,,,,,,,per diem,17.21,17.21,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,UHC MGG,UHC MGG,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,VA,VA,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Wellcare MGG,Wellcare MGG,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Bright Health - commercial,Bright Health - commercial,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,17.21,17.21,Bright Health MGG,Bright Health MGG,17.21,,,,,,,case rate,17.21,17.21,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Aetna,Aetna,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Aetna MGG,Aetna MGG,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,BCBS,BCBS,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,BCBS MGG,BCBS MGG,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Cigna,Cigna,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Cigna MGG,Cigna MGG,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Humana,Humana,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Humana MGG,Humana MGG,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Optum VA,Optum VA,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,UHC,UHC,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,UHC MGG,UHC MGG,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,VA,VA,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Wellcare MGG,Wellcare MGG,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Bright Health - commercial,Bright Health - commercial,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,21.89,21.89,Bright Health MGG,Bright Health MGG,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Aetna,Aetna,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Aetna MGG,Aetna MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,BCBS,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS MGG,BCBS MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Cigna,Cigna,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Cigna MGG,Cigna MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Humana,Humana,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Humana MGG,Humana MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Optum VA,Optum VA,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,UHC,UHC,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,UHC MGG,UHC MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,VA,VA,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Wellcare MGG,Wellcare MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Bright Health - commercial,Bright Health - commercial,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Bright Health MGG,Bright Health MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Aetna,Aetna,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Aetna MGG,Aetna MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,BCBS,BCBS,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,BCBS MGG,BCBS MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Cigna,Cigna,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Cigna MGG,Cigna MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Humana,Humana,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Humana MGG,Humana MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Optum VA,Optum VA,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,UHC,UHC,25.65,,,,,,,per diem,25.65,25.65,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,UHC MGG,UHC MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,VA,VA,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Wellcare MGG,Wellcare MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Bright Health - commercial,Bright Health - commercial,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,25.65,25.65,Bright Health MGG,Bright Health MGG,25.65,,,,,,,case rate,25.65,25.65,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Aetna,Aetna,285.06,,,,,,,per diem,285.06,285.06,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Aetna MGG,Aetna MGG,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,BCBS,BCBS,285.06,,,,,,,per diem,285.06,285.06,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,BCBS MGG,BCBS MGG,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Cigna,Cigna,285.06,,,,,,,per diem,285.06,285.06,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Cigna MGG,Cigna MGG,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Humana,Humana,285.06,,,,,,,per diem,285.06,285.06,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Humana MGG,Humana MGG,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Optum VA,Optum VA,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,UHC,UHC,285.06,,,,,,,per diem,285.06,285.06,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,UHC MGG,UHC MGG,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,VA,VA,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Wellcare MGG,Wellcare MGG,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Bright Health - commercial,Bright Health - commercial,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,285.06,285.06,Bright Health MGG,Bright Health MGG,285.06,,,,,,,case rate,285.06,285.06,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Aetna,Aetna,36.81,,,,,,,per diem,36.81,36.81,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Aetna MGG,Aetna MGG,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,BCBS,BCBS,36.81,,,,,,,per diem,36.81,36.81,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,BCBS MGG,BCBS MGG,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Cigna,Cigna,36.81,,,,,,,per diem,36.81,36.81,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Cigna MGG,Cigna MGG,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Humana,Humana,36.81,,,,,,,per diem,36.81,36.81,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Humana MGG,Humana MGG,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Optum VA,Optum VA,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,UHC,UHC,36.81,,,,,,,per diem,36.81,36.81,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,UHC MGG,UHC MGG,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,VA,VA,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Wellcare MGG,Wellcare MGG,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Bright Health - commercial,Bright Health - commercial,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,36.81,36.81,Bright Health MGG,Bright Health MGG,36.81,,,,,,,case rate,36.81,36.81,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Aetna,Aetna,334.98,,,,,,,per diem,334.98,334.98,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Aetna MGG,Aetna MGG,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,BCBS,BCBS,334.98,,,,,,,per diem,334.98,334.98,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,BCBS MGG,BCBS MGG,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Cigna,Cigna,334.98,,,,,,,per diem,334.98,334.98,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Cigna MGG,Cigna MGG,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Humana,Humana,334.98,,,,,,,per diem,334.98,334.98,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Humana MGG,Humana MGG,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Optum VA,Optum VA,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,UHC,UHC,334.98,,,,,,,per diem,334.98,334.98,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,UHC MGG,UHC MGG,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,VA,VA,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Wellcare MGG,Wellcare MGG,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Bright Health - commercial,Bright Health - commercial,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,334.98,334.98,Bright Health MGG,Bright Health MGG,334.98,,,,,,,case rate,334.98,334.98,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Aetna,Aetna,424.5,,,,,,,per diem,424.5,424.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Aetna MGG,Aetna MGG,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,BCBS,BCBS,424.5,,,,,,,per diem,424.5,424.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,BCBS MGG,BCBS MGG,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Cigna,Cigna,424.5,,,,,,,per diem,424.5,424.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Cigna MGG,Cigna MGG,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Humana,Humana,424.5,,,,,,,per diem,424.5,424.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Humana MGG,Humana MGG,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Optum VA,Optum VA,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,UHC,UHC,424.5,,,,,,,per diem,424.5,424.5,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,UHC MGG,UHC MGG,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,VA,VA,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Wellcare MGG,Wellcare MGG,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Bright Health - commercial,Bright Health - commercial,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,424.5,424.5,Bright Health MGG,Bright Health MGG,424.5,,,,,,,case rate,424.5,424.5,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Aetna,Aetna,734.82,,,,,,,per diem,734.82,734.82,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Aetna MGG,Aetna MGG,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,BCBS,BCBS,734.82,,,,,,,per diem,734.82,734.82,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,BCBS MGG,BCBS MGG,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Cigna,Cigna,734.82,,,,,,,per diem,734.82,734.82,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Cigna MGG,Cigna MGG,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Humana,Humana,734.82,,,,,,,per diem,734.82,734.82,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Humana MGG,Humana MGG,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Optum VA,Optum VA,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,UHC,UHC,734.82,,,,,,,per diem,734.82,734.82,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,UHC MGG,UHC MGG,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,VA,VA,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Wellcare MGG,Wellcare MGG,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Bright Health - commercial,Bright Health - commercial,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,734.82,734.82,Bright Health MGG,Bright Health MGG,734.82,,,,,,,case rate,734.82,734.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna,Aetna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Aetna MGG,Aetna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS,BCBS,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,BCBS MGG,BCBS MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna,Cigna,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Cigna MGG,Cigna MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana,Humana,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Humana MGG,Humana MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Optum VA,Optum VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC,UHC,5.82,,,,,,,per diem,5.82,5.82,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,UHC MGG,UHC MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,VA,VA,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Wellcare MGG,Wellcare MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health - commercial,Bright Health - commercial,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,5.82,5.82,Bright Health MGG,Bright Health MGG,5.82,,,,,,,case rate,5.82,5.82,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Aetna,Aetna,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Aetna MGG,Aetna MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,BCBS,BCBS,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,BCBS MGG,BCBS MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Cigna,Cigna,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Cigna MGG,Cigna MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Humana,Humana,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Humana MGG,Humana MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Optum VA,Optum VA,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,UHC,UHC,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,UHC MGG,UHC MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,VA,VA,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Wellcare MGG,Wellcare MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Bright Health - commercial,Bright Health - commercial,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Bright Health MGG,Bright Health MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Aetna,Aetna,9.06,,,,,,,per diem,9.06,9.06,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Aetna MGG,Aetna MGG,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,BCBS,BCBS,9.06,,,,,,,per diem,9.06,9.06,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,BCBS MGG,BCBS MGG,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Cigna,Cigna,9.06,,,,,,,per diem,9.06,9.06,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Cigna MGG,Cigna MGG,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Humana,Humana,9.06,,,,,,,per diem,9.06,9.06,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Humana MGG,Humana MGG,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Optum VA,Optum VA,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,UHC,UHC,9.06,,,,,,,per diem,9.06,9.06,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,UHC MGG,UHC MGG,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,VA,VA,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Wellcare MGG,Wellcare MGG,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Bright Health - commercial,Bright Health - commercial,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.06,9.06,Bright Health MGG,Bright Health MGG,9.06,,,,,,,case rate,9.06,9.06,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Aetna,Aetna,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Aetna MGG,Aetna MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,BCBS,BCBS,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,BCBS MGG,BCBS MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Cigna,Cigna,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Cigna MGG,Cigna MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Humana,Humana,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Humana MGG,Humana MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Optum VA,Optum VA,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,UHC,UHC,200.4,,,,,,,per diem,200.4,200.4,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,UHC MGG,UHC MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,VA,VA,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Wellcare MGG,Wellcare MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Bright Health - commercial,Bright Health - commercial,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,200.4,200.4,Bright Health MGG,Bright Health MGG,200.4,,,,,,,case rate,200.4,200.4,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Aetna,Aetna,228.3,,,,,,,per diem,228.3,228.3,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Aetna MGG,Aetna MGG,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,BCBS,BCBS,228.3,,,,,,,per diem,228.3,228.3,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,BCBS MGG,BCBS MGG,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Cigna,Cigna,228.3,,,,,,,per diem,228.3,228.3,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Cigna MGG,Cigna MGG,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Humana,Humana,228.3,,,,,,,per diem,228.3,228.3,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Humana MGG,Humana MGG,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Optum VA,Optum VA,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,UHC,UHC,228.3,,,,,,,per diem,228.3,228.3,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,UHC MGG,UHC MGG,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,VA,VA,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Wellcare MGG,Wellcare MGG,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Bright Health - commercial,Bright Health - commercial,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,228.3,228.3,Bright Health MGG,Bright Health MGG,228.3,,,,,,,case rate,228.3,228.3,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Aetna,Aetna,494.83,,,,,,,per diem,494.83,494.83,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Aetna MGG,Aetna MGG,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,BCBS,BCBS,494.83,,,,,,,per diem,494.83,494.83,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,BCBS MGG,BCBS MGG,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Cigna,Cigna,494.83,,,,,,,per diem,494.83,494.83,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Cigna MGG,Cigna MGG,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Humana,Humana,494.83,,,,,,,per diem,494.83,494.83,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Humana MGG,Humana MGG,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Optum VA,Optum VA,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,UHC,UHC,494.83,,,,,,,per diem,494.83,494.83,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,UHC MGG,UHC MGG,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,VA,VA,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Wellcare MGG,Wellcare MGG,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Bright Health - commercial,Bright Health - commercial,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,494.83,494.83,Bright Health MGG,Bright Health MGG,494.83,,,,,,,case rate,494.83,494.83,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Aetna,Aetna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Aetna MGG,Aetna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,BCBS,BCBS,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,BCBS MGG,BCBS MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Cigna,Cigna,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Cigna MGG,Cigna MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Humana,Humana,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Humana MGG,Humana MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Optum VA,Optum VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,UHC,UHC,26.52,,,,,,,per diem,26.52,26.52,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,UHC MGG,UHC MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,VA,VA,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Wellcare MGG,Wellcare MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Bright Health - commercial,Bright Health - commercial,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,26.52,26.52,Bright Health MGG,Bright Health MGG,26.52,,,,,,,case rate,26.52,26.52,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Aetna,Aetna,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Aetna MGG,Aetna MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,BCBS,BCBS,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,BCBS MGG,BCBS MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Cigna,Cigna,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Cigna MGG,Cigna MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Humana,Humana,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Humana MGG,Humana MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Optum VA,Optum VA,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,UHC,UHC,7.9,,,,,,,per diem,7.9,7.9,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,UHC MGG,UHC MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,VA,VA,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Wellcare MGG,Wellcare MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Bright Health - commercial,Bright Health - commercial,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,7.9,7.9,Bright Health MGG,Bright Health MGG,7.9,,,,,,,case rate,7.9,7.9,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Aetna,Aetna,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Aetna MGG,Aetna MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,BCBS,BCBS,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,BCBS MGG,BCBS MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Cigna,Cigna,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Cigna MGG,Cigna MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Humana,Humana,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Humana MGG,Humana MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Optum VA,Optum VA,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,UHC,UHC,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,UHC MGG,UHC MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,VA,VA,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Wellcare MGG,Wellcare MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Bright Health - commercial,Bright Health - commercial,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Bright Health MGG,Bright Health MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Aetna,Aetna,11.64,,,,,,,per diem,11.64,11.64,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Aetna MGG,Aetna MGG,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,BCBS,BCBS,11.64,,,,,,,per diem,11.64,11.64,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,BCBS MGG,BCBS MGG,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Cigna,Cigna,11.64,,,,,,,per diem,11.64,11.64,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Cigna MGG,Cigna MGG,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Humana,Humana,11.64,,,,,,,per diem,11.64,11.64,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Humana MGG,Humana MGG,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Optum VA,Optum VA,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,UHC,UHC,11.64,,,,,,,per diem,11.64,11.64,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,UHC MGG,UHC MGG,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,VA,VA,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Wellcare MGG,Wellcare MGG,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Bright Health - commercial,Bright Health - commercial,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,11.64,11.64,Bright Health MGG,Bright Health MGG,11.64,,,,,,,case rate,11.64,11.64,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Aetna,Aetna,14.97,,,,,,,per diem,14.97,14.97,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Aetna MGG,Aetna MGG,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,BCBS,BCBS,14.97,,,,,,,per diem,14.97,14.97,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,BCBS MGG,BCBS MGG,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Cigna,Cigna,14.97,,,,,,,per diem,14.97,14.97,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Cigna MGG,Cigna MGG,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Humana,Humana,14.97,,,,,,,per diem,14.97,14.97,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Humana MGG,Humana MGG,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Optum VA,Optum VA,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,UHC,UHC,14.97,,,,,,,per diem,14.97,14.97,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,UHC MGG,UHC MGG,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,VA,VA,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Wellcare MGG,Wellcare MGG,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Bright Health - commercial,Bright Health - commercial,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.97,14.97,Bright Health MGG,Bright Health MGG,14.97,,,,,,,case rate,14.97,14.97,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Aetna,Aetna,23.55,,,,,,,per diem,23.55,23.55,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Aetna MGG,Aetna MGG,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,BCBS,BCBS,23.55,,,,,,,per diem,23.55,23.55,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,BCBS MGG,BCBS MGG,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Cigna,Cigna,23.55,,,,,,,per diem,23.55,23.55,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Cigna MGG,Cigna MGG,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Humana,Humana,23.55,,,,,,,per diem,23.55,23.55,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Humana MGG,Humana MGG,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Optum VA,Optum VA,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,UHC,UHC,23.55,,,,,,,per diem,23.55,23.55,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,UHC MGG,UHC MGG,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,VA,VA,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Wellcare MGG,Wellcare MGG,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Bright Health - commercial,Bright Health - commercial,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,23.55,23.55,Bright Health MGG,Bright Health MGG,23.55,,,,,,,case rate,23.55,23.55,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Aetna,Aetna,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Aetna MGG,Aetna MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,BCBS,BCBS,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,BCBS MGG,BCBS MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Cigna,Cigna,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Cigna MGG,Cigna MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Humana,Humana,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Humana MGG,Humana MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Optum VA,Optum VA,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,UHC,UHC,96,,,,,,,per diem,96,96,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,UHC MGG,UHC MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,VA,VA,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Wellcare MGG,Wellcare MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Bright Health - commercial,Bright Health - commercial,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,96,96,Bright Health MGG,Bright Health MGG,96,,,,,,,case rate,96,96,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Aetna,Aetna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Aetna MGG,Aetna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,BCBS,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS MGG,BCBS MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Cigna,Cigna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Cigna MGG,Cigna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Humana,Humana,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Humana MGG,Humana MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Optum VA,Optum VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UHC,UHC,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UHC MGG,UHC MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Wellcare MGG,Wellcare MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Bright Health - commercial,Bright Health - commercial,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Bright Health MGG,Bright Health MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Aetna,Aetna,435.48,,,,,,,per diem,435.48,435.48,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Aetna MGG,Aetna MGG,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,BCBS,BCBS,435.48,,,,,,,per diem,435.48,435.48,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,BCBS MGG,BCBS MGG,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Cigna,Cigna,435.48,,,,,,,per diem,435.48,435.48,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Cigna MGG,Cigna MGG,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Humana,Humana,435.48,,,,,,,per diem,435.48,435.48,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Humana MGG,Humana MGG,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Optum VA,Optum VA,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,UHC,UHC,435.48,,,,,,,per diem,435.48,435.48,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,UHC MGG,UHC MGG,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,VA,VA,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Wellcare MGG,Wellcare MGG,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Bright Health - commercial,Bright Health - commercial,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,435.48,435.48,Bright Health MGG,Bright Health MGG,435.48,,,,,,,case rate,435.48,435.48,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Aetna,Aetna,468,,,,,,,per diem,468,468,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Aetna MGG,Aetna MGG,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,BCBS,BCBS,468,,,,,,,per diem,468,468,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,BCBS MGG,BCBS MGG,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Cigna,Cigna,468,,,,,,,per diem,468,468,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Cigna MGG,Cigna MGG,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Humana,Humana,468,,,,,,,per diem,468,468,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Humana MGG,Humana MGG,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Optum VA,Optum VA,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,UHC,UHC,468,,,,,,,per diem,468,468,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,UHC MGG,UHC MGG,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,VA,VA,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Wellcare MGG,Wellcare MGG,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Bright Health - commercial,Bright Health - commercial,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,468,468,Bright Health MGG,Bright Health MGG,468,,,,,,,case rate,468,468,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Aetna,Aetna,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Aetna MGG,Aetna MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,BCBS,BCBS,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,BCBS MGG,BCBS MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Cigna,Cigna,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Cigna MGG,Cigna MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Humana,Humana,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Humana MGG,Humana MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Optum VA,Optum VA,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,UHC,UHC,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,UHC MGG,UHC MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,VA,VA,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Wellcare MGG,Wellcare MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Bright Health - commercial,Bright Health - commercial,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Bright Health MGG,Bright Health MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna,Aetna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna MGG,Aetna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,BCBS,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS MGG,BCBS MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna,Cigna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna MGG,Cigna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana,Humana,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana MGG,Humana MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Optum VA,Optum VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC,UHC,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC MGG,UHC MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,VA,VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Wellcare MGG,Wellcare MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health - commercial,Bright Health - commercial,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health MGG,Bright Health MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Aetna,Aetna,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Aetna MGG,Aetna MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,BCBS,BCBS,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,BCBS MGG,BCBS MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Cigna,Cigna,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Cigna MGG,Cigna MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Humana,Humana,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Humana MGG,Humana MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Optum VA,Optum VA,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,UHC,UHC,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,UHC MGG,UHC MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,VA,VA,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Wellcare MGG,Wellcare MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Bright Health - commercial,Bright Health - commercial,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Bright Health MGG,Bright Health MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Aetna,Aetna,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Aetna MGG,Aetna MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,BCBS,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS MGG,BCBS MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Cigna,Cigna,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Cigna MGG,Cigna MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Humana,Humana,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Humana MGG,Humana MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Optum VA,Optum VA,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UHC,UHC,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UHC MGG,UHC MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,VA,VA,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Wellcare MGG,Wellcare MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Bright Health - commercial,Bright Health - commercial,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,Bright Health MGG,Bright Health MGG,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Aetna,Aetna,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Aetna MGG,Aetna MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,BCBS,BCBS,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,BCBS MGG,BCBS MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Cigna,Cigna,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Cigna MGG,Cigna MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Humana,Humana,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Humana MGG,Humana MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Optum VA,Optum VA,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,UHC,UHC,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,UHC MGG,UHC MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,VA,VA,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Wellcare MGG,Wellcare MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Bright Health - commercial,Bright Health - commercial,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Bright Health MGG,Bright Health MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Aetna,Aetna,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Aetna MGG,Aetna MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,BCBS,BCBS,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,BCBS MGG,BCBS MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Cigna,Cigna,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Cigna MGG,Cigna MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Humana,Humana,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Humana MGG,Humana MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Optum VA,Optum VA,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,UHC,UHC,166.26,,,,,,,per diem,166.26,166.26,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,UHC MGG,UHC MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,VA,VA,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Wellcare MGG,Wellcare MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Bright Health - commercial,Bright Health - commercial,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,166.26,166.26,Bright Health MGG,Bright Health MGG,166.26,,,,,,,case rate,166.26,166.26,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Aetna,Aetna,138.24,,,,,,,per diem,138.24,138.24,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Aetna MGG,Aetna MGG,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,BCBS,BCBS,138.24,,,,,,,per diem,138.24,138.24,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,BCBS MGG,BCBS MGG,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Cigna,Cigna,138.24,,,,,,,per diem,138.24,138.24,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Cigna MGG,Cigna MGG,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Humana,Humana,138.24,,,,,,,per diem,138.24,138.24,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Humana MGG,Humana MGG,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Optum VA,Optum VA,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,UHC,UHC,138.24,,,,,,,per diem,138.24,138.24,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,UHC MGG,UHC MGG,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,VA,VA,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Wellcare MGG,Wellcare MGG,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Bright Health - commercial,Bright Health - commercial,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,138.24,138.24,Bright Health MGG,Bright Health MGG,138.24,,,,,,,case rate,138.24,138.24,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Aetna,Aetna,108.51,,,,,,,per diem,108.51,108.51,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Aetna MGG,Aetna MGG,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,BCBS,BCBS,108.51,,,,,,,per diem,108.51,108.51,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,BCBS MGG,BCBS MGG,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Cigna,Cigna,108.51,,,,,,,per diem,108.51,108.51,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Cigna MGG,Cigna MGG,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Humana,Humana,108.51,,,,,,,per diem,108.51,108.51,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Humana MGG,Humana MGG,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Optum VA,Optum VA,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,UHC,UHC,108.51,,,,,,,per diem,108.51,108.51,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,UHC MGG,UHC MGG,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,VA,VA,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Wellcare MGG,Wellcare MGG,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Bright Health - commercial,Bright Health - commercial,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,108.51,108.51,Bright Health MGG,Bright Health MGG,108.51,,,,,,,case rate,108.51,108.51,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Aetna,Aetna,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Aetna MGG,Aetna MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,BCBS,BCBS,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,BCBS MGG,BCBS MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Cigna,Cigna,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Cigna MGG,Cigna MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Humana,Humana,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Humana MGG,Humana MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Optum VA,Optum VA,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,UHC,UHC,1196.4,,,,,,,per diem,1196.4,1196.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,UHC MGG,UHC MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,VA,VA,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Wellcare MGG,Wellcare MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Bright Health - commercial,Bright Health - commercial,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,1196.4,1196.4,Bright Health MGG,Bright Health MGG,1196.4,,,,,,,case rate,1196.4,1196.4,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Aetna,Aetna,22.65,,,,,,,per diem,22.65,22.65,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Aetna MGG,Aetna MGG,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,BCBS,BCBS,22.65,,,,,,,per diem,22.65,22.65,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,BCBS MGG,BCBS MGG,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Cigna,Cigna,22.65,,,,,,,per diem,22.65,22.65,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Cigna MGG,Cigna MGG,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Humana,Humana,22.65,,,,,,,per diem,22.65,22.65,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Humana MGG,Humana MGG,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Optum VA,Optum VA,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,UHC,UHC,22.65,,,,,,,per diem,22.65,22.65,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,UHC MGG,UHC MGG,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,VA,VA,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Wellcare MGG,Wellcare MGG,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Bright Health - commercial,Bright Health - commercial,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,22.65,22.65,Bright Health MGG,Bright Health MGG,22.65,,,,,,,case rate,22.65,22.65,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Aetna,Aetna,75.54,,,,,,,per diem,75.54,75.54,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Aetna MGG,Aetna MGG,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,BCBS,BCBS,75.54,,,,,,,per diem,75.54,75.54,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,BCBS MGG,BCBS MGG,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Cigna,Cigna,75.54,,,,,,,per diem,75.54,75.54,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Cigna MGG,Cigna MGG,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Humana,Humana,75.54,,,,,,,per diem,75.54,75.54,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Humana MGG,Humana MGG,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Optum VA,Optum VA,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,UHC,UHC,75.54,,,,,,,per diem,75.54,75.54,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,UHC MGG,UHC MGG,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,VA,VA,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Wellcare MGG,Wellcare MGG,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Bright Health - commercial,Bright Health - commercial,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,75.54,75.54,Bright Health MGG,Bright Health MGG,75.54,,,,,,,case rate,75.54,75.54,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Aetna,Aetna,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Aetna MGG,Aetna MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,BCBS,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS MGG,BCBS MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Cigna,Cigna,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Cigna MGG,Cigna MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Humana,Humana,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Humana MGG,Humana MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Optum VA,Optum VA,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UHC,UHC,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UHC MGG,UHC MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA,VA,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Wellcare MGG,Wellcare MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Bright Health - commercial,Bright Health - commercial,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,Bright Health MGG,Bright Health MGG,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Aetna,Aetna,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Aetna MGG,Aetna MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,BCBS,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS MGG,BCBS MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Cigna,Cigna,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Cigna MGG,Cigna MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Humana,Humana,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Humana MGG,Humana MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Optum VA,Optum VA,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,UHC,UHC,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,UHC MGG,UHC MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,VA,VA,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Wellcare MGG,Wellcare MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Bright Health - commercial,Bright Health - commercial,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Bright Health MGG,Bright Health MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Aetna,Aetna,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Aetna MGG,Aetna MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,BCBS,BCBS,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,BCBS MGG,BCBS MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Cigna,Cigna,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Cigna MGG,Cigna MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Humana,Humana,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Humana MGG,Humana MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Optum VA,Optum VA,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,UHC,UHC,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,UHC MGG,UHC MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,VA,VA,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Wellcare MGG,Wellcare MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Bright Health - commercial,Bright Health - commercial,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Bright Health MGG,Bright Health MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Aetna,Aetna,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Aetna MGG,Aetna MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,BCBS,BCBS,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,BCBS MGG,BCBS MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Cigna,Cigna,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Cigna MGG,Cigna MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Humana,Humana,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Humana MGG,Humana MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Optum VA,Optum VA,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,UHC,UHC,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,UHC MGG,UHC MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,VA,VA,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Wellcare MGG,Wellcare MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Bright Health - commercial,Bright Health - commercial,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Bright Health MGG,Bright Health MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Aetna,Aetna,482.94,,,,,,,per diem,482.94,482.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Aetna MGG,Aetna MGG,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,BCBS,BCBS,482.94,,,,,,,per diem,482.94,482.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,BCBS MGG,BCBS MGG,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Cigna,Cigna,482.94,,,,,,,per diem,482.94,482.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Cigna MGG,Cigna MGG,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Humana,Humana,482.94,,,,,,,per diem,482.94,482.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Humana MGG,Humana MGG,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Optum VA,Optum VA,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,UHC,UHC,482.94,,,,,,,per diem,482.94,482.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,UHC MGG,UHC MGG,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,VA,VA,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Wellcare MGG,Wellcare MGG,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Bright Health - commercial,Bright Health - commercial,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,482.94,482.94,Bright Health MGG,Bright Health MGG,482.94,,,,,,,case rate,482.94,482.94,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Aetna,Aetna,195.45,,,,,,,per diem,195.45,195.45,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Aetna MGG,Aetna MGG,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,BCBS,BCBS,195.45,,,,,,,per diem,195.45,195.45,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,BCBS MGG,BCBS MGG,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Cigna,Cigna,195.45,,,,,,,per diem,195.45,195.45,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Cigna MGG,Cigna MGG,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Humana,Humana,195.45,,,,,,,per diem,195.45,195.45,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Humana MGG,Humana MGG,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Optum VA,Optum VA,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,UHC,UHC,195.45,,,,,,,per diem,195.45,195.45,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,UHC MGG,UHC MGG,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,VA,VA,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Wellcare MGG,Wellcare MGG,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Bright Health - commercial,Bright Health - commercial,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,195.45,195.45,Bright Health MGG,Bright Health MGG,195.45,,,,,,,case rate,195.45,195.45,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Aetna,Aetna,5.49,,,,,,,per diem,5.49,5.49,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Aetna MGG,Aetna MGG,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,BCBS,BCBS,5.49,,,,,,,per diem,5.49,5.49,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,BCBS MGG,BCBS MGG,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Cigna,Cigna,5.49,,,,,,,per diem,5.49,5.49,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Cigna MGG,Cigna MGG,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Humana,Humana,5.49,,,,,,,per diem,5.49,5.49,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Humana MGG,Humana MGG,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Optum VA,Optum VA,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,UHC,UHC,5.49,,,,,,,per diem,5.49,5.49,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,UHC MGG,UHC MGG,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,VA,VA,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Wellcare MGG,Wellcare MGG,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Bright Health - commercial,Bright Health - commercial,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.49,5.49,Bright Health MGG,Bright Health MGG,5.49,,,,,,,case rate,5.49,5.49,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Aetna,Aetna,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Aetna MGG,Aetna MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,BCBS,BCBS,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,BCBS MGG,BCBS MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Cigna,Cigna,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Cigna MGG,Cigna MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Humana,Humana,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Humana MGG,Humana MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Optum VA,Optum VA,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,UHC,UHC,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,UHC MGG,UHC MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,VA,VA,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Wellcare MGG,Wellcare MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Bright Health - commercial,Bright Health - commercial,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Bright Health MGG,Bright Health MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Aetna,Aetna,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Aetna MGG,Aetna MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,BCBS,BCBS,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,BCBS MGG,BCBS MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Cigna,Cigna,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Cigna MGG,Cigna MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Humana,Humana,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Humana MGG,Humana MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Optum VA,Optum VA,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,UHC,UHC,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,UHC MGG,UHC MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,VA,VA,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Wellcare MGG,Wellcare MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Bright Health - commercial,Bright Health - commercial,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Bright Health MGG,Bright Health MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Aetna,Aetna,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Aetna MGG,Aetna MGG,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,BCBS,BCBS,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,BCBS MGG,BCBS MGG,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Cigna,Cigna,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Cigna MGG,Cigna MGG,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Humana,Humana,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Humana MGG,Humana MGG,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Optum VA,Optum VA,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,UHC,UHC,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,UHC MGG,UHC MGG,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,VA,VA,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Wellcare MGG,Wellcare MGG,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Bright Health - commercial,Bright Health - commercial,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,Bright Health MGG,Bright Health MGG,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Aetna,Aetna,27.03,,,,,,,per diem,27.03,27.03,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Aetna MGG,Aetna MGG,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,BCBS,BCBS,27.03,,,,,,,per diem,27.03,27.03,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,BCBS MGG,BCBS MGG,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Cigna,Cigna,27.03,,,,,,,per diem,27.03,27.03,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Cigna MGG,Cigna MGG,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Humana,Humana,27.03,,,,,,,per diem,27.03,27.03,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Humana MGG,Humana MGG,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Optum VA,Optum VA,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,UHC,UHC,27.03,,,,,,,per diem,27.03,27.03,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,UHC MGG,UHC MGG,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,VA,VA,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Wellcare MGG,Wellcare MGG,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Bright Health - commercial,Bright Health - commercial,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,27.03,27.03,Bright Health MGG,Bright Health MGG,27.03,,,,,,,case rate,27.03,27.03,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Aetna,Aetna,1094.04,,,,,,,per diem,1094.04,1094.04,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Aetna MGG,Aetna MGG,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,BCBS,BCBS,1094.04,,,,,,,per diem,1094.04,1094.04,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,BCBS MGG,BCBS MGG,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Cigna,Cigna,1094.04,,,,,,,per diem,1094.04,1094.04,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Cigna MGG,Cigna MGG,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Humana,Humana,1094.04,,,,,,,per diem,1094.04,1094.04,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Humana MGG,Humana MGG,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Optum VA,Optum VA,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,UHC,UHC,1094.04,,,,,,,per diem,1094.04,1094.04,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,UHC MGG,UHC MGG,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,VA,VA,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Wellcare MGG,Wellcare MGG,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Bright Health - commercial,Bright Health - commercial,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1094.04,1094.04,Bright Health MGG,Bright Health MGG,1094.04,,,,,,,case rate,1094.04,1094.04,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Aetna,Aetna,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Aetna MGG,Aetna MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,BCBS,BCBS,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,BCBS MGG,BCBS MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Cigna,Cigna,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Cigna MGG,Cigna MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Humana,Humana,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Humana MGG,Humana MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Optum VA,Optum VA,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,UHC,UHC,105.06,,,,,,,per diem,105.06,105.06,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,UHC MGG,UHC MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,VA,VA,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Wellcare MGG,Wellcare MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Bright Health - commercial,Bright Health - commercial,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,105.06,105.06,Bright Health MGG,Bright Health MGG,105.06,,,,,,,case rate,105.06,105.06,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Aetna,Aetna,1375.17,,,,,,,per diem,1375.17,1375.17,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Aetna MGG,Aetna MGG,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,BCBS,BCBS,1375.17,,,,,,,per diem,1375.17,1375.17,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,BCBS MGG,BCBS MGG,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Cigna,Cigna,1375.17,,,,,,,per diem,1375.17,1375.17,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Cigna MGG,Cigna MGG,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Humana,Humana,1375.17,,,,,,,per diem,1375.17,1375.17,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Humana MGG,Humana MGG,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Optum VA,Optum VA,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,UHC,UHC,1375.17,,,,,,,per diem,1375.17,1375.17,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,UHC MGG,UHC MGG,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,VA,VA,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Wellcare MGG,Wellcare MGG,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Bright Health - commercial,Bright Health - commercial,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1375.17,1375.17,Bright Health MGG,Bright Health MGG,1375.17,,,,,,,case rate,1375.17,1375.17,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Aetna,Aetna,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Aetna MGG,Aetna MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS,BCBS,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS MGG,BCBS MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Cigna,Cigna,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Cigna MGG,Cigna MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Humana,Humana,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Humana MGG,Humana MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Optum VA,Optum VA,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,UHC,UHC,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,UHC MGG,UHC MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,VA,VA,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Wellcare MGG,Wellcare MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Bright Health - commercial,Bright Health - commercial,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Bright Health MGG,Bright Health MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Aetna,Aetna,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Aetna MGG,Aetna MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,BCBS,BCBS,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,BCBS MGG,BCBS MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Cigna,Cigna,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Cigna MGG,Cigna MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Humana,Humana,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Humana MGG,Humana MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Optum VA,Optum VA,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,UHC,UHC,11.76,,,,,,,per diem,11.76,11.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,UHC MGG,UHC MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,VA,VA,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Wellcare MGG,Wellcare MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Bright Health - commercial,Bright Health - commercial,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,11.76,11.76,Bright Health MGG,Bright Health MGG,11.76,,,,,,,case rate,11.76,11.76,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Aetna,Aetna,28.11,,,,,,,per diem,28.11,28.11,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Aetna MGG,Aetna MGG,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,BCBS,BCBS,28.11,,,,,,,per diem,28.11,28.11,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,BCBS MGG,BCBS MGG,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Cigna,Cigna,28.11,,,,,,,per diem,28.11,28.11,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Cigna MGG,Cigna MGG,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Humana,Humana,28.11,,,,,,,per diem,28.11,28.11,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Humana MGG,Humana MGG,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Optum VA,Optum VA,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,UHC,UHC,28.11,,,,,,,per diem,28.11,28.11,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,UHC MGG,UHC MGG,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,VA,VA,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Wellcare MGG,Wellcare MGG,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Bright Health - commercial,Bright Health - commercial,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,28.11,28.11,Bright Health MGG,Bright Health MGG,28.11,,,,,,,case rate,28.11,28.11,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Aetna,Aetna,33.09,,,,,,,per diem,33.09,33.09,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Aetna MGG,Aetna MGG,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,BCBS,BCBS,33.09,,,,,,,per diem,33.09,33.09,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,BCBS MGG,BCBS MGG,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Cigna,Cigna,33.09,,,,,,,per diem,33.09,33.09,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Cigna MGG,Cigna MGG,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Humana,Humana,33.09,,,,,,,per diem,33.09,33.09,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Humana MGG,Humana MGG,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Optum VA,Optum VA,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,UHC,UHC,33.09,,,,,,,per diem,33.09,33.09,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,UHC MGG,UHC MGG,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,VA,VA,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Wellcare MGG,Wellcare MGG,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Bright Health - commercial,Bright Health - commercial,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,33.09,33.09,Bright Health MGG,Bright Health MGG,33.09,,,,,,,case rate,33.09,33.09,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna,Aetna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna MGG,Aetna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,BCBS,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS MGG,BCBS MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna,Cigna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna MGG,Cigna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana,Humana,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana MGG,Humana MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Optum VA,Optum VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC,UHC,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC MGG,UHC MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,VA,VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Wellcare MGG,Wellcare MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health - commercial,Bright Health - commercial,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health MGG,Bright Health MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Aetna,Aetna,649.17,,,,,,,per diem,649.17,649.17,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Aetna MGG,Aetna MGG,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,BCBS,BCBS,649.17,,,,,,,per diem,649.17,649.17,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,BCBS MGG,BCBS MGG,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Cigna,Cigna,649.17,,,,,,,per diem,649.17,649.17,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Cigna MGG,Cigna MGG,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Humana,Humana,649.17,,,,,,,per diem,649.17,649.17,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Humana MGG,Humana MGG,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Optum VA,Optum VA,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,UHC,UHC,649.17,,,,,,,per diem,649.17,649.17,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,UHC MGG,UHC MGG,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,VA,VA,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Wellcare MGG,Wellcare MGG,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Bright Health - commercial,Bright Health - commercial,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,649.17,649.17,Bright Health MGG,Bright Health MGG,649.17,,,,,,,case rate,649.17,649.17,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna,Aetna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna MGG,Aetna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS,BCBS,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS MGG,BCBS MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna,Cigna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna MGG,Cigna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana,Humana,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana MGG,Humana MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Optum VA,Optum VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC,UHC,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC MGG,UHC MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,VA,VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Wellcare MGG,Wellcare MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health - commercial,Bright Health - commercial,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health MGG,Bright Health MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna,Aetna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna MGG,Aetna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS,BCBS,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS MGG,BCBS MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna,Cigna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna MGG,Cigna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana,Humana,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana MGG,Humana MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Optum VA,Optum VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC,UHC,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC MGG,UHC MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,VA,VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Wellcare MGG,Wellcare MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health - commercial,Bright Health - commercial,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health MGG,Bright Health MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Aetna,Aetna,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Aetna MGG,Aetna MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,BCBS,BCBS,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,BCBS MGG,BCBS MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Cigna,Cigna,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Cigna MGG,Cigna MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Humana,Humana,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Humana MGG,Humana MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Optum VA,Optum VA,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,UHC,UHC,12.48,,,,,,,per diem,12.48,12.48,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,UHC MGG,UHC MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,VA,VA,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Wellcare MGG,Wellcare MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Bright Health - commercial,Bright Health - commercial,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,12.48,12.48,Bright Health MGG,Bright Health MGG,12.48,,,,,,,case rate,12.48,12.48,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Aetna,Aetna,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Aetna MGG,Aetna MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,BCBS,BCBS,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,BCBS MGG,BCBS MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Cigna,Cigna,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Cigna MGG,Cigna MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Humana,Humana,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Humana MGG,Humana MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Optum VA,Optum VA,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,UHC,UHC,10.86,,,,,,,per diem,10.86,10.86,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,UHC MGG,UHC MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,VA,VA,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Wellcare MGG,Wellcare MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Bright Health - commercial,Bright Health - commercial,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,10.86,10.86,Bright Health MGG,Bright Health MGG,10.86,,,,,,,case rate,10.86,10.86,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Aetna,Aetna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Aetna MGG,Aetna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,BCBS,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS MGG,BCBS MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Cigna,Cigna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Cigna MGG,Cigna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Humana,Humana,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Humana MGG,Humana MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Optum VA,Optum VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,UHC,UHC,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,UHC MGG,UHC MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,VA,VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Wellcare MGG,Wellcare MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Bright Health - commercial,Bright Health - commercial,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Bright Health MGG,Bright Health MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Aetna,Aetna,26.19,,,,,,,per diem,26.19,26.19,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Aetna MGG,Aetna MGG,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,BCBS,BCBS,26.19,,,,,,,per diem,26.19,26.19,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,BCBS MGG,BCBS MGG,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Cigna,Cigna,26.19,,,,,,,per diem,26.19,26.19,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Cigna MGG,Cigna MGG,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Humana,Humana,26.19,,,,,,,per diem,26.19,26.19,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Humana MGG,Humana MGG,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Optum VA,Optum VA,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,UHC,UHC,26.19,,,,,,,per diem,26.19,26.19,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,UHC MGG,UHC MGG,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,VA,VA,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Wellcare MGG,Wellcare MGG,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Bright Health - commercial,Bright Health - commercial,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,26.19,26.19,Bright Health MGG,Bright Health MGG,26.19,,,,,,,case rate,26.19,26.19,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Aetna,Aetna,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Aetna MGG,Aetna MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,BCBS,BCBS,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,BCBS MGG,BCBS MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Cigna,Cigna,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Cigna MGG,Cigna MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Humana,Humana,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Humana MGG,Humana MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Optum VA,Optum VA,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,UHC,UHC,33.72,,,,,,,per diem,33.72,33.72,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,UHC MGG,UHC MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,VA,VA,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Wellcare MGG,Wellcare MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Bright Health - commercial,Bright Health - commercial,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,33.72,33.72,Bright Health MGG,Bright Health MGG,33.72,,,,,,,case rate,33.72,33.72,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Aetna,Aetna,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Aetna MGG,Aetna MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,BCBS,BCBS,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,BCBS MGG,BCBS MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Cigna,Cigna,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Cigna MGG,Cigna MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Humana,Humana,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Humana MGG,Humana MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Optum VA,Optum VA,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,UHC,UHC,5.47,,,,,,,per diem,5.47,5.47,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,UHC MGG,UHC MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,VA,VA,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Wellcare MGG,Wellcare MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Bright Health - commercial,Bright Health - commercial,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.47,5.47,Bright Health MGG,Bright Health MGG,5.47,,,,,,,case rate,5.47,5.47,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Aetna,Aetna,120.12,,,,,,,per diem,120.12,120.12,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Aetna MGG,Aetna MGG,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,BCBS,BCBS,120.12,,,,,,,per diem,120.12,120.12,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,BCBS MGG,BCBS MGG,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Cigna,Cigna,120.12,,,,,,,per diem,120.12,120.12,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Cigna MGG,Cigna MGG,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Humana,Humana,120.12,,,,,,,per diem,120.12,120.12,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Humana MGG,Humana MGG,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Optum VA,Optum VA,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,UHC,UHC,120.12,,,,,,,per diem,120.12,120.12,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,UHC MGG,UHC MGG,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,VA,VA,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Wellcare MGG,Wellcare MGG,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Bright Health - commercial,Bright Health - commercial,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,120.12,120.12,Bright Health MGG,Bright Health MGG,120.12,,,,,,,case rate,120.12,120.12,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Aetna,Aetna,70.17,,,,,,,per diem,70.17,70.17,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Aetna MGG,Aetna MGG,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,BCBS,BCBS,70.17,,,,,,,per diem,70.17,70.17,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,BCBS MGG,BCBS MGG,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Cigna,Cigna,70.17,,,,,,,per diem,70.17,70.17,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Cigna MGG,Cigna MGG,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Humana,Humana,70.17,,,,,,,per diem,70.17,70.17,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Humana MGG,Humana MGG,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Optum VA,Optum VA,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,UHC,UHC,70.17,,,,,,,per diem,70.17,70.17,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,UHC MGG,UHC MGG,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,VA,VA,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Wellcare MGG,Wellcare MGG,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Bright Health - commercial,Bright Health - commercial,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,70.17,70.17,Bright Health MGG,Bright Health MGG,70.17,,,,,,,case rate,70.17,70.17,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Aetna,Aetna,52.56,,,,,,,per diem,52.56,52.56,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Aetna MGG,Aetna MGG,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,BCBS,BCBS,52.56,,,,,,,per diem,52.56,52.56,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,BCBS MGG,BCBS MGG,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Cigna,Cigna,52.56,,,,,,,per diem,52.56,52.56,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Cigna MGG,Cigna MGG,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Humana,Humana,52.56,,,,,,,per diem,52.56,52.56,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Humana MGG,Humana MGG,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Optum VA,Optum VA,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,UHC,UHC,52.56,,,,,,,per diem,52.56,52.56,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,UHC MGG,UHC MGG,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,VA,VA,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Wellcare MGG,Wellcare MGG,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Bright Health - commercial,Bright Health - commercial,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,52.56,52.56,Bright Health MGG,Bright Health MGG,52.56,,,,,,,case rate,52.56,52.56,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Aetna,Aetna,53.88,,,,,,,per diem,53.88,53.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Aetna MGG,Aetna MGG,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,BCBS,BCBS,53.88,,,,,,,per diem,53.88,53.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,BCBS MGG,BCBS MGG,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Cigna,Cigna,53.88,,,,,,,per diem,53.88,53.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Cigna MGG,Cigna MGG,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Humana,Humana,53.88,,,,,,,per diem,53.88,53.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Humana MGG,Humana MGG,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Optum VA,Optum VA,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,UHC,UHC,53.88,,,,,,,per diem,53.88,53.88,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,UHC MGG,UHC MGG,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,VA,VA,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Wellcare MGG,Wellcare MGG,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Bright Health - commercial,Bright Health - commercial,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,53.88,53.88,Bright Health MGG,Bright Health MGG,53.88,,,,,,,case rate,53.88,53.88,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Aetna,Aetna,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Aetna MGG,Aetna MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,BCBS,BCBS,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,BCBS MGG,BCBS MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Cigna,Cigna,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Cigna MGG,Cigna MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Humana,Humana,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Humana MGG,Humana MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Optum VA,Optum VA,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,UHC,UHC,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,UHC MGG,UHC MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,VA,VA,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Wellcare MGG,Wellcare MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Bright Health - commercial,Bright Health - commercial,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Bright Health MGG,Bright Health MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Aetna,Aetna,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Aetna MGG,Aetna MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,BCBS,BCBS,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,BCBS MGG,BCBS MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Cigna,Cigna,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Cigna MGG,Cigna MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Humana,Humana,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Humana MGG,Humana MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Optum VA,Optum VA,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,UHC,UHC,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,UHC MGG,UHC MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,VA,VA,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Wellcare MGG,Wellcare MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Bright Health - commercial,Bright Health - commercial,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Bright Health MGG,Bright Health MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Aetna,Aetna,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Aetna MGG,Aetna MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,BCBS,BCBS,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,BCBS MGG,BCBS MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Cigna,Cigna,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Cigna MGG,Cigna MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Humana,Humana,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Humana MGG,Humana MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Optum VA,Optum VA,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,UHC,UHC,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,UHC MGG,UHC MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,VA,VA,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Wellcare MGG,Wellcare MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Bright Health - commercial,Bright Health - commercial,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Bright Health MGG,Bright Health MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Aetna,Aetna,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Aetna MGG,Aetna MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,BCBS,BCBS,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,BCBS MGG,BCBS MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Cigna,Cigna,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Cigna MGG,Cigna MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Humana,Humana,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Humana MGG,Humana MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Optum VA,Optum VA,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,UHC,UHC,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,UHC MGG,UHC MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,VA,VA,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Wellcare MGG,Wellcare MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Bright Health - commercial,Bright Health - commercial,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Bright Health MGG,Bright Health MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Aetna,Aetna,15.18,,,,,,,per diem,15.18,15.18,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Aetna MGG,Aetna MGG,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,BCBS,BCBS,15.18,,,,,,,per diem,15.18,15.18,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,BCBS MGG,BCBS MGG,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Cigna,Cigna,15.18,,,,,,,per diem,15.18,15.18,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Cigna MGG,Cigna MGG,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Humana,Humana,15.18,,,,,,,per diem,15.18,15.18,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Humana MGG,Humana MGG,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Optum VA,Optum VA,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,UHC,UHC,15.18,,,,,,,per diem,15.18,15.18,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,UHC MGG,UHC MGG,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,VA,VA,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Wellcare MGG,Wellcare MGG,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Bright Health - commercial,Bright Health - commercial,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,15.18,15.18,Bright Health MGG,Bright Health MGG,15.18,,,,,,,case rate,15.18,15.18,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Aetna,Aetna,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Aetna MGG,Aetna MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,BCBS,BCBS,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,BCBS MGG,BCBS MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Cigna,Cigna,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Cigna MGG,Cigna MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Humana,Humana,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Humana MGG,Humana MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Optum VA,Optum VA,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,UHC,UHC,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,UHC MGG,UHC MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,VA,VA,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Wellcare MGG,Wellcare MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Bright Health - commercial,Bright Health - commercial,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Bright Health MGG,Bright Health MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Aetna,Aetna,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Aetna MGG,Aetna MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS,BCBS,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS MGG,BCBS MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Cigna,Cigna,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Cigna MGG,Cigna MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Humana,Humana,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Humana MGG,Humana MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Optum VA,Optum VA,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,UHC,UHC,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,UHC MGG,UHC MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,VA,VA,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Wellcare MGG,Wellcare MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Bright Health - commercial,Bright Health - commercial,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Bright Health MGG,Bright Health MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Aetna,Aetna,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Aetna MGG,Aetna MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,BCBS,BCBS,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,BCBS MGG,BCBS MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Cigna,Cigna,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Cigna MGG,Cigna MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Humana,Humana,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Humana MGG,Humana MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Optum VA,Optum VA,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,UHC,UHC,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,UHC MGG,UHC MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,VA,VA,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Wellcare MGG,Wellcare MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Bright Health - commercial,Bright Health - commercial,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,12.99,12.99,Bright Health MGG,Bright Health MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Aetna,Aetna,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Aetna MGG,Aetna MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,BCBS,BCBS,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,BCBS MGG,BCBS MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Cigna,Cigna,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Cigna MGG,Cigna MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Humana,Humana,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Humana MGG,Humana MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Optum VA,Optum VA,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,UHC,UHC,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,UHC MGG,UHC MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,VA,VA,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Wellcare MGG,Wellcare MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Bright Health - commercial,Bright Health - commercial,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Bright Health MGG,Bright Health MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna,Aetna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna MGG,Aetna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS,BCBS,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS MGG,BCBS MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna,Cigna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna MGG,Cigna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana,Humana,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana MGG,Humana MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Optum VA,Optum VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC,UHC,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC MGG,UHC MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,VA,VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Wellcare MGG,Wellcare MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health - commercial,Bright Health - commercial,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health MGG,Bright Health MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Aetna,Aetna,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Aetna MGG,Aetna MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,BCBS,BCBS,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,BCBS MGG,BCBS MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Cigna,Cigna,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Cigna MGG,Cigna MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Humana,Humana,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Humana MGG,Humana MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Optum VA,Optum VA,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,UHC,UHC,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,UHC MGG,UHC MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,VA,VA,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Wellcare MGG,Wellcare MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Bright Health - commercial,Bright Health - commercial,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Bright Health MGG,Bright Health MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Aetna,Aetna,769.35,,,,,,,per diem,769.35,769.35,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Aetna MGG,Aetna MGG,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,BCBS,BCBS,769.35,,,,,,,per diem,769.35,769.35,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,BCBS MGG,BCBS MGG,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Cigna,Cigna,769.35,,,,,,,per diem,769.35,769.35,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Cigna MGG,Cigna MGG,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Humana,Humana,769.35,,,,,,,per diem,769.35,769.35,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Humana MGG,Humana MGG,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Optum VA,Optum VA,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,UHC,UHC,769.35,,,,,,,per diem,769.35,769.35,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,UHC MGG,UHC MGG,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,VA,VA,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Wellcare MGG,Wellcare MGG,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Bright Health - commercial,Bright Health - commercial,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,769.35,769.35,Bright Health MGG,Bright Health MGG,769.35,,,,,,,case rate,769.35,769.35,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Aetna,Aetna,650.76,,,,,,,per diem,650.76,650.76,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Aetna MGG,Aetna MGG,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,BCBS,BCBS,650.76,,,,,,,per diem,650.76,650.76,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,BCBS MGG,BCBS MGG,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Cigna,Cigna,650.76,,,,,,,per diem,650.76,650.76,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Cigna MGG,Cigna MGG,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Humana,Humana,650.76,,,,,,,per diem,650.76,650.76,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Humana MGG,Humana MGG,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Optum VA,Optum VA,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,UHC,UHC,650.76,,,,,,,per diem,650.76,650.76,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,UHC MGG,UHC MGG,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,VA,VA,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Wellcare MGG,Wellcare MGG,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Bright Health - commercial,Bright Health - commercial,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,650.76,650.76,Bright Health MGG,Bright Health MGG,650.76,,,,,,,case rate,650.76,650.76,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna,Aetna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna MGG,Aetna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS,BCBS,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS MGG,BCBS MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna,Cigna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna MGG,Cigna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana,Humana,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana MGG,Humana MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Optum VA,Optum VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC,UHC,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC MGG,UHC MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,VA,VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Wellcare MGG,Wellcare MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health - commercial,Bright Health - commercial,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health MGG,Bright Health MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Aetna,Aetna,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Aetna MGG,Aetna MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,BCBS,BCBS,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,BCBS MGG,BCBS MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Cigna,Cigna,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Cigna MGG,Cigna MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Humana,Humana,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Humana MGG,Humana MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Optum VA,Optum VA,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,UHC,UHC,195.18,,,,,,,per diem,195.18,195.18,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,UHC MGG,UHC MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,VA,VA,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Wellcare MGG,Wellcare MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Bright Health - commercial,Bright Health - commercial,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,195.18,195.18,Bright Health MGG,Bright Health MGG,195.18,,,,,,,case rate,195.18,195.18,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Aetna,Aetna,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Aetna MGG,Aetna MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,BCBS,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS MGG,BCBS MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Cigna,Cigna,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Cigna MGG,Cigna MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Humana,Humana,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Humana MGG,Humana MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Optum VA,Optum VA,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UHC,UHC,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UHC MGG,UHC MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,VA,VA,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Wellcare MGG,Wellcare MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Bright Health - commercial,Bright Health - commercial,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,Bright Health MGG,Bright Health MGG,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Aetna,Aetna,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Aetna MGG,Aetna MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,BCBS,BCBS,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,BCBS MGG,BCBS MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Cigna,Cigna,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Cigna MGG,Cigna MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Humana,Humana,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Humana MGG,Humana MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Optum VA,Optum VA,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,UHC,UHC,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,UHC MGG,UHC MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,VA,VA,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Wellcare MGG,Wellcare MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Bright Health - commercial,Bright Health - commercial,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Bright Health MGG,Bright Health MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna,Aetna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna MGG,Aetna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS,BCBS,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS MGG,BCBS MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna,Cigna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna MGG,Cigna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana,Humana,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana MGG,Humana MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Optum VA,Optum VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC,UHC,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC MGG,UHC MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,VA,VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Wellcare MGG,Wellcare MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health - commercial,Bright Health - commercial,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health MGG,Bright Health MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Aetna,Aetna,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Aetna MGG,Aetna MGG,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,BCBS,BCBS,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,BCBS MGG,BCBS MGG,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Cigna,Cigna,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Cigna MGG,Cigna MGG,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Humana,Humana,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Humana MGG,Humana MGG,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Optum VA,Optum VA,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,UHC,UHC,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,UHC MGG,UHC MGG,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,VA,VA,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Wellcare MGG,Wellcare MGG,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Bright Health - commercial,Bright Health - commercial,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,Bright Health MGG,Bright Health MGG,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Aetna,Aetna,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Aetna MGG,Aetna MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,BCBS,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS MGG,BCBS MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Cigna,Cigna,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Cigna MGG,Cigna MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Humana,Humana,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Humana MGG,Humana MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Optum VA,Optum VA,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,UHC,UHC,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,UHC MGG,UHC MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,VA,VA,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Wellcare MGG,Wellcare MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Bright Health - commercial,Bright Health - commercial,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,Bright Health MGG,Bright Health MGG,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna,Aetna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Aetna MGG,Aetna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,BCBS,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS MGG,BCBS MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna,Cigna,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Cigna MGG,Cigna MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana,Humana,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Humana MGG,Humana MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Optum VA,Optum VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC,UHC,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UHC MGG,UHC MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,VA,VA,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Wellcare MGG,Wellcare MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health - commercial,Bright Health - commercial,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,Bright Health MGG,Bright Health MGG,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Aetna,Aetna,2188.74,,,,,,,per diem,2188.74,2188.74,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Aetna MGG,Aetna MGG,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,BCBS,BCBS,2188.74,,,,,,,per diem,2188.74,2188.74,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,BCBS MGG,BCBS MGG,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Cigna,Cigna,2188.74,,,,,,,per diem,2188.74,2188.74,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Cigna MGG,Cigna MGG,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Humana,Humana,2188.74,,,,,,,per diem,2188.74,2188.74,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Humana MGG,Humana MGG,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Optum VA,Optum VA,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,UHC,UHC,2188.74,,,,,,,per diem,2188.74,2188.74,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,UHC MGG,UHC MGG,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,VA,VA,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Wellcare MGG,Wellcare MGG,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Bright Health - commercial,Bright Health - commercial,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2188.74,2188.74,Bright Health MGG,Bright Health MGG,2188.74,,,,,,,case rate,2188.74,2188.74,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Aetna,Aetna,1291.8,,,,,,,per diem,1291.8,1291.8,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Aetna MGG,Aetna MGG,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,BCBS,BCBS,1291.8,,,,,,,per diem,1291.8,1291.8,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,BCBS MGG,BCBS MGG,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Cigna,Cigna,1291.8,,,,,,,per diem,1291.8,1291.8,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Cigna MGG,Cigna MGG,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Humana,Humana,1291.8,,,,,,,per diem,1291.8,1291.8,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Humana MGG,Humana MGG,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Optum VA,Optum VA,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,UHC,UHC,1291.8,,,,,,,per diem,1291.8,1291.8,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,UHC MGG,UHC MGG,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,VA,VA,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Wellcare MGG,Wellcare MGG,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Bright Health - commercial,Bright Health - commercial,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1291.8,1291.8,Bright Health MGG,Bright Health MGG,1291.8,,,,,,,case rate,1291.8,1291.8,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Aetna,Aetna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Aetna MGG,Aetna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,BCBS,BCBS,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,BCBS MGG,BCBS MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Cigna,Cigna,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Cigna MGG,Cigna MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Humana,Humana,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Humana MGG,Humana MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Optum VA,Optum VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,UHC,UHC,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,UHC MGG,UHC MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,VA,VA,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Wellcare MGG,Wellcare MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Bright Health - commercial,Bright Health - commercial,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,36,36,Bright Health MGG,Bright Health MGG,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Aetna,Aetna,105.15,,,,,,,per diem,105.15,105.15,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Aetna MGG,Aetna MGG,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,BCBS,BCBS,105.15,,,,,,,per diem,105.15,105.15,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,BCBS MGG,BCBS MGG,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Cigna,Cigna,105.15,,,,,,,per diem,105.15,105.15,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Cigna MGG,Cigna MGG,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Humana,Humana,105.15,,,,,,,per diem,105.15,105.15,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Humana MGG,Humana MGG,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Optum VA,Optum VA,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,UHC,UHC,105.15,,,,,,,per diem,105.15,105.15,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,UHC MGG,UHC MGG,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,VA,VA,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Wellcare MGG,Wellcare MGG,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Bright Health - commercial,Bright Health - commercial,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,105.15,105.15,Bright Health MGG,Bright Health MGG,105.15,,,,,,,case rate,105.15,105.15,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Aetna,Aetna,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Aetna MGG,Aetna MGG,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,BCBS,BCBS,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,BCBS MGG,BCBS MGG,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Cigna,Cigna,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Cigna MGG,Cigna MGG,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Humana,Humana,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Humana MGG,Humana MGG,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Optum VA,Optum VA,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,UHC,UHC,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,UHC MGG,UHC MGG,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,VA,VA,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Wellcare MGG,Wellcare MGG,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Bright Health - commercial,Bright Health - commercial,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,218.7,218.7,Bright Health MGG,Bright Health MGG,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Aetna,Aetna,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Aetna MGG,Aetna MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,BCBS,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS MGG,BCBS MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Cigna,Cigna,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Cigna MGG,Cigna MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Humana,Humana,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Humana MGG,Humana MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Optum VA,Optum VA,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UHC,UHC,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UHC MGG,UHC MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,VA,VA,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Wellcare MGG,Wellcare MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Bright Health - commercial,Bright Health - commercial,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,Bright Health MGG,Bright Health MGG,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Aetna,Aetna,74.19,,,,,,,per diem,74.19,74.19,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Aetna MGG,Aetna MGG,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,BCBS,BCBS,74.19,,,,,,,per diem,74.19,74.19,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,BCBS MGG,BCBS MGG,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Cigna,Cigna,74.19,,,,,,,per diem,74.19,74.19,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Cigna MGG,Cigna MGG,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Humana,Humana,74.19,,,,,,,per diem,74.19,74.19,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Humana MGG,Humana MGG,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Optum VA,Optum VA,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,UHC,UHC,74.19,,,,,,,per diem,74.19,74.19,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,UHC MGG,UHC MGG,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,VA,VA,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Wellcare MGG,Wellcare MGG,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Bright Health - commercial,Bright Health - commercial,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,74.19,74.19,Bright Health MGG,Bright Health MGG,74.19,,,,,,,case rate,74.19,74.19,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Aetna,Aetna,67.5,,,,,,,per diem,67.5,67.5,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Aetna MGG,Aetna MGG,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,BCBS,BCBS,67.5,,,,,,,per diem,67.5,67.5,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,BCBS MGG,BCBS MGG,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Cigna,Cigna,67.5,,,,,,,per diem,67.5,67.5,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Cigna MGG,Cigna MGG,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Humana,Humana,67.5,,,,,,,per diem,67.5,67.5,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Humana MGG,Humana MGG,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Optum VA,Optum VA,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,UHC,UHC,67.5,,,,,,,per diem,67.5,67.5,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,UHC MGG,UHC MGG,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,VA,VA,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Wellcare MGG,Wellcare MGG,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Bright Health - commercial,Bright Health - commercial,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,67.5,67.5,Bright Health MGG,Bright Health MGG,67.5,,,,,,,case rate,67.5,67.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Aetna,Aetna,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Aetna MGG,Aetna MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,BCBS,BCBS,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,BCBS MGG,BCBS MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Cigna,Cigna,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Cigna MGG,Cigna MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Humana,Humana,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Humana MGG,Humana MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Optum VA,Optum VA,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,UHC,UHC,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,UHC MGG,UHC MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,VA,VA,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Wellcare MGG,Wellcare MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Bright Health - commercial,Bright Health - commercial,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,29.01,29.01,Bright Health MGG,Bright Health MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Aetna,Aetna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Aetna MGG,Aetna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,BCBS,BCBS,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,BCBS MGG,BCBS MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Cigna,Cigna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Cigna MGG,Cigna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Humana,Humana,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Humana MGG,Humana MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Optum VA,Optum VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,UHC,UHC,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,UHC MGG,UHC MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,VA,VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Wellcare MGG,Wellcare MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Bright Health - commercial,Bright Health - commercial,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Bright Health MGG,Bright Health MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Aetna,Aetna,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Aetna MGG,Aetna MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,BCBS,BCBS,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,BCBS MGG,BCBS MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Cigna,Cigna,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Cigna MGG,Cigna MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Humana,Humana,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Humana MGG,Humana MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Optum VA,Optum VA,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,UHC,UHC,81,,,,,,,per diem,81,81,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,UHC MGG,UHC MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,VA,VA,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Wellcare MGG,Wellcare MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Bright Health - commercial,Bright Health - commercial,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,81,81,Bright Health MGG,Bright Health MGG,81,,,,,,,case rate,81,81,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Aetna,Aetna,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Aetna MGG,Aetna MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,BCBS,BCBS,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,BCBS MGG,BCBS MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Cigna,Cigna,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Cigna MGG,Cigna MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Humana,Humana,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Humana MGG,Humana MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Optum VA,Optum VA,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,UHC,UHC,13.77,,,,,,,per diem,13.77,13.77,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,UHC MGG,UHC MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,VA,VA,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Wellcare MGG,Wellcare MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Bright Health - commercial,Bright Health - commercial,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,13.77,13.77,Bright Health MGG,Bright Health MGG,13.77,,,,,,,case rate,13.77,13.77,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Aetna,Aetna,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Aetna MGG,Aetna MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,BCBS,BCBS,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,BCBS MGG,BCBS MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Cigna,Cigna,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Cigna MGG,Cigna MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Humana,Humana,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Humana MGG,Humana MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Optum VA,Optum VA,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,UHC,UHC,17.67,,,,,,,per diem,17.67,17.67,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,UHC MGG,UHC MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,VA,VA,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Wellcare MGG,Wellcare MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Bright Health - commercial,Bright Health - commercial,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,17.67,17.67,Bright Health MGG,Bright Health MGG,17.67,,,,,,,case rate,17.67,17.67,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Aetna,Aetna,102.09,,,,,,,per diem,102.09,102.09,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Aetna MGG,Aetna MGG,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,BCBS,BCBS,102.09,,,,,,,per diem,102.09,102.09,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,BCBS MGG,BCBS MGG,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Cigna,Cigna,102.09,,,,,,,per diem,102.09,102.09,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Cigna MGG,Cigna MGG,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Humana,Humana,102.09,,,,,,,per diem,102.09,102.09,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Humana MGG,Humana MGG,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Optum VA,Optum VA,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,UHC,UHC,102.09,,,,,,,per diem,102.09,102.09,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,UHC MGG,UHC MGG,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,VA,VA,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Wellcare MGG,Wellcare MGG,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Bright Health - commercial,Bright Health - commercial,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,102.09,102.09,Bright Health MGG,Bright Health MGG,102.09,,,,,,,case rate,102.09,102.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Aetna,Aetna,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Aetna MGG,Aetna MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,BCBS,BCBS,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,BCBS MGG,BCBS MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Cigna,Cigna,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Cigna MGG,Cigna MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Humana,Humana,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Humana MGG,Humana MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Optum VA,Optum VA,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,UHC,UHC,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,UHC MGG,UHC MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,VA,VA,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Wellcare MGG,Wellcare MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Bright Health - commercial,Bright Health - commercial,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Bright Health MGG,Bright Health MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Aetna,Aetna,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Aetna MGG,Aetna MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS,BCBS,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS MGG,BCBS MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Cigna,Cigna,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Cigna MGG,Cigna MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Humana,Humana,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Humana MGG,Humana MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Optum VA,Optum VA,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,UHC,UHC,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,UHC MGG,UHC MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,VA,VA,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Wellcare MGG,Wellcare MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Bright Health - commercial,Bright Health - commercial,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Bright Health MGG,Bright Health MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Aetna,Aetna,991.56,,,,,,,per diem,991.56,991.56,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Aetna MGG,Aetna MGG,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,BCBS,BCBS,991.56,,,,,,,per diem,991.56,991.56,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,BCBS MGG,BCBS MGG,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Cigna,Cigna,991.56,,,,,,,per diem,991.56,991.56,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Cigna MGG,Cigna MGG,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Humana,Humana,991.56,,,,,,,per diem,991.56,991.56,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Humana MGG,Humana MGG,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Optum VA,Optum VA,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,UHC,UHC,991.56,,,,,,,per diem,991.56,991.56,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,UHC MGG,UHC MGG,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,VA,VA,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Wellcare MGG,Wellcare MGG,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Bright Health - commercial,Bright Health - commercial,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,991.56,991.56,Bright Health MGG,Bright Health MGG,991.56,,,,,,,case rate,991.56,991.56,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Aetna,Aetna,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Aetna MGG,Aetna MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,BCBS,BCBS,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,BCBS MGG,BCBS MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Cigna,Cigna,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Cigna MGG,Cigna MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Humana,Humana,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Humana MGG,Humana MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Optum VA,Optum VA,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,UHC,UHC,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,UHC MGG,UHC MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,VA,VA,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Wellcare MGG,Wellcare MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Bright Health - commercial,Bright Health - commercial,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Bright Health MGG,Bright Health MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna,Aetna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna MGG,Aetna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,BCBS,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS MGG,BCBS MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna,Cigna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna MGG,Cigna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana,Humana,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana MGG,Humana MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Optum VA,Optum VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC,UHC,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC MGG,UHC MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,VA,VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Wellcare MGG,Wellcare MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health - commercial,Bright Health - commercial,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health MGG,Bright Health MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Aetna,Aetna,44.64,,,,,,,per diem,44.64,44.64,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Aetna MGG,Aetna MGG,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,BCBS,BCBS,44.64,,,,,,,per diem,44.64,44.64,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,BCBS MGG,BCBS MGG,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Cigna,Cigna,44.64,,,,,,,per diem,44.64,44.64,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Cigna MGG,Cigna MGG,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Humana,Humana,44.64,,,,,,,per diem,44.64,44.64,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Humana MGG,Humana MGG,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Optum VA,Optum VA,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,UHC,UHC,44.64,,,,,,,per diem,44.64,44.64,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,UHC MGG,UHC MGG,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,VA,VA,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Wellcare MGG,Wellcare MGG,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Bright Health - commercial,Bright Health - commercial,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,44.64,44.64,Bright Health MGG,Bright Health MGG,44.64,,,,,,,case rate,44.64,44.64,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Aetna,Aetna,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Aetna MGG,Aetna MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,BCBS,BCBS,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,BCBS MGG,BCBS MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Cigna,Cigna,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Cigna MGG,Cigna MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Humana,Humana,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Humana MGG,Humana MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Optum VA,Optum VA,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,UHC,UHC,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,UHC MGG,UHC MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,VA,VA,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Wellcare MGG,Wellcare MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Bright Health - commercial,Bright Health - commercial,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.16,14.16,Bright Health MGG,Bright Health MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Aetna,Aetna,163.89,,,,,,,per diem,163.89,163.89,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Aetna MGG,Aetna MGG,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,BCBS,BCBS,163.89,,,,,,,per diem,163.89,163.89,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,BCBS MGG,BCBS MGG,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Cigna,Cigna,163.89,,,,,,,per diem,163.89,163.89,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Cigna MGG,Cigna MGG,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Humana,Humana,163.89,,,,,,,per diem,163.89,163.89,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Humana MGG,Humana MGG,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Optum VA,Optum VA,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,UHC,UHC,163.89,,,,,,,per diem,163.89,163.89,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,UHC MGG,UHC MGG,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,VA,VA,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Wellcare MGG,Wellcare MGG,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Bright Health - commercial,Bright Health - commercial,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,163.89,163.89,Bright Health MGG,Bright Health MGG,163.89,,,,,,,case rate,163.89,163.89,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Aetna,Aetna,257.1,,,,,,,per diem,257.1,257.1,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Aetna MGG,Aetna MGG,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,BCBS,BCBS,257.1,,,,,,,per diem,257.1,257.1,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,BCBS MGG,BCBS MGG,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Cigna,Cigna,257.1,,,,,,,per diem,257.1,257.1,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Cigna MGG,Cigna MGG,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Humana,Humana,257.1,,,,,,,per diem,257.1,257.1,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Humana MGG,Humana MGG,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Optum VA,Optum VA,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,UHC,UHC,257.1,,,,,,,per diem,257.1,257.1,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,UHC MGG,UHC MGG,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,VA,VA,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Wellcare MGG,Wellcare MGG,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Bright Health - commercial,Bright Health - commercial,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,257.1,257.1,Bright Health MGG,Bright Health MGG,257.1,,,,,,,case rate,257.1,257.1,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Aetna,Aetna,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Aetna MGG,Aetna MGG,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,BCBS,BCBS,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,BCBS MGG,BCBS MGG,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Cigna,Cigna,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Cigna MGG,Cigna MGG,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Humana,Humana,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Humana MGG,Humana MGG,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Optum VA,Optum VA,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,UHC,UHC,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,UHC MGG,UHC MGG,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,VA,VA,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Wellcare MGG,Wellcare MGG,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Bright Health - commercial,Bright Health - commercial,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,147.84,147.84,Bright Health MGG,Bright Health MGG,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Aetna,Aetna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Aetna MGG,Aetna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,BCBS,BCBS,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,BCBS MGG,BCBS MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Cigna,Cigna,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Cigna MGG,Cigna MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Humana,Humana,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Humana MGG,Humana MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Optum VA,Optum VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,UHC,UHC,54,,,,,,,per diem,54,54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,UHC MGG,UHC MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,VA,VA,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Wellcare MGG,Wellcare MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Bright Health - commercial,Bright Health - commercial,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,54,54,Bright Health MGG,Bright Health MGG,54,,,,,,,case rate,54,54,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Aetna,Aetna,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Aetna MGG,Aetna MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,BCBS,BCBS,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,BCBS MGG,BCBS MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Cigna,Cigna,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Cigna MGG,Cigna MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Humana,Humana,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Humana MGG,Humana MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Optum VA,Optum VA,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,UHC,UHC,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,UHC MGG,UHC MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,VA,VA,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Wellcare MGG,Wellcare MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Bright Health - commercial,Bright Health - commercial,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Bright Health MGG,Bright Health MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Aetna,Aetna,184.44,,,,,,,per diem,184.44,184.44,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Aetna MGG,Aetna MGG,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,BCBS,BCBS,184.44,,,,,,,per diem,184.44,184.44,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,BCBS MGG,BCBS MGG,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Cigna,Cigna,184.44,,,,,,,per diem,184.44,184.44,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Cigna MGG,Cigna MGG,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Humana,Humana,184.44,,,,,,,per diem,184.44,184.44,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Humana MGG,Humana MGG,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Optum VA,Optum VA,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,UHC,UHC,184.44,,,,,,,per diem,184.44,184.44,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,UHC MGG,UHC MGG,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,VA,VA,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Wellcare MGG,Wellcare MGG,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Bright Health - commercial,Bright Health - commercial,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,184.44,184.44,Bright Health MGG,Bright Health MGG,184.44,,,,,,,case rate,184.44,184.44,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Aetna,Aetna,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Aetna MGG,Aetna MGG,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,BCBS,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS MGG,BCBS MGG,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Cigna,Cigna,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Cigna MGG,Cigna MGG,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Humana,Humana,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Humana MGG,Humana MGG,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Optum VA,Optum VA,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UHC,UHC,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UHC MGG,UHC MGG,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,VA,VA,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Wellcare MGG,Wellcare MGG,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Bright Health - commercial,Bright Health - commercial,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,Bright Health MGG,Bright Health MGG,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Aetna,Aetna,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Aetna MGG,Aetna MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,BCBS,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS MGG,BCBS MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Cigna,Cigna,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Cigna MGG,Cigna MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Humana,Humana,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Humana MGG,Humana MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Optum VA,Optum VA,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,UHC,UHC,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,UHC MGG,UHC MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,VA,VA,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Wellcare MGG,Wellcare MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Bright Health - commercial,Bright Health - commercial,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,14.4,14.4,Bright Health MGG,Bright Health MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Aetna,Aetna,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Aetna MGG,Aetna MGG,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,BCBS,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS MGG,BCBS MGG,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Cigna,Cigna,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Cigna MGG,Cigna MGG,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Humana,Humana,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Humana MGG,Humana MGG,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Optum VA,Optum VA,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UHC,UHC,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UHC MGG,UHC MGG,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,VA,VA,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Wellcare MGG,Wellcare MGG,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Bright Health - commercial,Bright Health - commercial,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,Bright Health MGG,Bright Health MGG,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Aetna,Aetna,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Aetna MGG,Aetna MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,BCBS,BCBS,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,BCBS MGG,BCBS MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Cigna,Cigna,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Cigna MGG,Cigna MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Humana,Humana,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Humana MGG,Humana MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Optum VA,Optum VA,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,UHC,UHC,17.64,,,,,,,per diem,17.64,17.64,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,UHC MGG,UHC MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,VA,VA,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Wellcare MGG,Wellcare MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Bright Health - commercial,Bright Health - commercial,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,17.64,17.64,Bright Health MGG,Bright Health MGG,17.64,,,,,,,case rate,17.64,17.64,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Aetna,Aetna,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Aetna MGG,Aetna MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,BCBS,BCBS,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,BCBS MGG,BCBS MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Cigna,Cigna,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Cigna MGG,Cigna MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Humana,Humana,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Humana MGG,Humana MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Optum VA,Optum VA,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,UHC,UHC,296.25,,,,,,,per diem,296.25,296.25,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,UHC MGG,UHC MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,VA,VA,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Wellcare MGG,Wellcare MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Bright Health - commercial,Bright Health - commercial,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,296.25,296.25,Bright Health MGG,Bright Health MGG,296.25,,,,,,,case rate,296.25,296.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Aetna,Aetna,123.21,,,,,,,per diem,123.21,123.21,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Aetna MGG,Aetna MGG,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,BCBS,BCBS,123.21,,,,,,,per diem,123.21,123.21,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,BCBS MGG,BCBS MGG,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Cigna,Cigna,123.21,,,,,,,per diem,123.21,123.21,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Cigna MGG,Cigna MGG,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Humana,Humana,123.21,,,,,,,per diem,123.21,123.21,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Humana MGG,Humana MGG,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Optum VA,Optum VA,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,UHC,UHC,123.21,,,,,,,per diem,123.21,123.21,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,UHC MGG,UHC MGG,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,VA,VA,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Wellcare MGG,Wellcare MGG,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Bright Health - commercial,Bright Health - commercial,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,123.21,123.21,Bright Health MGG,Bright Health MGG,123.21,,,,,,,case rate,123.21,123.21,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Aetna,Aetna,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Aetna MGG,Aetna MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,BCBS,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS MGG,BCBS MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Cigna,Cigna,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Cigna MGG,Cigna MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Humana,Humana,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Humana MGG,Humana MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Optum VA,Optum VA,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UHC,UHC,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UHC MGG,UHC MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,VA,VA,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Wellcare MGG,Wellcare MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Bright Health - commercial,Bright Health - commercial,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,Bright Health MGG,Bright Health MGG,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Aetna,Aetna,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Aetna MGG,Aetna MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,BCBS,BCBS,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,BCBS MGG,BCBS MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Cigna,Cigna,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Cigna MGG,Cigna MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Humana,Humana,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Humana MGG,Humana MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Optum VA,Optum VA,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,UHC,UHC,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,UHC MGG,UHC MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,VA,VA,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Wellcare MGG,Wellcare MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Bright Health - commercial,Bright Health - commercial,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Bright Health MGG,Bright Health MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Aetna,Aetna,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Aetna MGG,Aetna MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,BCBS,BCBS,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,BCBS MGG,BCBS MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Cigna,Cigna,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Cigna MGG,Cigna MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Humana,Humana,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Humana MGG,Humana MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Optum VA,Optum VA,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,UHC,UHC,141.93,,,,,,,per diem,141.93,141.93,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,UHC MGG,UHC MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,VA,VA,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Wellcare MGG,Wellcare MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Bright Health - commercial,Bright Health - commercial,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,141.93,141.93,Bright Health MGG,Bright Health MGG,141.93,,,,,,,case rate,141.93,141.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Aetna,Aetna,118.8,,,,,,,per diem,118.8,118.8,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Aetna MGG,Aetna MGG,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,BCBS,BCBS,118.8,,,,,,,per diem,118.8,118.8,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,BCBS MGG,BCBS MGG,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Cigna,Cigna,118.8,,,,,,,per diem,118.8,118.8,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Cigna MGG,Cigna MGG,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Humana,Humana,118.8,,,,,,,per diem,118.8,118.8,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Humana MGG,Humana MGG,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Optum VA,Optum VA,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,UHC,UHC,118.8,,,,,,,per diem,118.8,118.8,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,UHC MGG,UHC MGG,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,VA,VA,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Wellcare MGG,Wellcare MGG,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Bright Health - commercial,Bright Health - commercial,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,118.8,118.8,Bright Health MGG,Bright Health MGG,118.8,,,,,,,case rate,118.8,118.8,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna,Aetna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna MGG,Aetna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS,BCBS,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS MGG,BCBS MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna,Cigna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna MGG,Cigna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana,Humana,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana MGG,Humana MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Optum VA,Optum VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC,UHC,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC MGG,UHC MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,VA,VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Wellcare MGG,Wellcare MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health - commercial,Bright Health - commercial,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health MGG,Bright Health MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Aetna,Aetna,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Aetna MGG,Aetna MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,BCBS,BCBS,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,BCBS MGG,BCBS MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Cigna,Cigna,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Cigna MGG,Cigna MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Humana,Humana,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Humana MGG,Humana MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Optum VA,Optum VA,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,UHC,UHC,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,UHC MGG,UHC MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,VA,VA,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Wellcare MGG,Wellcare MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Bright Health - commercial,Bright Health - commercial,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Bright Health MGG,Bright Health MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Aetna,Aetna,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Aetna MGG,Aetna MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,BCBS,BCBS,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,BCBS MGG,BCBS MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Cigna,Cigna,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Cigna MGG,Cigna MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Humana,Humana,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Humana MGG,Humana MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Optum VA,Optum VA,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,UHC,UHC,80.55,,,,,,,per diem,80.55,80.55,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,UHC MGG,UHC MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,VA,VA,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Wellcare MGG,Wellcare MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Bright Health - commercial,Bright Health - commercial,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,80.55,80.55,Bright Health MGG,Bright Health MGG,80.55,,,,,,,case rate,80.55,80.55,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna,Aetna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna MGG,Aetna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS,BCBS,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS MGG,BCBS MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna,Cigna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna MGG,Cigna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana,Humana,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana MGG,Humana MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Optum VA,Optum VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC,UHC,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC MGG,UHC MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,VA,VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Wellcare MGG,Wellcare MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health - commercial,Bright Health - commercial,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health MGG,Bright Health MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Aetna,Aetna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Aetna MGG,Aetna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,BCBS,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS MGG,BCBS MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Cigna,Cigna,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Cigna MGG,Cigna MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Humana,Humana,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Humana MGG,Humana MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Optum VA,Optum VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,UHC,UHC,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,UHC MGG,UHC MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,VA,VA,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Wellcare MGG,Wellcare MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Bright Health - commercial,Bright Health - commercial,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,Bright Health MGG,Bright Health MGG,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Aetna,Aetna,116.13,,,,,,,per diem,116.13,116.13,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Aetna MGG,Aetna MGG,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,BCBS,BCBS,116.13,,,,,,,per diem,116.13,116.13,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,BCBS MGG,BCBS MGG,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Cigna,Cigna,116.13,,,,,,,per diem,116.13,116.13,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Cigna MGG,Cigna MGG,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Humana,Humana,116.13,,,,,,,per diem,116.13,116.13,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Humana MGG,Humana MGG,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Optum VA,Optum VA,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,UHC,UHC,116.13,,,,,,,per diem,116.13,116.13,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,UHC MGG,UHC MGG,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,VA,VA,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Wellcare MGG,Wellcare MGG,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Bright Health - commercial,Bright Health - commercial,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,116.13,116.13,Bright Health MGG,Bright Health MGG,116.13,,,,,,,case rate,116.13,116.13,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Aetna,Aetna,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Aetna MGG,Aetna MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,BCBS,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS MGG,BCBS MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Cigna,Cigna,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Cigna MGG,Cigna MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Humana,Humana,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Humana MGG,Humana MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Optum VA,Optum VA,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UHC,UHC,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UHC MGG,UHC MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,VA,VA,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Wellcare MGG,Wellcare MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Bright Health - commercial,Bright Health - commercial,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,Bright Health MGG,Bright Health MGG,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Aetna,Aetna,70.29,,,,,,,per diem,70.29,70.29,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Aetna MGG,Aetna MGG,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,BCBS,BCBS,70.29,,,,,,,per diem,70.29,70.29,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,BCBS MGG,BCBS MGG,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Cigna,Cigna,70.29,,,,,,,per diem,70.29,70.29,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Cigna MGG,Cigna MGG,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Humana,Humana,70.29,,,,,,,per diem,70.29,70.29,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Humana MGG,Humana MGG,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Optum VA,Optum VA,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,UHC,UHC,70.29,,,,,,,per diem,70.29,70.29,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,UHC MGG,UHC MGG,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,VA,VA,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Wellcare MGG,Wellcare MGG,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Bright Health - commercial,Bright Health - commercial,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,70.29,70.29,Bright Health MGG,Bright Health MGG,70.29,,,,,,,case rate,70.29,70.29,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Aetna,Aetna,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Aetna MGG,Aetna MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS,BCBS,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS MGG,BCBS MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Cigna,Cigna,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Cigna MGG,Cigna MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Humana,Humana,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Humana MGG,Humana MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Optum VA,Optum VA,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,UHC,UHC,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,UHC MGG,UHC MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,VA,VA,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Wellcare MGG,Wellcare MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Bright Health - commercial,Bright Health - commercial,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,Bright Health MGG,Bright Health MGG,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Aetna,Aetna,29.25,,,,,,,per diem,29.25,29.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Aetna MGG,Aetna MGG,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,BCBS,BCBS,29.25,,,,,,,per diem,29.25,29.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,BCBS MGG,BCBS MGG,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Cigna,Cigna,29.25,,,,,,,per diem,29.25,29.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Cigna MGG,Cigna MGG,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Humana,Humana,29.25,,,,,,,per diem,29.25,29.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Humana MGG,Humana MGG,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Optum VA,Optum VA,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,UHC,UHC,29.25,,,,,,,per diem,29.25,29.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,UHC MGG,UHC MGG,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,VA,VA,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Wellcare MGG,Wellcare MGG,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Bright Health - commercial,Bright Health - commercial,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,29.25,29.25,Bright Health MGG,Bright Health MGG,29.25,,,,,,,case rate,29.25,29.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Aetna,Aetna,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Aetna MGG,Aetna MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,BCBS,BCBS,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,BCBS MGG,BCBS MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Cigna,Cigna,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Cigna MGG,Cigna MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Humana,Humana,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Humana MGG,Humana MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Optum VA,Optum VA,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,UHC,UHC,13.74,,,,,,,per diem,13.74,13.74,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,UHC MGG,UHC MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,VA,VA,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Wellcare MGG,Wellcare MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Bright Health - commercial,Bright Health - commercial,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,13.74,13.74,Bright Health MGG,Bright Health MGG,13.74,,,,,,,case rate,13.74,13.74,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Aetna,Aetna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Aetna MGG,Aetna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,BCBS,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS MGG,BCBS MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Cigna,Cigna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Cigna MGG,Cigna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Humana,Humana,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Humana MGG,Humana MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Optum VA,Optum VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UHC,UHC,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UHC MGG,UHC MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA,VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Wellcare MGG,Wellcare MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Bright Health - commercial,Bright Health - commercial,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Bright Health MGG,Bright Health MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Aetna,Aetna,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Aetna MGG,Aetna MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,BCBS,BCBS,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,BCBS MGG,BCBS MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Cigna,Cigna,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Cigna MGG,Cigna MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Humana,Humana,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Humana MGG,Humana MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Optum VA,Optum VA,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,UHC,UHC,58.14,,,,,,,per diem,58.14,58.14,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,UHC MGG,UHC MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,VA,VA,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Wellcare MGG,Wellcare MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Bright Health - commercial,Bright Health - commercial,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,58.14,58.14,Bright Health MGG,Bright Health MGG,58.14,,,,,,,case rate,58.14,58.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna,Aetna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna MGG,Aetna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,BCBS,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS MGG,BCBS MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna,Cigna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna MGG,Cigna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana,Humana,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana MGG,Humana MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Optum VA,Optum VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC,UHC,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC MGG,UHC MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,VA,VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Wellcare MGG,Wellcare MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health - commercial,Bright Health - commercial,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health MGG,Bright Health MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Aetna,Aetna,107.31,,,,,,,per diem,107.31,107.31,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Aetna MGG,Aetna MGG,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,BCBS,BCBS,107.31,,,,,,,per diem,107.31,107.31,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,BCBS MGG,BCBS MGG,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Cigna,Cigna,107.31,,,,,,,per diem,107.31,107.31,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Cigna MGG,Cigna MGG,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Humana,Humana,107.31,,,,,,,per diem,107.31,107.31,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Humana MGG,Humana MGG,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Optum VA,Optum VA,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,UHC,UHC,107.31,,,,,,,per diem,107.31,107.31,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,UHC MGG,UHC MGG,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,VA,VA,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Wellcare MGG,Wellcare MGG,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Bright Health - commercial,Bright Health - commercial,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,107.31,107.31,Bright Health MGG,Bright Health MGG,107.31,,,,,,,case rate,107.31,107.31,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Aetna,Aetna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Aetna MGG,Aetna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,BCBS,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS MGG,BCBS MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Cigna,Cigna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Cigna MGG,Cigna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Humana,Humana,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Humana MGG,Humana MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Optum VA,Optum VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UHC,UHC,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UHC MGG,UHC MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA,VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Wellcare MGG,Wellcare MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Bright Health - commercial,Bright Health - commercial,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Bright Health MGG,Bright Health MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Aetna,Aetna,87.45,,,,,,,per diem,87.45,87.45,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Aetna MGG,Aetna MGG,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,BCBS,BCBS,87.45,,,,,,,per diem,87.45,87.45,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,BCBS MGG,BCBS MGG,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Cigna,Cigna,87.45,,,,,,,per diem,87.45,87.45,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Cigna MGG,Cigna MGG,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Humana,Humana,87.45,,,,,,,per diem,87.45,87.45,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Humana MGG,Humana MGG,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Optum VA,Optum VA,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,UHC,UHC,87.45,,,,,,,per diem,87.45,87.45,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,UHC MGG,UHC MGG,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,VA,VA,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Wellcare MGG,Wellcare MGG,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Bright Health - commercial,Bright Health - commercial,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,87.45,87.45,Bright Health MGG,Bright Health MGG,87.45,,,,,,,case rate,87.45,87.45,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Aetna,Aetna,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Aetna MGG,Aetna MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,BCBS,BCBS,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,BCBS MGG,BCBS MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Cigna,Cigna,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Cigna MGG,Cigna MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Humana,Humana,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Humana MGG,Humana MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Optum VA,Optum VA,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,UHC,UHC,9.03,,,,,,,per diem,9.03,9.03,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,UHC MGG,UHC MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,VA,VA,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Wellcare MGG,Wellcare MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Bright Health - commercial,Bright Health - commercial,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.03,9.03,Bright Health MGG,Bright Health MGG,9.03,,,,,,,case rate,9.03,9.03,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Aetna,Aetna,15.96,,,,,,,per diem,15.96,15.96,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Aetna MGG,Aetna MGG,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,BCBS,BCBS,15.96,,,,,,,per diem,15.96,15.96,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,BCBS MGG,BCBS MGG,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Cigna,Cigna,15.96,,,,,,,per diem,15.96,15.96,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Cigna MGG,Cigna MGG,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Humana,Humana,15.96,,,,,,,per diem,15.96,15.96,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Humana MGG,Humana MGG,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Optum VA,Optum VA,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,UHC,UHC,15.96,,,,,,,per diem,15.96,15.96,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,UHC MGG,UHC MGG,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,VA,VA,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Wellcare MGG,Wellcare MGG,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Bright Health - commercial,Bright Health - commercial,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.96,15.96,Bright Health MGG,Bright Health MGG,15.96,,,,,,,case rate,15.96,15.96,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Aetna,Aetna,54.54,,,,,,,per diem,54.54,54.54,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Aetna MGG,Aetna MGG,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,BCBS,BCBS,54.54,,,,,,,per diem,54.54,54.54,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,BCBS MGG,BCBS MGG,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Cigna,Cigna,54.54,,,,,,,per diem,54.54,54.54,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Cigna MGG,Cigna MGG,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Humana,Humana,54.54,,,,,,,per diem,54.54,54.54,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Humana MGG,Humana MGG,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Optum VA,Optum VA,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,UHC,UHC,54.54,,,,,,,per diem,54.54,54.54,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,UHC MGG,UHC MGG,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,VA,VA,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Wellcare MGG,Wellcare MGG,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Bright Health - commercial,Bright Health - commercial,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,54.54,54.54,Bright Health MGG,Bright Health MGG,54.54,,,,,,,case rate,54.54,54.54,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Aetna,Aetna,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Aetna MGG,Aetna MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,BCBS,BCBS,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,BCBS MGG,BCBS MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Cigna,Cigna,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Cigna MGG,Cigna MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Humana,Humana,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Humana MGG,Humana MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Optum VA,Optum VA,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,UHC,UHC,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,UHC MGG,UHC MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,VA,VA,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Wellcare MGG,Wellcare MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Bright Health - commercial,Bright Health - commercial,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Bright Health MGG,Bright Health MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Aetna,Aetna,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Aetna MGG,Aetna MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,BCBS,BCBS,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,BCBS MGG,BCBS MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Cigna,Cigna,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Cigna MGG,Cigna MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Humana,Humana,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Humana MGG,Humana MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Optum VA,Optum VA,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,UHC,UHC,101.31,,,,,,,per diem,101.31,101.31,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,UHC MGG,UHC MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,VA,VA,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Wellcare MGG,Wellcare MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Bright Health - commercial,Bright Health - commercial,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,101.31,101.31,Bright Health MGG,Bright Health MGG,101.31,,,,,,,case rate,101.31,101.31,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Aetna,Aetna,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Aetna MGG,Aetna MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,BCBS,BCBS,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,BCBS MGG,BCBS MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Cigna,Cigna,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Cigna MGG,Cigna MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Humana,Humana,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Humana MGG,Humana MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Optum VA,Optum VA,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,UHC,UHC,63.96,,,,,,,per diem,63.96,63.96,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,UHC MGG,UHC MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,VA,VA,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Wellcare MGG,Wellcare MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Bright Health - commercial,Bright Health - commercial,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.96,63.96,Bright Health MGG,Bright Health MGG,63.96,,,,,,,case rate,63.96,63.96,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Aetna,Aetna,13.26,,,,,,,per diem,13.26,13.26,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Aetna MGG,Aetna MGG,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,BCBS,BCBS,13.26,,,,,,,per diem,13.26,13.26,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,BCBS MGG,BCBS MGG,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Cigna,Cigna,13.26,,,,,,,per diem,13.26,13.26,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Cigna MGG,Cigna MGG,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Humana,Humana,13.26,,,,,,,per diem,13.26,13.26,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Humana MGG,Humana MGG,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Optum VA,Optum VA,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,UHC,UHC,13.26,,,,,,,per diem,13.26,13.26,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,UHC MGG,UHC MGG,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,VA,VA,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Wellcare MGG,Wellcare MGG,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Bright Health - commercial,Bright Health - commercial,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.26,13.26,Bright Health MGG,Bright Health MGG,13.26,,,,,,,case rate,13.26,13.26,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Aetna,Aetna,49.23,,,,,,,per diem,49.23,49.23,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Aetna MGG,Aetna MGG,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,BCBS,BCBS,49.23,,,,,,,per diem,49.23,49.23,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,BCBS MGG,BCBS MGG,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Cigna,Cigna,49.23,,,,,,,per diem,49.23,49.23,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Cigna MGG,Cigna MGG,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Humana,Humana,49.23,,,,,,,per diem,49.23,49.23,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Humana MGG,Humana MGG,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Optum VA,Optum VA,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,UHC,UHC,49.23,,,,,,,per diem,49.23,49.23,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,UHC MGG,UHC MGG,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,VA,VA,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Wellcare MGG,Wellcare MGG,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Bright Health - commercial,Bright Health - commercial,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,49.23,49.23,Bright Health MGG,Bright Health MGG,49.23,,,,,,,case rate,49.23,49.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Aetna,Aetna,327.84,,,,,,,per diem,327.84,327.84,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Aetna MGG,Aetna MGG,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,BCBS,BCBS,327.84,,,,,,,per diem,327.84,327.84,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,BCBS MGG,BCBS MGG,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Cigna,Cigna,327.84,,,,,,,per diem,327.84,327.84,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Cigna MGG,Cigna MGG,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Humana,Humana,327.84,,,,,,,per diem,327.84,327.84,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Humana MGG,Humana MGG,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Optum VA,Optum VA,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,UHC,UHC,327.84,,,,,,,per diem,327.84,327.84,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,UHC MGG,UHC MGG,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,VA,VA,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Wellcare MGG,Wellcare MGG,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Bright Health - commercial,Bright Health - commercial,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,327.84,327.84,Bright Health MGG,Bright Health MGG,327.84,,,,,,,case rate,327.84,327.84,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Aetna,Aetna,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Aetna MGG,Aetna MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,BCBS,BCBS,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,BCBS MGG,BCBS MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Cigna,Cigna,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Cigna MGG,Cigna MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Humana,Humana,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Humana MGG,Humana MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Optum VA,Optum VA,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,UHC,UHC,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,UHC MGG,UHC MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,VA,VA,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Wellcare MGG,Wellcare MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Bright Health - commercial,Bright Health - commercial,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Bright Health MGG,Bright Health MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Aetna,Aetna,1311.48,,,,,,,per diem,1311.48,1311.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Aetna MGG,Aetna MGG,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,BCBS,BCBS,1311.48,,,,,,,per diem,1311.48,1311.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,BCBS MGG,BCBS MGG,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Cigna,Cigna,1311.48,,,,,,,per diem,1311.48,1311.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Cigna MGG,Cigna MGG,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Humana,Humana,1311.48,,,,,,,per diem,1311.48,1311.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Humana MGG,Humana MGG,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Optum VA,Optum VA,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,UHC,UHC,1311.48,,,,,,,per diem,1311.48,1311.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,UHC MGG,UHC MGG,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,VA,VA,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Wellcare MGG,Wellcare MGG,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Bright Health - commercial,Bright Health - commercial,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1311.48,1311.48,Bright Health MGG,Bright Health MGG,1311.48,,,,,,,case rate,1311.48,1311.48,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Aetna,Aetna,13.08,,,,,,,per diem,13.08,13.08,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Aetna MGG,Aetna MGG,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,BCBS,BCBS,13.08,,,,,,,per diem,13.08,13.08,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,BCBS MGG,BCBS MGG,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Cigna,Cigna,13.08,,,,,,,per diem,13.08,13.08,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Cigna MGG,Cigna MGG,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Humana,Humana,13.08,,,,,,,per diem,13.08,13.08,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Humana MGG,Humana MGG,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Optum VA,Optum VA,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,UHC,UHC,13.08,,,,,,,per diem,13.08,13.08,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,UHC MGG,UHC MGG,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,VA,VA,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Wellcare MGG,Wellcare MGG,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Bright Health - commercial,Bright Health - commercial,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.08,13.08,Bright Health MGG,Bright Health MGG,13.08,,,,,,,case rate,13.08,13.08,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Aetna,Aetna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Aetna MGG,Aetna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,BCBS,BCBS,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,BCBS MGG,BCBS MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Cigna,Cigna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Cigna MGG,Cigna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Humana,Humana,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Humana MGG,Humana MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Optum VA,Optum VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,UHC,UHC,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,UHC MGG,UHC MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,VA,VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Wellcare MGG,Wellcare MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Bright Health - commercial,Bright Health - commercial,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Bright Health MGG,Bright Health MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Aetna,Aetna,23.91,,,,,,,per diem,23.91,23.91,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Aetna MGG,Aetna MGG,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,BCBS,BCBS,23.91,,,,,,,per diem,23.91,23.91,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,BCBS MGG,BCBS MGG,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Cigna,Cigna,23.91,,,,,,,per diem,23.91,23.91,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Cigna MGG,Cigna MGG,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Humana,Humana,23.91,,,,,,,per diem,23.91,23.91,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Humana MGG,Humana MGG,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Optum VA,Optum VA,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,UHC,UHC,23.91,,,,,,,per diem,23.91,23.91,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,UHC MGG,UHC MGG,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,VA,VA,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Wellcare MGG,Wellcare MGG,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Bright Health - commercial,Bright Health - commercial,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.91,23.91,Bright Health MGG,Bright Health MGG,23.91,,,,,,,case rate,23.91,23.91,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Aetna,Aetna,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Aetna MGG,Aetna MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,BCBS,BCBS,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,BCBS MGG,BCBS MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Cigna,Cigna,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Cigna MGG,Cigna MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Humana,Humana,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Humana MGG,Humana MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Optum VA,Optum VA,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,UHC,UHC,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,UHC MGG,UHC MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,VA,VA,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Wellcare MGG,Wellcare MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Bright Health - commercial,Bright Health - commercial,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Bright Health MGG,Bright Health MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Aetna,Aetna,416.4,,,,,,,per diem,416.4,416.4,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Aetna MGG,Aetna MGG,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,BCBS,BCBS,416.4,,,,,,,per diem,416.4,416.4,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,BCBS MGG,BCBS MGG,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Cigna,Cigna,416.4,,,,,,,per diem,416.4,416.4,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Cigna MGG,Cigna MGG,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Humana,Humana,416.4,,,,,,,per diem,416.4,416.4,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Humana MGG,Humana MGG,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Optum VA,Optum VA,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,UHC,UHC,416.4,,,,,,,per diem,416.4,416.4,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,UHC MGG,UHC MGG,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,VA,VA,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Wellcare MGG,Wellcare MGG,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Bright Health - commercial,Bright Health - commercial,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,416.4,416.4,Bright Health MGG,Bright Health MGG,416.4,,,,,,,case rate,416.4,416.4,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Aetna,Aetna,29.37,,,,,,,per diem,29.37,29.37,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Aetna MGG,Aetna MGG,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,BCBS,BCBS,29.37,,,,,,,per diem,29.37,29.37,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,BCBS MGG,BCBS MGG,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Cigna,Cigna,29.37,,,,,,,per diem,29.37,29.37,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Cigna MGG,Cigna MGG,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Humana,Humana,29.37,,,,,,,per diem,29.37,29.37,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Humana MGG,Humana MGG,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Optum VA,Optum VA,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,UHC,UHC,29.37,,,,,,,per diem,29.37,29.37,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,UHC MGG,UHC MGG,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,VA,VA,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Wellcare MGG,Wellcare MGG,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Bright Health - commercial,Bright Health - commercial,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,29.37,29.37,Bright Health MGG,Bright Health MGG,29.37,,,,,,,case rate,29.37,29.37,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Aetna,Aetna,58.41,,,,,,,per diem,58.41,58.41,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Aetna MGG,Aetna MGG,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,BCBS,BCBS,58.41,,,,,,,per diem,58.41,58.41,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,BCBS MGG,BCBS MGG,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Cigna,Cigna,58.41,,,,,,,per diem,58.41,58.41,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Cigna MGG,Cigna MGG,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Humana,Humana,58.41,,,,,,,per diem,58.41,58.41,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Humana MGG,Humana MGG,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Optum VA,Optum VA,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,UHC,UHC,58.41,,,,,,,per diem,58.41,58.41,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,UHC MGG,UHC MGG,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,VA,VA,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Wellcare MGG,Wellcare MGG,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Bright Health - commercial,Bright Health - commercial,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,58.41,58.41,Bright Health MGG,Bright Health MGG,58.41,,,,,,,case rate,58.41,58.41,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Aetna,Aetna,220.89,,,,,,,per diem,220.89,220.89,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Aetna MGG,Aetna MGG,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,BCBS,BCBS,220.89,,,,,,,per diem,220.89,220.89,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,BCBS MGG,BCBS MGG,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Cigna,Cigna,220.89,,,,,,,per diem,220.89,220.89,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Cigna MGG,Cigna MGG,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Humana,Humana,220.89,,,,,,,per diem,220.89,220.89,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Humana MGG,Humana MGG,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Optum VA,Optum VA,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,UHC,UHC,220.89,,,,,,,per diem,220.89,220.89,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,UHC MGG,UHC MGG,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,VA,VA,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Wellcare MGG,Wellcare MGG,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Bright Health - commercial,Bright Health - commercial,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,220.89,220.89,Bright Health MGG,Bright Health MGG,220.89,,,,,,,case rate,220.89,220.89,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Aetna,Aetna,50.82,,,,,,,per diem,50.82,50.82,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Aetna MGG,Aetna MGG,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,BCBS,BCBS,50.82,,,,,,,per diem,50.82,50.82,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,BCBS MGG,BCBS MGG,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Cigna,Cigna,50.82,,,,,,,per diem,50.82,50.82,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Cigna MGG,Cigna MGG,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Humana,Humana,50.82,,,,,,,per diem,50.82,50.82,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Humana MGG,Humana MGG,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Optum VA,Optum VA,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,UHC,UHC,50.82,,,,,,,per diem,50.82,50.82,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,UHC MGG,UHC MGG,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,VA,VA,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Wellcare MGG,Wellcare MGG,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Bright Health - commercial,Bright Health - commercial,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,50.82,50.82,Bright Health MGG,Bright Health MGG,50.82,,,,,,,case rate,50.82,50.82,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna,Aetna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Aetna MGG,Aetna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,BCBS,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS MGG,BCBS MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna,Cigna,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Cigna MGG,Cigna MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana,Humana,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Humana MGG,Humana MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Optum VA,Optum VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC,UHC,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UHC MGG,UHC MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,VA,VA,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Wellcare MGG,Wellcare MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health - commercial,Bright Health - commercial,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,Bright Health MGG,Bright Health MGG,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Aetna,Aetna,11.16,,,,,,,per diem,11.16,11.16,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Aetna MGG,Aetna MGG,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,BCBS,BCBS,11.16,,,,,,,per diem,11.16,11.16,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,BCBS MGG,BCBS MGG,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Cigna,Cigna,11.16,,,,,,,per diem,11.16,11.16,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Cigna MGG,Cigna MGG,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Humana,Humana,11.16,,,,,,,per diem,11.16,11.16,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Humana MGG,Humana MGG,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Optum VA,Optum VA,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,UHC,UHC,11.16,,,,,,,per diem,11.16,11.16,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,UHC MGG,UHC MGG,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,VA,VA,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Wellcare MGG,Wellcare MGG,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Bright Health - commercial,Bright Health - commercial,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.16,11.16,Bright Health MGG,Bright Health MGG,11.16,,,,,,,case rate,11.16,11.16,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Aetna,Aetna,69.3,,,,,,,per diem,69.3,69.3,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Aetna MGG,Aetna MGG,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,BCBS,BCBS,69.3,,,,,,,per diem,69.3,69.3,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,BCBS MGG,BCBS MGG,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Cigna,Cigna,69.3,,,,,,,per diem,69.3,69.3,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Cigna MGG,Cigna MGG,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Humana,Humana,69.3,,,,,,,per diem,69.3,69.3,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Humana MGG,Humana MGG,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Optum VA,Optum VA,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,UHC,UHC,69.3,,,,,,,per diem,69.3,69.3,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,UHC MGG,UHC MGG,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,VA,VA,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Wellcare MGG,Wellcare MGG,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Bright Health - commercial,Bright Health - commercial,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,69.3,69.3,Bright Health MGG,Bright Health MGG,69.3,,,,,,,case rate,69.3,69.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Aetna,Aetna,920.85,,,,,,,per diem,920.85,920.85,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Aetna MGG,Aetna MGG,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,BCBS,BCBS,920.85,,,,,,,per diem,920.85,920.85,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,BCBS MGG,BCBS MGG,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Cigna,Cigna,920.85,,,,,,,per diem,920.85,920.85,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Cigna MGG,Cigna MGG,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Humana,Humana,920.85,,,,,,,per diem,920.85,920.85,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Humana MGG,Humana MGG,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Optum VA,Optum VA,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,UHC,UHC,920.85,,,,,,,per diem,920.85,920.85,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,UHC MGG,UHC MGG,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,VA,VA,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Wellcare MGG,Wellcare MGG,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Bright Health - commercial,Bright Health - commercial,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,920.85,920.85,Bright Health MGG,Bright Health MGG,920.85,,,,,,,case rate,920.85,920.85,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Aetna,Aetna,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Aetna MGG,Aetna MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,BCBS,BCBS,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,BCBS MGG,BCBS MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Cigna,Cigna,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Cigna MGG,Cigna MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Humana,Humana,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Humana MGG,Humana MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Optum VA,Optum VA,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,UHC,UHC,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,UHC MGG,UHC MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,VA,VA,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Wellcare MGG,Wellcare MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Bright Health - commercial,Bright Health - commercial,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Bright Health MGG,Bright Health MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Aetna,Aetna,147.54,,,,,,,per diem,147.54,147.54,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Aetna MGG,Aetna MGG,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,BCBS,BCBS,147.54,,,,,,,per diem,147.54,147.54,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,BCBS MGG,BCBS MGG,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Cigna,Cigna,147.54,,,,,,,per diem,147.54,147.54,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Cigna MGG,Cigna MGG,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Humana,Humana,147.54,,,,,,,per diem,147.54,147.54,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Humana MGG,Humana MGG,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Optum VA,Optum VA,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,UHC,UHC,147.54,,,,,,,per diem,147.54,147.54,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,UHC MGG,UHC MGG,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,VA,VA,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Wellcare MGG,Wellcare MGG,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Bright Health - commercial,Bright Health - commercial,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,147.54,147.54,Bright Health MGG,Bright Health MGG,147.54,,,,,,,case rate,147.54,147.54,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Aetna,Aetna,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Aetna MGG,Aetna MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,BCBS,BCBS,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,BCBS MGG,BCBS MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Cigna,Cigna,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Cigna MGG,Cigna MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Humana,Humana,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Humana MGG,Humana MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Optum VA,Optum VA,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,UHC,UHC,7.74,,,,,,,per diem,7.74,7.74,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,UHC MGG,UHC MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,VA,VA,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Wellcare MGG,Wellcare MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Bright Health - commercial,Bright Health - commercial,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,7.74,7.74,Bright Health MGG,Bright Health MGG,7.74,,,,,,,case rate,7.74,7.74,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Aetna,Aetna,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Aetna MGG,Aetna MGG,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,BCBS,BCBS,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,BCBS MGG,BCBS MGG,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Cigna,Cigna,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Cigna MGG,Cigna MGG,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Humana,Humana,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Humana MGG,Humana MGG,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Optum VA,Optum VA,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,UHC,UHC,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,UHC MGG,UHC MGG,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,VA,VA,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Wellcare MGG,Wellcare MGG,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Bright Health - commercial,Bright Health - commercial,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,Bright Health MGG,Bright Health MGG,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Aetna,Aetna,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Aetna MGG,Aetna MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,BCBS,BCBS,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,BCBS MGG,BCBS MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Cigna,Cigna,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Cigna MGG,Cigna MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Humana,Humana,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Humana MGG,Humana MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Optum VA,Optum VA,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,UHC,UHC,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,UHC MGG,UHC MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,VA,VA,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Wellcare MGG,Wellcare MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Bright Health - commercial,Bright Health - commercial,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Bright Health MGG,Bright Health MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Aetna,Aetna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Aetna MGG,Aetna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,BCBS,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS MGG,BCBS MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Cigna,Cigna,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Cigna MGG,Cigna MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Humana,Humana,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Humana MGG,Humana MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Optum VA,Optum VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,UHC,UHC,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,UHC MGG,UHC MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,VA,VA,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Wellcare MGG,Wellcare MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Bright Health - commercial,Bright Health - commercial,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,Bright Health MGG,Bright Health MGG,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Aetna,Aetna,334.92,,,,,,,per diem,334.92,334.92,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Aetna MGG,Aetna MGG,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,BCBS,BCBS,334.92,,,,,,,per diem,334.92,334.92,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,BCBS MGG,BCBS MGG,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Cigna,Cigna,334.92,,,,,,,per diem,334.92,334.92,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Cigna MGG,Cigna MGG,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Humana,Humana,334.92,,,,,,,per diem,334.92,334.92,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Humana MGG,Humana MGG,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Optum VA,Optum VA,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,UHC,UHC,334.92,,,,,,,per diem,334.92,334.92,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,UHC MGG,UHC MGG,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,VA,VA,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Wellcare MGG,Wellcare MGG,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Bright Health - commercial,Bright Health - commercial,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,334.92,334.92,Bright Health MGG,Bright Health MGG,334.92,,,,,,,case rate,334.92,334.92,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Aetna,Aetna,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Aetna MGG,Aetna MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,BCBS,BCBS,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,BCBS MGG,BCBS MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Cigna,Cigna,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Cigna MGG,Cigna MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Humana,Humana,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Humana MGG,Humana MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Optum VA,Optum VA,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,UHC,UHC,62.22,,,,,,,per diem,62.22,62.22,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,UHC MGG,UHC MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,VA,VA,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Wellcare MGG,Wellcare MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Bright Health - commercial,Bright Health - commercial,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,62.22,62.22,Bright Health MGG,Bright Health MGG,62.22,,,,,,,case rate,62.22,62.22,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Aetna,Aetna,667.2,,,,,,,per diem,667.2,667.2,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Aetna MGG,Aetna MGG,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,BCBS,BCBS,667.2,,,,,,,per diem,667.2,667.2,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,BCBS MGG,BCBS MGG,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Cigna,Cigna,667.2,,,,,,,per diem,667.2,667.2,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Cigna MGG,Cigna MGG,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Humana,Humana,667.2,,,,,,,per diem,667.2,667.2,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Humana MGG,Humana MGG,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Optum VA,Optum VA,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,UHC,UHC,667.2,,,,,,,per diem,667.2,667.2,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,UHC MGG,UHC MGG,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,VA,VA,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Wellcare MGG,Wellcare MGG,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Bright Health - commercial,Bright Health - commercial,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,667.2,667.2,Bright Health MGG,Bright Health MGG,667.2,,,,,,,case rate,667.2,667.2,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Aetna,Aetna,23.52,,,,,,,per diem,23.52,23.52,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Aetna MGG,Aetna MGG,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,BCBS,BCBS,23.52,,,,,,,per diem,23.52,23.52,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,BCBS MGG,BCBS MGG,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Cigna,Cigna,23.52,,,,,,,per diem,23.52,23.52,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Cigna MGG,Cigna MGG,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Humana,Humana,23.52,,,,,,,per diem,23.52,23.52,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Humana MGG,Humana MGG,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Optum VA,Optum VA,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,UHC,UHC,23.52,,,,,,,per diem,23.52,23.52,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,UHC MGG,UHC MGG,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,VA,VA,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Wellcare MGG,Wellcare MGG,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Bright Health - commercial,Bright Health - commercial,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,23.52,23.52,Bright Health MGG,Bright Health MGG,23.52,,,,,,,case rate,23.52,23.52,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Aetna,Aetna,44.18,,,,,,,per diem,44.18,44.18,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Aetna MGG,Aetna MGG,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,BCBS,BCBS,44.18,,,,,,,per diem,44.18,44.18,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,BCBS MGG,BCBS MGG,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Cigna,Cigna,44.18,,,,,,,per diem,44.18,44.18,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Cigna MGG,Cigna MGG,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Humana,Humana,44.18,,,,,,,per diem,44.18,44.18,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Humana MGG,Humana MGG,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Optum VA,Optum VA,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,UHC,UHC,44.18,,,,,,,per diem,44.18,44.18,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,UHC MGG,UHC MGG,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,VA,VA,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Wellcare MGG,Wellcare MGG,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Bright Health - commercial,Bright Health - commercial,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,44.18,44.18,Bright Health MGG,Bright Health MGG,44.18,,,,,,,case rate,44.18,44.18,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Aetna,Aetna,44.22,,,,,,,per diem,44.22,44.22,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Aetna MGG,Aetna MGG,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,BCBS,BCBS,44.22,,,,,,,per diem,44.22,44.22,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,BCBS MGG,BCBS MGG,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Cigna,Cigna,44.22,,,,,,,per diem,44.22,44.22,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Cigna MGG,Cigna MGG,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Humana,Humana,44.22,,,,,,,per diem,44.22,44.22,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Humana MGG,Humana MGG,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Optum VA,Optum VA,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,UHC,UHC,44.22,,,,,,,per diem,44.22,44.22,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,UHC MGG,UHC MGG,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,VA,VA,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Wellcare MGG,Wellcare MGG,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Bright Health - commercial,Bright Health - commercial,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,44.22,44.22,Bright Health MGG,Bright Health MGG,44.22,,,,,,,case rate,44.22,44.22,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Aetna,Aetna,687.63,,,,,,,per diem,687.63,687.63,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Aetna MGG,Aetna MGG,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,BCBS,BCBS,687.63,,,,,,,per diem,687.63,687.63,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,BCBS MGG,BCBS MGG,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Cigna,Cigna,687.63,,,,,,,per diem,687.63,687.63,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Cigna MGG,Cigna MGG,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Humana,Humana,687.63,,,,,,,per diem,687.63,687.63,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Humana MGG,Humana MGG,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Optum VA,Optum VA,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,UHC,UHC,687.63,,,,,,,per diem,687.63,687.63,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,UHC MGG,UHC MGG,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,VA,VA,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Wellcare MGG,Wellcare MGG,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Bright Health - commercial,Bright Health - commercial,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,687.63,687.63,Bright Health MGG,Bright Health MGG,687.63,,,,,,,case rate,687.63,687.63,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna,Aetna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna MGG,Aetna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS,BCBS,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS MGG,BCBS MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna,Cigna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna MGG,Cigna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana,Humana,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana MGG,Humana MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Optum VA,Optum VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC,UHC,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC MGG,UHC MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,VA,VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Wellcare MGG,Wellcare MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health - commercial,Bright Health - commercial,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health MGG,Bright Health MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna,Aetna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna MGG,Aetna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,BCBS,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS MGG,BCBS MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna,Cigna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna MGG,Cigna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana,Humana,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana MGG,Humana MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Optum VA,Optum VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC,UHC,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC MGG,UHC MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Wellcare MGG,Wellcare MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health - commercial,Bright Health - commercial,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health MGG,Bright Health MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Aetna,Aetna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Aetna MGG,Aetna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,BCBS,BCBS,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,BCBS MGG,BCBS MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Cigna,Cigna,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Cigna MGG,Cigna MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Humana,Humana,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Humana MGG,Humana MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Optum VA,Optum VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,UHC,UHC,33.48,,,,,,,per diem,33.48,33.48,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,UHC MGG,UHC MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,VA,VA,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Wellcare MGG,Wellcare MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Bright Health - commercial,Bright Health - commercial,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,33.48,33.48,Bright Health MGG,Bright Health MGG,33.48,,,,,,,case rate,33.48,33.48,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Aetna,Aetna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Aetna MGG,Aetna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,BCBS,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS MGG,BCBS MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Cigna,Cigna,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Cigna MGG,Cigna MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Humana,Humana,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Humana MGG,Humana MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Optum VA,Optum VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UHC,UHC,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UHC MGG,UHC MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA,VA,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Wellcare MGG,Wellcare MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Bright Health - commercial,Bright Health - commercial,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,Bright Health MGG,Bright Health MGG,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Aetna,Aetna,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Aetna MGG,Aetna MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,BCBS,BCBS,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,BCBS MGG,BCBS MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Cigna,Cigna,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Cigna MGG,Cigna MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Humana,Humana,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Humana MGG,Humana MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Optum VA,Optum VA,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,UHC,UHC,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,UHC MGG,UHC MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,VA,VA,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Wellcare MGG,Wellcare MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Bright Health - commercial,Bright Health - commercial,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Bright Health MGG,Bright Health MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Aetna,Aetna,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Aetna MGG,Aetna MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,BCBS,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS MGG,BCBS MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Cigna,Cigna,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Cigna MGG,Cigna MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Humana,Humana,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Humana MGG,Humana MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Optum VA,Optum VA,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,UHC,UHC,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,UHC MGG,UHC MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,VA,VA,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Wellcare MGG,Wellcare MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Bright Health - commercial,Bright Health - commercial,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Bright Health MGG,Bright Health MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Aetna,Aetna,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Aetna MGG,Aetna MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,BCBS,BCBS,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,BCBS MGG,BCBS MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Cigna,Cigna,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Cigna MGG,Cigna MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Humana,Humana,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Humana MGG,Humana MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Optum VA,Optum VA,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,UHC,UHC,11.01,,,,,,,per diem,11.01,11.01,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,UHC MGG,UHC MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,VA,VA,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Wellcare MGG,Wellcare MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Bright Health - commercial,Bright Health - commercial,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.01,11.01,Bright Health MGG,Bright Health MGG,11.01,,,,,,,case rate,11.01,11.01,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Aetna,Aetna,409.47,,,,,,,per diem,409.47,409.47,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Aetna MGG,Aetna MGG,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,BCBS,BCBS,409.47,,,,,,,per diem,409.47,409.47,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,BCBS MGG,BCBS MGG,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Cigna,Cigna,409.47,,,,,,,per diem,409.47,409.47,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Cigna MGG,Cigna MGG,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Humana,Humana,409.47,,,,,,,per diem,409.47,409.47,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Humana MGG,Humana MGG,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Optum VA,Optum VA,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,UHC,UHC,409.47,,,,,,,per diem,409.47,409.47,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,UHC MGG,UHC MGG,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,VA,VA,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Wellcare MGG,Wellcare MGG,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Bright Health - commercial,Bright Health - commercial,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,409.47,409.47,Bright Health MGG,Bright Health MGG,409.47,,,,,,,case rate,409.47,409.47,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Aetna,Aetna,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Aetna MGG,Aetna MGG,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,BCBS,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS MGG,BCBS MGG,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Cigna,Cigna,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Cigna MGG,Cigna MGG,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Humana,Humana,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Humana MGG,Humana MGG,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Optum VA,Optum VA,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,UHC,UHC,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,UHC MGG,UHC MGG,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,VA,VA,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Wellcare MGG,Wellcare MGG,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Bright Health - commercial,Bright Health - commercial,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,Bright Health MGG,Bright Health MGG,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Aetna,Aetna,522,,,,,,,per diem,522,522,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Aetna MGG,Aetna MGG,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,BCBS,BCBS,522,,,,,,,per diem,522,522,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,BCBS MGG,BCBS MGG,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Cigna,Cigna,522,,,,,,,per diem,522,522,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Cigna MGG,Cigna MGG,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Humana,Humana,522,,,,,,,per diem,522,522,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Humana MGG,Humana MGG,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Optum VA,Optum VA,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,UHC,UHC,522,,,,,,,per diem,522,522,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,UHC MGG,UHC MGG,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,VA,VA,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Wellcare MGG,Wellcare MGG,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Bright Health - commercial,Bright Health - commercial,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,522,522,Bright Health MGG,Bright Health MGG,522,,,,,,,case rate,522,522,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Aetna,Aetna,604.2,,,,,,,per diem,604.2,604.2,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Aetna MGG,Aetna MGG,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,BCBS,BCBS,604.2,,,,,,,per diem,604.2,604.2,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,BCBS MGG,BCBS MGG,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Cigna,Cigna,604.2,,,,,,,per diem,604.2,604.2,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Cigna MGG,Cigna MGG,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Humana,Humana,604.2,,,,,,,per diem,604.2,604.2,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Humana MGG,Humana MGG,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Optum VA,Optum VA,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,UHC,UHC,604.2,,,,,,,per diem,604.2,604.2,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,UHC MGG,UHC MGG,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,VA,VA,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Wellcare MGG,Wellcare MGG,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Bright Health - commercial,Bright Health - commercial,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,604.2,604.2,Bright Health MGG,Bright Health MGG,604.2,,,,,,,case rate,604.2,604.2,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Aetna,Aetna,302.61,,,,,,,per diem,302.61,302.61,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Aetna MGG,Aetna MGG,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,BCBS,BCBS,302.61,,,,,,,per diem,302.61,302.61,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,BCBS MGG,BCBS MGG,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Cigna,Cigna,302.61,,,,,,,per diem,302.61,302.61,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Cigna MGG,Cigna MGG,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Humana,Humana,302.61,,,,,,,per diem,302.61,302.61,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Humana MGG,Humana MGG,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Optum VA,Optum VA,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,UHC,UHC,302.61,,,,,,,per diem,302.61,302.61,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,UHC MGG,UHC MGG,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,VA,VA,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Wellcare MGG,Wellcare MGG,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Bright Health - commercial,Bright Health - commercial,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,302.61,302.61,Bright Health MGG,Bright Health MGG,302.61,,,,,,,case rate,302.61,302.61,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Aetna,Aetna,845.22,,,,,,,per diem,845.22,845.22,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Aetna MGG,Aetna MGG,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,BCBS,BCBS,845.22,,,,,,,per diem,845.22,845.22,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,BCBS MGG,BCBS MGG,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Cigna,Cigna,845.22,,,,,,,per diem,845.22,845.22,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Cigna MGG,Cigna MGG,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Humana,Humana,845.22,,,,,,,per diem,845.22,845.22,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Humana MGG,Humana MGG,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Optum VA,Optum VA,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,UHC,UHC,845.22,,,,,,,per diem,845.22,845.22,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,UHC MGG,UHC MGG,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,VA,VA,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Wellcare MGG,Wellcare MGG,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Bright Health - commercial,Bright Health - commercial,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,845.22,845.22,Bright Health MGG,Bright Health MGG,845.22,,,,,,,case rate,845.22,845.22,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Aetna,Aetna,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Aetna MGG,Aetna MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,BCBS,BCBS,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,BCBS MGG,BCBS MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Cigna,Cigna,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Cigna MGG,Cigna MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Humana,Humana,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Humana MGG,Humana MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Optum VA,Optum VA,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,UHC,UHC,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,UHC MGG,UHC MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,VA,VA,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Wellcare MGG,Wellcare MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Bright Health - commercial,Bright Health - commercial,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Bright Health MGG,Bright Health MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Aetna,Aetna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Aetna MGG,Aetna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,BCBS,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS MGG,BCBS MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Cigna,Cigna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Cigna MGG,Cigna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Humana,Humana,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Humana MGG,Humana MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Optum VA,Optum VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UHC,UHC,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UHC MGG,UHC MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Wellcare MGG,Wellcare MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Bright Health - commercial,Bright Health - commercial,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Bright Health MGG,Bright Health MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Aetna,Aetna,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Aetna MGG,Aetna MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS,BCBS,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS MGG,BCBS MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Cigna,Cigna,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Cigna MGG,Cigna MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Humana,Humana,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Humana MGG,Humana MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Optum VA,Optum VA,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,UHC,UHC,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,UHC MGG,UHC MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,VA,VA,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Wellcare MGG,Wellcare MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Bright Health - commercial,Bright Health - commercial,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,Bright Health MGG,Bright Health MGG,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Aetna,Aetna,417.45,,,,,,,per diem,417.45,417.45,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Aetna MGG,Aetna MGG,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,BCBS,BCBS,417.45,,,,,,,per diem,417.45,417.45,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,BCBS MGG,BCBS MGG,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Cigna,Cigna,417.45,,,,,,,per diem,417.45,417.45,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Cigna MGG,Cigna MGG,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Humana,Humana,417.45,,,,,,,per diem,417.45,417.45,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Humana MGG,Humana MGG,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Optum VA,Optum VA,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,UHC,UHC,417.45,,,,,,,per diem,417.45,417.45,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,UHC MGG,UHC MGG,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,VA,VA,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Wellcare MGG,Wellcare MGG,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Bright Health - commercial,Bright Health - commercial,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,417.45,417.45,Bright Health MGG,Bright Health MGG,417.45,,,,,,,case rate,417.45,417.45,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Aetna,Aetna,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Aetna MGG,Aetna MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,BCBS,BCBS,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,BCBS MGG,BCBS MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Cigna,Cigna,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Cigna MGG,Cigna MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Humana,Humana,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Humana MGG,Humana MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Optum VA,Optum VA,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,UHC,UHC,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,UHC MGG,UHC MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,VA,VA,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Wellcare MGG,Wellcare MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Bright Health - commercial,Bright Health - commercial,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,15.33,15.33,Bright Health MGG,Bright Health MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Aetna,Aetna,252.51,,,,,,,per diem,252.51,252.51,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Aetna MGG,Aetna MGG,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,BCBS,BCBS,252.51,,,,,,,per diem,252.51,252.51,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,BCBS MGG,BCBS MGG,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Cigna,Cigna,252.51,,,,,,,per diem,252.51,252.51,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Cigna MGG,Cigna MGG,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Humana,Humana,252.51,,,,,,,per diem,252.51,252.51,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Humana MGG,Humana MGG,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Optum VA,Optum VA,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,UHC,UHC,252.51,,,,,,,per diem,252.51,252.51,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,UHC MGG,UHC MGG,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,VA,VA,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Wellcare MGG,Wellcare MGG,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Bright Health - commercial,Bright Health - commercial,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,252.51,252.51,Bright Health MGG,Bright Health MGG,252.51,,,,,,,case rate,252.51,252.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Aetna,Aetna,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Aetna MGG,Aetna MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,BCBS,BCBS,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,BCBS MGG,BCBS MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Cigna,Cigna,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Cigna MGG,Cigna MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Humana,Humana,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Humana MGG,Humana MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Optum VA,Optum VA,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,UHC,UHC,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,UHC MGG,UHC MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,VA,VA,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Wellcare MGG,Wellcare MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Bright Health - commercial,Bright Health - commercial,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Bright Health MGG,Bright Health MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Aetna,Aetna,246.03,,,,,,,per diem,246.03,246.03,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Aetna MGG,Aetna MGG,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,BCBS,BCBS,246.03,,,,,,,per diem,246.03,246.03,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,BCBS MGG,BCBS MGG,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Cigna,Cigna,246.03,,,,,,,per diem,246.03,246.03,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Cigna MGG,Cigna MGG,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Humana,Humana,246.03,,,,,,,per diem,246.03,246.03,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Humana MGG,Humana MGG,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Optum VA,Optum VA,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,UHC,UHC,246.03,,,,,,,per diem,246.03,246.03,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,UHC MGG,UHC MGG,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,VA,VA,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Wellcare MGG,Wellcare MGG,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Bright Health - commercial,Bright Health - commercial,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,246.03,246.03,Bright Health MGG,Bright Health MGG,246.03,,,,,,,case rate,246.03,246.03,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Aetna,Aetna,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Aetna MGG,Aetna MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,BCBS,BCBS,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,BCBS MGG,BCBS MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Cigna,Cigna,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Cigna MGG,Cigna MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Humana,Humana,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Humana MGG,Humana MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Optum VA,Optum VA,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,UHC,UHC,11.1,,,,,,,per diem,11.1,11.1,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,UHC MGG,UHC MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,VA,VA,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Wellcare MGG,Wellcare MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Bright Health - commercial,Bright Health - commercial,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.1,11.1,Bright Health MGG,Bright Health MGG,11.1,,,,,,,case rate,11.1,11.1,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Aetna,Aetna,291.57,,,,,,,per diem,291.57,291.57,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Aetna MGG,Aetna MGG,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,BCBS,BCBS,291.57,,,,,,,per diem,291.57,291.57,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,BCBS MGG,BCBS MGG,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Cigna,Cigna,291.57,,,,,,,per diem,291.57,291.57,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Cigna MGG,Cigna MGG,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Humana,Humana,291.57,,,,,,,per diem,291.57,291.57,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Humana MGG,Humana MGG,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Optum VA,Optum VA,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,UHC,UHC,291.57,,,,,,,per diem,291.57,291.57,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,UHC MGG,UHC MGG,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,VA,VA,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Wellcare MGG,Wellcare MGG,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Bright Health - commercial,Bright Health - commercial,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,291.57,291.57,Bright Health MGG,Bright Health MGG,291.57,,,,,,,case rate,291.57,291.57,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna,Aetna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna MGG,Aetna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS,BCBS,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS MGG,BCBS MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna,Cigna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna MGG,Cigna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana,Humana,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana MGG,Humana MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Optum VA,Optum VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC,UHC,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC MGG,UHC MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,VA,VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Wellcare MGG,Wellcare MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health - commercial,Bright Health - commercial,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health MGG,Bright Health MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Aetna,Aetna,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Aetna MGG,Aetna MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,BCBS,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS MGG,BCBS MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Cigna,Cigna,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Cigna MGG,Cigna MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Humana,Humana,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Humana MGG,Humana MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Optum VA,Optum VA,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UHC,UHC,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UHC MGG,UHC MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,VA,VA,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Wellcare MGG,Wellcare MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Bright Health - commercial,Bright Health - commercial,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Bright Health MGG,Bright Health MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Aetna,Aetna,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Aetna MGG,Aetna MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,BCBS,BCBS,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,BCBS MGG,BCBS MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Cigna,Cigna,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Cigna MGG,Cigna MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Humana,Humana,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Humana MGG,Humana MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Optum VA,Optum VA,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,UHC,UHC,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,UHC MGG,UHC MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,VA,VA,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Wellcare MGG,Wellcare MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Bright Health - commercial,Bright Health - commercial,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Bright Health MGG,Bright Health MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Aetna,Aetna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Aetna MGG,Aetna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,BCBS,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS MGG,BCBS MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Cigna,Cigna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Cigna MGG,Cigna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Humana,Humana,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Humana MGG,Humana MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Optum VA,Optum VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UHC,UHC,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UHC MGG,UHC MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,VA,VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Wellcare MGG,Wellcare MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Bright Health - commercial,Bright Health - commercial,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Bright Health MGG,Bright Health MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Aetna,Aetna,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Aetna MGG,Aetna MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,BCBS,BCBS,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,BCBS MGG,BCBS MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Cigna,Cigna,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Cigna MGG,Cigna MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Humana,Humana,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Humana MGG,Humana MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Optum VA,Optum VA,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,UHC,UHC,22.92,,,,,,,per diem,22.92,22.92,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,UHC MGG,UHC MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,VA,VA,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Wellcare MGG,Wellcare MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Bright Health - commercial,Bright Health - commercial,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,22.92,22.92,Bright Health MGG,Bright Health MGG,22.92,,,,,,,case rate,22.92,22.92,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Aetna,Aetna,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Aetna MGG,Aetna MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,BCBS,BCBS,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,BCBS MGG,BCBS MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Cigna,Cigna,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Cigna MGG,Cigna MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Humana,Humana,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Humana MGG,Humana MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Optum VA,Optum VA,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,UHC,UHC,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,UHC MGG,UHC MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,VA,VA,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Wellcare MGG,Wellcare MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Bright Health - commercial,Bright Health - commercial,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Bright Health MGG,Bright Health MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Aetna,Aetna,104.79,,,,,,,per diem,104.79,104.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Aetna MGG,Aetna MGG,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,BCBS,BCBS,104.79,,,,,,,per diem,104.79,104.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,BCBS MGG,BCBS MGG,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Cigna,Cigna,104.79,,,,,,,per diem,104.79,104.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Cigna MGG,Cigna MGG,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Humana,Humana,104.79,,,,,,,per diem,104.79,104.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Humana MGG,Humana MGG,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Optum VA,Optum VA,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,UHC,UHC,104.79,,,,,,,per diem,104.79,104.79,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,UHC MGG,UHC MGG,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,VA,VA,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Wellcare MGG,Wellcare MGG,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Bright Health - commercial,Bright Health - commercial,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,104.79,104.79,Bright Health MGG,Bright Health MGG,104.79,,,,,,,case rate,104.79,104.79,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Aetna,Aetna,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Aetna MGG,Aetna MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,BCBS,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS MGG,BCBS MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Cigna,Cigna,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Cigna MGG,Cigna MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Humana,Humana,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Humana MGG,Humana MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Optum VA,Optum VA,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UHC,UHC,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UHC MGG,UHC MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,VA,VA,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Wellcare MGG,Wellcare MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Bright Health - commercial,Bright Health - commercial,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Bright Health MGG,Bright Health MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Aetna,Aetna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Aetna MGG,Aetna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,BCBS,BCBS,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,BCBS MGG,BCBS MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Cigna,Cigna,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Cigna MGG,Cigna MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Humana,Humana,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Humana MGG,Humana MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Optum VA,Optum VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,UHC,UHC,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,UHC MGG,UHC MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,VA,VA,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Wellcare MGG,Wellcare MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Bright Health - commercial,Bright Health - commercial,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,78.75,78.75,Bright Health MGG,Bright Health MGG,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Aetna,Aetna,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Aetna MGG,Aetna MGG,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,BCBS,BCBS,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,BCBS MGG,BCBS MGG,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Cigna,Cigna,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Cigna MGG,Cigna MGG,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Humana,Humana,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Humana MGG,Humana MGG,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Optum VA,Optum VA,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,UHC,UHC,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,UHC MGG,UHC MGG,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,VA,VA,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Wellcare MGG,Wellcare MGG,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Bright Health - commercial,Bright Health - commercial,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,Bright Health MGG,Bright Health MGG,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Aetna,Aetna,326.25,,,,,,,per diem,326.25,326.25,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Aetna MGG,Aetna MGG,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,BCBS,BCBS,326.25,,,,,,,per diem,326.25,326.25,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,BCBS MGG,BCBS MGG,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Cigna,Cigna,326.25,,,,,,,per diem,326.25,326.25,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Cigna MGG,Cigna MGG,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Humana,Humana,326.25,,,,,,,per diem,326.25,326.25,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Humana MGG,Humana MGG,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Optum VA,Optum VA,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,UHC,UHC,326.25,,,,,,,per diem,326.25,326.25,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,UHC MGG,UHC MGG,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,VA,VA,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Wellcare MGG,Wellcare MGG,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Bright Health - commercial,Bright Health - commercial,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,326.25,326.25,Bright Health MGG,Bright Health MGG,326.25,,,,,,,case rate,326.25,326.25,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Aetna,Aetna,103.11,,,,,,,per diem,103.11,103.11,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Aetna MGG,Aetna MGG,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,BCBS,BCBS,103.11,,,,,,,per diem,103.11,103.11,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,BCBS MGG,BCBS MGG,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Cigna,Cigna,103.11,,,,,,,per diem,103.11,103.11,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Cigna MGG,Cigna MGG,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Humana,Humana,103.11,,,,,,,per diem,103.11,103.11,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Humana MGG,Humana MGG,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Optum VA,Optum VA,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,UHC,UHC,103.11,,,,,,,per diem,103.11,103.11,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,UHC MGG,UHC MGG,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,VA,VA,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Wellcare MGG,Wellcare MGG,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Bright Health - commercial,Bright Health - commercial,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,103.11,103.11,Bright Health MGG,Bright Health MGG,103.11,,,,,,,case rate,103.11,103.11,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Aetna,Aetna,106.2,,,,,,,per diem,106.2,106.2,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Aetna MGG,Aetna MGG,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,BCBS,BCBS,106.2,,,,,,,per diem,106.2,106.2,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,BCBS MGG,BCBS MGG,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Cigna,Cigna,106.2,,,,,,,per diem,106.2,106.2,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Cigna MGG,Cigna MGG,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Humana,Humana,106.2,,,,,,,per diem,106.2,106.2,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Humana MGG,Humana MGG,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Optum VA,Optum VA,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,UHC,UHC,106.2,,,,,,,per diem,106.2,106.2,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,UHC MGG,UHC MGG,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,VA,VA,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Wellcare MGG,Wellcare MGG,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Bright Health - commercial,Bright Health - commercial,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,106.2,106.2,Bright Health MGG,Bright Health MGG,106.2,,,,,,,case rate,106.2,106.2,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Aetna,Aetna,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Aetna MGG,Aetna MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,BCBS,BCBS,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,BCBS MGG,BCBS MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Cigna,Cigna,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Cigna MGG,Cigna MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Humana,Humana,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Humana MGG,Humana MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Optum VA,Optum VA,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,UHC,UHC,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,UHC MGG,UHC MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,VA,VA,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Wellcare MGG,Wellcare MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Bright Health - commercial,Bright Health - commercial,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Bright Health MGG,Bright Health MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Aetna,Aetna,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Aetna MGG,Aetna MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,BCBS,BCBS,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,BCBS MGG,BCBS MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Cigna,Cigna,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Cigna MGG,Cigna MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Humana,Humana,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Humana MGG,Humana MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Optum VA,Optum VA,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,UHC,UHC,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,UHC MGG,UHC MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,VA,VA,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Wellcare MGG,Wellcare MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Bright Health - commercial,Bright Health - commercial,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Bright Health MGG,Bright Health MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Aetna,Aetna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Aetna MGG,Aetna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,BCBS,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS MGG,BCBS MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Cigna,Cigna,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Cigna MGG,Cigna MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Humana,Humana,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Humana MGG,Humana MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Optum VA,Optum VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UHC,UHC,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UHC MGG,UHC MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,VA,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Wellcare MGG,Wellcare MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Bright Health - commercial,Bright Health - commercial,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,Bright Health MGG,Bright Health MGG,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Aetna,Aetna,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Aetna MGG,Aetna MGG,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,BCBS,BCBS,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,BCBS MGG,BCBS MGG,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Cigna,Cigna,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Cigna MGG,Cigna MGG,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Humana,Humana,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Humana MGG,Humana MGG,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Optum VA,Optum VA,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,UHC,UHC,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,UHC MGG,UHC MGG,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,VA,VA,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Wellcare MGG,Wellcare MGG,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Bright Health - commercial,Bright Health - commercial,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,54.51,54.51,Bright Health MGG,Bright Health MGG,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Aetna,Aetna,627.03,,,,,,,per diem,627.03,627.03,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Aetna MGG,Aetna MGG,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,BCBS,BCBS,627.03,,,,,,,per diem,627.03,627.03,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,BCBS MGG,BCBS MGG,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Cigna,Cigna,627.03,,,,,,,per diem,627.03,627.03,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Cigna MGG,Cigna MGG,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Humana,Humana,627.03,,,,,,,per diem,627.03,627.03,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Humana MGG,Humana MGG,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Optum VA,Optum VA,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,UHC,UHC,627.03,,,,,,,per diem,627.03,627.03,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,UHC MGG,UHC MGG,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,VA,VA,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Wellcare MGG,Wellcare MGG,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Bright Health - commercial,Bright Health - commercial,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,627.03,627.03,Bright Health MGG,Bright Health MGG,627.03,,,,,,,case rate,627.03,627.03,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Aetna,Aetna,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Aetna MGG,Aetna MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,BCBS,BCBS,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,BCBS MGG,BCBS MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Cigna,Cigna,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Cigna MGG,Cigna MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Humana,Humana,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Humana MGG,Humana MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Optum VA,Optum VA,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,UHC,UHC,28.8,,,,,,,per diem,28.8,28.8,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,UHC MGG,UHC MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,VA,VA,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Wellcare MGG,Wellcare MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Bright Health - commercial,Bright Health - commercial,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,28.8,28.8,Bright Health MGG,Bright Health MGG,28.8,,,,,,,case rate,28.8,28.8,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Aetna,Aetna,329.13,,,,,,,per diem,329.13,329.13,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Aetna MGG,Aetna MGG,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,BCBS,BCBS,329.13,,,,,,,per diem,329.13,329.13,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,BCBS MGG,BCBS MGG,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Cigna,Cigna,329.13,,,,,,,per diem,329.13,329.13,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Cigna MGG,Cigna MGG,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Humana,Humana,329.13,,,,,,,per diem,329.13,329.13,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Humana MGG,Humana MGG,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Optum VA,Optum VA,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,UHC,UHC,329.13,,,,,,,per diem,329.13,329.13,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,UHC MGG,UHC MGG,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,VA,VA,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Wellcare MGG,Wellcare MGG,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Bright Health - commercial,Bright Health - commercial,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,329.13,329.13,Bright Health MGG,Bright Health MGG,329.13,,,,,,,case rate,329.13,329.13,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Aetna,Aetna,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Aetna MGG,Aetna MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,BCBS,BCBS,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,BCBS MGG,BCBS MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Cigna,Cigna,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Cigna MGG,Cigna MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Humana,Humana,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Humana MGG,Humana MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Optum VA,Optum VA,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,UHC,UHC,12.99,,,,,,,per diem,12.99,12.99,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,UHC MGG,UHC MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,VA,VA,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Wellcare MGG,Wellcare MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Bright Health - commercial,Bright Health - commercial,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,12.99,12.99,Bright Health MGG,Bright Health MGG,12.99,,,,,,,case rate,12.99,12.99,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Aetna,Aetna,36.33,,,,,,,per diem,36.33,36.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Aetna MGG,Aetna MGG,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,BCBS,BCBS,36.33,,,,,,,per diem,36.33,36.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,BCBS MGG,BCBS MGG,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Cigna,Cigna,36.33,,,,,,,per diem,36.33,36.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Cigna MGG,Cigna MGG,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Humana,Humana,36.33,,,,,,,per diem,36.33,36.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Humana MGG,Humana MGG,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Optum VA,Optum VA,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,UHC,UHC,36.33,,,,,,,per diem,36.33,36.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,UHC MGG,UHC MGG,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,VA,VA,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Wellcare MGG,Wellcare MGG,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Bright Health - commercial,Bright Health - commercial,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,36.33,36.33,Bright Health MGG,Bright Health MGG,36.33,,,,,,,case rate,36.33,36.33,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Aetna,Aetna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Aetna MGG,Aetna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,BCBS,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS MGG,BCBS MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Cigna,Cigna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Cigna MGG,Cigna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Humana,Humana,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Humana MGG,Humana MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Optum VA,Optum VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UHC,UHC,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UHC MGG,UHC MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,VA,VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Wellcare MGG,Wellcare MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Bright Health - commercial,Bright Health - commercial,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Bright Health MGG,Bright Health MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Aetna,Aetna,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Aetna MGG,Aetna MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,BCBS,BCBS,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,BCBS MGG,BCBS MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Cigna,Cigna,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Cigna MGG,Cigna MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Humana,Humana,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Humana MGG,Humana MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Optum VA,Optum VA,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,UHC,UHC,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,UHC MGG,UHC MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,VA,VA,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Wellcare MGG,Wellcare MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Bright Health - commercial,Bright Health - commercial,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Bright Health MGG,Bright Health MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Aetna,Aetna,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Aetna MGG,Aetna MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,BCBS,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS MGG,BCBS MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Cigna,Cigna,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Cigna MGG,Cigna MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Humana,Humana,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Humana MGG,Humana MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Optum VA,Optum VA,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UHC,UHC,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UHC MGG,UHC MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,VA,VA,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Wellcare MGG,Wellcare MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Bright Health - commercial,Bright Health - commercial,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,Bright Health MGG,Bright Health MGG,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Aetna,Aetna,50.85,,,,,,,per diem,50.85,50.85,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Aetna MGG,Aetna MGG,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,BCBS,BCBS,50.85,,,,,,,per diem,50.85,50.85,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,BCBS MGG,BCBS MGG,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Cigna,Cigna,50.85,,,,,,,per diem,50.85,50.85,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Cigna MGG,Cigna MGG,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Humana,Humana,50.85,,,,,,,per diem,50.85,50.85,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Humana MGG,Humana MGG,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Optum VA,Optum VA,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,UHC,UHC,50.85,,,,,,,per diem,50.85,50.85,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,UHC MGG,UHC MGG,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,VA,VA,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Wellcare MGG,Wellcare MGG,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Bright Health - commercial,Bright Health - commercial,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,50.85,50.85,Bright Health MGG,Bright Health MGG,50.85,,,,,,,case rate,50.85,50.85,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Aetna,Aetna,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Aetna MGG,Aetna MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,BCBS,BCBS,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,BCBS MGG,BCBS MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Cigna,Cigna,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Cigna MGG,Cigna MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Humana,Humana,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Humana MGG,Humana MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Optum VA,Optum VA,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,UHC,UHC,20.13,,,,,,,per diem,20.13,20.13,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,UHC MGG,UHC MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,VA,VA,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Wellcare MGG,Wellcare MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Bright Health - commercial,Bright Health - commercial,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,20.13,20.13,Bright Health MGG,Bright Health MGG,20.13,,,,,,,case rate,20.13,20.13,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Aetna,Aetna,652.05,,,,,,,per diem,652.05,652.05,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Aetna MGG,Aetna MGG,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,BCBS,BCBS,652.05,,,,,,,per diem,652.05,652.05,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,BCBS MGG,BCBS MGG,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Cigna,Cigna,652.05,,,,,,,per diem,652.05,652.05,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Cigna MGG,Cigna MGG,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Humana,Humana,652.05,,,,,,,per diem,652.05,652.05,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Humana MGG,Humana MGG,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Optum VA,Optum VA,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,UHC,UHC,652.05,,,,,,,per diem,652.05,652.05,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,UHC MGG,UHC MGG,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,VA,VA,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Wellcare MGG,Wellcare MGG,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Bright Health - commercial,Bright Health - commercial,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,652.05,652.05,Bright Health MGG,Bright Health MGG,652.05,,,,,,,case rate,652.05,652.05,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Aetna,Aetna,129.72,,,,,,,per diem,129.72,129.72,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Aetna MGG,Aetna MGG,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,BCBS,BCBS,129.72,,,,,,,per diem,129.72,129.72,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,BCBS MGG,BCBS MGG,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Cigna,Cigna,129.72,,,,,,,per diem,129.72,129.72,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Cigna MGG,Cigna MGG,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Humana,Humana,129.72,,,,,,,per diem,129.72,129.72,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Humana MGG,Humana MGG,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Optum VA,Optum VA,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,UHC,UHC,129.72,,,,,,,per diem,129.72,129.72,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,UHC MGG,UHC MGG,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,VA,VA,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Wellcare MGG,Wellcare MGG,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Bright Health - commercial,Bright Health - commercial,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,129.72,129.72,Bright Health MGG,Bright Health MGG,129.72,,,,,,,case rate,129.72,129.72,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Aetna,Aetna,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Aetna MGG,Aetna MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,BCBS,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS MGG,BCBS MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Cigna,Cigna,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Cigna MGG,Cigna MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Humana,Humana,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Humana MGG,Humana MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Optum VA,Optum VA,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UHC,UHC,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UHC MGG,UHC MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,VA,VA,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Wellcare MGG,Wellcare MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Bright Health - commercial,Bright Health - commercial,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,Bright Health MGG,Bright Health MGG,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Aetna,Aetna,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Aetna MGG,Aetna MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,BCBS,BCBS,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,BCBS MGG,BCBS MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Cigna,Cigna,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Cigna MGG,Cigna MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Humana,Humana,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Humana MGG,Humana MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Optum VA,Optum VA,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,UHC,UHC,7.89,,,,,,,per diem,7.89,7.89,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,UHC MGG,UHC MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,VA,VA,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Wellcare MGG,Wellcare MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Bright Health - commercial,Bright Health - commercial,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,7.89,7.89,Bright Health MGG,Bright Health MGG,7.89,,,,,,,case rate,7.89,7.89,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Aetna,Aetna,714.63,,,,,,,per diem,714.63,714.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Aetna MGG,Aetna MGG,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,BCBS,BCBS,714.63,,,,,,,per diem,714.63,714.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,BCBS MGG,BCBS MGG,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Cigna,Cigna,714.63,,,,,,,per diem,714.63,714.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Cigna MGG,Cigna MGG,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Humana,Humana,714.63,,,,,,,per diem,714.63,714.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Humana MGG,Humana MGG,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Optum VA,Optum VA,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,UHC,UHC,714.63,,,,,,,per diem,714.63,714.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,UHC MGG,UHC MGG,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,VA,VA,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Wellcare MGG,Wellcare MGG,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Bright Health - commercial,Bright Health - commercial,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,714.63,714.63,Bright Health MGG,Bright Health MGG,714.63,,,,,,,case rate,714.63,714.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Aetna,Aetna,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Aetna MGG,Aetna MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,BCBS,BCBS,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,BCBS MGG,BCBS MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Cigna,Cigna,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Cigna MGG,Cigna MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Humana,Humana,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Humana MGG,Humana MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Optum VA,Optum VA,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,UHC,UHC,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,UHC MGG,UHC MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,VA,VA,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Wellcare MGG,Wellcare MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Bright Health - commercial,Bright Health - commercial,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Bright Health MGG,Bright Health MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Aetna,Aetna,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Aetna MGG,Aetna MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,BCBS,BCBS,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,BCBS MGG,BCBS MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Cigna,Cigna,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Cigna MGG,Cigna MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Humana,Humana,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Humana MGG,Humana MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Optum VA,Optum VA,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,UHC,UHC,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,UHC MGG,UHC MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,VA,VA,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Wellcare MGG,Wellcare MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Bright Health - commercial,Bright Health - commercial,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Bright Health MGG,Bright Health MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Aetna,Aetna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Aetna MGG,Aetna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,BCBS,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS MGG,BCBS MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Cigna,Cigna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Cigna MGG,Cigna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Humana,Humana,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Humana MGG,Humana MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Optum VA,Optum VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UHC,UHC,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UHC MGG,UHC MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,VA,VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Wellcare MGG,Wellcare MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Bright Health - commercial,Bright Health - commercial,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Bright Health MGG,Bright Health MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Aetna,Aetna,133.8,,,,,,,per diem,133.8,133.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Aetna MGG,Aetna MGG,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,BCBS,BCBS,133.8,,,,,,,per diem,133.8,133.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,BCBS MGG,BCBS MGG,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Cigna,Cigna,133.8,,,,,,,per diem,133.8,133.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Cigna MGG,Cigna MGG,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Humana,Humana,133.8,,,,,,,per diem,133.8,133.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Humana MGG,Humana MGG,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Optum VA,Optum VA,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,UHC,UHC,133.8,,,,,,,per diem,133.8,133.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,UHC MGG,UHC MGG,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,VA,VA,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Wellcare MGG,Wellcare MGG,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Bright Health - commercial,Bright Health - commercial,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,133.8,133.8,Bright Health MGG,Bright Health MGG,133.8,,,,,,,case rate,133.8,133.8,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Aetna,Aetna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Aetna MGG,Aetna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,BCBS,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS MGG,BCBS MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Cigna,Cigna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Cigna MGG,Cigna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Humana,Humana,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Humana MGG,Humana MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Optum VA,Optum VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UHC,UHC,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UHC MGG,UHC MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Wellcare MGG,Wellcare MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Bright Health - commercial,Bright Health - commercial,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Bright Health MGG,Bright Health MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Aetna,Aetna,84.24,,,,,,,per diem,84.24,84.24,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Aetna MGG,Aetna MGG,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,BCBS,BCBS,84.24,,,,,,,per diem,84.24,84.24,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,BCBS MGG,BCBS MGG,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Cigna,Cigna,84.24,,,,,,,per diem,84.24,84.24,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Cigna MGG,Cigna MGG,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Humana,Humana,84.24,,,,,,,per diem,84.24,84.24,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Humana MGG,Humana MGG,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Optum VA,Optum VA,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,UHC,UHC,84.24,,,,,,,per diem,84.24,84.24,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,UHC MGG,UHC MGG,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,VA,VA,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Wellcare MGG,Wellcare MGG,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Bright Health - commercial,Bright Health - commercial,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,84.24,84.24,Bright Health MGG,Bright Health MGG,84.24,,,,,,,case rate,84.24,84.24,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Aetna,Aetna,210.6,,,,,,,per diem,210.6,210.6,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Aetna MGG,Aetna MGG,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,BCBS,BCBS,210.6,,,,,,,per diem,210.6,210.6,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,BCBS MGG,BCBS MGG,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Cigna,Cigna,210.6,,,,,,,per diem,210.6,210.6,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Cigna MGG,Cigna MGG,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Humana,Humana,210.6,,,,,,,per diem,210.6,210.6,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Humana MGG,Humana MGG,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Optum VA,Optum VA,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,UHC,UHC,210.6,,,,,,,per diem,210.6,210.6,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,UHC MGG,UHC MGG,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,VA,VA,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Wellcare MGG,Wellcare MGG,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Bright Health - commercial,Bright Health - commercial,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,210.6,210.6,Bright Health MGG,Bright Health MGG,210.6,,,,,,,case rate,210.6,210.6,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Aetna,Aetna,239.88,,,,,,,per diem,239.88,239.88,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Aetna MGG,Aetna MGG,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,BCBS,BCBS,239.88,,,,,,,per diem,239.88,239.88,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,BCBS MGG,BCBS MGG,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Cigna,Cigna,239.88,,,,,,,per diem,239.88,239.88,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Cigna MGG,Cigna MGG,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Humana,Humana,239.88,,,,,,,per diem,239.88,239.88,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Humana MGG,Humana MGG,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Optum VA,Optum VA,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,UHC,UHC,239.88,,,,,,,per diem,239.88,239.88,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,UHC MGG,UHC MGG,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,VA,VA,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Wellcare MGG,Wellcare MGG,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Bright Health - commercial,Bright Health - commercial,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,239.88,239.88,Bright Health MGG,Bright Health MGG,239.88,,,,,,,case rate,239.88,239.88,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Aetna,Aetna,18.69,,,,,,,per diem,18.69,18.69,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Aetna MGG,Aetna MGG,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,BCBS,BCBS,18.69,,,,,,,per diem,18.69,18.69,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,BCBS MGG,BCBS MGG,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Cigna,Cigna,18.69,,,,,,,per diem,18.69,18.69,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Cigna MGG,Cigna MGG,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Humana,Humana,18.69,,,,,,,per diem,18.69,18.69,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Humana MGG,Humana MGG,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Optum VA,Optum VA,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,UHC,UHC,18.69,,,,,,,per diem,18.69,18.69,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,UHC MGG,UHC MGG,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,VA,VA,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Wellcare MGG,Wellcare MGG,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Bright Health - commercial,Bright Health - commercial,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,18.69,18.69,Bright Health MGG,Bright Health MGG,18.69,,,,,,,case rate,18.69,18.69,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Aetna,Aetna,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Aetna MGG,Aetna MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,BCBS,BCBS,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,BCBS MGG,BCBS MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Cigna,Cigna,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Cigna MGG,Cigna MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Humana,Humana,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Humana MGG,Humana MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Optum VA,Optum VA,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,UHC,UHC,32.94,,,,,,,per diem,32.94,32.94,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,UHC MGG,UHC MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,VA,VA,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Wellcare MGG,Wellcare MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Bright Health - commercial,Bright Health - commercial,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,32.94,32.94,Bright Health MGG,Bright Health MGG,32.94,,,,,,,case rate,32.94,32.94,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Aetna,Aetna,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Aetna MGG,Aetna MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,BCBS,BCBS,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,BCBS MGG,BCBS MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Cigna,Cigna,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Cigna MGG,Cigna MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Humana,Humana,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Humana MGG,Humana MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Optum VA,Optum VA,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,UHC,UHC,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,UHC MGG,UHC MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,VA,VA,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Wellcare MGG,Wellcare MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Bright Health - commercial,Bright Health - commercial,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Bright Health MGG,Bright Health MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Aetna,Aetna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Aetna MGG,Aetna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,BCBS,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS MGG,BCBS MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Cigna,Cigna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Cigna MGG,Cigna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Humana,Humana,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Humana MGG,Humana MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Optum VA,Optum VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UHC,UHC,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UHC MGG,UHC MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,VA,VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Wellcare MGG,Wellcare MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Bright Health - commercial,Bright Health - commercial,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Bright Health MGG,Bright Health MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Aetna,Aetna,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Aetna MGG,Aetna MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,BCBS,BCBS,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,BCBS MGG,BCBS MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Cigna,Cigna,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Cigna MGG,Cigna MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Humana,Humana,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Humana MGG,Humana MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Optum VA,Optum VA,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,UHC,UHC,15.33,,,,,,,per diem,15.33,15.33,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,UHC MGG,UHC MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,VA,VA,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Wellcare MGG,Wellcare MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Bright Health - commercial,Bright Health - commercial,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,15.33,15.33,Bright Health MGG,Bright Health MGG,15.33,,,,,,,case rate,15.33,15.33,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Aetna,Aetna,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Aetna MGG,Aetna MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,BCBS,BCBS,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,BCBS MGG,BCBS MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Cigna,Cigna,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Cigna MGG,Cigna MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Humana,Humana,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Humana MGG,Humana MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Optum VA,Optum VA,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,UHC,UHC,10.14,,,,,,,per diem,10.14,10.14,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,UHC MGG,UHC MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,VA,VA,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Wellcare MGG,Wellcare MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Bright Health - commercial,Bright Health - commercial,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.14,10.14,Bright Health MGG,Bright Health MGG,10.14,,,,,,,case rate,10.14,10.14,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Aetna,Aetna,517.32,,,,,,,per diem,517.32,517.32,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Aetna MGG,Aetna MGG,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,BCBS,BCBS,517.32,,,,,,,per diem,517.32,517.32,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,BCBS MGG,BCBS MGG,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Cigna,Cigna,517.32,,,,,,,per diem,517.32,517.32,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Cigna MGG,Cigna MGG,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Humana,Humana,517.32,,,,,,,per diem,517.32,517.32,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Humana MGG,Humana MGG,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Optum VA,Optum VA,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,UHC,UHC,517.32,,,,,,,per diem,517.32,517.32,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,UHC MGG,UHC MGG,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,VA,VA,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Wellcare MGG,Wellcare MGG,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Bright Health - commercial,Bright Health - commercial,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,517.32,517.32,Bright Health MGG,Bright Health MGG,517.32,,,,,,,case rate,517.32,517.32,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Aetna,Aetna,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Aetna MGG,Aetna MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,BCBS,BCBS,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,BCBS MGG,BCBS MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Cigna,Cigna,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Cigna MGG,Cigna MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Humana,Humana,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Humana MGG,Humana MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Optum VA,Optum VA,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,UHC,UHC,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,UHC MGG,UHC MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,VA,VA,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Wellcare MGG,Wellcare MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Bright Health - commercial,Bright Health - commercial,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Bright Health MGG,Bright Health MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Aetna,Aetna,549.84,,,,,,,per diem,549.84,549.84,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Aetna MGG,Aetna MGG,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,BCBS,BCBS,549.84,,,,,,,per diem,549.84,549.84,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,BCBS MGG,BCBS MGG,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Cigna,Cigna,549.84,,,,,,,per diem,549.84,549.84,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Cigna MGG,Cigna MGG,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Humana,Humana,549.84,,,,,,,per diem,549.84,549.84,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Humana MGG,Humana MGG,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Optum VA,Optum VA,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,UHC,UHC,549.84,,,,,,,per diem,549.84,549.84,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,UHC MGG,UHC MGG,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,VA,VA,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Wellcare MGG,Wellcare MGG,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Bright Health - commercial,Bright Health - commercial,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,549.84,549.84,Bright Health MGG,Bright Health MGG,549.84,,,,,,,case rate,549.84,549.84,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Aetna,Aetna,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Aetna MGG,Aetna MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,BCBS,BCBS,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,BCBS MGG,BCBS MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Cigna,Cigna,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Cigna MGG,Cigna MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Humana,Humana,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Humana MGG,Humana MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Optum VA,Optum VA,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,UHC,UHC,16.35,,,,,,,per diem,16.35,16.35,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,UHC MGG,UHC MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,VA,VA,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Wellcare MGG,Wellcare MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Bright Health - commercial,Bright Health - commercial,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,16.35,16.35,Bright Health MGG,Bright Health MGG,16.35,,,,,,,case rate,16.35,16.35,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Aetna,Aetna,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Aetna MGG,Aetna MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS,BCBS,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS MGG,BCBS MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Cigna,Cigna,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Cigna MGG,Cigna MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Humana,Humana,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Humana MGG,Humana MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Optum VA,Optum VA,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,UHC,UHC,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,UHC MGG,UHC MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,VA,VA,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Wellcare MGG,Wellcare MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Bright Health - commercial,Bright Health - commercial,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,Bright Health MGG,Bright Health MGG,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Aetna,Aetna,1304.1,,,,,,,per diem,1304.1,1304.1,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Aetna MGG,Aetna MGG,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,BCBS,BCBS,1304.1,,,,,,,per diem,1304.1,1304.1,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,BCBS MGG,BCBS MGG,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Cigna,Cigna,1304.1,,,,,,,per diem,1304.1,1304.1,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Cigna MGG,Cigna MGG,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Humana,Humana,1304.1,,,,,,,per diem,1304.1,1304.1,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Humana MGG,Humana MGG,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Optum VA,Optum VA,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,UHC,UHC,1304.1,,,,,,,per diem,1304.1,1304.1,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,UHC MGG,UHC MGG,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,VA,VA,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Wellcare MGG,Wellcare MGG,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Bright Health - commercial,Bright Health - commercial,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1304.1,1304.1,Bright Health MGG,Bright Health MGG,1304.1,,,,,,,case rate,1304.1,1304.1,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Aetna,Aetna,62.46,,,,,,,per diem,62.46,62.46,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Aetna MGG,Aetna MGG,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,BCBS,BCBS,62.46,,,,,,,per diem,62.46,62.46,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,BCBS MGG,BCBS MGG,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Cigna,Cigna,62.46,,,,,,,per diem,62.46,62.46,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Cigna MGG,Cigna MGG,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Humana,Humana,62.46,,,,,,,per diem,62.46,62.46,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Humana MGG,Humana MGG,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Optum VA,Optum VA,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,UHC,UHC,62.46,,,,,,,per diem,62.46,62.46,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,UHC MGG,UHC MGG,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,VA,VA,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Wellcare MGG,Wellcare MGG,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Bright Health - commercial,Bright Health - commercial,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,62.46,62.46,Bright Health MGG,Bright Health MGG,62.46,,,,,,,case rate,62.46,62.46,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Aetna,Aetna,1337.4,,,,,,,per diem,1337.4,1337.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Aetna MGG,Aetna MGG,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,BCBS,BCBS,1337.4,,,,,,,per diem,1337.4,1337.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,BCBS MGG,BCBS MGG,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Cigna,Cigna,1337.4,,,,,,,per diem,1337.4,1337.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Cigna MGG,Cigna MGG,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Humana,Humana,1337.4,,,,,,,per diem,1337.4,1337.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Humana MGG,Humana MGG,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Optum VA,Optum VA,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,UHC,UHC,1337.4,,,,,,,per diem,1337.4,1337.4,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,UHC MGG,UHC MGG,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,VA,VA,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Wellcare MGG,Wellcare MGG,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Bright Health - commercial,Bright Health - commercial,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1337.4,1337.4,Bright Health MGG,Bright Health MGG,1337.4,,,,,,,case rate,1337.4,1337.4,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Aetna,Aetna,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Aetna MGG,Aetna MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,BCBS,BCBS,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,BCBS MGG,BCBS MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Cigna,Cigna,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Cigna MGG,Cigna MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Humana,Humana,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Humana MGG,Humana MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Optum VA,Optum VA,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,UHC,UHC,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,UHC MGG,UHC MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,VA,VA,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Wellcare MGG,Wellcare MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Bright Health - commercial,Bright Health - commercial,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Bright Health MGG,Bright Health MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna,Aetna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna MGG,Aetna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS,BCBS,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS MGG,BCBS MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna,Cigna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna MGG,Cigna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana,Humana,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana MGG,Humana MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Optum VA,Optum VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC,UHC,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC MGG,UHC MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,VA,VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Wellcare MGG,Wellcare MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health - commercial,Bright Health - commercial,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health MGG,Bright Health MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Aetna,Aetna,49.5,,,,,,,per diem,49.5,49.5,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Aetna MGG,Aetna MGG,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,BCBS,BCBS,49.5,,,,,,,per diem,49.5,49.5,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,BCBS MGG,BCBS MGG,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Cigna,Cigna,49.5,,,,,,,per diem,49.5,49.5,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Cigna MGG,Cigna MGG,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Humana,Humana,49.5,,,,,,,per diem,49.5,49.5,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Humana MGG,Humana MGG,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Optum VA,Optum VA,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,UHC,UHC,49.5,,,,,,,per diem,49.5,49.5,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,UHC MGG,UHC MGG,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,VA,VA,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Wellcare MGG,Wellcare MGG,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Bright Health - commercial,Bright Health - commercial,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,49.5,49.5,Bright Health MGG,Bright Health MGG,49.5,,,,,,,case rate,49.5,49.5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Aetna,Aetna,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Aetna MGG,Aetna MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,BCBS,BCBS,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,BCBS MGG,BCBS MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Cigna,Cigna,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Cigna MGG,Cigna MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Humana,Humana,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Humana MGG,Humana MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Optum VA,Optum VA,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,UHC,UHC,38.82,,,,,,,per diem,38.82,38.82,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,UHC MGG,UHC MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,VA,VA,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Wellcare MGG,Wellcare MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Bright Health - commercial,Bright Health - commercial,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,38.82,38.82,Bright Health MGG,Bright Health MGG,38.82,,,,,,,case rate,38.82,38.82,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Aetna,Aetna,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Aetna MGG,Aetna MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,BCBS,BCBS,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,BCBS MGG,BCBS MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Cigna,Cigna,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Cigna MGG,Cigna MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Humana,Humana,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Humana MGG,Humana MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Optum VA,Optum VA,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,UHC,UHC,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,UHC MGG,UHC MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,VA,VA,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Wellcare MGG,Wellcare MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Bright Health - commercial,Bright Health - commercial,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Bright Health MGG,Bright Health MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Aetna,Aetna,69.06,,,,,,,per diem,69.06,69.06,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Aetna MGG,Aetna MGG,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,BCBS,BCBS,69.06,,,,,,,per diem,69.06,69.06,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,BCBS MGG,BCBS MGG,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Cigna,Cigna,69.06,,,,,,,per diem,69.06,69.06,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Cigna MGG,Cigna MGG,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Humana,Humana,69.06,,,,,,,per diem,69.06,69.06,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Humana MGG,Humana MGG,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Optum VA,Optum VA,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,UHC,UHC,69.06,,,,,,,per diem,69.06,69.06,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,UHC MGG,UHC MGG,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,VA,VA,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Wellcare MGG,Wellcare MGG,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Bright Health - commercial,Bright Health - commercial,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,69.06,69.06,Bright Health MGG,Bright Health MGG,69.06,,,,,,,case rate,69.06,69.06,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Aetna,Aetna,133.14,,,,,,,per diem,133.14,133.14,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Aetna MGG,Aetna MGG,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,BCBS,BCBS,133.14,,,,,,,per diem,133.14,133.14,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,BCBS MGG,BCBS MGG,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Cigna,Cigna,133.14,,,,,,,per diem,133.14,133.14,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Cigna MGG,Cigna MGG,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Humana,Humana,133.14,,,,,,,per diem,133.14,133.14,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Humana MGG,Humana MGG,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Optum VA,Optum VA,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,UHC,UHC,133.14,,,,,,,per diem,133.14,133.14,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,UHC MGG,UHC MGG,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,VA,VA,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Wellcare MGG,Wellcare MGG,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Bright Health - commercial,Bright Health - commercial,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,133.14,133.14,Bright Health MGG,Bright Health MGG,133.14,,,,,,,case rate,133.14,133.14,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Aetna,Aetna,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Aetna MGG,Aetna MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,BCBS,BCBS,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,BCBS MGG,BCBS MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Cigna,Cigna,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Cigna MGG,Cigna MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Humana,Humana,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Humana MGG,Humana MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Optum VA,Optum VA,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,UHC,UHC,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,UHC MGG,UHC MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,VA,VA,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Wellcare MGG,Wellcare MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Bright Health - commercial,Bright Health - commercial,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Bright Health MGG,Bright Health MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Aetna,Aetna,34.08,,,,,,,per diem,34.08,34.08,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Aetna MGG,Aetna MGG,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,BCBS,BCBS,34.08,,,,,,,per diem,34.08,34.08,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,BCBS MGG,BCBS MGG,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Cigna,Cigna,34.08,,,,,,,per diem,34.08,34.08,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Cigna MGG,Cigna MGG,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Humana,Humana,34.08,,,,,,,per diem,34.08,34.08,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Humana MGG,Humana MGG,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Optum VA,Optum VA,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,UHC,UHC,34.08,,,,,,,per diem,34.08,34.08,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,UHC MGG,UHC MGG,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,VA,VA,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Wellcare MGG,Wellcare MGG,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Bright Health - commercial,Bright Health - commercial,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,34.08,34.08,Bright Health MGG,Bright Health MGG,34.08,,,,,,,case rate,34.08,34.08,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Aetna,Aetna,1060.74,,,,,,,per diem,1060.74,1060.74,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Aetna MGG,Aetna MGG,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,BCBS,BCBS,1060.74,,,,,,,per diem,1060.74,1060.74,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,BCBS MGG,BCBS MGG,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Cigna,Cigna,1060.74,,,,,,,per diem,1060.74,1060.74,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Cigna MGG,Cigna MGG,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Humana,Humana,1060.74,,,,,,,per diem,1060.74,1060.74,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Humana MGG,Humana MGG,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Optum VA,Optum VA,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,UHC,UHC,1060.74,,,,,,,per diem,1060.74,1060.74,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,UHC MGG,UHC MGG,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,VA,VA,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Wellcare MGG,Wellcare MGG,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Bright Health - commercial,Bright Health - commercial,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1060.74,1060.74,Bright Health MGG,Bright Health MGG,1060.74,,,,,,,case rate,1060.74,1060.74,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Aetna,Aetna,39.42,,,,,,,per diem,39.42,39.42,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Aetna MGG,Aetna MGG,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,BCBS,BCBS,39.42,,,,,,,per diem,39.42,39.42,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,BCBS MGG,BCBS MGG,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Cigna,Cigna,39.42,,,,,,,per diem,39.42,39.42,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Cigna MGG,Cigna MGG,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Humana,Humana,39.42,,,,,,,per diem,39.42,39.42,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Humana MGG,Humana MGG,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Optum VA,Optum VA,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,UHC,UHC,39.42,,,,,,,per diem,39.42,39.42,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,UHC MGG,UHC MGG,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,VA,VA,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Wellcare MGG,Wellcare MGG,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Bright Health - commercial,Bright Health - commercial,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,39.42,39.42,Bright Health MGG,Bright Health MGG,39.42,,,,,,,case rate,39.42,39.42,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Aetna,Aetna,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Aetna MGG,Aetna MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,BCBS,BCBS,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,BCBS MGG,BCBS MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Cigna,Cigna,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Cigna MGG,Cigna MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Humana,Humana,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Humana MGG,Humana MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Optum VA,Optum VA,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,UHC,UHC,20.94,,,,,,,per diem,20.94,20.94,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,UHC MGG,UHC MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,VA,VA,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Wellcare MGG,Wellcare MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Bright Health - commercial,Bright Health - commercial,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,20.94,20.94,Bright Health MGG,Bright Health MGG,20.94,,,,,,,case rate,20.94,20.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Aetna,Aetna,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Aetna MGG,Aetna MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,BCBS,BCBS,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,BCBS MGG,BCBS MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Cigna,Cigna,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Cigna MGG,Cigna MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Humana,Humana,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Humana MGG,Humana MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Optum VA,Optum VA,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,UHC,UHC,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,UHC MGG,UHC MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,VA,VA,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Wellcare MGG,Wellcare MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Bright Health - commercial,Bright Health - commercial,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Bright Health MGG,Bright Health MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Aetna,Aetna,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Aetna MGG,Aetna MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,BCBS,BCBS,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,BCBS MGG,BCBS MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Cigna,Cigna,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Cigna MGG,Cigna MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Humana,Humana,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Humana MGG,Humana MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Optum VA,Optum VA,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,UHC,UHC,6.42,,,,,,,per diem,6.42,6.42,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,UHC MGG,UHC MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,VA,VA,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Wellcare MGG,Wellcare MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Bright Health - commercial,Bright Health - commercial,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,6.42,6.42,Bright Health MGG,Bright Health MGG,6.42,,,,,,,case rate,6.42,6.42,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Aetna,Aetna,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Aetna MGG,Aetna MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,BCBS,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS MGG,BCBS MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Cigna,Cigna,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Cigna MGG,Cigna MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Humana,Humana,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Humana MGG,Humana MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Optum VA,Optum VA,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UHC,UHC,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UHC MGG,UHC MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA,VA,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Wellcare MGG,Wellcare MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Bright Health - commercial,Bright Health - commercial,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,Bright Health MGG,Bright Health MGG,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Aetna,Aetna,849,,,,,,,per diem,849,849,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Aetna MGG,Aetna MGG,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,BCBS,BCBS,849,,,,,,,per diem,849,849,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,BCBS MGG,BCBS MGG,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Cigna,Cigna,849,,,,,,,per diem,849,849,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Cigna MGG,Cigna MGG,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Humana,Humana,849,,,,,,,per diem,849,849,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Humana MGG,Humana MGG,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Optum VA,Optum VA,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,UHC,UHC,849,,,,,,,per diem,849,849,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,UHC MGG,UHC MGG,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,VA,VA,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Wellcare MGG,Wellcare MGG,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Bright Health - commercial,Bright Health - commercial,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,849,849,Bright Health MGG,Bright Health MGG,849,,,,,,,case rate,849,849,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Aetna,Aetna,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Aetna MGG,Aetna MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,BCBS,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS MGG,BCBS MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Cigna,Cigna,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Cigna MGG,Cigna MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Humana,Humana,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Humana MGG,Humana MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Optum VA,Optum VA,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,UHC,UHC,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,UHC MGG,UHC MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,VA,VA,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Wellcare MGG,Wellcare MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Bright Health - commercial,Bright Health - commercial,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,Bright Health MGG,Bright Health MGG,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Aetna,Aetna,66.75,,,,,,,per diem,66.75,66.75,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Aetna MGG,Aetna MGG,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,BCBS,BCBS,66.75,,,,,,,per diem,66.75,66.75,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,BCBS MGG,BCBS MGG,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Cigna,Cigna,66.75,,,,,,,per diem,66.75,66.75,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Cigna MGG,Cigna MGG,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Humana,Humana,66.75,,,,,,,per diem,66.75,66.75,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Humana MGG,Humana MGG,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Optum VA,Optum VA,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,UHC,UHC,66.75,,,,,,,per diem,66.75,66.75,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,UHC MGG,UHC MGG,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,VA,VA,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Wellcare MGG,Wellcare MGG,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Bright Health - commercial,Bright Health - commercial,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,66.75,66.75,Bright Health MGG,Bright Health MGG,66.75,,,,,,,case rate,66.75,66.75,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna,Aetna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna MGG,Aetna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS,BCBS,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS MGG,BCBS MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna,Cigna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna MGG,Cigna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana,Humana,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana MGG,Humana MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Optum VA,Optum VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC,UHC,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC MGG,UHC MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,VA,VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Wellcare MGG,Wellcare MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health - commercial,Bright Health - commercial,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health MGG,Bright Health MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Aetna,Aetna,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Aetna MGG,Aetna MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,BCBS,BCBS,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,BCBS MGG,BCBS MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Cigna,Cigna,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Cigna MGG,Cigna MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Humana,Humana,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Humana MGG,Humana MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Optum VA,Optum VA,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,UHC,UHC,67.35,,,,,,,per diem,67.35,67.35,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,UHC MGG,UHC MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,VA,VA,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Wellcare MGG,Wellcare MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Bright Health - commercial,Bright Health - commercial,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,67.35,67.35,Bright Health MGG,Bright Health MGG,67.35,,,,,,,case rate,67.35,67.35,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Aetna,Aetna,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Aetna MGG,Aetna MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,BCBS,BCBS,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,BCBS MGG,BCBS MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Cigna,Cigna,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Cigna MGG,Cigna MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Humana,Humana,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Humana MGG,Humana MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Optum VA,Optum VA,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,UHC,UHC,13.5,,,,,,,per diem,13.5,13.5,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,UHC MGG,UHC MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,VA,VA,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Wellcare MGG,Wellcare MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Bright Health - commercial,Bright Health - commercial,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,13.5,13.5,Bright Health MGG,Bright Health MGG,13.5,,,,,,,case rate,13.5,13.5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Aetna,Aetna,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Aetna MGG,Aetna MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,BCBS,BCBS,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,BCBS MGG,BCBS MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Cigna,Cigna,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Cigna MGG,Cigna MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Humana,Humana,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Humana MGG,Humana MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Optum VA,Optum VA,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,UHC,UHC,14.73,,,,,,,per diem,14.73,14.73,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,UHC MGG,UHC MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,VA,VA,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Wellcare MGG,Wellcare MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Bright Health - commercial,Bright Health - commercial,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,14.73,14.73,Bright Health MGG,Bright Health MGG,14.73,,,,,,,case rate,14.73,14.73,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Aetna,Aetna,11.51,,,,,,,per diem,11.51,11.51,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Aetna MGG,Aetna MGG,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,BCBS,BCBS,11.51,,,,,,,per diem,11.51,11.51,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,BCBS MGG,BCBS MGG,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Cigna,Cigna,11.51,,,,,,,per diem,11.51,11.51,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Cigna MGG,Cigna MGG,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Humana,Humana,11.51,,,,,,,per diem,11.51,11.51,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Humana MGG,Humana MGG,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Optum VA,Optum VA,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,UHC,UHC,11.51,,,,,,,per diem,11.51,11.51,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,UHC MGG,UHC MGG,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,VA,VA,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Wellcare MGG,Wellcare MGG,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Bright Health - commercial,Bright Health - commercial,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,11.51,11.51,Bright Health MGG,Bright Health MGG,11.51,,,,,,,case rate,11.51,11.51,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Aetna,Aetna,204.42,,,,,,,per diem,204.42,204.42,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Aetna MGG,Aetna MGG,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,BCBS,BCBS,204.42,,,,,,,per diem,204.42,204.42,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,BCBS MGG,BCBS MGG,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Cigna,Cigna,204.42,,,,,,,per diem,204.42,204.42,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Cigna MGG,Cigna MGG,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Humana,Humana,204.42,,,,,,,per diem,204.42,204.42,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Humana MGG,Humana MGG,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Optum VA,Optum VA,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,UHC,UHC,204.42,,,,,,,per diem,204.42,204.42,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,UHC MGG,UHC MGG,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,VA,VA,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Wellcare MGG,Wellcare MGG,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Bright Health - commercial,Bright Health - commercial,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,204.42,204.42,Bright Health MGG,Bright Health MGG,204.42,,,,,,,case rate,204.42,204.42,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna,Aetna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna MGG,Aetna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS,BCBS,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS MGG,BCBS MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna,Cigna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna MGG,Cigna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana,Humana,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana MGG,Humana MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Optum VA,Optum VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC,UHC,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC MGG,UHC MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,VA,VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Wellcare MGG,Wellcare MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health - commercial,Bright Health - commercial,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health MGG,Bright Health MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Aetna,Aetna,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Aetna MGG,Aetna MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,BCBS,BCBS,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,BCBS MGG,BCBS MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Cigna,Cigna,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Cigna MGG,Cigna MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Humana,Humana,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Humana MGG,Humana MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Optum VA,Optum VA,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,UHC,UHC,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,UHC MGG,UHC MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,VA,VA,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Wellcare MGG,Wellcare MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Bright Health - commercial,Bright Health - commercial,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Bright Health MGG,Bright Health MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Aetna,Aetna,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Aetna MGG,Aetna MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,BCBS,BCBS,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,BCBS MGG,BCBS MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Cigna,Cigna,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Cigna MGG,Cigna MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Humana,Humana,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Humana MGG,Humana MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Optum VA,Optum VA,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,UHC,UHC,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,UHC MGG,UHC MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,VA,VA,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Wellcare MGG,Wellcare MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Bright Health - commercial,Bright Health - commercial,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Bright Health MGG,Bright Health MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Aetna,Aetna,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Aetna MGG,Aetna MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,BCBS,BCBS,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,BCBS MGG,BCBS MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Cigna,Cigna,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Cigna MGG,Cigna MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Humana,Humana,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Humana MGG,Humana MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Optum VA,Optum VA,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,UHC,UHC,68.58,,,,,,,per diem,68.58,68.58,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,UHC MGG,UHC MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,VA,VA,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Wellcare MGG,Wellcare MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Bright Health - commercial,Bright Health - commercial,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,68.58,68.58,Bright Health MGG,Bright Health MGG,68.58,,,,,,,case rate,68.58,68.58,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Aetna,Aetna,1558.5,,,,,,,per diem,1558.5,1558.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Aetna MGG,Aetna MGG,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,BCBS,BCBS,1558.5,,,,,,,per diem,1558.5,1558.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,BCBS MGG,BCBS MGG,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Cigna,Cigna,1558.5,,,,,,,per diem,1558.5,1558.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Cigna MGG,Cigna MGG,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Humana,Humana,1558.5,,,,,,,per diem,1558.5,1558.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Humana MGG,Humana MGG,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Optum VA,Optum VA,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,UHC,UHC,1558.5,,,,,,,per diem,1558.5,1558.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,UHC MGG,UHC MGG,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,VA,VA,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Wellcare MGG,Wellcare MGG,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Bright Health - commercial,Bright Health - commercial,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1558.5,1558.5,Bright Health MGG,Bright Health MGG,1558.5,,,,,,,case rate,1558.5,1558.5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Aetna,Aetna,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Aetna MGG,Aetna MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,BCBS,BCBS,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,BCBS MGG,BCBS MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Cigna,Cigna,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Cigna MGG,Cigna MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Humana,Humana,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Humana MGG,Humana MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Optum VA,Optum VA,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,UHC,UHC,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,UHC MGG,UHC MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,VA,VA,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Wellcare MGG,Wellcare MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Bright Health - commercial,Bright Health - commercial,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Bright Health MGG,Bright Health MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna,Aetna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna MGG,Aetna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,BCBS,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS MGG,BCBS MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna,Cigna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna MGG,Cigna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana,Humana,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana MGG,Humana MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Optum VA,Optum VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC,UHC,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC MGG,UHC MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,VA,VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Wellcare MGG,Wellcare MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health - commercial,Bright Health - commercial,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health MGG,Bright Health MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Aetna,Aetna,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Aetna MGG,Aetna MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,BCBS,BCBS,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,BCBS MGG,BCBS MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Cigna,Cigna,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Cigna MGG,Cigna MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Humana,Humana,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Humana MGG,Humana MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Optum VA,Optum VA,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,UHC,UHC,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,UHC MGG,UHC MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,VA,VA,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Wellcare MGG,Wellcare MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Bright Health - commercial,Bright Health - commercial,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Bright Health MGG,Bright Health MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna,Aetna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna MGG,Aetna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS,BCBS,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS MGG,BCBS MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna,Cigna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna MGG,Cigna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana,Humana,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana MGG,Humana MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Optum VA,Optum VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC,UHC,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC MGG,UHC MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,VA,VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Wellcare MGG,Wellcare MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health - commercial,Bright Health - commercial,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health MGG,Bright Health MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Aetna,Aetna,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Aetna MGG,Aetna MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,BCBS,BCBS,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,BCBS MGG,BCBS MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Cigna,Cigna,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Cigna MGG,Cigna MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Humana,Humana,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Humana MGG,Humana MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Optum VA,Optum VA,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,UHC,UHC,30.3,,,,,,,per diem,30.3,30.3,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,UHC MGG,UHC MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,VA,VA,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Wellcare MGG,Wellcare MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Bright Health - commercial,Bright Health - commercial,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,30.3,30.3,Bright Health MGG,Bright Health MGG,30.3,,,,,,,case rate,30.3,30.3,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Aetna,Aetna,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Aetna MGG,Aetna MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,BCBS,BCBS,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,BCBS MGG,BCBS MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Cigna,Cigna,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Cigna MGG,Cigna MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Humana,Humana,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Humana MGG,Humana MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Optum VA,Optum VA,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,UHC,UHC,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,UHC MGG,UHC MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,VA,VA,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Wellcare MGG,Wellcare MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Bright Health - commercial,Bright Health - commercial,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Bright Health MGG,Bright Health MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Aetna,Aetna,383.7,,,,,,,per diem,383.7,383.7,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Aetna MGG,Aetna MGG,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,BCBS,BCBS,383.7,,,,,,,per diem,383.7,383.7,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,BCBS MGG,BCBS MGG,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Cigna,Cigna,383.7,,,,,,,per diem,383.7,383.7,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Cigna MGG,Cigna MGG,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Humana,Humana,383.7,,,,,,,per diem,383.7,383.7,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Humana MGG,Humana MGG,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Optum VA,Optum VA,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,UHC,UHC,383.7,,,,,,,per diem,383.7,383.7,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,UHC MGG,UHC MGG,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,VA,VA,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Wellcare MGG,Wellcare MGG,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Bright Health - commercial,Bright Health - commercial,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,383.7,383.7,Bright Health MGG,Bright Health MGG,383.7,,,,,,,case rate,383.7,383.7,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Aetna,Aetna,17.16,,,,,,,per diem,17.16,17.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Aetna MGG,Aetna MGG,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,BCBS,BCBS,17.16,,,,,,,per diem,17.16,17.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,BCBS MGG,BCBS MGG,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Cigna,Cigna,17.16,,,,,,,per diem,17.16,17.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Cigna MGG,Cigna MGG,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Humana,Humana,17.16,,,,,,,per diem,17.16,17.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Humana MGG,Humana MGG,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Optum VA,Optum VA,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,UHC,UHC,17.16,,,,,,,per diem,17.16,17.16,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,UHC MGG,UHC MGG,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,VA,VA,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Wellcare MGG,Wellcare MGG,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Bright Health - commercial,Bright Health - commercial,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,17.16,17.16,Bright Health MGG,Bright Health MGG,17.16,,,,,,,case rate,17.16,17.16,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Aetna,Aetna,34.77,,,,,,,per diem,34.77,34.77,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Aetna MGG,Aetna MGG,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,BCBS,BCBS,34.77,,,,,,,per diem,34.77,34.77,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,BCBS MGG,BCBS MGG,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Cigna,Cigna,34.77,,,,,,,per diem,34.77,34.77,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Cigna MGG,Cigna MGG,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Humana,Humana,34.77,,,,,,,per diem,34.77,34.77,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Humana MGG,Humana MGG,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Optum VA,Optum VA,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,UHC,UHC,34.77,,,,,,,per diem,34.77,34.77,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,UHC MGG,UHC MGG,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,VA,VA,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Wellcare MGG,Wellcare MGG,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Bright Health - commercial,Bright Health - commercial,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,34.77,34.77,Bright Health MGG,Bright Health MGG,34.77,,,,,,,case rate,34.77,34.77,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92212252,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Aetna,Aetna,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Aetna MGG,Aetna MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,BCBS,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS MGG,BCBS MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Cigna,Cigna,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Cigna MGG,Cigna MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Humana,Humana,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Humana MGG,Humana MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Optum VA,Optum VA,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,UHC,UHC,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,UHC MGG,UHC MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,VA,VA,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Wellcare MGG,Wellcare MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Bright Health - commercial,Bright Health - commercial,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG TAB          ,92212253,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,Bright Health MGG,Bright Health MGG,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92212254,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Aetna,Aetna,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Aetna MGG,Aetna MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,BCBS,BCBS,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,BCBS MGG,BCBS MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Cigna,Cigna,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Cigna MGG,Cigna MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Humana,Humana,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Humana MGG,Humana MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Optum VA,Optum VA,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,UHC,UHC,25.77,,,,,,,per diem,25.77,25.77,"Per diem rate, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,UHC MGG,UHC MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,VA,VA,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Wellcare MGG,Wellcare MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Bright Health - commercial,Bright Health - commercial,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
EUCERIN CRE                   ,92212255,CDM,250,RC,,,,,,Inpatient,1,EA,25.77,25.77,Bright Health MGG,Bright Health MGG,25.77,,,,,,,case rate,25.77,25.77,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-500MG TAB,92212256,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Aetna,Aetna,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Aetna MGG,Aetna MGG,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,BCBS,BCBS,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,BCBS MGG,BCBS MGG,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Cigna,Cigna,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Cigna MGG,Cigna MGG,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Humana,Humana,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Humana MGG,Humana MGG,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Optum VA,Optum VA,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,UHC,UHC,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,UHC MGG,UHC MGG,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,VA,VA,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Wellcare MGG,Wellcare MGG,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Bright Health - commercial,Bright Health - commercial,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212257,CDM,250,RC,,,,,,Inpatient,1,EA,21.84,21.84,Bright Health MGG,Bright Health MGG,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Aetna,Aetna,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Aetna MGG,Aetna MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,BCBS,BCBS,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,BCBS MGG,BCBS MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Cigna,Cigna,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Cigna MGG,Cigna MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Humana,Humana,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Humana MGG,Humana MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Optum VA,Optum VA,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,UHC,UHC,83.73,,,,,,,per diem,83.73,83.73,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,UHC MGG,UHC MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,VA,VA,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Wellcare MGG,Wellcare MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Bright Health - commercial,Bright Health - commercial,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG TAB       ,92212258,CDM,250,RC,,,,,,Inpatient,1,EA,83.73,83.73,Bright Health MGG,Bright Health MGG,83.73,,,,,,,case rate,83.73,83.73,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna,Aetna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Aetna MGG,Aetna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS,BCBS,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,BCBS MGG,BCBS MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna,Cigna,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Cigna MGG,Cigna MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana,Humana,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Humana MGG,Humana MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Optum VA,Optum VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC,UHC,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,UHC MGG,UHC MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,VA,VA,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Wellcare MGG,Wellcare MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health - commercial,Bright Health - commercial,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
PREDNISOLONE 15MG/5ML SYR     ,92212259,CDM,250,RC,,,,,,Inpatient,1,EA,7.23,7.23,Bright Health MGG,Bright Health MGG,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92212260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92212261,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Aetna,Aetna,20.58,,,,,,,per diem,20.58,20.58,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Aetna MGG,Aetna MGG,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,BCBS,BCBS,20.58,,,,,,,per diem,20.58,20.58,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,BCBS MGG,BCBS MGG,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Cigna,Cigna,20.58,,,,,,,per diem,20.58,20.58,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Cigna MGG,Cigna MGG,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Humana,Humana,20.58,,,,,,,per diem,20.58,20.58,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Humana MGG,Humana MGG,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Optum VA,Optum VA,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,UHC,UHC,20.58,,,,,,,per diem,20.58,20.58,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,UHC MGG,UHC MGG,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,VA,VA,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Wellcare MGG,Wellcare MGG,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Bright Health - commercial,Bright Health - commercial,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212262,CDM,250,RC,,,,,,Inpatient,1,EA,20.58,20.58,Bright Health MGG,Bright Health MGG,20.58,,,,,,,case rate,20.58,20.58,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Aetna,Aetna,118.47,,,,,,,per diem,118.47,118.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Aetna MGG,Aetna MGG,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,BCBS,BCBS,118.47,,,,,,,per diem,118.47,118.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,BCBS MGG,BCBS MGG,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Cigna,Cigna,118.47,,,,,,,per diem,118.47,118.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Cigna MGG,Cigna MGG,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Humana,Humana,118.47,,,,,,,per diem,118.47,118.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Humana MGG,Humana MGG,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Optum VA,Optum VA,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,UHC,UHC,118.47,,,,,,,per diem,118.47,118.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,UHC MGG,UHC MGG,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,VA,VA,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Wellcare MGG,Wellcare MGG,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Bright Health - commercial,Bright Health - commercial,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212263,CDM,250,RC,,,,,,Inpatient,1,EA,118.47,118.47,Bright Health MGG,Bright Health MGG,118.47,,,,,,,case rate,118.47,118.47,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212265,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Aetna,Aetna,35.22,,,,,,,per diem,35.22,35.22,"Per diem rate, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Aetna MGG,Aetna MGG,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,BCBS,BCBS,35.22,,,,,,,per diem,35.22,35.22,"Per diem rate, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,BCBS MGG,BCBS MGG,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Cigna,Cigna,35.22,,,,,,,per diem,35.22,35.22,"Per diem rate, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Cigna MGG,Cigna MGG,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Humana,Humana,35.22,,,,,,,per diem,35.22,35.22,"Per diem rate, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Humana MGG,Humana MGG,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Optum VA,Optum VA,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,UHC,UHC,35.22,,,,,,,per diem,35.22,35.22,"Per diem rate, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,UHC MGG,UHC MGG,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,VA,VA,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Wellcare MGG,Wellcare MGG,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Bright Health - commercial,Bright Health - commercial,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
TESTOSTERONE 5MG/24HR TDM     ,92212266,CDM,250,RC,,,,,,Inpatient,1,EA,35.22,35.22,Bright Health MGG,Bright Health MGG,35.22,,,,,,,case rate,35.22,35.22,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE NA SYR ,92212267,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
VASOPRESSIN 10U/0.5ML INJ     ,92212269,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Aetna,Aetna,36.6,,,,,,,per diem,36.6,36.6,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Aetna MGG,Aetna MGG,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,BCBS,BCBS,36.6,,,,,,,per diem,36.6,36.6,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,BCBS MGG,BCBS MGG,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Cigna,Cigna,36.6,,,,,,,per diem,36.6,36.6,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Cigna MGG,Cigna MGG,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Humana,Humana,36.6,,,,,,,per diem,36.6,36.6,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Humana MGG,Humana MGG,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Optum VA,Optum VA,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,UHC,UHC,36.6,,,,,,,per diem,36.6,36.6,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,UHC MGG,UHC MGG,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,VA,VA,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Wellcare MGG,Wellcare MGG,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Bright Health - commercial,Bright Health - commercial,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212270,CDM,250,RC,,,,,,Inpatient,1,EA,36.6,36.6,Bright Health MGG,Bright Health MGG,36.6,,,,,,,case rate,36.6,36.6,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHADONE HCL 40MG TAB        ,92212272,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212273,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Aetna,Aetna,16.05,,,,,,,per diem,16.05,16.05,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Aetna MGG,Aetna MGG,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,BCBS,BCBS,16.05,,,,,,,per diem,16.05,16.05,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,BCBS MGG,BCBS MGG,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Cigna,Cigna,16.05,,,,,,,per diem,16.05,16.05,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Cigna MGG,Cigna MGG,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Humana,Humana,16.05,,,,,,,per diem,16.05,16.05,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Humana MGG,Humana MGG,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Optum VA,Optum VA,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,UHC,UHC,16.05,,,,,,,per diem,16.05,16.05,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,UHC MGG,UHC MGG,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,VA,VA,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Wellcare MGG,Wellcare MGG,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Bright Health - commercial,Bright Health - commercial,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92212274,CDM,250,RC,,,,,,Inpatient,1,EA,16.05,16.05,Bright Health MGG,Bright Health MGG,16.05,,,,,,,case rate,16.05,16.05,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212275,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92212276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Aetna,Aetna,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Aetna MGG,Aetna MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,BCBS,BCBS,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,BCBS MGG,BCBS MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Cigna,Cigna,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Cigna MGG,Cigna MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Humana,Humana,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Humana MGG,Humana MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Optum VA,Optum VA,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,UHC,UHC,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,UHC MGG,UHC MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,VA,VA,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Wellcare MGG,Wellcare MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Bright Health - commercial,Bright Health - commercial,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212277,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Bright Health MGG,Bright Health MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Aetna,Aetna,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Aetna MGG,Aetna MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,BCBS,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS MGG,BCBS MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Cigna,Cigna,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Cigna MGG,Cigna MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Humana,Humana,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Humana MGG,Humana MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Optum VA,Optum VA,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UHC,UHC,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UHC MGG,UHC MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,VA,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Wellcare MGG,Wellcare MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Bright Health - commercial,Bright Health - commercial,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 300MG/6.8ML ELI  ,92212278,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Bright Health MGG,Bright Health MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212279,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92212280,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Aetna,Aetna,464.07,,,,,,,per diem,464.07,464.07,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Aetna MGG,Aetna MGG,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,BCBS,BCBS,464.07,,,,,,,per diem,464.07,464.07,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,BCBS MGG,BCBS MGG,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Cigna,Cigna,464.07,,,,,,,per diem,464.07,464.07,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Cigna MGG,Cigna MGG,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Humana,Humana,464.07,,,,,,,per diem,464.07,464.07,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Humana MGG,Humana MGG,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Optum VA,Optum VA,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,UHC,UHC,464.07,,,,,,,per diem,464.07,464.07,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,UHC MGG,UHC MGG,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,VA,VA,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Wellcare MGG,Wellcare MGG,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Bright Health - commercial,Bright Health - commercial,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 100MCG ARO      ,92212281,CDM,250,RC,,,,,,Inpatient,1,EA,464.07,464.07,Bright Health MGG,Bright Health MGG,464.07,,,,,,,case rate,464.07,464.07,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Aetna,Aetna,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Aetna MGG,Aetna MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,BCBS,BCBS,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,BCBS MGG,BCBS MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Cigna,Cigna,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Cigna MGG,Cigna MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Humana,Humana,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Humana MGG,Humana MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Optum VA,Optum VA,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,UHC,UHC,31.53,,,,,,,per diem,31.53,31.53,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,UHC MGG,UHC MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,VA,VA,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Wellcare MGG,Wellcare MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Bright Health - commercial,Bright Health - commercial,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92212282,CDM,250,RC,,,,,,Inpatient,1,EA,31.53,31.53,Bright Health MGG,Bright Health MGG,31.53,,,,,,,case rate,31.53,31.53,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna,Aetna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Aetna MGG,Aetna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS,BCBS,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,BCBS MGG,BCBS MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna,Cigna,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Cigna MGG,Cigna MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana,Humana,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Humana MGG,Humana MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Optum VA,Optum VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC,UHC,6.51,,,,,,,per diem,6.51,6.51,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,UHC MGG,UHC MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,VA,VA,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Wellcare MGG,Wellcare MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health - commercial,Bright Health - commercial,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92212283,CDM,250,RC,,,,,,Inpatient,1,EA,6.51,6.51,Bright Health MGG,Bright Health MGG,6.51,,,,,,,case rate,6.51,6.51,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX SGL         ,92212284,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Aetna,Aetna,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Aetna MGG,Aetna MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,BCBS,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS MGG,BCBS MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Cigna,Cigna,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Cigna MGG,Cigna MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Humana,Humana,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Humana MGG,Humana MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Optum VA,Optum VA,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,UHC,UHC,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,UHC MGG,UHC MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,VA,VA,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Wellcare MGG,Wellcare MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Bright Health - commercial,Bright Health - commercial,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
OXAPROZIN 600MG TAB           ,92212285,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,Bright Health MGG,Bright Health MGG,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92212287,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Aetna,Aetna,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Aetna MGG,Aetna MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,BCBS,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS MGG,BCBS MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Cigna,Cigna,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Cigna MGG,Cigna MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Humana,Humana,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Humana MGG,Humana MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Optum VA,Optum VA,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,UHC,UHC,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,UHC MGG,UHC MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,VA,VA,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Wellcare MGG,Wellcare MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Bright Health - commercial,Bright Health - commercial,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212288,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,Bright Health MGG,Bright Health MGG,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Aetna,Aetna,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Aetna MGG,Aetna MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,BCBS,BCBS,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,BCBS MGG,BCBS MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Cigna,Cigna,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Cigna MGG,Cigna MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Humana,Humana,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Humana MGG,Humana MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Optum VA,Optum VA,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,UHC,UHC,9.36,,,,,,,per diem,9.36,9.36,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,UHC MGG,UHC MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,VA,VA,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Wellcare MGG,Wellcare MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Bright Health - commercial,Bright Health - commercial,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212289,CDM,250,RC,,,,,,Inpatient,1,EA,9.36,9.36,Bright Health MGG,Bright Health MGG,9.36,,,,,,,case rate,9.36,9.36,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Aetna,Aetna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Aetna MGG,Aetna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,BCBS,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS MGG,BCBS MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Cigna,Cigna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Cigna MGG,Cigna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Humana,Humana,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Humana MGG,Humana MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Optum VA,Optum VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UHC,UHC,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UHC MGG,UHC MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,VA,VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Wellcare MGG,Wellcare MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Bright Health - commercial,Bright Health - commercial,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 50MG TAB      ,92212290,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Bright Health MGG,Bright Health MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Aetna,Aetna,19.86,,,,,,,per diem,19.86,19.86,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Aetna MGG,Aetna MGG,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,BCBS,BCBS,19.86,,,,,,,per diem,19.86,19.86,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,BCBS MGG,BCBS MGG,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Cigna,Cigna,19.86,,,,,,,per diem,19.86,19.86,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Cigna MGG,Cigna MGG,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Humana,Humana,19.86,,,,,,,per diem,19.86,19.86,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Humana MGG,Humana MGG,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Optum VA,Optum VA,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,UHC,UHC,19.86,,,,,,,per diem,19.86,19.86,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,UHC MGG,UHC MGG,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,VA,VA,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Wellcare MGG,Wellcare MGG,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Bright Health - commercial,Bright Health - commercial,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 0.5% EYE SOL  ,92212291,CDM,250,RC,,,,,,Inpatient,1,EA,19.86,19.86,Bright Health MGG,Bright Health MGG,19.86,,,,,,,case rate,19.86,19.86,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212292,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Aetna,Aetna,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Aetna MGG,Aetna MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,BCBS,BCBS,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,BCBS MGG,BCBS MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Cigna,Cigna,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Cigna MGG,Cigna MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Humana,Humana,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Humana MGG,Humana MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Optum VA,Optum VA,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,UHC,UHC,13.56,,,,,,,per diem,13.56,13.56,"Per diem rate, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,UHC MGG,UHC MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,VA,VA,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Wellcare MGG,Wellcare MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Bright Health - commercial,Bright Health - commercial,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
BARIUM SULF 2.1% SUS          ,92212293,CDM,250,RC,,,,,,Inpatient,1,EA,13.56,13.56,Bright Health MGG,Bright Health MGG,13.56,,,,,,,case rate,13.56,13.56,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Aetna,Aetna,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Aetna MGG,Aetna MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,BCBS,BCBS,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,BCBS MGG,BCBS MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Cigna,Cigna,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Cigna MGG,Cigna MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Humana,Humana,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Humana MGG,Humana MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Optum VA,Optum VA,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,UHC,UHC,21.63,,,,,,,per diem,21.63,21.63,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,UHC MGG,UHC MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,VA,VA,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Wellcare MGG,Wellcare MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Bright Health - commercial,Bright Health - commercial,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 20MG TAB ,92212295,CDM,250,RC,,,,,,Inpatient,1,EA,21.63,21.63,Bright Health MGG,Bright Health MGG,21.63,,,,,,,case rate,21.63,21.63,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Aetna,Aetna,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Aetna MGG,Aetna MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,BCBS,BCBS,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,BCBS MGG,BCBS MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Cigna,Cigna,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Cigna MGG,Cigna MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Humana,Humana,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Humana MGG,Humana MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Optum VA,Optum VA,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,UHC,UHC,7.83,,,,,,,per diem,7.83,7.83,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,UHC MGG,UHC MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,VA,VA,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Wellcare MGG,Wellcare MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Bright Health - commercial,Bright Health - commercial,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212296,CDM,250,RC,,,,,,Inpatient,1,EA,7.83,7.83,Bright Health MGG,Bright Health MGG,7.83,,,,,,,case rate,7.83,7.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Aetna,Aetna,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Aetna MGG,Aetna MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,BCBS,BCBS,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,BCBS MGG,BCBS MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Cigna,Cigna,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Cigna MGG,Cigna MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Humana,Humana,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Humana MGG,Humana MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Optum VA,Optum VA,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,UHC,UHC,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,UHC MGG,UHC MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,VA,VA,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Wellcare MGG,Wellcare MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Bright Health - commercial,Bright Health - commercial,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212297,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Bright Health MGG,Bright Health MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92212298,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212299,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Aetna,Aetna,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Aetna MGG,Aetna MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,BCBS,BCBS,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,BCBS MGG,BCBS MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Cigna,Cigna,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Cigna MGG,Cigna MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Humana,Humana,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Humana MGG,Humana MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Optum VA,Optum VA,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,UHC,UHC,46.8,,,,,,,per diem,46.8,46.8,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,UHC MGG,UHC MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,VA,VA,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Wellcare MGG,Wellcare MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Bright Health - commercial,Bright Health - commercial,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92212300,CDM,250,RC,,,,,,Inpatient,1,EA,46.8,46.8,Bright Health MGG,Bright Health MGG,46.8,,,,,,,case rate,46.8,46.8,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna,Aetna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna MGG,Aetna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,BCBS,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS MGG,BCBS MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna,Cigna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna MGG,Cigna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana,Humana,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana MGG,Humana MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Optum VA,Optum VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC,UHC,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC MGG,UHC MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,VA,VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Wellcare MGG,Wellcare MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health - commercial,Bright Health - commercial,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212301,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health MGG,Bright Health MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Aetna,Aetna,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Aetna MGG,Aetna MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,BCBS,BCBS,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,BCBS MGG,BCBS MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Cigna,Cigna,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Cigna MGG,Cigna MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Humana,Humana,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Humana MGG,Humana MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Optum VA,Optum VA,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,UHC,UHC,44.13,,,,,,,per diem,44.13,44.13,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,UHC MGG,UHC MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,VA,VA,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Wellcare MGG,Wellcare MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Bright Health - commercial,Bright Health - commercial,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92212302,CDM,250,RC,,,,,,Inpatient,1,EA,44.13,44.13,Bright Health MGG,Bright Health MGG,44.13,,,,,,,case rate,44.13,44.13,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92212303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG ECT         ,92212304,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Aetna,Aetna,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Aetna MGG,Aetna MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,BCBS,BCBS,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,BCBS MGG,BCBS MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Cigna,Cigna,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Cigna MGG,Cigna MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Humana,Humana,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Humana MGG,Humana MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Optum VA,Optum VA,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,UHC,UHC,16.59,,,,,,,per diem,16.59,16.59,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,UHC MGG,UHC MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,VA,VA,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Wellcare MGG,Wellcare MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Bright Health - commercial,Bright Health - commercial,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212305,CDM,250,RC,,,,,,Inpatient,1,EA,16.59,16.59,Bright Health MGG,Bright Health MGG,16.59,,,,,,,case rate,16.59,16.59,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Aetna,Aetna,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Aetna MGG,Aetna MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,BCBS,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS MGG,BCBS MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Cigna,Cigna,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Cigna MGG,Cigna MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Humana,Humana,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Humana MGG,Humana MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Optum VA,Optum VA,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UHC,UHC,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UHC MGG,UHC MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,VA,VA,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Wellcare MGG,Wellcare MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Bright Health - commercial,Bright Health - commercial,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 4MG TAB          ,92212306,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Bright Health MGG,Bright Health MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Aetna,Aetna,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Aetna MGG,Aetna MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,BCBS,BCBS,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,BCBS MGG,BCBS MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Cigna,Cigna,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Cigna MGG,Cigna MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Humana,Humana,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Humana MGG,Humana MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Optum VA,Optum VA,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,UHC,UHC,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,UHC MGG,UHC MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,VA,VA,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Wellcare MGG,Wellcare MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Bright Health - commercial,Bright Health - commercial,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92212307,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Bright Health MGG,Bright Health MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212308,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212309,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92212310,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Aetna,Aetna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Aetna MGG,Aetna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,BCBS,BCBS,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,BCBS MGG,BCBS MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Cigna,Cigna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Cigna MGG,Cigna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Humana,Humana,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Humana MGG,Humana MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Optum VA,Optum VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,UHC,UHC,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,UHC MGG,UHC MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,VA,VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Wellcare MGG,Wellcare MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Bright Health - commercial,Bright Health - commercial,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92212311,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Bright Health MGG,Bright Health MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Aetna,Aetna,63.03,,,,,,,per diem,63.03,63.03,"Per diem rate, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Aetna MGG,Aetna MGG,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,BCBS,BCBS,63.03,,,,,,,per diem,63.03,63.03,"Per diem rate, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,BCBS MGG,BCBS MGG,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Cigna,Cigna,63.03,,,,,,,per diem,63.03,63.03,"Per diem rate, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Cigna MGG,Cigna MGG,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Humana,Humana,63.03,,,,,,,per diem,63.03,63.03,"Per diem rate, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Humana MGG,Humana MGG,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Optum VA,Optum VA,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,UHC,UHC,63.03,,,,,,,per diem,63.03,63.03,"Per diem rate, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,UHC MGG,UHC MGG,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,VA,VA,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Wellcare MGG,Wellcare MGG,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Bright Health - commercial,Bright Health - commercial,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
HAEMOPHILUS B VACC 10MCG INJ  ,92212312,CDM,250,RC,,,,,,Inpatient,1,EA,63.03,63.03,Bright Health MGG,Bright Health MGG,63.03,,,,,,,case rate,63.03,63.03,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Aetna,Aetna,312.18,,,,,,,per diem,312.18,312.18,"Per diem rate, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Aetna MGG,Aetna MGG,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,BCBS,BCBS,312.18,,,,,,,per diem,312.18,312.18,"Per diem rate, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,BCBS MGG,BCBS MGG,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Cigna,Cigna,312.18,,,,,,,per diem,312.18,312.18,"Per diem rate, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Cigna MGG,Cigna MGG,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Humana,Humana,312.18,,,,,,,per diem,312.18,312.18,"Per diem rate, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Humana MGG,Humana MGG,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Optum VA,Optum VA,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,UHC,UHC,312.18,,,,,,,per diem,312.18,312.18,"Per diem rate, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,UHC MGG,UHC MGG,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,VA,VA,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Wellcare MGG,Wellcare MGG,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Bright Health - commercial,Bright Health - commercial,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
AZELASTINE HCL 0.05% SOL      ,92212313,CDM,250,RC,,,,,,Inpatient,1,EA,312.18,312.18,Bright Health MGG,Bright Health MGG,312.18,,,,,,,case rate,312.18,312.18,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Aetna,Aetna,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Aetna MGG,Aetna MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,BCBS,BCBS,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,BCBS MGG,BCBS MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Cigna,Cigna,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Cigna MGG,Cigna MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Humana,Humana,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Humana MGG,Humana MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Optum VA,Optum VA,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,UHC,UHC,12.12,,,,,,,per diem,12.12,12.12,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,UHC MGG,UHC MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,VA,VA,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Wellcare MGG,Wellcare MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Bright Health - commercial,Bright Health - commercial,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212314,CDM,250,RC,,,,,,Inpatient,1,EA,12.12,12.12,Bright Health MGG,Bright Health MGG,12.12,,,,,,,case rate,12.12,12.12,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG ECT            ,92212315,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Aetna,Aetna,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Aetna MGG,Aetna MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,BCBS,BCBS,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,BCBS MGG,BCBS MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Cigna,Cigna,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Cigna MGG,Cigna MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Humana,Humana,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Humana MGG,Humana MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Optum VA,Optum VA,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,UHC,UHC,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,UHC MGG,UHC MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,VA,VA,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Wellcare MGG,Wellcare MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Bright Health - commercial,Bright Health - commercial,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212317,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Bright Health MGG,Bright Health MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212318,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna,Aetna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna MGG,Aetna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,BCBS,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS MGG,BCBS MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna,Cigna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna MGG,Cigna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana,Humana,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana MGG,Humana MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Optum VA,Optum VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC,UHC,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC MGG,UHC MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,VA,VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Wellcare MGG,Wellcare MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health - commercial,Bright Health - commercial,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92212320,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health MGG,Bright Health MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Aetna,Aetna,81.39,,,,,,,per diem,81.39,81.39,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Aetna MGG,Aetna MGG,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,BCBS,BCBS,81.39,,,,,,,per diem,81.39,81.39,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,BCBS MGG,BCBS MGG,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Cigna,Cigna,81.39,,,,,,,per diem,81.39,81.39,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Cigna MGG,Cigna MGG,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Humana,Humana,81.39,,,,,,,per diem,81.39,81.39,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Humana MGG,Humana MGG,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Optum VA,Optum VA,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,UHC,UHC,81.39,,,,,,,per diem,81.39,81.39,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,UHC MGG,UHC MGG,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,VA,VA,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Wellcare MGG,Wellcare MGG,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Bright Health - commercial,Bright Health - commercial,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92212321,CDM,250,RC,,,,,,Inpatient,1,EA,81.39,81.39,Bright Health MGG,Bright Health MGG,81.39,,,,,,,case rate,81.39,81.39,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92212322,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Aetna,Aetna,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Aetna MGG,Aetna MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS,BCBS,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS MGG,BCBS MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Cigna,Cigna,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Cigna MGG,Cigna MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Humana,Humana,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Humana MGG,Humana MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Optum VA,Optum VA,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,UHC,UHC,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,UHC MGG,UHC MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,VA,VA,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Wellcare MGG,Wellcare MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Bright Health - commercial,Bright Health - commercial,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG SUP   ,92212323,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,Bright Health MGG,Bright Health MGG,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92212324,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212325,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna,Aetna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna MGG,Aetna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS,BCBS,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS MGG,BCBS MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna,Cigna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna MGG,Cigna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana,Humana,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana MGG,Humana MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Optum VA,Optum VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC,UHC,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC MGG,UHC MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,VA,VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Wellcare MGG,Wellcare MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health - commercial,Bright Health - commercial,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212326,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health MGG,Bright Health MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Aetna,Aetna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Aetna MGG,Aetna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,BCBS,BCBS,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,BCBS MGG,BCBS MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Cigna,Cigna,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Cigna MGG,Cigna MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Humana,Humana,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Humana MGG,Humana MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Optum VA,Optum VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,UHC,UHC,72,,,,,,,per diem,72,72,"Per diem rate, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,UHC MGG,UHC MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,VA,VA,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Wellcare MGG,Wellcare MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Bright Health - commercial,Bright Health - commercial,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
CEFAZOLIN 10GM INJ            ,92212327,CDM,250,RC,,,,,,Inpatient,1,EA,72,72,Bright Health MGG,Bright Health MGG,72,,,,,,,case rate,72,72,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92212328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Aetna,Aetna,123.45,,,,,,,per diem,123.45,123.45,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Aetna MGG,Aetna MGG,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,BCBS,BCBS,123.45,,,,,,,per diem,123.45,123.45,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,BCBS MGG,BCBS MGG,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Cigna,Cigna,123.45,,,,,,,per diem,123.45,123.45,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Cigna MGG,Cigna MGG,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Humana,Humana,123.45,,,,,,,per diem,123.45,123.45,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Humana MGG,Humana MGG,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Optum VA,Optum VA,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,UHC,UHC,123.45,,,,,,,per diem,123.45,123.45,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,UHC MGG,UHC MGG,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,VA,VA,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Wellcare MGG,Wellcare MGG,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Bright Health - commercial,Bright Health - commercial,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG TAB       ,92212329,CDM,250,RC,,,,,,Inpatient,1,EA,123.45,123.45,Bright Health MGG,Bright Health MGG,123.45,,,,,,,case rate,123.45,123.45,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Aetna,Aetna,416.76,,,,,,,per diem,416.76,416.76,"Per diem rate, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Aetna MGG,Aetna MGG,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,BCBS,BCBS,416.76,,,,,,,per diem,416.76,416.76,"Per diem rate, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,BCBS MGG,BCBS MGG,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Cigna,Cigna,416.76,,,,,,,per diem,416.76,416.76,"Per diem rate, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Cigna MGG,Cigna MGG,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Humana,Humana,416.76,,,,,,,per diem,416.76,416.76,"Per diem rate, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Humana MGG,Humana MGG,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Optum VA,Optum VA,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,UHC,UHC,416.76,,,,,,,per diem,416.76,416.76,"Per diem rate, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,UHC MGG,UHC MGG,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,VA,VA,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Wellcare MGG,Wellcare MGG,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Bright Health - commercial,Bright Health - commercial,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
ESTRADIOL CYPIONATE 5MG/ML OIL,92212330,CDM,250,RC,,,,,,Inpatient,1,EA,416.76,416.76,Bright Health MGG,Bright Health MGG,416.76,,,,,,,case rate,416.76,416.76,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Aetna,Aetna,47.46,,,,,,,per diem,47.46,47.46,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Aetna MGG,Aetna MGG,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,BCBS,BCBS,47.46,,,,,,,per diem,47.46,47.46,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,BCBS MGG,BCBS MGG,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Cigna,Cigna,47.46,,,,,,,per diem,47.46,47.46,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Cigna MGG,Cigna MGG,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Humana,Humana,47.46,,,,,,,per diem,47.46,47.46,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Humana MGG,Humana MGG,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Optum VA,Optum VA,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,UHC,UHC,47.46,,,,,,,per diem,47.46,47.46,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,UHC MGG,UHC MGG,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,VA,VA,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Wellcare MGG,Wellcare MGG,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Bright Health - commercial,Bright Health - commercial,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92212331,CDM,250,RC,,,,,,Inpatient,1,EA,47.46,47.46,Bright Health MGG,Bright Health MGG,47.46,,,,,,,case rate,47.46,47.46,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92212332,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Aetna,Aetna,16.92,,,,,,,per diem,16.92,16.92,"Per diem rate, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Aetna MGG,Aetna MGG,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,BCBS,BCBS,16.92,,,,,,,per diem,16.92,16.92,"Per diem rate, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,BCBS MGG,BCBS MGG,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Cigna,Cigna,16.92,,,,,,,per diem,16.92,16.92,"Per diem rate, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Cigna MGG,Cigna MGG,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Humana,Humana,16.92,,,,,,,per diem,16.92,16.92,"Per diem rate, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Humana MGG,Humana MGG,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Optum VA,Optum VA,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,UHC,UHC,16.92,,,,,,,per diem,16.92,16.92,"Per diem rate, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,UHC MGG,UHC MGG,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,VA,VA,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Wellcare MGG,Wellcare MGG,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Bright Health - commercial,Bright Health - commercial,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
CHLOROQUINE PH 500MG TAB      ,92212333,CDM,250,RC,,,,,,Inpatient,1,EA,16.92,16.92,Bright Health MGG,Bright Health MGG,16.92,,,,,,,case rate,16.92,16.92,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Aetna,Aetna,576.18,,,,,,,per diem,576.18,576.18,"Per diem rate, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Aetna MGG,Aetna MGG,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,BCBS,BCBS,576.18,,,,,,,per diem,576.18,576.18,"Per diem rate, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,BCBS MGG,BCBS MGG,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Cigna,Cigna,576.18,,,,,,,per diem,576.18,576.18,"Per diem rate, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Cigna MGG,Cigna MGG,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Humana,Humana,576.18,,,,,,,per diem,576.18,576.18,"Per diem rate, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Humana MGG,Humana MGG,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Optum VA,Optum VA,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,UHC,UHC,576.18,,,,,,,per diem,576.18,576.18,"Per diem rate, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,UHC MGG,UHC MGG,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,VA,VA,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Wellcare MGG,Wellcare MGG,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Bright Health - commercial,Bright Health - commercial,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
HEPATITIS B IMMUNE G 312U/ML I,92212334,CDM,250,RC,,,,,,Inpatient,1,EA,576.18,576.18,Bright Health MGG,Bright Health MGG,576.18,,,,,,,case rate,576.18,576.18,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92212335,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Aetna,Aetna,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Aetna MGG,Aetna MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,BCBS,BCBS,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,BCBS MGG,BCBS MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Cigna,Cigna,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Cigna MGG,Cigna MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Humana,Humana,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Humana MGG,Humana MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Optum VA,Optum VA,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,UHC,UHC,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,UHC MGG,UHC MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,VA,VA,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Wellcare MGG,Wellcare MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Bright Health - commercial,Bright Health - commercial,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212336,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Bright Health MGG,Bright Health MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 250MG TER              ,92212337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Aetna,Aetna,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Aetna MGG,Aetna MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,BCBS,BCBS,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,BCBS MGG,BCBS MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Cigna,Cigna,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Cigna MGG,Cigna MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Humana,Humana,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Humana MGG,Humana MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Optum VA,Optum VA,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,UHC,UHC,98.64,,,,,,,per diem,98.64,98.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,UHC MGG,UHC MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,VA,VA,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Wellcare MGG,Wellcare MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Bright Health - commercial,Bright Health - commercial,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212338,CDM,250,RC,,,,,,Inpatient,1,EA,98.64,98.64,Bright Health MGG,Bright Health MGG,98.64,,,,,,,case rate,98.64,98.64,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Aetna,Aetna,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Aetna MGG,Aetna MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,BCBS,BCBS,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,BCBS MGG,BCBS MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Cigna,Cigna,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Cigna MGG,Cigna MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Humana,Humana,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Humana MGG,Humana MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Optum VA,Optum VA,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,UHC,UHC,9.66,,,,,,,per diem,9.66,9.66,"Per diem rate, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,UHC MGG,UHC MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,VA,VA,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Wellcare MGG,Wellcare MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Bright Health - commercial,Bright Health - commercial,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
DOXYCYCLINE CALCIUM 50MG/5ML S,92212339,CDM,250,RC,,,,,,Inpatient,1,EA,9.66,9.66,Bright Health MGG,Bright Health MGG,9.66,,,,,,,case rate,9.66,9.66,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Aetna,Aetna,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Aetna MGG,Aetna MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,BCBS,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS MGG,BCBS MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Cigna,Cigna,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Cigna MGG,Cigna MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Humana,Humana,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Humana MGG,Humana MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Optum VA,Optum VA,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UHC,UHC,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UHC MGG,UHC MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,VA,VA,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Wellcare MGG,Wellcare MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Bright Health - commercial,Bright Health - commercial,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 100MG TAB ,92212340,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,Bright Health MGG,Bright Health MGG,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92212341,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Aetna,Aetna,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Aetna MGG,Aetna MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,BCBS,BCBS,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,BCBS MGG,BCBS MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Cigna,Cigna,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Cigna MGG,Cigna MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Humana,Humana,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Humana MGG,Humana MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Optum VA,Optum VA,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,UHC,UHC,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,UHC MGG,UHC MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,VA,VA,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Wellcare MGG,Wellcare MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Bright Health - commercial,Bright Health - commercial,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212342,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Bright Health MGG,Bright Health MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92212343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Aetna,Aetna,79.56,,,,,,,per diem,79.56,79.56,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Aetna MGG,Aetna MGG,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,BCBS,BCBS,79.56,,,,,,,per diem,79.56,79.56,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,BCBS MGG,BCBS MGG,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Cigna,Cigna,79.56,,,,,,,per diem,79.56,79.56,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Cigna MGG,Cigna MGG,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Humana,Humana,79.56,,,,,,,per diem,79.56,79.56,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Humana MGG,Humana MGG,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Optum VA,Optum VA,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,UHC,UHC,79.56,,,,,,,per diem,79.56,79.56,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,UHC MGG,UHC MGG,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,VA,VA,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Wellcare MGG,Wellcare MGG,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Bright Health - commercial,Bright Health - commercial,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212344,CDM,250,RC,,,,,,Inpatient,1,EA,79.56,79.56,Bright Health MGG,Bright Health MGG,79.56,,,,,,,case rate,79.56,79.56,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Aetna,Aetna,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Aetna MGG,Aetna MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,BCBS,BCBS,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,BCBS MGG,BCBS MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Cigna,Cigna,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Cigna MGG,Cigna MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Humana,Humana,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Humana MGG,Humana MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Optum VA,Optum VA,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,UHC,UHC,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,UHC MGG,UHC MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,VA,VA,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Wellcare MGG,Wellcare MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Bright Health - commercial,Bright Health - commercial,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 100MG TAB     ,92212345,CDM,250,RC,,,,,,Inpatient,1,EA,10.92,10.92,Bright Health MGG,Bright Health MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212346,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Aetna,Aetna,103.98,,,,,,,per diem,103.98,103.98,"Per diem rate, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Aetna MGG,Aetna MGG,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,BCBS,BCBS,103.98,,,,,,,per diem,103.98,103.98,"Per diem rate, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,BCBS MGG,BCBS MGG,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Cigna,Cigna,103.98,,,,,,,per diem,103.98,103.98,"Per diem rate, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Cigna MGG,Cigna MGG,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Humana,Humana,103.98,,,,,,,per diem,103.98,103.98,"Per diem rate, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Humana MGG,Humana MGG,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Optum VA,Optum VA,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,UHC,UHC,103.98,,,,,,,per diem,103.98,103.98,"Per diem rate, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,UHC MGG,UHC MGG,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,VA,VA,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Wellcare MGG,Wellcare MGG,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Bright Health - commercial,Bright Health - commercial,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92212347,CDM,250,RC,,,,,,Inpatient,1,EA,103.98,103.98,Bright Health MGG,Bright Health MGG,103.98,,,,,,,case rate,103.98,103.98,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Aetna,Aetna,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Aetna MGG,Aetna MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,BCBS,BCBS,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,BCBS MGG,BCBS MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Cigna,Cigna,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Cigna MGG,Cigna MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Humana,Humana,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Humana MGG,Humana MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Optum VA,Optum VA,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,UHC,UHC,18.6,,,,,,,per diem,18.6,18.6,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,UHC MGG,UHC MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,VA,VA,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Wellcare MGG,Wellcare MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Bright Health - commercial,Bright Health - commercial,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212348,CDM,250,RC,,,,,,Inpatient,1,EA,18.6,18.6,Bright Health MGG,Bright Health MGG,18.6,,,,,,,case rate,18.6,18.6,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212349,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212350,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 12.5MG TAB   ,92212351,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Aetna,Aetna,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Aetna MGG,Aetna MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,BCBS,BCBS,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,BCBS MGG,BCBS MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Cigna,Cigna,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Cigna MGG,Cigna MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Humana,Humana,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Humana MGG,Humana MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Optum VA,Optum VA,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,UHC,UHC,238.26,,,,,,,per diem,238.26,238.26,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,UHC MGG,UHC MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,VA,VA,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Wellcare MGG,Wellcare MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Bright Health - commercial,Bright Health - commercial,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92212352,CDM,250,RC,,,,,,Inpatient,1,EA,238.26,238.26,Bright Health MGG,Bright Health MGG,238.26,,,,,,,case rate,238.26,238.26,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92212353,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Aetna,Aetna,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Aetna MGG,Aetna MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,BCBS,BCBS,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,BCBS MGG,BCBS MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Cigna,Cigna,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Cigna MGG,Cigna MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Humana,Humana,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Humana MGG,Humana MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Optum VA,Optum VA,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,UHC,UHC,12.15,,,,,,,per diem,12.15,12.15,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,UHC MGG,UHC MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,VA,VA,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Wellcare MGG,Wellcare MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Bright Health - commercial,Bright Health - commercial,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212355,CDM,250,RC,,,,,,Inpatient,1,EA,12.15,12.15,Bright Health MGG,Bright Health MGG,12.15,,,,,,,case rate,12.15,12.15,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Aetna,Aetna,11.82,,,,,,,per diem,11.82,11.82,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Aetna MGG,Aetna MGG,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,BCBS,BCBS,11.82,,,,,,,per diem,11.82,11.82,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,BCBS MGG,BCBS MGG,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Cigna,Cigna,11.82,,,,,,,per diem,11.82,11.82,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Cigna MGG,Cigna MGG,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Humana,Humana,11.82,,,,,,,per diem,11.82,11.82,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Humana MGG,Humana MGG,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Optum VA,Optum VA,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,UHC,UHC,11.82,,,,,,,per diem,11.82,11.82,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,UHC MGG,UHC MGG,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,VA,VA,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Wellcare MGG,Wellcare MGG,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Bright Health - commercial,Bright Health - commercial,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212357,CDM,250,RC,,,,,,Inpatient,1,EA,11.82,11.82,Bright Health MGG,Bright Health MGG,11.82,,,,,,,case rate,11.82,11.82,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Aetna,Aetna,284.4,,,,,,,per diem,284.4,284.4,"Per diem rate, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Aetna MGG,Aetna MGG,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,BCBS,BCBS,284.4,,,,,,,per diem,284.4,284.4,"Per diem rate, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,BCBS MGG,BCBS MGG,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Cigna,Cigna,284.4,,,,,,,per diem,284.4,284.4,"Per diem rate, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Cigna MGG,Cigna MGG,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Humana,Humana,284.4,,,,,,,per diem,284.4,284.4,"Per diem rate, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Humana MGG,Humana MGG,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Optum VA,Optum VA,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,UHC,UHC,284.4,,,,,,,per diem,284.4,284.4,"Per diem rate, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,UHC MGG,UHC MGG,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,VA,VA,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Wellcare MGG,Wellcare MGG,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Bright Health - commercial,Bright Health - commercial,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
PENTAMIDINE ISETHIONATE 300 IN,92212358,CDM,250,RC,,,,,,Inpatient,1,EA,284.4,284.4,Bright Health MGG,Bright Health MGG,284.4,,,,,,,case rate,284.4,284.4,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Aetna,Aetna,125.61,,,,,,,per diem,125.61,125.61,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Aetna MGG,Aetna MGG,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,BCBS,BCBS,125.61,,,,,,,per diem,125.61,125.61,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,BCBS MGG,BCBS MGG,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Cigna,Cigna,125.61,,,,,,,per diem,125.61,125.61,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Cigna MGG,Cigna MGG,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Humana,Humana,125.61,,,,,,,per diem,125.61,125.61,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Humana MGG,Humana MGG,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Optum VA,Optum VA,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,UHC,UHC,125.61,,,,,,,per diem,125.61,125.61,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,UHC MGG,UHC MGG,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,VA,VA,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Wellcare MGG,Wellcare MGG,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Bright Health - commercial,Bright Health - commercial,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92212359,CDM,250,RC,,,,,,Inpatient,1,EA,125.61,125.61,Bright Health MGG,Bright Health MGG,125.61,,,,,,,case rate,125.61,125.61,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92212360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna,Aetna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna MGG,Aetna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS,BCBS,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS MGG,BCBS MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna,Cigna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna MGG,Cigna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana,Humana,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana MGG,Humana MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Optum VA,Optum VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC,UHC,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC MGG,UHC MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,VA,VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Wellcare MGG,Wellcare MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health - commercial,Bright Health - commercial,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92212361,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health MGG,Bright Health MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RESERPINE 0.25MG TAB          ,92212362,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Aetna,Aetna,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Aetna MGG,Aetna MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS,BCBS,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS MGG,BCBS MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Cigna,Cigna,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Cigna MGG,Cigna MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Humana,Humana,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Humana MGG,Humana MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Optum VA,Optum VA,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,UHC,UHC,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,UHC MGG,UHC MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,VA,VA,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Wellcare MGG,Wellcare MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Bright Health - commercial,Bright Health - commercial,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92212363,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,Bright Health MGG,Bright Health MGG,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Aetna,Aetna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Aetna MGG,Aetna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,BCBS,BCBS,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,BCBS MGG,BCBS MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Cigna,Cigna,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Cigna MGG,Cigna MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Humana,Humana,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Humana MGG,Humana MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Optum VA,Optum VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,UHC,UHC,285,,,,,,,per diem,285,285,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,UHC MGG,UHC MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,VA,VA,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Wellcare MGG,Wellcare MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Bright Health - commercial,Bright Health - commercial,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212364,CDM,250,RC,,,,,,Inpatient,1,EA,285,285,Bright Health MGG,Bright Health MGG,285,,,,,,,case rate,285,285,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92212365,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92212366,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 75MG/0.6ML LIQ   ,92212367,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Aetna,Aetna,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Aetna MGG,Aetna MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,BCBS,BCBS,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,BCBS MGG,BCBS MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Cigna,Cigna,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Cigna MGG,Cigna MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Humana,Humana,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Humana MGG,Humana MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Optum VA,Optum VA,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,UHC,UHC,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,UHC MGG,UHC MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,VA,VA,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Wellcare MGG,Wellcare MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Bright Health - commercial,Bright Health - commercial,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 5MG TAB        ,92212368,CDM,250,RC,,,,,,Inpatient,1,EA,18.21,18.21,Bright Health MGG,Bright Health MGG,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Aetna,Aetna,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Aetna MGG,Aetna MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,BCBS,BCBS,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,BCBS MGG,BCBS MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Cigna,Cigna,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Cigna MGG,Cigna MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Humana,Humana,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Humana MGG,Humana MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Optum VA,Optum VA,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,UHC,UHC,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,UHC MGG,UHC MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,VA,VA,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Wellcare MGG,Wellcare MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Bright Health - commercial,Bright Health - commercial,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 0.5% CRE  ,92212369,CDM,250,RC,,,,,,Inpatient,1,EA,8.97,8.97,Bright Health MGG,Bright Health MGG,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92212370,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92212371,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92212372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Aetna,Aetna,21.96,,,,,,,per diem,21.96,21.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Aetna MGG,Aetna MGG,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,BCBS,BCBS,21.96,,,,,,,per diem,21.96,21.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,BCBS MGG,BCBS MGG,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Cigna,Cigna,21.96,,,,,,,per diem,21.96,21.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Cigna MGG,Cigna MGG,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Humana,Humana,21.96,,,,,,,per diem,21.96,21.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Humana MGG,Humana MGG,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Optum VA,Optum VA,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,UHC,UHC,21.96,,,,,,,per diem,21.96,21.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,UHC MGG,UHC MGG,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,VA,VA,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Wellcare MGG,Wellcare MGG,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Bright Health - commercial,Bright Health - commercial,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212373,CDM,250,RC,,,,,,Inpatient,1,EA,21.96,21.96,Bright Health MGG,Bright Health MGG,21.96,,,,,,,case rate,21.96,21.96,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92212374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Aetna,Aetna,242.64,,,,,,,per diem,242.64,242.64,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Aetna MGG,Aetna MGG,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,BCBS,BCBS,242.64,,,,,,,per diem,242.64,242.64,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,BCBS MGG,BCBS MGG,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Cigna,Cigna,242.64,,,,,,,per diem,242.64,242.64,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Cigna MGG,Cigna MGG,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Humana,Humana,242.64,,,,,,,per diem,242.64,242.64,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Humana MGG,Humana MGG,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Optum VA,Optum VA,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,UHC,UHC,242.64,,,,,,,per diem,242.64,242.64,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,UHC MGG,UHC MGG,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,VA,VA,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Wellcare MGG,Wellcare MGG,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Bright Health - commercial,Bright Health - commercial,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212375,CDM,250,RC,,,,,,Inpatient,1,EA,242.64,242.64,Bright Health MGG,Bright Health MGG,242.64,,,,,,,case rate,242.64,242.64,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Aetna,Aetna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Aetna MGG,Aetna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,BCBS,BCBS,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,BCBS MGG,BCBS MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Cigna,Cigna,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Cigna MGG,Cigna MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Humana,Humana,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Humana MGG,Humana MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Optum VA,Optum VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,UHC,UHC,18.75,,,,,,,per diem,18.75,18.75,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,UHC MGG,UHC MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,VA,VA,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Wellcare MGG,Wellcare MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Bright Health - commercial,Bright Health - commercial,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92212376,CDM,250,RC,,,,,,Inpatient,1,EA,18.75,18.75,Bright Health MGG,Bright Health MGG,18.75,,,,,,,case rate,18.75,18.75,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Aetna,Aetna,200.88,,,,,,,per diem,200.88,200.88,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Aetna MGG,Aetna MGG,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,BCBS,BCBS,200.88,,,,,,,per diem,200.88,200.88,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,BCBS MGG,BCBS MGG,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Cigna,Cigna,200.88,,,,,,,per diem,200.88,200.88,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Cigna MGG,Cigna MGG,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Humana,Humana,200.88,,,,,,,per diem,200.88,200.88,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Humana MGG,Humana MGG,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Optum VA,Optum VA,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,UHC,UHC,200.88,,,,,,,per diem,200.88,200.88,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,UHC MGG,UHC MGG,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,VA,VA,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Wellcare MGG,Wellcare MGG,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Bright Health - commercial,Bright Health - commercial,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212378,CDM,250,RC,,,,,,Inpatient,1,EA,200.88,200.88,Bright Health MGG,Bright Health MGG,200.88,,,,,,,case rate,200.88,200.88,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92212379,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Aetna,Aetna,44.52,,,,,,,per diem,44.52,44.52,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Aetna MGG,Aetna MGG,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,BCBS,BCBS,44.52,,,,,,,per diem,44.52,44.52,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,BCBS MGG,BCBS MGG,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Cigna,Cigna,44.52,,,,,,,per diem,44.52,44.52,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Cigna MGG,Cigna MGG,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Humana,Humana,44.52,,,,,,,per diem,44.52,44.52,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Humana MGG,Humana MGG,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Optum VA,Optum VA,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,UHC,UHC,44.52,,,,,,,per diem,44.52,44.52,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,UHC MGG,UHC MGG,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,VA,VA,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Wellcare MGG,Wellcare MGG,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Bright Health - commercial,Bright Health - commercial,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 600MG/D5W INJ,92212380,CDM,250,RC,,,,,,Inpatient,1,EA,44.52,44.52,Bright Health MGG,Bright Health MGG,44.52,,,,,,,case rate,44.52,44.52,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Aetna,Aetna,23.76,,,,,,,per diem,23.76,23.76,"Per diem rate, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Aetna MGG,Aetna MGG,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,BCBS,BCBS,23.76,,,,,,,per diem,23.76,23.76,"Per diem rate, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,BCBS MGG,BCBS MGG,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Cigna,Cigna,23.76,,,,,,,per diem,23.76,23.76,"Per diem rate, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Cigna MGG,Cigna MGG,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Humana,Humana,23.76,,,,,,,per diem,23.76,23.76,"Per diem rate, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Humana MGG,Humana MGG,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Optum VA,Optum VA,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,UHC,UHC,23.76,,,,,,,per diem,23.76,23.76,"Per diem rate, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,UHC MGG,UHC MGG,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,VA,VA,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Wellcare MGG,Wellcare MGG,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Bright Health - commercial,Bright Health - commercial,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
RALOXIFENE HCL 60MG TAB       ,92212381,CDM,250,RC,,,,,,Inpatient,1,EA,23.76,23.76,Bright Health MGG,Bright Health MGG,23.76,,,,,,,case rate,23.76,23.76,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Aetna,Aetna,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Aetna MGG,Aetna MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,BCBS,BCBS,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,BCBS MGG,BCBS MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Cigna,Cigna,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Cigna MGG,Cigna MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Humana,Humana,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Humana MGG,Humana MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Optum VA,Optum VA,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,UHC,UHC,9.24,,,,,,,per diem,9.24,9.24,"Per diem rate, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,UHC MGG,UHC MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,VA,VA,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Wellcare MGG,Wellcare MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Bright Health - commercial,Bright Health - commercial,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
ALOE VERA/GLYCERIN GEL        ,92212382,CDM,250,RC,,,,,,Inpatient,1,EA,9.24,9.24,Bright Health MGG,Bright Health MGG,9.24,,,,,,,case rate,9.24,9.24,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Aetna,Aetna,261.99,,,,,,,per diem,261.99,261.99,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Aetna MGG,Aetna MGG,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,BCBS,BCBS,261.99,,,,,,,per diem,261.99,261.99,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,BCBS MGG,BCBS MGG,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Cigna,Cigna,261.99,,,,,,,per diem,261.99,261.99,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Cigna MGG,Cigna MGG,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Humana,Humana,261.99,,,,,,,per diem,261.99,261.99,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Humana MGG,Humana MGG,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Optum VA,Optum VA,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,UHC,UHC,261.99,,,,,,,per diem,261.99,261.99,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,UHC MGG,UHC MGG,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,VA,VA,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Wellcare MGG,Wellcare MGG,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Bright Health - commercial,Bright Health - commercial,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212384,CDM,250,RC,,,,,,Inpatient,1,EA,261.99,261.99,Bright Health MGG,Bright Health MGG,261.99,,,,,,,case rate,261.99,261.99,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212385,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna,Aetna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Aetna MGG,Aetna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,BCBS,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS MGG,BCBS MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna,Cigna,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Cigna MGG,Cigna MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana,Humana,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Humana MGG,Humana MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Optum VA,Optum VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC,UHC,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UHC MGG,UHC MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,VA,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Wellcare MGG,Wellcare MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health - commercial,Bright Health - commercial,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212386,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,Bright Health MGG,Bright Health MGG,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Aetna,Aetna,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Aetna MGG,Aetna MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,BCBS,BCBS,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,BCBS MGG,BCBS MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Cigna,Cigna,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Cigna MGG,Cigna MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Humana,Humana,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Humana MGG,Humana MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Optum VA,Optum VA,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,UHC,UHC,186.69,,,,,,,per diem,186.69,186.69,"Per diem rate, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,UHC MGG,UHC MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,VA,VA,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Wellcare MGG,Wellcare MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Bright Health - commercial,Bright Health - commercial,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
COCAINE 4% SOL                ,92212387,CDM,250,RC,,,,,,Inpatient,1,EA,186.69,186.69,Bright Health MGG,Bright Health MGG,186.69,,,,,,,case rate,186.69,186.69,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Aetna,Aetna,851.46,,,,,,,per diem,851.46,851.46,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Aetna MGG,Aetna MGG,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,BCBS,BCBS,851.46,,,,,,,per diem,851.46,851.46,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,BCBS MGG,BCBS MGG,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Cigna,Cigna,851.46,,,,,,,per diem,851.46,851.46,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Cigna MGG,Cigna MGG,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Humana,Humana,851.46,,,,,,,per diem,851.46,851.46,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Humana MGG,Humana MGG,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Optum VA,Optum VA,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,UHC,UHC,851.46,,,,,,,per diem,851.46,851.46,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,UHC MGG,UHC MGG,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,VA,VA,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Wellcare MGG,Wellcare MGG,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Bright Health - commercial,Bright Health - commercial,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92212389,CDM,250,RC,,,,,,Inpatient,1,EA,851.46,851.46,Bright Health MGG,Bright Health MGG,851.46,,,,,,,case rate,851.46,851.46,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Aetna,Aetna,67.74,,,,,,,per diem,67.74,67.74,"Per diem rate, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Aetna MGG,Aetna MGG,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,BCBS,BCBS,67.74,,,,,,,per diem,67.74,67.74,"Per diem rate, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,BCBS MGG,BCBS MGG,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Cigna,Cigna,67.74,,,,,,,per diem,67.74,67.74,"Per diem rate, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Cigna MGG,Cigna MGG,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Humana,Humana,67.74,,,,,,,per diem,67.74,67.74,"Per diem rate, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Humana MGG,Humana MGG,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Optum VA,Optum VA,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,UHC,UHC,67.74,,,,,,,per diem,67.74,67.74,"Per diem rate, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,UHC MGG,UHC MGG,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,VA,VA,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Wellcare MGG,Wellcare MGG,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Bright Health - commercial,Bright Health - commercial,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
PENTAZOCINE LACTATE 30MG/ML IN,92212390,CDM,250,RC,,,,,,Inpatient,1,EA,67.74,67.74,Bright Health MGG,Bright Health MGG,67.74,,,,,,,case rate,67.74,67.74,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Aetna,Aetna,761.34,,,,,,,per diem,761.34,761.34,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Aetna MGG,Aetna MGG,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,BCBS,BCBS,761.34,,,,,,,per diem,761.34,761.34,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,BCBS MGG,BCBS MGG,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Cigna,Cigna,761.34,,,,,,,per diem,761.34,761.34,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Cigna MGG,Cigna MGG,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Humana,Humana,761.34,,,,,,,per diem,761.34,761.34,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Humana MGG,Humana MGG,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Optum VA,Optum VA,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,UHC,UHC,761.34,,,,,,,per diem,761.34,761.34,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,UHC MGG,UHC MGG,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,VA,VA,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Wellcare MGG,Wellcare MGG,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Bright Health - commercial,Bright Health - commercial,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% SOL      ,92212391,CDM,250,RC,,,,,,Inpatient,1,EA,761.34,761.34,Bright Health MGG,Bright Health MGG,761.34,,,,,,,case rate,761.34,761.34,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212392,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Aetna,Aetna,416.31,,,,,,,per diem,416.31,416.31,"Per diem rate, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Aetna MGG,Aetna MGG,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,BCBS,BCBS,416.31,,,,,,,per diem,416.31,416.31,"Per diem rate, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,BCBS MGG,BCBS MGG,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Cigna,Cigna,416.31,,,,,,,per diem,416.31,416.31,"Per diem rate, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Cigna MGG,Cigna MGG,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Humana,Humana,416.31,,,,,,,per diem,416.31,416.31,"Per diem rate, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Humana MGG,Humana MGG,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Optum VA,Optum VA,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,UHC,UHC,416.31,,,,,,,per diem,416.31,416.31,"Per diem rate, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,UHC MGG,UHC MGG,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,VA,VA,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Wellcare MGG,Wellcare MGG,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Bright Health - commercial,Bright Health - commercial,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
OXACILLIN NA 10GM INJ         ,92212393,CDM,250,RC,,,,,,Inpatient,1,EA,416.31,416.31,Bright Health MGG,Bright Health MGG,416.31,,,,,,,case rate,416.31,416.31,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Aetna,Aetna,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Aetna MGG,Aetna MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,BCBS,BCBS,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,BCBS MGG,BCBS MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Cigna,Cigna,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Cigna MGG,Cigna MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Humana,Humana,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Humana MGG,Humana MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Optum VA,Optum VA,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,UHC,UHC,11.49,,,,,,,per diem,11.49,11.49,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,UHC MGG,UHC MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,VA,VA,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Wellcare MGG,Wellcare MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Bright Health - commercial,Bright Health - commercial,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 25MG TAB        ,92212394,CDM,250,RC,,,,,,Inpatient,1,EA,11.49,11.49,Bright Health MGG,Bright Health MGG,11.49,,,,,,,case rate,11.49,11.49,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92212395,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212396,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON POLYSACCH 150MG CAP      ,92212397,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Aetna,Aetna,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Aetna MGG,Aetna MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS,BCBS,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS MGG,BCBS MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Cigna,Cigna,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Cigna MGG,Cigna MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Humana,Humana,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Humana MGG,Humana MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Optum VA,Optum VA,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,UHC,UHC,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,UHC MGG,UHC MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,VA,VA,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Wellcare MGG,Wellcare MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Bright Health - commercial,Bright Health - commercial,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 400MG TER       ,92212398,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Bright Health MGG,Bright Health MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Aetna,Aetna,1594.59,,,,,,,per diem,1594.59,1594.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Aetna MGG,Aetna MGG,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,BCBS,BCBS,1594.59,,,,,,,per diem,1594.59,1594.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,BCBS MGG,BCBS MGG,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Cigna,Cigna,1594.59,,,,,,,per diem,1594.59,1594.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Cigna MGG,Cigna MGG,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Humana,Humana,1594.59,,,,,,,per diem,1594.59,1594.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Humana MGG,Humana MGG,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Optum VA,Optum VA,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,UHC,UHC,1594.59,,,,,,,per diem,1594.59,1594.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,UHC MGG,UHC MGG,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,VA,VA,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Wellcare MGG,Wellcare MGG,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Bright Health - commercial,Bright Health - commercial,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.05% OIN       ,92212399,CDM,250,RC,,,,,,Inpatient,1,EA,1594.59,1594.59,Bright Health MGG,Bright Health MGG,1594.59,,,,,,,case rate,1594.59,1594.59,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212400,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Aetna,Aetna,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Aetna MGG,Aetna MGG,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,BCBS,BCBS,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,BCBS MGG,BCBS MGG,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Cigna,Cigna,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Cigna MGG,Cigna MGG,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Humana,Humana,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Humana MGG,Humana MGG,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Optum VA,Optum VA,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,UHC,UHC,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,UHC MGG,UHC MGG,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,VA,VA,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Wellcare MGG,Wellcare MGG,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Bright Health - commercial,Bright Health - commercial,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1MG/ML INJ      ,92212401,CDM,250,RC,,,,,,Inpatient,1,EA,45.39,45.39,Bright Health MGG,Bright Health MGG,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Aetna,Aetna,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Aetna MGG,Aetna MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,BCBS,BCBS,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,BCBS MGG,BCBS MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Cigna,Cigna,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Cigna MGG,Cigna MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Humana,Humana,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Humana MGG,Humana MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Optum VA,Optum VA,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,UHC,UHC,35.64,,,,,,,per diem,35.64,35.64,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,UHC MGG,UHC MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,VA,VA,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Wellcare MGG,Wellcare MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Bright Health - commercial,Bright Health - commercial,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92212402,CDM,250,RC,,,,,,Inpatient,1,EA,35.64,35.64,Bright Health MGG,Bright Health MGG,35.64,,,,,,,case rate,35.64,35.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Aetna,Aetna,20.34,,,,,,,per diem,20.34,20.34,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Aetna MGG,Aetna MGG,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,BCBS,BCBS,20.34,,,,,,,per diem,20.34,20.34,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,BCBS MGG,BCBS MGG,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Cigna,Cigna,20.34,,,,,,,per diem,20.34,20.34,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Cigna MGG,Cigna MGG,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Humana,Humana,20.34,,,,,,,per diem,20.34,20.34,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Humana MGG,Humana MGG,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Optum VA,Optum VA,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,UHC,UHC,20.34,,,,,,,per diem,20.34,20.34,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,UHC MGG,UHC MGG,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,VA,VA,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Wellcare MGG,Wellcare MGG,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Bright Health - commercial,Bright Health - commercial,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212403,CDM,250,RC,,,,,,Inpatient,1,EA,20.34,20.34,Bright Health MGG,Bright Health MGG,20.34,,,,,,,case rate,20.34,20.34,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Aetna,Aetna,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Aetna MGG,Aetna MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,BCBS,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS MGG,BCBS MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Cigna,Cigna,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Cigna MGG,Cigna MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Humana,Humana,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Humana MGG,Humana MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Optum VA,Optum VA,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UHC,UHC,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UHC MGG,UHC MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA,VA,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Wellcare MGG,Wellcare MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Bright Health - commercial,Bright Health - commercial,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 2MG TAB        ,92212404,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,Bright Health MGG,Bright Health MGG,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Aetna,Aetna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Aetna MGG,Aetna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,BCBS,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS MGG,BCBS MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Cigna,Cigna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Cigna MGG,Cigna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Humana,Humana,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Humana MGG,Humana MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Optum VA,Optum VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UHC,UHC,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UHC MGG,UHC MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA,VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Wellcare MGG,Wellcare MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Bright Health - commercial,Bright Health - commercial,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92212405,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Bright Health MGG,Bright Health MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92212406,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Aetna,Aetna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Aetna MGG,Aetna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,BCBS,BCBS,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,BCBS MGG,BCBS MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Cigna,Cigna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Cigna MGG,Cigna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Humana,Humana,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Humana MGG,Humana MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Optum VA,Optum VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,UHC,UHC,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,UHC MGG,UHC MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,VA,VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Wellcare MGG,Wellcare MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Bright Health - commercial,Bright Health - commercial,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92212407,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Bright Health MGG,Bright Health MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92212408,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Aetna,Aetna,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Aetna MGG,Aetna MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,BCBS,BCBS,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,BCBS MGG,BCBS MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Cigna,Cigna,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Cigna MGG,Cigna MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Humana,Humana,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Humana MGG,Humana MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Optum VA,Optum VA,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,UHC,UHC,52.02,,,,,,,per diem,52.02,52.02,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,UHC MGG,UHC MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,VA,VA,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Wellcare MGG,Wellcare MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Bright Health - commercial,Bright Health - commercial,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM/50ML INJ     ,92212409,CDM,250,RC,,,,,,Inpatient,1,EA,52.02,52.02,Bright Health MGG,Bright Health MGG,52.02,,,,,,,case rate,52.02,52.02,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Aetna,Aetna,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Aetna MGG,Aetna MGG,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,BCBS,BCBS,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,BCBS MGG,BCBS MGG,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Cigna,Cigna,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Cigna MGG,Cigna MGG,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Humana,Humana,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Humana MGG,Humana MGG,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Optum VA,Optum VA,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,UHC,UHC,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,UHC MGG,UHC MGG,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,VA,VA,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Wellcare MGG,Wellcare MGG,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Bright Health - commercial,Bright Health - commercial,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92212410,CDM,250,RC,,,,,,Inpatient,1,EA,630,630,Bright Health MGG,Bright Health MGG,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Aetna,Aetna,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Aetna MGG,Aetna MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,BCBS,BCBS,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,BCBS MGG,BCBS MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Cigna,Cigna,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Cigna MGG,Cigna MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Humana,Humana,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Humana MGG,Humana MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Optum VA,Optum VA,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,UHC,UHC,8.94,,,,,,,per diem,8.94,8.94,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,UHC MGG,UHC MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,VA,VA,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Wellcare MGG,Wellcare MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Bright Health - commercial,Bright Health - commercial,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92212411,CDM,250,RC,,,,,,Inpatient,1,EA,8.94,8.94,Bright Health MGG,Bright Health MGG,8.94,,,,,,,case rate,8.94,8.94,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Aetna,Aetna,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Aetna MGG,Aetna MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,BCBS,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS MGG,BCBS MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Cigna,Cigna,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Cigna MGG,Cigna MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Humana,Humana,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Humana MGG,Humana MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Optum VA,Optum VA,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UHC,UHC,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UHC MGG,UHC MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,VA,VA,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Wellcare MGG,Wellcare MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Bright Health - commercial,Bright Health - commercial,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212412,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Bright Health MGG,Bright Health MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Aetna,Aetna,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Aetna MGG,Aetna MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,BCBS,BCBS,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,BCBS MGG,BCBS MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Cigna,Cigna,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Cigna MGG,Cigna MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Humana,Humana,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Humana MGG,Humana MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Optum VA,Optum VA,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,UHC,UHC,39.6,,,,,,,per diem,39.6,39.6,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,UHC MGG,UHC MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,VA,VA,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Wellcare MGG,Wellcare MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Bright Health - commercial,Bright Health - commercial,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212413,CDM,250,RC,,,,,,Inpatient,1,EA,39.6,39.6,Bright Health MGG,Bright Health MGG,39.6,,,,,,,case rate,39.6,39.6,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Aetna,Aetna,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Aetna MGG,Aetna MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,BCBS,BCBS,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,BCBS MGG,BCBS MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Cigna,Cigna,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Cigna MGG,Cigna MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Humana,Humana,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Humana MGG,Humana MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Optum VA,Optum VA,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,UHC,UHC,29.85,,,,,,,per diem,29.85,29.85,"Per diem rate, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,UHC MGG,UHC MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,VA,VA,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Wellcare MGG,Wellcare MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Bright Health - commercial,Bright Health - commercial,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
PENTOSAN POLYSULFATE NA 100 CA,92212414,CDM,250,RC,,,,,,Inpatient,1,EA,29.85,29.85,Bright Health MGG,Bright Health MGG,29.85,,,,,,,case rate,29.85,29.85,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Aetna,Aetna,390.09,,,,,,,per diem,390.09,390.09,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Aetna MGG,Aetna MGG,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,BCBS,BCBS,390.09,,,,,,,per diem,390.09,390.09,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,BCBS MGG,BCBS MGG,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Cigna,Cigna,390.09,,,,,,,per diem,390.09,390.09,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Cigna MGG,Cigna MGG,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Humana,Humana,390.09,,,,,,,per diem,390.09,390.09,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Humana MGG,Humana MGG,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Optum VA,Optum VA,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,UHC,UHC,390.09,,,,,,,per diem,390.09,390.09,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,UHC MGG,UHC MGG,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,VA,VA,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Wellcare MGG,Wellcare MGG,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Bright Health - commercial,Bright Health - commercial,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 40MG/ML SUS       ,92212415,CDM,250,RC,,,,,,Inpatient,1,EA,390.09,390.09,Bright Health MGG,Bright Health MGG,390.09,,,,,,,case rate,390.09,390.09,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Aetna,Aetna,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Aetna MGG,Aetna MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,BCBS,BCBS,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,BCBS MGG,BCBS MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Cigna,Cigna,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Cigna MGG,Cigna MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Humana,Humana,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Humana MGG,Humana MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Optum VA,Optum VA,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,UHC,UHC,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,UHC MGG,UHC MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,VA,VA,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Wellcare MGG,Wellcare MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Bright Health - commercial,Bright Health - commercial,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212416,CDM,258,RC,,,,,,Inpatient,1,EA,8.25,8.25,Bright Health MGG,Bright Health MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92212417,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Aetna,Aetna,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Aetna MGG,Aetna MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,BCBS,BCBS,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,BCBS MGG,BCBS MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Cigna,Cigna,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Cigna MGG,Cigna MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Humana,Humana,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Humana MGG,Humana MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Optum VA,Optum VA,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,UHC,UHC,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,UHC MGG,UHC MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,VA,VA,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Wellcare MGG,Wellcare MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Bright Health - commercial,Bright Health - commercial,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
CASTOR/PERU BALSAM/TRYPSIN SPR,92212418,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Bright Health MGG,Bright Health MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TER       ,92212419,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Aetna,Aetna,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Aetna MGG,Aetna MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,BCBS,BCBS,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,BCBS MGG,BCBS MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Cigna,Cigna,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Cigna MGG,Cigna MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Humana,Humana,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Humana MGG,Humana MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Optum VA,Optum VA,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,UHC,UHC,98.94,,,,,,,per diem,98.94,98.94,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,UHC MGG,UHC MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,VA,VA,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Wellcare MGG,Wellcare MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Bright Health - commercial,Bright Health - commercial,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92212420,CDM,250,RC,,,,,,Inpatient,1,EA,98.94,98.94,Bright Health MGG,Bright Health MGG,98.94,,,,,,,case rate,98.94,98.94,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92212421,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Aetna,Aetna,119.25,,,,,,,per diem,119.25,119.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Aetna MGG,Aetna MGG,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,BCBS,BCBS,119.25,,,,,,,per diem,119.25,119.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,BCBS MGG,BCBS MGG,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Cigna,Cigna,119.25,,,,,,,per diem,119.25,119.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Cigna MGG,Cigna MGG,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Humana,Humana,119.25,,,,,,,per diem,119.25,119.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Humana MGG,Humana MGG,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Optum VA,Optum VA,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,UHC,UHC,119.25,,,,,,,per diem,119.25,119.25,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,UHC MGG,UHC MGG,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,VA,VA,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Wellcare MGG,Wellcare MGG,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Bright Health - commercial,Bright Health - commercial,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92212422,CDM,250,RC,,,,,,Inpatient,1,EA,119.25,119.25,Bright Health MGG,Bright Health MGG,119.25,,,,,,,case rate,119.25,119.25,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Aetna,Aetna,326.16,,,,,,,per diem,326.16,326.16,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Aetna MGG,Aetna MGG,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,BCBS,BCBS,326.16,,,,,,,per diem,326.16,326.16,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,BCBS MGG,BCBS MGG,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Cigna,Cigna,326.16,,,,,,,per diem,326.16,326.16,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Cigna MGG,Cigna MGG,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Humana,Humana,326.16,,,,,,,per diem,326.16,326.16,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Humana MGG,Humana MGG,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Optum VA,Optum VA,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,UHC,UHC,326.16,,,,,,,per diem,326.16,326.16,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,UHC MGG,UHC MGG,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,VA,VA,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Wellcare MGG,Wellcare MGG,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Bright Health - commercial,Bright Health - commercial,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212423,CDM,250,RC,,,,,,Inpatient,1,EA,326.16,326.16,Bright Health MGG,Bright Health MGG,326.16,,,,,,,case rate,326.16,326.16,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Aetna,Aetna,319.17,,,,,,,per diem,319.17,319.17,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Aetna MGG,Aetna MGG,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,BCBS,BCBS,319.17,,,,,,,per diem,319.17,319.17,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,BCBS MGG,BCBS MGG,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Cigna,Cigna,319.17,,,,,,,per diem,319.17,319.17,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Cigna MGG,Cigna MGG,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Humana,Humana,319.17,,,,,,,per diem,319.17,319.17,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Humana MGG,Humana MGG,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Optum VA,Optum VA,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,UHC,UHC,319.17,,,,,,,per diem,319.17,319.17,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,UHC MGG,UHC MGG,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,VA,VA,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Wellcare MGG,Wellcare MGG,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Bright Health - commercial,Bright Health - commercial,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/HC CRE ,92212424,CDM,250,RC,,,,,,Inpatient,1,EA,319.17,319.17,Bright Health MGG,Bright Health MGG,319.17,,,,,,,case rate,319.17,319.17,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Aetna,Aetna,259.14,,,,,,,per diem,259.14,259.14,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Aetna MGG,Aetna MGG,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,BCBS,BCBS,259.14,,,,,,,per diem,259.14,259.14,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,BCBS MGG,BCBS MGG,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Cigna,Cigna,259.14,,,,,,,per diem,259.14,259.14,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Cigna MGG,Cigna MGG,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Humana,Humana,259.14,,,,,,,per diem,259.14,259.14,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Humana MGG,Humana MGG,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Optum VA,Optum VA,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,UHC,UHC,259.14,,,,,,,per diem,259.14,259.14,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,UHC MGG,UHC MGG,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,VA,VA,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Wellcare MGG,Wellcare MGG,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Bright Health - commercial,Bright Health - commercial,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92212425,CDM,250,RC,,,,,,Inpatient,1,EA,259.14,259.14,Bright Health MGG,Bright Health MGG,259.14,,,,,,,case rate,259.14,259.14,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Aetna,Aetna,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Aetna MGG,Aetna MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,BCBS,BCBS,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,BCBS MGG,BCBS MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Cigna,Cigna,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Cigna MGG,Cigna MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Humana,Humana,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Humana MGG,Humana MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Optum VA,Optum VA,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,UHC,UHC,14.3,,,,,,,per diem,14.3,14.3,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,UHC MGG,UHC MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,VA,VA,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Wellcare MGG,Wellcare MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Bright Health - commercial,Bright Health - commercial,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92212426,CDM,250,RC,,,,,,Inpatient,1,EA,14.3,14.3,Bright Health MGG,Bright Health MGG,14.3,,,,,,,case rate,14.3,14.3,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92212427,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 15MG/ML INJ          ,92212428,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212429,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212430,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Aetna,Aetna,14.94,,,,,,,per diem,14.94,14.94,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Aetna MGG,Aetna MGG,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,BCBS,BCBS,14.94,,,,,,,per diem,14.94,14.94,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,BCBS MGG,BCBS MGG,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Cigna,Cigna,14.94,,,,,,,per diem,14.94,14.94,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Cigna MGG,Cigna MGG,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Humana,Humana,14.94,,,,,,,per diem,14.94,14.94,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Humana MGG,Humana MGG,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Optum VA,Optum VA,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,UHC,UHC,14.94,,,,,,,per diem,14.94,14.94,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,UHC MGG,UHC MGG,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,VA,VA,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Wellcare MGG,Wellcare MGG,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Bright Health - commercial,Bright Health - commercial,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 200MG TAB      ,92212431,CDM,250,RC,,,,,,Inpatient,1,EA,14.94,14.94,Bright Health MGG,Bright Health MGG,14.94,,,,,,,case rate,14.94,14.94,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Aetna,Aetna,676.8,,,,,,,per diem,676.8,676.8,"Per diem rate, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Aetna MGG,Aetna MGG,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,BCBS,BCBS,676.8,,,,,,,per diem,676.8,676.8,"Per diem rate, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,BCBS MGG,BCBS MGG,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Cigna,Cigna,676.8,,,,,,,per diem,676.8,676.8,"Per diem rate, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Cigna MGG,Cigna MGG,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Humana,Humana,676.8,,,,,,,per diem,676.8,676.8,"Per diem rate, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Humana MGG,Humana MGG,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Optum VA,Optum VA,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,UHC,UHC,676.8,,,,,,,per diem,676.8,676.8,"Per diem rate, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,UHC MGG,UHC MGG,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,VA,VA,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Wellcare MGG,Wellcare MGG,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Bright Health - commercial,Bright Health - commercial,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
SEVOFLURANE LIQ               ,92212432,CDM,250,RC,,,,,,Inpatient,1,EA,676.8,676.8,Bright Health MGG,Bright Health MGG,676.8,,,,,,,case rate,676.8,676.8,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLEMASTINE FUMARATE 1.34MG TAB,92212433,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 220MG CAP           ,92212434,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212435,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG/5ML ELI   ,92212436,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Aetna,Aetna,310.86,,,,,,,per diem,310.86,310.86,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Aetna MGG,Aetna MGG,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,BCBS,BCBS,310.86,,,,,,,per diem,310.86,310.86,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,BCBS MGG,BCBS MGG,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Cigna,Cigna,310.86,,,,,,,per diem,310.86,310.86,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Cigna MGG,Cigna MGG,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Humana,Humana,310.86,,,,,,,per diem,310.86,310.86,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Humana MGG,Humana MGG,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Optum VA,Optum VA,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,UHC,UHC,310.86,,,,,,,per diem,310.86,310.86,"Per diem rate, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,UHC MGG,UHC MGG,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,VA,VA,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Wellcare MGG,Wellcare MGG,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Bright Health - commercial,Bright Health - commercial,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
VARICELLA VIRUS 1350PFU PDS   ,92212437,CDM,250,RC,,,,,,Inpatient,1,EA,310.86,310.86,Bright Health MGG,Bright Health MGG,310.86,,,,,,,case rate,310.86,310.86,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Aetna,Aetna,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Aetna MGG,Aetna MGG,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,BCBS,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS MGG,BCBS MGG,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Cigna,Cigna,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Cigna MGG,Cigna MGG,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Humana,Humana,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Humana MGG,Humana MGG,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Optum VA,Optum VA,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,UHC,UHC,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,UHC MGG,UHC MGG,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,VA,VA,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Wellcare MGG,Wellcare MGG,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Bright Health - commercial,Bright Health - commercial,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92212438,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,Bright Health MGG,Bright Health MGG,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Aetna,Aetna,556.59,,,,,,,per diem,556.59,556.59,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Aetna MGG,Aetna MGG,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,BCBS,BCBS,556.59,,,,,,,per diem,556.59,556.59,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,BCBS MGG,BCBS MGG,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Cigna,Cigna,556.59,,,,,,,per diem,556.59,556.59,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Cigna MGG,Cigna MGG,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Humana,Humana,556.59,,,,,,,per diem,556.59,556.59,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Humana MGG,Humana MGG,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Optum VA,Optum VA,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,UHC,UHC,556.59,,,,,,,per diem,556.59,556.59,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,UHC MGG,UHC MGG,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,VA,VA,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Wellcare MGG,Wellcare MGG,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Bright Health - commercial,Bright Health - commercial,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-1% CRE    ,92212439,CDM,250,RC,,,,,,Inpatient,1,EA,556.59,556.59,Bright Health MGG,Bright Health MGG,556.59,,,,,,,case rate,556.59,556.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Aetna,Aetna,46.59,,,,,,,per diem,46.59,46.59,"Per diem rate, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Aetna MGG,Aetna MGG,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,BCBS,BCBS,46.59,,,,,,,per diem,46.59,46.59,"Per diem rate, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,BCBS MGG,BCBS MGG,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Cigna,Cigna,46.59,,,,,,,per diem,46.59,46.59,"Per diem rate, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Cigna MGG,Cigna MGG,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Humana,Humana,46.59,,,,,,,per diem,46.59,46.59,"Per diem rate, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Humana MGG,Humana MGG,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Optum VA,Optum VA,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,UHC,UHC,46.59,,,,,,,per diem,46.59,46.59,"Per diem rate, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,UHC MGG,UHC MGG,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,VA,VA,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Wellcare MGG,Wellcare MGG,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Bright Health - commercial,Bright Health - commercial,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
VALACYCLOVIR HCL 500MG TAB    ,92212440,CDM,250,RC,,,,,,Inpatient,1,EA,46.59,46.59,Bright Health MGG,Bright Health MGG,46.59,,,,,,,case rate,46.59,46.59,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT TAB  ,92212441,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92212442,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Aetna,Aetna,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Aetna MGG,Aetna MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS,BCBS,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS MGG,BCBS MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Cigna,Cigna,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Cigna MGG,Cigna MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Humana,Humana,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Humana MGG,Humana MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Optum VA,Optum VA,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,UHC,UHC,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,UHC MGG,UHC MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,VA,VA,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Wellcare MGG,Wellcare MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Bright Health - commercial,Bright Health - commercial,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE                  ,92212443,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Bright Health MGG,Bright Health MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Aetna,Aetna,60.75,,,,,,,per diem,60.75,60.75,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Aetna MGG,Aetna MGG,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,BCBS,BCBS,60.75,,,,,,,per diem,60.75,60.75,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,BCBS MGG,BCBS MGG,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Cigna,Cigna,60.75,,,,,,,per diem,60.75,60.75,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Cigna MGG,Cigna MGG,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Humana,Humana,60.75,,,,,,,per diem,60.75,60.75,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Humana MGG,Humana MGG,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Optum VA,Optum VA,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,UHC,UHC,60.75,,,,,,,per diem,60.75,60.75,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,UHC MGG,UHC MGG,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,VA,VA,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Wellcare MGG,Wellcare MGG,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Bright Health - commercial,Bright Health - commercial,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212444,CDM,250,RC,,,,,,Inpatient,1,EA,60.75,60.75,Bright Health MGG,Bright Health MGG,60.75,,,,,,,case rate,60.75,60.75,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Aetna,Aetna,67.71,,,,,,,per diem,67.71,67.71,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Aetna MGG,Aetna MGG,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,BCBS,BCBS,67.71,,,,,,,per diem,67.71,67.71,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,BCBS MGG,BCBS MGG,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Cigna,Cigna,67.71,,,,,,,per diem,67.71,67.71,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Cigna MGG,Cigna MGG,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Humana,Humana,67.71,,,,,,,per diem,67.71,67.71,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Humana MGG,Humana MGG,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Optum VA,Optum VA,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,UHC,UHC,67.71,,,,,,,per diem,67.71,67.71,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,UHC MGG,UHC MGG,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,VA,VA,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Wellcare MGG,Wellcare MGG,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Bright Health - commercial,Bright Health - commercial,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92212445,CDM,250,RC,,,,,,Inpatient,1,EA,67.71,67.71,Bright Health MGG,Bright Health MGG,67.71,,,,,,,case rate,67.71,67.71,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92212446,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212447,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Aetna,Aetna,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Aetna MGG,Aetna MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,BCBS,BCBS,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,BCBS MGG,BCBS MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Cigna,Cigna,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Cigna MGG,Cigna MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Humana,Humana,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Humana MGG,Humana MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Optum VA,Optum VA,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,UHC,UHC,11.73,,,,,,,per diem,11.73,11.73,"Per diem rate, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,UHC MGG,UHC MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,VA,VA,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Wellcare MGG,Wellcare MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Bright Health - commercial,Bright Health - commercial,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
DEXTROSE 40% IVS              ,92212448,CDM,258,RC,,,,,,Inpatient,1,EA,11.73,11.73,Bright Health MGG,Bright Health MGG,11.73,,,,,,,case rate,11.73,11.73,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna,Aetna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna MGG,Aetna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,BCBS,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS MGG,BCBS MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna,Cigna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna MGG,Cigna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana,Humana,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana MGG,Humana MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Optum VA,Optum VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC,UHC,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC MGG,UHC MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,VA,VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Wellcare MGG,Wellcare MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health - commercial,Bright Health - commercial,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92212449,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health MGG,Bright Health MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Aetna,Aetna,1133.4,,,,,,,per diem,1133.4,1133.4,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Aetna MGG,Aetna MGG,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,BCBS,BCBS,1133.4,,,,,,,per diem,1133.4,1133.4,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,BCBS MGG,BCBS MGG,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Cigna,Cigna,1133.4,,,,,,,per diem,1133.4,1133.4,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Cigna MGG,Cigna MGG,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Humana,Humana,1133.4,,,,,,,per diem,1133.4,1133.4,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Humana MGG,Humana MGG,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Optum VA,Optum VA,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,UHC,UHC,1133.4,,,,,,,per diem,1133.4,1133.4,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,UHC MGG,UHC MGG,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,VA,VA,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Wellcare MGG,Wellcare MGG,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Bright Health - commercial,Bright Health - commercial,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/ML INJ      ,92212450,CDM,250,RC,,,,,,Inpatient,1,EA,1133.4,1133.4,Bright Health MGG,Bright Health MGG,1133.4,,,,,,,case rate,1133.4,1133.4,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna,Aetna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna MGG,Aetna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS,BCBS,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS MGG,BCBS MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna,Cigna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna MGG,Cigna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana,Humana,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana MGG,Humana MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Optum VA,Optum VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC,UHC,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC MGG,UHC MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,VA,VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Wellcare MGG,Wellcare MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health - commercial,Bright Health - commercial,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUGATED ESTROGENS 0.3MG TAB,92212451,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health MGG,Bright Health MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna,Aetna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna MGG,Aetna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS,BCBS,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS MGG,BCBS MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna,Cigna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna MGG,Cigna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana,Humana,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana MGG,Humana MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Optum VA,Optum VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC,UHC,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC MGG,UHC MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,VA,VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Wellcare MGG,Wellcare MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health - commercial,Bright Health - commercial,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TER       ,92212452,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health MGG,Bright Health MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHAZOLAMIDE 50MG TAB        ,92212453,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Aetna,Aetna,57.66,,,,,,,per diem,57.66,57.66,"Per diem rate, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Aetna MGG,Aetna MGG,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,BCBS,BCBS,57.66,,,,,,,per diem,57.66,57.66,"Per diem rate, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,BCBS MGG,BCBS MGG,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Cigna,Cigna,57.66,,,,,,,per diem,57.66,57.66,"Per diem rate, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Cigna MGG,Cigna MGG,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Humana,Humana,57.66,,,,,,,per diem,57.66,57.66,"Per diem rate, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Humana MGG,Humana MGG,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Optum VA,Optum VA,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,UHC,UHC,57.66,,,,,,,per diem,57.66,57.66,"Per diem rate, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,UHC MGG,UHC MGG,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,VA,VA,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Wellcare MGG,Wellcare MGG,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Bright Health - commercial,Bright Health - commercial,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
ALUM AMMONIUM POW             ,92212454,CDM,250,RC,,,,,,Inpatient,1,EA,57.66,57.66,Bright Health MGG,Bright Health MGG,57.66,,,,,,,case rate,57.66,57.66,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna,Aetna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna MGG,Aetna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS,BCBS,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS MGG,BCBS MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna,Cigna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna MGG,Cigna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana,Humana,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana MGG,Humana MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Optum VA,Optum VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC,UHC,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC MGG,UHC MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,VA,VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Wellcare MGG,Wellcare MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health - commercial,Bright Health - commercial,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212455,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health MGG,Bright Health MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92212456,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Aetna,Aetna,32.82,,,,,,,per diem,32.82,32.82,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Aetna MGG,Aetna MGG,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,BCBS,BCBS,32.82,,,,,,,per diem,32.82,32.82,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,BCBS MGG,BCBS MGG,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Cigna,Cigna,32.82,,,,,,,per diem,32.82,32.82,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Cigna MGG,Cigna MGG,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Humana,Humana,32.82,,,,,,,per diem,32.82,32.82,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Humana MGG,Humana MGG,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Optum VA,Optum VA,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,UHC,UHC,32.82,,,,,,,per diem,32.82,32.82,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,UHC MGG,UHC MGG,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,VA,VA,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Wellcare MGG,Wellcare MGG,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Bright Health - commercial,Bright Health - commercial,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 200MG TAB         ,92212457,CDM,250,RC,,,,,,Inpatient,1,EA,32.82,32.82,Bright Health MGG,Bright Health MGG,32.82,,,,,,,case rate,32.82,32.82,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92212458,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Aetna,Aetna,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Aetna MGG,Aetna MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,BCBS,BCBS,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,BCBS MGG,BCBS MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Cigna,Cigna,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Cigna MGG,Cigna MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Humana,Humana,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Humana MGG,Humana MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Optum VA,Optum VA,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,UHC,UHC,139.2,,,,,,,per diem,139.2,139.2,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,UHC MGG,UHC MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,VA,VA,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Wellcare MGG,Wellcare MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Bright Health - commercial,Bright Health - commercial,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% PAD       ,92212459,CDM,250,RC,,,,,,Inpatient,1,EA,139.2,139.2,Bright Health MGG,Bright Health MGG,139.2,,,,,,,case rate,139.2,139.2,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92212460,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Aetna,Aetna,920.43,,,,,,,per diem,920.43,920.43,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Aetna MGG,Aetna MGG,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,BCBS,BCBS,920.43,,,,,,,per diem,920.43,920.43,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,BCBS MGG,BCBS MGG,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Cigna,Cigna,920.43,,,,,,,per diem,920.43,920.43,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Cigna MGG,Cigna MGG,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Humana,Humana,920.43,,,,,,,per diem,920.43,920.43,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Humana MGG,Humana MGG,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Optum VA,Optum VA,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,UHC,UHC,920.43,,,,,,,per diem,920.43,920.43,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,UHC MGG,UHC MGG,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,VA,VA,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Wellcare MGG,Wellcare MGG,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Bright Health - commercial,Bright Health - commercial,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92212461,CDM,250,RC,,,,,,Inpatient,1,EA,920.43,920.43,Bright Health MGG,Bright Health MGG,920.43,,,,,,,case rate,920.43,920.43,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Aetna,Aetna,81.72,,,,,,,per diem,81.72,81.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Aetna MGG,Aetna MGG,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,BCBS,BCBS,81.72,,,,,,,per diem,81.72,81.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,BCBS MGG,BCBS MGG,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Cigna,Cigna,81.72,,,,,,,per diem,81.72,81.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Cigna MGG,Cigna MGG,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Humana,Humana,81.72,,,,,,,per diem,81.72,81.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Humana MGG,Humana MGG,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Optum VA,Optum VA,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,UHC,UHC,81.72,,,,,,,per diem,81.72,81.72,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,UHC MGG,UHC MGG,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,VA,VA,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Wellcare MGG,Wellcare MGG,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Bright Health - commercial,Bright Health - commercial,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 10MG/ML INJ   ,92212462,CDM,250,RC,,,,,,Inpatient,1,EA,81.72,81.72,Bright Health MGG,Bright Health MGG,81.72,,,,,,,case rate,81.72,81.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Aetna,Aetna,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Aetna MGG,Aetna MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,BCBS,BCBS,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,BCBS MGG,BCBS MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Cigna,Cigna,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Cigna MGG,Cigna MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Humana,Humana,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Humana MGG,Humana MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Optum VA,Optum VA,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,UHC,UHC,9.72,,,,,,,per diem,9.72,9.72,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,UHC MGG,UHC MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,VA,VA,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Wellcare MGG,Wellcare MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Bright Health - commercial,Bright Health - commercial,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212463,CDM,250,RC,,,,,,Inpatient,1,EA,9.72,9.72,Bright Health MGG,Bright Health MGG,9.72,,,,,,,case rate,9.72,9.72,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212464,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212465,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Aetna,Aetna,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Aetna MGG,Aetna MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,BCBS,BCBS,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,BCBS MGG,BCBS MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Cigna,Cigna,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Cigna MGG,Cigna MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Humana,Humana,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Humana MGG,Humana MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Optum VA,Optum VA,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,UHC,UHC,16.56,,,,,,,per diem,16.56,16.56,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,UHC MGG,UHC MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,VA,VA,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Wellcare MGG,Wellcare MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Bright Health - commercial,Bright Health - commercial,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212466,CDM,250,RC,,,,,,Inpatient,1,EA,16.56,16.56,Bright Health MGG,Bright Health MGG,16.56,,,,,,,case rate,16.56,16.56,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212467,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Aetna,Aetna,500.55,,,,,,,per diem,500.55,500.55,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Aetna MGG,Aetna MGG,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,BCBS,BCBS,500.55,,,,,,,per diem,500.55,500.55,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,BCBS MGG,BCBS MGG,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Cigna,Cigna,500.55,,,,,,,per diem,500.55,500.55,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Cigna MGG,Cigna MGG,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Humana,Humana,500.55,,,,,,,per diem,500.55,500.55,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Humana MGG,Humana MGG,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Optum VA,Optum VA,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,UHC,UHC,500.55,,,,,,,per diem,500.55,500.55,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,UHC MGG,UHC MGG,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,VA,VA,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Wellcare MGG,Wellcare MGG,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Bright Health - commercial,Bright Health - commercial,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92212468,CDM,250,RC,,,,,,Inpatient,1,EA,500.55,500.55,Bright Health MGG,Bright Health MGG,500.55,,,,,,,case rate,500.55,500.55,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Aetna,Aetna,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Aetna MGG,Aetna MGG,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,BCBS,BCBS,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,BCBS MGG,BCBS MGG,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Cigna,Cigna,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Cigna MGG,Cigna MGG,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Humana,Humana,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Humana MGG,Humana MGG,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Optum VA,Optum VA,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,UHC,UHC,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,UHC MGG,UHC MGG,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,VA,VA,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Wellcare MGG,Wellcare MGG,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Bright Health - commercial,Bright Health - commercial,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212469,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,Bright Health MGG,Bright Health MGG,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92212470,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Aetna,Aetna,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Aetna MGG,Aetna MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS,BCBS,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS MGG,BCBS MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Cigna,Cigna,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Cigna MGG,Cigna MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Humana,Humana,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Humana MGG,Humana MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Optum VA,Optum VA,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,UHC,UHC,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,UHC MGG,UHC MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,VA,VA,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Wellcare MGG,Wellcare MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Bright Health - commercial,Bright Health - commercial,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CAMPHOR MENTHOL 0.5%-0.5% LOT ,92212471,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,Bright Health MGG,Bright Health MGG,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Aetna,Aetna,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Aetna MGG,Aetna MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,BCBS,BCBS,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,BCBS MGG,BCBS MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Cigna,Cigna,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Cigna MGG,Cigna MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Humana,Humana,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Humana MGG,Humana MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Optum VA,Optum VA,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,UHC,UHC,14.16,,,,,,,per diem,14.16,14.16,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,UHC MGG,UHC MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,VA,VA,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Wellcare MGG,Wellcare MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Bright Health - commercial,Bright Health - commercial,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212472,CDM,258,RC,,,,,,Inpatient,1,EA,14.16,14.16,Bright Health MGG,Bright Health MGG,14.16,,,,,,,case rate,14.16,14.16,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92212473,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Aetna,Aetna,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Aetna MGG,Aetna MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,BCBS,BCBS,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,BCBS MGG,BCBS MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Cigna,Cigna,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Cigna MGG,Cigna MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Humana,Humana,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Humana MGG,Humana MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Optum VA,Optum VA,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,UHC,UHC,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,UHC MGG,UHC MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,VA,VA,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Wellcare MGG,Wellcare MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Bright Health - commercial,Bright Health - commercial,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG TAB      ,92212474,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Bright Health MGG,Bright Health MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Aetna,Aetna,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Aetna MGG,Aetna MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,BCBS,BCBS,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,BCBS MGG,BCBS MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Cigna,Cigna,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Cigna MGG,Cigna MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Humana,Humana,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Humana MGG,Humana MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Optum VA,Optum VA,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,UHC,UHC,9.21,,,,,,,per diem,9.21,9.21,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,UHC MGG,UHC MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,VA,VA,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Wellcare MGG,Wellcare MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Bright Health - commercial,Bright Health - commercial,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 25MG/5ML SUS      ,92212475,CDM,250,RC,,,,,,Inpatient,1,EA,9.21,9.21,Bright Health MGG,Bright Health MGG,9.21,,,,,,,case rate,9.21,9.21,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92212476,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Aetna,Aetna,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Aetna MGG,Aetna MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,BCBS,BCBS,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,BCBS MGG,BCBS MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Cigna,Cigna,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Cigna MGG,Cigna MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Humana,Humana,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Humana MGG,Humana MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Optum VA,Optum VA,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,UHC,UHC,112.5,,,,,,,per diem,112.5,112.5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,UHC MGG,UHC MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,VA,VA,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Wellcare MGG,Wellcare MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Bright Health - commercial,Bright Health - commercial,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212477,CDM,250,RC,,,,,,Inpatient,1,EA,112.5,112.5,Bright Health MGG,Bright Health MGG,112.5,,,,,,,case rate,112.5,112.5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92212478,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92212479,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Aetna,Aetna,272.85,,,,,,,per diem,272.85,272.85,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Aetna MGG,Aetna MGG,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,BCBS,BCBS,272.85,,,,,,,per diem,272.85,272.85,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,BCBS MGG,BCBS MGG,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Cigna,Cigna,272.85,,,,,,,per diem,272.85,272.85,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Cigna MGG,Cigna MGG,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Humana,Humana,272.85,,,,,,,per diem,272.85,272.85,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Humana MGG,Humana MGG,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Optum VA,Optum VA,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,UHC,UHC,272.85,,,,,,,per diem,272.85,272.85,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,UHC MGG,UHC MGG,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,VA,VA,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Wellcare MGG,Wellcare MGG,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Bright Health - commercial,Bright Health - commercial,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL HC 1%-2.5% LOT  ,92212480,CDM,250,RC,,,,,,Inpatient,1,EA,272.85,272.85,Bright Health MGG,Bright Health MGG,272.85,,,,,,,case rate,272.85,272.85,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Aetna,Aetna,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Aetna MGG,Aetna MGG,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,BCBS,BCBS,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,BCBS MGG,BCBS MGG,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Cigna,Cigna,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Cigna MGG,Cigna MGG,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Humana,Humana,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Humana MGG,Humana MGG,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Optum VA,Optum VA,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,UHC,UHC,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,UHC MGG,UHC MGG,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,VA,VA,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Wellcare MGG,Wellcare MGG,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Bright Health - commercial,Bright Health - commercial,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 300MG CER       ,92212481,CDM,250,RC,,,,,,Inpatient,1,EA,5.74,5.74,Bright Health MGG,Bright Health MGG,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Aetna,Aetna,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Aetna MGG,Aetna MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,BCBS,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS MGG,BCBS MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Cigna,Cigna,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Cigna MGG,Cigna MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Humana,Humana,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Humana MGG,Humana MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Optum VA,Optum VA,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,UHC,UHC,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,UHC MGG,UHC MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,VA,VA,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Wellcare MGG,Wellcare MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Bright Health - commercial,Bright Health - commercial,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 50MG TAB      ,92212482,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Bright Health MGG,Bright Health MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Aetna,Aetna,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Aetna MGG,Aetna MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,BCBS,BCBS,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,BCBS MGG,BCBS MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Cigna,Cigna,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Cigna MGG,Cigna MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Humana,Humana,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Humana MGG,Humana MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Optum VA,Optum VA,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,UHC,UHC,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,UHC MGG,UHC MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,VA,VA,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Wellcare MGG,Wellcare MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Bright Health - commercial,Bright Health - commercial,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
COAL TAR 0.5% SHA             ,92212483,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Bright Health MGG,Bright Health MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000U TAB         ",92212484,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92212485,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92212486,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212487,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna,Aetna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna MGG,Aetna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS,BCBS,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS MGG,BCBS MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna,Cigna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna MGG,Cigna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana,Humana,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana MGG,Humana MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Optum VA,Optum VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC,UHC,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC MGG,UHC MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,VA,VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Wellcare MGG,Wellcare MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health - commercial,Bright Health - commercial,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TER            ,92212488,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health MGG,Bright Health MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Aetna,Aetna,721.2,,,,,,,per diem,721.2,721.2,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Aetna MGG,Aetna MGG,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,BCBS,BCBS,721.2,,,,,,,per diem,721.2,721.2,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,BCBS MGG,BCBS MGG,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Cigna,Cigna,721.2,,,,,,,per diem,721.2,721.2,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Cigna MGG,Cigna MGG,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Humana,Humana,721.2,,,,,,,per diem,721.2,721.2,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Humana MGG,Humana MGG,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Optum VA,Optum VA,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,UHC,UHC,721.2,,,,,,,per diem,721.2,721.2,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,UHC MGG,UHC MGG,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,VA,VA,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Wellcare MGG,Wellcare MGG,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Bright Health - commercial,Bright Health - commercial,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212489,CDM,250,RC,,,,,,Inpatient,1,EA,721.2,721.2,Bright Health MGG,Bright Health MGG,721.2,,,,,,,case rate,721.2,721.2,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 1.07GM TAB          ,92212490,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Aetna,Aetna,830.64,,,,,,,per diem,830.64,830.64,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Aetna MGG,Aetna MGG,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,BCBS,BCBS,830.64,,,,,,,per diem,830.64,830.64,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,BCBS MGG,BCBS MGG,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Cigna,Cigna,830.64,,,,,,,per diem,830.64,830.64,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Cigna MGG,Cigna MGG,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Humana,Humana,830.64,,,,,,,per diem,830.64,830.64,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Humana MGG,Humana MGG,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Optum VA,Optum VA,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,UHC,UHC,830.64,,,,,,,per diem,830.64,830.64,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,UHC MGG,UHC MGG,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,VA,VA,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Wellcare MGG,Wellcare MGG,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Bright Health - commercial,Bright Health - commercial,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/0.5ML INJ   ,92212491,CDM,250,RC,,,,,,Inpatient,1,EA,830.64,830.64,Bright Health MGG,Bright Health MGG,830.64,,,,,,,case rate,830.64,830.64,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212492,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Aetna,Aetna,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Aetna MGG,Aetna MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,BCBS,BCBS,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,BCBS MGG,BCBS MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Cigna,Cigna,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Cigna MGG,Cigna MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Humana,Humana,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Humana MGG,Humana MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Optum VA,Optum VA,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,UHC,UHC,18.15,,,,,,,per diem,18.15,18.15,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,UHC MGG,UHC MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,VA,VA,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Wellcare MGG,Wellcare MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Bright Health - commercial,Bright Health - commercial,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212493,CDM,250,RC,,,,,,Inpatient,1,EA,18.15,18.15,Bright Health MGG,Bright Health MGG,18.15,,,,,,,case rate,18.15,18.15,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Aetna,Aetna,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Aetna MGG,Aetna MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,BCBS,BCBS,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,BCBS MGG,BCBS MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Cigna,Cigna,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Cigna MGG,Cigna MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Humana,Humana,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Humana MGG,Humana MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Optum VA,Optum VA,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,UHC,UHC,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,UHC MGG,UHC MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,VA,VA,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Wellcare MGG,Wellcare MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Bright Health - commercial,Bright Health - commercial,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212494,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Bright Health MGG,Bright Health MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TIZANIDINE HCL 4MG TAB        ,92212495,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Aetna,Aetna,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Aetna MGG,Aetna MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,BCBS,BCBS,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,BCBS MGG,BCBS MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Cigna,Cigna,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Cigna MGG,Cigna MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Humana,Humana,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Humana MGG,Humana MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Optum VA,Optum VA,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,UHC,UHC,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,UHC MGG,UHC MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,VA,VA,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Wellcare MGG,Wellcare MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Bright Health - commercial,Bright Health - commercial,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG/ML INJ        ,92212496,CDM,250,RC,,,,,,Inpatient,1,EA,22.26,22.26,Bright Health MGG,Bright Health MGG,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Aetna,Aetna,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Aetna MGG,Aetna MGG,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,BCBS,BCBS,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,BCBS MGG,BCBS MGG,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Cigna,Cigna,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Cigna MGG,Cigna MGG,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Humana,Humana,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Humana MGG,Humana MGG,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Optum VA,Optum VA,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,UHC,UHC,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,UHC MGG,UHC MGG,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,VA,VA,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Wellcare MGG,Wellcare MGG,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Bright Health - commercial,Bright Health - commercial,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
SODIUM FLORIDE 1.1% CRE       ,92212497,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,Bright Health MGG,Bright Health MGG,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212498,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Aetna,Aetna,309.48,,,,,,,per diem,309.48,309.48,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Aetna MGG,Aetna MGG,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,BCBS,BCBS,309.48,,,,,,,per diem,309.48,309.48,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,BCBS MGG,BCBS MGG,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Cigna,Cigna,309.48,,,,,,,per diem,309.48,309.48,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Cigna MGG,Cigna MGG,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Humana,Humana,309.48,,,,,,,per diem,309.48,309.48,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Humana MGG,Humana MGG,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Optum VA,Optum VA,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,UHC,UHC,309.48,,,,,,,per diem,309.48,309.48,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,UHC MGG,UHC MGG,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,VA,VA,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Wellcare MGG,Wellcare MGG,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Bright Health - commercial,Bright Health - commercial,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212499,CDM,250,RC,,,,,,Inpatient,1,EA,309.48,309.48,Bright Health MGG,Bright Health MGG,309.48,,,,,,,case rate,309.48,309.48,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Aetna,Aetna,62.25,,,,,,,per diem,62.25,62.25,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Aetna MGG,Aetna MGG,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,BCBS,BCBS,62.25,,,,,,,per diem,62.25,62.25,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,BCBS MGG,BCBS MGG,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Cigna,Cigna,62.25,,,,,,,per diem,62.25,62.25,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Cigna MGG,Cigna MGG,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Humana,Humana,62.25,,,,,,,per diem,62.25,62.25,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Humana MGG,Humana MGG,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Optum VA,Optum VA,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,UHC,UHC,62.25,,,,,,,per diem,62.25,62.25,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,UHC MGG,UHC MGG,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,VA,VA,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Wellcare MGG,Wellcare MGG,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Bright Health - commercial,Bright Health - commercial,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 150MG TAB         ,92212500,CDM,250,RC,,,,,,Inpatient,1,EA,62.25,62.25,Bright Health MGG,Bright Health MGG,62.25,,,,,,,case rate,62.25,62.25,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Aetna,Aetna,561.93,,,,,,,per diem,561.93,561.93,"Per diem rate, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Aetna MGG,Aetna MGG,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,BCBS,BCBS,561.93,,,,,,,per diem,561.93,561.93,"Per diem rate, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,BCBS MGG,BCBS MGG,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Cigna,Cigna,561.93,,,,,,,per diem,561.93,561.93,"Per diem rate, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Cigna MGG,Cigna MGG,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Humana,Humana,561.93,,,,,,,per diem,561.93,561.93,"Per diem rate, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Humana MGG,Humana MGG,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Optum VA,Optum VA,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,UHC,UHC,561.93,,,,,,,per diem,561.93,561.93,"Per diem rate, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,UHC MGG,UHC MGG,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,VA,VA,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Wellcare MGG,Wellcare MGG,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Bright Health - commercial,Bright Health - commercial,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
APRACLONIDINE 0.5% EYE SOL    ,92212501,CDM,250,RC,,,,,,Inpatient,1,EA,561.93,561.93,Bright Health MGG,Bright Health MGG,561.93,,,,,,,case rate,561.93,561.93,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Aetna,Aetna,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Aetna MGG,Aetna MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,BCBS,BCBS,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,BCBS MGG,BCBS MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Cigna,Cigna,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Cigna MGG,Cigna MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Humana,Humana,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Humana MGG,Humana MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Optum VA,Optum VA,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,UHC,UHC,10.41,,,,,,,per diem,10.41,10.41,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,UHC MGG,UHC MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,VA,VA,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Wellcare MGG,Wellcare MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Bright Health - commercial,Bright Health - commercial,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 8,000U/ML LIQ  ",92212502,CDM,250,RC,,,,,,Inpatient,1,EA,10.41,10.41,Bright Health MGG,Bright Health MGG,10.41,,,,,,,case rate,10.41,10.41,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna,Aetna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna MGG,Aetna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS,BCBS,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS MGG,BCBS MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna,Cigna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna MGG,Cigna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana,Humana,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana MGG,Humana MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Optum VA,Optum VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC,UHC,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC MGG,UHC MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,VA,VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Wellcare MGG,Wellcare MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health - commercial,Bright Health - commercial,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-500 CAP,92212503,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health MGG,Bright Health MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Aetna,Aetna,133.2,,,,,,,per diem,133.2,133.2,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Aetna MGG,Aetna MGG,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,BCBS,BCBS,133.2,,,,,,,per diem,133.2,133.2,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,BCBS MGG,BCBS MGG,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Cigna,Cigna,133.2,,,,,,,per diem,133.2,133.2,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Cigna MGG,Cigna MGG,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Humana,Humana,133.2,,,,,,,per diem,133.2,133.2,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Humana MGG,Humana MGG,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Optum VA,Optum VA,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,UHC,UHC,133.2,,,,,,,per diem,133.2,133.2,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,UHC MGG,UHC MGG,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,VA,VA,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Wellcare MGG,Wellcare MGG,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Bright Health - commercial,Bright Health - commercial,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92212504,CDM,250,RC,,,,,,Inpatient,1,EA,133.2,133.2,Bright Health MGG,Bright Health MGG,133.2,,,,,,,case rate,133.2,133.2,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Aetna,Aetna,227.49,,,,,,,per diem,227.49,227.49,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Aetna MGG,Aetna MGG,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,BCBS,BCBS,227.49,,,,,,,per diem,227.49,227.49,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,BCBS MGG,BCBS MGG,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Cigna,Cigna,227.49,,,,,,,per diem,227.49,227.49,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Cigna MGG,Cigna MGG,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Humana,Humana,227.49,,,,,,,per diem,227.49,227.49,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Humana MGG,Humana MGG,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Optum VA,Optum VA,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,UHC,UHC,227.49,,,,,,,per diem,227.49,227.49,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,UHC MGG,UHC MGG,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,VA,VA,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Wellcare MGG,Wellcare MGG,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Bright Health - commercial,Bright Health - commercial,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92212505,CDM,250,RC,,,,,,Inpatient,1,EA,227.49,227.49,Bright Health MGG,Bright Health MGG,227.49,,,,,,,case rate,227.49,227.49,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Aetna,Aetna,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Aetna MGG,Aetna MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,BCBS,BCBS,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,BCBS MGG,BCBS MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Cigna,Cigna,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Cigna MGG,Cigna MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Humana,Humana,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Humana MGG,Humana MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Optum VA,Optum VA,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,UHC,UHC,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,UHC MGG,UHC MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,VA,VA,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Wellcare MGG,Wellcare MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Bright Health - commercial,Bright Health - commercial,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CLOZAPINE 100MG TAB           ,92212506,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Bright Health MGG,Bright Health MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Aetna,Aetna,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Aetna MGG,Aetna MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,BCBS,BCBS,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,BCBS MGG,BCBS MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Cigna,Cigna,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Cigna MGG,Cigna MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Humana,Humana,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Humana MGG,Humana MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Optum VA,Optum VA,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,UHC,UHC,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,UHC MGG,UHC MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,VA,VA,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Wellcare MGG,Wellcare MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Bright Health - commercial,Bright Health - commercial,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92212507,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Bright Health MGG,Bright Health MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NABUMETONE 500MG TAB          ,92212508,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Aetna,Aetna,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Aetna MGG,Aetna MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,BCBS,BCBS,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,BCBS MGG,BCBS MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Cigna,Cigna,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Cigna MGG,Cigna MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Humana,Humana,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Humana MGG,Humana MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Optum VA,Optum VA,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,UHC,UHC,89.1,,,,,,,per diem,89.1,89.1,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,UHC MGG,UHC MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,VA,VA,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Wellcare MGG,Wellcare MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Bright Health - commercial,Bright Health - commercial,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 5MCG/0.5ML IN,92212509,CDM,250,RC,,,,,,Inpatient,1,EA,89.1,89.1,Bright Health MGG,Bright Health MGG,89.1,,,,,,,case rate,89.1,89.1,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212510,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Aetna,Aetna,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Aetna MGG,Aetna MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,BCBS,BCBS,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,BCBS MGG,BCBS MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Cigna,Cigna,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Cigna MGG,Cigna MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Humana,Humana,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Humana MGG,Humana MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Optum VA,Optum VA,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,UHC,UHC,7.41,,,,,,,per diem,7.41,7.41,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,UHC MGG,UHC MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,VA,VA,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Wellcare MGG,Wellcare MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Bright Health - commercial,Bright Health - commercial,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212511,CDM,250,RC,,,,,,Inpatient,1,EA,7.41,7.41,Bright Health MGG,Bright Health MGG,7.41,,,,,,,case rate,7.41,7.41,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Aetna,Aetna,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Aetna MGG,Aetna MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,BCBS,BCBS,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,BCBS MGG,BCBS MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Cigna,Cigna,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Cigna MGG,Cigna MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Humana,Humana,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Humana MGG,Humana MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Optum VA,Optum VA,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,UHC,UHC,681.9,,,,,,,per diem,681.9,681.9,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,UHC MGG,UHC MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,VA,VA,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Wellcare MGG,Wellcare MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Bright Health - commercial,Bright Health - commercial,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212512,CDM,250,RC,,,,,,Inpatient,1,EA,681.9,681.9,Bright Health MGG,Bright Health MGG,681.9,,,,,,,case rate,681.9,681.9,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZOLPIDEM TARTRATE 5MG TAB     ,92212513,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Aetna,Aetna,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Aetna MGG,Aetna MGG,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,BCBS,BCBS,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,BCBS MGG,BCBS MGG,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Cigna,Cigna,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Cigna MGG,Cigna MGG,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Humana,Humana,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Humana MGG,Humana MGG,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Optum VA,Optum VA,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,UHC,UHC,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,UHC MGG,UHC MGG,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,VA,VA,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Wellcare MGG,Wellcare MGG,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Bright Health - commercial,Bright Health - commercial,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% TIN     ,92212514,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,Bright Health MGG,Bright Health MGG,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna,Aetna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna MGG,Aetna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS,BCBS,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS MGG,BCBS MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna,Cigna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna MGG,Cigna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana,Humana,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana MGG,Humana MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Optum VA,Optum VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC,UHC,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC MGG,UHC MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,VA,VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Wellcare MGG,Wellcare MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health - commercial,Bright Health - commercial,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212515,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health MGG,Bright Health MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Aetna,Aetna,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Aetna MGG,Aetna MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,BCBS,BCBS,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,BCBS MGG,BCBS MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Cigna,Cigna,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Cigna MGG,Cigna MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Humana,Humana,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Humana MGG,Humana MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Optum VA,Optum VA,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,UHC,UHC,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,UHC MGG,UHC MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,VA,VA,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Wellcare MGG,Wellcare MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Bright Health - commercial,Bright Health - commercial,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212516,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Bright Health MGG,Bright Health MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92212517,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212518,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212519,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92212520,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Aetna,Aetna,155.37,,,,,,,per diem,155.37,155.37,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Aetna MGG,Aetna MGG,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,BCBS,BCBS,155.37,,,,,,,per diem,155.37,155.37,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,BCBS MGG,BCBS MGG,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Cigna,Cigna,155.37,,,,,,,per diem,155.37,155.37,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Cigna MGG,Cigna MGG,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Humana,Humana,155.37,,,,,,,per diem,155.37,155.37,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Humana MGG,Humana MGG,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Optum VA,Optum VA,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,UHC,UHC,155.37,,,,,,,per diem,155.37,155.37,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,UHC MGG,UHC MGG,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,VA,VA,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Wellcare MGG,Wellcare MGG,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Bright Health - commercial,Bright Health - commercial,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 125MG/5ML PDR  ,92212521,CDM,250,RC,,,,,,Inpatient,1,EA,155.37,155.37,Bright Health MGG,Bright Health MGG,155.37,,,,,,,case rate,155.37,155.37,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212522,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM ACETATE 667MG CAP     ,92212523,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Aetna,Aetna,345.45,,,,,,,per diem,345.45,345.45,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Aetna MGG,Aetna MGG,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,BCBS,BCBS,345.45,,,,,,,per diem,345.45,345.45,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,BCBS MGG,BCBS MGG,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Cigna,Cigna,345.45,,,,,,,per diem,345.45,345.45,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Cigna MGG,Cigna MGG,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Humana,Humana,345.45,,,,,,,per diem,345.45,345.45,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Humana MGG,Humana MGG,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Optum VA,Optum VA,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,UHC,UHC,345.45,,,,,,,per diem,345.45,345.45,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,UHC MGG,UHC MGG,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,VA,VA,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Wellcare MGG,Wellcare MGG,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Bright Health - commercial,Bright Health - commercial,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212524,CDM,250,RC,,,,,,Inpatient,1,EA,345.45,345.45,Bright Health MGG,Bright Health MGG,345.45,,,,,,,case rate,345.45,345.45,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Aetna,Aetna,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Aetna MGG,Aetna MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,BCBS,BCBS,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,BCBS MGG,BCBS MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Cigna,Cigna,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Cigna MGG,Cigna MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Humana,Humana,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Humana MGG,Humana MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Optum VA,Optum VA,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,UHC,UHC,39.54,,,,,,,per diem,39.54,39.54,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,UHC MGG,UHC MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,VA,VA,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Wellcare MGG,Wellcare MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Bright Health - commercial,Bright Health - commercial,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92212525,CDM,250,RC,,,,,,Inpatient,1,EA,39.54,39.54,Bright Health MGG,Bright Health MGG,39.54,,,,,,,case rate,39.54,39.54,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Aetna,Aetna,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Aetna MGG,Aetna MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,BCBS,BCBS,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,BCBS MGG,BCBS MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Cigna,Cigna,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Cigna MGG,Cigna MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Humana,Humana,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Humana MGG,Humana MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Optum VA,Optum VA,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,UHC,UHC,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,UHC MGG,UHC MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,VA,VA,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Wellcare MGG,Wellcare MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Bright Health - commercial,Bright Health - commercial,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92212526,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Bright Health MGG,Bright Health MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Aetna,Aetna,72.6,,,,,,,per diem,72.6,72.6,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Aetna MGG,Aetna MGG,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,BCBS,BCBS,72.6,,,,,,,per diem,72.6,72.6,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,BCBS MGG,BCBS MGG,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Cigna,Cigna,72.6,,,,,,,per diem,72.6,72.6,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Cigna MGG,Cigna MGG,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Humana,Humana,72.6,,,,,,,per diem,72.6,72.6,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Humana MGG,Humana MGG,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Optum VA,Optum VA,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,UHC,UHC,72.6,,,,,,,per diem,72.6,72.6,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,UHC MGG,UHC MGG,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,VA,VA,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Wellcare MGG,Wellcare MGG,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Bright Health - commercial,Bright Health - commercial,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG/ML INJ   ,92212527,CDM,250,RC,,,,,,Inpatient,1,EA,72.6,72.6,Bright Health MGG,Bright Health MGG,72.6,,,,,,,case rate,72.6,72.6,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212528,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92212529,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92212530,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92212531,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Aetna,Aetna,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Aetna MGG,Aetna MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,BCBS,BCBS,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,BCBS MGG,BCBS MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Cigna,Cigna,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Cigna MGG,Cigna MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Humana,Humana,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Humana MGG,Humana MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Optum VA,Optum VA,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,UHC,UHC,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,UHC MGG,UHC MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,VA,VA,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Wellcare MGG,Wellcare MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Bright Health - commercial,Bright Health - commercial,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92212532,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Bright Health MGG,Bright Health MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212533,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Aetna,Aetna,84.42,,,,,,,per diem,84.42,84.42,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Aetna MGG,Aetna MGG,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,BCBS,BCBS,84.42,,,,,,,per diem,84.42,84.42,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,BCBS MGG,BCBS MGG,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Cigna,Cigna,84.42,,,,,,,per diem,84.42,84.42,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Cigna MGG,Cigna MGG,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Humana,Humana,84.42,,,,,,,per diem,84.42,84.42,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Humana MGG,Humana MGG,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Optum VA,Optum VA,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,UHC,UHC,84.42,,,,,,,per diem,84.42,84.42,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,UHC MGG,UHC MGG,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,VA,VA,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Wellcare MGG,Wellcare MGG,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Bright Health - commercial,Bright Health - commercial,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212534,CDM,250,RC,,,,,,Inpatient,1,EA,84.42,84.42,Bright Health MGG,Bright Health MGG,84.42,,,,,,,case rate,84.42,84.42,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Aetna,Aetna,274.71,,,,,,,per diem,274.71,274.71,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Aetna MGG,Aetna MGG,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,BCBS,BCBS,274.71,,,,,,,per diem,274.71,274.71,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,BCBS MGG,BCBS MGG,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Cigna,Cigna,274.71,,,,,,,per diem,274.71,274.71,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Cigna MGG,Cigna MGG,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Humana,Humana,274.71,,,,,,,per diem,274.71,274.71,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Humana MGG,Humana MGG,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Optum VA,Optum VA,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,UHC,UHC,274.71,,,,,,,per diem,274.71,274.71,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,UHC MGG,UHC MGG,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,VA,VA,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Wellcare MGG,Wellcare MGG,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Bright Health - commercial,Bright Health - commercial,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212535,CDM,250,RC,,,,,,Inpatient,1,EA,274.71,274.71,Bright Health MGG,Bright Health MGG,274.71,,,,,,,case rate,274.71,274.71,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212536,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Aetna,Aetna,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Aetna MGG,Aetna MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,BCBS,BCBS,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,BCBS MGG,BCBS MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Cigna,Cigna,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Cigna MGG,Cigna MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Humana,Humana,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Humana MGG,Humana MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Optum VA,Optum VA,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,UHC,UHC,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,UHC MGG,UHC MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,VA,VA,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Wellcare MGG,Wellcare MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Bright Health - commercial,Bright Health - commercial,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LABETALOL HCL 5MG/ML INJ      ,92212537,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Bright Health MGG,Bright Health MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML INJ      ,92212538,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Aetna,Aetna,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Aetna MGG,Aetna MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,BCBS,BCBS,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,BCBS MGG,BCBS MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Cigna,Cigna,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Cigna MGG,Cigna MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Humana,Humana,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Humana MGG,Humana MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Optum VA,Optum VA,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,UHC,UHC,14.64,,,,,,,per diem,14.64,14.64,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,UHC MGG,UHC MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,VA,VA,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Wellcare MGG,Wellcare MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Bright Health - commercial,Bright Health - commercial,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 150MG TAB  ,92212539,CDM,250,RC,,,,,,Inpatient,1,EA,14.64,14.64,Bright Health MGG,Bright Health MGG,14.64,,,,,,,case rate,14.64,14.64,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Aetna,Aetna,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Aetna MGG,Aetna MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,BCBS,BCBS,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,BCBS MGG,BCBS MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Cigna,Cigna,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Cigna MGG,Cigna MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Humana,Humana,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Humana MGG,Humana MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Optum VA,Optum VA,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,UHC,UHC,20.1,,,,,,,per diem,20.1,20.1,"Per diem rate, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,UHC MGG,UHC MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,VA,VA,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Wellcare MGG,Wellcare MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Bright Health - commercial,Bright Health - commercial,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
DIVALPROEX NA 500MG TER       ,92212540,CDM,250,RC,,,,,,Inpatient,1,EA,20.1,20.1,Bright Health MGG,Bright Health MGG,20.1,,,,,,,case rate,20.1,20.1,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92212541,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Aetna,Aetna,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Aetna MGG,Aetna MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,BCBS,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS MGG,BCBS MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Cigna,Cigna,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Cigna MGG,Cigna MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Humana,Humana,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Humana MGG,Humana MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Optum VA,Optum VA,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UHC,UHC,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UHC MGG,UHC MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA,VA,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Wellcare MGG,Wellcare MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Bright Health - commercial,Bright Health - commercial,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92212542,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Bright Health MGG,Bright Health MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna,Aetna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Aetna MGG,Aetna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS,BCBS,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,BCBS MGG,BCBS MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna,Cigna,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Cigna MGG,Cigna MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana,Humana,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Humana MGG,Humana MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Optum VA,Optum VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC,UHC,21.24,,,,,,,per diem,21.24,21.24,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,UHC MGG,UHC MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,VA,VA,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Wellcare MGG,Wellcare MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health - commercial,Bright Health - commercial,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.9MG TAB,92212543,CDM,250,RC,,,,,,Inpatient,1,EA,21.24,21.24,Bright Health MGG,Bright Health MGG,21.24,,,,,,,case rate,21.24,21.24,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92212544,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Aetna,Aetna,122.34,,,,,,,per diem,122.34,122.34,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Aetna MGG,Aetna MGG,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,BCBS,BCBS,122.34,,,,,,,per diem,122.34,122.34,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,BCBS MGG,BCBS MGG,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Cigna,Cigna,122.34,,,,,,,per diem,122.34,122.34,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Cigna MGG,Cigna MGG,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Humana,Humana,122.34,,,,,,,per diem,122.34,122.34,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Humana MGG,Humana MGG,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Optum VA,Optum VA,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,UHC,UHC,122.34,,,,,,,per diem,122.34,122.34,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,UHC MGG,UHC MGG,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,VA,VA,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Wellcare MGG,Wellcare MGG,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Bright Health - commercial,Bright Health - commercial,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM INJ             ,92212545,CDM,250,RC,,,,,,Inpatient,1,EA,122.34,122.34,Bright Health MGG,Bright Health MGG,122.34,,,,,,,case rate,122.34,122.34,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Aetna,Aetna,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Aetna MGG,Aetna MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,BCBS,BCBS,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,BCBS MGG,BCBS MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Cigna,Cigna,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Cigna MGG,Cigna MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Humana,Humana,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Humana MGG,Humana MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Optum VA,Optum VA,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,UHC,UHC,13.35,,,,,,,per diem,13.35,13.35,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,UHC MGG,UHC MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,VA,VA,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Wellcare MGG,Wellcare MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Bright Health - commercial,Bright Health - commercial,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92212546,CDM,250,RC,,,,,,Inpatient,1,EA,13.35,13.35,Bright Health MGG,Bright Health MGG,13.35,,,,,,,case rate,13.35,13.35,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Aetna,Aetna,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Aetna MGG,Aetna MGG,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,BCBS,BCBS,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,BCBS MGG,BCBS MGG,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Cigna,Cigna,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Cigna MGG,Cigna MGG,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Humana,Humana,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Humana MGG,Humana MGG,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Optum VA,Optum VA,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,UHC,UHC,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,UHC MGG,UHC MGG,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,VA,VA,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Wellcare MGG,Wellcare MGG,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Bright Health - commercial,Bright Health - commercial,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212547,CDM,250,RC,,,,,,Inpatient,1,EA,205.8,205.8,Bright Health MGG,Bright Health MGG,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Aetna,Aetna,1787.58,,,,,,,per diem,1787.58,1787.58,"Per diem rate, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Aetna MGG,Aetna MGG,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,BCBS,BCBS,1787.58,,,,,,,per diem,1787.58,1787.58,"Per diem rate, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,BCBS MGG,BCBS MGG,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Cigna,Cigna,1787.58,,,,,,,per diem,1787.58,1787.58,"Per diem rate, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Cigna MGG,Cigna MGG,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Humana,Humana,1787.58,,,,,,,per diem,1787.58,1787.58,"Per diem rate, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Humana MGG,Humana MGG,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Optum VA,Optum VA,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,UHC,UHC,1787.58,,,,,,,per diem,1787.58,1787.58,"Per diem rate, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,UHC MGG,UHC MGG,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,VA,VA,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Wellcare MGG,Wellcare MGG,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Bright Health - commercial,Bright Health - commercial,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
DACLIZUMAB 5MG/ML INJ         ,92212548,CDM,250,RC,,,,,,Inpatient,1,EA,1787.58,1787.58,Bright Health MGG,Bright Health MGG,1787.58,,,,,,,case rate,1787.58,1787.58,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Aetna,Aetna,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Aetna MGG,Aetna MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,BCBS,BCBS,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,BCBS MGG,BCBS MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Cigna,Cigna,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Cigna MGG,Cigna MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Humana,Humana,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Humana MGG,Humana MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Optum VA,Optum VA,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,UHC,UHC,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,UHC MGG,UHC MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,VA,VA,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Wellcare MGG,Wellcare MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Bright Health - commercial,Bright Health - commercial,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212549,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Bright Health MGG,Bright Health MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 300MG TAB       ,92212550,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92212551,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92212552,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Aetna,Aetna,106.95,,,,,,,per diem,106.95,106.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Aetna MGG,Aetna MGG,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,BCBS,BCBS,106.95,,,,,,,per diem,106.95,106.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,BCBS MGG,BCBS MGG,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Cigna,Cigna,106.95,,,,,,,per diem,106.95,106.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Cigna MGG,Cigna MGG,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Humana,Humana,106.95,,,,,,,per diem,106.95,106.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Humana MGG,Humana MGG,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Optum VA,Optum VA,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,UHC,UHC,106.95,,,,,,,per diem,106.95,106.95,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,UHC MGG,UHC MGG,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,VA,VA,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Wellcare MGG,Wellcare MGG,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Bright Health - commercial,Bright Health - commercial,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 1% CRE    ,92212553,CDM,250,RC,,,,,,Inpatient,1,EA,106.95,106.95,Bright Health MGG,Bright Health MGG,106.95,,,,,,,case rate,106.95,106.95,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Aetna,Aetna,63.84,,,,,,,per diem,63.84,63.84,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Aetna MGG,Aetna MGG,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,BCBS,BCBS,63.84,,,,,,,per diem,63.84,63.84,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,BCBS MGG,BCBS MGG,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Cigna,Cigna,63.84,,,,,,,per diem,63.84,63.84,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Cigna MGG,Cigna MGG,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Humana,Humana,63.84,,,,,,,per diem,63.84,63.84,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Humana MGG,Humana MGG,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Optum VA,Optum VA,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,UHC,UHC,63.84,,,,,,,per diem,63.84,63.84,"Per diem rate, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,UHC MGG,UHC MGG,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,VA,VA,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Wellcare MGG,Wellcare MGG,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Bright Health - commercial,Bright Health - commercial,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
CARTEOLOL HCL 1% EYE SOL      ,92212554,CDM,250,RC,,,,,,Inpatient,1,EA,63.84,63.84,Bright Health MGG,Bright Health MGG,63.84,,,,,,,case rate,63.84,63.84,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212555,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212556,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Aetna,Aetna,84.3,,,,,,,per diem,84.3,84.3,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Aetna MGG,Aetna MGG,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,BCBS,BCBS,84.3,,,,,,,per diem,84.3,84.3,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,BCBS MGG,BCBS MGG,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Cigna,Cigna,84.3,,,,,,,per diem,84.3,84.3,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Cigna MGG,Cigna MGG,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Humana,Humana,84.3,,,,,,,per diem,84.3,84.3,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Humana MGG,Humana MGG,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Optum VA,Optum VA,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,UHC,UHC,84.3,,,,,,,per diem,84.3,84.3,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,UHC MGG,UHC MGG,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,VA,VA,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Wellcare MGG,Wellcare MGG,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Bright Health - commercial,Bright Health - commercial,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/5ML SOL   ,92212557,CDM,250,RC,,,,,,Inpatient,1,EA,84.3,84.3,Bright Health MGG,Bright Health MGG,84.3,,,,,,,case rate,84.3,84.3,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92212558,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Aetna,Aetna,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Aetna MGG,Aetna MGG,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,BCBS,BCBS,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,BCBS MGG,BCBS MGG,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Cigna,Cigna,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Cigna MGG,Cigna MGG,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Humana,Humana,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Humana MGG,Humana MGG,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Optum VA,Optum VA,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,UHC,UHC,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,UHC MGG,UHC MGG,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,VA,VA,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Wellcare MGG,Wellcare MGG,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Bright Health - commercial,Bright Health - commercial,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES/SULFISOX SUS  ,92212559,CDM,250,RC,,,,,,Inpatient,1,EA,47.91,47.91,Bright Health MGG,Bright Health MGG,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG LIQ       ,92212560,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Aetna,Aetna,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Aetna MGG,Aetna MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,BCBS,BCBS,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,BCBS MGG,BCBS MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Cigna,Cigna,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Cigna MGG,Cigna MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Humana,Humana,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Humana MGG,Humana MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Optum VA,Optum VA,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,UHC,UHC,28.62,,,,,,,per diem,28.62,28.62,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,UHC MGG,UHC MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,VA,VA,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Wellcare MGG,Wellcare MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Bright Health - commercial,Bright Health - commercial,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 4% INJ         ,92212561,CDM,250,RC,,,,,,Inpatient,1,EA,28.62,28.62,Bright Health MGG,Bright Health MGG,28.62,,,,,,,case rate,28.62,28.62,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Aetna,Aetna,180.3,,,,,,,per diem,180.3,180.3,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Aetna MGG,Aetna MGG,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,BCBS,BCBS,180.3,,,,,,,per diem,180.3,180.3,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,BCBS MGG,BCBS MGG,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Cigna,Cigna,180.3,,,,,,,per diem,180.3,180.3,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Cigna MGG,Cigna MGG,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Humana,Humana,180.3,,,,,,,per diem,180.3,180.3,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Humana MGG,Humana MGG,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Optum VA,Optum VA,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,UHC,UHC,180.3,,,,,,,per diem,180.3,180.3,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,UHC MGG,UHC MGG,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,VA,VA,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Wellcare MGG,Wellcare MGG,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Bright Health - commercial,Bright Health - commercial,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% OIN            ,92212562,CDM,250,RC,,,,,,Inpatient,1,EA,180.3,180.3,Bright Health MGG,Bright Health MGG,180.3,,,,,,,case rate,180.3,180.3,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Aetna,Aetna,44.31,,,,,,,per diem,44.31,44.31,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Aetna MGG,Aetna MGG,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,BCBS,BCBS,44.31,,,,,,,per diem,44.31,44.31,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,BCBS MGG,BCBS MGG,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Cigna,Cigna,44.31,,,,,,,per diem,44.31,44.31,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Cigna MGG,Cigna MGG,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Humana,Humana,44.31,,,,,,,per diem,44.31,44.31,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Humana MGG,Humana MGG,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Optum VA,Optum VA,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,UHC,UHC,44.31,,,,,,,per diem,44.31,44.31,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,UHC MGG,UHC MGG,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,VA,VA,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Wellcare MGG,Wellcare MGG,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Bright Health - commercial,Bright Health - commercial,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92212563,CDM,250,RC,,,,,,Inpatient,1,EA,44.31,44.31,Bright Health MGG,Bright Health MGG,44.31,,,,,,,case rate,44.31,44.31,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna,Aetna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna MGG,Aetna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,BCBS,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS MGG,BCBS MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna,Cigna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna MGG,Cigna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana,Humana,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana MGG,Humana MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Optum VA,Optum VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC,UHC,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC MGG,UHC MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,VA,VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Wellcare MGG,Wellcare MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health - commercial,Bright Health - commercial,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212564,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health MGG,Bright Health MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 10MG TAB          ,92212565,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212566,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Aetna,Aetna,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Aetna MGG,Aetna MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,BCBS,BCBS,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,BCBS MGG,BCBS MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Cigna,Cigna,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Cigna MGG,Cigna MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Humana,Humana,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Humana MGG,Humana MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Optum VA,Optum VA,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,UHC,UHC,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,UHC MGG,UHC MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,VA,VA,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Wellcare MGG,Wellcare MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Bright Health - commercial,Bright Health - commercial,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92212567,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Bright Health MGG,Bright Health MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Aetna,Aetna,1329.25,,,,,,,per diem,1329.25,1329.25,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Aetna MGG,Aetna MGG,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,BCBS,BCBS,1329.25,,,,,,,per diem,1329.25,1329.25,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,BCBS MGG,BCBS MGG,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Cigna,Cigna,1329.25,,,,,,,per diem,1329.25,1329.25,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Cigna MGG,Cigna MGG,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Humana,Humana,1329.25,,,,,,,per diem,1329.25,1329.25,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Humana MGG,Humana MGG,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Optum VA,Optum VA,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,UHC,UHC,1329.25,,,,,,,per diem,1329.25,1329.25,"Per diem rate, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,UHC MGG,UHC MGG,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,VA,VA,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Wellcare MGG,Wellcare MGG,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Bright Health - commercial,Bright Health - commercial,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
CALCIPOTRIENE 0.005% CRE      ,92212568,CDM,250,RC,,,,,,Inpatient,1,EA,1329.25,1329.25,Bright Health MGG,Bright Health MGG,1329.25,,,,,,,case rate,1329.25,1329.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Aetna,Aetna,177.06,,,,,,,per diem,177.06,177.06,"Per diem rate, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Aetna MGG,Aetna MGG,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,BCBS,BCBS,177.06,,,,,,,per diem,177.06,177.06,"Per diem rate, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,BCBS MGG,BCBS MGG,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Cigna,Cigna,177.06,,,,,,,per diem,177.06,177.06,"Per diem rate, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Cigna MGG,Cigna MGG,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Humana,Humana,177.06,,,,,,,per diem,177.06,177.06,"Per diem rate, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Humana MGG,Humana MGG,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Optum VA,Optum VA,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,UHC,UHC,177.06,,,,,,,per diem,177.06,177.06,"Per diem rate, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,UHC MGG,UHC MGG,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,VA,VA,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Wellcare MGG,Wellcare MGG,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Bright Health - commercial,Bright Health - commercial,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
FOLIC ACID 5MG/ML INJ         ,92212569,CDM,250,RC,,,,,,Inpatient,1,EA,177.06,177.06,Bright Health MGG,Bright Health MGG,177.06,,,,,,,case rate,177.06,177.06,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Aetna,Aetna,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Aetna MGG,Aetna MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,BCBS,BCBS,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,BCBS MGG,BCBS MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Cigna,Cigna,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Cigna MGG,Cigna MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Humana,Humana,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Humana MGG,Humana MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Optum VA,Optum VA,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,UHC,UHC,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,UHC MGG,UHC MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,VA,VA,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Wellcare MGG,Wellcare MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Bright Health - commercial,Bright Health - commercial,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212570,CDM,250,RC,,,,,,Inpatient,1,EA,9.81,9.81,Bright Health MGG,Bright Health MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MOEXIPRIL HCL 7.5MG TAB       ,92212571,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Aetna,Aetna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Aetna MGG,Aetna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,BCBS,BCBS,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,BCBS MGG,BCBS MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Cigna,Cigna,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Cigna MGG,Cigna MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Humana,Humana,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Humana MGG,Humana MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Optum VA,Optum VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,UHC,UHC,8.64,,,,,,,per diem,8.64,8.64,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,UHC MGG,UHC MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,VA,VA,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Wellcare MGG,Wellcare MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Bright Health - commercial,Bright Health - commercial,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92212572,CDM,250,RC,,,,,,Inpatient,1,EA,8.64,8.64,Bright Health MGG,Bright Health MGG,8.64,,,,,,,case rate,8.64,8.64,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92212573,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/5ML LIQ   ,92212574,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.45% IVS           ,92212575,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Aetna,Aetna,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Aetna MGG,Aetna MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,BCBS,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS MGG,BCBS MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Cigna,Cigna,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Cigna MGG,Cigna MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Humana,Humana,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Humana MGG,Humana MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Optum VA,Optum VA,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UHC,UHC,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UHC MGG,UHC MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,VA,VA,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Wellcare MGG,Wellcare MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Bright Health - commercial,Bright Health - commercial,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92212576,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,Bright Health MGG,Bright Health MGG,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92212577,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Aetna,Aetna,24.06,,,,,,,per diem,24.06,24.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Aetna MGG,Aetna MGG,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,BCBS,BCBS,24.06,,,,,,,per diem,24.06,24.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,BCBS MGG,BCBS MGG,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Cigna,Cigna,24.06,,,,,,,per diem,24.06,24.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Cigna MGG,Cigna MGG,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Humana,Humana,24.06,,,,,,,per diem,24.06,24.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Humana MGG,Humana MGG,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Optum VA,Optum VA,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,UHC,UHC,24.06,,,,,,,per diem,24.06,24.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,UHC MGG,UHC MGG,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,VA,VA,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Wellcare MGG,Wellcare MGG,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Bright Health - commercial,Bright Health - commercial,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 500MG TAB   ,92212578,CDM,250,RC,,,,,,Inpatient,1,EA,24.06,24.06,Bright Health MGG,Bright Health MGG,24.06,,,,,,,case rate,24.06,24.06,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Aetna,Aetna,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Aetna MGG,Aetna MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,BCBS,BCBS,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,BCBS MGG,BCBS MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Cigna,Cigna,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Cigna MGG,Cigna MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Humana,Humana,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Humana MGG,Humana MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Optum VA,Optum VA,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,UHC,UHC,15.84,,,,,,,per diem,15.84,15.84,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,UHC MGG,UHC MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,VA,VA,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Wellcare MGG,Wellcare MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Bright Health - commercial,Bright Health - commercial,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212579,CDM,250,RC,,,,,,Inpatient,1,EA,15.84,15.84,Bright Health MGG,Bright Health MGG,15.84,,,,,,,case rate,15.84,15.84,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92212580,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212581,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 100MG CAP     ,92212582,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Aetna,Aetna,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Aetna MGG,Aetna MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,BCBS,BCBS,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,BCBS MGG,BCBS MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Cigna,Cigna,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Cigna MGG,Cigna MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Humana,Humana,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Humana MGG,Humana MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Optum VA,Optum VA,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,UHC,UHC,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,UHC MGG,UHC MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,VA,VA,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Wellcare MGG,Wellcare MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Bright Health - commercial,Bright Health - commercial,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG C24        ,92212583,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Bright Health MGG,Bright Health MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Aetna,Aetna,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Aetna MGG,Aetna MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,BCBS,BCBS,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,BCBS MGG,BCBS MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Cigna,Cigna,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Cigna MGG,Cigna MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Humana,Humana,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Humana MGG,Humana MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Optum VA,Optum VA,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,UHC,UHC,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,UHC MGG,UHC MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,VA,VA,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Wellcare MGG,Wellcare MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Bright Health - commercial,Bright Health - commercial,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212584,CDM,250,RC,,,,,,Inpatient,1,EA,9.99,9.99,Bright Health MGG,Bright Health MGG,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Aetna,Aetna,41.16,,,,,,,per diem,41.16,41.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Aetna MGG,Aetna MGG,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,BCBS,BCBS,41.16,,,,,,,per diem,41.16,41.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,BCBS MGG,BCBS MGG,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Cigna,Cigna,41.16,,,,,,,per diem,41.16,41.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Cigna MGG,Cigna MGG,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Humana,Humana,41.16,,,,,,,per diem,41.16,41.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Humana MGG,Humana MGG,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Optum VA,Optum VA,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,UHC,UHC,41.16,,,,,,,per diem,41.16,41.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,UHC MGG,UHC MGG,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,VA,VA,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Wellcare MGG,Wellcare MGG,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Bright Health - commercial,Bright Health - commercial,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92212585,CDM,250,RC,,,,,,Inpatient,1,EA,41.16,41.16,Bright Health MGG,Bright Health MGG,41.16,,,,,,,case rate,41.16,41.16,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Aetna,Aetna,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Aetna MGG,Aetna MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,BCBS,BCBS,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,BCBS MGG,BCBS MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Cigna,Cigna,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Cigna MGG,Cigna MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Humana,Humana,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Humana MGG,Humana MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Optum VA,Optum VA,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,UHC,UHC,12.72,,,,,,,per diem,12.72,12.72,"Per diem rate, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,UHC MGG,UHC MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,VA,VA,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Wellcare MGG,Wellcare MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Bright Health - commercial,Bright Health - commercial,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
METHENAMINE HIPP 1GM TAB      ,92212586,CDM,250,RC,,,,,,Inpatient,1,EA,12.72,12.72,Bright Health MGG,Bright Health MGG,12.72,,,,,,,case rate,12.72,12.72,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Aetna,Aetna,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Aetna MGG,Aetna MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,BCBS,BCBS,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,BCBS MGG,BCBS MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Cigna,Cigna,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Cigna MGG,Cigna MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Humana,Humana,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Humana MGG,Humana MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Optum VA,Optum VA,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,UHC,UHC,217.26,,,,,,,per diem,217.26,217.26,"Per diem rate, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,UHC MGG,UHC MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,VA,VA,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Wellcare MGG,Wellcare MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Bright Health - commercial,Bright Health - commercial,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
CARBACHOL 3% SOL              ,92212587,CDM,250,RC,,,,,,Inpatient,1,EA,217.26,217.26,Bright Health MGG,Bright Health MGG,217.26,,,,,,,case rate,217.26,217.26,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 2.5MG TAB       ,92212588,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92212589,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Aetna,Aetna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Aetna MGG,Aetna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,BCBS,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS MGG,BCBS MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Cigna,Cigna,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Cigna MGG,Cigna MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Humana,Humana,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Humana MGG,Humana MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Optum VA,Optum VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UHC,UHC,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UHC MGG,UHC MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,VA,VA,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Wellcare MGG,Wellcare MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Bright Health - commercial,Bright Health - commercial,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92212590,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,Bright Health MGG,Bright Health MGG,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna,Aetna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna MGG,Aetna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS,BCBS,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS MGG,BCBS MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna,Cigna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna MGG,Cigna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana,Humana,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana MGG,Humana MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Optum VA,Optum VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC,UHC,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC MGG,UHC MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,VA,VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Wellcare MGG,Wellcare MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health - commercial,Bright Health - commercial,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212591,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health MGG,Bright Health MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Aetna,Aetna,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Aetna MGG,Aetna MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,BCBS,BCBS,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,BCBS MGG,BCBS MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Cigna,Cigna,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Cigna MGG,Cigna MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Humana,Humana,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Humana MGG,Humana MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Optum VA,Optum VA,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,UHC,UHC,32.67,,,,,,,per diem,32.67,32.67,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,UHC MGG,UHC MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,VA,VA,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Wellcare MGG,Wellcare MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Bright Health - commercial,Bright Health - commercial,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92212592,CDM,250,RC,,,,,,Inpatient,1,EA,32.67,32.67,Bright Health MGG,Bright Health MGG,32.67,,,,,,,case rate,32.67,32.67,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Aetna,Aetna,747.33,,,,,,,per diem,747.33,747.33,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Aetna MGG,Aetna MGG,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,BCBS,BCBS,747.33,,,,,,,per diem,747.33,747.33,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,BCBS MGG,BCBS MGG,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Cigna,Cigna,747.33,,,,,,,per diem,747.33,747.33,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Cigna MGG,Cigna MGG,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Humana,Humana,747.33,,,,,,,per diem,747.33,747.33,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Humana MGG,Humana MGG,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Optum VA,Optum VA,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,UHC,UHC,747.33,,,,,,,per diem,747.33,747.33,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,UHC MGG,UHC MGG,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,VA,VA,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Wellcare MGG,Wellcare MGG,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Bright Health - commercial,Bright Health - commercial,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG AER,92212593,CDM,250,RC,,,,,,Inpatient,1,EA,747.33,747.33,Bright Health MGG,Bright Health MGG,747.33,,,,,,,case rate,747.33,747.33,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212594,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Aetna,Aetna,15.69,,,,,,,per diem,15.69,15.69,"Per diem rate, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Aetna MGG,Aetna MGG,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,BCBS,BCBS,15.69,,,,,,,per diem,15.69,15.69,"Per diem rate, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,BCBS MGG,BCBS MGG,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Cigna,Cigna,15.69,,,,,,,per diem,15.69,15.69,"Per diem rate, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Cigna MGG,Cigna MGG,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Humana,Humana,15.69,,,,,,,per diem,15.69,15.69,"Per diem rate, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Humana MGG,Humana MGG,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Optum VA,Optum VA,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,UHC,UHC,15.69,,,,,,,per diem,15.69,15.69,"Per diem rate, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,UHC MGG,UHC MGG,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,VA,VA,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Wellcare MGG,Wellcare MGG,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Bright Health - commercial,Bright Health - commercial,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
SAQUINAVIR MESYLATE 200MG CAP ,92212595,CDM,250,RC,,,,,,Inpatient,1,EA,15.69,15.69,Bright Health MGG,Bright Health MGG,15.69,,,,,,,case rate,15.69,15.69,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92212596,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212597,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Aetna,Aetna,3382.27,,,,,,,per diem,3382.27,3382.27,"Per diem rate, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Aetna MGG,Aetna MGG,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,BCBS,BCBS,3382.27,,,,,,,per diem,3382.27,3382.27,"Per diem rate, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,BCBS MGG,BCBS MGG,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Cigna,Cigna,3382.27,,,,,,,per diem,3382.27,3382.27,"Per diem rate, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Cigna MGG,Cigna MGG,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Humana,Humana,3382.27,,,,,,,per diem,3382.27,3382.27,"Per diem rate, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Humana MGG,Humana MGG,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Optum VA,Optum VA,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,UHC,UHC,3382.27,,,,,,,per diem,3382.27,3382.27,"Per diem rate, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,UHC MGG,UHC MGG,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,VA,VA,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Wellcare MGG,Wellcare MGG,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Bright Health - commercial,Bright Health - commercial,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
RITUXAMAB 10MG/ML INJ         ,92212598,CDM,250,RC,,,,,,Inpatient,1,EA,3382.27,3382.27,Bright Health MGG,Bright Health MGG,3382.27,,,,,,,case rate,3382.27,3382.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Aetna,Aetna,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Aetna MGG,Aetna MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,BCBS,BCBS,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,BCBS MGG,BCBS MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Cigna,Cigna,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Cigna MGG,Cigna MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Humana,Humana,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Humana MGG,Humana MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Optum VA,Optum VA,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,UHC,UHC,65.73,,,,,,,per diem,65.73,65.73,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,UHC MGG,UHC MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,VA,VA,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Wellcare MGG,Wellcare MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Bright Health - commercial,Bright Health - commercial,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG/50ML D5W IN,92212599,CDM,250,RC,,,,,,Inpatient,1,EA,65.73,65.73,Bright Health MGG,Bright Health MGG,65.73,,,,,,,case rate,65.73,65.73,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Aetna,Aetna,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Aetna MGG,Aetna MGG,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,BCBS,BCBS,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,BCBS MGG,BCBS MGG,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Cigna,Cigna,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Cigna MGG,Cigna MGG,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Humana,Humana,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Humana MGG,Humana MGG,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Optum VA,Optum VA,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,UHC,UHC,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,UHC MGG,UHC MGG,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,VA,VA,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Wellcare MGG,Wellcare MGG,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Bright Health - commercial,Bright Health - commercial,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212600,CDM,250,RC,,,,,,Inpatient,1,EA,146.19,146.19,Bright Health MGG,Bright Health MGG,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Aetna,Aetna,827.52,,,,,,,per diem,827.52,827.52,"Per diem rate, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Aetna MGG,Aetna MGG,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,BCBS,BCBS,827.52,,,,,,,per diem,827.52,827.52,"Per diem rate, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,BCBS MGG,BCBS MGG,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Cigna,Cigna,827.52,,,,,,,per diem,827.52,827.52,"Per diem rate, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Cigna MGG,Cigna MGG,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Humana,Humana,827.52,,,,,,,per diem,827.52,827.52,"Per diem rate, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Humana MGG,Humana MGG,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Optum VA,Optum VA,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,UHC,UHC,827.52,,,,,,,per diem,827.52,827.52,"Per diem rate, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,UHC MGG,UHC MGG,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,VA,VA,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Wellcare MGG,Wellcare MGG,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Bright Health - commercial,Bright Health - commercial,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
IRINOTECAN HCL 20MG/ML INJ    ,92212601,CDM,250,RC,,,,,,Inpatient,1,EA,827.52,827.52,Bright Health MGG,Bright Health MGG,827.52,,,,,,,case rate,827.52,827.52,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600MG CTB        ,92212602,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Aetna,Aetna,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Aetna MGG,Aetna MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,BCBS,BCBS,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,BCBS MGG,BCBS MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Cigna,Cigna,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Cigna MGG,Cigna MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Humana,Humana,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Humana MGG,Humana MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Optum VA,Optum VA,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,UHC,UHC,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,UHC MGG,UHC MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,VA,VA,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Wellcare MGG,Wellcare MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Bright Health - commercial,Bright Health - commercial,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92212603,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Bright Health MGG,Bright Health MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Aetna,Aetna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Aetna MGG,Aetna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,BCBS,BCBS,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,BCBS MGG,BCBS MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Cigna,Cigna,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Cigna MGG,Cigna MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Humana,Humana,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Humana MGG,Humana MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Optum VA,Optum VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,UHC,UHC,15.15,,,,,,,per diem,15.15,15.15,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,UHC MGG,UHC MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,VA,VA,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Wellcare MGG,Wellcare MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Bright Health - commercial,Bright Health - commercial,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 875-125MG TA,92212604,CDM,250,RC,,,,,,Inpatient,1,EA,15.15,15.15,Bright Health MGG,Bright Health MGG,15.15,,,,,,,case rate,15.15,15.15,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna,Aetna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna MGG,Aetna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS,BCBS,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS MGG,BCBS MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna,Cigna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna MGG,Cigna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana,Humana,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana MGG,Humana MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Optum VA,Optum VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC,UHC,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC MGG,UHC MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,VA,VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Wellcare MGG,Wellcare MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health - commercial,Bright Health - commercial,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG/5ML ELI,92212605,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health MGG,Bright Health MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHENAMINE MAND/NAPH BASIC TA,92212606,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212607,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Aetna,Aetna,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Aetna MGG,Aetna MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,BCBS,BCBS,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,BCBS MGG,BCBS MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Cigna,Cigna,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Cigna MGG,Cigna MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Humana,Humana,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Humana MGG,Humana MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Optum VA,Optum VA,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,UHC,UHC,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,UHC MGG,UHC MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,VA,VA,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Wellcare MGG,Wellcare MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Bright Health - commercial,Bright Health - commercial,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG TAB          ,92212608,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Bright Health MGG,Bright Health MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Aetna,Aetna,38.7,,,,,,,per diem,38.7,38.7,"Per diem rate, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Aetna MGG,Aetna MGG,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,BCBS,BCBS,38.7,,,,,,,per diem,38.7,38.7,"Per diem rate, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,BCBS MGG,BCBS MGG,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Cigna,Cigna,38.7,,,,,,,per diem,38.7,38.7,"Per diem rate, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Cigna MGG,Cigna MGG,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Humana,Humana,38.7,,,,,,,per diem,38.7,38.7,"Per diem rate, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Humana MGG,Humana MGG,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Optum VA,Optum VA,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,UHC,UHC,38.7,,,,,,,per diem,38.7,38.7,"Per diem rate, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,UHC MGG,UHC MGG,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,VA,VA,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Wellcare MGG,Wellcare MGG,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Bright Health - commercial,Bright Health - commercial,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CROMOLYN NA 5.2MG SPR         ,92212609,CDM,250,RC,,,,,,Inpatient,1,EA,38.7,38.7,Bright Health MGG,Bright Health MGG,38.7,,,,,,,case rate,38.7,38.7,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Aetna,Aetna,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Aetna MGG,Aetna MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,BCBS,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS MGG,BCBS MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Cigna,Cigna,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Cigna MGG,Cigna MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Humana,Humana,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Humana MGG,Humana MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Optum VA,Optum VA,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UHC,UHC,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UHC MGG,UHC MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,VA,VA,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Wellcare MGG,Wellcare MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Bright Health - commercial,Bright Health - commercial,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5GM PDR    ,92212610,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,Bright Health MGG,Bright Health MGG,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92212611,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Aetna,Aetna,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Aetna MGG,Aetna MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,BCBS,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS MGG,BCBS MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Cigna,Cigna,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Cigna MGG,Cigna MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Humana,Humana,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Humana MGG,Humana MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Optum VA,Optum VA,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,UHC,UHC,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,UHC MGG,UHC MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,VA,VA,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Wellcare MGG,Wellcare MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Bright Health - commercial,Bright Health - commercial,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212612,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Bright Health MGG,Bright Health MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Aetna,Aetna,45.27,,,,,,,per diem,45.27,45.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Aetna MGG,Aetna MGG,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,BCBS,BCBS,45.27,,,,,,,per diem,45.27,45.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,BCBS MGG,BCBS MGG,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Cigna,Cigna,45.27,,,,,,,per diem,45.27,45.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Cigna MGG,Cigna MGG,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Humana,Humana,45.27,,,,,,,per diem,45.27,45.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Humana MGG,Humana MGG,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Optum VA,Optum VA,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,UHC,UHC,45.27,,,,,,,per diem,45.27,45.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,UHC MGG,UHC MGG,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,VA,VA,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Wellcare MGG,Wellcare MGG,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Bright Health - commercial,Bright Health - commercial,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.075MG/DAY TDM     ,92212613,CDM,250,RC,,,,,,Inpatient,1,EA,45.27,45.27,Bright Health MGG,Bright Health MGG,45.27,,,,,,,case rate,45.27,45.27,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Aetna,Aetna,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Aetna MGG,Aetna MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,BCBS,BCBS,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,BCBS MGG,BCBS MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Cigna,Cigna,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Cigna MGG,Cigna MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Humana,Humana,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Humana MGG,Humana MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Optum VA,Optum VA,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,UHC,UHC,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,UHC MGG,UHC MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,VA,VA,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Wellcare MGG,Wellcare MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Bright Health - commercial,Bright Health - commercial,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212614,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Bright Health MGG,Bright Health MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Aetna,Aetna,217.83,,,,,,,per diem,217.83,217.83,"Per diem rate, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Aetna MGG,Aetna MGG,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,BCBS,BCBS,217.83,,,,,,,per diem,217.83,217.83,"Per diem rate, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,BCBS MGG,BCBS MGG,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Cigna,Cigna,217.83,,,,,,,per diem,217.83,217.83,"Per diem rate, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Cigna MGG,Cigna MGG,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Humana,Humana,217.83,,,,,,,per diem,217.83,217.83,"Per diem rate, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Humana MGG,Humana MGG,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Optum VA,Optum VA,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,UHC,UHC,217.83,,,,,,,per diem,217.83,217.83,"Per diem rate, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,UHC MGG,UHC MGG,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,VA,VA,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Wellcare MGG,Wellcare MGG,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Bright Health - commercial,Bright Health - commercial,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
FOSFOMYCIN TROMETHAINE 3GM PDS,92212615,CDM,250,RC,,,,,,Inpatient,1,EA,217.83,217.83,Bright Health MGG,Bright Health MGG,217.83,,,,,,,case rate,217.83,217.83,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92212616,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212617,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Aetna,Aetna,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Aetna MGG,Aetna MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS,BCBS,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS MGG,BCBS MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Cigna,Cigna,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Cigna MGG,Cigna MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Humana,Humana,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Humana MGG,Humana MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Optum VA,Optum VA,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,UHC,UHC,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,UHC MGG,UHC MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,VA,VA,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Wellcare MGG,Wellcare MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Bright Health - commercial,Bright Health - commercial,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92212618,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Bright Health MGG,Bright Health MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Aetna,Aetna,182.82,,,,,,,per diem,182.82,182.82,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Aetna MGG,Aetna MGG,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,BCBS,BCBS,182.82,,,,,,,per diem,182.82,182.82,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,BCBS MGG,BCBS MGG,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Cigna,Cigna,182.82,,,,,,,per diem,182.82,182.82,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Cigna MGG,Cigna MGG,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Humana,Humana,182.82,,,,,,,per diem,182.82,182.82,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Humana MGG,Humana MGG,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Optum VA,Optum VA,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,UHC,UHC,182.82,,,,,,,per diem,182.82,182.82,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,UHC MGG,UHC MGG,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,VA,VA,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Wellcare MGG,Wellcare MGG,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Bright Health - commercial,Bright Health - commercial,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212619,CDM,250,RC,,,,,,Inpatient,1,EA,182.82,182.82,Bright Health MGG,Bright Health MGG,182.82,,,,,,,case rate,182.82,182.82,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Aetna,Aetna,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Aetna MGG,Aetna MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,BCBS,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS MGG,BCBS MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Cigna,Cigna,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Cigna MGG,Cigna MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Humana,Humana,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Humana MGG,Humana MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Optum VA,Optum VA,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UHC,UHC,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UHC MGG,UHC MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,VA,VA,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Wellcare MGG,Wellcare MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Bright Health - commercial,Bright Health - commercial,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 0.25MG TAB  ,92212620,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Bright Health MGG,Bright Health MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Aetna,Aetna,54.69,,,,,,,per diem,54.69,54.69,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Aetna MGG,Aetna MGG,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,BCBS,BCBS,54.69,,,,,,,per diem,54.69,54.69,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,BCBS MGG,BCBS MGG,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Cigna,Cigna,54.69,,,,,,,per diem,54.69,54.69,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Cigna MGG,Cigna MGG,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Humana,Humana,54.69,,,,,,,per diem,54.69,54.69,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Humana MGG,Humana MGG,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Optum VA,Optum VA,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,UHC,UHC,54.69,,,,,,,per diem,54.69,54.69,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,UHC MGG,UHC MGG,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,VA,VA,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Wellcare MGG,Wellcare MGG,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Bright Health - commercial,Bright Health - commercial,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.1MG/DAY TDM       ,92212621,CDM,250,RC,,,,,,Inpatient,1,EA,54.69,54.69,Bright Health MGG,Bright Health MGG,54.69,,,,,,,case rate,54.69,54.69,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212622,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna,Aetna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Aetna MGG,Aetna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS,BCBS,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,BCBS MGG,BCBS MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna,Cigna,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Cigna MGG,Cigna MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana,Humana,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Humana MGG,Humana MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Optum VA,Optum VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC,UHC,5.1,,,,,,,per diem,5.1,5.1,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,UHC MGG,UHC MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,VA,VA,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Wellcare MGG,Wellcare MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health - commercial,Bright Health - commercial,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 50MG/ML INJ    ,92212623,CDM,250,RC,,,,,,Inpatient,1,EA,5.1,5.1,Bright Health MGG,Bright Health MGG,5.1,,,,,,,case rate,5.1,5.1,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Aetna,Aetna,131.46,,,,,,,per diem,131.46,131.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Aetna MGG,Aetna MGG,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,BCBS,BCBS,131.46,,,,,,,per diem,131.46,131.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,BCBS MGG,BCBS MGG,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Cigna,Cigna,131.46,,,,,,,per diem,131.46,131.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Cigna MGG,Cigna MGG,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Humana,Humana,131.46,,,,,,,per diem,131.46,131.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Humana MGG,Humana MGG,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Optum VA,Optum VA,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,UHC,UHC,131.46,,,,,,,per diem,131.46,131.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,UHC MGG,UHC MGG,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,VA,VA,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Wellcare MGG,Wellcare MGG,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Bright Health - commercial,Bright Health - commercial,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG/100ML D5W I,92212624,CDM,250,RC,,,,,,Inpatient,1,EA,131.46,131.46,Bright Health MGG,Bright Health MGG,131.46,,,,,,,case rate,131.46,131.46,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Aetna,Aetna,6.63,,,,,,,per diem,6.63,6.63,"Per diem rate, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Aetna MGG,Aetna MGG,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,BCBS,BCBS,6.63,,,,,,,per diem,6.63,6.63,"Per diem rate, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,BCBS MGG,BCBS MGG,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Cigna,Cigna,6.63,,,,,,,per diem,6.63,6.63,"Per diem rate, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Cigna MGG,Cigna MGG,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Humana,Humana,6.63,,,,,,,per diem,6.63,6.63,"Per diem rate, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Humana MGG,Humana MGG,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Optum VA,Optum VA,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,UHC,UHC,6.63,,,,,,,per diem,6.63,6.63,"Per diem rate, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,UHC MGG,UHC MGG,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,VA,VA,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Wellcare MGG,Wellcare MGG,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Bright Health - commercial,Bright Health - commercial,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
ORPHENADRINE CITRATE 100MG TER,92212625,CDM,250,RC,,,,,,Inpatient,1,EA,6.63,6.63,Bright Health MGG,Bright Health MGG,6.63,,,,,,,case rate,6.63,6.63,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 100/5-100/5 LIQ ,92212626,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Aetna,Aetna,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Aetna MGG,Aetna MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,BCBS,BCBS,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,BCBS MGG,BCBS MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Cigna,Cigna,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Cigna MGG,Cigna MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Humana,Humana,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Humana MGG,Humana MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Optum VA,Optum VA,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,UHC,UHC,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,UHC MGG,UHC MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,VA,VA,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Wellcare MGG,Wellcare MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Bright Health - commercial,Bright Health - commercial,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
HALOPERIDOL LACTATE 5MG/ML    ,92212627,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Bright Health MGG,Bright Health MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Aetna,Aetna,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Aetna MGG,Aetna MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,BCBS,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS MGG,BCBS MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Cigna,Cigna,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Cigna MGG,Cigna MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Humana,Humana,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Humana MGG,Humana MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Optum VA,Optum VA,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,UHC,UHC,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,UHC MGG,UHC MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,VA,VA,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Wellcare MGG,Wellcare MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Bright Health - commercial,Bright Health - commercial,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMIQUIMOD 5% CRE              ,92212628,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,Bright Health MGG,Bright Health MGG,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212629,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Aetna,Aetna,162.03,,,,,,,per diem,162.03,162.03,"Per diem rate, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Aetna MGG,Aetna MGG,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,BCBS,BCBS,162.03,,,,,,,per diem,162.03,162.03,"Per diem rate, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,BCBS MGG,BCBS MGG,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Cigna,Cigna,162.03,,,,,,,per diem,162.03,162.03,"Per diem rate, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Cigna MGG,Cigna MGG,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Humana,Humana,162.03,,,,,,,per diem,162.03,162.03,"Per diem rate, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Humana MGG,Humana MGG,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Optum VA,Optum VA,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,UHC,UHC,162.03,,,,,,,per diem,162.03,162.03,"Per diem rate, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,UHC MGG,UHC MGG,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,VA,VA,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Wellcare MGG,Wellcare MGG,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Bright Health - commercial,Bright Health - commercial,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
RITONAVIR 80MG/ML SOL         ,92212630,CDM,250,RC,,,,,,Inpatient,1,EA,162.03,162.03,Bright Health MGG,Bright Health MGG,162.03,,,,,,,case rate,162.03,162.03,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Aetna,Aetna,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Aetna MGG,Aetna MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,BCBS,BCBS,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,BCBS MGG,BCBS MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Cigna,Cigna,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Cigna MGG,Cigna MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Humana,Humana,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Humana MGG,Humana MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Optum VA,Optum VA,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,UHC,UHC,540,,,,,,,per diem,540,540,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,UHC MGG,UHC MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,VA,VA,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Wellcare MGG,Wellcare MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Bright Health - commercial,Bright Health - commercial,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% SOL   ,92212631,CDM,250,RC,,,,,,Inpatient,1,EA,540,540,Bright Health MGG,Bright Health MGG,540,,,,,,,case rate,540,540,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Aetna,Aetna,1829.73,,,,,,,per diem,1829.73,1829.73,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Aetna MGG,Aetna MGG,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,BCBS,BCBS,1829.73,,,,,,,per diem,1829.73,1829.73,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,BCBS MGG,BCBS MGG,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Cigna,Cigna,1829.73,,,,,,,per diem,1829.73,1829.73,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Cigna MGG,Cigna MGG,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Humana,Humana,1829.73,,,,,,,per diem,1829.73,1829.73,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Humana MGG,Humana MGG,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Optum VA,Optum VA,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,UHC,UHC,1829.73,,,,,,,per diem,1829.73,1829.73,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,UHC MGG,UHC MGG,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,VA,VA,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Wellcare MGG,Wellcare MGG,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Bright Health - commercial,Bright Health - commercial,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212632,CDM,250,RC,,,,,,Inpatient,1,EA,1829.73,1829.73,Bright Health MGG,Bright Health MGG,1829.73,,,,,,,case rate,1829.73,1829.73,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212633,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Aetna,Aetna,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Aetna MGG,Aetna MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,BCBS,BCBS,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,BCBS MGG,BCBS MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Cigna,Cigna,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Cigna MGG,Cigna MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Humana,Humana,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Humana MGG,Humana MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Optum VA,Optum VA,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,UHC,UHC,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,UHC MGG,UHC MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,VA,VA,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Wellcare MGG,Wellcare MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Bright Health - commercial,Bright Health - commercial,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212634,CDM,250,RC,,,,,,Inpatient,1,EA,13.17,13.17,Bright Health MGG,Bright Health MGG,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Aetna,Aetna,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Aetna MGG,Aetna MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,BCBS,BCBS,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,BCBS MGG,BCBS MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Cigna,Cigna,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Cigna MGG,Cigna MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Humana,Humana,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Humana MGG,Humana MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Optum VA,Optum VA,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,UHC,UHC,22.86,,,,,,,per diem,22.86,22.86,"Per diem rate, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,UHC MGG,UHC MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,VA,VA,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Wellcare MGG,Wellcare MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Bright Health - commercial,Bright Health - commercial,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
SODIUM CL 5% IVS              ,92212635,CDM,258,RC,,,,,,Inpatient,1,EA,22.86,22.86,Bright Health MGG,Bright Health MGG,22.86,,,,,,,case rate,22.86,22.86,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ TER        ,92212636,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212637,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Aetna,Aetna,302.25,,,,,,,per diem,302.25,302.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Aetna MGG,Aetna MGG,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,BCBS,BCBS,302.25,,,,,,,per diem,302.25,302.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,BCBS MGG,BCBS MGG,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Cigna,Cigna,302.25,,,,,,,per diem,302.25,302.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Cigna MGG,Cigna MGG,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Humana,Humana,302.25,,,,,,,per diem,302.25,302.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Humana MGG,Humana MGG,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Optum VA,Optum VA,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,UHC,UHC,302.25,,,,,,,per diem,302.25,302.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,UHC MGG,UHC MGG,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,VA,VA,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Wellcare MGG,Wellcare MGG,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Bright Health - commercial,Bright Health - commercial,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92212638,CDM,250,RC,,,,,,Inpatient,1,EA,302.25,302.25,Bright Health MGG,Bright Health MGG,302.25,,,,,,,case rate,302.25,302.25,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Aetna,Aetna,203.04,,,,,,,per diem,203.04,203.04,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Aetna MGG,Aetna MGG,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,BCBS,BCBS,203.04,,,,,,,per diem,203.04,203.04,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,BCBS MGG,BCBS MGG,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Cigna,Cigna,203.04,,,,,,,per diem,203.04,203.04,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Cigna MGG,Cigna MGG,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Humana,Humana,203.04,,,,,,,per diem,203.04,203.04,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Humana MGG,Humana MGG,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Optum VA,Optum VA,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,UHC,UHC,203.04,,,,,,,per diem,203.04,203.04,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,UHC MGG,UHC MGG,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,VA,VA,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Wellcare MGG,Wellcare MGG,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Bright Health - commercial,Bright Health - commercial,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% OIN    ,92212639,CDM,250,RC,,,,,,Inpatient,1,EA,203.04,203.04,Bright Health MGG,Bright Health MGG,203.04,,,,,,,case rate,203.04,203.04,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Aetna,Aetna,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Aetna MGG,Aetna MGG,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,BCBS,BCBS,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,BCBS MGG,BCBS MGG,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Cigna,Cigna,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Cigna MGG,Cigna MGG,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Humana,Humana,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Humana MGG,Humana MGG,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Optum VA,Optum VA,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,UHC,UHC,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,UHC MGG,UHC MGG,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,VA,VA,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Wellcare MGG,Wellcare MGG,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Bright Health - commercial,Bright Health - commercial,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92212640,CDM,250,RC,,,,,,Inpatient,1,EA,25.74,25.74,Bright Health MGG,Bright Health MGG,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Aetna,Aetna,134.22,,,,,,,per diem,134.22,134.22,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Aetna MGG,Aetna MGG,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,BCBS,BCBS,134.22,,,,,,,per diem,134.22,134.22,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,BCBS MGG,BCBS MGG,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Cigna,Cigna,134.22,,,,,,,per diem,134.22,134.22,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Cigna MGG,Cigna MGG,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Humana,Humana,134.22,,,,,,,per diem,134.22,134.22,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Humana MGG,Humana MGG,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Optum VA,Optum VA,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,UHC,UHC,134.22,,,,,,,per diem,134.22,134.22,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,UHC MGG,UHC MGG,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,VA,VA,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Wellcare MGG,Wellcare MGG,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Bright Health - commercial,Bright Health - commercial,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 25MG/ML INJ      ,92212641,CDM,250,RC,,,,,,Inpatient,1,EA,134.22,134.22,Bright Health MGG,Bright Health MGG,134.22,,,,,,,case rate,134.22,134.22,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92212642,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212643,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92212644,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Aetna,Aetna,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Aetna MGG,Aetna MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,BCBS,BCBS,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,BCBS MGG,BCBS MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Cigna,Cigna,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Cigna MGG,Cigna MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Humana,Humana,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Humana MGG,Humana MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Optum VA,Optum VA,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,UHC,UHC,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,UHC MGG,UHC MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,VA,VA,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Wellcare MGG,Wellcare MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Bright Health - commercial,Bright Health - commercial,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212645,CDM,250,RC,,,,,,Inpatient,1,EA,33.24,33.24,Bright Health MGG,Bright Health MGG,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Aetna,Aetna,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Aetna MGG,Aetna MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,BCBS,BCBS,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,BCBS MGG,BCBS MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Cigna,Cigna,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Cigna MGG,Cigna MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Humana,Humana,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Humana MGG,Humana MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Optum VA,Optum VA,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,UHC,UHC,158.82,,,,,,,per diem,158.82,158.82,"Per diem rate, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,UHC MGG,UHC MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,VA,VA,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Wellcare MGG,Wellcare MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Bright Health - commercial,Bright Health - commercial,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
AMINO ACIDS 6% IVS            ,92212646,CDM,258,RC,,,,,,Inpatient,1,EA,158.82,158.82,Bright Health MGG,Bright Health MGG,158.82,,,,,,,case rate,158.82,158.82,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212647,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212648,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Aetna,Aetna,65.25,,,,,,,per diem,65.25,65.25,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Aetna MGG,Aetna MGG,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,BCBS,BCBS,65.25,,,,,,,per diem,65.25,65.25,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,BCBS MGG,BCBS MGG,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Cigna,Cigna,65.25,,,,,,,per diem,65.25,65.25,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Cigna MGG,Cigna MGG,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Humana,Humana,65.25,,,,,,,per diem,65.25,65.25,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Humana MGG,Humana MGG,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Optum VA,Optum VA,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,UHC,UHC,65.25,,,,,,,per diem,65.25,65.25,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,UHC MGG,UHC MGG,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,VA,VA,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Wellcare MGG,Wellcare MGG,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Bright Health - commercial,Bright Health - commercial,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5/0.5GM I,92212649,CDM,250,RC,J2543,HCPCS,,,,Inpatient,1,EA,65.25,65.25,Bright Health MGG,Bright Health MGG,65.25,,,,,,,case rate,65.25,65.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Aetna,Aetna,686.67,,,,,,,per diem,686.67,686.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Aetna MGG,Aetna MGG,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,BCBS,BCBS,686.67,,,,,,,per diem,686.67,686.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,BCBS MGG,BCBS MGG,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Cigna,Cigna,686.67,,,,,,,per diem,686.67,686.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Cigna MGG,Cigna MGG,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Humana,Humana,686.67,,,,,,,per diem,686.67,686.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Humana MGG,Humana MGG,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Optum VA,Optum VA,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,UHC,UHC,686.67,,,,,,,per diem,686.67,686.67,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,UHC MGG,UHC MGG,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,VA,VA,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Wellcare MGG,Wellcare MGG,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Bright Health - commercial,Bright Health - commercial,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 150MG/ML S,92212650,CDM,250,RC,,,,,,Inpatient,1,EA,686.67,686.67,Bright Health MGG,Bright Health MGG,686.67,,,,,,,case rate,686.67,686.67,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212651,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92212652,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92212653,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Aetna,Aetna,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Aetna MGG,Aetna MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,BCBS,BCBS,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,BCBS MGG,BCBS MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Cigna,Cigna,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Cigna MGG,Cigna MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Humana,Humana,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Humana MGG,Humana MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Optum VA,Optum VA,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,UHC,UHC,12.45,,,,,,,per diem,12.45,12.45,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,UHC MGG,UHC MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,VA,VA,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Wellcare MGG,Wellcare MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Bright Health - commercial,Bright Health - commercial,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92212654,CDM,250,RC,,,,,,Inpatient,1,EA,12.45,12.45,Bright Health MGG,Bright Health MGG,12.45,,,,,,,case rate,12.45,12.45,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NIACIN 500MG TAB              ,92212655,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212656,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Aetna,Aetna,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Aetna MGG,Aetna MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,BCBS,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS MGG,BCBS MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Cigna,Cigna,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Cigna MGG,Cigna MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Humana,Humana,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Humana MGG,Humana MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Optum VA,Optum VA,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UHC,UHC,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UHC MGG,UHC MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,VA,VA,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Wellcare MGG,Wellcare MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Bright Health - commercial,Bright Health - commercial,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
VALSARTAN 80MG TAB            ,92212657,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,Bright Health MGG,Bright Health MGG,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92212658,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Aetna,Aetna,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Aetna MGG,Aetna MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,BCBS,BCBS,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,BCBS MGG,BCBS MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Cigna,Cigna,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Cigna MGG,Cigna MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Humana,Humana,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Humana MGG,Humana MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Optum VA,Optum VA,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,UHC,UHC,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,UHC MGG,UHC MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,VA,VA,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Wellcare MGG,Wellcare MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Bright Health - commercial,Bright Health - commercial,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
POTASSIUM CL 40MEQ/15ML SOL   ,92212659,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Bright Health MGG,Bright Health MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG/2ML INJ    ,92212660,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Aetna,Aetna,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Aetna MGG,Aetna MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,BCBS,BCBS,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,BCBS MGG,BCBS MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Cigna,Cigna,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Cigna MGG,Cigna MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Humana,Humana,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Humana MGG,Humana MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Optum VA,Optum VA,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,UHC,UHC,18.87,,,,,,,per diem,18.87,18.87,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,UHC MGG,UHC MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,VA,VA,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Wellcare MGG,Wellcare MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Bright Health - commercial,Bright Health - commercial,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 30MG SUP  ,92212661,CDM,250,RC,,,,,,Inpatient,1,EA,18.87,18.87,Bright Health MGG,Bright Health MGG,18.87,,,,,,,case rate,18.87,18.87,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92212662,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Aetna,Aetna,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Aetna MGG,Aetna MGG,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,BCBS,BCBS,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,BCBS MGG,BCBS MGG,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Cigna,Cigna,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Cigna MGG,Cigna MGG,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Humana,Humana,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Humana MGG,Humana MGG,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Optum VA,Optum VA,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,UHC,UHC,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,UHC MGG,UHC MGG,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,VA,VA,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Wellcare MGG,Wellcare MGG,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Bright Health - commercial,Bright Health - commercial,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 10MG TAB        ,92212663,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,Bright Health MGG,Bright Health MGG,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Aetna,Aetna,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Aetna MGG,Aetna MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,BCBS,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS MGG,BCBS MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Cigna,Cigna,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Cigna MGG,Cigna MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Humana,Humana,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Humana MGG,Humana MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Optum VA,Optum VA,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UHC,UHC,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UHC MGG,UHC MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,VA,VA,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Wellcare MGG,Wellcare MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Bright Health - commercial,Bright Health - commercial,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92212664,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,Bright Health MGG,Bright Health MGG,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna,Aetna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Aetna MGG,Aetna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS,BCBS,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,BCBS MGG,BCBS MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna,Cigna,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Cigna MGG,Cigna MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana,Humana,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Humana MGG,Humana MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Optum VA,Optum VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC,UHC,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,UHC MGG,UHC MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,VA,VA,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Wellcare MGG,Wellcare MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health - commercial,Bright Health - commercial,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212665,CDM,250,RC,,,,,,Inpatient,1,EA,6.78,6.78,Bright Health MGG,Bright Health MGG,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna,Aetna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Aetna MGG,Aetna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,BCBS,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS MGG,BCBS MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna,Cigna,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Cigna MGG,Cigna MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana,Humana,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Humana MGG,Humana MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Optum VA,Optum VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC,UHC,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UHC MGG,UHC MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,VA,VA,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Wellcare MGG,Wellcare MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health - commercial,Bright Health - commercial,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 5MG TAB        ,92212666,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,Bright Health MGG,Bright Health MGG,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Aetna,Aetna,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Aetna MGG,Aetna MGG,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,BCBS,BCBS,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,BCBS MGG,BCBS MGG,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Cigna,Cigna,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Cigna MGG,Cigna MGG,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Humana,Humana,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Humana MGG,Humana MGG,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Optum VA,Optum VA,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,UHC,UHC,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,UHC MGG,UHC MGG,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,VA,VA,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Wellcare MGG,Wellcare MGG,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Bright Health - commercial,Bright Health - commercial,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92212667,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,Bright Health MGG,Bright Health MGG,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92212668,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212669,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Aetna,Aetna,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Aetna MGG,Aetna MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,BCBS,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS MGG,BCBS MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Cigna,Cigna,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Cigna MGG,Cigna MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Humana,Humana,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Humana MGG,Humana MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Optum VA,Optum VA,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UHC,UHC,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UHC MGG,UHC MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA,VA,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Wellcare MGG,Wellcare MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Bright Health - commercial,Bright Health - commercial,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SUP   ,92212670,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,Bright Health MGG,Bright Health MGG,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Aetna,Aetna,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Aetna MGG,Aetna MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,BCBS,BCBS,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,BCBS MGG,BCBS MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Cigna,Cigna,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Cigna MGG,Cigna MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Humana,Humana,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Humana MGG,Humana MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Optum VA,Optum VA,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,UHC,UHC,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,UHC MGG,UHC MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,VA,VA,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Wellcare MGG,Wellcare MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Bright Health - commercial,Bright Health - commercial,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212671,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Bright Health MGG,Bright Health MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92212672,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92212673,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Aetna,Aetna,15.63,,,,,,,per diem,15.63,15.63,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Aetna MGG,Aetna MGG,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,BCBS,BCBS,15.63,,,,,,,per diem,15.63,15.63,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,BCBS MGG,BCBS MGG,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Cigna,Cigna,15.63,,,,,,,per diem,15.63,15.63,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Cigna MGG,Cigna MGG,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Humana,Humana,15.63,,,,,,,per diem,15.63,15.63,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Humana MGG,Humana MGG,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Optum VA,Optum VA,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,UHC,UHC,15.63,,,,,,,per diem,15.63,15.63,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,UHC MGG,UHC MGG,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,VA,VA,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Wellcare MGG,Wellcare MGG,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Bright Health - commercial,Bright Health - commercial,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92212674,CDM,250,RC,,,,,,Inpatient,1,EA,15.63,15.63,Bright Health MGG,Bright Health MGG,15.63,,,,,,,case rate,15.63,15.63,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Aetna,Aetna,217.95,,,,,,,per diem,217.95,217.95,"Per diem rate, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Aetna MGG,Aetna MGG,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,BCBS,BCBS,217.95,,,,,,,per diem,217.95,217.95,"Per diem rate, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,BCBS MGG,BCBS MGG,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Cigna,Cigna,217.95,,,,,,,per diem,217.95,217.95,"Per diem rate, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Cigna MGG,Cigna MGG,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Humana,Humana,217.95,,,,,,,per diem,217.95,217.95,"Per diem rate, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Humana MGG,Humana MGG,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Optum VA,Optum VA,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,UHC,UHC,217.95,,,,,,,per diem,217.95,217.95,"Per diem rate, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,UHC MGG,UHC MGG,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,VA,VA,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Wellcare MGG,Wellcare MGG,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Bright Health - commercial,Bright Health - commercial,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MMR VACCINE LIVE PDS          ,92212675,CDM,250,RC,,,,,,Inpatient,1,EA,217.95,217.95,Bright Health MGG,Bright Health MGG,217.95,,,,,,,case rate,217.95,217.95,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92212676,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Aetna,Aetna,79.59,,,,,,,per diem,79.59,79.59,"Per diem rate, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Aetna MGG,Aetna MGG,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,BCBS,BCBS,79.59,,,,,,,per diem,79.59,79.59,"Per diem rate, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,BCBS MGG,BCBS MGG,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Cigna,Cigna,79.59,,,,,,,per diem,79.59,79.59,"Per diem rate, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Cigna MGG,Cigna MGG,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Humana,Humana,79.59,,,,,,,per diem,79.59,79.59,"Per diem rate, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Humana MGG,Humana MGG,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Optum VA,Optum VA,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,UHC,UHC,79.59,,,,,,,per diem,79.59,79.59,"Per diem rate, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,UHC MGG,UHC MGG,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,VA,VA,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Wellcare MGG,Wellcare MGG,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Bright Health - commercial,Bright Health - commercial,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
NAFCILLIN 2GM INJ             ,92212677,CDM,250,RC,,,,,,Inpatient,1,EA,79.59,79.59,Bright Health MGG,Bright Health MGG,79.59,,,,,,,case rate,79.59,79.59,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212678,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Aetna,Aetna,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Aetna MGG,Aetna MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,BCBS,BCBS,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,BCBS MGG,BCBS MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Cigna,Cigna,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Cigna MGG,Cigna MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Humana,Humana,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Humana MGG,Humana MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Optum VA,Optum VA,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,UHC,UHC,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,UHC MGG,UHC MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,VA,VA,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Wellcare MGG,Wellcare MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Bright Health - commercial,Bright Health - commercial,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212679,CDM,250,RC,,,,,,Inpatient,1,EA,29.61,29.61,Bright Health MGG,Bright Health MGG,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Aetna,Aetna,253.2,,,,,,,per diem,253.2,253.2,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Aetna MGG,Aetna MGG,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,BCBS,BCBS,253.2,,,,,,,per diem,253.2,253.2,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,BCBS MGG,BCBS MGG,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Cigna,Cigna,253.2,,,,,,,per diem,253.2,253.2,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Cigna MGG,Cigna MGG,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Humana,Humana,253.2,,,,,,,per diem,253.2,253.2,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Humana MGG,Humana MGG,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Optum VA,Optum VA,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,UHC,UHC,253.2,,,,,,,per diem,253.2,253.2,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,UHC MGG,UHC MGG,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,VA,VA,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Wellcare MGG,Wellcare MGG,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Bright Health - commercial,Bright Health - commercial,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92212680,CDM,250,RC,,,,,,Inpatient,1,EA,253.2,253.2,Bright Health MGG,Bright Health MGG,253.2,,,,,,,case rate,253.2,253.2,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Aetna,Aetna,618.93,,,,,,,per diem,618.93,618.93,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Aetna MGG,Aetna MGG,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,BCBS,BCBS,618.93,,,,,,,per diem,618.93,618.93,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,BCBS MGG,BCBS MGG,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Cigna,Cigna,618.93,,,,,,,per diem,618.93,618.93,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Cigna MGG,Cigna MGG,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Humana,Humana,618.93,,,,,,,per diem,618.93,618.93,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Humana MGG,Humana MGG,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Optum VA,Optum VA,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,UHC,UHC,618.93,,,,,,,per diem,618.93,618.93,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,UHC MGG,UHC MGG,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,VA,VA,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Wellcare MGG,Wellcare MGG,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Bright Health - commercial,Bright Health - commercial,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92212681,CDM,250,RC,,,,,,Inpatient,1,EA,618.93,618.93,Bright Health MGG,Bright Health MGG,618.93,,,,,,,case rate,618.93,618.93,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 5MG TAB       ,92212682,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Aetna,Aetna,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Aetna MGG,Aetna MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,BCBS,BCBS,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,BCBS MGG,BCBS MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Cigna,Cigna,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Cigna MGG,Cigna MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Humana,Humana,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Humana MGG,Humana MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Optum VA,Optum VA,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,UHC,UHC,375,,,,,,,per diem,375,375,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,UHC MGG,UHC MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,VA,VA,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Wellcare MGG,Wellcare MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Bright Health - commercial,Bright Health - commercial,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92212683,CDM,250,RC,,,,,,Inpatient,1,EA,375,375,Bright Health MGG,Bright Health MGG,375,,,,,,,case rate,375,375,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Aetna,Aetna,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Aetna MGG,Aetna MGG,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,BCBS,BCBS,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,BCBS MGG,BCBS MGG,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Cigna,Cigna,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Cigna MGG,Cigna MGG,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Humana,Humana,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Humana MGG,Humana MGG,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Optum VA,Optum VA,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,UHC,UHC,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,UHC MGG,UHC MGG,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,VA,VA,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Wellcare MGG,Wellcare MGG,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Bright Health - commercial,Bright Health - commercial,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92212684,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,Bright Health MGG,Bright Health MGG,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92212685,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212686,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92212687,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Aetna,Aetna,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Aetna MGG,Aetna MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,BCBS,BCBS,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,BCBS MGG,BCBS MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Cigna,Cigna,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Cigna MGG,Cigna MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Humana,Humana,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Humana MGG,Humana MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Optum VA,Optum VA,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,UHC,UHC,7.2,,,,,,,per diem,7.2,7.2,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,UHC MGG,UHC MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,VA,VA,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Wellcare MGG,Wellcare MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Bright Health - commercial,Bright Health - commercial,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 20MCG/ML SUS ,92212688,CDM,250,RC,,,,,,Inpatient,1,EA,7.2,7.2,Bright Health MGG,Bright Health MGG,7.2,,,,,,,case rate,7.2,7.2,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Aetna,Aetna,138.48,,,,,,,per diem,138.48,138.48,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Aetna MGG,Aetna MGG,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,BCBS,BCBS,138.48,,,,,,,per diem,138.48,138.48,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,BCBS MGG,BCBS MGG,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Cigna,Cigna,138.48,,,,,,,per diem,138.48,138.48,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Cigna MGG,Cigna MGG,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Humana,Humana,138.48,,,,,,,per diem,138.48,138.48,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Humana MGG,Humana MGG,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Optum VA,Optum VA,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,UHC,UHC,138.48,,,,,,,per diem,138.48,138.48,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,UHC MGG,UHC MGG,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,VA,VA,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Wellcare MGG,Wellcare MGG,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Bright Health - commercial,Bright Health - commercial,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 2GM INJ    ,92212689,CDM,250,RC,,,,,,Inpatient,1,EA,138.48,138.48,Bright Health MGG,Bright Health MGG,138.48,,,,,,,case rate,138.48,138.48,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN LIQ              ,92212690,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Aetna,Aetna,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Aetna MGG,Aetna MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,BCBS,BCBS,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,BCBS MGG,BCBS MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Cigna,Cigna,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Cigna MGG,Cigna MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Humana,Humana,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Humana MGG,Humana MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Optum VA,Optum VA,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,UHC,UHC,33.9,,,,,,,per diem,33.9,33.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,UHC MGG,UHC MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,VA,VA,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Wellcare MGG,Wellcare MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Bright Health - commercial,Bright Health - commercial,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 800MG/D5W INJ    ,92212691,CDM,250,RC,,,,,,Inpatient,1,EA,33.9,33.9,Bright Health MGG,Bright Health MGG,33.9,,,,,,,case rate,33.9,33.9,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212692,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Aetna,Aetna,79.53,,,,,,,per diem,79.53,79.53,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Aetna MGG,Aetna MGG,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,BCBS,BCBS,79.53,,,,,,,per diem,79.53,79.53,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,BCBS MGG,BCBS MGG,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Cigna,Cigna,79.53,,,,,,,per diem,79.53,79.53,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Cigna MGG,Cigna MGG,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Humana,Humana,79.53,,,,,,,per diem,79.53,79.53,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Humana MGG,Humana MGG,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Optum VA,Optum VA,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,UHC,UHC,79.53,,,,,,,per diem,79.53,79.53,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,UHC MGG,UHC MGG,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,VA,VA,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Wellcare MGG,Wellcare MGG,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Bright Health - commercial,Bright Health - commercial,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 99% LIQ     ,92212693,CDM,250,RC,,,,,,Inpatient,1,EA,79.53,79.53,Bright Health MGG,Bright Health MGG,79.53,,,,,,,case rate,79.53,79.53,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Aetna,Aetna,70.95,,,,,,,per diem,70.95,70.95,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Aetna MGG,Aetna MGG,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,BCBS,BCBS,70.95,,,,,,,per diem,70.95,70.95,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,BCBS MGG,BCBS MGG,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Cigna,Cigna,70.95,,,,,,,per diem,70.95,70.95,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Cigna MGG,Cigna MGG,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Humana,Humana,70.95,,,,,,,per diem,70.95,70.95,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Humana MGG,Humana MGG,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Optum VA,Optum VA,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,UHC,UHC,70.95,,,,,,,per diem,70.95,70.95,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,UHC MGG,UHC MGG,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,VA,VA,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Wellcare MGG,Wellcare MGG,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Bright Health - commercial,Bright Health - commercial,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92212694,CDM,250,RC,,,,,,Inpatient,1,EA,70.95,70.95,Bright Health MGG,Bright Health MGG,70.95,,,,,,,case rate,70.95,70.95,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92212695,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Aetna,Aetna,41.94,,,,,,,per diem,41.94,41.94,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Aetna MGG,Aetna MGG,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,BCBS,BCBS,41.94,,,,,,,per diem,41.94,41.94,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,BCBS MGG,BCBS MGG,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Cigna,Cigna,41.94,,,,,,,per diem,41.94,41.94,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Cigna MGG,Cigna MGG,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Humana,Humana,41.94,,,,,,,per diem,41.94,41.94,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Humana MGG,Humana MGG,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Optum VA,Optum VA,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,UHC,UHC,41.94,,,,,,,per diem,41.94,41.94,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,UHC MGG,UHC MGG,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,VA,VA,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Wellcare MGG,Wellcare MGG,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Bright Health - commercial,Bright Health - commercial,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 125MG INJ  ,92212696,CDM,250,RC,J2930,HCPCS,,,,Inpatient,1,EA,41.94,41.94,Bright Health MGG,Bright Health MGG,41.94,,,,,,,case rate,41.94,41.94,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92212697,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Aetna,Aetna,119.76,,,,,,,per diem,119.76,119.76,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Aetna MGG,Aetna MGG,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,BCBS,BCBS,119.76,,,,,,,per diem,119.76,119.76,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,BCBS MGG,BCBS MGG,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Cigna,Cigna,119.76,,,,,,,per diem,119.76,119.76,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Cigna MGG,Cigna MGG,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Humana,Humana,119.76,,,,,,,per diem,119.76,119.76,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Humana MGG,Humana MGG,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Optum VA,Optum VA,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,UHC,UHC,119.76,,,,,,,per diem,119.76,119.76,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,UHC MGG,UHC MGG,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,VA,VA,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Wellcare MGG,Wellcare MGG,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Bright Health - commercial,Bright Health - commercial,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM/50ML INJ        ,92212698,CDM,250,RC,,,,,,Inpatient,1,EA,119.76,119.76,Bright Health MGG,Bright Health MGG,119.76,,,,,,,case rate,119.76,119.76,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92212699,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Aetna,Aetna,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Aetna MGG,Aetna MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,BCBS,BCBS,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,BCBS MGG,BCBS MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Cigna,Cigna,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Cigna MGG,Cigna MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Humana,Humana,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Humana MGG,Humana MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Optum VA,Optum VA,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,UHC,UHC,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,UHC MGG,UHC MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,VA,VA,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Wellcare MGG,Wellcare MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Bright Health - commercial,Bright Health - commercial,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92212700,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Bright Health MGG,Bright Health MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92212701,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 400MG CAP      ,92212702,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Aetna,Aetna,347.91,,,,,,,per diem,347.91,347.91,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Aetna MGG,Aetna MGG,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,BCBS,BCBS,347.91,,,,,,,per diem,347.91,347.91,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,BCBS MGG,BCBS MGG,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Cigna,Cigna,347.91,,,,,,,per diem,347.91,347.91,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Cigna MGG,Cigna MGG,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Humana,Humana,347.91,,,,,,,per diem,347.91,347.91,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Humana MGG,Humana MGG,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Optum VA,Optum VA,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,UHC,UHC,347.91,,,,,,,per diem,347.91,347.91,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,UHC MGG,UHC MGG,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,VA,VA,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Wellcare MGG,Wellcare MGG,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Bright Health - commercial,Bright Health - commercial,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212703,CDM,250,RC,,,,,,Inpatient,1,EA,347.91,347.91,Bright Health MGG,Bright Health MGG,347.91,,,,,,,case rate,347.91,347.91,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92212704,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Aetna,Aetna,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Aetna MGG,Aetna MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,BCBS,BCBS,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,BCBS MGG,BCBS MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Cigna,Cigna,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Cigna MGG,Cigna MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Humana,Humana,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Humana MGG,Humana MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Optum VA,Optum VA,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,UHC,UHC,12.78,,,,,,,per diem,12.78,12.78,"Per diem rate, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,UHC MGG,UHC MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,VA,VA,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Wellcare MGG,Wellcare MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Bright Health - commercial,Bright Health - commercial,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
SOD CITRATE/CITRIC ACID LIQ   ,92212705,CDM,250,RC,,,,,,Inpatient,1,EA,12.78,12.78,Bright Health MGG,Bright Health MGG,12.78,,,,,,,case rate,12.78,12.78,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Aetna,Aetna,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Aetna MGG,Aetna MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,BCBS,BCBS,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,BCBS MGG,BCBS MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Cigna,Cigna,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Cigna MGG,Cigna MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Humana,Humana,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Humana MGG,Humana MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Optum VA,Optum VA,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,UHC,UHC,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,UHC MGG,UHC MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,VA,VA,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Wellcare MGG,Wellcare MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Bright Health - commercial,Bright Health - commercial,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 15GM INJ ,92212706,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,Bright Health MGG,Bright Health MGG,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna,Aetna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna MGG,Aetna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS,BCBS,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS MGG,BCBS MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna,Cigna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna MGG,Cigna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana,Humana,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana MGG,Humana MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Optum VA,Optum VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC,UHC,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC MGG,UHC MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,VA,VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Wellcare MGG,Wellcare MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health - commercial,Bright Health - commercial,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212707,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health MGG,Bright Health MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Aetna,Aetna,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Aetna MGG,Aetna MGG,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,BCBS,BCBS,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,BCBS MGG,BCBS MGG,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Cigna,Cigna,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Cigna MGG,Cigna MGG,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Humana,Humana,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Humana MGG,Humana MGG,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Optum VA,Optum VA,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,UHC,UHC,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,UHC MGG,UHC MGG,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,VA,VA,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Wellcare MGG,Wellcare MGG,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Bright Health - commercial,Bright Health - commercial,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212708,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,Bright Health MGG,Bright Health MGG,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Aetna,Aetna,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Aetna MGG,Aetna MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,BCBS,BCBS,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,BCBS MGG,BCBS MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Cigna,Cigna,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Cigna MGG,Cigna MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Humana,Humana,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Humana MGG,Humana MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Optum VA,Optum VA,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,UHC,UHC,5.01,,,,,,,per diem,5.01,5.01,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,UHC MGG,UHC MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,VA,VA,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Wellcare MGG,Wellcare MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Bright Health - commercial,Bright Health - commercial,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92212709,CDM,250,RC,,,,,,Inpatient,1,EA,5.01,5.01,Bright Health MGG,Bright Health MGG,5.01,,,,,,,case rate,5.01,5.01,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Aetna,Aetna,1025.97,,,,,,,per diem,1025.97,1025.97,"Per diem rate, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Aetna MGG,Aetna MGG,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,BCBS,BCBS,1025.97,,,,,,,per diem,1025.97,1025.97,"Per diem rate, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,BCBS MGG,BCBS MGG,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Cigna,Cigna,1025.97,,,,,,,per diem,1025.97,1025.97,"Per diem rate, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Cigna MGG,Cigna MGG,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Humana,Humana,1025.97,,,,,,,per diem,1025.97,1025.97,"Per diem rate, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Humana MGG,Humana MGG,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Optum VA,Optum VA,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,UHC,UHC,1025.97,,,,,,,per diem,1025.97,1025.97,"Per diem rate, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,UHC MGG,UHC MGG,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,VA,VA,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Wellcare MGG,Wellcare MGG,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Bright Health - commercial,Bright Health - commercial,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
PODOFILOX 0.5% TOPICAL GEL    ,92212710,CDM,250,RC,,,,,,Inpatient,1,EA,1025.97,1025.97,Bright Health MGG,Bright Health MGG,1025.97,,,,,,,case rate,1025.97,1025.97,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Aetna,Aetna,383.13,,,,,,,per diem,383.13,383.13,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Aetna MGG,Aetna MGG,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,BCBS,BCBS,383.13,,,,,,,per diem,383.13,383.13,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,BCBS MGG,BCBS MGG,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Cigna,Cigna,383.13,,,,,,,per diem,383.13,383.13,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Cigna MGG,Cigna MGG,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Humana,Humana,383.13,,,,,,,per diem,383.13,383.13,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Humana MGG,Humana MGG,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Optum VA,Optum VA,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,UHC,UHC,383.13,,,,,,,per diem,383.13,383.13,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,UHC MGG,UHC MGG,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,VA,VA,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Wellcare MGG,Wellcare MGG,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Bright Health - commercial,Bright Health - commercial,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212711,CDM,250,RC,,,,,,Inpatient,1,EA,383.13,383.13,Bright Health MGG,Bright Health MGG,383.13,,,,,,,case rate,383.13,383.13,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92212712,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212713,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212714,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212715,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Aetna,Aetna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Aetna MGG,Aetna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,BCBS,BCBS,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,BCBS MGG,BCBS MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Cigna,Cigna,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Cigna MGG,Cigna MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Humana,Humana,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Humana MGG,Humana MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Optum VA,Optum VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,UHC,UHC,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,UHC MGG,UHC MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,VA,VA,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Wellcare MGG,Wellcare MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Bright Health - commercial,Bright Health - commercial,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 5MG/ML INJ      ,92212716,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,Bright Health MGG,Bright Health MGG,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Aetna,Aetna,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Aetna MGG,Aetna MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,BCBS,BCBS,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,BCBS MGG,BCBS MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Cigna,Cigna,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Cigna MGG,Cigna MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Humana,Humana,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Humana MGG,Humana MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Optum VA,Optum VA,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,UHC,UHC,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,UHC MGG,UHC MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,VA,VA,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Wellcare MGG,Wellcare MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Bright Health - commercial,Bright Health - commercial,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL 625MG TAB     ,92212717,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Bright Health MGG,Bright Health MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Aetna,Aetna,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Aetna MGG,Aetna MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,BCBS,BCBS,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,BCBS MGG,BCBS MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Cigna,Cigna,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Cigna MGG,Cigna MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Humana,Humana,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Humana MGG,Humana MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Optum VA,Optum VA,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,UHC,UHC,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,UHC MGG,UHC MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,VA,VA,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Wellcare MGG,Wellcare MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Bright Health - commercial,Bright Health - commercial,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92212718,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Bright Health MGG,Bright Health MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Aetna,Aetna,51.9,,,,,,,per diem,51.9,51.9,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Aetna MGG,Aetna MGG,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,BCBS,BCBS,51.9,,,,,,,per diem,51.9,51.9,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,BCBS MGG,BCBS MGG,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Cigna,Cigna,51.9,,,,,,,per diem,51.9,51.9,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Cigna MGG,Cigna MGG,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Humana,Humana,51.9,,,,,,,per diem,51.9,51.9,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Humana MGG,Humana MGG,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Optum VA,Optum VA,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,UHC,UHC,51.9,,,,,,,per diem,51.9,51.9,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,UHC MGG,UHC MGG,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,VA,VA,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Wellcare MGG,Wellcare MGG,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Bright Health - commercial,Bright Health - commercial,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212719,CDM,250,RC,,,,,,Inpatient,1,EA,51.9,51.9,Bright Health MGG,Bright Health MGG,51.9,,,,,,,case rate,51.9,51.9,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Aetna,Aetna,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Aetna MGG,Aetna MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,BCBS,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS MGG,BCBS MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Cigna,Cigna,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Cigna MGG,Cigna MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Humana,Humana,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Humana MGG,Humana MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Optum VA,Optum VA,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UHC,UHC,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UHC MGG,UHC MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA,VA,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Wellcare MGG,Wellcare MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Bright Health - commercial,Bright Health - commercial,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG SGL      ,92212720,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Bright Health MGG,Bright Health MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna,Aetna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna MGG,Aetna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS,BCBS,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS MGG,BCBS MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna,Cigna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna MGG,Cigna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana,Humana,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana MGG,Humana MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Optum VA,Optum VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC,UHC,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC MGG,UHC MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,VA,VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Wellcare MGG,Wellcare MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health - commercial,Bright Health - commercial,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 10MG TAB      ,92212721,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health MGG,Bright Health MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACEBUTOLOL HCL 200MG CAP      ,92212722,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Aetna,Aetna,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Aetna MGG,Aetna MGG,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,BCBS,BCBS,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,BCBS MGG,BCBS MGG,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Cigna,Cigna,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Cigna MGG,Cigna MGG,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Humana,Humana,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Humana MGG,Humana MGG,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Optum VA,Optum VA,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,UHC,UHC,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,UHC MGG,UHC MGG,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,VA,VA,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Wellcare MGG,Wellcare MGG,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Bright Health - commercial,Bright Health - commercial,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 400MG TAB       ,92212723,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,Bright Health MGG,Bright Health MGG,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92212724,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Aetna,Aetna,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Aetna MGG,Aetna MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,BCBS,BCBS,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,BCBS MGG,BCBS MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Cigna,Cigna,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Cigna MGG,Cigna MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Humana,Humana,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Humana MGG,Humana MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Optum VA,Optum VA,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,UHC,UHC,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,UHC MGG,UHC MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,VA,VA,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Wellcare MGG,Wellcare MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Bright Health - commercial,Bright Health - commercial,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
"CYANOCOBALAMIN 1,000MCG/ML INJ",92212725,CDM,250,RC,J3420,HCPCS,,,,Inpatient,1,EA,5.19,5.19,Bright Health MGG,Bright Health MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Aetna,Aetna,129.12,,,,,,,per diem,129.12,129.12,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Aetna MGG,Aetna MGG,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,BCBS,BCBS,129.12,,,,,,,per diem,129.12,129.12,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,BCBS MGG,BCBS MGG,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Cigna,Cigna,129.12,,,,,,,per diem,129.12,129.12,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Cigna MGG,Cigna MGG,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Humana,Humana,129.12,,,,,,,per diem,129.12,129.12,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Humana MGG,Humana MGG,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Optum VA,Optum VA,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,UHC,UHC,129.12,,,,,,,per diem,129.12,129.12,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,UHC MGG,UHC MGG,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,VA,VA,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Wellcare MGG,Wellcare MGG,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Bright Health - commercial,Bright Health - commercial,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92212726,CDM,250,RC,,,,,,Inpatient,1,EA,129.12,129.12,Bright Health MGG,Bright Health MGG,129.12,,,,,,,case rate,129.12,129.12,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 1MG TAB            ,92212727,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Aetna,Aetna,55.41,,,,,,,per diem,55.41,55.41,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Aetna MGG,Aetna MGG,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,BCBS,BCBS,55.41,,,,,,,per diem,55.41,55.41,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,BCBS MGG,BCBS MGG,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Cigna,Cigna,55.41,,,,,,,per diem,55.41,55.41,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Cigna MGG,Cigna MGG,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Humana,Humana,55.41,,,,,,,per diem,55.41,55.41,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Humana MGG,Humana MGG,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Optum VA,Optum VA,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,UHC,UHC,55.41,,,,,,,per diem,55.41,55.41,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,UHC MGG,UHC MGG,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,VA,VA,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Wellcare MGG,Wellcare MGG,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Bright Health - commercial,Bright Health - commercial,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG ODT            ,92212728,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Bright Health MGG,Bright Health MGG,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Aetna,Aetna,18.09,,,,,,,per diem,18.09,18.09,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Aetna MGG,Aetna MGG,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,BCBS,BCBS,18.09,,,,,,,per diem,18.09,18.09,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,BCBS MGG,BCBS MGG,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Cigna,Cigna,18.09,,,,,,,per diem,18.09,18.09,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Cigna MGG,Cigna MGG,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Humana,Humana,18.09,,,,,,,per diem,18.09,18.09,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Humana MGG,Humana MGG,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Optum VA,Optum VA,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,UHC,UHC,18.09,,,,,,,per diem,18.09,18.09,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,UHC MGG,UHC MGG,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,VA,VA,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Wellcare MGG,Wellcare MGG,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Bright Health - commercial,Bright Health - commercial,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125 TAB ,92212729,CDM,250,RC,,,,,,Inpatient,1,EA,18.09,18.09,Bright Health MGG,Bright Health MGG,18.09,,,,,,,case rate,18.09,18.09,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Aetna,Aetna,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Aetna MGG,Aetna MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,BCBS,BCBS,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,BCBS MGG,BCBS MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Cigna,Cigna,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Cigna MGG,Cigna MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Humana,Humana,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Humana MGG,Humana MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Optum VA,Optum VA,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,UHC,UHC,22.5,,,,,,,per diem,22.5,22.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,UHC MGG,UHC MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,VA,VA,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Wellcare MGG,Wellcare MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Bright Health - commercial,Bright Health - commercial,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 4MEQ/ML INJ    ,92212730,CDM,250,RC,,,,,,Inpatient,1,EA,22.5,22.5,Bright Health MGG,Bright Health MGG,22.5,,,,,,,case rate,22.5,22.5,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Aetna,Aetna,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Aetna MGG,Aetna MGG,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,BCBS,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS MGG,BCBS MGG,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Cigna,Cigna,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Cigna MGG,Cigna MGG,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Humana,Humana,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Humana MGG,Humana MGG,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Optum VA,Optum VA,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,UHC,UHC,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,UHC MGG,UHC MGG,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,VA,VA,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Wellcare MGG,Wellcare MGG,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Bright Health - commercial,Bright Health - commercial,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92212731,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,Bright Health MGG,Bright Health MGG,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Aetna,Aetna,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Aetna MGG,Aetna MGG,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,BCBS,BCBS,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,BCBS MGG,BCBS MGG,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Cigna,Cigna,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Cigna MGG,Cigna MGG,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Humana,Humana,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Humana MGG,Humana MGG,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Optum VA,Optum VA,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,UHC,UHC,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,UHC MGG,UHC MGG,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,VA,VA,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Wellcare MGG,Wellcare MGG,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Bright Health - commercial,Bright Health - commercial,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92212732,CDM,250,RC,,,,,,Inpatient,1,EA,16.17,16.17,Bright Health MGG,Bright Health MGG,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 50MG TAB           ,92212733,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Aetna,Aetna,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Aetna MGG,Aetna MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,BCBS,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS MGG,BCBS MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Cigna,Cigna,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Cigna MGG,Cigna MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Humana,Humana,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Humana MGG,Humana MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Optum VA,Optum VA,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,UHC,UHC,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,UHC MGG,UHC MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,VA,VA,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Wellcare MGG,Wellcare MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Bright Health - commercial,Bright Health - commercial,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212734,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,Bright Health MGG,Bright Health MGG,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Aetna,Aetna,162.24,,,,,,,per diem,162.24,162.24,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Aetna MGG,Aetna MGG,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,BCBS,BCBS,162.24,,,,,,,per diem,162.24,162.24,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,BCBS MGG,BCBS MGG,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Cigna,Cigna,162.24,,,,,,,per diem,162.24,162.24,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Cigna MGG,Cigna MGG,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Humana,Humana,162.24,,,,,,,per diem,162.24,162.24,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Humana MGG,Humana MGG,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Optum VA,Optum VA,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,UHC,UHC,162.24,,,,,,,per diem,162.24,162.24,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,UHC MGG,UHC MGG,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,VA,VA,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Wellcare MGG,Wellcare MGG,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Bright Health - commercial,Bright Health - commercial,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92212735,CDM,250,RC,,,,,,Inpatient,1,EA,162.24,162.24,Bright Health MGG,Bright Health MGG,162.24,,,,,,,case rate,162.24,162.24,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL                 ,92212736,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Aetna,Aetna,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Aetna MGG,Aetna MGG,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,BCBS,BCBS,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,BCBS MGG,BCBS MGG,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Cigna,Cigna,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Cigna MGG,Cigna MGG,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Humana,Humana,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Humana MGG,Humana MGG,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Optum VA,Optum VA,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,UHC,UHC,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,UHC MGG,UHC MGG,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,VA,VA,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Wellcare MGG,Wellcare MGG,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Bright Health - commercial,Bright Health - commercial,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
PETROLATUM SHARK LIVER OIL OIN,92212737,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,Bright Health MGG,Bright Health MGG,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Aetna,Aetna,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Aetna MGG,Aetna MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,BCBS,BCBS,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,BCBS MGG,BCBS MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Cigna,Cigna,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Cigna MGG,Cigna MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Humana,Humana,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Humana MGG,Humana MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Optum VA,Optum VA,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,UHC,UHC,111.21,,,,,,,per diem,111.21,111.21,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,UHC MGG,UHC MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,VA,VA,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Wellcare MGG,Wellcare MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Bright Health - commercial,Bright Health - commercial,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212738,CDM,250,RC,,,,,,Inpatient,1,EA,111.21,111.21,Bright Health MGG,Bright Health MGG,111.21,,,,,,,case rate,111.21,111.21,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna,Aetna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna MGG,Aetna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS,BCBS,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS MGG,BCBS MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna,Cigna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna MGG,Cigna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana,Humana,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana MGG,Humana MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Optum VA,Optum VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC,UHC,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC MGG,UHC MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,VA,VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Wellcare MGG,Wellcare MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health - commercial,Bright Health - commercial,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92212739,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health MGG,Bright Health MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212740,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Aetna,Aetna,38.91,,,,,,,per diem,38.91,38.91,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Aetna MGG,Aetna MGG,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,BCBS,BCBS,38.91,,,,,,,per diem,38.91,38.91,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,BCBS MGG,BCBS MGG,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Cigna,Cigna,38.91,,,,,,,per diem,38.91,38.91,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Cigna MGG,Cigna MGG,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Humana,Humana,38.91,,,,,,,per diem,38.91,38.91,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Humana MGG,Humana MGG,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Optum VA,Optum VA,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,UHC,UHC,38.91,,,,,,,per diem,38.91,38.91,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,UHC MGG,UHC MGG,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,VA,VA,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Wellcare MGG,Wellcare MGG,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Bright Health - commercial,Bright Health - commercial,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92212741,CDM,250,RC,,,,,,Inpatient,1,EA,38.91,38.91,Bright Health MGG,Bright Health MGG,38.91,,,,,,,case rate,38.91,38.91,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92212742,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92212743,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Aetna,Aetna,878.64,,,,,,,per diem,878.64,878.64,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Aetna MGG,Aetna MGG,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,BCBS,BCBS,878.64,,,,,,,per diem,878.64,878.64,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,BCBS MGG,BCBS MGG,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Cigna,Cigna,878.64,,,,,,,per diem,878.64,878.64,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Cigna MGG,Cigna MGG,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Humana,Humana,878.64,,,,,,,per diem,878.64,878.64,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Humana MGG,Humana MGG,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Optum VA,Optum VA,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,UHC,UHC,878.64,,,,,,,per diem,878.64,878.64,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,UHC MGG,UHC MGG,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,VA,VA,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Wellcare MGG,Wellcare MGG,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Bright Health - commercial,Bright Health - commercial,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212744,CDM,250,RC,,,,,,Inpatient,1,EA,878.64,878.64,Bright Health MGG,Bright Health MGG,878.64,,,,,,,case rate,878.64,878.64,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Aetna,Aetna,409.5,,,,,,,per diem,409.5,409.5,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Aetna MGG,Aetna MGG,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,BCBS,BCBS,409.5,,,,,,,per diem,409.5,409.5,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,BCBS MGG,BCBS MGG,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Cigna,Cigna,409.5,,,,,,,per diem,409.5,409.5,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Cigna MGG,Cigna MGG,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Humana,Humana,409.5,,,,,,,per diem,409.5,409.5,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Humana MGG,Humana MGG,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Optum VA,Optum VA,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,UHC,UHC,409.5,,,,,,,per diem,409.5,409.5,"Per diem rate, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,UHC MGG,UHC MGG,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,VA,VA,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Wellcare MGG,Wellcare MGG,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Bright Health - commercial,Bright Health - commercial,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
CICLOPIROX OLAMINE 0.77% CRE  ,92212745,CDM,250,RC,,,,,,Inpatient,1,EA,409.5,409.5,Bright Health MGG,Bright Health MGG,409.5,,,,,,,case rate,409.5,409.5,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Aetna,Aetna,97.32,,,,,,,per diem,97.32,97.32,"Per diem rate, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Aetna MGG,Aetna MGG,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,BCBS,BCBS,97.32,,,,,,,per diem,97.32,97.32,"Per diem rate, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,BCBS MGG,BCBS MGG,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Cigna,Cigna,97.32,,,,,,,per diem,97.32,97.32,"Per diem rate, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Cigna MGG,Cigna MGG,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Humana,Humana,97.32,,,,,,,per diem,97.32,97.32,"Per diem rate, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Humana MGG,Humana MGG,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Optum VA,Optum VA,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,UHC,UHC,97.32,,,,,,,per diem,97.32,97.32,"Per diem rate, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,UHC MGG,UHC MGG,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,VA,VA,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Wellcare MGG,Wellcare MGG,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Bright Health - commercial,Bright Health - commercial,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
MEPERIDINE 10MG/ML INJ        ,92212746,CDM,250,RC,,,,,,Inpatient,1,EA,97.32,97.32,Bright Health MGG,Bright Health MGG,97.32,,,,,,,case rate,97.32,97.32,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Aetna,Aetna,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Aetna MGG,Aetna MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,BCBS,BCBS,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,BCBS MGG,BCBS MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Cigna,Cigna,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Cigna MGG,Cigna MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Humana,Humana,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Humana MGG,Humana MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Optum VA,Optum VA,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,UHC,UHC,57.12,,,,,,,per diem,57.12,57.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,UHC MGG,UHC MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,VA,VA,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Wellcare MGG,Wellcare MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Bright Health - commercial,Bright Health - commercial,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 500MG I,92212747,CDM,250,RC,,,,,,Inpatient,1,EA,57.12,57.12,Bright Health MGG,Bright Health MGG,57.12,,,,,,,case rate,57.12,57.12,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212748,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Aetna,Aetna,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Aetna MGG,Aetna MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,BCBS,BCBS,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,BCBS MGG,BCBS MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Cigna,Cigna,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Cigna MGG,Cigna MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Humana,Humana,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Humana MGG,Humana MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Optum VA,Optum VA,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,UHC,UHC,641.19,,,,,,,per diem,641.19,641.19,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,UHC MGG,UHC MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,VA,VA,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Wellcare MGG,Wellcare MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Bright Health - commercial,Bright Health - commercial,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92212749,CDM,250,RC,,,,,,Inpatient,1,EA,641.19,641.19,Bright Health MGG,Bright Health MGG,641.19,,,,,,,case rate,641.19,641.19,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRIDOSTIBMINE BR 60MG TAB    ,92212750,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92212751,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92212752,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Aetna,Aetna,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Aetna MGG,Aetna MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,BCBS,BCBS,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,BCBS MGG,BCBS MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Cigna,Cigna,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Cigna MGG,Cigna MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Humana,Humana,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Humana MGG,Humana MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Optum VA,Optum VA,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,UHC,UHC,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,UHC MGG,UHC MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,VA,VA,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Wellcare MGG,Wellcare MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Bright Health - commercial,Bright Health - commercial,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212753,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,Bright Health MGG,Bright Health MGG,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92212754,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92212755,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Aetna,Aetna,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Aetna MGG,Aetna MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,BCBS,BCBS,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,BCBS MGG,BCBS MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Cigna,Cigna,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Cigna MGG,Cigna MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Humana,Humana,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Humana MGG,Humana MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Optum VA,Optum VA,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,UHC,UHC,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,UHC MGG,UHC MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,VA,VA,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Wellcare MGG,Wellcare MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Bright Health - commercial,Bright Health - commercial,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 10MG/ML INJ    ,92212756,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Bright Health MGG,Bright Health MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINTOX PLUS CTB               ,92212757,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Aetna,Aetna,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Aetna MGG,Aetna MGG,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,BCBS,BCBS,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,BCBS MGG,BCBS MGG,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Cigna,Cigna,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Cigna MGG,Cigna MGG,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Humana,Humana,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Humana MGG,Humana MGG,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Optum VA,Optum VA,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,UHC,UHC,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,UHC MGG,UHC MGG,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,VA,VA,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Wellcare MGG,Wellcare MGG,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Bright Health - commercial,Bright Health - commercial,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
PYSLLIUM 6GM PDR              ,92212758,CDM,250,RC,,,,,,Inpatient,1,EA,97.02,97.02,Bright Health MGG,Bright Health MGG,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Aetna,Aetna,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Aetna MGG,Aetna MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,BCBS,BCBS,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,BCBS MGG,BCBS MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Cigna,Cigna,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Cigna MGG,Cigna MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Humana,Humana,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Humana MGG,Humana MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Optum VA,Optum VA,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,UHC,UHC,190.56,,,,,,,per diem,190.56,190.56,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,UHC MGG,UHC MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,VA,VA,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Wellcare MGG,Wellcare MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Bright Health - commercial,Bright Health - commercial,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92212759,CDM,250,RC,,,,,,Inpatient,1,EA,190.56,190.56,Bright Health MGG,Bright Health MGG,190.56,,,,,,,case rate,190.56,190.56,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLYBURIDE METFORMIN 5/500MG TA,92212760,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Aetna,Aetna,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Aetna MGG,Aetna MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,BCBS,BCBS,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,BCBS MGG,BCBS MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Cigna,Cigna,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Cigna MGG,Cigna MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Humana,Humana,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Humana MGG,Humana MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Optum VA,Optum VA,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,UHC,UHC,14.76,,,,,,,per diem,14.76,14.76,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,UHC MGG,UHC MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,VA,VA,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Wellcare MGG,Wellcare MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Bright Health - commercial,Bright Health - commercial,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212761,CDM,250,RC,,,,,,Inpatient,1,EA,14.76,14.76,Bright Health MGG,Bright Health MGG,14.76,,,,,,,case rate,14.76,14.76,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92212762,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Aetna,Aetna,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Aetna MGG,Aetna MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,BCBS,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS MGG,BCBS MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Cigna,Cigna,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Cigna MGG,Cigna MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Humana,Humana,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Humana MGG,Humana MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Optum VA,Optum VA,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UHC,UHC,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UHC MGG,UHC MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA,VA,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Wellcare MGG,Wellcare MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Bright Health - commercial,Bright Health - commercial,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
ZAFIRLUKAST 20MG TAB          ,92212763,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Bright Health MGG,Bright Health MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Aetna,Aetna,26.76,,,,,,,per diem,26.76,26.76,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Aetna MGG,Aetna MGG,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,BCBS,BCBS,26.76,,,,,,,per diem,26.76,26.76,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,BCBS MGG,BCBS MGG,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Cigna,Cigna,26.76,,,,,,,per diem,26.76,26.76,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Cigna MGG,Cigna MGG,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Humana,Humana,26.76,,,,,,,per diem,26.76,26.76,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Humana MGG,Humana MGG,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Optum VA,Optum VA,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,UHC,UHC,26.76,,,,,,,per diem,26.76,26.76,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,UHC MGG,UHC MGG,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,VA,VA,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Wellcare MGG,Wellcare MGG,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Bright Health - commercial,Bright Health - commercial,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212764,CDM,250,RC,,,,,,Inpatient,1,EA,26.76,26.76,Bright Health MGG,Bright Health MGG,26.76,,,,,,,case rate,26.76,26.76,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Aetna,Aetna,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Aetna MGG,Aetna MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,BCBS,BCBS,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,BCBS MGG,BCBS MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Cigna,Cigna,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Cigna MGG,Cigna MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Humana,Humana,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Humana MGG,Humana MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Optum VA,Optum VA,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,UHC,UHC,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,UHC MGG,UHC MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,VA,VA,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Wellcare MGG,Wellcare MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Bright Health - commercial,Bright Health - commercial,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 5MG TAB     ,92212765,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Bright Health MGG,Bright Health MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Aetna,Aetna,43.95,,,,,,,per diem,43.95,43.95,"Per diem rate, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Aetna MGG,Aetna MGG,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,BCBS,BCBS,43.95,,,,,,,per diem,43.95,43.95,"Per diem rate, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,BCBS MGG,BCBS MGG,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Cigna,Cigna,43.95,,,,,,,per diem,43.95,43.95,"Per diem rate, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Cigna MGG,Cigna MGG,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Humana,Humana,43.95,,,,,,,per diem,43.95,43.95,"Per diem rate, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Humana MGG,Humana MGG,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Optum VA,Optum VA,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,UHC,UHC,43.95,,,,,,,per diem,43.95,43.95,"Per diem rate, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,UHC MGG,UHC MGG,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,VA,VA,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Wellcare MGG,Wellcare MGG,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Bright Health - commercial,Bright Health - commercial,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
PETROLATUM ZINC OXIDE 51-20% P,92212766,CDM,250,RC,,,,,,Inpatient,1,EA,43.95,43.95,Bright Health MGG,Bright Health MGG,43.95,,,,,,,case rate,43.95,43.95,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212767,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Aetna,Aetna,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Aetna MGG,Aetna MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,BCBS,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS MGG,BCBS MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Cigna,Cigna,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Cigna MGG,Cigna MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Humana,Humana,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Humana MGG,Humana MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Optum VA,Optum VA,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,UHC,UHC,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,UHC MGG,UHC MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,VA,VA,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Wellcare MGG,Wellcare MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Bright Health - commercial,Bright Health - commercial,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92212768,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Bright Health MGG,Bright Health MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Aetna,Aetna,359.16,,,,,,,per diem,359.16,359.16,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Aetna MGG,Aetna MGG,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,BCBS,BCBS,359.16,,,,,,,per diem,359.16,359.16,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,BCBS MGG,BCBS MGG,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Cigna,Cigna,359.16,,,,,,,per diem,359.16,359.16,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Cigna MGG,Cigna MGG,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Humana,Humana,359.16,,,,,,,per diem,359.16,359.16,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Humana MGG,Humana MGG,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Optum VA,Optum VA,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,UHC,UHC,359.16,,,,,,,per diem,359.16,359.16,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,UHC MGG,UHC MGG,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,VA,VA,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Wellcare MGG,Wellcare MGG,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Bright Health - commercial,Bright Health - commercial,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212769,CDM,250,RC,,,,,,Inpatient,1,EA,359.16,359.16,Bright Health MGG,Bright Health MGG,359.16,,,,,,,case rate,359.16,359.16,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Aetna,Aetna,149.64,,,,,,,per diem,149.64,149.64,"Per diem rate, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Aetna MGG,Aetna MGG,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,BCBS,BCBS,149.64,,,,,,,per diem,149.64,149.64,"Per diem rate, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,BCBS MGG,BCBS MGG,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Cigna,Cigna,149.64,,,,,,,per diem,149.64,149.64,"Per diem rate, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Cigna MGG,Cigna MGG,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Humana,Humana,149.64,,,,,,,per diem,149.64,149.64,"Per diem rate, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Humana MGG,Humana MGG,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Optum VA,Optum VA,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,UHC,UHC,149.64,,,,,,,per diem,149.64,149.64,"Per diem rate, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,UHC MGG,UHC MGG,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,VA,VA,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Wellcare MGG,Wellcare MGG,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Bright Health - commercial,Bright Health - commercial,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
INSULIN LISPRO U100 PEN       ,92212770,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,149.64,149.64,Bright Health MGG,Bright Health MGG,149.64,,,,,,,case rate,149.64,149.64,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92212771,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Aetna,Aetna,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Aetna MGG,Aetna MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,BCBS,BCBS,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,BCBS MGG,BCBS MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Cigna,Cigna,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Cigna MGG,Cigna MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Humana,Humana,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Humana MGG,Humana MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Optum VA,Optum VA,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,UHC,UHC,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,UHC MGG,UHC MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,VA,VA,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Wellcare MGG,Wellcare MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Bright Health - commercial,Bright Health - commercial,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 40MG TAB       ,92212772,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Bright Health MGG,Bright Health MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna,Aetna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Aetna MGG,Aetna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS,BCBS,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,BCBS MGG,BCBS MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna,Cigna,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Cigna MGG,Cigna MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana,Humana,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Humana MGG,Humana MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Optum VA,Optum VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC,UHC,6,,,,,,,per diem,6,6,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,UHC MGG,UHC MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,VA,VA,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Wellcare MGG,Wellcare MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health - commercial,Bright Health - commercial,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 37.5MG TAB    ,92212773,CDM,250,RC,,,,,,Inpatient,1,EA,6,6,Bright Health MGG,Bright Health MGG,6,,,,,,,case rate,6,6,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92212774,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Aetna,Aetna,129.09,,,,,,,per diem,129.09,129.09,"Per diem rate, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Aetna MGG,Aetna MGG,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,BCBS,BCBS,129.09,,,,,,,per diem,129.09,129.09,"Per diem rate, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,BCBS MGG,BCBS MGG,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Cigna,Cigna,129.09,,,,,,,per diem,129.09,129.09,"Per diem rate, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Cigna MGG,Cigna MGG,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Humana,Humana,129.09,,,,,,,per diem,129.09,129.09,"Per diem rate, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Humana MGG,Humana MGG,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Optum VA,Optum VA,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,UHC,UHC,129.09,,,,,,,per diem,129.09,129.09,"Per diem rate, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,UHC MGG,UHC MGG,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,VA,VA,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Wellcare MGG,Wellcare MGG,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Bright Health - commercial,Bright Health - commercial,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ATOVAQUONE 750MG/5ML SUS      ,92212775,CDM,250,RC,,,,,,Inpatient,1,EA,129.09,129.09,Bright Health MGG,Bright Health MGG,129.09,,,,,,,case rate,129.09,129.09,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Aetna,Aetna,101.34,,,,,,,per diem,101.34,101.34,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Aetna MGG,Aetna MGG,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,BCBS,BCBS,101.34,,,,,,,per diem,101.34,101.34,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,BCBS MGG,BCBS MGG,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Cigna,Cigna,101.34,,,,,,,per diem,101.34,101.34,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Cigna MGG,Cigna MGG,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Humana,Humana,101.34,,,,,,,per diem,101.34,101.34,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Humana MGG,Humana MGG,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Optum VA,Optum VA,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,UHC,UHC,101.34,,,,,,,per diem,101.34,101.34,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,UHC MGG,UHC MGG,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,VA,VA,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Wellcare MGG,Wellcare MGG,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Bright Health - commercial,Bright Health - commercial,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92212776,CDM,250,RC,,,,,,Inpatient,1,EA,101.34,101.34,Bright Health MGG,Bright Health MGG,101.34,,,,,,,case rate,101.34,101.34,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Aetna,Aetna,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Aetna MGG,Aetna MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,BCBS,BCBS,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,BCBS MGG,BCBS MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Cigna,Cigna,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Cigna MGG,Cigna MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Humana,Humana,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Humana MGG,Humana MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Optum VA,Optum VA,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,UHC,UHC,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,UHC MGG,UHC MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,VA,VA,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Wellcare MGG,Wellcare MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Bright Health - commercial,Bright Health - commercial,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92212777,CDM,250,RC,,,,,,Inpatient,1,EA,8.43,8.43,Bright Health MGG,Bright Health MGG,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.4MG TAB          ,92212778,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Aetna,Aetna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Aetna MGG,Aetna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,BCBS,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS MGG,BCBS MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Cigna,Cigna,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Cigna MGG,Cigna MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Humana,Humana,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Humana MGG,Humana MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Optum VA,Optum VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UHC,UHC,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UHC MGG,UHC MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA,VA,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Wellcare MGG,Wellcare MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Bright Health - commercial,Bright Health - commercial,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92212779,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,Bright Health MGG,Bright Health MGG,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Aetna,Aetna,69.63,,,,,,,per diem,69.63,69.63,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Aetna MGG,Aetna MGG,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,BCBS,BCBS,69.63,,,,,,,per diem,69.63,69.63,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,BCBS MGG,BCBS MGG,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Cigna,Cigna,69.63,,,,,,,per diem,69.63,69.63,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Cigna MGG,Cigna MGG,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Humana,Humana,69.63,,,,,,,per diem,69.63,69.63,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Humana MGG,Humana MGG,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Optum VA,Optum VA,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,UHC,UHC,69.63,,,,,,,per diem,69.63,69.63,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,UHC MGG,UHC MGG,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,VA,VA,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Wellcare MGG,Wellcare MGG,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Bright Health - commercial,Bright Health - commercial,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212780,CDM,250,RC,,,,,,Inpatient,1,EA,69.63,69.63,Bright Health MGG,Bright Health MGG,69.63,,,,,,,case rate,69.63,69.63,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92212781,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92212782,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92212783,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SILVER NITRATE KNO3 75-25% SWA,92212784,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Aetna,Aetna,32.37,,,,,,,per diem,32.37,32.37,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Aetna MGG,Aetna MGG,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,BCBS,BCBS,32.37,,,,,,,per diem,32.37,32.37,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,BCBS MGG,BCBS MGG,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Cigna,Cigna,32.37,,,,,,,per diem,32.37,32.37,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Cigna MGG,Cigna MGG,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Humana,Humana,32.37,,,,,,,per diem,32.37,32.37,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Humana MGG,Humana MGG,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Optum VA,Optum VA,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,UHC,UHC,32.37,,,,,,,per diem,32.37,32.37,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,UHC MGG,UHC MGG,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,VA,VA,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Wellcare MGG,Wellcare MGG,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Bright Health - commercial,Bright Health - commercial,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92212785,CDM,250,RC,,,,,,Inpatient,1,EA,32.37,32.37,Bright Health MGG,Bright Health MGG,32.37,,,,,,,case rate,32.37,32.37,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212786,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Aetna,Aetna,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Aetna MGG,Aetna MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,BCBS,BCBS,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,BCBS MGG,BCBS MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Cigna,Cigna,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Cigna MGG,Cigna MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Humana,Humana,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Humana MGG,Humana MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Optum VA,Optum VA,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,UHC,UHC,67.32,,,,,,,per diem,67.32,67.32,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,UHC MGG,UHC MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,VA,VA,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Wellcare MGG,Wellcare MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Bright Health - commercial,Bright Health - commercial,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212787,CDM,250,RC,,,,,,Inpatient,1,EA,67.32,67.32,Bright Health MGG,Bright Health MGG,67.32,,,,,,,case rate,67.32,67.32,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Aetna,Aetna,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Aetna MGG,Aetna MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,BCBS,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS MGG,BCBS MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Cigna,Cigna,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Cigna MGG,Cigna MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Humana,Humana,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Humana MGG,Humana MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Optum VA,Optum VA,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UHC,UHC,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UHC MGG,UHC MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,VA,VA,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Wellcare MGG,Wellcare MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Bright Health - commercial,Bright Health - commercial,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/ML INJ         ,92212788,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,Bright Health MGG,Bright Health MGG,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Aetna,Aetna,29.82,,,,,,,per diem,29.82,29.82,"Per diem rate, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Aetna MGG,Aetna MGG,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,BCBS,BCBS,29.82,,,,,,,per diem,29.82,29.82,"Per diem rate, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,BCBS MGG,BCBS MGG,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Cigna,Cigna,29.82,,,,,,,per diem,29.82,29.82,"Per diem rate, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Cigna MGG,Cigna MGG,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Humana,Humana,29.82,,,,,,,per diem,29.82,29.82,"Per diem rate, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Humana MGG,Humana MGG,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Optum VA,Optum VA,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,UHC,UHC,29.82,,,,,,,per diem,29.82,29.82,"Per diem rate, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,UHC MGG,UHC MGG,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,VA,VA,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Wellcare MGG,Wellcare MGG,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Bright Health - commercial,Bright Health - commercial,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
TEMAZEPAM 7.5MG CAP           ,92212789,CDM,250,RC,,,,,,Inpatient,1,EA,29.82,29.82,Bright Health MGG,Bright Health MGG,29.82,,,,,,,case rate,29.82,29.82,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Aetna,Aetna,816.42,,,,,,,per diem,816.42,816.42,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Aetna MGG,Aetna MGG,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,BCBS,BCBS,816.42,,,,,,,per diem,816.42,816.42,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,BCBS MGG,BCBS MGG,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Cigna,Cigna,816.42,,,,,,,per diem,816.42,816.42,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Cigna MGG,Cigna MGG,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Humana,Humana,816.42,,,,,,,per diem,816.42,816.42,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Humana MGG,Humana MGG,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Optum VA,Optum VA,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,UHC,UHC,816.42,,,,,,,per diem,816.42,816.42,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,UHC MGG,UHC MGG,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,VA,VA,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Wellcare MGG,Wellcare MGG,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Bright Health - commercial,Bright Health - commercial,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG/5ML SU,92212790,CDM,250,RC,,,,,,Inpatient,1,EA,816.42,816.42,Bright Health MGG,Bright Health MGG,816.42,,,,,,,case rate,816.42,816.42,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Aetna,Aetna,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Aetna MGG,Aetna MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,BCBS,BCBS,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,BCBS MGG,BCBS MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Cigna,Cigna,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Cigna MGG,Cigna MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Humana,Humana,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Humana MGG,Humana MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Optum VA,Optum VA,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,UHC,UHC,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,UHC MGG,UHC MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,VA,VA,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Wellcare MGG,Wellcare MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Bright Health - commercial,Bright Health - commercial,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 12.5MG TAB         ,92212791,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Bright Health MGG,Bright Health MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna,Aetna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna MGG,Aetna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS,BCBS,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS MGG,BCBS MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna,Cigna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna MGG,Cigna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana,Humana,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana MGG,Humana MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Optum VA,Optum VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC,UHC,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC MGG,UHC MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,VA,VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Wellcare MGG,Wellcare MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health - commercial,Bright Health - commercial,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TER        ,92212792,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health MGG,Bright Health MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Aetna,Aetna,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Aetna MGG,Aetna MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,BCBS,BCBS,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,BCBS MGG,BCBS MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Cigna,Cigna,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Cigna MGG,Cigna MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Humana,Humana,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Humana MGG,Humana MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Optum VA,Optum VA,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,UHC,UHC,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,UHC MGG,UHC MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,VA,VA,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Wellcare MGG,Wellcare MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Bright Health - commercial,Bright Health - commercial,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92212793,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Bright Health MGG,Bright Health MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Aetna,Aetna,217.68,,,,,,,per diem,217.68,217.68,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Aetna MGG,Aetna MGG,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,BCBS,BCBS,217.68,,,,,,,per diem,217.68,217.68,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,BCBS MGG,BCBS MGG,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Cigna,Cigna,217.68,,,,,,,per diem,217.68,217.68,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Cigna MGG,Cigna MGG,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Humana,Humana,217.68,,,,,,,per diem,217.68,217.68,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Humana MGG,Humana MGG,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Optum VA,Optum VA,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,UHC,UHC,217.68,,,,,,,per diem,217.68,217.68,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,UHC MGG,UHC MGG,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,VA,VA,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Wellcare MGG,Wellcare MGG,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Bright Health - commercial,Bright Health - commercial,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92212794,CDM,250,RC,,,,,,Inpatient,1,EA,217.68,217.68,Bright Health MGG,Bright Health MGG,217.68,,,,,,,case rate,217.68,217.68,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212795,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92212796,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Aetna,Aetna,39.78,,,,,,,per diem,39.78,39.78,"Per diem rate, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Aetna MGG,Aetna MGG,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,BCBS,BCBS,39.78,,,,,,,per diem,39.78,39.78,"Per diem rate, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,BCBS MGG,BCBS MGG,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Cigna,Cigna,39.78,,,,,,,per diem,39.78,39.78,"Per diem rate, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Cigna MGG,Cigna MGG,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Humana,Humana,39.78,,,,,,,per diem,39.78,39.78,"Per diem rate, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Humana MGG,Humana MGG,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Optum VA,Optum VA,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,UHC,UHC,39.78,,,,,,,per diem,39.78,39.78,"Per diem rate, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,UHC MGG,UHC MGG,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,VA,VA,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Wellcare MGG,Wellcare MGG,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Bright Health - commercial,Bright Health - commercial,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
ALUMINUM ACETATE SOL          ,92212797,CDM,250,RC,,,,,,Inpatient,1,EA,39.78,39.78,Bright Health MGG,Bright Health MGG,39.78,,,,,,,case rate,39.78,39.78,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Aetna,Aetna,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Aetna MGG,Aetna MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,BCBS,BCBS,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,BCBS MGG,BCBS MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Cigna,Cigna,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Cigna MGG,Cigna MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Humana,Humana,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Humana MGG,Humana MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Optum VA,Optum VA,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,UHC,UHC,279,,,,,,,per diem,279,279,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,UHC MGG,UHC MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,VA,VA,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Wellcare MGG,Wellcare MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Bright Health - commercial,Bright Health - commercial,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92212798,CDM,250,RC,,,,,,Inpatient,1,EA,279,279,Bright Health MGG,Bright Health MGG,279,,,,,,,case rate,279,279,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Aetna,Aetna,175.68,,,,,,,per diem,175.68,175.68,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Aetna MGG,Aetna MGG,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,BCBS,BCBS,175.68,,,,,,,per diem,175.68,175.68,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,BCBS MGG,BCBS MGG,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Cigna,Cigna,175.68,,,,,,,per diem,175.68,175.68,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Cigna MGG,Cigna MGG,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Humana,Humana,175.68,,,,,,,per diem,175.68,175.68,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Humana MGG,Humana MGG,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Optum VA,Optum VA,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,UHC,UHC,175.68,,,,,,,per diem,175.68,175.68,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,UHC MGG,UHC MGG,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,VA,VA,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Wellcare MGG,Wellcare MGG,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Bright Health - commercial,Bright Health - commercial,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG ODT           ,92212799,CDM,250,RC,,,,,,Inpatient,1,EA,175.68,175.68,Bright Health MGG,Bright Health MGG,175.68,,,,,,,case rate,175.68,175.68,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Aetna,Aetna,605.7,,,,,,,per diem,605.7,605.7,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Aetna MGG,Aetna MGG,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,BCBS,BCBS,605.7,,,,,,,per diem,605.7,605.7,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,BCBS MGG,BCBS MGG,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Cigna,Cigna,605.7,,,,,,,per diem,605.7,605.7,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Cigna MGG,Cigna MGG,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Humana,Humana,605.7,,,,,,,per diem,605.7,605.7,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Humana MGG,Humana MGG,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Optum VA,Optum VA,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,UHC,UHC,605.7,,,,,,,per diem,605.7,605.7,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,UHC MGG,UHC MGG,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,VA,VA,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Wellcare MGG,Wellcare MGG,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Bright Health - commercial,Bright Health - commercial,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULF SUS   ,92212800,CDM,250,RC,,,,,,Inpatient,1,EA,605.7,605.7,Bright Health MGG,Bright Health MGG,605.7,,,,,,,case rate,605.7,605.7,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Aetna,Aetna,159.39,,,,,,,per diem,159.39,159.39,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Aetna MGG,Aetna MGG,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,BCBS,BCBS,159.39,,,,,,,per diem,159.39,159.39,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,BCBS MGG,BCBS MGG,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Cigna,Cigna,159.39,,,,,,,per diem,159.39,159.39,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Cigna MGG,Cigna MGG,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Humana,Humana,159.39,,,,,,,per diem,159.39,159.39,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Humana MGG,Humana MGG,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Optum VA,Optum VA,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,UHC,UHC,159.39,,,,,,,per diem,159.39,159.39,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,UHC MGG,UHC MGG,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,VA,VA,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Wellcare MGG,Wellcare MGG,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Bright Health - commercial,Bright Health - commercial,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92212801,CDM,250,RC,,,,,,Inpatient,1,EA,159.39,159.39,Bright Health MGG,Bright Health MGG,159.39,,,,,,,case rate,159.39,159.39,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Aetna,Aetna,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Aetna MGG,Aetna MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,BCBS,BCBS,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,BCBS MGG,BCBS MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Cigna,Cigna,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Cigna MGG,Cigna MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Humana,Humana,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Humana MGG,Humana MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Optum VA,Optum VA,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,UHC,UHC,195.72,,,,,,,per diem,195.72,195.72,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,UHC MGG,UHC MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,VA,VA,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Wellcare MGG,Wellcare MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Bright Health - commercial,Bright Health - commercial,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92212802,CDM,250,RC,,,,,,Inpatient,1,EA,195.72,195.72,Bright Health MGG,Bright Health MGG,195.72,,,,,,,case rate,195.72,195.72,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Aetna,Aetna,1579.47,,,,,,,per diem,1579.47,1579.47,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Aetna MGG,Aetna MGG,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,BCBS,BCBS,1579.47,,,,,,,per diem,1579.47,1579.47,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,BCBS MGG,BCBS MGG,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Cigna,Cigna,1579.47,,,,,,,per diem,1579.47,1579.47,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Cigna MGG,Cigna MGG,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Humana,Humana,1579.47,,,,,,,per diem,1579.47,1579.47,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Humana MGG,Humana MGG,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Optum VA,Optum VA,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,UHC,UHC,1579.47,,,,,,,per diem,1579.47,1579.47,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,UHC MGG,UHC MGG,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,VA,VA,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Wellcare MGG,Wellcare MGG,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Bright Health - commercial,Bright Health - commercial,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92212803,CDM,250,RC,,,,,,Inpatient,1,EA,1579.47,1579.47,Bright Health MGG,Bright Health MGG,1579.47,,,,,,,case rate,1579.47,1579.47,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212804,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna,Aetna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna MGG,Aetna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,BCBS,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS MGG,BCBS MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna,Cigna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna MGG,Cigna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana,Humana,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana MGG,Humana MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Optum VA,Optum VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC,UHC,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC MGG,UHC MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,VA,VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Wellcare MGG,Wellcare MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health - commercial,Bright Health - commercial,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92212805,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health MGG,Bright Health MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Aetna,Aetna,35.13,,,,,,,per diem,35.13,35.13,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Aetna MGG,Aetna MGG,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,BCBS,BCBS,35.13,,,,,,,per diem,35.13,35.13,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,BCBS MGG,BCBS MGG,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Cigna,Cigna,35.13,,,,,,,per diem,35.13,35.13,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Cigna MGG,Cigna MGG,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Humana,Humana,35.13,,,,,,,per diem,35.13,35.13,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Humana MGG,Humana MGG,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Optum VA,Optum VA,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,UHC,UHC,35.13,,,,,,,per diem,35.13,35.13,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,UHC MGG,UHC MGG,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,VA,VA,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Wellcare MGG,Wellcare MGG,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Bright Health - commercial,Bright Health - commercial,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212806,CDM,250,RC,,,,,,Inpatient,1,EA,35.13,35.13,Bright Health MGG,Bright Health MGG,35.13,,,,,,,case rate,35.13,35.13,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Aetna,Aetna,45.12,,,,,,,per diem,45.12,45.12,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Aetna MGG,Aetna MGG,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,BCBS,BCBS,45.12,,,,,,,per diem,45.12,45.12,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,BCBS MGG,BCBS MGG,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Cigna,Cigna,45.12,,,,,,,per diem,45.12,45.12,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Cigna MGG,Cigna MGG,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Humana,Humana,45.12,,,,,,,per diem,45.12,45.12,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Humana MGG,Humana MGG,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Optum VA,Optum VA,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,UHC,UHC,45.12,,,,,,,per diem,45.12,45.12,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,UHC MGG,UHC MGG,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,VA,VA,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Wellcare MGG,Wellcare MGG,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Bright Health - commercial,Bright Health - commercial,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92212807,CDM,250,RC,,,,,,Inpatient,1,EA,45.12,45.12,Bright Health MGG,Bright Health MGG,45.12,,,,,,,case rate,45.12,45.12,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Aetna,Aetna,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Aetna MGG,Aetna MGG,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,BCBS,BCBS,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,BCBS MGG,BCBS MGG,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Cigna,Cigna,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Cigna MGG,Cigna MGG,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Humana,Humana,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Humana MGG,Humana MGG,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Optum VA,Optum VA,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,UHC,UHC,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,UHC MGG,UHC MGG,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,VA,VA,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Wellcare MGG,Wellcare MGG,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Bright Health - commercial,Bright Health - commercial,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 400MG TAB     ,92212808,CDM,250,RC,,,,,,Inpatient,1,EA,39.87,39.87,Bright Health MGG,Bright Health MGG,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92212809,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92212810,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92212811,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Aetna,Aetna,77.64,,,,,,,per diem,77.64,77.64,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Aetna MGG,Aetna MGG,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,BCBS,BCBS,77.64,,,,,,,per diem,77.64,77.64,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,BCBS MGG,BCBS MGG,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Cigna,Cigna,77.64,,,,,,,per diem,77.64,77.64,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Cigna MGG,Cigna MGG,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Humana,Humana,77.64,,,,,,,per diem,77.64,77.64,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Humana MGG,Humana MGG,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Optum VA,Optum VA,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,UHC,UHC,77.64,,,,,,,per diem,77.64,77.64,"Per diem rate, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,UHC MGG,UHC MGG,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,VA,VA,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Wellcare MGG,Wellcare MGG,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Bright Health - commercial,Bright Health - commercial,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
DESMOPRESSIN ACET 4MCG/ML INJ ,92212812,CDM,250,RC,,,,,,Inpatient,1,EA,77.64,77.64,Bright Health MGG,Bright Health MGG,77.64,,,,,,,case rate,77.64,77.64,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Aetna,Aetna,32.73,,,,,,,per diem,32.73,32.73,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Aetna MGG,Aetna MGG,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,BCBS,BCBS,32.73,,,,,,,per diem,32.73,32.73,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,BCBS MGG,BCBS MGG,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Cigna,Cigna,32.73,,,,,,,per diem,32.73,32.73,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Cigna MGG,Cigna MGG,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Humana,Humana,32.73,,,,,,,per diem,32.73,32.73,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Humana MGG,Humana MGG,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Optum VA,Optum VA,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,UHC,UHC,32.73,,,,,,,per diem,32.73,32.73,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,UHC MGG,UHC MGG,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,VA,VA,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Wellcare MGG,Wellcare MGG,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Bright Health - commercial,Bright Health - commercial,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92212813,CDM,250,RC,,,,,,Inpatient,1,EA,32.73,32.73,Bright Health MGG,Bright Health MGG,32.73,,,,,,,case rate,32.73,32.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Aetna,Aetna,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Aetna MGG,Aetna MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,BCBS,BCBS,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,BCBS MGG,BCBS MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Cigna,Cigna,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Cigna MGG,Cigna MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Humana,Humana,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Humana MGG,Humana MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Optum VA,Optum VA,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,UHC,UHC,12.75,,,,,,,per diem,12.75,12.75,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,UHC MGG,UHC MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,VA,VA,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Wellcare MGG,Wellcare MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Bright Health - commercial,Bright Health - commercial,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 1MG TAB        ,92212814,CDM,250,RC,,,,,,Inpatient,1,EA,12.75,12.75,Bright Health MGG,Bright Health MGG,12.75,,,,,,,case rate,12.75,12.75,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212815,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Aetna,Aetna,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Aetna MGG,Aetna MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,BCBS,BCBS,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,BCBS MGG,BCBS MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Cigna,Cigna,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Cigna MGG,Cigna MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Humana,Humana,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Humana MGG,Humana MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Optum VA,Optum VA,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,UHC,UHC,18.06,,,,,,,per diem,18.06,18.06,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,UHC MGG,UHC MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,VA,VA,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Wellcare MGG,Wellcare MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Bright Health - commercial,Bright Health - commercial,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG TAB      ,92212816,CDM,250,RC,,,,,,Inpatient,1,EA,18.06,18.06,Bright Health MGG,Bright Health MGG,18.06,,,,,,,case rate,18.06,18.06,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Aetna,Aetna,15.36,,,,,,,per diem,15.36,15.36,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Aetna MGG,Aetna MGG,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,BCBS,BCBS,15.36,,,,,,,per diem,15.36,15.36,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,BCBS MGG,BCBS MGG,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Cigna,Cigna,15.36,,,,,,,per diem,15.36,15.36,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Cigna MGG,Cigna MGG,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Humana,Humana,15.36,,,,,,,per diem,15.36,15.36,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Humana MGG,Humana MGG,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Optum VA,Optum VA,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,UHC,UHC,15.36,,,,,,,per diem,15.36,15.36,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,UHC MGG,UHC MGG,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,VA,VA,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Wellcare MGG,Wellcare MGG,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Bright Health - commercial,Bright Health - commercial,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 600MG TAB       ,92212817,CDM,250,RC,,,,,,Inpatient,1,EA,15.36,15.36,Bright Health MGG,Bright Health MGG,15.36,,,,,,,case rate,15.36,15.36,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Aetna,Aetna,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Aetna MGG,Aetna MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,BCBS,BCBS,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,BCBS MGG,BCBS MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Cigna,Cigna,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Cigna MGG,Cigna MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Humana,Humana,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Humana MGG,Humana MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Optum VA,Optum VA,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,UHC,UHC,249.48,,,,,,,per diem,249.48,249.48,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,UHC MGG,UHC MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,VA,VA,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Wellcare MGG,Wellcare MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Bright Health - commercial,Bright Health - commercial,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92212818,CDM,250,RC,,,,,,Inpatient,1,EA,249.48,249.48,Bright Health MGG,Bright Health MGG,249.48,,,,,,,case rate,249.48,249.48,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Aetna,Aetna,160.44,,,,,,,per diem,160.44,160.44,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Aetna MGG,Aetna MGG,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,BCBS,BCBS,160.44,,,,,,,per diem,160.44,160.44,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,BCBS MGG,BCBS MGG,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Cigna,Cigna,160.44,,,,,,,per diem,160.44,160.44,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Cigna MGG,Cigna MGG,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Humana,Humana,160.44,,,,,,,per diem,160.44,160.44,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Humana MGG,Humana MGG,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Optum VA,Optum VA,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,UHC,UHC,160.44,,,,,,,per diem,160.44,160.44,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,UHC MGG,UHC MGG,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,VA,VA,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Wellcare MGG,Wellcare MGG,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Bright Health - commercial,Bright Health - commercial,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 10MG/ML SUS       ,92212819,CDM,250,RC,,,,,,Inpatient,1,EA,160.44,160.44,Bright Health MGG,Bright Health MGG,160.44,,,,,,,case rate,160.44,160.44,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92212820,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 4MG TAB           ,92212821,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Aetna,Aetna,49.65,,,,,,,per diem,49.65,49.65,"Per diem rate, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Aetna MGG,Aetna MGG,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,BCBS,BCBS,49.65,,,,,,,per diem,49.65,49.65,"Per diem rate, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,BCBS MGG,BCBS MGG,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Cigna,Cigna,49.65,,,,,,,per diem,49.65,49.65,"Per diem rate, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Cigna MGG,Cigna MGG,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Humana,Humana,49.65,,,,,,,per diem,49.65,49.65,"Per diem rate, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Humana MGG,Humana MGG,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Optum VA,Optum VA,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,UHC,UHC,49.65,,,,,,,per diem,49.65,49.65,"Per diem rate, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,UHC MGG,UHC MGG,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,VA,VA,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Wellcare MGG,Wellcare MGG,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Bright Health - commercial,Bright Health - commercial,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
LAMIVUDINE ZIDOVUDIN 150-300 T,92212822,CDM,250,RC,,,,,,Inpatient,1,EA,49.65,49.65,Bright Health MGG,Bright Health MGG,49.65,,,,,,,case rate,49.65,49.65,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212823,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Aetna,Aetna,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Aetna MGG,Aetna MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,BCBS,BCBS,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,BCBS MGG,BCBS MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Cigna,Cigna,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Cigna MGG,Cigna MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Humana,Humana,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Humana MGG,Humana MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Optum VA,Optum VA,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,UHC,UHC,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,UHC MGG,UHC MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,VA,VA,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Wellcare MGG,Wellcare MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Bright Health - commercial,Bright Health - commercial,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 40MG TAB       ,92212824,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Bright Health MGG,Bright Health MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Aetna,Aetna,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Aetna MGG,Aetna MGG,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,BCBS,BCBS,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,BCBS MGG,BCBS MGG,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Cigna,Cigna,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Cigna MGG,Cigna MGG,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Humana,Humana,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Humana MGG,Humana MGG,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Optum VA,Optum VA,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,UHC,UHC,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,UHC MGG,UHC MGG,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,VA,VA,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Wellcare MGG,Wellcare MGG,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Bright Health - commercial,Bright Health - commercial,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
FAMOTIDINE 40MG TAB           ,92212825,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,Bright Health MGG,Bright Health MGG,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISRADIPINE 2.5MG CAP          ,92212826,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Aetna,Aetna,66.72,,,,,,,per diem,66.72,66.72,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Aetna MGG,Aetna MGG,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,BCBS,BCBS,66.72,,,,,,,per diem,66.72,66.72,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,BCBS MGG,BCBS MGG,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Cigna,Cigna,66.72,,,,,,,per diem,66.72,66.72,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Cigna MGG,Cigna MGG,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Humana,Humana,66.72,,,,,,,per diem,66.72,66.72,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Humana MGG,Humana MGG,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Optum VA,Optum VA,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,UHC,UHC,66.72,,,,,,,per diem,66.72,66.72,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,UHC MGG,UHC MGG,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,VA,VA,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Wellcare MGG,Wellcare MGG,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Bright Health - commercial,Bright Health - commercial,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92212827,CDM,250,RC,,,,,,Inpatient,1,EA,66.72,66.72,Bright Health MGG,Bright Health MGG,66.72,,,,,,,case rate,66.72,66.72,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92212828,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Aetna,Aetna,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Aetna MGG,Aetna MGG,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,BCBS,BCBS,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,BCBS MGG,BCBS MGG,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Cigna,Cigna,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Cigna MGG,Cigna MGG,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Humana,Humana,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Humana MGG,Humana MGG,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Optum VA,Optum VA,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,UHC,UHC,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,UHC MGG,UHC MGG,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,VA,VA,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Wellcare MGG,Wellcare MGG,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Bright Health - commercial,Bright Health - commercial,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92212829,CDM,250,RC,,,,,,Inpatient,1,EA,14.34,14.34,Bright Health MGG,Bright Health MGG,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92212830,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92212831,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Aetna,Aetna,17.06,,,,,,,per diem,17.06,17.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Aetna MGG,Aetna MGG,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,BCBS,BCBS,17.06,,,,,,,per diem,17.06,17.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,BCBS MGG,BCBS MGG,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Cigna,Cigna,17.06,,,,,,,per diem,17.06,17.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Cigna MGG,Cigna MGG,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Humana,Humana,17.06,,,,,,,per diem,17.06,17.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Humana MGG,Humana MGG,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Optum VA,Optum VA,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,UHC,UHC,17.06,,,,,,,per diem,17.06,17.06,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,UHC MGG,UHC MGG,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,VA,VA,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Wellcare MGG,Wellcare MGG,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Bright Health - commercial,Bright Health - commercial,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92212832,CDM,250,RC,,,,,,Inpatient,1,EA,17.06,17.06,Bright Health MGG,Bright Health MGG,17.06,,,,,,,case rate,17.06,17.06,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Aetna,Aetna,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Aetna MGG,Aetna MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS,BCBS,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS MGG,BCBS MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Cigna,Cigna,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Cigna MGG,Cigna MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Humana,Humana,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Humana MGG,Humana MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Optum VA,Optum VA,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,UHC,UHC,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,UHC MGG,UHC MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,VA,VA,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Wellcare MGG,Wellcare MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Bright Health - commercial,Bright Health - commercial,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212833,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Bright Health MGG,Bright Health MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Aetna,Aetna,54.57,,,,,,,per diem,54.57,54.57,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Aetna MGG,Aetna MGG,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,BCBS,BCBS,54.57,,,,,,,per diem,54.57,54.57,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,BCBS MGG,BCBS MGG,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Cigna,Cigna,54.57,,,,,,,per diem,54.57,54.57,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Cigna MGG,Cigna MGG,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Humana,Humana,54.57,,,,,,,per diem,54.57,54.57,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Humana MGG,Humana MGG,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Optum VA,Optum VA,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,UHC,UHC,54.57,,,,,,,per diem,54.57,54.57,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,UHC MGG,UHC MGG,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,VA,VA,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Wellcare MGG,Wellcare MGG,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Bright Health - commercial,Bright Health - commercial,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% GEL          ,92212834,CDM,250,RC,,,,,,Inpatient,1,EA,54.57,54.57,Bright Health MGG,Bright Health MGG,54.57,,,,,,,case rate,54.57,54.57,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Aetna,Aetna,24.72,,,,,,,per diem,24.72,24.72,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Aetna MGG,Aetna MGG,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,BCBS,BCBS,24.72,,,,,,,per diem,24.72,24.72,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,BCBS MGG,BCBS MGG,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Cigna,Cigna,24.72,,,,,,,per diem,24.72,24.72,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Cigna MGG,Cigna MGG,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Humana,Humana,24.72,,,,,,,per diem,24.72,24.72,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Humana MGG,Humana MGG,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Optum VA,Optum VA,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,UHC,UHC,24.72,,,,,,,per diem,24.72,24.72,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,UHC MGG,UHC MGG,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,VA,VA,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Wellcare MGG,Wellcare MGG,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Bright Health - commercial,Bright Health - commercial,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92212835,CDM,250,RC,,,,,,Inpatient,1,EA,24.72,24.72,Bright Health MGG,Bright Health MGG,24.72,,,,,,,case rate,24.72,24.72,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Aetna,Aetna,5353.2,,,,,,,per diem,5353.2,5353.2,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Aetna MGG,Aetna MGG,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,BCBS,BCBS,5353.2,,,,,,,per diem,5353.2,5353.2,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,BCBS MGG,BCBS MGG,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Cigna,Cigna,5353.2,,,,,,,per diem,5353.2,5353.2,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Cigna MGG,Cigna MGG,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Humana,Humana,5353.2,,,,,,,per diem,5353.2,5353.2,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Humana MGG,Humana MGG,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Optum VA,Optum VA,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,UHC,UHC,5353.2,,,,,,,per diem,5353.2,5353.2,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,UHC MGG,UHC MGG,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,VA,VA,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Wellcare MGG,Wellcare MGG,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Bright Health - commercial,Bright Health - commercial,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 500U/ML IN,92212836,CDM,250,RC,,,,,,Inpatient,1,EA,5353.2,5353.2,Bright Health MGG,Bright Health MGG,5353.2,,,,,,,case rate,5353.2,5353.2,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Aetna,Aetna,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Aetna MGG,Aetna MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,BCBS,BCBS,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,BCBS MGG,BCBS MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Cigna,Cigna,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Cigna MGG,Cigna MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Humana,Humana,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Humana MGG,Humana MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Optum VA,Optum VA,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,UHC,UHC,7.38,,,,,,,per diem,7.38,7.38,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,UHC MGG,UHC MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,VA,VA,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Wellcare MGG,Wellcare MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Bright Health - commercial,Bright Health - commercial,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212837,CDM,250,RC,,,,,,Inpatient,1,EA,7.38,7.38,Bright Health MGG,Bright Health MGG,7.38,,,,,,,case rate,7.38,7.38,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92212838,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Aetna,Aetna,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Aetna MGG,Aetna MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,BCBS,BCBS,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,BCBS MGG,BCBS MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Cigna,Cigna,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Cigna MGG,Cigna MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Humana,Humana,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Humana MGG,Humana MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Optum VA,Optum VA,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,UHC,UHC,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,UHC MGG,UHC MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,VA,VA,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Wellcare MGG,Wellcare MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Bright Health - commercial,Bright Health - commercial,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92212839,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Bright Health MGG,Bright Health MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 20MG/5ML SOL    ,92212840,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Aetna,Aetna,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Aetna MGG,Aetna MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,BCBS,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS MGG,BCBS MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Cigna,Cigna,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Cigna MGG,Cigna MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Humana,Humana,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Humana MGG,Humana MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Optum VA,Optum VA,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UHC,UHC,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UHC MGG,UHC MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,VA,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Wellcare MGG,Wellcare MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Bright Health - commercial,Bright Health - commercial,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92212841,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,Bright Health MGG,Bright Health MGG,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Aetna,Aetna,130.68,,,,,,,per diem,130.68,130.68,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Aetna MGG,Aetna MGG,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,BCBS,BCBS,130.68,,,,,,,per diem,130.68,130.68,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,BCBS MGG,BCBS MGG,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Cigna,Cigna,130.68,,,,,,,per diem,130.68,130.68,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Cigna MGG,Cigna MGG,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Humana,Humana,130.68,,,,,,,per diem,130.68,130.68,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Humana MGG,Humana MGG,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Optum VA,Optum VA,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,UHC,UHC,130.68,,,,,,,per diem,130.68,130.68,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,UHC MGG,UHC MGG,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,VA,VA,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Wellcare MGG,Wellcare MGG,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Bright Health - commercial,Bright Health - commercial,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212842,CDM,250,RC,,,,,,Inpatient,1,EA,130.68,130.68,Bright Health MGG,Bright Health MGG,130.68,,,,,,,case rate,130.68,130.68,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92212843,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Aetna,Aetna,37.38,,,,,,,per diem,37.38,37.38,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Aetna MGG,Aetna MGG,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,BCBS,BCBS,37.38,,,,,,,per diem,37.38,37.38,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,BCBS MGG,BCBS MGG,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Cigna,Cigna,37.38,,,,,,,per diem,37.38,37.38,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Cigna MGG,Cigna MGG,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Humana,Humana,37.38,,,,,,,per diem,37.38,37.38,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Humana MGG,Humana MGG,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Optum VA,Optum VA,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,UHC,UHC,37.38,,,,,,,per diem,37.38,37.38,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,UHC MGG,UHC MGG,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,VA,VA,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Wellcare MGG,Wellcare MGG,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Bright Health - commercial,Bright Health - commercial,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212844,CDM,250,RC,,,,,,Inpatient,1,EA,37.38,37.38,Bright Health MGG,Bright Health MGG,37.38,,,,,,,case rate,37.38,37.38,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Aetna,Aetna,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Aetna MGG,Aetna MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,BCBS,BCBS,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,BCBS MGG,BCBS MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Cigna,Cigna,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Cigna MGG,Cigna MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Humana,Humana,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Humana MGG,Humana MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Optum VA,Optum VA,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,UHC,UHC,48.57,,,,,,,per diem,48.57,48.57,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,UHC MGG,UHC MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,VA,VA,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Wellcare MGG,Wellcare MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Bright Health - commercial,Bright Health - commercial,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92212845,CDM,250,RC,,,,,,Inpatient,1,EA,48.57,48.57,Bright Health MGG,Bright Health MGG,48.57,,,,,,,case rate,48.57,48.57,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Aetna,Aetna,207.6,,,,,,,per diem,207.6,207.6,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Aetna MGG,Aetna MGG,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,BCBS,BCBS,207.6,,,,,,,per diem,207.6,207.6,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,BCBS MGG,BCBS MGG,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Cigna,Cigna,207.6,,,,,,,per diem,207.6,207.6,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Cigna MGG,Cigna MGG,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Humana,Humana,207.6,,,,,,,per diem,207.6,207.6,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Humana MGG,Humana MGG,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Optum VA,Optum VA,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,UHC,UHC,207.6,,,,,,,per diem,207.6,207.6,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,UHC MGG,UHC MGG,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,VA,VA,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Wellcare MGG,Wellcare MGG,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Bright Health - commercial,Bright Health - commercial,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212846,CDM,250,RC,,,,,,Inpatient,1,EA,207.6,207.6,Bright Health MGG,Bright Health MGG,207.6,,,,,,,case rate,207.6,207.6,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Aetna,Aetna,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Aetna MGG,Aetna MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,BCBS,BCBS,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,BCBS MGG,BCBS MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Cigna,Cigna,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Cigna MGG,Cigna MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Humana,Humana,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Humana MGG,Humana MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Optum VA,Optum VA,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,UHC,UHC,60.96,,,,,,,per diem,60.96,60.96,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,UHC MGG,UHC MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,VA,VA,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Wellcare MGG,Wellcare MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Bright Health - commercial,Bright Health - commercial,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92212847,CDM,250,RC,,,,,,Inpatient,1,EA,60.96,60.96,Bright Health MGG,Bright Health MGG,60.96,,,,,,,case rate,60.96,60.96,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Aetna,Aetna,889.86,,,,,,,per diem,889.86,889.86,"Per diem rate, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Aetna MGG,Aetna MGG,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,BCBS,BCBS,889.86,,,,,,,per diem,889.86,889.86,"Per diem rate, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,BCBS MGG,BCBS MGG,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Cigna,Cigna,889.86,,,,,,,per diem,889.86,889.86,"Per diem rate, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Cigna MGG,Cigna MGG,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Humana,Humana,889.86,,,,,,,per diem,889.86,889.86,"Per diem rate, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Humana MGG,Humana MGG,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Optum VA,Optum VA,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,UHC,UHC,889.86,,,,,,,per diem,889.86,889.86,"Per diem rate, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,UHC MGG,UHC MGG,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,VA,VA,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Wellcare MGG,Wellcare MGG,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Bright Health - commercial,Bright Health - commercial,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
TRETINOIN 0.01% GEL           ,92212848,CDM,250,RC,,,,,,Inpatient,1,EA,889.86,889.86,Bright Health MGG,Bright Health MGG,889.86,,,,,,,case rate,889.86,889.86,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92212849,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Aetna,Aetna,41.73,,,,,,,per diem,41.73,41.73,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Aetna MGG,Aetna MGG,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,BCBS,BCBS,41.73,,,,,,,per diem,41.73,41.73,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,BCBS MGG,BCBS MGG,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Cigna,Cigna,41.73,,,,,,,per diem,41.73,41.73,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Cigna MGG,Cigna MGG,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Humana,Humana,41.73,,,,,,,per diem,41.73,41.73,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Humana MGG,Humana MGG,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Optum VA,Optum VA,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,UHC,UHC,41.73,,,,,,,per diem,41.73,41.73,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,UHC MGG,UHC MGG,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,VA,VA,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Wellcare MGG,Wellcare MGG,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Bright Health - commercial,Bright Health - commercial,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212850,CDM,250,RC,,,,,,Inpatient,1,EA,41.73,41.73,Bright Health MGG,Bright Health MGG,41.73,,,,,,,case rate,41.73,41.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Aetna,Aetna,188.13,,,,,,,per diem,188.13,188.13,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Aetna MGG,Aetna MGG,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,BCBS,BCBS,188.13,,,,,,,per diem,188.13,188.13,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,BCBS MGG,BCBS MGG,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Cigna,Cigna,188.13,,,,,,,per diem,188.13,188.13,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Cigna MGG,Cigna MGG,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Humana,Humana,188.13,,,,,,,per diem,188.13,188.13,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Humana MGG,Humana MGG,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Optum VA,Optum VA,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,UHC,UHC,188.13,,,,,,,per diem,188.13,188.13,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,UHC MGG,UHC MGG,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,VA,VA,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Wellcare MGG,Wellcare MGG,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Bright Health - commercial,Bright Health - commercial,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92212851,CDM,250,RC,,,,,,Inpatient,1,EA,188.13,188.13,Bright Health MGG,Bright Health MGG,188.13,,,,,,,case rate,188.13,188.13,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna,Aetna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Aetna MGG,Aetna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS,BCBS,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,BCBS MGG,BCBS MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna,Cigna,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Cigna MGG,Cigna MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana,Humana,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Humana MGG,Humana MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Optum VA,Optum VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC,UHC,7.17,,,,,,,per diem,7.17,7.17,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,UHC MGG,UHC MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,VA,VA,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Wellcare MGG,Wellcare MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health - commercial,Bright Health - commercial,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92212852,CDM,250,RC,,,,,,Inpatient,1,EA,7.17,7.17,Bright Health MGG,Bright Health MGG,7.17,,,,,,,case rate,7.17,7.17,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92212853,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Aetna,Aetna,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Aetna MGG,Aetna MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,BCBS,BCBS,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,BCBS MGG,BCBS MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Cigna,Cigna,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Cigna MGG,Cigna MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Humana,Humana,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Humana MGG,Humana MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Optum VA,Optum VA,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,UHC,UHC,55.62,,,,,,,per diem,55.62,55.62,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,UHC MGG,UHC MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,VA,VA,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Wellcare MGG,Wellcare MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Bright Health - commercial,Bright Health - commercial,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92212854,CDM,250,RC,,,,,,Inpatient,1,EA,55.62,55.62,Bright Health MGG,Bright Health MGG,55.62,,,,,,,case rate,55.62,55.62,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92212855,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92212856,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92212857,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Aetna,Aetna,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Aetna MGG,Aetna MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,BCBS,BCBS,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,BCBS MGG,BCBS MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Cigna,Cigna,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Cigna MGG,Cigna MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Humana,Humana,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Humana MGG,Humana MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Optum VA,Optum VA,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,UHC,UHC,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,UHC MGG,UHC MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,VA,VA,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Wellcare MGG,Wellcare MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Bright Health - commercial,Bright Health - commercial,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212858,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Bright Health MGG,Bright Health MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92212859,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Aetna,Aetna,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Aetna MGG,Aetna MGG,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,BCBS,BCBS,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,BCBS MGG,BCBS MGG,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Cigna,Cigna,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Cigna MGG,Cigna MGG,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Humana,Humana,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Humana MGG,Humana MGG,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Optum VA,Optum VA,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,UHC,UHC,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,UHC MGG,UHC MGG,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,VA,VA,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Wellcare MGG,Wellcare MGG,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Bright Health - commercial,Bright Health - commercial,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
CARBOXYMETHYLCELLULOSE SODIUM ,92212860,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,Bright Health MGG,Bright Health MGG,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92212861,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLUCOSAMINE 500MG CAP         ,92212862,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Aetna,Aetna,158.19,,,,,,,per diem,158.19,158.19,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Aetna MGG,Aetna MGG,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,BCBS,BCBS,158.19,,,,,,,per diem,158.19,158.19,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,BCBS MGG,BCBS MGG,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Cigna,Cigna,158.19,,,,,,,per diem,158.19,158.19,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Cigna MGG,Cigna MGG,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Humana,Humana,158.19,,,,,,,per diem,158.19,158.19,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Humana MGG,Humana MGG,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Optum VA,Optum VA,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,UHC,UHC,158.19,,,,,,,per diem,158.19,158.19,"Per diem rate, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,UHC MGG,UHC MGG,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,VA,VA,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Wellcare MGG,Wellcare MGG,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Bright Health - commercial,Bright Health - commercial,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
DIDANOSINE 10MG/ML SUS        ,92212863,CDM,250,RC,,,,,,Inpatient,1,EA,158.19,158.19,Bright Health MGG,Bright Health MGG,158.19,,,,,,,case rate,158.19,158.19,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Aetna,Aetna,23.04,,,,,,,per diem,23.04,23.04,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Aetna MGG,Aetna MGG,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,BCBS,BCBS,23.04,,,,,,,per diem,23.04,23.04,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,BCBS MGG,BCBS MGG,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Cigna,Cigna,23.04,,,,,,,per diem,23.04,23.04,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Cigna MGG,Cigna MGG,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Humana,Humana,23.04,,,,,,,per diem,23.04,23.04,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Humana MGG,Humana MGG,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Optum VA,Optum VA,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,UHC,UHC,23.04,,,,,,,per diem,23.04,23.04,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,UHC MGG,UHC MGG,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,VA,VA,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Wellcare MGG,Wellcare MGG,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Bright Health - commercial,Bright Health - commercial,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92212864,CDM,250,RC,,,,,,Inpatient,1,EA,23.04,23.04,Bright Health MGG,Bright Health MGG,23.04,,,,,,,case rate,23.04,23.04,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Aetna,Aetna,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Aetna MGG,Aetna MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,BCBS,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS MGG,BCBS MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Cigna,Cigna,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Cigna MGG,Cigna MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Humana,Humana,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Humana MGG,Humana MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Optum VA,Optum VA,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,UHC,UHC,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,UHC MGG,UHC MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,VA,VA,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Wellcare MGG,Wellcare MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Bright Health - commercial,Bright Health - commercial,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
KETAMINE HCL 50MG/ML INJ      ,92212865,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,Bright Health MGG,Bright Health MGG,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 10% INH SOL         ,92212866,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 450MG TER   ,92212867,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Aetna,Aetna,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Aetna MGG,Aetna MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,BCBS,BCBS,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,BCBS MGG,BCBS MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Cigna,Cigna,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Cigna MGG,Cigna MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Humana,Humana,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Humana MGG,Humana MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Optum VA,Optum VA,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,UHC,UHC,335.82,,,,,,,per diem,335.82,335.82,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,UHC MGG,UHC MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,VA,VA,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Wellcare MGG,Wellcare MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Bright Health - commercial,Bright Health - commercial,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92212868,CDM,250,RC,,,,,,Inpatient,1,EA,335.82,335.82,Bright Health MGG,Bright Health MGG,335.82,,,,,,,case rate,335.82,335.82,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Aetna,Aetna,227.85,,,,,,,per diem,227.85,227.85,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Aetna MGG,Aetna MGG,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,BCBS,BCBS,227.85,,,,,,,per diem,227.85,227.85,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,BCBS MGG,BCBS MGG,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Cigna,Cigna,227.85,,,,,,,per diem,227.85,227.85,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Cigna MGG,Cigna MGG,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Humana,Humana,227.85,,,,,,,per diem,227.85,227.85,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Humana MGG,Humana MGG,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Optum VA,Optum VA,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,UHC,UHC,227.85,,,,,,,per diem,227.85,227.85,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,UHC MGG,UHC MGG,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,VA,VA,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Wellcare MGG,Wellcare MGG,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Bright Health - commercial,Bright Health - commercial,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212869,CDM,250,RC,,,,,,Inpatient,1,EA,227.85,227.85,Bright Health MGG,Bright Health MGG,227.85,,,,,,,case rate,227.85,227.85,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna,Aetna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Aetna MGG,Aetna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS,BCBS,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,BCBS MGG,BCBS MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna,Cigna,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Cigna MGG,Cigna MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana,Humana,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Humana MGG,Humana MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Optum VA,Optum VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC,UHC,18,,,,,,,per diem,18,18,"Per diem rate, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,UHC MGG,UHC MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,VA,VA,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Wellcare MGG,Wellcare MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health - commercial,Bright Health - commercial,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
OFLOXACIN 400MG TAB           ,92212870,CDM,250,RC,,,,,,Inpatient,1,EA,18,18,Bright Health MGG,Bright Health MGG,18,,,,,,,case rate,18,18,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Aetna,Aetna,216.99,,,,,,,per diem,216.99,216.99,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Aetna MGG,Aetna MGG,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,BCBS,BCBS,216.99,,,,,,,per diem,216.99,216.99,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,BCBS MGG,BCBS MGG,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Cigna,Cigna,216.99,,,,,,,per diem,216.99,216.99,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Cigna MGG,Cigna MGG,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Humana,Humana,216.99,,,,,,,per diem,216.99,216.99,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Humana MGG,Humana MGG,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Optum VA,Optum VA,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,UHC,UHC,216.99,,,,,,,per diem,216.99,216.99,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,UHC MGG,UHC MGG,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,VA,VA,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Wellcare MGG,Wellcare MGG,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Bright Health - commercial,Bright Health - commercial,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92212871,CDM,250,RC,,,,,,Inpatient,1,EA,216.99,216.99,Bright Health MGG,Bright Health MGG,216.99,,,,,,,case rate,216.99,216.99,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Aetna,Aetna,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Aetna MGG,Aetna MGG,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,BCBS,BCBS,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,BCBS MGG,BCBS MGG,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Cigna,Cigna,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Cigna MGG,Cigna MGG,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Humana,Humana,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Humana MGG,Humana MGG,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Optum VA,Optum VA,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,UHC,UHC,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,UHC MGG,UHC MGG,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,VA,VA,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Wellcare MGG,Wellcare MGG,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Bright Health - commercial,Bright Health - commercial,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
MEBENDAZOLE 100MG CTB         ,92212872,CDM,250,RC,,,,,,Inpatient,1,EA,17.49,17.49,Bright Health MGG,Bright Health MGG,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Aetna,Aetna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Aetna MGG,Aetna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,BCBS,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS MGG,BCBS MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Cigna,Cigna,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Cigna MGG,Cigna MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Humana,Humana,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Humana MGG,Humana MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Optum VA,Optum VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UHC,UHC,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UHC MGG,UHC MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA,VA,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Wellcare MGG,Wellcare MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Bright Health - commercial,Bright Health - commercial,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMMONIA AROMATIC SOL          ,92212873,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,Bright Health MGG,Bright Health MGG,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212874,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna,Aetna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna MGG,Aetna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS,BCBS,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS MGG,BCBS MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna,Cigna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna MGG,Cigna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana,Humana,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana MGG,Humana MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Optum VA,Optum VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC,UHC,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC MGG,UHC MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,VA,VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Wellcare MGG,Wellcare MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health - commercial,Bright Health - commercial,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92212875,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health MGG,Bright Health MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETHAMBUTOL HCL 100MG TAB      ,92212876,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERGOTAMINE CAFFEINE 100/1 TAB ,92212877,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Aetna,Aetna,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Aetna MGG,Aetna MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,BCBS,BCBS,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,BCBS MGG,BCBS MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Cigna,Cigna,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Cigna MGG,Cigna MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Humana,Humana,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Humana MGG,Humana MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Optum VA,Optum VA,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,UHC,UHC,8.28,,,,,,,per diem,8.28,8.28,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,UHC MGG,UHC MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,VA,VA,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Wellcare MGG,Wellcare MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Bright Health - commercial,Bright Health - commercial,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 10MEQ TER   ,92212878,CDM,250,RC,,,,,,Inpatient,1,EA,8.28,8.28,Bright Health MGG,Bright Health MGG,8.28,,,,,,,case rate,8.28,8.28,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Aetna,Aetna,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Aetna MGG,Aetna MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,BCBS,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS MGG,BCBS MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Cigna,Cigna,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Cigna MGG,Cigna MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Humana,Humana,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Humana MGG,Humana MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Optum VA,Optum VA,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,UHC,UHC,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,UHC MGG,UHC MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,VA,VA,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Wellcare MGG,Wellcare MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Bright Health - commercial,Bright Health - commercial,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 100MG TAB  ,92212879,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,Bright Health MGG,Bright Health MGG,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Aetna,Aetna,13.59,,,,,,,per diem,13.59,13.59,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Aetna MGG,Aetna MGG,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,BCBS,BCBS,13.59,,,,,,,per diem,13.59,13.59,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,BCBS MGG,BCBS MGG,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Cigna,Cigna,13.59,,,,,,,per diem,13.59,13.59,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Cigna MGG,Cigna MGG,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Humana,Humana,13.59,,,,,,,per diem,13.59,13.59,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Humana MGG,Humana MGG,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Optum VA,Optum VA,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,UHC,UHC,13.59,,,,,,,per diem,13.59,13.59,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,UHC MGG,UHC MGG,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,VA,VA,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Wellcare MGG,Wellcare MGG,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Bright Health - commercial,Bright Health - commercial,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212880,CDM,250,RC,,,,,,Inpatient,1,EA,13.59,13.59,Bright Health MGG,Bright Health MGG,13.59,,,,,,,case rate,13.59,13.59,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Aetna,Aetna,43.44,,,,,,,per diem,43.44,43.44,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Aetna MGG,Aetna MGG,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,BCBS,BCBS,43.44,,,,,,,per diem,43.44,43.44,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,BCBS MGG,BCBS MGG,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Cigna,Cigna,43.44,,,,,,,per diem,43.44,43.44,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Cigna MGG,Cigna MGG,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Humana,Humana,43.44,,,,,,,per diem,43.44,43.44,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Humana MGG,Humana MGG,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Optum VA,Optum VA,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,UHC,UHC,43.44,,,,,,,per diem,43.44,43.44,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,UHC MGG,UHC MGG,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,VA,VA,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Wellcare MGG,Wellcare MGG,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Bright Health - commercial,Bright Health - commercial,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92212881,CDM,250,RC,,,,,,Inpatient,1,EA,43.44,43.44,Bright Health MGG,Bright Health MGG,43.44,,,,,,,case rate,43.44,43.44,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Aetna,Aetna,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Aetna MGG,Aetna MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,BCBS,BCBS,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,BCBS MGG,BCBS MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Cigna,Cigna,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Cigna MGG,Cigna MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Humana,Humana,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Humana MGG,Humana MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Optum VA,Optum VA,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,UHC,UHC,8.25,,,,,,,per diem,8.25,8.25,"Per diem rate, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,UHC MGG,UHC MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,VA,VA,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Wellcare MGG,Wellcare MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Bright Health - commercial,Bright Health - commercial,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
ISOPROPYL ALCOHOL 70% LIQ     ,92212882,CDM,250,RC,,,,,,Inpatient,1,EA,8.25,8.25,Bright Health MGG,Bright Health MGG,8.25,,,,,,,case rate,8.25,8.25,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Aetna,Aetna,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Aetna MGG,Aetna MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS,BCBS,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS MGG,BCBS MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Cigna,Cigna,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Cigna MGG,Cigna MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Humana,Humana,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Humana MGG,Humana MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Optum VA,Optum VA,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,UHC,UHC,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,UHC MGG,UHC MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,VA,VA,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Wellcare MGG,Wellcare MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Bright Health - commercial,Bright Health - commercial,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92212883,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,Bright Health MGG,Bright Health MGG,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212884,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Aetna,Aetna,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Aetna MGG,Aetna MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS,BCBS,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS MGG,BCBS MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Cigna,Cigna,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Cigna MGG,Cigna MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Humana,Humana,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Humana MGG,Humana MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Optum VA,Optum VA,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,UHC,UHC,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,UHC MGG,UHC MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,VA,VA,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Wellcare MGG,Wellcare MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Bright Health - commercial,Bright Health - commercial,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG CER      ,92212885,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,Bright Health MGG,Bright Health MGG,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212886,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Aetna,Aetna,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Aetna MGG,Aetna MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,BCBS,BCBS,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,BCBS MGG,BCBS MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Cigna,Cigna,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Cigna MGG,Cigna MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Humana,Humana,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Humana MGG,Humana MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Optum VA,Optum VA,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,UHC,UHC,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,UHC MGG,UHC MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,VA,VA,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Wellcare MGG,Wellcare MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Bright Health - commercial,Bright Health - commercial,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92212887,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Bright Health MGG,Bright Health MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Aetna,Aetna,47.82,,,,,,,per diem,47.82,47.82,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Aetna MGG,Aetna MGG,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,BCBS,BCBS,47.82,,,,,,,per diem,47.82,47.82,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,BCBS MGG,BCBS MGG,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Cigna,Cigna,47.82,,,,,,,per diem,47.82,47.82,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Cigna MGG,Cigna MGG,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Humana,Humana,47.82,,,,,,,per diem,47.82,47.82,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Humana MGG,Humana MGG,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Optum VA,Optum VA,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,UHC,UHC,47.82,,,,,,,per diem,47.82,47.82,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,UHC MGG,UHC MGG,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,VA,VA,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Wellcare MGG,Wellcare MGG,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Bright Health - commercial,Bright Health - commercial,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B SOL    ,92212888,CDM,250,RC,,,,,,Inpatient,1,EA,47.82,47.82,Bright Health MGG,Bright Health MGG,47.82,,,,,,,case rate,47.82,47.82,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Aetna,Aetna,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Aetna MGG,Aetna MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,BCBS,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS MGG,BCBS MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Cigna,Cigna,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Cigna MGG,Cigna MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Humana,Humana,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Humana MGG,Humana MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Optum VA,Optum VA,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UHC,UHC,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UHC MGG,UHC MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,VA,VA,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Wellcare MGG,Wellcare MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Bright Health - commercial,Bright Health - commercial,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212889,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,Bright Health MGG,Bright Health MGG,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Aetna,Aetna,57.48,,,,,,,per diem,57.48,57.48,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Aetna MGG,Aetna MGG,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,BCBS,BCBS,57.48,,,,,,,per diem,57.48,57.48,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,BCBS MGG,BCBS MGG,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Cigna,Cigna,57.48,,,,,,,per diem,57.48,57.48,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Cigna MGG,Cigna MGG,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Humana,Humana,57.48,,,,,,,per diem,57.48,57.48,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Humana MGG,Humana MGG,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Optum VA,Optum VA,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,UHC,UHC,57.48,,,,,,,per diem,57.48,57.48,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,UHC MGG,UHC MGG,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,VA,VA,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Wellcare MGG,Wellcare MGG,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Bright Health - commercial,Bright Health - commercial,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 50MG/250ML INJ  ,92212890,CDM,250,RC,,,,,,Inpatient,1,EA,57.48,57.48,Bright Health MGG,Bright Health MGG,57.48,,,,,,,case rate,57.48,57.48,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Aetna,Aetna,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Aetna MGG,Aetna MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,BCBS,BCBS,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,BCBS MGG,BCBS MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Cigna,Cigna,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Cigna MGG,Cigna MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Humana,Humana,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Humana MGG,Humana MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Optum VA,Optum VA,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,UHC,UHC,5.19,,,,,,,per diem,5.19,5.19,"Per diem rate, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,UHC MGG,UHC MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,VA,VA,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Wellcare MGG,Wellcare MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Bright Health - commercial,Bright Health - commercial,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
POTASSIUM CITRATE 5MEQ TER    ,92212891,CDM,250,RC,,,,,,Inpatient,1,EA,5.19,5.19,Bright Health MGG,Bright Health MGG,5.19,,,,,,,case rate,5.19,5.19,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Aetna,Aetna,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Aetna MGG,Aetna MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,BCBS,BCBS,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,BCBS MGG,BCBS MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Cigna,Cigna,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Cigna MGG,Cigna MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Humana,Humana,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Humana MGG,Humana MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Optum VA,Optum VA,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,UHC,UHC,6.81,,,,,,,per diem,6.81,6.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,UHC MGG,UHC MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,VA,VA,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Wellcare MGG,Wellcare MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Bright Health - commercial,Bright Health - commercial,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92212892,CDM,250,RC,,,,,,Inpatient,1,EA,6.81,6.81,Bright Health MGG,Bright Health MGG,6.81,,,,,,,case rate,6.81,6.81,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Aetna,Aetna,282.84,,,,,,,per diem,282.84,282.84,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Aetna MGG,Aetna MGG,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,BCBS,BCBS,282.84,,,,,,,per diem,282.84,282.84,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,BCBS MGG,BCBS MGG,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Cigna,Cigna,282.84,,,,,,,per diem,282.84,282.84,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Cigna MGG,Cigna MGG,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Humana,Humana,282.84,,,,,,,per diem,282.84,282.84,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Humana MGG,Humana MGG,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Optum VA,Optum VA,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,UHC,UHC,282.84,,,,,,,per diem,282.84,282.84,"Per diem rate, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,UHC MGG,UHC MGG,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,VA,VA,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Wellcare MGG,Wellcare MGG,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Bright Health - commercial,Bright Health - commercial,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
TRETINOIN 0.05% CRE           ,92212893,CDM,250,RC,,,,,,Inpatient,1,EA,282.84,282.84,Bright Health MGG,Bright Health MGG,282.84,,,,,,,case rate,282.84,282.84,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna,Aetna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Aetna MGG,Aetna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS,BCBS,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,BCBS MGG,BCBS MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna,Cigna,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Cigna MGG,Cigna MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana,Humana,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Humana MGG,Humana MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Optum VA,Optum VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC,UHC,32.4,,,,,,,per diem,32.4,32.4,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,UHC MGG,UHC MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,VA,VA,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Wellcare MGG,Wellcare MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health - commercial,Bright Health - commercial,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92212894,CDM,250,RC,,,,,,Inpatient,1,EA,32.4,32.4,Bright Health MGG,Bright Health MGG,32.4,,,,,,,case rate,32.4,32.4,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 120MG TER       ,92212895,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Aetna,Aetna,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Aetna MGG,Aetna MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,BCBS,BCBS,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,BCBS MGG,BCBS MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Cigna,Cigna,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Cigna MGG,Cigna MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Humana,Humana,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Humana MGG,Humana MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Optum VA,Optum VA,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,UHC,UHC,6.66,,,,,,,per diem,6.66,6.66,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,UHC MGG,UHC MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,VA,VA,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Wellcare MGG,Wellcare MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Bright Health - commercial,Bright Health - commercial,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92212896,CDM,250,RC,,,,,,Inpatient,1,EA,6.66,6.66,Bright Health MGG,Bright Health MGG,6.66,,,,,,,case rate,6.66,6.66,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Aetna,Aetna,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Aetna MGG,Aetna MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,BCBS,BCBS,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,BCBS MGG,BCBS MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Cigna,Cigna,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Cigna MGG,Cigna MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Humana,Humana,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Humana MGG,Humana MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Optum VA,Optum VA,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,UHC,UHC,36.72,,,,,,,per diem,36.72,36.72,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,UHC MGG,UHC MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,VA,VA,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Wellcare MGG,Wellcare MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Bright Health - commercial,Bright Health - commercial,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212897,CDM,250,RC,,,,,,Inpatient,1,EA,36.72,36.72,Bright Health MGG,Bright Health MGG,36.72,,,,,,,case rate,36.72,36.72,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Aetna,Aetna,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Aetna MGG,Aetna MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,BCBS,BCBS,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,BCBS MGG,BCBS MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Cigna,Cigna,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Cigna MGG,Cigna MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Humana,Humana,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Humana MGG,Humana MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Optum VA,Optum VA,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,UHC,UHC,32.64,,,,,,,per diem,32.64,32.64,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,UHC MGG,UHC MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,VA,VA,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Wellcare MGG,Wellcare MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Bright Health - commercial,Bright Health - commercial,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92212898,CDM,250,RC,,,,,,Inpatient,1,EA,32.64,32.64,Bright Health MGG,Bright Health MGG,32.64,,,,,,,case rate,32.64,32.64,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG CTB        ,92212899,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Aetna,Aetna,57.15,,,,,,,per diem,57.15,57.15,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Aetna MGG,Aetna MGG,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,BCBS,BCBS,57.15,,,,,,,per diem,57.15,57.15,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,BCBS MGG,BCBS MGG,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Cigna,Cigna,57.15,,,,,,,per diem,57.15,57.15,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Cigna MGG,Cigna MGG,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Humana,Humana,57.15,,,,,,,per diem,57.15,57.15,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Humana MGG,Humana MGG,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Optum VA,Optum VA,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,UHC,UHC,57.15,,,,,,,per diem,57.15,57.15,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,UHC MGG,UHC MGG,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,VA,VA,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Wellcare MGG,Wellcare MGG,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Bright Health - commercial,Bright Health - commercial,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% OIN ,92212900,CDM,250,RC,,,,,,Inpatient,1,EA,57.15,57.15,Bright Health MGG,Bright Health MGG,57.15,,,,,,,case rate,57.15,57.15,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92212901,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212902,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Aetna,Aetna,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Aetna MGG,Aetna MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,BCBS,BCBS,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,BCBS MGG,BCBS MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Cigna,Cigna,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Cigna MGG,Cigna MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Humana,Humana,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Humana MGG,Humana MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Optum VA,Optum VA,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,UHC,UHC,5.97,,,,,,,per diem,5.97,5.97,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,UHC MGG,UHC MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,VA,VA,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Wellcare MGG,Wellcare MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Bright Health - commercial,Bright Health - commercial,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92212903,CDM,250,RC,,,,,,Inpatient,1,EA,5.97,5.97,Bright Health MGG,Bright Health MGG,5.97,,,,,,,case rate,5.97,5.97,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Aetna,Aetna,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Aetna MGG,Aetna MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,BCBS,BCBS,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,BCBS MGG,BCBS MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Cigna,Cigna,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Cigna MGG,Cigna MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Humana,Humana,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Humana MGG,Humana MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Optum VA,Optum VA,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,UHC,UHC,11.46,,,,,,,per diem,11.46,11.46,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,UHC MGG,UHC MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,VA,VA,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Wellcare MGG,Wellcare MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Bright Health - commercial,Bright Health - commercial,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 75-0.2 E,92212904,CDM,250,RC,,,,,,Inpatient,1,EA,11.46,11.46,Bright Health MGG,Bright Health MGG,11.46,,,,,,,case rate,11.46,11.46,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92212905,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212906,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92212907,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Aetna,Aetna,288.99,,,,,,,per diem,288.99,288.99,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Aetna MGG,Aetna MGG,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,BCBS,BCBS,288.99,,,,,,,per diem,288.99,288.99,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,BCBS MGG,BCBS MGG,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Cigna,Cigna,288.99,,,,,,,per diem,288.99,288.99,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Cigna MGG,Cigna MGG,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Humana,Humana,288.99,,,,,,,per diem,288.99,288.99,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Humana MGG,Humana MGG,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Optum VA,Optum VA,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,UHC,UHC,288.99,,,,,,,per diem,288.99,288.99,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,UHC MGG,UHC MGG,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,VA,VA,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Wellcare MGG,Wellcare MGG,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Bright Health - commercial,Bright Health - commercial,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212908,CDM,250,RC,,,,,,Inpatient,1,EA,288.99,288.99,Bright Health MGG,Bright Health MGG,288.99,,,,,,,case rate,288.99,288.99,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92212909,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Aetna,Aetna,144.48,,,,,,,per diem,144.48,144.48,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Aetna MGG,Aetna MGG,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,BCBS,BCBS,144.48,,,,,,,per diem,144.48,144.48,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,BCBS MGG,BCBS MGG,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Cigna,Cigna,144.48,,,,,,,per diem,144.48,144.48,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Cigna MGG,Cigna MGG,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Humana,Humana,144.48,,,,,,,per diem,144.48,144.48,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Humana MGG,Humana MGG,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Optum VA,Optum VA,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,UHC,UHC,144.48,,,,,,,per diem,144.48,144.48,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,UHC MGG,UHC MGG,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,VA,VA,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Wellcare MGG,Wellcare MGG,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Bright Health - commercial,Bright Health - commercial,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212910,CDM,250,RC,,,,,,Inpatient,1,EA,144.48,144.48,Bright Health MGG,Bright Health MGG,144.48,,,,,,,case rate,144.48,144.48,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Aetna,Aetna,577.95,,,,,,,per diem,577.95,577.95,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Aetna MGG,Aetna MGG,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,BCBS,BCBS,577.95,,,,,,,per diem,577.95,577.95,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,BCBS MGG,BCBS MGG,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Cigna,Cigna,577.95,,,,,,,per diem,577.95,577.95,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Cigna MGG,Cigna MGG,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Humana,Humana,577.95,,,,,,,per diem,577.95,577.95,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Humana MGG,Humana MGG,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Optum VA,Optum VA,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,UHC,UHC,577.95,,,,,,,per diem,577.95,577.95,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,UHC MGG,UHC MGG,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,VA,VA,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Wellcare MGG,Wellcare MGG,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Bright Health - commercial,Bright Health - commercial,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% EMO        ,92212911,CDM,250,RC,,,,,,Inpatient,1,EA,577.95,577.95,Bright Health MGG,Bright Health MGG,577.95,,,,,,,case rate,577.95,577.95,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212912,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Aetna,Aetna,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Aetna MGG,Aetna MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,BCBS,BCBS,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,BCBS MGG,BCBS MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Cigna,Cigna,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Cigna MGG,Cigna MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Humana,Humana,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Humana MGG,Humana MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Optum VA,Optum VA,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,UHC,UHC,18.03,,,,,,,per diem,18.03,18.03,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,UHC MGG,UHC MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,VA,VA,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Wellcare MGG,Wellcare MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Bright Health - commercial,Bright Health - commercial,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 2% INJ        ,92212913,CDM,250,RC,,,,,,Inpatient,1,EA,18.03,18.03,Bright Health MGG,Bright Health MGG,18.03,,,,,,,case rate,18.03,18.03,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212914,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92212915,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Aetna,Aetna,70.23,,,,,,,per diem,70.23,70.23,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Aetna MGG,Aetna MGG,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,BCBS,BCBS,70.23,,,,,,,per diem,70.23,70.23,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,BCBS MGG,BCBS MGG,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Cigna,Cigna,70.23,,,,,,,per diem,70.23,70.23,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Cigna MGG,Cigna MGG,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Humana,Humana,70.23,,,,,,,per diem,70.23,70.23,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Humana MGG,Humana MGG,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Optum VA,Optum VA,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,UHC,UHC,70.23,,,,,,,per diem,70.23,70.23,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,UHC MGG,UHC MGG,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,VA,VA,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Wellcare MGG,Wellcare MGG,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Bright Health - commercial,Bright Health - commercial,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92212916,CDM,250,RC,,,,,,Inpatient,1,EA,70.23,70.23,Bright Health MGG,Bright Health MGG,70.23,,,,,,,case rate,70.23,70.23,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92212917,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 10MG CAP             ,92212918,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Aetna,Aetna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Aetna MGG,Aetna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,BCBS,BCBS,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,BCBS MGG,BCBS MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Cigna,Cigna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Cigna MGG,Cigna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Humana,Humana,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Humana MGG,Humana MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Optum VA,Optum VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,UHC,UHC,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,UHC MGG,UHC MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,VA,VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Wellcare MGG,Wellcare MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Bright Health - commercial,Bright Health - commercial,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
DISULFIRAM 250MG TAB          ,92212919,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Bright Health MGG,Bright Health MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92212920,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Aetna,Aetna,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Aetna MGG,Aetna MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,BCBS,BCBS,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,BCBS MGG,BCBS MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Cigna,Cigna,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Cigna MGG,Cigna MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Humana,Humana,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Humana MGG,Humana MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Optum VA,Optum VA,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,UHC,UHC,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,UHC MGG,UHC MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,VA,VA,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Wellcare MGG,Wellcare MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Bright Health - commercial,Bright Health - commercial,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 30MEQ/L IVS     ,92212921,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Bright Health MGG,Bright Health MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92212922,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Aetna,Aetna,80.1,,,,,,,per diem,80.1,80.1,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Aetna MGG,Aetna MGG,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,BCBS,BCBS,80.1,,,,,,,per diem,80.1,80.1,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,BCBS MGG,BCBS MGG,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Cigna,Cigna,80.1,,,,,,,per diem,80.1,80.1,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Cigna MGG,Cigna MGG,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Humana,Humana,80.1,,,,,,,per diem,80.1,80.1,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Humana MGG,Humana MGG,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Optum VA,Optum VA,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,UHC,UHC,80.1,,,,,,,per diem,80.1,80.1,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,UHC MGG,UHC MGG,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,VA,VA,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Wellcare MGG,Wellcare MGG,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Bright Health - commercial,Bright Health - commercial,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92212923,CDM,250,RC,,,,,,Inpatient,1,EA,80.1,80.1,Bright Health MGG,Bright Health MGG,80.1,,,,,,,case rate,80.1,80.1,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Aetna,Aetna,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Aetna MGG,Aetna MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,BCBS,BCBS,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,BCBS MGG,BCBS MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Cigna,Cigna,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Cigna MGG,Cigna MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Humana,Humana,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Humana MGG,Humana MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Optum VA,Optum VA,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,UHC,UHC,50.55,,,,,,,per diem,50.55,50.55,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,UHC MGG,UHC MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,VA,VA,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Wellcare MGG,Wellcare MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Bright Health - commercial,Bright Health - commercial,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50MG/ML INJ   ,92212924,CDM,250,RC,,,,,,Inpatient,1,EA,50.55,50.55,Bright Health MGG,Bright Health MGG,50.55,,,,,,,case rate,50.55,50.55,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92212925,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Aetna,Aetna,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Aetna MGG,Aetna MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,BCBS,BCBS,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,BCBS MGG,BCBS MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Cigna,Cigna,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Cigna MGG,Cigna MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Humana,Humana,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Humana MGG,Humana MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Optum VA,Optum VA,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,UHC,UHC,10.47,,,,,,,per diem,10.47,10.47,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,UHC MGG,UHC MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,VA,VA,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Wellcare MGG,Wellcare MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Bright Health - commercial,Bright Health - commercial,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212926,CDM,250,RC,,,,,,Inpatient,1,EA,10.47,10.47,Bright Health MGG,Bright Health MGG,10.47,,,,,,,case rate,10.47,10.47,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Aetna,Aetna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Aetna MGG,Aetna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,BCBS,BCBS,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,BCBS MGG,BCBS MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Cigna,Cigna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Cigna MGG,Cigna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Humana,Humana,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Humana MGG,Humana MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Optum VA,Optum VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,UHC,UHC,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,UHC MGG,UHC MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,VA,VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Wellcare MGG,Wellcare MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Bright Health - commercial,Bright Health - commercial,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
RIVASTIGMINE TARTRATE 1.5MG CA,92212927,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Bright Health MGG,Bright Health MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Aetna,Aetna,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Aetna MGG,Aetna MGG,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,BCBS,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS MGG,BCBS MGG,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Cigna,Cigna,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Cigna MGG,Cigna MGG,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Humana,Humana,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Humana MGG,Humana MGG,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Optum VA,Optum VA,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UHC,UHC,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UHC MGG,UHC MGG,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,VA,VA,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Wellcare MGG,Wellcare MGG,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Bright Health - commercial,Bright Health - commercial,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
KETAMINE HCL 100MG/ML INJ     ,92212928,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,Bright Health MGG,Bright Health MGG,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Aetna,Aetna,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Aetna MGG,Aetna MGG,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,BCBS,BCBS,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,BCBS MGG,BCBS MGG,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Cigna,Cigna,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Cigna MGG,Cigna MGG,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Humana,Humana,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Humana MGG,Humana MGG,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Optum VA,Optum VA,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,UHC,UHC,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,UHC MGG,UHC MGG,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,VA,VA,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Wellcare MGG,Wellcare MGG,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Bright Health - commercial,Bright Health - commercial,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
ABACAVIR SULF LAMI ZIDO TAB   ,92212929,CDM,250,RC,,,,,,Inpatient,1,EA,87.15,87.15,Bright Health MGG,Bright Health MGG,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212930,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 50MG/5ML SYR       ,92212931,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Aetna,Aetna,5.34,,,,,,,per diem,5.34,5.34,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Aetna MGG,Aetna MGG,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,BCBS,BCBS,5.34,,,,,,,per diem,5.34,5.34,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,BCBS MGG,BCBS MGG,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Cigna,Cigna,5.34,,,,,,,per diem,5.34,5.34,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Cigna MGG,Cigna MGG,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Humana,Humana,5.34,,,,,,,per diem,5.34,5.34,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Humana MGG,Humana MGG,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Optum VA,Optum VA,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,UHC,UHC,5.34,,,,,,,per diem,5.34,5.34,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,UHC MGG,UHC MGG,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,VA,VA,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Wellcare MGG,Wellcare MGG,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Bright Health - commercial,Bright Health - commercial,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SYR       ,92212932,CDM,250,RC,,,,,,Inpatient,1,EA,5.34,5.34,Bright Health MGG,Bright Health MGG,5.34,,,,,,,case rate,5.34,5.34,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Aetna,Aetna,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Aetna MGG,Aetna MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,BCBS,BCBS,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,BCBS MGG,BCBS MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Cigna,Cigna,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Cigna MGG,Cigna MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Humana,Humana,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Humana MGG,Humana MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Optum VA,Optum VA,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,UHC,UHC,8.52,,,,,,,per diem,8.52,8.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,UHC MGG,UHC MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,VA,VA,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Wellcare MGG,Wellcare MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Bright Health - commercial,Bright Health - commercial,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 45MG TAB          ,92212933,CDM,250,RC,,,,,,Inpatient,1,EA,8.52,8.52,Bright Health MGG,Bright Health MGG,8.52,,,,,,,case rate,8.52,8.52,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna,Aetna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna MGG,Aetna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,BCBS,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS MGG,BCBS MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna,Cigna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna MGG,Cigna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana,Humana,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana MGG,Humana MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Optum VA,Optum VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC,UHC,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC MGG,UHC MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,VA,VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Wellcare MGG,Wellcare MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health - commercial,Bright Health - commercial,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 15MG TER        ,92212934,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health MGG,Bright Health MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Aetna,Aetna,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Aetna MGG,Aetna MGG,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,BCBS,BCBS,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,BCBS MGG,BCBS MGG,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Cigna,Cigna,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Cigna MGG,Cigna MGG,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Humana,Humana,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Humana MGG,Humana MGG,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Optum VA,Optum VA,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,UHC,UHC,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,UHC MGG,UHC MGG,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,VA,VA,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Wellcare MGG,Wellcare MGG,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Bright Health - commercial,Bright Health - commercial,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92212935,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,Bright Health MGG,Bright Health MGG,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92212936,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92212937,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Aetna,Aetna,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Aetna MGG,Aetna MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,BCBS,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS MGG,BCBS MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Cigna,Cigna,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Cigna MGG,Cigna MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Humana,Humana,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Humana MGG,Humana MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Optum VA,Optum VA,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UHC,UHC,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UHC MGG,UHC MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,VA,VA,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Wellcare MGG,Wellcare MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Bright Health - commercial,Bright Health - commercial,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92212938,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,Bright Health MGG,Bright Health MGG,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL                 ,92212939,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Aetna,Aetna,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Aetna MGG,Aetna MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,BCBS,BCBS,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,BCBS MGG,BCBS MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Cigna,Cigna,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Cigna MGG,Cigna MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Humana,Humana,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Humana MGG,Humana MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Optum VA,Optum VA,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,UHC,UHC,93.6,,,,,,,per diem,93.6,93.6,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,UHC MGG,UHC MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,VA,VA,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Wellcare MGG,Wellcare MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Bright Health - commercial,Bright Health - commercial,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92212940,CDM,250,RC,,,,,,Inpatient,1,EA,93.6,93.6,Bright Health MGG,Bright Health MGG,93.6,,,,,,,case rate,93.6,93.6,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Aetna,Aetna,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Aetna MGG,Aetna MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,BCBS,BCBS,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,BCBS MGG,BCBS MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Cigna,Cigna,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Cigna MGG,Cigna MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Humana,Humana,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Humana MGG,Humana MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Optum VA,Optum VA,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,UHC,UHC,19.29,,,,,,,per diem,19.29,19.29,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,UHC MGG,UHC MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,VA,VA,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Wellcare MGG,Wellcare MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Bright Health - commercial,Bright Health - commercial,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92212941,CDM,250,RC,,,,,,Inpatient,1,EA,19.29,19.29,Bright Health MGG,Bright Health MGG,19.29,,,,,,,case rate,19.29,19.29,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92212942,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Aetna,Aetna,23.01,,,,,,,per diem,23.01,23.01,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Aetna MGG,Aetna MGG,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,BCBS,BCBS,23.01,,,,,,,per diem,23.01,23.01,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,BCBS MGG,BCBS MGG,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Cigna,Cigna,23.01,,,,,,,per diem,23.01,23.01,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Cigna MGG,Cigna MGG,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Humana,Humana,23.01,,,,,,,per diem,23.01,23.01,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Humana MGG,Humana MGG,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Optum VA,Optum VA,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,UHC,UHC,23.01,,,,,,,per diem,23.01,23.01,"Per diem rate, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,UHC MGG,UHC MGG,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,VA,VA,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Wellcare MGG,Wellcare MGG,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Bright Health - commercial,Bright Health - commercial,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
METFORMIN HCL 500MG TAB       ,92212943,CDM,250,RC,,,,,,Inpatient,1,EA,23.01,23.01,Bright Health MGG,Bright Health MGG,23.01,,,,,,,case rate,23.01,23.01,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Aetna,Aetna,306.39,,,,,,,per diem,306.39,306.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Aetna MGG,Aetna MGG,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,BCBS,BCBS,306.39,,,,,,,per diem,306.39,306.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,BCBS MGG,BCBS MGG,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Cigna,Cigna,306.39,,,,,,,per diem,306.39,306.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Cigna MGG,Cigna MGG,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Humana,Humana,306.39,,,,,,,per diem,306.39,306.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Humana MGG,Humana MGG,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Optum VA,Optum VA,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,UHC,UHC,306.39,,,,,,,per diem,306.39,306.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,UHC MGG,UHC MGG,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,VA,VA,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Wellcare MGG,Wellcare MGG,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Bright Health - commercial,Bright Health - commercial,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92212944,CDM,250,RC,,,,,,Inpatient,1,EA,306.39,306.39,Bright Health MGG,Bright Health MGG,306.39,,,,,,,case rate,306.39,306.39,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Aetna,Aetna,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Aetna MGG,Aetna MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,BCBS,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS MGG,BCBS MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Cigna,Cigna,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Cigna MGG,Cigna MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Humana,Humana,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Humana MGG,Humana MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Optum VA,Optum VA,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UHC,UHC,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UHC MGG,UHC MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,VA,VA,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Wellcare MGG,Wellcare MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Bright Health - commercial,Bright Health - commercial,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
OXAZEPAM 30MG CAP             ,92212945,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Bright Health MGG,Bright Health MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Aetna,Aetna,1024.92,,,,,,,per diem,1024.92,1024.92,"Per diem rate, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Aetna MGG,Aetna MGG,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,BCBS,BCBS,1024.92,,,,,,,per diem,1024.92,1024.92,"Per diem rate, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,BCBS MGG,BCBS MGG,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Cigna,Cigna,1024.92,,,,,,,per diem,1024.92,1024.92,"Per diem rate, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Cigna MGG,Cigna MGG,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Humana,Humana,1024.92,,,,,,,per diem,1024.92,1024.92,"Per diem rate, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Humana MGG,Humana MGG,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Optum VA,Optum VA,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,UHC,UHC,1024.92,,,,,,,per diem,1024.92,1024.92,"Per diem rate, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,UHC MGG,UHC MGG,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,VA,VA,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Wellcare MGG,Wellcare MGG,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Bright Health - commercial,Bright Health - commercial,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
INSULIN LISPRO RCMB 75/25U INJ,92212946,CDM,250,RC,,,,,,Inpatient,1,EA,1024.92,1024.92,Bright Health MGG,Bright Health MGG,1024.92,,,,,,,case rate,1024.92,1024.92,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAALOX SUS                    ,92212947,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212948,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 1000MG TAB      ,92212949,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Aetna,Aetna,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Aetna MGG,Aetna MGG,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,BCBS,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS MGG,BCBS MGG,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Cigna,Cigna,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Cigna MGG,Cigna MGG,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Humana,Humana,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Humana MGG,Humana MGG,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Optum VA,Optum VA,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UHC,UHC,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UHC MGG,UHC MGG,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA,VA,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Wellcare MGG,Wellcare MGG,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Bright Health - commercial,Bright Health - commercial,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 8MG TAB    ,92212950,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,Bright Health MGG,Bright Health MGG,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Aetna,Aetna,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Aetna MGG,Aetna MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS,BCBS,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS MGG,BCBS MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Cigna,Cigna,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Cigna MGG,Cigna MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Humana,Humana,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Humana MGG,Humana MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Optum VA,Optum VA,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,UHC,UHC,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,UHC MGG,UHC MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,VA,VA,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Wellcare MGG,Wellcare MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Bright Health - commercial,Bright Health - commercial,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG/ML INJ       ,92212951,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,Bright Health MGG,Bright Health MGG,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Aetna,Aetna,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Aetna MGG,Aetna MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,BCBS,BCBS,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,BCBS MGG,BCBS MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Cigna,Cigna,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Cigna MGG,Cigna MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Humana,Humana,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Humana MGG,Humana MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Optum VA,Optum VA,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,UHC,UHC,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,UHC MGG,UHC MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,VA,VA,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Wellcare MGG,Wellcare MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Bright Health - commercial,Bright Health - commercial,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 2.5% LOT     ,92212952,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Bright Health MGG,Bright Health MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212953,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Aetna,Aetna,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Aetna MGG,Aetna MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,BCBS,BCBS,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,BCBS MGG,BCBS MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Cigna,Cigna,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Cigna MGG,Cigna MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Humana,Humana,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Humana MGG,Humana MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Optum VA,Optum VA,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,UHC,UHC,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,UHC MGG,UHC MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,VA,VA,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Wellcare MGG,Wellcare MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Bright Health - commercial,Bright Health - commercial,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92212954,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Bright Health MGG,Bright Health MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Aetna,Aetna,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Aetna MGG,Aetna MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS,BCBS,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS MGG,BCBS MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Cigna,Cigna,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Cigna MGG,Cigna MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Humana,Humana,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Humana MGG,Humana MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Optum VA,Optum VA,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,UHC,UHC,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,UHC MGG,UHC MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,VA,VA,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Wellcare MGG,Wellcare MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Bright Health - commercial,Bright Health - commercial,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92212955,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,Bright Health MGG,Bright Health MGG,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212956,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG/ML INJ      ,92212957,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEMORRHOID SUP                ,92212958,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92212959,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Aetna,Aetna,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Aetna MGG,Aetna MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,BCBS,BCBS,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,BCBS MGG,BCBS MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Cigna,Cigna,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Cigna MGG,Cigna MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Humana,Humana,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Humana MGG,Humana MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Optum VA,Optum VA,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,UHC,UHC,14.91,,,,,,,per diem,14.91,14.91,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,UHC MGG,UHC MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,VA,VA,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Wellcare MGG,Wellcare MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Bright Health - commercial,Bright Health - commercial,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212960,CDM,250,RC,J1940,HCPCS,,,,Inpatient,1,EA,14.91,14.91,Bright Health MGG,Bright Health MGG,14.91,,,,,,,case rate,14.91,14.91,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METFORMIN HCL 850MG TAB       ,92212961,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92212962,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Aetna,Aetna,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Aetna MGG,Aetna MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,BCBS,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS MGG,BCBS MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Cigna,Cigna,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Cigna MGG,Cigna MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Humana,Humana,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Humana MGG,Humana MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Optum VA,Optum VA,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,UHC,UHC,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,UHC MGG,UHC MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,VA,VA,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Wellcare MGG,Wellcare MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Bright Health - commercial,Bright Health - commercial,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92212963,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,Bright Health MGG,Bright Health MGG,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92212964,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 10MG TAB  ,92212965,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 2.5MG CER       ,92212966,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna,Aetna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna MGG,Aetna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS,BCBS,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS MGG,BCBS MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna,Cigna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna MGG,Cigna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana,Humana,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana MGG,Humana MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Optum VA,Optum VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC,UHC,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC MGG,UHC MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,VA,VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Wellcare MGG,Wellcare MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health - commercial,Bright Health - commercial,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 2MG TAB    ,92212967,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health MGG,Bright Health MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92212968,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Aetna,Aetna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Aetna MGG,Aetna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,BCBS,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS MGG,BCBS MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Cigna,Cigna,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Cigna MGG,Cigna MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Humana,Humana,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Humana MGG,Humana MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Optum VA,Optum VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UHC,UHC,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UHC MGG,UHC MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,VA,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Wellcare MGG,Wellcare MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Bright Health - commercial,Bright Health - commercial,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92212969,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,Bright Health MGG,Bright Health MGG,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92212970,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF 500MG TAB       ,92212971,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Aetna,Aetna,702.93,,,,,,,per diem,702.93,702.93,"Per diem rate, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Aetna MGG,Aetna MGG,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,BCBS,BCBS,702.93,,,,,,,per diem,702.93,702.93,"Per diem rate, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,BCBS MGG,BCBS MGG,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Cigna,Cigna,702.93,,,,,,,per diem,702.93,702.93,"Per diem rate, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Cigna MGG,Cigna MGG,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Humana,Humana,702.93,,,,,,,per diem,702.93,702.93,"Per diem rate, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Humana MGG,Humana MGG,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Optum VA,Optum VA,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,UHC,UHC,702.93,,,,,,,per diem,702.93,702.93,"Per diem rate, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,UHC MGG,UHC MGG,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,VA,VA,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Wellcare MGG,Wellcare MGG,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Bright Health - commercial,Bright Health - commercial,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
LOTEPREDNOL ETABONATE 0.2% SUS,92212972,CDM,250,RC,,,,,,Inpatient,1,EA,702.93,702.93,Bright Health MGG,Bright Health MGG,702.93,,,,,,,case rate,702.93,702.93,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92212973,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 6.5MG CER       ,92212974,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 10MG TAB    ,92212975,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Aetna,Aetna,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Aetna MGG,Aetna MGG,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,BCBS,BCBS,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,BCBS MGG,BCBS MGG,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Cigna,Cigna,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Cigna MGG,Cigna MGG,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Humana,Humana,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Humana MGG,Humana MGG,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Optum VA,Optum VA,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,UHC,UHC,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,UHC MGG,UHC MGG,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,VA,VA,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Wellcare MGG,Wellcare MGG,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Bright Health - commercial,Bright Health - commercial,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92212976,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,Bright Health MGG,Bright Health MGG,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Aetna,Aetna,66.9,,,,,,,per diem,66.9,66.9,"Per diem rate, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Aetna MGG,Aetna MGG,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,BCBS,BCBS,66.9,,,,,,,per diem,66.9,66.9,"Per diem rate, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,BCBS MGG,BCBS MGG,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Cigna,Cigna,66.9,,,,,,,per diem,66.9,66.9,"Per diem rate, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Cigna MGG,Cigna MGG,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Humana,Humana,66.9,,,,,,,per diem,66.9,66.9,"Per diem rate, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Humana MGG,Humana MGG,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Optum VA,Optum VA,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,UHC,UHC,66.9,,,,,,,per diem,66.9,66.9,"Per diem rate, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,UHC MGG,UHC MGG,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,VA,VA,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Wellcare MGG,Wellcare MGG,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Bright Health - commercial,Bright Health - commercial,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
TACROLIMUS 5MG CAP            ,92212977,CDM,250,RC,,,,,,Inpatient,1,EA,66.9,66.9,Bright Health MGG,Bright Health MGG,66.9,,,,,,,case rate,66.9,66.9,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROMORPHONE HCL             ,92212978,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Aetna,Aetna,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Aetna MGG,Aetna MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,BCBS,BCBS,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,BCBS MGG,BCBS MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Cigna,Cigna,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Cigna MGG,Cigna MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Humana,Humana,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Humana MGG,Humana MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Optum VA,Optum VA,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,UHC,UHC,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,UHC MGG,UHC MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,VA,VA,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Wellcare MGG,Wellcare MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Bright Health - commercial,Bright Health - commercial,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212979,CDM,250,RC,,,,,,Inpatient,1,EA,160.65,160.65,Bright Health MGG,Bright Health MGG,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Aetna,Aetna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Aetna MGG,Aetna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,BCBS,BCBS,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,BCBS MGG,BCBS MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Cigna,Cigna,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Cigna MGG,Cigna MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Humana,Humana,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Humana MGG,Humana MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Optum VA,Optum VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,UHC,UHC,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,UHC MGG,UHC MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,VA,VA,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Wellcare MGG,Wellcare MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Bright Health - commercial,Bright Health - commercial,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
DEXTROSE 10%/WATER IVS        ,92212980,CDM,258,RC,,,,,,Inpatient,1,EA,27.3,27.3,Bright Health MGG,Bright Health MGG,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92212981,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Aetna,Aetna,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Aetna MGG,Aetna MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,BCBS,BCBS,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,BCBS MGG,BCBS MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Cigna,Cigna,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Cigna MGG,Cigna MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Humana,Humana,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Humana MGG,Humana MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Optum VA,Optum VA,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,UHC,UHC,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,UHC MGG,UHC MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,VA,VA,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Wellcare MGG,Wellcare MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Bright Health - commercial,Bright Health - commercial,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92212982,CDM,250,RC,,,,,,Inpatient,1,EA,7.86,7.86,Bright Health MGG,Bright Health MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Aetna,Aetna,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Aetna MGG,Aetna MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,BCBS,BCBS,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,BCBS MGG,BCBS MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Cigna,Cigna,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Cigna MGG,Cigna MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Humana,Humana,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Humana MGG,Humana MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Optum VA,Optum VA,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,UHC,UHC,9.6,,,,,,,per diem,9.6,9.6,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,UHC MGG,UHC MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,VA,VA,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Wellcare MGG,Wellcare MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Bright Health - commercial,Bright Health - commercial,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92212983,CDM,250,RC,,,,,,Inpatient,1,EA,9.6,9.6,Bright Health MGG,Bright Health MGG,9.6,,,,,,,case rate,9.6,9.6,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Aetna,Aetna,64.11,,,,,,,per diem,64.11,64.11,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Aetna MGG,Aetna MGG,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,BCBS,BCBS,64.11,,,,,,,per diem,64.11,64.11,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,BCBS MGG,BCBS MGG,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Cigna,Cigna,64.11,,,,,,,per diem,64.11,64.11,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Cigna MGG,Cigna MGG,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Humana,Humana,64.11,,,,,,,per diem,64.11,64.11,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Humana MGG,Humana MGG,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Optum VA,Optum VA,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,UHC,UHC,64.11,,,,,,,per diem,64.11,64.11,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,UHC MGG,UHC MGG,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,VA,VA,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Wellcare MGG,Wellcare MGG,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Bright Health - commercial,Bright Health - commercial,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92212984,CDM,250,RC,,,,,,Inpatient,1,EA,64.11,64.11,Bright Health MGG,Bright Health MGG,64.11,,,,,,,case rate,64.11,64.11,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Aetna,Aetna,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Aetna MGG,Aetna MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,BCBS,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS MGG,BCBS MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Cigna,Cigna,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Cigna MGG,Cigna MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Humana,Humana,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Humana MGG,Humana MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Optum VA,Optum VA,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UHC,UHC,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UHC MGG,UHC MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,VA,VA,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Wellcare MGG,Wellcare MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Bright Health - commercial,Bright Health - commercial,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92212985,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Bright Health MGG,Bright Health MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Aetna,Aetna,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Aetna MGG,Aetna MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS,BCBS,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS MGG,BCBS MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Cigna,Cigna,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Cigna MGG,Cigna MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Humana,Humana,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Humana MGG,Humana MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Optum VA,Optum VA,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,UHC,UHC,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,UHC MGG,UHC MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,VA,VA,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Wellcare MGG,Wellcare MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Bright Health - commercial,Bright Health - commercial,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
CARBIDOPA 25MG TAB            ,92212986,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,Bright Health MGG,Bright Health MGG,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92212987,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE 5MG TAB   ,92212988,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Aetna,Aetna,10.77,,,,,,,per diem,10.77,10.77,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Aetna MGG,Aetna MGG,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,BCBS,BCBS,10.77,,,,,,,per diem,10.77,10.77,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,BCBS MGG,BCBS MGG,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Cigna,Cigna,10.77,,,,,,,per diem,10.77,10.77,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Cigna MGG,Cigna MGG,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Humana,Humana,10.77,,,,,,,per diem,10.77,10.77,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Humana MGG,Humana MGG,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Optum VA,Optum VA,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,UHC,UHC,10.77,,,,,,,per diem,10.77,10.77,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,UHC MGG,UHC MGG,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,VA,VA,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Wellcare MGG,Wellcare MGG,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Bright Health - commercial,Bright Health - commercial,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 30MG TAB        ,92212989,CDM,250,RC,,,,,,Inpatient,1,EA,10.77,10.77,Bright Health MGG,Bright Health MGG,10.77,,,,,,,case rate,10.77,10.77,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Aetna,Aetna,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Aetna MGG,Aetna MGG,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,BCBS,BCBS,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,BCBS MGG,BCBS MGG,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Cigna,Cigna,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Cigna MGG,Cigna MGG,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Humana,Humana,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Humana MGG,Humana MGG,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Optum VA,Optum VA,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,UHC,UHC,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,UHC MGG,UHC MGG,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,VA,VA,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Wellcare MGG,Wellcare MGG,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Bright Health - commercial,Bright Health - commercial,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT K,92212990,CDM,250,RC,,,,,,Inpatient,1,EA,59.97,59.97,Bright Health MGG,Bright Health MGG,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Aetna,Aetna,7.98,,,,,,,per diem,7.98,7.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Aetna MGG,Aetna MGG,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,BCBS,BCBS,7.98,,,,,,,per diem,7.98,7.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,BCBS MGG,BCBS MGG,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Cigna,Cigna,7.98,,,,,,,per diem,7.98,7.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Cigna MGG,Cigna MGG,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Humana,Humana,7.98,,,,,,,per diem,7.98,7.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Humana MGG,Humana MGG,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Optum VA,Optum VA,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,UHC,UHC,7.98,,,,,,,per diem,7.98,7.98,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,UHC MGG,UHC MGG,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,VA,VA,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Wellcare MGG,Wellcare MGG,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Bright Health - commercial,Bright Health - commercial,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212991,CDM,250,RC,,,,,,Inpatient,1,EA,7.98,7.98,Bright Health MGG,Bright Health MGG,7.98,,,,,,,case rate,7.98,7.98,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna,Aetna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna MGG,Aetna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS,BCBS,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS MGG,BCBS MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna,Cigna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna MGG,Cigna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana,Humana,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana MGG,Humana MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Optum VA,Optum VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC,UHC,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC MGG,UHC MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,VA,VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Wellcare MGG,Wellcare MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health - commercial,Bright Health - commercial,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212992,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health MGG,Bright Health MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Aetna,Aetna,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Aetna MGG,Aetna MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,BCBS,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS MGG,BCBS MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Cigna,Cigna,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Cigna MGG,Cigna MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Humana,Humana,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Humana MGG,Humana MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Optum VA,Optum VA,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UHC,UHC,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UHC MGG,UHC MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,VA,VA,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Wellcare MGG,Wellcare MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Bright Health - commercial,Bright Health - commercial,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
BUPRENORPHINE NAOLXONE 2-0.5 T,92212993,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,Bright Health MGG,Bright Health MGG,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92212994,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92212995,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Aetna,Aetna,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Aetna MGG,Aetna MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,BCBS,BCBS,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,BCBS MGG,BCBS MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Cigna,Cigna,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Cigna MGG,Cigna MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Humana,Humana,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Humana MGG,Humana MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Optum VA,Optum VA,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,UHC,UHC,7.02,,,,,,,per diem,7.02,7.02,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,UHC MGG,UHC MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,VA,VA,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Wellcare MGG,Wellcare MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Bright Health - commercial,Bright Health - commercial,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1MG TAB     ,92212996,CDM,250,RC,,,,,,Inpatient,1,EA,7.02,7.02,Bright Health MGG,Bright Health MGG,7.02,,,,,,,case rate,7.02,7.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Aetna,Aetna,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Aetna MGG,Aetna MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,BCBS,BCBS,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,BCBS MGG,BCBS MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Cigna,Cigna,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Cigna MGG,Cigna MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Humana,Humana,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Humana MGG,Humana MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Optum VA,Optum VA,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,UHC,UHC,11.88,,,,,,,per diem,11.88,11.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,UHC MGG,UHC MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,VA,VA,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Wellcare MGG,Wellcare MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Bright Health - commercial,Bright Health - commercial,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% OIN       ,92212997,CDM,250,RC,,,,,,Inpatient,1,EA,11.88,11.88,Bright Health MGG,Bright Health MGG,11.88,,,,,,,case rate,11.88,11.88,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Aetna,Aetna,38.97,,,,,,,per diem,38.97,38.97,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Aetna MGG,Aetna MGG,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,BCBS,BCBS,38.97,,,,,,,per diem,38.97,38.97,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,BCBS MGG,BCBS MGG,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Cigna,Cigna,38.97,,,,,,,per diem,38.97,38.97,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Cigna MGG,Cigna MGG,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Humana,Humana,38.97,,,,,,,per diem,38.97,38.97,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Humana MGG,Humana MGG,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Optum VA,Optum VA,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,UHC,UHC,38.97,,,,,,,per diem,38.97,38.97,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,UHC MGG,UHC MGG,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,VA,VA,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Wellcare MGG,Wellcare MGG,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Bright Health - commercial,Bright Health - commercial,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92212998,CDM,250,RC,,,,,,Inpatient,1,EA,38.97,38.97,Bright Health MGG,Bright Health MGG,38.97,,,,,,,case rate,38.97,38.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna,Aetna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Aetna MGG,Aetna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS,BCBS,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,BCBS MGG,BCBS MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna,Cigna,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Cigna MGG,Cigna MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana,Humana,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Humana MGG,Humana MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Optum VA,Optum VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC,UHC,5.94,,,,,,,per diem,5.94,5.94,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,UHC MGG,UHC MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,VA,VA,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Wellcare MGG,Wellcare MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health - commercial,Bright Health - commercial,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92212999,CDM,250,RC,,,,,,Inpatient,1,EA,5.94,5.94,Bright Health MGG,Bright Health MGG,5.94,,,,,,,case rate,5.94,5.94,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Aetna,Aetna,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Aetna MGG,Aetna MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,BCBS,BCBS,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,BCBS MGG,BCBS MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Cigna,Cigna,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Cigna MGG,Cigna MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Humana,Humana,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Humana MGG,Humana MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Optum VA,Optum VA,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,UHC,UHC,19.8,,,,,,,per diem,19.8,19.8,"Per diem rate, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,UHC MGG,UHC MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,VA,VA,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Wellcare MGG,Wellcare MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Bright Health - commercial,Bright Health - commercial,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
OXANDROLONE 2.5MG TAB         ,92213000,CDM,250,RC,,,,,,Inpatient,1,EA,19.8,19.8,Bright Health MGG,Bright Health MGG,19.8,,,,,,,case rate,19.8,19.8,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92213001,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Aetna,Aetna,549.93,,,,,,,per diem,549.93,549.93,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Aetna MGG,Aetna MGG,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,BCBS,BCBS,549.93,,,,,,,per diem,549.93,549.93,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,BCBS MGG,BCBS MGG,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Cigna,Cigna,549.93,,,,,,,per diem,549.93,549.93,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Cigna MGG,Cigna MGG,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Humana,Humana,549.93,,,,,,,per diem,549.93,549.93,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Humana MGG,Humana MGG,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Optum VA,Optum VA,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,UHC,UHC,549.93,,,,,,,per diem,549.93,549.93,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,UHC MGG,UHC MGG,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,VA,VA,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Wellcare MGG,Wellcare MGG,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Bright Health - commercial,Bright Health - commercial,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92213002,CDM,250,RC,,,,,,Inpatient,1,EA,549.93,549.93,Bright Health MGG,Bright Health MGG,549.93,,,,,,,case rate,549.93,549.93,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Aetna,Aetna,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Aetna MGG,Aetna MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,BCBS,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS MGG,BCBS MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Cigna,Cigna,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Cigna MGG,Cigna MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Humana,Humana,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Humana MGG,Humana MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Optum VA,Optum VA,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UHC,UHC,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UHC MGG,UHC MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,VA,VA,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Wellcare MGG,Wellcare MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Bright Health - commercial,Bright Health - commercial,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 100MG TAB   ,92213003,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,Bright Health MGG,Bright Health MGG,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"METFORMIN HCL 1,000MG TAB     ",92213004,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Aetna,Aetna,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Aetna MGG,Aetna MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,BCBS,BCBS,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,BCBS MGG,BCBS MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Cigna,Cigna,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Cigna MGG,Cigna MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Humana,Humana,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Humana MGG,Humana MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Optum VA,Optum VA,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,UHC,UHC,22.8,,,,,,,per diem,22.8,22.8,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,UHC MGG,UHC MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,VA,VA,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Wellcare MGG,Wellcare MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Bright Health - commercial,Bright Health - commercial,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92213005,CDM,250,RC,,,,,,Inpatient,1,EA,22.8,22.8,Bright Health MGG,Bright Health MGG,22.8,,,,,,,case rate,22.8,22.8,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213006,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Aetna,Aetna,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Aetna MGG,Aetna MGG,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,BCBS,BCBS,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,BCBS MGG,BCBS MGG,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Cigna,Cigna,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Cigna MGG,Cigna MGG,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Humana,Humana,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Humana MGG,Humana MGG,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Optum VA,Optum VA,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,UHC,UHC,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,UHC MGG,UHC MGG,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,VA,VA,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Wellcare MGG,Wellcare MGG,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Bright Health - commercial,Bright Health - commercial,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 225MG TAB     ,92213007,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,Bright Health MGG,Bright Health MGG,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Aetna,Aetna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Aetna MGG,Aetna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,BCBS,BCBS,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,BCBS MGG,BCBS MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Cigna,Cigna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Cigna MGG,Cigna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Humana,Humana,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Humana MGG,Humana MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Optum VA,Optum VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,UHC,UHC,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,UHC MGG,UHC MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,VA,VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Wellcare MGG,Wellcare MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Bright Health - commercial,Bright Health - commercial,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 5MG/ML INJ    ,92213008,CDM,250,RC,J1630,HCPCS,,,,Inpatient,1,EA,216,216,Bright Health MGG,Bright Health MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Aetna,Aetna,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Aetna MGG,Aetna MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,BCBS,BCBS,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,BCBS MGG,BCBS MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Cigna,Cigna,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Cigna MGG,Cigna MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Humana,Humana,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Humana MGG,Humana MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Optum VA,Optum VA,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,UHC,UHC,21.72,,,,,,,per diem,21.72,21.72,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,UHC MGG,UHC MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,VA,VA,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Wellcare MGG,Wellcare MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Bright Health - commercial,Bright Health - commercial,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213009,CDM,250,RC,,,,,,Inpatient,1,EA,21.72,21.72,Bright Health MGG,Bright Health MGG,21.72,,,,,,,case rate,21.72,21.72,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Aetna,Aetna,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Aetna MGG,Aetna MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,BCBS,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS MGG,BCBS MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Cigna,Cigna,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Cigna MGG,Cigna MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Humana,Humana,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Humana MGG,Humana MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Optum VA,Optum VA,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UHC,UHC,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UHC MGG,UHC MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA,VA,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Wellcare MGG,Wellcare MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Bright Health - commercial,Bright Health - commercial,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92213010,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,Bright Health MGG,Bright Health MGG,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Aetna,Aetna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Aetna MGG,Aetna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,BCBS,BCBS,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,BCBS MGG,BCBS MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Cigna,Cigna,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Cigna MGG,Cigna MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Humana,Humana,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Humana MGG,Humana MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Optum VA,Optum VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,UHC,UHC,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,UHC MGG,UHC MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,VA,VA,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Wellcare MGG,Wellcare MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Bright Health - commercial,Bright Health - commercial,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213011,CDM,250,RC,,,,,,Inpatient,1,EA,128.52,128.52,Bright Health MGG,Bright Health MGG,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Aetna,Aetna,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Aetna MGG,Aetna MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,BCBS,BCBS,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,BCBS MGG,BCBS MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Cigna,Cigna,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Cigna MGG,Cigna MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Humana,Humana,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Humana MGG,Humana MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Optum VA,Optum VA,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,UHC,UHC,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,UHC MGG,UHC MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,VA,VA,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Wellcare MGG,Wellcare MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Bright Health - commercial,Bright Health - commercial,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 2.5-167/5ML S,92213012,CDM,250,RC,,,,,,Inpatient,1,EA,5.46,5.46,Bright Health MGG,Bright Health MGG,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Aetna,Aetna,67.56,,,,,,,per diem,67.56,67.56,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Aetna MGG,Aetna MGG,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,BCBS,BCBS,67.56,,,,,,,per diem,67.56,67.56,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,BCBS MGG,BCBS MGG,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Cigna,Cigna,67.56,,,,,,,per diem,67.56,67.56,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Cigna MGG,Cigna MGG,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Humana,Humana,67.56,,,,,,,per diem,67.56,67.56,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Humana MGG,Humana MGG,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Optum VA,Optum VA,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,UHC,UHC,67.56,,,,,,,per diem,67.56,67.56,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,UHC MGG,UHC MGG,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,VA,VA,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Wellcare MGG,Wellcare MGG,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Bright Health - commercial,Bright Health - commercial,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 500ML I,92213013,CDM,250,RC,,,,,,Inpatient,1,EA,67.56,67.56,Bright Health MGG,Bright Health MGG,67.56,,,,,,,case rate,67.56,67.56,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Aetna,Aetna,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Aetna MGG,Aetna MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,BCBS,BCBS,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,BCBS MGG,BCBS MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Cigna,Cigna,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Cigna MGG,Cigna MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Humana,Humana,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Humana MGG,Humana MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Optum VA,Optum VA,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,UHC,UHC,81.06,,,,,,,per diem,81.06,81.06,"Per diem rate, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,UHC MGG,UHC MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,VA,VA,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Wellcare MGG,Wellcare MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Bright Health - commercial,Bright Health - commercial,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ISOPROTERENOL HCL 0.2MG/ML INJ,92213014,CDM,250,RC,,,,,,Inpatient,1,EA,81.06,81.06,Bright Health MGG,Bright Health MGG,81.06,,,,,,,case rate,81.06,81.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Aetna,Aetna,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Aetna MGG,Aetna MGG,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,BCBS,BCBS,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,BCBS MGG,BCBS MGG,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Cigna,Cigna,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Cigna MGG,Cigna MGG,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Humana,Humana,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Humana MGG,Humana MGG,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Optum VA,Optum VA,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,UHC,UHC,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,UHC MGG,UHC MGG,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,VA,VA,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Wellcare MGG,Wellcare MGG,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Bright Health - commercial,Bright Health - commercial,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 60MG/0.6ML INJ  ,92213015,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,Bright Health MGG,Bright Health MGG,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Aetna,Aetna,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Aetna MGG,Aetna MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,BCBS,BCBS,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,BCBS MGG,BCBS MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Cigna,Cigna,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Cigna MGG,Cigna MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Humana,Humana,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Humana MGG,Humana MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Optum VA,Optum VA,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,UHC,UHC,8.91,,,,,,,per diem,8.91,8.91,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,UHC MGG,UHC MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,VA,VA,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Wellcare MGG,Wellcare MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Bright Health - commercial,Bright Health - commercial,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92213016,CDM,250,RC,,,,,,Inpatient,1,EA,8.91,8.91,Bright Health MGG,Bright Health MGG,8.91,,,,,,,case rate,8.91,8.91,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Aetna,Aetna,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Aetna MGG,Aetna MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,BCBS,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS MGG,BCBS MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Cigna,Cigna,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Cigna MGG,Cigna MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Humana,Humana,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Humana MGG,Humana MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Optum VA,Optum VA,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UHC,UHC,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UHC MGG,UHC MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA,VA,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Wellcare MGG,Wellcare MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Bright Health - commercial,Bright Health - commercial,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 15MG TAB        ,92213017,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,Bright Health MGG,Bright Health MGG,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 25MG TAB            ,92213018,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Aetna,Aetna,32.16,,,,,,,per diem,32.16,32.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Aetna MGG,Aetna MGG,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,BCBS,BCBS,32.16,,,,,,,per diem,32.16,32.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,BCBS MGG,BCBS MGG,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Cigna,Cigna,32.16,,,,,,,per diem,32.16,32.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Cigna MGG,Cigna MGG,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Humana,Humana,32.16,,,,,,,per diem,32.16,32.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Humana MGG,Humana MGG,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Optum VA,Optum VA,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,UHC,UHC,32.16,,,,,,,per diem,32.16,32.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,UHC MGG,UHC MGG,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,VA,VA,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Wellcare MGG,Wellcare MGG,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Bright Health - commercial,Bright Health - commercial,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 30MG TAB     ,92213019,CDM,250,RC,,,,,,Inpatient,1,EA,32.16,32.16,Bright Health MGG,Bright Health MGG,32.16,,,,,,,case rate,32.16,32.16,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 1MG TAB    ,92213020,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Aetna,Aetna,728.04,,,,,,,per diem,728.04,728.04,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Aetna MGG,Aetna MGG,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,BCBS,BCBS,728.04,,,,,,,per diem,728.04,728.04,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,BCBS MGG,BCBS MGG,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Cigna,Cigna,728.04,,,,,,,per diem,728.04,728.04,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Cigna MGG,Cigna MGG,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Humana,Humana,728.04,,,,,,,per diem,728.04,728.04,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Humana MGG,Humana MGG,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Optum VA,Optum VA,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,UHC,UHC,728.04,,,,,,,per diem,728.04,728.04,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,UHC MGG,UHC MGG,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,VA,VA,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Wellcare MGG,Wellcare MGG,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Bright Health - commercial,Bright Health - commercial,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% OIN        ,92213021,CDM,250,RC,,,,,,Inpatient,1,EA,728.04,728.04,Bright Health MGG,Bright Health MGG,728.04,,,,,,,case rate,728.04,728.04,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Aetna,Aetna,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Aetna MGG,Aetna MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,BCBS,BCBS,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,BCBS MGG,BCBS MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Cigna,Cigna,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Cigna MGG,Cigna MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Humana,Humana,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Humana MGG,Humana MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Optum VA,Optum VA,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,UHC,UHC,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,UHC MGG,UHC MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,VA,VA,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Wellcare MGG,Wellcare MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Bright Health - commercial,Bright Health - commercial,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92213022,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Bright Health MGG,Bright Health MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Aetna,Aetna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Aetna MGG,Aetna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,BCBS,BCBS,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,BCBS MGG,BCBS MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Cigna,Cigna,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Cigna MGG,Cigna MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Humana,Humana,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Humana MGG,Humana MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Optum VA,Optum VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,UHC,UHC,25,,,,,,,per diem,25,25,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,UHC MGG,UHC MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,VA,VA,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Wellcare MGG,Wellcare MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Bright Health - commercial,Bright Health - commercial,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/ML INJ         ",92213023,CDM,250,RC,,,,,,Inpatient,1,EA,25,25,Bright Health MGG,Bright Health MGG,25,,,,,,,case rate,25,25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92213024,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Aetna,Aetna,52.68,,,,,,,per diem,52.68,52.68,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Aetna MGG,Aetna MGG,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,BCBS,BCBS,52.68,,,,,,,per diem,52.68,52.68,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,BCBS MGG,BCBS MGG,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Cigna,Cigna,52.68,,,,,,,per diem,52.68,52.68,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Cigna MGG,Cigna MGG,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Humana,Humana,52.68,,,,,,,per diem,52.68,52.68,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Humana MGG,Humana MGG,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Optum VA,Optum VA,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,UHC,UHC,52.68,,,,,,,per diem,52.68,52.68,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,UHC MGG,UHC MGG,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,VA,VA,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Wellcare MGG,Wellcare MGG,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Bright Health - commercial,Bright Health - commercial,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92213025,CDM,250,RC,,,,,,Inpatient,1,EA,52.68,52.68,Bright Health MGG,Bright Health MGG,52.68,,,,,,,case rate,52.68,52.68,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.75MG TAB      ,92213026,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92213027,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Aetna,Aetna,557.61,,,,,,,per diem,557.61,557.61,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Aetna MGG,Aetna MGG,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,BCBS,BCBS,557.61,,,,,,,per diem,557.61,557.61,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,BCBS MGG,BCBS MGG,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Cigna,Cigna,557.61,,,,,,,per diem,557.61,557.61,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Cigna MGG,Cigna MGG,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Humana,Humana,557.61,,,,,,,per diem,557.61,557.61,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Humana MGG,Humana MGG,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Optum VA,Optum VA,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,UHC,UHC,557.61,,,,,,,per diem,557.61,557.61,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,UHC MGG,UHC MGG,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,VA,VA,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Wellcare MGG,Wellcare MGG,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Bright Health - commercial,Bright Health - commercial,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 500MG CAP         ,92213028,CDM,250,RC,,,,,,Inpatient,1,EA,557.61,557.61,Bright Health MGG,Bright Health MGG,557.61,,,,,,,case rate,557.61,557.61,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Aetna,Aetna,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Aetna MGG,Aetna MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,BCBS,BCBS,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,BCBS MGG,BCBS MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Cigna,Cigna,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Cigna MGG,Cigna MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Humana,Humana,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Humana MGG,Humana MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Optum VA,Optum VA,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,UHC,UHC,7.8,,,,,,,per diem,7.8,7.8,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,UHC MGG,UHC MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,VA,VA,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Wellcare MGG,Wellcare MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Bright Health - commercial,Bright Health - commercial,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213029,CDM,250,RC,,,,,,Inpatient,1,EA,7.8,7.8,Bright Health MGG,Bright Health MGG,7.8,,,,,,,case rate,7.8,7.8,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN 10U/ML-NS INJ         ,92213030,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Aetna,Aetna,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Aetna MGG,Aetna MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,BCBS,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS MGG,BCBS MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Cigna,Cigna,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Cigna MGG,Cigna MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Humana,Humana,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Humana MGG,Humana MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Optum VA,Optum VA,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,UHC,UHC,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,UHC MGG,UHC MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,VA,VA,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Wellcare MGG,Wellcare MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Bright Health - commercial,Bright Health - commercial,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 4.5GM INJ  ,92213031,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,Bright Health MGG,Bright Health MGG,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213032,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.5MG TAB       ,92213033,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Aetna,Aetna,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Aetna MGG,Aetna MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,BCBS,BCBS,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,BCBS MGG,BCBS MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Cigna,Cigna,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Cigna MGG,Cigna MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Humana,Humana,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Humana MGG,Humana MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Optum VA,Optum VA,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,UHC,UHC,5.16,,,,,,,per diem,5.16,5.16,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,UHC MGG,UHC MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,VA,VA,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Wellcare MGG,Wellcare MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Bright Health - commercial,Bright Health - commercial,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213034,CDM,250,RC,,,,,,Inpatient,1,EA,5.16,5.16,Bright Health MGG,Bright Health MGG,5.16,,,,,,,case rate,5.16,5.16,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Aetna,Aetna,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Aetna MGG,Aetna MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,BCBS,BCBS,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,BCBS MGG,BCBS MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Cigna,Cigna,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Cigna MGG,Cigna MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Humana,Humana,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Humana MGG,Humana MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Optum VA,Optum VA,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,UHC,UHC,169.59,,,,,,,per diem,169.59,169.59,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,UHC MGG,UHC MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,VA,VA,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Wellcare MGG,Wellcare MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Bright Health - commercial,Bright Health - commercial,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 50 INJ        ,92213035,CDM,250,RC,,,,,,Inpatient,1,EA,169.59,169.59,Bright Health MGG,Bright Health MGG,169.59,,,,,,,case rate,169.59,169.59,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Aetna,Aetna,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Aetna MGG,Aetna MGG,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,BCBS,BCBS,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,BCBS MGG,BCBS MGG,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Cigna,Cigna,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Cigna MGG,Cigna MGG,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Humana,Humana,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Humana MGG,Humana MGG,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Optum VA,Optum VA,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,UHC,UHC,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,UHC MGG,UHC MGG,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,VA,VA,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Wellcare MGG,Wellcare MGG,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Bright Health - commercial,Bright Health - commercial,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213036,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,Bright Health MGG,Bright Health MGG,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92213037,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92213038,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Aetna,Aetna,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Aetna MGG,Aetna MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,BCBS,BCBS,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,BCBS MGG,BCBS MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Cigna,Cigna,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Cigna MGG,Cigna MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Humana,Humana,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Humana MGG,Humana MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Optum VA,Optum VA,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,UHC,UHC,55.05,,,,,,,per diem,55.05,55.05,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,UHC MGG,UHC MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,VA,VA,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Wellcare MGG,Wellcare MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Bright Health - commercial,Bright Health - commercial,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213039,CDM,250,RC,,,,,,Inpatient,1,EA,55.05,55.05,Bright Health MGG,Bright Health MGG,55.05,,,,,,,case rate,55.05,55.05,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Aetna,Aetna,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Aetna MGG,Aetna MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,BCBS,BCBS,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,BCBS MGG,BCBS MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Cigna,Cigna,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Cigna MGG,Cigna MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Humana,Humana,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Humana MGG,Humana MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Optum VA,Optum VA,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,UHC,UHC,7.44,,,,,,,per diem,7.44,7.44,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,UHC MGG,UHC MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,VA,VA,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Wellcare MGG,Wellcare MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Bright Health - commercial,Bright Health - commercial,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92213040,CDM,250,RC,,,,,,Inpatient,1,EA,7.44,7.44,Bright Health MGG,Bright Health MGG,7.44,,,,,,,case rate,7.44,7.44,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Aetna,Aetna,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Aetna MGG,Aetna MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,BCBS,BCBS,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,BCBS MGG,BCBS MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Cigna,Cigna,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Cigna MGG,Cigna MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Humana,Humana,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Humana MGG,Humana MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Optum VA,Optum VA,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,UHC,UHC,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,UHC MGG,UHC MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,VA,VA,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Wellcare MGG,Wellcare MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Bright Health - commercial,Bright Health - commercial,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TER         ,92213041,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Bright Health MGG,Bright Health MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna,Aetna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna MGG,Aetna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS,BCBS,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS MGG,BCBS MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna,Cigna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna MGG,Cigna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana,Humana,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana MGG,Humana MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Optum VA,Optum VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC,UHC,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC MGG,UHC MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,VA,VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Wellcare MGG,Wellcare MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health - commercial,Bright Health - commercial,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92213042,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health MGG,Bright Health MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Aetna,Aetna,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Aetna MGG,Aetna MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,BCBS,BCBS,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,BCBS MGG,BCBS MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Cigna,Cigna,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Cigna MGG,Cigna MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Humana,Humana,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Humana MGG,Humana MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Optum VA,Optum VA,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,UHC,UHC,14.19,,,,,,,per diem,14.19,14.19,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,UHC MGG,UHC MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,VA,VA,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Wellcare MGG,Wellcare MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Bright Health - commercial,Bright Health - commercial,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 10MG/ML SOL   ,92213043,CDM,250,RC,,,,,,Inpatient,1,EA,14.19,14.19,Bright Health MGG,Bright Health MGG,14.19,,,,,,,case rate,14.19,14.19,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Aetna,Aetna,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Aetna MGG,Aetna MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,BCBS,BCBS,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,BCBS MGG,BCBS MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Cigna,Cigna,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Cigna MGG,Cigna MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Humana,Humana,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Humana MGG,Humana MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Optum VA,Optum VA,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,UHC,UHC,7.11,,,,,,,per diem,7.11,7.11,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,UHC MGG,UHC MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,VA,VA,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Wellcare MGG,Wellcare MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Bright Health - commercial,Bright Health - commercial,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE           ,92213044,CDM,250,RC,,,,,,Inpatient,1,EA,7.11,7.11,Bright Health MGG,Bright Health MGG,7.11,,,,,,,case rate,7.11,7.11,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92213045,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Aetna,Aetna,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Aetna MGG,Aetna MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,BCBS,BCBS,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,BCBS MGG,BCBS MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Cigna,Cigna,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Cigna MGG,Cigna MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Humana,Humana,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Humana MGG,Humana MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Optum VA,Optum VA,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,UHC,UHC,27.48,,,,,,,per diem,27.48,27.48,"Per diem rate, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,UHC MGG,UHC MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,VA,VA,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Wellcare MGG,Wellcare MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Bright Health - commercial,Bright Health - commercial,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
"HEPARIN 10,000U/ML INJ        ",92213046,CDM,250,RC,,,,,,Inpatient,1,EA,27.48,27.48,Bright Health MGG,Bright Health MGG,27.48,,,,,,,case rate,27.48,27.48,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213047,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92213048,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 8MG/ML INJ           ,92213049,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Aetna,Aetna,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Aetna MGG,Aetna MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,BCBS,BCBS,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,BCBS MGG,BCBS MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Cigna,Cigna,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Cigna MGG,Cigna MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Humana,Humana,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Humana MGG,Humana MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Optum VA,Optum VA,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,UHC,UHC,43.29,,,,,,,per diem,43.29,43.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,UHC MGG,UHC MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,VA,VA,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Wellcare MGG,Wellcare MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Bright Health - commercial,Bright Health - commercial,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92213050,CDM,250,RC,,,,,,Inpatient,1,EA,43.29,43.29,Bright Health MGG,Bright Health MGG,43.29,,,,,,,case rate,43.29,43.29,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92213051,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Aetna,Aetna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Aetna MGG,Aetna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,BCBS,BCBS,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,BCBS MGG,BCBS MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Cigna,Cigna,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Cigna MGG,Cigna MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Humana,Humana,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Humana MGG,Humana MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Optum VA,Optum VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,UHC,UHC,19.38,,,,,,,per diem,19.38,19.38,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,UHC MGG,UHC MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,VA,VA,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Wellcare MGG,Wellcare MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Bright Health - commercial,Bright Health - commercial,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92213052,CDM,250,RC,,,,,,Inpatient,1,EA,19.38,19.38,Bright Health MGG,Bright Health MGG,19.38,,,,,,,case rate,19.38,19.38,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Aetna,Aetna,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Aetna MGG,Aetna MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,BCBS,BCBS,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,BCBS MGG,BCBS MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Cigna,Cigna,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Cigna MGG,Cigna MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Humana,Humana,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Humana MGG,Humana MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Optum VA,Optum VA,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,UHC,UHC,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,UHC MGG,UHC MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,VA,VA,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Wellcare MGG,Wellcare MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Bright Health - commercial,Bright Health - commercial,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213053,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Bright Health MGG,Bright Health MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Aetna,Aetna,17.28,,,,,,,per diem,17.28,17.28,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Aetna MGG,Aetna MGG,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,BCBS,BCBS,17.28,,,,,,,per diem,17.28,17.28,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,BCBS MGG,BCBS MGG,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Cigna,Cigna,17.28,,,,,,,per diem,17.28,17.28,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Cigna MGG,Cigna MGG,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Humana,Humana,17.28,,,,,,,per diem,17.28,17.28,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Humana MGG,Humana MGG,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Optum VA,Optum VA,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,UHC,UHC,17.28,,,,,,,per diem,17.28,17.28,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,UHC MGG,UHC MGG,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,VA,VA,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Wellcare MGG,Wellcare MGG,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Bright Health - commercial,Bright Health - commercial,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213054,CDM,250,RC,,,,,,Inpatient,1,EA,17.28,17.28,Bright Health MGG,Bright Health MGG,17.28,,,,,,,case rate,17.28,17.28,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Aetna,Aetna,66.48,,,,,,,per diem,66.48,66.48,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Aetna MGG,Aetna MGG,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,BCBS,BCBS,66.48,,,,,,,per diem,66.48,66.48,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,BCBS MGG,BCBS MGG,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Cigna,Cigna,66.48,,,,,,,per diem,66.48,66.48,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Cigna MGG,Cigna MGG,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Humana,Humana,66.48,,,,,,,per diem,66.48,66.48,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Humana MGG,Humana MGG,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Optum VA,Optum VA,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,UHC,UHC,66.48,,,,,,,per diem,66.48,66.48,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,UHC MGG,UHC MGG,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,VA,VA,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Wellcare MGG,Wellcare MGG,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Bright Health - commercial,Bright Health - commercial,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG/ML INJ        ,92213055,CDM,250,RC,,,,,,Inpatient,1,EA,66.48,66.48,Bright Health MGG,Bright Health MGG,66.48,,,,,,,case rate,66.48,66.48,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Aetna,Aetna,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Aetna MGG,Aetna MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,BCBS,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS MGG,BCBS MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Cigna,Cigna,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Cigna MGG,Cigna MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Humana,Humana,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Humana MGG,Humana MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Optum VA,Optum VA,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,UHC,UHC,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,UHC MGG,UHC MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,VA,VA,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Wellcare MGG,Wellcare MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Bright Health - commercial,Bright Health - commercial,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 10MG CAP       ,92213056,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,Bright Health MGG,Bright Health MGG,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Aetna,Aetna,21.03,,,,,,,per diem,21.03,21.03,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Aetna MGG,Aetna MGG,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,BCBS,BCBS,21.03,,,,,,,per diem,21.03,21.03,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,BCBS MGG,BCBS MGG,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Cigna,Cigna,21.03,,,,,,,per diem,21.03,21.03,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Cigna MGG,Cigna MGG,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Humana,Humana,21.03,,,,,,,per diem,21.03,21.03,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Humana MGG,Humana MGG,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Optum VA,Optum VA,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,UHC,UHC,21.03,,,,,,,per diem,21.03,21.03,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,UHC MGG,UHC MGG,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,VA,VA,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Wellcare MGG,Wellcare MGG,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Bright Health - commercial,Bright Health - commercial,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 15MG TAB     ,92213057,CDM,250,RC,,,,,,Inpatient,1,EA,21.03,21.03,Bright Health MGG,Bright Health MGG,21.03,,,,,,,case rate,21.03,21.03,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna,Aetna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna MGG,Aetna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS,BCBS,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS MGG,BCBS MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna,Cigna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna MGG,Cigna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana,Humana,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana MGG,Humana MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Optum VA,Optum VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC,UHC,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC MGG,UHC MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,VA,VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Wellcare MGG,Wellcare MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health - commercial,Bright Health - commercial,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 2.5MG TAB ,92213058,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health MGG,Bright Health MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Aetna,Aetna,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Aetna MGG,Aetna MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,BCBS,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS MGG,BCBS MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Cigna,Cigna,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Cigna MGG,Cigna MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Humana,Humana,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Humana MGG,Humana MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Optum VA,Optum VA,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,UHC,UHC,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,UHC MGG,UHC MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,VA,VA,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Wellcare MGG,Wellcare MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Bright Health - commercial,Bright Health - commercial,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213059,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,Bright Health MGG,Bright Health MGG,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna,Aetna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Aetna MGG,Aetna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS,BCBS,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,BCBS MGG,BCBS MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna,Cigna,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Cigna MGG,Cigna MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana,Humana,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Humana MGG,Humana MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Optum VA,Optum VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC,UHC,8.01,,,,,,,per diem,8.01,8.01,"Per diem rate, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,UHC MGG,UHC MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,VA,VA,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Wellcare MGG,Wellcare MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health - commercial,Bright Health - commercial,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
FENOFIBRATE 200MG CAP         ,92213060,CDM,250,RC,,,,,,Inpatient,1,EA,8.01,8.01,Bright Health MGG,Bright Health MGG,8.01,,,,,,,case rate,8.01,8.01,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92213061,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Aetna,Aetna,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Aetna MGG,Aetna MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,BCBS,BCBS,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,BCBS MGG,BCBS MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Cigna,Cigna,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Cigna MGG,Cigna MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Humana,Humana,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Humana MGG,Humana MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Optum VA,Optum VA,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,UHC,UHC,7.14,,,,,,,per diem,7.14,7.14,"Per diem rate, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,UHC MGG,UHC MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,VA,VA,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Wellcare MGG,Wellcare MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Bright Health - commercial,Bright Health - commercial,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
FENOFIBRATE 160MG TAB         ,92213062,CDM,250,RC,,,,,,Inpatient,1,EA,7.14,7.14,Bright Health MGG,Bright Health MGG,7.14,,,,,,,case rate,7.14,7.14,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Aetna,Aetna,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Aetna MGG,Aetna MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,BCBS,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS MGG,BCBS MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Cigna,Cigna,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Cigna MGG,Cigna MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Humana,Humana,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Humana MGG,Humana MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Optum VA,Optum VA,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,UHC,UHC,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,UHC MGG,UHC MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,VA,VA,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Wellcare MGG,Wellcare MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Bright Health - commercial,Bright Health - commercial,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TER            ,92213063,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,Bright Health MGG,Bright Health MGG,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Aetna,Aetna,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Aetna MGG,Aetna MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,BCBS,BCBS,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,BCBS MGG,BCBS MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Cigna,Cigna,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Cigna MGG,Cigna MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Humana,Humana,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Humana MGG,Humana MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Optum VA,Optum VA,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,UHC,UHC,6.15,,,,,,,per diem,6.15,6.15,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,UHC MGG,UHC MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,VA,VA,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Wellcare MGG,Wellcare MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Bright Health - commercial,Bright Health - commercial,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92213064,CDM,250,RC,,,,,,Inpatient,1,EA,6.15,6.15,Bright Health MGG,Bright Health MGG,6.15,,,,,,,case rate,6.15,6.15,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna,Aetna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Aetna MGG,Aetna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,BCBS,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS MGG,BCBS MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna,Cigna,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Cigna MGG,Cigna MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana,Humana,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Humana MGG,Humana MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Optum VA,Optum VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC,UHC,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UHC MGG,UHC MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,VA,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Wellcare MGG,Wellcare MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health - commercial,Bright Health - commercial,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92213065,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,Bright Health MGG,Bright Health MGG,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92213066,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Aetna,Aetna,288.15,,,,,,,per diem,288.15,288.15,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Aetna MGG,Aetna MGG,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,BCBS,BCBS,288.15,,,,,,,per diem,288.15,288.15,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,BCBS MGG,BCBS MGG,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Cigna,Cigna,288.15,,,,,,,per diem,288.15,288.15,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Cigna MGG,Cigna MGG,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Humana,Humana,288.15,,,,,,,per diem,288.15,288.15,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Humana MGG,Humana MGG,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Optum VA,Optum VA,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,UHC,UHC,288.15,,,,,,,per diem,288.15,288.15,"Per diem rate, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,UHC MGG,UHC MGG,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,VA,VA,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Wellcare MGG,Wellcare MGG,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Bright Health - commercial,Bright Health - commercial,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
FLUCYTOSINE 250MG CAP         ,92213067,CDM,250,RC,,,,,,Inpatient,1,EA,288.15,288.15,Bright Health MGG,Bright Health MGG,288.15,,,,,,,case rate,288.15,288.15,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213068,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Aetna,Aetna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Aetna MGG,Aetna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,BCBS,BCBS,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,BCBS MGG,BCBS MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Cigna,Cigna,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Cigna MGG,Cigna MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Humana,Humana,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Humana MGG,Humana MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Optum VA,Optum VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,UHC,UHC,180,,,,,,,per diem,180,180,"Per diem rate, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,UHC MGG,UHC MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,VA,VA,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Wellcare MGG,Wellcare MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Bright Health - commercial,Bright Health - commercial,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
IRON SUCROSE 20MG/ML INJ      ,92213069,CDM,250,RC,,,,,,Inpatient,1,EA,180,180,Bright Health MGG,Bright Health MGG,180,,,,,,,case rate,180,180,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Aetna,Aetna,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Aetna MGG,Aetna MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS,BCBS,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS MGG,BCBS MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Cigna,Cigna,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Cigna MGG,Cigna MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Humana,Humana,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Humana MGG,Humana MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Optum VA,Optum VA,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,UHC,UHC,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,UHC MGG,UHC MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,VA,VA,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Wellcare MGG,Wellcare MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Bright Health - commercial,Bright Health - commercial,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
LANOLIN MINERAL OIL PETROLAT O,92213070,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,Bright Health MGG,Bright Health MGG,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92213071,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Aetna,Aetna,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Aetna MGG,Aetna MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,BCBS,BCBS,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,BCBS MGG,BCBS MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Cigna,Cigna,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Cigna MGG,Cigna MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Humana,Humana,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Humana MGG,Humana MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Optum VA,Optum VA,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,UHC,UHC,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,UHC MGG,UHC MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,VA,VA,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Wellcare MGG,Wellcare MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Bright Health - commercial,Bright Health - commercial,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
CA CL/DEX/NACL/NALACT IVS     ,92213072,CDM,258,RC,,,,,,Inpatient,1,EA,10.92,10.92,Bright Health MGG,Bright Health MGG,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Aetna,Aetna,3369.6,,,,,,,per diem,3369.6,3369.6,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Aetna MGG,Aetna MGG,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,BCBS,BCBS,3369.6,,,,,,,per diem,3369.6,3369.6,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,BCBS MGG,BCBS MGG,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Cigna,Cigna,3369.6,,,,,,,per diem,3369.6,3369.6,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Cigna MGG,Cigna MGG,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Humana,Humana,3369.6,,,,,,,per diem,3369.6,3369.6,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Humana MGG,Humana MGG,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Optum VA,Optum VA,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,UHC,UHC,3369.6,,,,,,,per diem,3369.6,3369.6,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,UHC MGG,UHC MGG,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,VA,VA,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Wellcare MGG,Wellcare MGG,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Bright Health - commercial,Bright Health - commercial,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 40,000U/ ML INJ  ",92213073,CDM,250,RC,,,,,,Inpatient,1,EA,3369.6,3369.6,Bright Health MGG,Bright Health MGG,3369.6,,,,,,,case rate,3369.6,3369.6,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna,Aetna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Aetna MGG,Aetna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS,BCBS,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,BCBS MGG,BCBS MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna,Cigna,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Cigna MGG,Cigna MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana,Humana,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Humana MGG,Humana MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Optum VA,Optum VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC,UHC,7.71,,,,,,,per diem,7.71,7.71,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,UHC MGG,UHC MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,VA,VA,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Wellcare MGG,Wellcare MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health - commercial,Bright Health - commercial,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92213074,CDM,250,RC,,,,,,Inpatient,1,EA,7.71,7.71,Bright Health MGG,Bright Health MGG,7.71,,,,,,,case rate,7.71,7.71,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92213075,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Aetna,Aetna,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Aetna MGG,Aetna MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,BCBS,BCBS,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,BCBS MGG,BCBS MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Cigna,Cigna,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Cigna MGG,Cigna MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Humana,Humana,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Humana MGG,Humana MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Optum VA,Optum VA,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,UHC,UHC,144,,,,,,,per diem,144,144,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,UHC MGG,UHC MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,VA,VA,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Wellcare MGG,Wellcare MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Bright Health - commercial,Bright Health - commercial,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213076,CDM,250,RC,,,,,,Inpatient,1,EA,144,144,Bright Health MGG,Bright Health MGG,144,,,,,,,case rate,144,144,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna,Aetna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Aetna MGG,Aetna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS,BCBS,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,BCBS MGG,BCBS MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna,Cigna,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Cigna MGG,Cigna MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana,Humana,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Humana MGG,Humana MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Optum VA,Optum VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC,UHC,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,UHC MGG,UHC MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,VA,VA,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Wellcare MGG,Wellcare MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health - commercial,Bright Health - commercial,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
FENOFIBRATE 134MG CAP         ,92213077,CDM,250,RC,,,,,,Inpatient,1,EA,5.88,5.88,Bright Health MGG,Bright Health MGG,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213078,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92213079,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Aetna,Aetna,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Aetna MGG,Aetna MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,BCBS,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS MGG,BCBS MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Cigna,Cigna,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Cigna MGG,Cigna MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Humana,Humana,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Humana MGG,Humana MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Optum VA,Optum VA,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UHC,UHC,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UHC MGG,UHC MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,VA,VA,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Wellcare MGG,Wellcare MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Bright Health - commercial,Bright Health - commercial,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 0.1MG/ML INJ  ,92213080,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,Bright Health MGG,Bright Health MGG,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FENOFIBRATE 54MG TAB          ,92213081,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Aetna,Aetna,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Aetna MGG,Aetna MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,BCBS,BCBS,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,BCBS MGG,BCBS MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Cigna,Cigna,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Cigna MGG,Cigna MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Humana,Humana,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Humana MGG,Humana MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Optum VA,Optum VA,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,UHC,UHC,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,UHC MGG,UHC MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,VA,VA,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Wellcare MGG,Wellcare MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Bright Health - commercial,Bright Health - commercial,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.3% SOL         ,92213082,CDM,250,RC,,,,,,Inpatient,1,EA,25.38,25.38,Bright Health MGG,Bright Health MGG,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92213083,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIGLITOL 25MG TAB             ,92213084,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Aetna,Aetna,43.89,,,,,,,per diem,43.89,43.89,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Aetna MGG,Aetna MGG,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,BCBS,BCBS,43.89,,,,,,,per diem,43.89,43.89,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,BCBS MGG,BCBS MGG,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Cigna,Cigna,43.89,,,,,,,per diem,43.89,43.89,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Cigna MGG,Cigna MGG,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Humana,Humana,43.89,,,,,,,per diem,43.89,43.89,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Humana MGG,Humana MGG,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Optum VA,Optum VA,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,UHC,UHC,43.89,,,,,,,per diem,43.89,43.89,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,UHC MGG,UHC MGG,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,VA,VA,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Wellcare MGG,Wellcare MGG,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Bright Health - commercial,Bright Health - commercial,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 200MG/100ML INJ ,92213085,CDM,250,RC,,,,,,Inpatient,1,EA,43.89,43.89,Bright Health MGG,Bright Health MGG,43.89,,,,,,,case rate,43.89,43.89,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 60MG TAB     ,92213086,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Aetna,Aetna,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Aetna MGG,Aetna MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,BCBS,BCBS,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,BCBS MGG,BCBS MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Cigna,Cigna,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Cigna MGG,Cigna MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Humana,Humana,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Humana MGG,Humana MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Optum VA,Optum VA,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,UHC,UHC,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,UHC MGG,UHC MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,VA,VA,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Wellcare MGG,Wellcare MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Bright Health - commercial,Bright Health - commercial,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213087,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Bright Health MGG,Bright Health MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Aetna,Aetna,26.16,,,,,,,per diem,26.16,26.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Aetna MGG,Aetna MGG,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,BCBS,BCBS,26.16,,,,,,,per diem,26.16,26.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,BCBS MGG,BCBS MGG,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Cigna,Cigna,26.16,,,,,,,per diem,26.16,26.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Cigna MGG,Cigna MGG,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Humana,Humana,26.16,,,,,,,per diem,26.16,26.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Humana MGG,Humana MGG,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Optum VA,Optum VA,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,UHC,UHC,26.16,,,,,,,per diem,26.16,26.16,"Per diem rate, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,UHC MGG,UHC MGG,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,VA,VA,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Wellcare MGG,Wellcare MGG,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Bright Health - commercial,Bright Health - commercial,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
PIOGLITAZONE HCL 45MG TAB     ,92213088,CDM,250,RC,,,,,,Inpatient,1,EA,26.16,26.16,Bright Health MGG,Bright Health MGG,26.16,,,,,,,case rate,26.16,26.16,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Aetna,Aetna,156.81,,,,,,,per diem,156.81,156.81,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Aetna MGG,Aetna MGG,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,BCBS,BCBS,156.81,,,,,,,per diem,156.81,156.81,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,BCBS MGG,BCBS MGG,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Cigna,Cigna,156.81,,,,,,,per diem,156.81,156.81,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Cigna MGG,Cigna MGG,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Humana,Humana,156.81,,,,,,,per diem,156.81,156.81,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Humana MGG,Humana MGG,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Optum VA,Optum VA,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,UHC,UHC,156.81,,,,,,,per diem,156.81,156.81,"Per diem rate, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,UHC MGG,UHC MGG,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,VA,VA,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Wellcare MGG,Wellcare MGG,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Bright Health - commercial,Bright Health - commercial,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
NALBUPHINE HCL 20MG/ML INJ    ,92213089,CDM,250,RC,,,,,,Inpatient,1,EA,156.81,156.81,Bright Health MGG,Bright Health MGG,156.81,,,,,,,case rate,156.81,156.81,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
K CL/NABCRB/NACL/NASULF/PEG PD,92213090,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92213091,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Aetna,Aetna,33.87,,,,,,,per diem,33.87,33.87,"Per diem rate, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Aetna MGG,Aetna MGG,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,BCBS,BCBS,33.87,,,,,,,per diem,33.87,33.87,"Per diem rate, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,BCBS MGG,BCBS MGG,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Cigna,Cigna,33.87,,,,,,,per diem,33.87,33.87,"Per diem rate, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Cigna MGG,Cigna MGG,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Humana,Humana,33.87,,,,,,,per diem,33.87,33.87,"Per diem rate, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Humana MGG,Humana MGG,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Optum VA,Optum VA,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,UHC,UHC,33.87,,,,,,,per diem,33.87,33.87,"Per diem rate, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,UHC MGG,UHC MGG,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,VA,VA,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Wellcare MGG,Wellcare MGG,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Bright Health - commercial,Bright Health - commercial,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
DEXTROSE 50%/WATER INJ        ,92213092,CDM,250,RC,,,,,,Inpatient,1,EA,33.87,33.87,Bright Health MGG,Bright Health MGG,33.87,,,,,,,case rate,33.87,33.87,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Aetna,Aetna,551.01,,,,,,,per diem,551.01,551.01,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Aetna MGG,Aetna MGG,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,BCBS,BCBS,551.01,,,,,,,per diem,551.01,551.01,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,BCBS MGG,BCBS MGG,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Cigna,Cigna,551.01,,,,,,,per diem,551.01,551.01,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Cigna MGG,Cigna MGG,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Humana,Humana,551.01,,,,,,,per diem,551.01,551.01,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Humana MGG,Humana MGG,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Optum VA,Optum VA,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,UHC,UHC,551.01,,,,,,,per diem,551.01,551.01,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,UHC MGG,UHC MGG,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,VA,VA,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Wellcare MGG,Wellcare MGG,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Bright Health - commercial,Bright Health - commercial,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 2MG INJ      ,92213093,CDM,250,RC,,,,,,Inpatient,1,EA,551.01,551.01,Bright Health MGG,Bright Health MGG,551.01,,,,,,,case rate,551.01,551.01,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92213094,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Aetna,Aetna,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Aetna MGG,Aetna MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,BCBS,BCBS,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,BCBS MGG,BCBS MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Cigna,Cigna,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Cigna MGG,Cigna MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Humana,Humana,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Humana MGG,Humana MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Optum VA,Optum VA,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,UHC,UHC,40.89,,,,,,,per diem,40.89,40.89,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,UHC MGG,UHC MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,VA,VA,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Wellcare MGG,Wellcare MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Bright Health - commercial,Bright Health - commercial,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92213095,CDM,250,RC,,,,,,Inpatient,1,EA,40.89,40.89,Bright Health MGG,Bright Health MGG,40.89,,,,,,,case rate,40.89,40.89,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92213096,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92213097,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92213098,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213099,CDM,250,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Aetna,Aetna,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Aetna MGG,Aetna MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,BCBS,BCBS,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,BCBS MGG,BCBS MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Cigna,Cigna,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Cigna MGG,Cigna MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Humana,Humana,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Humana MGG,Humana MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Optum VA,Optum VA,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,UHC,UHC,5.07,,,,,,,per diem,5.07,5.07,"Per diem rate, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,UHC MGG,UHC MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,VA,VA,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Wellcare MGG,Wellcare MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Bright Health - commercial,Bright Health - commercial,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
MINOXIDIL 10MG TAB            ,92213100,CDM,250,RC,,,,,,Inpatient,1,EA,5.07,5.07,Bright Health MGG,Bright Health MGG,5.07,,,,,,,case rate,5.07,5.07,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Aetna,Aetna,88.44,,,,,,,per diem,88.44,88.44,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Aetna MGG,Aetna MGG,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,BCBS,BCBS,88.44,,,,,,,per diem,88.44,88.44,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,BCBS MGG,BCBS MGG,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Cigna,Cigna,88.44,,,,,,,per diem,88.44,88.44,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Cigna MGG,Cigna MGG,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Humana,Humana,88.44,,,,,,,per diem,88.44,88.44,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Humana MGG,Humana MGG,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Optum VA,Optum VA,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,UHC,UHC,88.44,,,,,,,per diem,88.44,88.44,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,UHC MGG,UHC MGG,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,VA,VA,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Wellcare MGG,Wellcare MGG,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Bright Health - commercial,Bright Health - commercial,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 400MG/200ML INJ ,92213101,CDM,250,RC,,,,,,Inpatient,1,EA,88.44,88.44,Bright Health MGG,Bright Health MGG,88.44,,,,,,,case rate,88.44,88.44,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92213102,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92213103,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG/ML INJ    ,92213104,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Aetna,Aetna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Aetna MGG,Aetna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,BCBS,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS MGG,BCBS MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Cigna,Cigna,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Cigna MGG,Cigna MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Humana,Humana,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Humana MGG,Humana MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Optum VA,Optum VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UHC,UHC,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UHC MGG,UHC MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,VA,VA,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Wellcare MGG,Wellcare MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Bright Health - commercial,Bright Health - commercial,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92213105,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,Bright Health MGG,Bright Health MGG,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Aetna,Aetna,806.19,,,,,,,per diem,806.19,806.19,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Aetna MGG,Aetna MGG,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,BCBS,BCBS,806.19,,,,,,,per diem,806.19,806.19,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,BCBS MGG,BCBS MGG,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Cigna,Cigna,806.19,,,,,,,per diem,806.19,806.19,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Cigna MGG,Cigna MGG,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Humana,Humana,806.19,,,,,,,per diem,806.19,806.19,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Humana MGG,Humana MGG,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Optum VA,Optum VA,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,UHC,UHC,806.19,,,,,,,per diem,806.19,806.19,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,UHC MGG,UHC MGG,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,VA,VA,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Wellcare MGG,Wellcare MGG,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Bright Health - commercial,Bright Health - commercial,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213106,CDM,250,RC,,,,,,Inpatient,1,EA,806.19,806.19,Bright Health MGG,Bright Health MGG,806.19,,,,,,,case rate,806.19,806.19,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Aetna,Aetna,542.7,,,,,,,per diem,542.7,542.7,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Aetna MGG,Aetna MGG,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,BCBS,BCBS,542.7,,,,,,,per diem,542.7,542.7,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,BCBS MGG,BCBS MGG,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Cigna,Cigna,542.7,,,,,,,per diem,542.7,542.7,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Cigna MGG,Cigna MGG,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Humana,Humana,542.7,,,,,,,per diem,542.7,542.7,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Humana MGG,Humana MGG,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Optum VA,Optum VA,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,UHC,UHC,542.7,,,,,,,per diem,542.7,542.7,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,UHC MGG,UHC MGG,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,VA,VA,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Wellcare MGG,Wellcare MGG,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Bright Health - commercial,Bright Health - commercial,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213107,CDM,250,RC,,,,,,Inpatient,1,EA,542.7,542.7,Bright Health MGG,Bright Health MGG,542.7,,,,,,,case rate,542.7,542.7,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Aetna,Aetna,1069.2,,,,,,,per diem,1069.2,1069.2,"Per diem rate, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Aetna MGG,Aetna MGG,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,BCBS,BCBS,1069.2,,,,,,,per diem,1069.2,1069.2,"Per diem rate, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,BCBS MGG,BCBS MGG,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Cigna,Cigna,1069.2,,,,,,,per diem,1069.2,1069.2,"Per diem rate, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Cigna MGG,Cigna MGG,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Humana,Humana,1069.2,,,,,,,per diem,1069.2,1069.2,"Per diem rate, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Humana MGG,Humana MGG,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Optum VA,Optum VA,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,UHC,UHC,1069.2,,,,,,,per diem,1069.2,1069.2,"Per diem rate, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,UHC MGG,UHC MGG,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,VA,VA,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Wellcare MGG,Wellcare MGG,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Bright Health - commercial,Bright Health - commercial,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
CISATRACURUIM BESYL 10MG/ML IN,92213108,CDM,250,RC,,,,,,Inpatient,1,EA,1069.2,1069.2,Bright Health MGG,Bright Health MGG,1069.2,,,,,,,case rate,1069.2,1069.2,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Aetna,Aetna,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Aetna MGG,Aetna MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,BCBS,BCBS,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,BCBS MGG,BCBS MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Cigna,Cigna,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Cigna MGG,Cigna MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Humana,Humana,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Humana MGG,Humana MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Optum VA,Optum VA,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,UHC,UHC,8.31,,,,,,,per diem,8.31,8.31,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,UHC MGG,UHC MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,VA,VA,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Wellcare MGG,Wellcare MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Bright Health - commercial,Bright Health - commercial,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92213109,CDM,250,RC,,,,,,Inpatient,1,EA,8.31,8.31,Bright Health MGG,Bright Health MGG,8.31,,,,,,,case rate,8.31,8.31,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Aetna,Aetna,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Aetna MGG,Aetna MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,BCBS,BCBS,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,BCBS MGG,BCBS MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Cigna,Cigna,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Cigna MGG,Cigna MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Humana,Humana,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Humana MGG,Humana MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Optum VA,Optum VA,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,UHC,UHC,535.32,,,,,,,per diem,535.32,535.32,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,UHC MGG,UHC MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,VA,VA,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Wellcare MGG,Wellcare MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Bright Health - commercial,Bright Health - commercial,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92213110,CDM,250,RC,,,,,,Inpatient,1,EA,535.32,535.32,Bright Health MGG,Bright Health MGG,535.32,,,,,,,case rate,535.32,535.32,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TER     ,92213111,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92213112,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Aetna,Aetna,286.2,,,,,,,per diem,286.2,286.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Aetna MGG,Aetna MGG,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,BCBS,BCBS,286.2,,,,,,,per diem,286.2,286.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,BCBS MGG,BCBS MGG,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Cigna,Cigna,286.2,,,,,,,per diem,286.2,286.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Cigna MGG,Cigna MGG,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Humana,Humana,286.2,,,,,,,per diem,286.2,286.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Humana MGG,Humana MGG,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Optum VA,Optum VA,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,UHC,UHC,286.2,,,,,,,per diem,286.2,286.2,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,UHC MGG,UHC MGG,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,VA,VA,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Wellcare MGG,Wellcare MGG,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Bright Health - commercial,Bright Health - commercial,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92213113,CDM,250,RC,,,,,,Inpatient,1,EA,286.2,286.2,Bright Health MGG,Bright Health MGG,286.2,,,,,,,case rate,286.2,286.2,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Aetna,Aetna,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Aetna MGG,Aetna MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,BCBS,BCBS,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,BCBS MGG,BCBS MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Cigna,Cigna,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Cigna MGG,Cigna MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Humana,Humana,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Humana MGG,Humana MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Optum VA,Optum VA,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,UHC,UHC,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,UHC MGG,UHC MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,VA,VA,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Wellcare MGG,Wellcare MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Bright Health - commercial,Bright Health - commercial,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
VALSARTAN 40MG TAB            ,92213114,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Bright Health MGG,Bright Health MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92213115,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOAMING ANTACID CTB           ,92213116,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CU SE VITA VITB VITC Z TAB    ,92213117,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92213118,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Aetna,Aetna,95.7,,,,,,,per diem,95.7,95.7,"Per diem rate, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Aetna MGG,Aetna MGG,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,BCBS,BCBS,95.7,,,,,,,per diem,95.7,95.7,"Per diem rate, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,BCBS MGG,BCBS MGG,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Cigna,Cigna,95.7,,,,,,,per diem,95.7,95.7,"Per diem rate, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Cigna MGG,Cigna MGG,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Humana,Humana,95.7,,,,,,,per diem,95.7,95.7,"Per diem rate, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Humana MGG,Humana MGG,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Optum VA,Optum VA,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,UHC,UHC,95.7,,,,,,,per diem,95.7,95.7,"Per diem rate, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,UHC MGG,UHC MGG,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,VA,VA,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Wellcare MGG,Wellcare MGG,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Bright Health - commercial,Bright Health - commercial,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
ZINC SULF 1MG/ML INJ          ,92213119,CDM,250,RC,,,,,,Inpatient,1,EA,95.7,95.7,Bright Health MGG,Bright Health MGG,95.7,,,,,,,case rate,95.7,95.7,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92213120,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Aetna,Aetna,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Aetna MGG,Aetna MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,BCBS,BCBS,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,BCBS MGG,BCBS MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Cigna,Cigna,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Cigna MGG,Cigna MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Humana,Humana,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Humana MGG,Humana MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Optum VA,Optum VA,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,UHC,UHC,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,UHC MGG,UHC MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,VA,VA,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Wellcare MGG,Wellcare MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Bright Health - commercial,Bright Health - commercial,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 1MG/ML INJ    ,92213121,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Bright Health MGG,Bright Health MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GLIMEPIRIDE 2MG TAB           ,92213122,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Aetna,Aetna,29.76,,,,,,,per diem,29.76,29.76,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Aetna MGG,Aetna MGG,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,BCBS,BCBS,29.76,,,,,,,per diem,29.76,29.76,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,BCBS MGG,BCBS MGG,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Cigna,Cigna,29.76,,,,,,,per diem,29.76,29.76,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Cigna MGG,Cigna MGG,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Humana,Humana,29.76,,,,,,,per diem,29.76,29.76,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Humana MGG,Humana MGG,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Optum VA,Optum VA,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,UHC,UHC,29.76,,,,,,,per diem,29.76,29.76,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,UHC MGG,UHC MGG,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,VA,VA,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Wellcare MGG,Wellcare MGG,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Bright Health - commercial,Bright Health - commercial,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 10MG/ML INJ     ,92213123,CDM,250,RC,,,,,,Inpatient,1,EA,29.76,29.76,Bright Health MGG,Bright Health MGG,29.76,,,,,,,case rate,29.76,29.76,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Aetna,Aetna,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Aetna MGG,Aetna MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,BCBS,BCBS,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,BCBS MGG,BCBS MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Cigna,Cigna,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Cigna MGG,Cigna MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Humana,Humana,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Humana MGG,Humana MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Optum VA,Optum VA,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,UHC,UHC,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,UHC MGG,UHC MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,VA,VA,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Wellcare MGG,Wellcare MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Bright Health - commercial,Bright Health - commercial,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
NALTREXONE 50MG TAB           ,92213124,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Bright Health MGG,Bright Health MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Aetna,Aetna,25.56,,,,,,,per diem,25.56,25.56,"Per diem rate, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Aetna MGG,Aetna MGG,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,BCBS,BCBS,25.56,,,,,,,per diem,25.56,25.56,"Per diem rate, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,BCBS MGG,BCBS MGG,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Cigna,Cigna,25.56,,,,,,,per diem,25.56,25.56,"Per diem rate, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Cigna MGG,Cigna MGG,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Humana,Humana,25.56,,,,,,,per diem,25.56,25.56,"Per diem rate, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Humana MGG,Humana MGG,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Optum VA,Optum VA,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,UHC,UHC,25.56,,,,,,,per diem,25.56,25.56,"Per diem rate, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,UHC MGG,UHC MGG,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,VA,VA,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Wellcare MGG,Wellcare MGG,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Bright Health - commercial,Bright Health - commercial,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
STAVIDOME 20MG CAP            ,92213125,CDM,250,RC,,,,,,Inpatient,1,EA,25.56,25.56,Bright Health MGG,Bright Health MGG,25.56,,,,,,,case rate,25.56,25.56,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Aetna,Aetna,19.08,,,,,,,per diem,19.08,19.08,"Per diem rate, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Aetna MGG,Aetna MGG,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,BCBS,BCBS,19.08,,,,,,,per diem,19.08,19.08,"Per diem rate, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,BCBS MGG,BCBS MGG,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Cigna,Cigna,19.08,,,,,,,per diem,19.08,19.08,"Per diem rate, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Cigna MGG,Cigna MGG,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Humana,Humana,19.08,,,,,,,per diem,19.08,19.08,"Per diem rate, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Humana MGG,Humana MGG,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Optum VA,Optum VA,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,UHC,UHC,19.08,,,,,,,per diem,19.08,19.08,"Per diem rate, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,UHC MGG,UHC MGG,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,VA,VA,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Wellcare MGG,Wellcare MGG,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Bright Health - commercial,Bright Health - commercial,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
METHYLTESTOSTERONE 10MG TAB   ,92213126,CDM,250,RC,,,,,,Inpatient,1,EA,19.08,19.08,Bright Health MGG,Bright Health MGG,19.08,,,,,,,case rate,19.08,19.08,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Aetna,Aetna,273.75,,,,,,,per diem,273.75,273.75,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Aetna MGG,Aetna MGG,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,BCBS,BCBS,273.75,,,,,,,per diem,273.75,273.75,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,BCBS MGG,BCBS MGG,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Cigna,Cigna,273.75,,,,,,,per diem,273.75,273.75,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Cigna MGG,Cigna MGG,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Humana,Humana,273.75,,,,,,,per diem,273.75,273.75,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Humana MGG,Humana MGG,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Optum VA,Optum VA,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,UHC,UHC,273.75,,,,,,,per diem,273.75,273.75,"Per diem rate, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,UHC MGG,UHC MGG,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,VA,VA,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Wellcare MGG,Wellcare MGG,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Bright Health - commercial,Bright Health - commercial,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
FOSCARNET NA 24MG/ML INJ      ,92213127,CDM,250,RC,,,,,,Inpatient,1,EA,273.75,273.75,Bright Health MGG,Bright Health MGG,273.75,,,,,,,case rate,273.75,273.75,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna,Aetna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Aetna MGG,Aetna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS,BCBS,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,BCBS MGG,BCBS MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna,Cigna,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Cigna MGG,Cigna MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana,Humana,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Humana MGG,Humana MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Optum VA,Optum VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC,UHC,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,UHC MGG,UHC MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,VA,VA,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Wellcare MGG,Wellcare MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health - commercial,Bright Health - commercial,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92213128,CDM,250,RC,,,,,,Inpatient,1,EA,52.5,52.5,Bright Health MGG,Bright Health MGG,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Aetna,Aetna,909,,,,,,,per diem,909,909,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Aetna MGG,Aetna MGG,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,BCBS,BCBS,909,,,,,,,per diem,909,909,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,BCBS MGG,BCBS MGG,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Cigna,Cigna,909,,,,,,,per diem,909,909,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Cigna MGG,Cigna MGG,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Humana,Humana,909,,,,,,,per diem,909,909,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Humana MGG,Humana MGG,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Optum VA,Optum VA,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,UHC,UHC,909,,,,,,,per diem,909,909,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,UHC MGG,UHC MGG,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,VA,VA,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Wellcare MGG,Wellcare MGG,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Bright Health - commercial,Bright Health - commercial,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 3GM INJ       ,92213129,CDM,250,RC,,,,,,Inpatient,1,EA,909,909,Bright Health MGG,Bright Health MGG,909,,,,,,,case rate,909,909,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
METAPROTERENOL SULF 20MG TAB  ,92213130,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MINOXIDIL 2.5MG TAB           ,92213131,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213132,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Aetna,Aetna,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Aetna MGG,Aetna MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,BCBS,BCBS,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,BCBS MGG,BCBS MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Cigna,Cigna,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Cigna MGG,Cigna MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Humana,Humana,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Humana MGG,Humana MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Optum VA,Optum VA,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,UHC,UHC,9.87,,,,,,,per diem,9.87,9.87,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,UHC MGG,UHC MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,VA,VA,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Wellcare MGG,Wellcare MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Bright Health - commercial,Bright Health - commercial,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 10MG TER        ,92213133,CDM,250,RC,,,,,,Inpatient,1,EA,9.87,9.87,Bright Health MGG,Bright Health MGG,9.87,,,,,,,case rate,9.87,9.87,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213134,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Aetna,Aetna,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Aetna MGG,Aetna MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,BCBS,BCBS,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,BCBS MGG,BCBS MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Cigna,Cigna,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Cigna MGG,Cigna MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Humana,Humana,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Humana MGG,Humana MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Optum VA,Optum VA,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,UHC,UHC,8.67,,,,,,,per diem,8.67,8.67,"Per diem rate, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,UHC MGG,UHC MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,VA,VA,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Wellcare MGG,Wellcare MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Bright Health - commercial,Bright Health - commercial,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
ZIND OXIDE OIN                ,92213135,CDM,250,RC,,,,,,Inpatient,1,EA,8.67,8.67,Bright Health MGG,Bright Health MGG,8.67,,,,,,,case rate,8.67,8.67,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 40MG TAB       ,92213136,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMINOPHYLLINE 100MG TAB       ,92213137,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 20MG TAB       ,92213138,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 50MCG TAB     ,92213139,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Aetna,Aetna,205.2,,,,,,,per diem,205.2,205.2,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Aetna MGG,Aetna MGG,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,BCBS,BCBS,205.2,,,,,,,per diem,205.2,205.2,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,BCBS MGG,BCBS MGG,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Cigna,Cigna,205.2,,,,,,,per diem,205.2,205.2,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Cigna MGG,Cigna MGG,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Humana,Humana,205.2,,,,,,,per diem,205.2,205.2,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Humana MGG,Humana MGG,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Optum VA,Optum VA,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,UHC,UHC,205.2,,,,,,,per diem,205.2,205.2,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,UHC MGG,UHC MGG,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,VA,VA,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Wellcare MGG,Wellcare MGG,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Bright Health - commercial,Bright Health - commercial,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92213140,CDM,250,RC,,,,,,Inpatient,1,EA,205.2,205.2,Bright Health MGG,Bright Health MGG,205.2,,,,,,,case rate,205.2,205.2,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Aetna,Aetna,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Aetna MGG,Aetna MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,BCBS,BCBS,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,BCBS MGG,BCBS MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Cigna,Cigna,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Cigna MGG,Cigna MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Humana,Humana,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Humana MGG,Humana MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Optum VA,Optum VA,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,UHC,UHC,288.96,,,,,,,per diem,288.96,288.96,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,UHC MGG,UHC MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,VA,VA,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Wellcare MGG,Wellcare MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Bright Health - commercial,Bright Health - commercial,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92213141,CDM,250,RC,,,,,,Inpatient,1,EA,288.96,288.96,Bright Health MGG,Bright Health MGG,288.96,,,,,,,case rate,288.96,288.96,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Aetna,Aetna,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Aetna MGG,Aetna MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,BCBS,BCBS,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,BCBS MGG,BCBS MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Cigna,Cigna,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Cigna MGG,Cigna MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Humana,Humana,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Humana MGG,Humana MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Optum VA,Optum VA,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,UHC,UHC,9.81,,,,,,,per diem,9.81,9.81,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,UHC MGG,UHC MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,VA,VA,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Wellcare MGG,Wellcare MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Bright Health - commercial,Bright Health - commercial,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213142,CDM,258,RC,,,,,,Inpatient,1,EA,9.81,9.81,Bright Health MGG,Bright Health MGG,9.81,,,,,,,case rate,9.81,9.81,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213143,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRANDOLAPRIL 1MG TAB          ,92213144,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Aetna,Aetna,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Aetna MGG,Aetna MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,BCBS,BCBS,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,BCBS MGG,BCBS MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Cigna,Cigna,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Cigna MGG,Cigna MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Humana,Humana,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Humana MGG,Humana MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Optum VA,Optum VA,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,UHC,UHC,450,,,,,,,per diem,450,450,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,UHC MGG,UHC MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,VA,VA,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Wellcare MGG,Wellcare MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Bright Health - commercial,Bright Health - commercial,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92213145,CDM,250,RC,,,,,,Inpatient,1,EA,450,450,Bright Health MGG,Bright Health MGG,450,,,,,,,case rate,450,450,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Aetna,Aetna,1376.88,,,,,,,per diem,1376.88,1376.88,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Aetna MGG,Aetna MGG,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,BCBS,BCBS,1376.88,,,,,,,per diem,1376.88,1376.88,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,BCBS MGG,BCBS MGG,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Cigna,Cigna,1376.88,,,,,,,per diem,1376.88,1376.88,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Cigna MGG,Cigna MGG,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Humana,Humana,1376.88,,,,,,,per diem,1376.88,1376.88,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Humana MGG,Humana MGG,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Optum VA,Optum VA,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,UHC,UHC,1376.88,,,,,,,per diem,1376.88,1376.88,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,UHC MGG,UHC MGG,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,VA,VA,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Wellcare MGG,Wellcare MGG,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Bright Health - commercial,Bright Health - commercial,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% CRE          ,92213146,CDM,250,RC,,,,,,Inpatient,1,EA,1376.88,1376.88,Bright Health MGG,Bright Health MGG,1376.88,,,,,,,case rate,1376.88,1376.88,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna,Aetna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna MGG,Aetna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS,BCBS,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS MGG,BCBS MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna,Cigna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna MGG,Cigna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana,Humana,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana MGG,Humana MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Optum VA,Optum VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC,UHC,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC MGG,UHC MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,VA,VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Wellcare MGG,Wellcare MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health - commercial,Bright Health - commercial,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92213147,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health MGG,Bright Health MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Aetna,Aetna,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Aetna MGG,Aetna MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,BCBS,BCBS,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,BCBS MGG,BCBS MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Cigna,Cigna,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Cigna MGG,Cigna MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Humana,Humana,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Humana MGG,Humana MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Optum VA,Optum VA,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,UHC,UHC,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,UHC MGG,UHC MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,VA,VA,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Wellcare MGG,Wellcare MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Bright Health - commercial,Bright Health - commercial,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OFLOXACIN 300MG TAB           ,92213148,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Bright Health MGG,Bright Health MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna,Aetna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Aetna MGG,Aetna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS,BCBS,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,BCBS MGG,BCBS MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna,Cigna,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Cigna MGG,Cigna MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana,Humana,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Humana MGG,Humana MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Optum VA,Optum VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC,UHC,6.96,,,,,,,per diem,6.96,6.96,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,UHC MGG,UHC MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,VA,VA,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Wellcare MGG,Wellcare MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health - commercial,Bright Health - commercial,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92213149,CDM,250,RC,,,,,,Inpatient,1,EA,6.96,6.96,Bright Health MGG,Bright Health MGG,6.96,,,,,,,case rate,6.96,6.96,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92213150,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92213151,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Aetna,Aetna,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Aetna MGG,Aetna MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,BCBS,BCBS,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,BCBS MGG,BCBS MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Cigna,Cigna,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Cigna MGG,Cigna MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Humana,Humana,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Humana MGG,Humana MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Optum VA,Optum VA,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,UHC,UHC,9.3,,,,,,,per diem,9.3,9.3,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,UHC MGG,UHC MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,VA,VA,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Wellcare MGG,Wellcare MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Bright Health - commercial,Bright Health - commercial,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92213152,CDM,250,RC,,,,,,Inpatient,1,EA,9.3,9.3,Bright Health MGG,Bright Health MGG,9.3,,,,,,,case rate,9.3,9.3,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92213153,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Aetna,Aetna,505.44,,,,,,,per diem,505.44,505.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Aetna MGG,Aetna MGG,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,BCBS,BCBS,505.44,,,,,,,per diem,505.44,505.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,BCBS MGG,BCBS MGG,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Cigna,Cigna,505.44,,,,,,,per diem,505.44,505.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Cigna MGG,Cigna MGG,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Humana,Humana,505.44,,,,,,,per diem,505.44,505.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Humana MGG,Humana MGG,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Optum VA,Optum VA,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,UHC,UHC,505.44,,,,,,,per diem,505.44,505.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,UHC MGG,UHC MGG,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,VA,VA,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Wellcare MGG,Wellcare MGG,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Bright Health - commercial,Bright Health - commercial,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 1.2GM INJ          ,92213154,CDM,250,RC,,,,,,Inpatient,1,EA,505.44,505.44,Bright Health MGG,Bright Health MGG,505.44,,,,,,,case rate,505.44,505.44,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna,Aetna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Aetna MGG,Aetna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS,BCBS,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,BCBS MGG,BCBS MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna,Cigna,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Cigna MGG,Cigna MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana,Humana,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Humana MGG,Humana MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Optum VA,Optum VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC,UHC,9,,,,,,,per diem,9,9,"Per diem rate, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,UHC MGG,UHC MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,VA,VA,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Wellcare MGG,Wellcare MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health - commercial,Bright Health - commercial,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
CORTISONE ACETATE 25MG TAB    ,92213155,CDM,250,RC,,,,,,Inpatient,1,EA,9,9,Bright Health MGG,Bright Health MGG,9,,,,,,,case rate,9,9,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Aetna,Aetna,125.79,,,,,,,per diem,125.79,125.79,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Aetna MGG,Aetna MGG,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,BCBS,BCBS,125.79,,,,,,,per diem,125.79,125.79,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,BCBS MGG,BCBS MGG,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Cigna,Cigna,125.79,,,,,,,per diem,125.79,125.79,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Cigna MGG,Cigna MGG,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Humana,Humana,125.79,,,,,,,per diem,125.79,125.79,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Humana MGG,Humana MGG,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Optum VA,Optum VA,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,UHC,UHC,125.79,,,,,,,per diem,125.79,125.79,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,UHC MGG,UHC MGG,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,VA,VA,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Wellcare MGG,Wellcare MGG,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Bright Health - commercial,Bright Health - commercial,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 150MG/ML INJ    ,92213156,CDM,250,RC,,,,,,Inpatient,1,EA,125.79,125.79,Bright Health MGG,Bright Health MGG,125.79,,,,,,,case rate,125.79,125.79,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Aetna,Aetna,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Aetna MGG,Aetna MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,BCBS,BCBS,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,BCBS MGG,BCBS MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Cigna,Cigna,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Cigna MGG,Cigna MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Humana,Humana,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Humana MGG,Humana MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Optum VA,Optum VA,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,UHC,UHC,15.6,,,,,,,per diem,15.6,15.6,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,UHC MGG,UHC MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,VA,VA,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Wellcare MGG,Wellcare MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Bright Health - commercial,Bright Health - commercial,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 10MG TAB ,92213157,CDM,250,RC,,,,,,Inpatient,1,EA,15.6,15.6,Bright Health MGG,Bright Health MGG,15.6,,,,,,,case rate,15.6,15.6,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Aetna,Aetna,67.68,,,,,,,per diem,67.68,67.68,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Aetna MGG,Aetna MGG,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,BCBS,BCBS,67.68,,,,,,,per diem,67.68,67.68,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,BCBS MGG,BCBS MGG,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Cigna,Cigna,67.68,,,,,,,per diem,67.68,67.68,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Cigna MGG,Cigna MGG,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Humana,Humana,67.68,,,,,,,per diem,67.68,67.68,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Humana MGG,Humana MGG,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Optum VA,Optum VA,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,UHC,UHC,67.68,,,,,,,per diem,67.68,67.68,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,UHC MGG,UHC MGG,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,VA,VA,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Wellcare MGG,Wellcare MGG,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Bright Health - commercial,Bright Health - commercial,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 50MG/ML INJ      ,92213158,CDM,250,RC,,,,,,Inpatient,1,EA,67.68,67.68,Bright Health MGG,Bright Health MGG,67.68,,,,,,,case rate,67.68,67.68,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB KCL 25MEQ TEF,92213159,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92213160,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Aetna,Aetna,15840.66,,,,,,,per diem,15840.66,15840.66,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Aetna MGG,Aetna MGG,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,BCBS,BCBS,15840.66,,,,,,,per diem,15840.66,15840.66,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,BCBS MGG,BCBS MGG,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Cigna,Cigna,15840.66,,,,,,,per diem,15840.66,15840.66,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Cigna MGG,Cigna MGG,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Humana,Humana,15840.66,,,,,,,per diem,15840.66,15840.66,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Humana MGG,Humana MGG,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Optum VA,Optum VA,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,UHC,UHC,15840.66,,,,,,,per diem,15840.66,15840.66,"Per diem rate, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,UHC MGG,UHC MGG,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,VA,VA,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Wellcare MGG,Wellcare MGG,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Bright Health - commercial,Bright Health - commercial,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
ALTEPLASE RECOMB 50MG INJ     ,92213161,CDM,250,RC,,,,,,Inpatient,1,EA,15840.66,15840.66,Bright Health MGG,Bright Health MGG,15840.66,,,,,,,case rate,15840.66,15840.66,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HOMATROP HYDROCODONE BIT SYR  ,92213162,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92213163,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92213164,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 60MG TAB        ,92213165,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Aetna,Aetna,45.06,,,,,,,per diem,45.06,45.06,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Aetna MGG,Aetna MGG,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,BCBS,BCBS,45.06,,,,,,,per diem,45.06,45.06,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,BCBS MGG,BCBS MGG,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Cigna,Cigna,45.06,,,,,,,per diem,45.06,45.06,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Cigna MGG,Cigna MGG,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Humana,Humana,45.06,,,,,,,per diem,45.06,45.06,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Humana MGG,Humana MGG,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Optum VA,Optum VA,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,UHC,UHC,45.06,,,,,,,per diem,45.06,45.06,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,UHC MGG,UHC MGG,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,VA,VA,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Wellcare MGG,Wellcare MGG,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Bright Health - commercial,Bright Health - commercial,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 500-250ML I,92213166,CDM,250,RC,,,,,,Inpatient,1,EA,45.06,45.06,Bright Health MGG,Bright Health MGG,45.06,,,,,,,case rate,45.06,45.06,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORTHALIDONE 25MG TAB       ,92213167,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Aetna,Aetna,156.51,,,,,,,per diem,156.51,156.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Aetna MGG,Aetna MGG,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,BCBS,BCBS,156.51,,,,,,,per diem,156.51,156.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,BCBS MGG,BCBS MGG,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Cigna,Cigna,156.51,,,,,,,per diem,156.51,156.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Cigna MGG,Cigna MGG,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Humana,Humana,156.51,,,,,,,per diem,156.51,156.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Humana MGG,Humana MGG,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Optum VA,Optum VA,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,UHC,UHC,156.51,,,,,,,per diem,156.51,156.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,UHC MGG,UHC MGG,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,VA,VA,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Wellcare MGG,Wellcare MGG,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Bright Health - commercial,Bright Health - commercial,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92213168,CDM,250,RC,,,,,,Inpatient,1,EA,156.51,156.51,Bright Health MGG,Bright Health MGG,156.51,,,,,,,case rate,156.51,156.51,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Aetna,Aetna,115.14,,,,,,,per diem,115.14,115.14,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Aetna MGG,Aetna MGG,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,BCBS,BCBS,115.14,,,,,,,per diem,115.14,115.14,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,BCBS MGG,BCBS MGG,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Cigna,Cigna,115.14,,,,,,,per diem,115.14,115.14,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Cigna MGG,Cigna MGG,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Humana,Humana,115.14,,,,,,,per diem,115.14,115.14,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Humana MGG,Humana MGG,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Optum VA,Optum VA,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,UHC,UHC,115.14,,,,,,,per diem,115.14,115.14,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,UHC MGG,UHC MGG,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,VA,VA,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Wellcare MGG,Wellcare MGG,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Bright Health - commercial,Bright Health - commercial,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 600-42.9/5 S,92213169,CDM,250,RC,,,,,,Inpatient,1,EA,115.14,115.14,Bright Health MGG,Bright Health MGG,115.14,,,,,,,case rate,115.14,115.14,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Aetna,Aetna,100.62,,,,,,,per diem,100.62,100.62,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Aetna MGG,Aetna MGG,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,BCBS,BCBS,100.62,,,,,,,per diem,100.62,100.62,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,BCBS MGG,BCBS MGG,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Cigna,Cigna,100.62,,,,,,,per diem,100.62,100.62,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Cigna MGG,Cigna MGG,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Humana,Humana,100.62,,,,,,,per diem,100.62,100.62,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Humana MGG,Humana MGG,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Optum VA,Optum VA,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,UHC,UHC,100.62,,,,,,,per diem,100.62,100.62,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,UHC MGG,UHC MGG,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,VA,VA,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Wellcare MGG,Wellcare MGG,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Bright Health - commercial,Bright Health - commercial,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 120MG/0.8ML INJ ,92213170,CDM,250,RC,,,,,,Inpatient,1,EA,100.62,100.62,Bright Health MGG,Bright Health MGG,100.62,,,,,,,case rate,100.62,100.62,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Aetna,Aetna,46.44,,,,,,,per diem,46.44,46.44,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Aetna MGG,Aetna MGG,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,BCBS,BCBS,46.44,,,,,,,per diem,46.44,46.44,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,BCBS MGG,BCBS MGG,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Cigna,Cigna,46.44,,,,,,,per diem,46.44,46.44,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Cigna MGG,Cigna MGG,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Humana,Humana,46.44,,,,,,,per diem,46.44,46.44,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Humana MGG,Humana MGG,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Optum VA,Optum VA,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,UHC,UHC,46.44,,,,,,,per diem,46.44,46.44,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,UHC MGG,UHC MGG,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,VA,VA,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Wellcare MGG,Wellcare MGG,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Bright Health - commercial,Bright Health - commercial,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92213171,CDM,250,RC,,,,,,Inpatient,1,EA,46.44,46.44,Bright Health MGG,Bright Health MGG,46.44,,,,,,,case rate,46.44,46.44,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Aetna,Aetna,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Aetna MGG,Aetna MGG,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,BCBS,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS MGG,BCBS MGG,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Cigna,Cigna,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Cigna MGG,Cigna MGG,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Humana,Humana,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Humana MGG,Humana MGG,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Optum VA,Optum VA,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,UHC,UHC,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,UHC MGG,UHC MGG,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,VA,VA,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Wellcare MGG,Wellcare MGG,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Bright Health - commercial,Bright Health - commercial,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 4MG TAB        ,92213172,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,Bright Health MGG,Bright Health MGG,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIOTHYRONINE NA 25MCG TAB     ,92213173,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Aetna,Aetna,462.18,,,,,,,per diem,462.18,462.18,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Aetna MGG,Aetna MGG,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,BCBS,BCBS,462.18,,,,,,,per diem,462.18,462.18,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,BCBS MGG,BCBS MGG,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Cigna,Cigna,462.18,,,,,,,per diem,462.18,462.18,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Cigna MGG,Cigna MGG,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Humana,Humana,462.18,,,,,,,per diem,462.18,462.18,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Humana MGG,Humana MGG,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Optum VA,Optum VA,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,UHC,UHC,462.18,,,,,,,per diem,462.18,462.18,"Per diem rate, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,UHC MGG,UHC MGG,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,VA,VA,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Wellcare MGG,Wellcare MGG,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Bright Health - commercial,Bright Health - commercial,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
IOPAMIDOL 61%  INJ            ,92213174,CDM,250,RC,,,,,,Inpatient,1,EA,462.18,462.18,Bright Health MGG,Bright Health MGG,462.18,,,,,,,case rate,462.18,462.18,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Aetna,Aetna,127.23,,,,,,,per diem,127.23,127.23,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Aetna MGG,Aetna MGG,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,BCBS,BCBS,127.23,,,,,,,per diem,127.23,127.23,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,BCBS MGG,BCBS MGG,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Cigna,Cigna,127.23,,,,,,,per diem,127.23,127.23,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Cigna MGG,Cigna MGG,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Humana,Humana,127.23,,,,,,,per diem,127.23,127.23,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Humana MGG,Humana MGG,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Optum VA,Optum VA,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,UHC,UHC,127.23,,,,,,,per diem,127.23,127.23,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,UHC MGG,UHC MGG,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,VA,VA,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Wellcare MGG,Wellcare MGG,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Bright Health - commercial,Bright Health - commercial,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG/ML INJ   ,92213175,CDM,250,RC,,,,,,Inpatient,1,EA,127.23,127.23,Bright Health MGG,Bright Health MGG,127.23,,,,,,,case rate,127.23,127.23,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92213176,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92213177,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Aetna,Aetna,13.53,,,,,,,per diem,13.53,13.53,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Aetna MGG,Aetna MGG,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,BCBS,BCBS,13.53,,,,,,,per diem,13.53,13.53,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,BCBS MGG,BCBS MGG,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Cigna,Cigna,13.53,,,,,,,per diem,13.53,13.53,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Cigna MGG,Cigna MGG,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Humana,Humana,13.53,,,,,,,per diem,13.53,13.53,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Humana MGG,Humana MGG,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Optum VA,Optum VA,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,UHC,UHC,13.53,,,,,,,per diem,13.53,13.53,"Per diem rate, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,UHC MGG,UHC MGG,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,VA,VA,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Wellcare MGG,Wellcare MGG,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Bright Health - commercial,Bright Health - commercial,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ESCITALOPRAM OXALATE 20MG TAB ,92213178,CDM,250,RC,,,,,,Inpatient,1,EA,13.53,13.53,Bright Health MGG,Bright Health MGG,13.53,,,,,,,case rate,13.53,13.53,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92213179,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Aetna,Aetna,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Aetna MGG,Aetna MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,BCBS,BCBS,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,BCBS MGG,BCBS MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Cigna,Cigna,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Cigna MGG,Cigna MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Humana,Humana,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Humana MGG,Humana MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Optum VA,Optum VA,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,UHC,UHC,6.09,,,,,,,per diem,6.09,6.09,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,UHC MGG,UHC MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,VA,VA,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Wellcare MGG,Wellcare MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Bright Health - commercial,Bright Health - commercial,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 60MG TER        ,92213180,CDM,250,RC,,,,,,Inpatient,1,EA,6.09,6.09,Bright Health MGG,Bright Health MGG,6.09,,,,,,,case rate,6.09,6.09,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Aetna,Aetna,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Aetna MGG,Aetna MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,BCBS,BCBS,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,BCBS MGG,BCBS MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Cigna,Cigna,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Cigna MGG,Cigna MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Humana,Humana,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Humana MGG,Humana MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Optum VA,Optum VA,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,UHC,UHC,55.14,,,,,,,per diem,55.14,55.14,"Per diem rate, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,UHC MGG,UHC MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,VA,VA,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Wellcare MGG,Wellcare MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Bright Health - commercial,Bright Health - commercial,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
MORPHINE  200MG TER           ,92213181,CDM,250,RC,,,,,,Inpatient,1,EA,55.14,55.14,Bright Health MGG,Bright Health MGG,55.14,,,,,,,case rate,55.14,55.14,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92213182,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92213183,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Aetna,Aetna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Aetna MGG,Aetna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,BCBS,BCBS,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,BCBS MGG,BCBS MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Cigna,Cigna,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Cigna MGG,Cigna MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Humana,Humana,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Humana MGG,Humana MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Optum VA,Optum VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,UHC,UHC,37.5,,,,,,,per diem,37.5,37.5,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,UHC MGG,UHC MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,VA,VA,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Wellcare MGG,Wellcare MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Bright Health - commercial,Bright Health - commercial,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92213184,CDM,250,RC,,,,,,Inpatient,1,EA,37.5,37.5,Bright Health MGG,Bright Health MGG,37.5,,,,,,,case rate,37.5,37.5,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Aetna,Aetna,125.29,,,,,,,per diem,125.29,125.29,"Per diem rate, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Aetna MGG,Aetna MGG,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,BCBS,BCBS,125.29,,,,,,,per diem,125.29,125.29,"Per diem rate, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,BCBS MGG,BCBS MGG,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Cigna,Cigna,125.29,,,,,,,per diem,125.29,125.29,"Per diem rate, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Cigna MGG,Cigna MGG,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Humana,Humana,125.29,,,,,,,per diem,125.29,125.29,"Per diem rate, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Humana MGG,Humana MGG,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Optum VA,Optum VA,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,UHC,UHC,125.29,,,,,,,per diem,125.29,125.29,"Per diem rate, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,UHC MGG,UHC MGG,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,VA,VA,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Wellcare MGG,Wellcare MGG,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Bright Health - commercial,Bright Health - commercial,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
ONDANSETRON 8MG ODT           ,92213185,CDM,250,RC,,,,,,Inpatient,1,EA,125.29,125.29,Bright Health MGG,Bright Health MGG,125.29,,,,,,,case rate,125.29,125.29,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Aetna,Aetna,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Aetna MGG,Aetna MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,BCBS,BCBS,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,BCBS MGG,BCBS MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Cigna,Cigna,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Cigna MGG,Cigna MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Humana,Humana,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Humana MGG,Humana MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Optum VA,Optum VA,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,UHC,UHC,8.58,,,,,,,per diem,8.58,8.58,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,UHC MGG,UHC MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,VA,VA,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Wellcare MGG,Wellcare MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Bright Health - commercial,Bright Health - commercial,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 100MG CAP   ,92213186,CDM,250,RC,,,,,,Inpatient,1,EA,8.58,8.58,Bright Health MGG,Bright Health MGG,8.58,,,,,,,case rate,8.58,8.58,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Aetna,Aetna,49.05,,,,,,,per diem,49.05,49.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Aetna MGG,Aetna MGG,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,BCBS,BCBS,49.05,,,,,,,per diem,49.05,49.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,BCBS MGG,BCBS MGG,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Cigna,Cigna,49.05,,,,,,,per diem,49.05,49.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Cigna MGG,Cigna MGG,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Humana,Humana,49.05,,,,,,,per diem,49.05,49.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Humana MGG,Humana MGG,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Optum VA,Optum VA,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,UHC,UHC,49.05,,,,,,,per diem,49.05,49.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,UHC MGG,UHC MGG,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,VA,VA,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Wellcare MGG,Wellcare MGG,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Bright Health - commercial,Bright Health - commercial,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92213187,CDM,250,RC,,,,,,Inpatient,1,EA,49.05,49.05,Bright Health MGG,Bright Health MGG,49.05,,,,,,,case rate,49.05,49.05,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna,Aetna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Aetna MGG,Aetna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,BCBS,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS MGG,BCBS MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna,Cigna,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Cigna MGG,Cigna MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana,Humana,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Humana MGG,Humana MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Optum VA,Optum VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC,UHC,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UHC MGG,UHC MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,VA,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Wellcare MGG,Wellcare MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health - commercial,Bright Health - commercial,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213188,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,Bright Health MGG,Bright Health MGG,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 25MG TAB      ,92213189,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Aetna,Aetna,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Aetna MGG,Aetna MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,BCBS,BCBS,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,BCBS MGG,BCBS MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Cigna,Cigna,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Cigna MGG,Cigna MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Humana,Humana,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Humana MGG,Humana MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Optum VA,Optum VA,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,UHC,UHC,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,UHC MGG,UHC MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,VA,VA,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Wellcare MGG,Wellcare MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Bright Health - commercial,Bright Health - commercial,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92213190,CDM,250,RC,,,,,,Inpatient,1,EA,23.64,23.64,Bright Health MGG,Bright Health MGG,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Aetna,Aetna,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Aetna MGG,Aetna MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,BCBS,BCBS,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,BCBS MGG,BCBS MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Cigna,Cigna,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Cigna MGG,Cigna MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Humana,Humana,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Humana MGG,Humana MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Optum VA,Optum VA,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,UHC,UHC,7.86,,,,,,,per diem,7.86,7.86,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,UHC MGG,UHC MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,VA,VA,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Wellcare MGG,Wellcare MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Bright Health - commercial,Bright Health - commercial,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213191,CDM,258,RC,,,,,,Inpatient,1,EA,7.86,7.86,Bright Health MGG,Bright Health MGG,7.86,,,,,,,case rate,7.86,7.86,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 50MG TAB      ,92213192,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXAPINE 50MG TAB            ,92213193,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Aetna,Aetna,1340.01,,,,,,,per diem,1340.01,1340.01,"Per diem rate, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Aetna MGG,Aetna MGG,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,BCBS,BCBS,1340.01,,,,,,,per diem,1340.01,1340.01,"Per diem rate, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,BCBS MGG,BCBS MGG,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Cigna,Cigna,1340.01,,,,,,,per diem,1340.01,1340.01,"Per diem rate, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Cigna MGG,Cigna MGG,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Humana,Humana,1340.01,,,,,,,per diem,1340.01,1340.01,"Per diem rate, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Humana MGG,Humana MGG,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Optum VA,Optum VA,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,UHC,UHC,1340.01,,,,,,,per diem,1340.01,1340.01,"Per diem rate, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,UHC MGG,UHC MGG,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,VA,VA,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Wellcare MGG,Wellcare MGG,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Bright Health - commercial,Bright Health - commercial,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
BOSENTAN 62.5MG TAB           ,92213194,CDM,250,RC,,,,,,Inpatient,1,EA,1340.01,1340.01,Bright Health MGG,Bright Health MGG,1340.01,,,,,,,case rate,1340.01,1340.01,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92213195,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Aetna,Aetna,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Aetna MGG,Aetna MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,BCBS,BCBS,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,BCBS MGG,BCBS MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Cigna,Cigna,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Cigna MGG,Cigna MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Humana,Humana,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Humana MGG,Humana MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Optum VA,Optum VA,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,UHC,UHC,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,UHC MGG,UHC MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,VA,VA,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Wellcare MGG,Wellcare MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Bright Health - commercial,Bright Health - commercial,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213196,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Bright Health MGG,Bright Health MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Aetna,Aetna,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Aetna MGG,Aetna MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,BCBS,BCBS,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,BCBS MGG,BCBS MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Cigna,Cigna,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Cigna MGG,Cigna MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Humana,Humana,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Humana MGG,Humana MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Optum VA,Optum VA,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,UHC,UHC,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,UHC MGG,UHC MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,VA,VA,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Wellcare MGG,Wellcare MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Bright Health - commercial,Bright Health - commercial,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
IODINE MILD TIN               ,92213197,CDM,250,RC,,,,,,Inpatient,1,EA,56.07,56.07,Bright Health MGG,Bright Health MGG,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Aetna,Aetna,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Aetna MGG,Aetna MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,BCBS,BCBS,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,BCBS MGG,BCBS MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Cigna,Cigna,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Cigna MGG,Cigna MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Humana,Humana,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Humana MGG,Humana MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Optum VA,Optum VA,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,UHC,UHC,31.11,,,,,,,per diem,31.11,31.11,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,UHC MGG,UHC MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,VA,VA,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Wellcare MGG,Wellcare MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Bright Health - commercial,Bright Health - commercial,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92213198,CDM,250,RC,,,,,,Inpatient,1,EA,31.11,31.11,Bright Health MGG,Bright Health MGG,31.11,,,,,,,case rate,31.11,31.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213199,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 2.5MG TAB    ,92213200,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Aetna,Aetna,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Aetna MGG,Aetna MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,BCBS,BCBS,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,BCBS MGG,BCBS MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Cigna,Cigna,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Cigna MGG,Cigna MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Humana,Humana,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Humana MGG,Humana MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Optum VA,Optum VA,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,UHC,UHC,12.81,,,,,,,per diem,12.81,12.81,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,UHC MGG,UHC MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,VA,VA,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Wellcare MGG,Wellcare MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Bright Health - commercial,Bright Health - commercial,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 1% SPR      ,92213201,CDM,250,RC,,,,,,Inpatient,1,EA,12.81,12.81,Bright Health MGG,Bright Health MGG,12.81,,,,,,,case rate,12.81,12.81,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213202,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna,Aetna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Aetna MGG,Aetna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,BCBS,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS MGG,BCBS MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna,Cigna,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Cigna MGG,Cigna MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana,Humana,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Humana MGG,Humana MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Optum VA,Optum VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC,UHC,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,UHC MGG,UHC MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,VA,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Wellcare MGG,Wellcare MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health - commercial,Bright Health - commercial,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213203,CDM,258,RC,,,,,,Inpatient,1,EA,18.9,18.9,Bright Health MGG,Bright Health MGG,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Aetna,Aetna,697.89,,,,,,,per diem,697.89,697.89,"Per diem rate, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Aetna MGG,Aetna MGG,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,BCBS,BCBS,697.89,,,,,,,per diem,697.89,697.89,"Per diem rate, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,BCBS MGG,BCBS MGG,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Cigna,Cigna,697.89,,,,,,,per diem,697.89,697.89,"Per diem rate, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Cigna MGG,Cigna MGG,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Humana,Humana,697.89,,,,,,,per diem,697.89,697.89,"Per diem rate, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Humana MGG,Humana MGG,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Optum VA,Optum VA,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,UHC,UHC,697.89,,,,,,,per diem,697.89,697.89,"Per diem rate, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,UHC MGG,UHC MGG,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,VA,VA,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Wellcare MGG,Wellcare MGG,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Bright Health - commercial,Bright Health - commercial,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
BOSENTAN 125MG TAB            ,92213204,CDM,250,RC,,,,,,Inpatient,1,EA,697.89,697.89,Bright Health MGG,Bright Health MGG,697.89,,,,,,,case rate,697.89,697.89,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213205,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92213206,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Aetna,Aetna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Aetna MGG,Aetna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,BCBS,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS MGG,BCBS MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Cigna,Cigna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Cigna MGG,Cigna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Humana,Humana,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Humana MGG,Humana MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Optum VA,Optum VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UHC,UHC,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UHC MGG,UHC MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,VA,VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Wellcare MGG,Wellcare MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Bright Health - commercial,Bright Health - commercial,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92213207,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Bright Health MGG,Bright Health MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TORSEMIDE 5MG TAB             ,92213208,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Aetna,Aetna,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Aetna MGG,Aetna MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,BCBS,BCBS,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,BCBS MGG,BCBS MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Cigna,Cigna,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Cigna MGG,Cigna MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Humana,Humana,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Humana MGG,Humana MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Optum VA,Optum VA,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,UHC,UHC,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,UHC MGG,UHC MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,VA,VA,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Wellcare MGG,Wellcare MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Bright Health - commercial,Bright Health - commercial,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
CLOPIDOGREL HSO4 75MG TAB     ,92213209,CDM,250,RC,,,,,,Inpatient,1,EA,22.32,22.32,Bright Health MGG,Bright Health MGG,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDROXYUREA 300MG CAP         ,92213210,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Aetna,Aetna,185.34,,,,,,,per diem,185.34,185.34,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Aetna MGG,Aetna MGG,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,BCBS,BCBS,185.34,,,,,,,per diem,185.34,185.34,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,BCBS MGG,BCBS MGG,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Cigna,Cigna,185.34,,,,,,,per diem,185.34,185.34,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Cigna MGG,Cigna MGG,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Humana,Humana,185.34,,,,,,,per diem,185.34,185.34,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Humana MGG,Humana MGG,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Optum VA,Optum VA,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,UHC,UHC,185.34,,,,,,,per diem,185.34,185.34,"Per diem rate, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,UHC MGG,UHC MGG,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,VA,VA,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Wellcare MGG,Wellcare MGG,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Bright Health - commercial,Bright Health - commercial,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
HALOPERIDOL DEC 100MG/ML INJ  ,92213211,CDM,250,RC,,,,,,Inpatient,1,EA,185.34,185.34,Bright Health MGG,Bright Health MGG,185.34,,,,,,,case rate,185.34,185.34,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92213212,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213213,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Aetna,Aetna,41.79,,,,,,,per diem,41.79,41.79,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Aetna MGG,Aetna MGG,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,BCBS,BCBS,41.79,,,,,,,per diem,41.79,41.79,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,BCBS MGG,BCBS MGG,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Cigna,Cigna,41.79,,,,,,,per diem,41.79,41.79,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Cigna MGG,Cigna MGG,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Humana,Humana,41.79,,,,,,,per diem,41.79,41.79,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Humana MGG,Humana MGG,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Optum VA,Optum VA,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,UHC,UHC,41.79,,,,,,,per diem,41.79,41.79,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,UHC MGG,UHC MGG,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,VA,VA,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Wellcare MGG,Wellcare MGG,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Bright Health - commercial,Bright Health - commercial,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG TAB        ,92213214,CDM,250,RC,,,,,,Inpatient,1,EA,41.79,41.79,Bright Health MGG,Bright Health MGG,41.79,,,,,,,case rate,41.79,41.79,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Aetna,Aetna,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Aetna MGG,Aetna MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,BCBS,BCBS,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,BCBS MGG,BCBS MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Cigna,Cigna,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Cigna MGG,Cigna MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Humana,Humana,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Humana MGG,Humana MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Optum VA,Optum VA,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,UHC,UHC,7.32,,,,,,,per diem,7.32,7.32,"Per diem rate, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,UHC MGG,UHC MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,VA,VA,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Wellcare MGG,Wellcare MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Bright Health - commercial,Bright Health - commercial,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
PANCURONIUM 2MG/ML INJ        ,92213215,CDM,250,RC,,,,,,Inpatient,1,EA,7.32,7.32,Bright Health MGG,Bright Health MGG,7.32,,,,,,,case rate,7.32,7.32,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MEPROBAMATE 200MG TAB         ,92213216,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213217,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Aetna,Aetna,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Aetna MGG,Aetna MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,BCBS,BCBS,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,BCBS MGG,BCBS MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Cigna,Cigna,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Cigna MGG,Cigna MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Humana,Humana,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Humana MGG,Humana MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Optum VA,Optum VA,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,UHC,UHC,11.79,,,,,,,per diem,11.79,11.79,"Per diem rate, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,UHC MGG,UHC MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,VA,VA,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Wellcare MGG,Wellcare MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Bright Health - commercial,Bright Health - commercial,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
INFLUENZA VACCINE INJ         ,92213218,CDM,250,RC,,,,,,Inpatient,1,EA,11.79,11.79,Bright Health MGG,Bright Health MGG,11.79,,,,,,,case rate,11.79,11.79,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Aetna,Aetna,161.46,,,,,,,per diem,161.46,161.46,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Aetna MGG,Aetna MGG,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,BCBS,BCBS,161.46,,,,,,,per diem,161.46,161.46,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,BCBS MGG,BCBS MGG,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Cigna,Cigna,161.46,,,,,,,per diem,161.46,161.46,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Cigna MGG,Cigna MGG,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Humana,Humana,161.46,,,,,,,per diem,161.46,161.46,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Humana MGG,Humana MGG,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Optum VA,Optum VA,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,UHC,UHC,161.46,,,,,,,per diem,161.46,161.46,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,UHC MGG,UHC MGG,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,VA,VA,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Wellcare MGG,Wellcare MGG,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Bright Health - commercial,Bright Health - commercial,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM POW      ",92213219,CDM,250,RC,,,,,,Inpatient,1,EA,161.46,161.46,Bright Health MGG,Bright Health MGG,161.46,,,,,,,case rate,161.46,161.46,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92213220,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POLYVINYL ALCOHOL POVIDONE SOL,92213221,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna,Aetna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Aetna MGG,Aetna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,BCBS,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS MGG,BCBS MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna,Cigna,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Cigna MGG,Cigna MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana,Humana,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Humana MGG,Humana MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Optum VA,Optum VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC,UHC,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,UHC MGG,UHC MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,VA,VA,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Wellcare MGG,Wellcare MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health - commercial,Bright Health - commercial,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213222,CDM,258,RC,,,,,,Inpatient,1,EA,12.66,12.66,Bright Health MGG,Bright Health MGG,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Aetna,Aetna,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Aetna MGG,Aetna MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,BCBS,BCBS,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,BCBS MGG,BCBS MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Cigna,Cigna,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Cigna MGG,Cigna MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Humana,Humana,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Humana MGG,Humana MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Optum VA,Optum VA,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,UHC,UHC,5.13,,,,,,,per diem,5.13,5.13,"Per diem rate, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,UHC MGG,UHC MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,VA,VA,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Wellcare MGG,Wellcare MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Bright Health - commercial,Bright Health - commercial,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
RAMIPRIL 2.5MG CAP            ,92213223,CDM,250,RC,,,,,,Inpatient,1,EA,5.13,5.13,Bright Health MGG,Bright Health MGG,5.13,,,,,,,case rate,5.13,5.13,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHENE HCL 65MG CAP     ,92213224,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92213225,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Aetna,Aetna,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Aetna MGG,Aetna MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,BCBS,BCBS,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,BCBS MGG,BCBS MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Cigna,Cigna,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Cigna MGG,Cigna MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Humana,Humana,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Humana MGG,Humana MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Optum VA,Optum VA,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,UHC,UHC,24.21,,,,,,,per diem,24.21,24.21,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,UHC MGG,UHC MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,VA,VA,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Wellcare MGG,Wellcare MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Bright Health - commercial,Bright Health - commercial,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 0.5% SOL         ,92213226,CDM,250,RC,,,,,,Inpatient,1,EA,24.21,24.21,Bright Health MGG,Bright Health MGG,24.21,,,,,,,case rate,24.21,24.21,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Aetna,Aetna,24.87,,,,,,,per diem,24.87,24.87,"Per diem rate, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Aetna MGG,Aetna MGG,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,BCBS,BCBS,24.87,,,,,,,per diem,24.87,24.87,"Per diem rate, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,BCBS MGG,BCBS MGG,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Cigna,Cigna,24.87,,,,,,,per diem,24.87,24.87,"Per diem rate, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Cigna MGG,Cigna MGG,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Humana,Humana,24.87,,,,,,,per diem,24.87,24.87,"Per diem rate, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Humana MGG,Humana MGG,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Optum VA,Optum VA,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,UHC,UHC,24.87,,,,,,,per diem,24.87,24.87,"Per diem rate, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,UHC MGG,UHC MGG,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,VA,VA,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Wellcare MGG,Wellcare MGG,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Bright Health - commercial,Bright Health - commercial,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
BENZOIN COMPOUND TIN          ,92213227,CDM,250,RC,,,,,,Inpatient,1,EA,24.87,24.87,Bright Health MGG,Bright Health MGG,24.87,,,,,,,case rate,24.87,24.87,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Aetna,Aetna,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Aetna MGG,Aetna MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS,BCBS,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS MGG,BCBS MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Cigna,Cigna,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Cigna MGG,Cigna MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Humana,Humana,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Humana MGG,Humana MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Optum VA,Optum VA,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,UHC,UHC,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,UHC MGG,UHC MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,VA,VA,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Wellcare MGG,Wellcare MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Bright Health - commercial,Bright Health - commercial,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
CEFOXITIN NA 2GM INJ          ,92213228,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,Bright Health MGG,Bright Health MGG,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Aetna,Aetna,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Aetna MGG,Aetna MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,BCBS,BCBS,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,BCBS MGG,BCBS MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Cigna,Cigna,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Cigna MGG,Cigna MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Humana,Humana,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Humana MGG,Humana MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Optum VA,Optum VA,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,UHC,UHC,20.37,,,,,,,per diem,20.37,20.37,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,UHC MGG,UHC MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,VA,VA,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Wellcare MGG,Wellcare MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Bright Health - commercial,Bright Health - commercial,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92213229,CDM,250,RC,,,,,,Inpatient,1,EA,20.37,20.37,Bright Health MGG,Bright Health MGG,20.37,,,,,,,case rate,20.37,20.37,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna,Aetna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Aetna MGG,Aetna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS,BCBS,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,BCBS MGG,BCBS MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna,Cigna,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Cigna MGG,Cigna MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana,Humana,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Humana MGG,Humana MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Optum VA,Optum VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC,UHC,216,,,,,,,per diem,216,216,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,UHC MGG,UHC MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,VA,VA,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Wellcare MGG,Wellcare MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health - commercial,Bright Health - commercial,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92213230,CDM,250,RC,,,,,,Inpatient,1,EA,216,216,Bright Health MGG,Bright Health MGG,216,,,,,,,case rate,216,216,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92213231,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LACTO ACIDOPH/PECTIN 25MMU TAB,92213232,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Aetna,Aetna,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Aetna MGG,Aetna MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,BCBS,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS MGG,BCBS MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Cigna,Cigna,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Cigna MGG,Cigna MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Humana,Humana,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Humana MGG,Humana MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Optum VA,Optum VA,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UHC,UHC,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UHC MGG,UHC MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,VA,VA,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Wellcare MGG,Wellcare MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Bright Health - commercial,Bright Health - commercial,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92213233,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,Bright Health MGG,Bright Health MGG,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Aetna,Aetna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Aetna MGG,Aetna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,BCBS,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS MGG,BCBS MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Cigna,Cigna,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Cigna MGG,Cigna MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Humana,Humana,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Humana MGG,Humana MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Optum VA,Optum VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UHC,UHC,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UHC MGG,UHC MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,VA,VA,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Wellcare MGG,Wellcare MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Bright Health - commercial,Bright Health - commercial,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92213234,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,Bright Health MGG,Bright Health MGG,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Aetna,Aetna,36.36,,,,,,,per diem,36.36,36.36,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Aetna MGG,Aetna MGG,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,BCBS,BCBS,36.36,,,,,,,per diem,36.36,36.36,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,BCBS MGG,BCBS MGG,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Cigna,Cigna,36.36,,,,,,,per diem,36.36,36.36,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Cigna MGG,Cigna MGG,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Humana,Humana,36.36,,,,,,,per diem,36.36,36.36,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Humana MGG,Humana MGG,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Optum VA,Optum VA,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,UHC,UHC,36.36,,,,,,,per diem,36.36,36.36,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,UHC MGG,UHC MGG,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,VA,VA,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Wellcare MGG,Wellcare MGG,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Bright Health - commercial,Bright Health - commercial,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92213235,CDM,250,RC,,,,,,Inpatient,1,EA,36.36,36.36,Bright Health MGG,Bright Health MGG,36.36,,,,,,,case rate,36.36,36.36,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
APAP/BUTALBITAL/CAFF/COD CAP  ,92213236,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TRAMADOL HCL APAP 37.5-325MG T,92213237,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 10MG TAB      ,92213238,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Aetna,Aetna,12.21,,,,,,,per diem,12.21,12.21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Aetna MGG,Aetna MGG,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,BCBS,BCBS,12.21,,,,,,,per diem,12.21,12.21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,BCBS MGG,BCBS MGG,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Cigna,Cigna,12.21,,,,,,,per diem,12.21,12.21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Cigna MGG,Cigna MGG,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Humana,Humana,12.21,,,,,,,per diem,12.21,12.21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Humana MGG,Humana MGG,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Optum VA,Optum VA,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,UHC,UHC,12.21,,,,,,,per diem,12.21,12.21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,UHC MGG,UHC MGG,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,VA,VA,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Wellcare MGG,Wellcare MGG,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Bright Health - commercial,Bright Health - commercial,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213239,CDM,258,RC,,,,,,Inpatient,1,EA,12.21,12.21,Bright Health MGG,Bright Health MGG,12.21,,,,,,,case rate,12.21,12.21,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92213240,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92213241,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Aetna,Aetna,1333.98,,,,,,,per diem,1333.98,1333.98,"Per diem rate, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Aetna MGG,Aetna MGG,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,BCBS,BCBS,1333.98,,,,,,,per diem,1333.98,1333.98,"Per diem rate, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,BCBS MGG,BCBS MGG,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Cigna,Cigna,1333.98,,,,,,,per diem,1333.98,1333.98,"Per diem rate, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Cigna MGG,Cigna MGG,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Humana,Humana,1333.98,,,,,,,per diem,1333.98,1333.98,"Per diem rate, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Humana MGG,Humana MGG,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Optum VA,Optum VA,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,UHC,UHC,1333.98,,,,,,,per diem,1333.98,1333.98,"Per diem rate, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,UHC MGG,UHC MGG,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,VA,VA,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Wellcare MGG,Wellcare MGG,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Bright Health - commercial,Bright Health - commercial,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
INTERFERON BETA-1B 0.3MG PDS  ,92213242,CDM,250,RC,,,,,,Inpatient,1,EA,1333.98,1333.98,Bright Health MGG,Bright Health MGG,1333.98,,,,,,,case rate,1333.98,1333.98,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna,Aetna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Aetna MGG,Aetna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,BCBS,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS MGG,BCBS MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna,Cigna,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Cigna MGG,Cigna MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana,Humana,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Humana MGG,Humana MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Optum VA,Optum VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC,UHC,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UHC MGG,UHC MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,VA,VA,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Wellcare MGG,Wellcare MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health - commercial,Bright Health - commercial,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 100U/ML INJ     ,92213243,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,Bright Health MGG,Bright Health MGG,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Aetna,Aetna,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Aetna MGG,Aetna MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,BCBS,BCBS,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,BCBS MGG,BCBS MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Cigna,Cigna,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Cigna MGG,Cigna MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Humana,Humana,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Humana MGG,Humana MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Optum VA,Optum VA,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,UHC,UHC,14.88,,,,,,,per diem,14.88,14.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,UHC MGG,UHC MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,VA,VA,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Wellcare MGG,Wellcare MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Bright Health - commercial,Bright Health - commercial,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92213244,CDM,250,RC,,,,,,Inpatient,1,EA,14.88,14.88,Bright Health MGG,Bright Health MGG,14.88,,,,,,,case rate,14.88,14.88,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Aetna,Aetna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Aetna MGG,Aetna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,BCBS,BCBS,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,BCBS MGG,BCBS MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Cigna,Cigna,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Cigna MGG,Cigna MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Humana,Humana,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Humana MGG,Humana MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Optum VA,Optum VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,UHC,UHC,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,UHC MGG,UHC MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,VA,VA,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Wellcare MGG,Wellcare MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Bright Health - commercial,Bright Health - commercial,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROGEN PEROXIDE 3% SOL      ,92213245,CDM,250,RC,,,,,,Inpatient,1,EA,63,63,Bright Health MGG,Bright Health MGG,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
COLCHICINE PROBENECID .5-500 T,92213246,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Aetna,Aetna,120.63,,,,,,,per diem,120.63,120.63,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Aetna MGG,Aetna MGG,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,BCBS,BCBS,120.63,,,,,,,per diem,120.63,120.63,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,BCBS MGG,BCBS MGG,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Cigna,Cigna,120.63,,,,,,,per diem,120.63,120.63,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Cigna MGG,Cigna MGG,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Humana,Humana,120.63,,,,,,,per diem,120.63,120.63,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Humana MGG,Humana MGG,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Optum VA,Optum VA,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,UHC,UHC,120.63,,,,,,,per diem,120.63,120.63,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,UHC MGG,UHC MGG,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,VA,VA,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Wellcare MGG,Wellcare MGG,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Bright Health - commercial,Bright Health - commercial,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92213247,CDM,250,RC,,,,,,Inpatient,1,EA,120.63,120.63,Bright Health MGG,Bright Health MGG,120.63,,,,,,,case rate,120.63,120.63,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Aetna,Aetna,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Aetna MGG,Aetna MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS,BCBS,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS MGG,BCBS MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Cigna,Cigna,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Cigna MGG,Cigna MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Humana,Humana,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Humana MGG,Humana MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Optum VA,Optum VA,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,UHC,UHC,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,UHC MGG,UHC MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,VA,VA,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Wellcare MGG,Wellcare MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Bright Health - commercial,Bright Health - commercial,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92213248,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,Bright Health MGG,Bright Health MGG,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 200MG TAB      ,92213249,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna,Aetna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Aetna MGG,Aetna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS,BCBS,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,BCBS MGG,BCBS MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna,Cigna,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Cigna MGG,Cigna MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana,Humana,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Humana MGG,Humana MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Optum VA,Optum VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC,UHC,21.6,,,,,,,per diem,21.6,21.6,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,UHC MGG,UHC MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,VA,VA,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Wellcare MGG,Wellcare MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health - commercial,Bright Health - commercial,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213250,CDM,258,RC,,,,,,Inpatient,1,EA,21.6,21.6,Bright Health MGG,Bright Health MGG,21.6,,,,,,,case rate,21.6,21.6,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Aetna,Aetna,499.02,,,,,,,per diem,499.02,499.02,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Aetna MGG,Aetna MGG,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,BCBS,BCBS,499.02,,,,,,,per diem,499.02,499.02,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,BCBS MGG,BCBS MGG,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Cigna,Cigna,499.02,,,,,,,per diem,499.02,499.02,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Cigna MGG,Cigna MGG,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Humana,Humana,499.02,,,,,,,per diem,499.02,499.02,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Humana MGG,Humana MGG,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Optum VA,Optum VA,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,UHC,UHC,499.02,,,,,,,per diem,499.02,499.02,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,UHC MGG,UHC MGG,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,VA,VA,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Wellcare MGG,Wellcare MGG,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Bright Health - commercial,Bright Health - commercial,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% GEL     ,92213251,CDM,250,RC,,,,,,Inpatient,1,EA,499.02,499.02,Bright Health MGG,Bright Health MGG,499.02,,,,,,,case rate,499.02,499.02,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Aetna,Aetna,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Aetna MGG,Aetna MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,BCBS,BCBS,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,BCBS MGG,BCBS MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Cigna,Cigna,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Cigna MGG,Cigna MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Humana,Humana,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Humana MGG,Humana MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Optum VA,Optum VA,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,UHC,UHC,160.59,,,,,,,per diem,160.59,160.59,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,UHC MGG,UHC MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,VA,VA,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Wellcare MGG,Wellcare MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Bright Health - commercial,Bright Health - commercial,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92213252,CDM,250,RC,,,,,,Inpatient,1,EA,160.59,160.59,Bright Health MGG,Bright Health MGG,160.59,,,,,,,case rate,160.59,160.59,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna,Aetna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Aetna MGG,Aetna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,BCBS,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS MGG,BCBS MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna,Cigna,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Cigna MGG,Cigna MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana,Humana,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Humana MGG,Humana MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Optum VA,Optum VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC,UHC,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UHC MGG,UHC MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,VA,VA,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Wellcare MGG,Wellcare MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health - commercial,Bright Health - commercial,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 15MG TAB        ,92213253,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,Bright Health MGG,Bright Health MGG,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna,Aetna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Aetna MGG,Aetna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS,BCBS,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,BCBS MGG,BCBS MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna,Cigna,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Cigna MGG,Cigna MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana,Humana,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Humana MGG,Humana MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Optum VA,Optum VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC,UHC,5.22,,,,,,,per diem,5.22,5.22,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,UHC MGG,UHC MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,VA,VA,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Wellcare MGG,Wellcare MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health - commercial,Bright Health - commercial,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 60MG TAB      ,92213254,CDM,250,RC,,,,,,Inpatient,1,EA,5.22,5.22,Bright Health MGG,Bright Health MGG,5.22,,,,,,,case rate,5.22,5.22,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92213255,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Aetna,Aetna,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Aetna MGG,Aetna MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,BCBS,BCBS,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,BCBS MGG,BCBS MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Cigna,Cigna,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Cigna MGG,Cigna MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Humana,Humana,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Humana MGG,Humana MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Optum VA,Optum VA,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,UHC,UHC,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,UHC MGG,UHC MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,VA,VA,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Wellcare MGG,Wellcare MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Bright Health - commercial,Bright Health - commercial,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM OIN      ",92213256,CDM,250,RC,,,,,,Inpatient,1,EA,75.6,75.6,Bright Health MGG,Bright Health MGG,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Aetna,Aetna,593.31,,,,,,,per diem,593.31,593.31,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Aetna MGG,Aetna MGG,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,BCBS,BCBS,593.31,,,,,,,per diem,593.31,593.31,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,BCBS MGG,BCBS MGG,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Cigna,Cigna,593.31,,,,,,,per diem,593.31,593.31,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Cigna MGG,Cigna MGG,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Humana,Humana,593.31,,,,,,,per diem,593.31,593.31,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Humana MGG,Humana MGG,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Optum VA,Optum VA,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,UHC,UHC,593.31,,,,,,,per diem,593.31,593.31,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,UHC MGG,UHC MGG,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,VA,VA,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Wellcare MGG,Wellcare MGG,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Bright Health - commercial,Bright Health - commercial,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/ACT SPR   ,92213257,CDM,250,RC,,,,,,Inpatient,1,EA,593.31,593.31,Bright Health MGG,Bright Health MGG,593.31,,,,,,,case rate,593.31,593.31,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Aetna,Aetna,268.17,,,,,,,per diem,268.17,268.17,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Aetna MGG,Aetna MGG,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,BCBS,BCBS,268.17,,,,,,,per diem,268.17,268.17,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,BCBS MGG,BCBS MGG,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Cigna,Cigna,268.17,,,,,,,per diem,268.17,268.17,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Cigna MGG,Cigna MGG,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Humana,Humana,268.17,,,,,,,per diem,268.17,268.17,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Humana MGG,Humana MGG,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Optum VA,Optum VA,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,UHC,UHC,268.17,,,,,,,per diem,268.17,268.17,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,UHC MGG,UHC MGG,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,VA,VA,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Wellcare MGG,Wellcare MGG,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Bright Health - commercial,Bright Health - commercial,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 L,92213258,CDM,250,RC,,,,,,Inpatient,1,EA,268.17,268.17,Bright Health MGG,Bright Health MGG,268.17,,,,,,,case rate,268.17,268.17,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Aetna,Aetna,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Aetna MGG,Aetna MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,BCBS,BCBS,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,BCBS MGG,BCBS MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Cigna,Cigna,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Cigna MGG,Cigna MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Humana,Humana,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Humana MGG,Humana MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Optum VA,Optum VA,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,UHC,UHC,148.14,,,,,,,per diem,148.14,148.14,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,UHC MGG,UHC MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,VA,VA,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Wellcare MGG,Wellcare MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Bright Health - commercial,Bright Health - commercial,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92213259,CDM,250,RC,,,,,,Inpatient,1,EA,148.14,148.14,Bright Health MGG,Bright Health MGG,148.14,,,,,,,case rate,148.14,148.14,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92213260,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Aetna,Aetna,46.89,,,,,,,per diem,46.89,46.89,"Per diem rate, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Aetna MGG,Aetna MGG,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,BCBS,BCBS,46.89,,,,,,,per diem,46.89,46.89,"Per diem rate, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,BCBS MGG,BCBS MGG,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Cigna,Cigna,46.89,,,,,,,per diem,46.89,46.89,"Per diem rate, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Cigna MGG,Cigna MGG,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Humana,Humana,46.89,,,,,,,per diem,46.89,46.89,"Per diem rate, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Humana MGG,Humana MGG,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Optum VA,Optum VA,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,UHC,UHC,46.89,,,,,,,per diem,46.89,46.89,"Per diem rate, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,UHC MGG,UHC MGG,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,VA,VA,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Wellcare MGG,Wellcare MGG,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Bright Health - commercial,Bright Health - commercial,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
CR CU MN SE ZN TRACE ELEMENT I,92213261,CDM,250,RC,,,,,,Inpatient,1,EA,46.89,46.89,Bright Health MGG,Bright Health MGG,46.89,,,,,,,case rate,46.89,46.89,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92213262,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Aetna,Aetna,969.06,,,,,,,per diem,969.06,969.06,"Per diem rate, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Aetna MGG,Aetna MGG,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,BCBS,BCBS,969.06,,,,,,,per diem,969.06,969.06,"Per diem rate, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,BCBS MGG,BCBS MGG,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Cigna,Cigna,969.06,,,,,,,per diem,969.06,969.06,"Per diem rate, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Cigna MGG,Cigna MGG,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Humana,Humana,969.06,,,,,,,per diem,969.06,969.06,"Per diem rate, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Humana MGG,Humana MGG,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Optum VA,Optum VA,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,UHC,UHC,969.06,,,,,,,per diem,969.06,969.06,"Per diem rate, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,UHC MGG,UHC MGG,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,VA,VA,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Wellcare MGG,Wellcare MGG,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Bright Health - commercial,Bright Health - commercial,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
SOMATROPIN E-COLI DERIVE 5MG P,92213263,CDM,250,RC,,,,,,Inpatient,1,EA,969.06,969.06,Bright Health MGG,Bright Health MGG,969.06,,,,,,,case rate,969.06,969.06,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PHOS K NA PDR                 ,92213264,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Aetna,Aetna,17.52,,,,,,,per diem,17.52,17.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Aetna MGG,Aetna MGG,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,BCBS,BCBS,17.52,,,,,,,per diem,17.52,17.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,BCBS MGG,BCBS MGG,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Cigna,Cigna,17.52,,,,,,,per diem,17.52,17.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Cigna MGG,Cigna MGG,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Humana,Humana,17.52,,,,,,,per diem,17.52,17.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Humana MGG,Humana MGG,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Optum VA,Optum VA,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,UHC,UHC,17.52,,,,,,,per diem,17.52,17.52,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,UHC MGG,UHC MGG,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,VA,VA,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Wellcare MGG,Wellcare MGG,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Bright Health - commercial,Bright Health - commercial,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 30MG ODT          ,92213265,CDM,250,RC,,,,,,Inpatient,1,EA,17.52,17.52,Bright Health MGG,Bright Health MGG,17.52,,,,,,,case rate,17.52,17.52,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Aetna,Aetna,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Aetna MGG,Aetna MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,BCBS,BCBS,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,BCBS MGG,BCBS MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Cigna,Cigna,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Cigna MGG,Cigna MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Humana,Humana,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Humana MGG,Humana MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Optum VA,Optum VA,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,UHC,UHC,29.01,,,,,,,per diem,29.01,29.01,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,UHC MGG,UHC MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,VA,VA,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Wellcare MGG,Wellcare MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Bright Health - commercial,Bright Health - commercial,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92213266,CDM,250,RC,,,,,,Inpatient,1,EA,29.01,29.01,Bright Health MGG,Bright Health MGG,29.01,,,,,,,case rate,29.01,29.01,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Aetna,Aetna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Aetna MGG,Aetna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,BCBS,BCBS,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,BCBS MGG,BCBS MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Cigna,Cigna,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Cigna MGG,Cigna MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Humana,Humana,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Humana MGG,Humana MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Optum VA,Optum VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,UHC,UHC,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,UHC MGG,UHC MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,VA,VA,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Wellcare MGG,Wellcare MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Bright Health - commercial,Bright Health - commercial,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213267,CDM,258,RC,,,,,,Inpatient,1,EA,21,21,Bright Health MGG,Bright Health MGG,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB 25MEQ TEF    ,92213268,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92213269,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213270,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213271,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Aetna,Aetna,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Aetna MGG,Aetna MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,BCBS,BCBS,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,BCBS MGG,BCBS MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Cigna,Cigna,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Cigna MGG,Cigna MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Humana,Humana,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Humana MGG,Humana MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Optum VA,Optum VA,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,UHC,UHC,13.38,,,,,,,per diem,13.38,13.38,"Per diem rate, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,UHC MGG,UHC MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,VA,VA,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Wellcare MGG,Wellcare MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Bright Health - commercial,Bright Health - commercial,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
TACROLIMUS 1MG CAP            ,92213272,CDM,250,RC,,,,,,Inpatient,1,EA,13.38,13.38,Bright Health MGG,Bright Health MGG,13.38,,,,,,,case rate,13.38,13.38,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Aetna,Aetna,286.68,,,,,,,per diem,286.68,286.68,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Aetna MGG,Aetna MGG,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,BCBS,BCBS,286.68,,,,,,,per diem,286.68,286.68,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,BCBS MGG,BCBS MGG,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Cigna,Cigna,286.68,,,,,,,per diem,286.68,286.68,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Cigna MGG,Cigna MGG,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Humana,Humana,286.68,,,,,,,per diem,286.68,286.68,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Humana MGG,Humana MGG,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Optum VA,Optum VA,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,UHC,UHC,286.68,,,,,,,per diem,286.68,286.68,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,UHC MGG,UHC MGG,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,VA,VA,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Wellcare MGG,Wellcare MGG,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Bright Health - commercial,Bright Health - commercial,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92213273,CDM,258,RC,,,,,,Inpatient,1,EA,286.68,286.68,Bright Health MGG,Bright Health MGG,286.68,,,,,,,case rate,286.68,286.68,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Aetna,Aetna,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Aetna MGG,Aetna MGG,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,BCBS,BCBS,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,BCBS MGG,BCBS MGG,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Cigna,Cigna,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Cigna MGG,Cigna MGG,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Humana,Humana,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Humana MGG,Humana MGG,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Optum VA,Optum VA,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,UHC,UHC,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,UHC MGG,UHC MGG,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,VA,VA,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Wellcare MGG,Wellcare MGG,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Bright Health - commercial,Bright Health - commercial,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"HEPARIN 5,000U/0.5ML INJ      ",92213274,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,Bright Health MGG,Bright Health MGG,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Aetna,Aetna,41.49,,,,,,,per diem,41.49,41.49,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Aetna MGG,Aetna MGG,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,BCBS,BCBS,41.49,,,,,,,per diem,41.49,41.49,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,BCBS MGG,BCBS MGG,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Cigna,Cigna,41.49,,,,,,,per diem,41.49,41.49,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Cigna MGG,Cigna MGG,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Humana,Humana,41.49,,,,,,,per diem,41.49,41.49,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Humana MGG,Humana MGG,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Optum VA,Optum VA,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,UHC,UHC,41.49,,,,,,,per diem,41.49,41.49,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,UHC MGG,UHC MGG,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,VA,VA,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Wellcare MGG,Wellcare MGG,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Bright Health - commercial,Bright Health - commercial,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:200,000 INJ",92213275,CDM,250,RC,,,,,,Inpatient,1,EA,41.49,41.49,Bright Health MGG,Bright Health MGG,41.49,,,,,,,case rate,41.49,41.49,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92213276,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Aetna,Aetna,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Aetna MGG,Aetna MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,BCBS,BCBS,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,BCBS MGG,BCBS MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Cigna,Cigna,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Cigna MGG,Cigna MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Humana,Humana,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Humana MGG,Humana MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Optum VA,Optum VA,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,UHC,UHC,20.61,,,,,,,per diem,20.61,20.61,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,UHC MGG,UHC MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,VA,VA,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Wellcare MGG,Wellcare MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Bright Health - commercial,Bright Health - commercial,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213277,CDM,258,RC,,,,,,Inpatient,1,EA,20.61,20.61,Bright Health MGG,Bright Health MGG,20.61,,,,,,,case rate,20.61,20.61,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNA 50MG-8.6MG T,92213278,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Aetna,Aetna,388.74,,,,,,,per diem,388.74,388.74,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Aetna MGG,Aetna MGG,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,BCBS,BCBS,388.74,,,,,,,per diem,388.74,388.74,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,BCBS MGG,BCBS MGG,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Cigna,Cigna,388.74,,,,,,,per diem,388.74,388.74,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Cigna MGG,Cigna MGG,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Humana,Humana,388.74,,,,,,,per diem,388.74,388.74,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Humana MGG,Humana MGG,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Optum VA,Optum VA,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,UHC,UHC,388.74,,,,,,,per diem,388.74,388.74,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,UHC MGG,UHC MGG,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,VA,VA,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Wellcare MGG,Wellcare MGG,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Bright Health - commercial,Bright Health - commercial,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG INJ       ,92213279,CDM,250,RC,,,,,,Inpatient,1,EA,388.74,388.74,Bright Health MGG,Bright Health MGG,388.74,,,,,,,case rate,388.74,388.74,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Aetna,Aetna,73.56,,,,,,,per diem,73.56,73.56,"Per diem rate, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Aetna MGG,Aetna MGG,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,BCBS,BCBS,73.56,,,,,,,per diem,73.56,73.56,"Per diem rate, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,BCBS MGG,BCBS MGG,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Cigna,Cigna,73.56,,,,,,,per diem,73.56,73.56,"Per diem rate, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Cigna MGG,Cigna MGG,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Humana,Humana,73.56,,,,,,,per diem,73.56,73.56,"Per diem rate, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Humana MGG,Humana MGG,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Optum VA,Optum VA,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,UHC,UHC,73.56,,,,,,,per diem,73.56,73.56,"Per diem rate, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,UHC MGG,UHC MGG,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,VA,VA,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Wellcare MGG,Wellcare MGG,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Bright Health - commercial,Bright Health - commercial,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
SILDENAFIL CITRATE 100MG TAB  ,92213280,CDM,250,RC,,,,,,Inpatient,1,EA,73.56,73.56,Bright Health MGG,Bright Health MGG,73.56,,,,,,,case rate,73.56,73.56,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92213281,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Aetna,Aetna,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Aetna MGG,Aetna MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,BCBS,BCBS,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,BCBS MGG,BCBS MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Cigna,Cigna,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Cigna MGG,Cigna MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Humana,Humana,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Humana MGG,Humana MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Optum VA,Optum VA,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,UHC,UHC,6.03,,,,,,,per diem,6.03,6.03,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,UHC MGG,UHC MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,VA,VA,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Wellcare MGG,Wellcare MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Bright Health - commercial,Bright Health - commercial,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213282,CDM,250,RC,,,,,,Inpatient,1,EA,6.03,6.03,Bright Health MGG,Bright Health MGG,6.03,,,,,,,case rate,6.03,6.03,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Aetna,Aetna,331.26,,,,,,,per diem,331.26,331.26,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Aetna MGG,Aetna MGG,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,BCBS,BCBS,331.26,,,,,,,per diem,331.26,331.26,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,BCBS MGG,BCBS MGG,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Cigna,Cigna,331.26,,,,,,,per diem,331.26,331.26,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Cigna MGG,Cigna MGG,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Humana,Humana,331.26,,,,,,,per diem,331.26,331.26,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Humana MGG,Humana MGG,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Optum VA,Optum VA,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,UHC,UHC,331.26,,,,,,,per diem,331.26,331.26,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,UHC MGG,UHC MGG,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,VA,VA,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Wellcare MGG,Wellcare MGG,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Bright Health - commercial,Bright Health - commercial,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92213283,CDM,258,RC,,,,,,Inpatient,1,EA,331.26,331.26,Bright Health MGG,Bright Health MGG,331.26,,,,,,,case rate,331.26,331.26,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Aetna,Aetna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Aetna MGG,Aetna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,BCBS,BCBS,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,BCBS MGG,BCBS MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Cigna,Cigna,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Cigna MGG,Cigna MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Humana,Humana,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Humana MGG,Humana MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Optum VA,Optum VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,UHC,UHC,40.5,,,,,,,per diem,40.5,40.5,"Per diem rate, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,UHC MGG,UHC MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,VA,VA,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Wellcare MGG,Wellcare MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Bright Health - commercial,Bright Health - commercial,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
ANASTROZOLE 1MG TAB           ,92213284,CDM,250,RC,,,,,,Inpatient,1,EA,40.5,40.5,Bright Health MGG,Bright Health MGG,40.5,,,,,,,case rate,40.5,40.5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 50-325MG TAB ,92213285,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 150MG TAB   ,92213286,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Aetna,Aetna,397.83,,,,,,,per diem,397.83,397.83,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Aetna MGG,Aetna MGG,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,BCBS,BCBS,397.83,,,,,,,per diem,397.83,397.83,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,BCBS MGG,BCBS MGG,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Cigna,Cigna,397.83,,,,,,,per diem,397.83,397.83,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Cigna MGG,Cigna MGG,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Humana,Humana,397.83,,,,,,,per diem,397.83,397.83,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Humana MGG,Humana MGG,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Optum VA,Optum VA,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,UHC,UHC,397.83,,,,,,,per diem,397.83,397.83,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,UHC MGG,UHC MGG,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,VA,VA,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Wellcare MGG,Wellcare MGG,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Bright Health - commercial,Bright Health - commercial,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% OIN      ,92213287,CDM,250,RC,,,,,,Inpatient,1,EA,397.83,397.83,Bright Health MGG,Bright Health MGG,397.83,,,,,,,case rate,397.83,397.83,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213288,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Aetna,Aetna,18.39,,,,,,,per diem,18.39,18.39,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Aetna MGG,Aetna MGG,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,BCBS,BCBS,18.39,,,,,,,per diem,18.39,18.39,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,BCBS MGG,BCBS MGG,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Cigna,Cigna,18.39,,,,,,,per diem,18.39,18.39,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Cigna MGG,Cigna MGG,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Humana,Humana,18.39,,,,,,,per diem,18.39,18.39,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Humana MGG,Humana MGG,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Optum VA,Optum VA,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,UHC,UHC,18.39,,,,,,,per diem,18.39,18.39,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,UHC MGG,UHC MGG,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,VA,VA,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Wellcare MGG,Wellcare MGG,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Bright Health - commercial,Bright Health - commercial,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213289,CDM,250,RC,,,,,,Inpatient,1,EA,18.39,18.39,Bright Health MGG,Bright Health MGG,18.39,,,,,,,case rate,18.39,18.39,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Aetna,Aetna,119.88,,,,,,,per diem,119.88,119.88,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Aetna MGG,Aetna MGG,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,BCBS,BCBS,119.88,,,,,,,per diem,119.88,119.88,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,BCBS MGG,BCBS MGG,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Cigna,Cigna,119.88,,,,,,,per diem,119.88,119.88,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Cigna MGG,Cigna MGG,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Humana,Humana,119.88,,,,,,,per diem,119.88,119.88,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Humana MGG,Humana MGG,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Optum VA,Optum VA,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,UHC,UHC,119.88,,,,,,,per diem,119.88,119.88,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,UHC MGG,UHC MGG,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,VA,VA,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Wellcare MGG,Wellcare MGG,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Bright Health - commercial,Bright Health - commercial,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 2% SOL    ,92213290,CDM,250,RC,,,,,,Inpatient,1,EA,119.88,119.88,Bright Health MGG,Bright Health MGG,119.88,,,,,,,case rate,119.88,119.88,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Aetna,Aetna,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Aetna MGG,Aetna MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,BCBS,BCBS,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,BCBS MGG,BCBS MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Cigna,Cigna,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Cigna MGG,Cigna MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Humana,Humana,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Humana MGG,Humana MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Optum VA,Optum VA,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,UHC,UHC,9.69,,,,,,,per diem,9.69,9.69,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,UHC MGG,UHC MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,VA,VA,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Wellcare MGG,Wellcare MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Bright Health - commercial,Bright Health - commercial,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92213291,CDM,250,RC,,,,,,Inpatient,1,EA,9.69,9.69,Bright Health MGG,Bright Health MGG,9.69,,,,,,,case rate,9.69,9.69,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Aetna,Aetna,56.16,,,,,,,per diem,56.16,56.16,"Per diem rate, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Aetna MGG,Aetna MGG,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,BCBS,BCBS,56.16,,,,,,,per diem,56.16,56.16,"Per diem rate, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,BCBS MGG,BCBS MGG,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Cigna,Cigna,56.16,,,,,,,per diem,56.16,56.16,"Per diem rate, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Cigna MGG,Cigna MGG,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Humana,Humana,56.16,,,,,,,per diem,56.16,56.16,"Per diem rate, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Humana MGG,Humana MGG,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Optum VA,Optum VA,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,UHC,UHC,56.16,,,,,,,per diem,56.16,56.16,"Per diem rate, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,UHC MGG,UHC MGG,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,VA,VA,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Wellcare MGG,Wellcare MGG,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Bright Health - commercial,Bright Health - commercial,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
OXYQUINOLINE SULF 0.025% GEL  ,92213292,CDM,250,RC,,,,,,Inpatient,1,EA,56.16,56.16,Bright Health MGG,Bright Health MGG,56.16,,,,,,,case rate,56.16,56.16,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Aetna,Aetna,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Aetna MGG,Aetna MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,BCBS,BCBS,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,BCBS MGG,BCBS MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Cigna,Cigna,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Cigna MGG,Cigna MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Humana,Humana,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Humana MGG,Humana MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Optum VA,Optum VA,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,UHC,UHC,59.4,,,,,,,per diem,59.4,59.4,"Per diem rate, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,UHC MGG,UHC MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,VA,VA,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Wellcare MGG,Wellcare MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Bright Health - commercial,Bright Health - commercial,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
"LACTIC ACID 10% VIT E 3,500U C",92213293,CDM,250,RC,,,,,,Inpatient,1,EA,59.4,59.4,Bright Health MGG,Bright Health MGG,59.4,,,,,,,case rate,59.4,59.4,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92213294,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Aetna,Aetna,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Aetna MGG,Aetna MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,BCBS,BCBS,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,BCBS MGG,BCBS MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Cigna,Cigna,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Cigna MGG,Cigna MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Humana,Humana,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Humana MGG,Humana MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Optum VA,Optum VA,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,UHC,UHC,12.96,,,,,,,per diem,12.96,12.96,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,UHC MGG,UHC MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,VA,VA,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Wellcare MGG,Wellcare MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Bright Health - commercial,Bright Health - commercial,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 2GM INJ         ,92213295,CDM,250,RC,,,,,,Inpatient,1,EA,12.96,12.96,Bright Health MGG,Bright Health MGG,12.96,,,,,,,case rate,12.96,12.96,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213296,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Aetna,Aetna,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Aetna MGG,Aetna MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,BCBS,BCBS,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,BCBS MGG,BCBS MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Cigna,Cigna,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Cigna MGG,Cigna MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Humana,Humana,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Humana MGG,Humana MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Optum VA,Optum VA,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,UHC,UHC,26.61,,,,,,,per diem,26.61,26.61,"Per diem rate, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,UHC MGG,UHC MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,VA,VA,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Wellcare MGG,Wellcare MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Bright Health - commercial,Bright Health - commercial,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
GABAPENTIN 800MG TAB          ,92213297,CDM,250,RC,,,,,,Inpatient,1,EA,26.61,26.61,Bright Health MGG,Bright Health MGG,26.61,,,,,,,case rate,26.61,26.61,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Aetna,Aetna,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Aetna MGG,Aetna MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,BCBS,BCBS,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,BCBS MGG,BCBS MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Cigna,Cigna,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Cigna MGG,Cigna MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Humana,Humana,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Humana MGG,Humana MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Optum VA,Optum VA,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,UHC,UHC,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,UHC MGG,UHC MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,VA,VA,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Wellcare MGG,Wellcare MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Bright Health - commercial,Bright Health - commercial,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92213298,CDM,250,RC,,,,,,Inpatient,1,EA,6.54,6.54,Bright Health MGG,Bright Health MGG,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Aetna,Aetna,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Aetna MGG,Aetna MGG,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,BCBS,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS MGG,BCBS MGG,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Cigna,Cigna,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Cigna MGG,Cigna MGG,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Humana,Humana,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Humana MGG,Humana MGG,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Optum VA,Optum VA,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,UHC,UHC,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,UHC MGG,UHC MGG,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,VA,VA,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Wellcare MGG,Wellcare MGG,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Bright Health - commercial,Bright Health - commercial,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213299,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,Bright Health MGG,Bright Health MGG,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Aetna,Aetna,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Aetna MGG,Aetna MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,BCBS,BCBS,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,BCBS MGG,BCBS MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Cigna,Cigna,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Cigna MGG,Cigna MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Humana,Humana,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Humana MGG,Humana MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Optum VA,Optum VA,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,UHC,UHC,26.79,,,,,,,per diem,26.79,26.79,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,UHC MGG,UHC MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,VA,VA,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Wellcare MGG,Wellcare MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Bright Health - commercial,Bright Health - commercial,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:200,000 INJ",92213300,CDM,250,RC,,,,,,Inpatient,1,EA,26.79,26.79,Bright Health MGG,Bright Health MGG,26.79,,,,,,,case rate,26.79,26.79,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213301,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HEPARIN FLUSH 10U/ML INJ      ,92213302,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92213303,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna,Aetna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Aetna MGG,Aetna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS,BCBS,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,BCBS MGG,BCBS MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna,Cigna,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Cigna MGG,Cigna MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana,Humana,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Humana MGG,Humana MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Optum VA,Optum VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC,UHC,5.04,,,,,,,per diem,5.04,5.04,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,UHC MGG,UHC MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,VA,VA,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Wellcare MGG,Wellcare MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health - commercial,Bright Health - commercial,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92213304,CDM,250,RC,,,,,,Inpatient,1,EA,5.04,5.04,Bright Health MGG,Bright Health MGG,5.04,,,,,,,case rate,5.04,5.04,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Aetna,Aetna,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Aetna MGG,Aetna MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,BCBS,BCBS,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,BCBS MGG,BCBS MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Cigna,Cigna,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Cigna MGG,Cigna MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Humana,Humana,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Humana MGG,Humana MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Optum VA,Optum VA,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,UHC,UHC,12.84,,,,,,,per diem,12.84,12.84,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,UHC MGG,UHC MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,VA,VA,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Wellcare MGG,Wellcare MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Bright Health - commercial,Bright Health - commercial,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213305,CDM,250,RC,,,,,,Inpatient,1,EA,12.84,12.84,Bright Health MGG,Bright Health MGG,12.84,,,,,,,case rate,12.84,12.84,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Aetna,Aetna,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Aetna MGG,Aetna MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,BCBS,BCBS,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,BCBS MGG,BCBS MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Cigna,Cigna,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Cigna MGG,Cigna MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Humana,Humana,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Humana MGG,Humana MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Optum VA,Optum VA,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,UHC,UHC,25.95,,,,,,,per diem,25.95,25.95,"Per diem rate, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,UHC MGG,UHC MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,VA,VA,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Wellcare MGG,Wellcare MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Bright Health - commercial,Bright Health - commercial,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
AMINOCAPROIC ACID 250MG/ML INJ,92213306,CDM,250,RC,,,,,,Inpatient,1,EA,25.95,25.95,Bright Health MGG,Bright Health MGG,25.95,,,,,,,case rate,25.95,25.95,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Aetna,Aetna,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Aetna MGG,Aetna MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,BCBS,BCBS,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,BCBS MGG,BCBS MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Cigna,Cigna,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Cigna MGG,Cigna MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Humana,Humana,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Humana MGG,Humana MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Optum VA,Optum VA,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,UHC,UHC,7.08,,,,,,,per diem,7.08,7.08,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,UHC MGG,UHC MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,VA,VA,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Wellcare MGG,Wellcare MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Bright Health - commercial,Bright Health - commercial,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG ODT          ,92213307,CDM,250,RC,,,,,,Inpatient,1,EA,7.08,7.08,Bright Health MGG,Bright Health MGG,7.08,,,,,,,case rate,7.08,7.08,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Aetna,Aetna,27.39,,,,,,,per diem,27.39,27.39,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Aetna MGG,Aetna MGG,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,BCBS,BCBS,27.39,,,,,,,per diem,27.39,27.39,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,BCBS MGG,BCBS MGG,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Cigna,Cigna,27.39,,,,,,,per diem,27.39,27.39,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Cigna MGG,Cigna MGG,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Humana,Humana,27.39,,,,,,,per diem,27.39,27.39,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Humana MGG,Humana MGG,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Optum VA,Optum VA,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,UHC,UHC,27.39,,,,,,,per diem,27.39,27.39,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,UHC MGG,UHC MGG,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,VA,VA,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Wellcare MGG,Wellcare MGG,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Bright Health - commercial,Bright Health - commercial,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213308,CDM,250,RC,,,,,,Inpatient,1,EA,27.39,27.39,Bright Health MGG,Bright Health MGG,27.39,,,,,,,case rate,27.39,27.39,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Aetna,Aetna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Aetna MGG,Aetna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,BCBS,BCBS,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,BCBS MGG,BCBS MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Cigna,Cigna,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Cigna MGG,Cigna MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Humana,Humana,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Humana MGG,Humana MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Optum VA,Optum VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,UHC,UHC,30,,,,,,,per diem,30,30,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,UHC MGG,UHC MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,VA,VA,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Wellcare MGG,Wellcare MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Bright Health - commercial,Bright Health - commercial,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92213309,CDM,250,RC,,,,,,Inpatient,1,EA,30,30,Bright Health MGG,Bright Health MGG,30,,,,,,,case rate,30,30,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Aetna,Aetna,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Aetna MGG,Aetna MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,BCBS,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS MGG,BCBS MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Cigna,Cigna,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Cigna MGG,Cigna MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Humana,Humana,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Humana MGG,Humana MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Optum VA,Optum VA,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,UHC,UHC,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,UHC MGG,UHC MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,VA,VA,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Wellcare MGG,Wellcare MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Bright Health - commercial,Bright Health - commercial,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
DEXTROSE 5%/WATER IVS         ,92213310,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,Bright Health MGG,Bright Health MGG,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna,Aetna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Aetna MGG,Aetna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,BCBS,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS MGG,BCBS MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna,Cigna,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Cigna MGG,Cigna MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana,Humana,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Humana MGG,Humana MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Optum VA,Optum VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC,UHC,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UHC MGG,UHC MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,VA,VA,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Wellcare MGG,Wellcare MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health - commercial,Bright Health - commercial,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213311,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,Bright Health MGG,Bright Health MGG,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Aetna,Aetna,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Aetna MGG,Aetna MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,BCBS,BCBS,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,BCBS MGG,BCBS MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Cigna,Cigna,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Cigna MGG,Cigna MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Humana,Humana,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Humana MGG,Humana MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Optum VA,Optum VA,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,UHC,UHC,9.15,,,,,,,per diem,9.15,9.15,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,UHC MGG,UHC MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,VA,VA,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Wellcare MGG,Wellcare MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Bright Health - commercial,Bright Health - commercial,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 10MG TAB       ,92213312,CDM,250,RC,,,,,,Inpatient,1,EA,9.15,9.15,Bright Health MGG,Bright Health MGG,9.15,,,,,,,case rate,9.15,9.15,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Aetna,Aetna,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Aetna MGG,Aetna MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,BCBS,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS MGG,BCBS MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Cigna,Cigna,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Cigna MGG,Cigna MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Humana,Humana,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Humana MGG,Humana MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Optum VA,Optum VA,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UHC,UHC,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UHC MGG,UHC MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA,VA,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Wellcare MGG,Wellcare MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Bright Health - commercial,Bright Health - commercial,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92213313,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,Bright Health MGG,Bright Health MGG,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92213314,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Aetna,Aetna,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Aetna MGG,Aetna MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,BCBS,BCBS,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,BCBS MGG,BCBS MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Cigna,Cigna,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Cigna MGG,Cigna MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Humana,Humana,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Humana MGG,Humana MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Optum VA,Optum VA,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,UHC,UHC,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,UHC MGG,UHC MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,VA,VA,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Wellcare MGG,Wellcare MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Bright Health - commercial,Bright Health - commercial,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 40MG CAP       ,92213315,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,Bright Health MGG,Bright Health MGG,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PREDNISOLONE NA POS 15MG/5ML S,92213316,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Aetna,Aetna,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Aetna MGG,Aetna MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,BCBS,BCBS,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,BCBS MGG,BCBS MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Cigna,Cigna,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Cigna MGG,Cigna MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Humana,Humana,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Humana MGG,Humana MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Optum VA,Optum VA,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,UHC,UHC,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,UHC MGG,UHC MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,VA,VA,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Wellcare MGG,Wellcare MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Bright Health - commercial,Bright Health - commercial,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 20MG ECC      ,92213317,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Bright Health MGG,Bright Health MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Aetna,Aetna,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Aetna MGG,Aetna MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,BCBS,BCBS,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,BCBS MGG,BCBS MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Cigna,Cigna,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Cigna MGG,Cigna MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Humana,Humana,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Humana MGG,Humana MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Optum VA,Optum VA,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,UHC,UHC,17.07,,,,,,,per diem,17.07,17.07,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,UHC MGG,UHC MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,VA,VA,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Wellcare MGG,Wellcare MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Bright Health - commercial,Bright Health - commercial,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG/5ML SUS   ,92213318,CDM,250,RC,,,,,,Inpatient,1,EA,17.07,17.07,Bright Health MGG,Bright Health MGG,17.07,,,,,,,case rate,17.07,17.07,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92213319,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Aetna,Aetna,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Aetna MGG,Aetna MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,BCBS,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS MGG,BCBS MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Cigna,Cigna,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Cigna MGG,Cigna MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Humana,Humana,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Humana MGG,Humana MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Optum VA,Optum VA,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UHC,UHC,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UHC MGG,UHC MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA,VA,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Wellcare MGG,Wellcare MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Bright Health - commercial,Bright Health - commercial,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92213320,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,Bright Health MGG,Bright Health MGG,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Aetna,Aetna,132.69,,,,,,,per diem,132.69,132.69,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Aetna MGG,Aetna MGG,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,BCBS,BCBS,132.69,,,,,,,per diem,132.69,132.69,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,BCBS MGG,BCBS MGG,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Cigna,Cigna,132.69,,,,,,,per diem,132.69,132.69,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Cigna MGG,Cigna MGG,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Humana,Humana,132.69,,,,,,,per diem,132.69,132.69,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Humana MGG,Humana MGG,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Optum VA,Optum VA,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,UHC,UHC,132.69,,,,,,,per diem,132.69,132.69,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,UHC MGG,UHC MGG,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,VA,VA,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Wellcare MGG,Wellcare MGG,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Bright Health - commercial,Bright Health - commercial,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 10MG/ML INJ    ,92213321,CDM,250,RC,,,,,,Inpatient,1,EA,132.69,132.69,Bright Health MGG,Bright Health MGG,132.69,,,,,,,case rate,132.69,132.69,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Aetna,Aetna,53.76,,,,,,,per diem,53.76,53.76,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Aetna MGG,Aetna MGG,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,BCBS,BCBS,53.76,,,,,,,per diem,53.76,53.76,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,BCBS MGG,BCBS MGG,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Cigna,Cigna,53.76,,,,,,,per diem,53.76,53.76,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Cigna MGG,Cigna MGG,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Humana,Humana,53.76,,,,,,,per diem,53.76,53.76,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Humana MGG,Humana MGG,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Optum VA,Optum VA,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,UHC,UHC,53.76,,,,,,,per diem,53.76,53.76,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,UHC MGG,UHC MGG,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,VA,VA,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Wellcare MGG,Wellcare MGG,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Bright Health - commercial,Bright Health - commercial,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92213322,CDM,250,RC,,,,,,Inpatient,1,EA,53.76,53.76,Bright Health MGG,Bright Health MGG,53.76,,,,,,,case rate,53.76,53.76,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Aetna,Aetna,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Aetna MGG,Aetna MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,BCBS,BCBS,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,BCBS MGG,BCBS MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Cigna,Cigna,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Cigna MGG,Cigna MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Humana,Humana,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Humana MGG,Humana MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Optum VA,Optum VA,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,UHC,UHC,16.98,,,,,,,per diem,16.98,16.98,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,UHC MGG,UHC MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,VA,VA,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Wellcare MGG,Wellcare MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Bright Health - commercial,Bright Health - commercial,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 10MG TAB       ,92213323,CDM,250,RC,,,,,,Inpatient,1,EA,16.98,16.98,Bright Health MGG,Bright Health MGG,16.98,,,,,,,case rate,16.98,16.98,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Aetna,Aetna,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Aetna MGG,Aetna MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,BCBS,BCBS,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,BCBS MGG,BCBS MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Cigna,Cigna,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Cigna MGG,Cigna MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Humana,Humana,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Humana MGG,Humana MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Optum VA,Optum VA,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,UHC,UHC,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,UHC MGG,UHC MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,VA,VA,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Wellcare MGG,Wellcare MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Bright Health - commercial,Bright Health - commercial,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
DEXTROSE 2.5%/WATER IVS       ,92213324,CDM,258,RC,,,,,,Inpatient,1,EA,14.49,14.49,Bright Health MGG,Bright Health MGG,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Aetna,Aetna,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Aetna MGG,Aetna MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,BCBS,BCBS,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,BCBS MGG,BCBS MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Cigna,Cigna,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Cigna MGG,Cigna MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Humana,Humana,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Humana MGG,Humana MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Optum VA,Optum VA,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,UHC,UHC,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,UHC MGG,UHC MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,VA,VA,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Wellcare MGG,Wellcare MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Bright Health - commercial,Bright Health - commercial,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92213325,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Bright Health MGG,Bright Health MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Aetna,Aetna,8.37,,,,,,,per diem,8.37,8.37,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Aetna MGG,Aetna MGG,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,BCBS,BCBS,8.37,,,,,,,per diem,8.37,8.37,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,BCBS MGG,BCBS MGG,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Cigna,Cigna,8.37,,,,,,,per diem,8.37,8.37,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Cigna MGG,Cigna MGG,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Humana,Humana,8.37,,,,,,,per diem,8.37,8.37,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Humana MGG,Humana MGG,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Optum VA,Optum VA,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,UHC,UHC,8.37,,,,,,,per diem,8.37,8.37,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,UHC MGG,UHC MGG,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,VA,VA,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Wellcare MGG,Wellcare MGG,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Bright Health - commercial,Bright Health - commercial,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213326,CDM,250,RC,,,,,,Inpatient,1,EA,8.37,8.37,Bright Health MGG,Bright Health MGG,8.37,,,,,,,case rate,8.37,8.37,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Aetna,Aetna,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Aetna MGG,Aetna MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,BCBS,BCBS,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,BCBS MGG,BCBS MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Cigna,Cigna,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Cigna MGG,Cigna MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Humana,Humana,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Humana MGG,Humana MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Optum VA,Optum VA,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,UHC,UHC,11.07,,,,,,,per diem,11.07,11.07,"Per diem rate, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,UHC MGG,UHC MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,VA,VA,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Wellcare MGG,Wellcare MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Bright Health - commercial,Bright Health - commercial,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
ZALEPLON 5MG CAP              ,92213327,CDM,250,RC,,,,,,Inpatient,1,EA,11.07,11.07,Bright Health MGG,Bright Health MGG,11.07,,,,,,,case rate,11.07,11.07,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 315 W/D 200U T,92213328,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Aetna,Aetna,1024.2,,,,,,,per diem,1024.2,1024.2,"Per diem rate, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Aetna MGG,Aetna MGG,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,BCBS,BCBS,1024.2,,,,,,,per diem,1024.2,1024.2,"Per diem rate, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,BCBS MGG,BCBS MGG,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Cigna,Cigna,1024.2,,,,,,,per diem,1024.2,1024.2,"Per diem rate, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Cigna MGG,Cigna MGG,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Humana,Humana,1024.2,,,,,,,per diem,1024.2,1024.2,"Per diem rate, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Humana MGG,Humana MGG,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Optum VA,Optum VA,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,UHC,UHC,1024.2,,,,,,,per diem,1024.2,1024.2,"Per diem rate, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,UHC MGG,UHC MGG,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,VA,VA,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Wellcare MGG,Wellcare MGG,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Bright Health - commercial,Bright Health - commercial,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
DIAZOXIDE 50MG/ML SUS         ,92213329,CDM,250,RC,,,,,,Inpatient,1,EA,1024.2,1024.2,Bright Health MGG,Bright Health MGG,1024.2,,,,,,,case rate,1024.2,1024.2,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Aetna,Aetna,43.74,,,,,,,per diem,43.74,43.74,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Aetna MGG,Aetna MGG,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,BCBS,BCBS,43.74,,,,,,,per diem,43.74,43.74,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,BCBS MGG,BCBS MGG,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Cigna,Cigna,43.74,,,,,,,per diem,43.74,43.74,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Cigna MGG,Cigna MGG,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Humana,Humana,43.74,,,,,,,per diem,43.74,43.74,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Humana MGG,Humana MGG,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Optum VA,Optum VA,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,UHC,UHC,43.74,,,,,,,per diem,43.74,43.74,"Per diem rate, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,UHC MGG,UHC MGG,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,VA,VA,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Wellcare MGG,Wellcare MGG,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Bright Health - commercial,Bright Health - commercial,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
TESTOSTERONE 1% GEL           ,92213330,CDM,250,RC,,,,,,Inpatient,1,EA,43.74,43.74,Bright Health MGG,Bright Health MGG,43.74,,,,,,,case rate,43.74,43.74,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Aetna,Aetna,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Aetna MGG,Aetna MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,BCBS,BCBS,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,BCBS MGG,BCBS MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Cigna,Cigna,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Cigna MGG,Cigna MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Humana,Humana,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Humana MGG,Humana MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Optum VA,Optum VA,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,UHC,UHC,9.12,,,,,,,per diem,9.12,9.12,"Per diem rate, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,UHC MGG,UHC MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,VA,VA,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Wellcare MGG,Wellcare MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Bright Health - commercial,Bright Health - commercial,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
D5W-1/4NS/KCL 10MEQ/L IVS     ,92213331,CDM,258,RC,,,,,,Inpatient,1,EA,9.12,9.12,Bright Health MGG,Bright Health MGG,9.12,,,,,,,case rate,9.12,9.12,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Aetna,Aetna,26.67,,,,,,,per diem,26.67,26.67,"Per diem rate, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Aetna MGG,Aetna MGG,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,BCBS,BCBS,26.67,,,,,,,per diem,26.67,26.67,"Per diem rate, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,BCBS MGG,BCBS MGG,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Cigna,Cigna,26.67,,,,,,,per diem,26.67,26.67,"Per diem rate, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Cigna MGG,Cigna MGG,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Humana,Humana,26.67,,,,,,,per diem,26.67,26.67,"Per diem rate, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Humana MGG,Humana MGG,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Optum VA,Optum VA,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,UHC,UHC,26.67,,,,,,,per diem,26.67,26.67,"Per diem rate, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,UHC MGG,UHC MGG,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,VA,VA,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Wellcare MGG,Wellcare MGG,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Bright Health - commercial,Bright Health - commercial,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
RABEPRAXOLE NA 20MG ECT       ,92213332,CDM,250,RC,,,,,,Inpatient,1,EA,26.67,26.67,Bright Health MGG,Bright Health MGG,26.67,,,,,,,case rate,26.67,26.67,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Aetna,Aetna,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Aetna MGG,Aetna MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,BCBS,BCBS,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,BCBS MGG,BCBS MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Cigna,Cigna,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Cigna MGG,Cigna MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Humana,Humana,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Humana MGG,Humana MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Optum VA,Optum VA,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,UHC,UHC,40.32,,,,,,,per diem,40.32,40.32,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,UHC MGG,UHC MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,VA,VA,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Wellcare MGG,Wellcare MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Bright Health - commercial,Bright Health - commercial,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92213333,CDM,250,RC,,,,,,Inpatient,1,EA,40.32,40.32,Bright Health MGG,Bright Health MGG,40.32,,,,,,,case rate,40.32,40.32,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Aetna,Aetna,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Aetna MGG,Aetna MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,BCBS,BCBS,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,BCBS MGG,BCBS MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Cigna,Cigna,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Cigna MGG,Cigna MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Humana,Humana,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Humana MGG,Humana MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Optum VA,Optum VA,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,UHC,UHC,18.78,,,,,,,per diem,18.78,18.78,"Per diem rate, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,UHC MGG,UHC MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,VA,VA,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Wellcare MGG,Wellcare MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Bright Health - commercial,Bright Health - commercial,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
ESOMEPRAXOLE MG 40MG ECC      ,92213334,CDM,250,RC,,,,,,Inpatient,1,EA,18.78,18.78,Bright Health MGG,Bright Health MGG,18.78,,,,,,,case rate,18.78,18.78,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Aetna,Aetna,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Aetna MGG,Aetna MGG,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,BCBS,BCBS,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,BCBS MGG,BCBS MGG,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Cigna,Cigna,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Cigna MGG,Cigna MGG,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Humana,Humana,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Humana MGG,Humana MGG,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Optum VA,Optum VA,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,UHC,UHC,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,UHC MGG,UHC MGG,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,VA,VA,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Wellcare MGG,Wellcare MGG,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Bright Health - commercial,Bright Health - commercial,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% GFS      ,92213335,CDM,250,RC,,,,,,Inpatient,1,EA,59.19,59.19,Bright Health MGG,Bright Health MGG,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Aetna,Aetna,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Aetna MGG,Aetna MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,BCBS,BCBS,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,BCBS MGG,BCBS MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Cigna,Cigna,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Cigna MGG,Cigna MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Humana,Humana,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Humana MGG,Humana MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Optum VA,Optum VA,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,UHC,UHC,13.11,,,,,,,per diem,13.11,13.11,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,UHC MGG,UHC MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,VA,VA,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Wellcare MGG,Wellcare MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Bright Health - commercial,Bright Health - commercial,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92213336,CDM,250,RC,,,,,,Inpatient,1,EA,13.11,13.11,Bright Health MGG,Bright Health MGG,13.11,,,,,,,case rate,13.11,13.11,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL CDP 25-10 TA,92213337,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Aetna,Aetna,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Aetna MGG,Aetna MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,BCBS,BCBS,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,BCBS MGG,BCBS MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Cigna,Cigna,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Cigna MGG,Cigna MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Humana,Humana,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Humana MGG,Humana MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Optum VA,Optum VA,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,UHC,UHC,37.05,,,,,,,per diem,37.05,37.05,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,UHC MGG,UHC MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,VA,VA,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Wellcare MGG,Wellcare MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Bright Health - commercial,Bright Health - commercial,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213338,CDM,250,RC,,,,,,Inpatient,1,EA,37.05,37.05,Bright Health MGG,Bright Health MGG,37.05,,,,,,,case rate,37.05,37.05,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Aetna,Aetna,140.46,,,,,,,per diem,140.46,140.46,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Aetna MGG,Aetna MGG,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,BCBS,BCBS,140.46,,,,,,,per diem,140.46,140.46,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,BCBS MGG,BCBS MGG,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Cigna,Cigna,140.46,,,,,,,per diem,140.46,140.46,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Cigna MGG,Cigna MGG,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Humana,Humana,140.46,,,,,,,per diem,140.46,140.46,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Humana MGG,Humana MGG,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Optum VA,Optum VA,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,UHC,UHC,140.46,,,,,,,per diem,140.46,140.46,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,UHC MGG,UHC MGG,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,VA,VA,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Wellcare MGG,Wellcare MGG,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Bright Health - commercial,Bright Health - commercial,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92213339,CDM,250,RC,,,,,,Inpatient,1,EA,140.46,140.46,Bright Health MGG,Bright Health MGG,140.46,,,,,,,case rate,140.46,140.46,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Aetna,Aetna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Aetna MGG,Aetna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,BCBS,BCBS,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,BCBS MGG,BCBS MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Cigna,Cigna,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Cigna MGG,Cigna MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Humana,Humana,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Humana MGG,Humana MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Optum VA,Optum VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,UHC,UHC,12.09,,,,,,,per diem,12.09,12.09,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,UHC MGG,UHC MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,VA,VA,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Wellcare MGG,Wellcare MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Bright Health - commercial,Bright Health - commercial,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 300MG CAP     ,92213340,CDM,250,RC,,,,,,Inpatient,1,EA,12.09,12.09,Bright Health MGG,Bright Health MGG,12.09,,,,,,,case rate,12.09,12.09,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Aetna,Aetna,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Aetna MGG,Aetna MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,BCBS,BCBS,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,BCBS MGG,BCBS MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Cigna,Cigna,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Cigna MGG,Cigna MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Humana,Humana,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Humana MGG,Humana MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Optum VA,Optum VA,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,UHC,UHC,16.62,,,,,,,per diem,16.62,16.62,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,UHC MGG,UHC MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,VA,VA,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Wellcare MGG,Wellcare MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Bright Health - commercial,Bright Health - commercial,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92213341,CDM,250,RC,,,,,,Inpatient,1,EA,16.62,16.62,Bright Health MGG,Bright Health MGG,16.62,,,,,,,case rate,16.62,16.62,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Aetna,Aetna,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Aetna MGG,Aetna MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,BCBS,BCBS,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,BCBS MGG,BCBS MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Cigna,Cigna,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Cigna MGG,Cigna MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Humana,Humana,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Humana MGG,Humana MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Optum VA,Optum VA,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,UHC,UHC,9.9,,,,,,,per diem,9.9,9.9,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,UHC MGG,UHC MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,VA,VA,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Wellcare MGG,Wellcare MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Bright Health - commercial,Bright Health - commercial,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213342,CDM,250,RC,,,,,,Inpatient,1,EA,9.9,9.9,Bright Health MGG,Bright Health MGG,9.9,,,,,,,case rate,9.9,9.9,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213343,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Aetna,Aetna,378.39,,,,,,,per diem,378.39,378.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Aetna MGG,Aetna MGG,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,BCBS,BCBS,378.39,,,,,,,per diem,378.39,378.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,BCBS MGG,BCBS MGG,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Cigna,Cigna,378.39,,,,,,,per diem,378.39,378.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Cigna MGG,Cigna MGG,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Humana,Humana,378.39,,,,,,,per diem,378.39,378.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Humana MGG,Humana MGG,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Optum VA,Optum VA,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,UHC,UHC,378.39,,,,,,,per diem,378.39,378.39,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,UHC MGG,UHC MGG,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,VA,VA,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Wellcare MGG,Wellcare MGG,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Bright Health - commercial,Bright Health - commercial,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213344,CDM,250,RC,,,,,,Inpatient,1,EA,378.39,378.39,Bright Health MGG,Bright Health MGG,378.39,,,,,,,case rate,378.39,378.39,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Aetna,Aetna,138.42,,,,,,,per diem,138.42,138.42,"Per diem rate, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Aetna MGG,Aetna MGG,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,BCBS,BCBS,138.42,,,,,,,per diem,138.42,138.42,"Per diem rate, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,BCBS MGG,BCBS MGG,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Cigna,Cigna,138.42,,,,,,,per diem,138.42,138.42,"Per diem rate, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Cigna MGG,Cigna MGG,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Humana,Humana,138.42,,,,,,,per diem,138.42,138.42,"Per diem rate, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Humana MGG,Humana MGG,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Optum VA,Optum VA,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,UHC,UHC,138.42,,,,,,,per diem,138.42,138.42,"Per diem rate, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,UHC MGG,UHC MGG,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,VA,VA,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Wellcare MGG,Wellcare MGG,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Bright Health - commercial,Bright Health - commercial,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
AMINO ACIDS 7% IVS            ,92213345,CDM,258,RC,,,,,,Inpatient,1,EA,138.42,138.42,Bright Health MGG,Bright Health MGG,138.42,,,,,,,case rate,138.42,138.42,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Aetna,Aetna,30.87,,,,,,,per diem,30.87,30.87,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Aetna MGG,Aetna MGG,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,BCBS,BCBS,30.87,,,,,,,per diem,30.87,30.87,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,BCBS MGG,BCBS MGG,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Cigna,Cigna,30.87,,,,,,,per diem,30.87,30.87,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Cigna MGG,Cigna MGG,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Humana,Humana,30.87,,,,,,,per diem,30.87,30.87,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Humana MGG,Humana MGG,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Optum VA,Optum VA,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,UHC,UHC,30.87,,,,,,,per diem,30.87,30.87,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,UHC MGG,UHC MGG,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,VA,VA,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Wellcare MGG,Wellcare MGG,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Bright Health - commercial,Bright Health - commercial,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92213346,CDM,250,RC,,,,,,Inpatient,1,EA,30.87,30.87,Bright Health MGG,Bright Health MGG,30.87,,,,,,,case rate,30.87,30.87,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92213347,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Aetna,Aetna,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Aetna MGG,Aetna MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,BCBS,BCBS,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,BCBS MGG,BCBS MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Cigna,Cigna,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Cigna MGG,Cigna MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Humana,Humana,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Humana MGG,Humana MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Optum VA,Optum VA,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,UHC,UHC,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,UHC MGG,UHC MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,VA,VA,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Wellcare MGG,Wellcare MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Bright Health - commercial,Bright Health - commercial,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92213348,CDM,250,RC,,,,,,Inpatient,1,EA,18.93,18.93,Bright Health MGG,Bright Health MGG,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Aetna,Aetna,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Aetna MGG,Aetna MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,BCBS,BCBS,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,BCBS MGG,BCBS MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Cigna,Cigna,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Cigna MGG,Cigna MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Humana,Humana,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Humana MGG,Humana MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Optum VA,Optum VA,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,UHC,UHC,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,UHC MGG,UHC MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,VA,VA,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Wellcare MGG,Wellcare MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Bright Health - commercial,Bright Health - commercial,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 10/6.25 TAB   ,92213349,CDM,250,RC,,,,,,Inpatient,1,EA,22.11,22.11,Bright Health MGG,Bright Health MGG,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Aetna,Aetna,27.42,,,,,,,per diem,27.42,27.42,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Aetna MGG,Aetna MGG,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,BCBS,BCBS,27.42,,,,,,,per diem,27.42,27.42,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,BCBS MGG,BCBS MGG,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Cigna,Cigna,27.42,,,,,,,per diem,27.42,27.42,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Cigna MGG,Cigna MGG,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Humana,Humana,27.42,,,,,,,per diem,27.42,27.42,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Humana MGG,Humana MGG,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Optum VA,Optum VA,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,UHC,UHC,27.42,,,,,,,per diem,27.42,27.42,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,UHC MGG,UHC MGG,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,VA,VA,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Wellcare MGG,Wellcare MGG,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Bright Health - commercial,Bright Health - commercial,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG/5ML SUS     ,92213350,CDM,250,RC,,,,,,Inpatient,1,EA,27.42,27.42,Bright Health MGG,Bright Health MGG,27.42,,,,,,,case rate,27.42,27.42,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Aetna,Aetna,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Aetna MGG,Aetna MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS,BCBS,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS MGG,BCBS MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Cigna,Cigna,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Cigna MGG,Cigna MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Humana,Humana,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Humana MGG,Humana MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Optum VA,Optum VA,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,UHC,UHC,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,UHC MGG,UHC MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,VA,VA,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Wellcare MGG,Wellcare MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Bright Health - commercial,Bright Health - commercial,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
"LIDOCAINE 0.5%/EPI 1:200,000 I",92213351,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,Bright Health MGG,Bright Health MGG,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92213352,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Aetna,Aetna,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Aetna MGG,Aetna MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,BCBS,BCBS,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,BCBS MGG,BCBS MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Cigna,Cigna,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Cigna MGG,Cigna MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Humana,Humana,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Humana MGG,Humana MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Optum VA,Optum VA,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,UHC,UHC,69.54,,,,,,,per diem,69.54,69.54,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,UHC MGG,UHC MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,VA,VA,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Wellcare MGG,Wellcare MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Bright Health - commercial,Bright Health - commercial,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 250ML I,92213353,CDM,250,RC,,,,,,Inpatient,1,EA,69.54,69.54,Bright Health MGG,Bright Health MGG,69.54,,,,,,,case rate,69.54,69.54,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92213354,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Aetna,Aetna,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Aetna MGG,Aetna MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,BCBS,BCBS,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,BCBS MGG,BCBS MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Cigna,Cigna,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Cigna MGG,Cigna MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Humana,Humana,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Humana MGG,Humana MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Optum VA,Optum VA,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,UHC,UHC,29.13,,,,,,,per diem,29.13,29.13,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,UHC MGG,UHC MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,VA,VA,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Wellcare MGG,Wellcare MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Bright Health - commercial,Bright Health - commercial,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92213355,CDM,250,RC,,,,,,Inpatient,1,EA,29.13,29.13,Bright Health MGG,Bright Health MGG,29.13,,,,,,,case rate,29.13,29.13,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92213356,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Aetna,Aetna,111.18,,,,,,,per diem,111.18,111.18,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Aetna MGG,Aetna MGG,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,BCBS,BCBS,111.18,,,,,,,per diem,111.18,111.18,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,BCBS MGG,BCBS MGG,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Cigna,Cigna,111.18,,,,,,,per diem,111.18,111.18,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Cigna MGG,Cigna MGG,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Humana,Humana,111.18,,,,,,,per diem,111.18,111.18,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Humana MGG,Humana MGG,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Optum VA,Optum VA,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,UHC,UHC,111.18,,,,,,,per diem,111.18,111.18,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,UHC MGG,UHC MGG,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,VA,VA,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Wellcare MGG,Wellcare MGG,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Bright Health - commercial,Bright Health - commercial,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213357,CDM,250,RC,,,,,,Inpatient,1,EA,111.18,111.18,Bright Health MGG,Bright Health MGG,111.18,,,,,,,case rate,111.18,111.18,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Aetna,Aetna,29.22,,,,,,,per diem,29.22,29.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Aetna MGG,Aetna MGG,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,BCBS,BCBS,29.22,,,,,,,per diem,29.22,29.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,BCBS MGG,BCBS MGG,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Cigna,Cigna,29.22,,,,,,,per diem,29.22,29.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Cigna MGG,Cigna MGG,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Humana,Humana,29.22,,,,,,,per diem,29.22,29.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Humana MGG,Humana MGG,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Optum VA,Optum VA,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,UHC,UHC,29.22,,,,,,,per diem,29.22,29.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,UHC MGG,UHC MGG,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,VA,VA,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Wellcare MGG,Wellcare MGG,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Bright Health - commercial,Bright Health - commercial,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92213358,CDM,250,RC,,,,,,Inpatient,1,EA,29.22,29.22,Bright Health MGG,Bright Health MGG,29.22,,,,,,,case rate,29.22,29.22,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92213359,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92213360,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Aetna,Aetna,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Aetna MGG,Aetna MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,BCBS,BCBS,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,BCBS MGG,BCBS MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Cigna,Cigna,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Cigna MGG,Cigna MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Humana,Humana,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Humana MGG,Humana MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Optum VA,Optum VA,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,UHC,UHC,10.38,,,,,,,per diem,10.38,10.38,"Per diem rate, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,UHC MGG,UHC MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,VA,VA,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Wellcare MGG,Wellcare MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Bright Health - commercial,Bright Health - commercial,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
D5W KCL 0.224% IVS            ,92213361,CDM,258,RC,,,,,,Inpatient,1,EA,10.38,10.38,Bright Health MGG,Bright Health MGG,10.38,,,,,,,case rate,10.38,10.38,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Aetna,Aetna,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Aetna MGG,Aetna MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,BCBS,BCBS,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,BCBS MGG,BCBS MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Cigna,Cigna,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Cigna MGG,Cigna MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Humana,Humana,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Humana MGG,Humana MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Optum VA,Optum VA,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,UHC,UHC,15.24,,,,,,,per diem,15.24,15.24,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,UHC MGG,UHC MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,VA,VA,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Wellcare MGG,Wellcare MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Bright Health - commercial,Bright Health - commercial,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 150MG CER     ,92213362,CDM,250,RC,,,,,,Inpatient,1,EA,15.24,15.24,Bright Health MGG,Bright Health MGG,15.24,,,,,,,case rate,15.24,15.24,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Aetna,Aetna,559.62,,,,,,,per diem,559.62,559.62,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Aetna MGG,Aetna MGG,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,BCBS,BCBS,559.62,,,,,,,per diem,559.62,559.62,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,BCBS MGG,BCBS MGG,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Cigna,Cigna,559.62,,,,,,,per diem,559.62,559.62,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Cigna MGG,Cigna MGG,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Humana,Humana,559.62,,,,,,,per diem,559.62,559.62,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Humana MGG,Humana MGG,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Optum VA,Optum VA,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,UHC,UHC,559.62,,,,,,,per diem,559.62,559.62,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,UHC MGG,UHC MGG,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,VA,VA,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Wellcare MGG,Wellcare MGG,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Bright Health - commercial,Bright Health - commercial,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL TIMOLOR MAL SO,92213363,CDM,250,RC,,,,,,Inpatient,1,EA,559.62,559.62,Bright Health MGG,Bright Health MGG,559.62,,,,,,,case rate,559.62,559.62,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna,Aetna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Aetna MGG,Aetna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS,BCBS,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,BCBS MGG,BCBS MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna,Cigna,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Cigna MGG,Cigna MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana,Humana,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Humana MGG,Humana MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Optum VA,Optum VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC,UHC,7.92,,,,,,,per diem,7.92,7.92,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,UHC MGG,UHC MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,VA,VA,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Wellcare MGG,Wellcare MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health - commercial,Bright Health - commercial,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213364,CDM,250,RC,,,,,,Inpatient,1,EA,7.92,7.92,Bright Health MGG,Bright Health MGG,7.92,,,,,,,case rate,7.92,7.92,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Aetna,Aetna,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Aetna MGG,Aetna MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,BCBS,BCBS,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,BCBS MGG,BCBS MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Cigna,Cigna,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Cigna MGG,Cigna MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Humana,Humana,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Humana MGG,Humana MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Optum VA,Optum VA,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,UHC,UHC,15.3,,,,,,,per diem,15.3,15.3,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,UHC MGG,UHC MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,VA,VA,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Wellcare MGG,Wellcare MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Bright Health - commercial,Bright Health - commercial,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213365,CDM,250,RC,,,,,,Inpatient,1,EA,15.3,15.3,Bright Health MGG,Bright Health MGG,15.3,,,,,,,case rate,15.3,15.3,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Aetna,Aetna,64.38,,,,,,,per diem,64.38,64.38,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Aetna MGG,Aetna MGG,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,BCBS,BCBS,64.38,,,,,,,per diem,64.38,64.38,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,BCBS MGG,BCBS MGG,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Cigna,Cigna,64.38,,,,,,,per diem,64.38,64.38,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Cigna MGG,Cigna MGG,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Humana,Humana,64.38,,,,,,,per diem,64.38,64.38,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Humana MGG,Humana MGG,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Optum VA,Optum VA,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,UHC,UHC,64.38,,,,,,,per diem,64.38,64.38,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,UHC MGG,UHC MGG,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,VA,VA,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Wellcare MGG,Wellcare MGG,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Bright Health - commercial,Bright Health - commercial,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 800MG/D5W 500ML I,92213366,CDM,250,RC,,,,,,Inpatient,1,EA,64.38,64.38,Bright Health MGG,Bright Health MGG,64.38,,,,,,,case rate,64.38,64.38,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Aetna,Aetna,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Aetna MGG,Aetna MGG,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,BCBS,BCBS,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,BCBS MGG,BCBS MGG,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Cigna,Cigna,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Cigna MGG,Cigna MGG,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Humana,Humana,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Humana MGG,Humana MGG,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Optum VA,Optum VA,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,UHC,UHC,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,UHC MGG,UHC MGG,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,VA,VA,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Wellcare MGG,Wellcare MGG,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Bright Health - commercial,Bright Health - commercial,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
MONTELUKAST NA 5MG CTB        ,92213367,CDM,250,RC,,,,,,Inpatient,1,EA,16.97,16.97,Bright Health MGG,Bright Health MGG,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXTROSE 5%-1/2NS IVS         ,92213368,CDM,258,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Aetna,Aetna,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Aetna MGG,Aetna MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,BCBS,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS MGG,BCBS MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Cigna,Cigna,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Cigna MGG,Cigna MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Humana,Humana,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Humana MGG,Humana MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Optum VA,Optum VA,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,UHC,UHC,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,UHC MGG,UHC MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,VA,VA,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Wellcare MGG,Wellcare MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Bright Health - commercial,Bright Health - commercial,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
PENICILLAMINE 250MG CAP       ,92213369,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,Bright Health MGG,Bright Health MGG,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Aetna,Aetna,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Aetna MGG,Aetna MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,BCBS,BCBS,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,BCBS MGG,BCBS MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Cigna,Cigna,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Cigna MGG,Cigna MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Humana,Humana,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Humana MGG,Humana MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Optum VA,Optum VA,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,UHC,UHC,25.14,,,,,,,per diem,25.14,25.14,"Per diem rate, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,UHC MGG,UHC MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,VA,VA,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Wellcare MGG,Wellcare MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Bright Health - commercial,Bright Health - commercial,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
IODINE STRONG TIN             ,92213370,CDM,250,RC,,,,,,Inpatient,1,EA,25.14,25.14,Bright Health MGG,Bright Health MGG,25.14,,,,,,,case rate,25.14,25.14,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Aetna,Aetna,209.37,,,,,,,per diem,209.37,209.37,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Aetna MGG,Aetna MGG,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,BCBS,BCBS,209.37,,,,,,,per diem,209.37,209.37,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,BCBS MGG,BCBS MGG,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Cigna,Cigna,209.37,,,,,,,per diem,209.37,209.37,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Cigna MGG,Cigna MGG,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Humana,Humana,209.37,,,,,,,per diem,209.37,209.37,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Humana MGG,Humana MGG,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Optum VA,Optum VA,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,UHC,UHC,209.37,,,,,,,per diem,209.37,209.37,"Per diem rate, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,UHC MGG,UHC MGG,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,VA,VA,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Wellcare MGG,Wellcare MGG,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Bright Health - commercial,Bright Health - commercial,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
GADOTERIDOL 279.3MG/ML INJ    ,92213371,CDM,250,RC,,,,,,Inpatient,1,EA,209.37,209.37,Bright Health MGG,Bright Health MGG,209.37,,,,,,,case rate,209.37,209.37,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN THYMOL 3-0.6MG T,92213372,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Aetna,Aetna,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Aetna MGG,Aetna MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,BCBS,BCBS,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,BCBS MGG,BCBS MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Cigna,Cigna,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Cigna MGG,Cigna MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Humana,Humana,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Humana MGG,Humana MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Optum VA,Optum VA,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,UHC,UHC,9.33,,,,,,,per diem,9.33,9.33,"Per diem rate, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,UHC MGG,UHC MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,VA,VA,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Wellcare MGG,Wellcare MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Bright Health - commercial,Bright Health - commercial,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
D5W-1/3NS/KCL 20MEQ/L IVS     ,92213373,CDM,258,RC,,,,,,Inpatient,1,EA,9.33,9.33,Bright Health MGG,Bright Health MGG,9.33,,,,,,,case rate,9.33,9.33,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92213374,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMIODARONE HCL 200MG TAB      ,92213375,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna,Aetna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Aetna MGG,Aetna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,BCBS,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS MGG,BCBS MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna,Cigna,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Cigna MGG,Cigna MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana,Humana,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Humana MGG,Humana MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Optum VA,Optum VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC,UHC,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UHC MGG,UHC MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,VA,VA,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Wellcare MGG,Wellcare MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health - commercial,Bright Health - commercial,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92213376,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,Bright Health MGG,Bright Health MGG,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMOXICILLIN 200MG CTB         ,92213377,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Aetna,Aetna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Aetna MGG,Aetna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,BCBS,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS MGG,BCBS MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Cigna,Cigna,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Cigna MGG,Cigna MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Humana,Humana,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Humana MGG,Humana MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Optum VA,Optum VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UHC,UHC,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UHC MGG,UHC MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,VA,VA,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Wellcare MGG,Wellcare MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Bright Health - commercial,Bright Health - commercial,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92213378,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,Bright Health MGG,Bright Health MGG,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Aetna,Aetna,46.29,,,,,,,per diem,46.29,46.29,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Aetna MGG,Aetna MGG,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,BCBS,BCBS,46.29,,,,,,,per diem,46.29,46.29,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,BCBS MGG,BCBS MGG,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Cigna,Cigna,46.29,,,,,,,per diem,46.29,46.29,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Cigna MGG,Cigna MGG,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Humana,Humana,46.29,,,,,,,per diem,46.29,46.29,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Humana MGG,Humana MGG,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Optum VA,Optum VA,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,UHC,UHC,46.29,,,,,,,per diem,46.29,46.29,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,UHC MGG,UHC MGG,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,VA,VA,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Wellcare MGG,Wellcare MGG,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Bright Health - commercial,Bright Health - commercial,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75MG CER      ,92213379,CDM,250,RC,,,,,,Inpatient,1,EA,46.29,46.29,Bright Health MGG,Bright Health MGG,46.29,,,,,,,case rate,46.29,46.29,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Aetna,Aetna,39.48,,,,,,,per diem,39.48,39.48,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Aetna MGG,Aetna MGG,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,BCBS,BCBS,39.48,,,,,,,per diem,39.48,39.48,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,BCBS MGG,BCBS MGG,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Cigna,Cigna,39.48,,,,,,,per diem,39.48,39.48,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Cigna MGG,Cigna MGG,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Humana,Humana,39.48,,,,,,,per diem,39.48,39.48,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Humana MGG,Humana MGG,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Optum VA,Optum VA,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,UHC,UHC,39.48,,,,,,,per diem,39.48,39.48,"Per diem rate, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,UHC MGG,UHC MGG,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,VA,VA,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Wellcare MGG,Wellcare MGG,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Bright Health - commercial,Bright Health - commercial,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
DOPAMINE HCL 400MG/D5W 250ML I,92213380,CDM,250,RC,,,,,,Inpatient,1,EA,39.48,39.48,Bright Health MGG,Bright Health MGG,39.48,,,,,,,case rate,39.48,39.48,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92213381,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Aetna,Aetna,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Aetna MGG,Aetna MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,BCBS,BCBS,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,BCBS MGG,BCBS MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Cigna,Cigna,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Cigna MGG,Cigna MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Humana,Humana,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Humana MGG,Humana MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Optum VA,Optum VA,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,UHC,UHC,32.34,,,,,,,per diem,32.34,32.34,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,UHC MGG,UHC MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,VA,VA,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Wellcare MGG,Wellcare MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Bright Health - commercial,Bright Health - commercial,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92213382,CDM,250,RC,,,,,,Inpatient,1,EA,32.34,32.34,Bright Health MGG,Bright Health MGG,32.34,,,,,,,case rate,32.34,32.34,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MAPROTILINE HCL 25MG TAB      ,92213383,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 2MG/5ML SYR    ,92213384,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Aetna,Aetna,104.01,,,,,,,per diem,104.01,104.01,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Aetna MGG,Aetna MGG,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,BCBS,BCBS,104.01,,,,,,,per diem,104.01,104.01,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,BCBS MGG,BCBS MGG,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Cigna,Cigna,104.01,,,,,,,per diem,104.01,104.01,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Cigna MGG,Cigna MGG,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Humana,Humana,104.01,,,,,,,per diem,104.01,104.01,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Humana MGG,Humana MGG,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Optum VA,Optum VA,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,UHC,UHC,104.01,,,,,,,per diem,104.01,104.01,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,UHC MGG,UHC MGG,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,VA,VA,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Wellcare MGG,Wellcare MGG,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Bright Health - commercial,Bright Health - commercial,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG/ML INJ,92213385,CDM,250,RC,,,,,,Inpatient,1,EA,104.01,104.01,Bright Health MGG,Bright Health MGG,104.01,,,,,,,case rate,104.01,104.01,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92213386,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Aetna,Aetna,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Aetna MGG,Aetna MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,BCBS,BCBS,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,BCBS MGG,BCBS MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Cigna,Cigna,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Cigna MGG,Cigna MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Humana,Humana,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Humana MGG,Humana MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Optum VA,Optum VA,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,UHC,UHC,360,,,,,,,per diem,360,360,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,UHC MGG,UHC MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,VA,VA,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Wellcare MGG,Wellcare MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Bright Health - commercial,Bright Health - commercial,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPID 5MG/ML IN,92213387,CDM,250,RC,,,,,,Inpatient,1,EA,360,360,Bright Health MGG,Bright Health MGG,360,,,,,,,case rate,360,360,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92213388,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92213389,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Aetna,Aetna,870.6,,,,,,,per diem,870.6,870.6,"Per diem rate, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Aetna MGG,Aetna MGG,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,BCBS,BCBS,870.6,,,,,,,per diem,870.6,870.6,"Per diem rate, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,BCBS MGG,BCBS MGG,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Cigna,Cigna,870.6,,,,,,,per diem,870.6,870.6,"Per diem rate, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Cigna MGG,Cigna MGG,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Humana,Humana,870.6,,,,,,,per diem,870.6,870.6,"Per diem rate, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Humana MGG,Humana MGG,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Optum VA,Optum VA,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,UHC,UHC,870.6,,,,,,,per diem,870.6,870.6,"Per diem rate, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,UHC MGG,UHC MGG,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,VA,VA,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Wellcare MGG,Wellcare MGG,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Bright Health - commercial,Bright Health - commercial,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
ETANERCEPT 25MG INJ           ,92213390,CDM,250,RC,,,,,,Inpatient,1,EA,870.6,870.6,Bright Health MGG,Bright Health MGG,870.6,,,,,,,case rate,870.6,870.6,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna,Aetna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Aetna MGG,Aetna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS,BCBS,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,BCBS MGG,BCBS MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna,Cigna,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Cigna MGG,Cigna MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana,Humana,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Humana MGG,Humana MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Optum VA,Optum VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC,UHC,5,,,,,,,per diem,5,5,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,UHC MGG,UHC MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,VA,VA,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Wellcare MGG,Wellcare MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health - commercial,Bright Health - commercial,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 100MG TAB      ,92213391,CDM,250,RC,,,,,,Inpatient,1,EA,5,5,Bright Health MGG,Bright Health MGG,5,,,,,,,case rate,5,5,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92213392,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Aetna,Aetna,55.41,,,,,,,per diem,55.41,55.41,"Per diem rate, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92213392,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Aetna MGG,Aetna MGG,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92213392,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,BCBS,BCBS,55.41,,,,,,,per diem,55.41,55.41,"Per diem rate, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92213392,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,BCBS MGG,BCBS MGG,55.41,,,,,,,case rate,55.41,55.41,"Case rate contract, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92213392,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Cigna,Cigna,55.41,,,,,,,per diem,55.41,55.41,"Per diem rate, code is bundled with other services"
MILRINONE D5W 0.2MG/ML INJ    ,92213392,CDM,250,RC,,,,,,Inpatient,1,EA,55.41,55.41,Cigna MGG,Cigna MGG,55.41